Streptococcal

J Antimicrob Chemother, 1995 Dec, 36(6), 1021 - 30
Clinical significance of pneumococcal bacteraemias in a general hospital: a prospective study 1989-1993; Gomez J et al.; We studied 71 patients with pneumococcal bacteraemia (PB) who were hospitalized between 1989 and 1993 . The Streptococcus pneumoniae was classified as penicillin-sensitive (PS) or resistant (PR) . Age, sex, underlying disease (McCabe classification), and other clinical and laboratory features were recorded on admission, at discharge and one month later . The incidence of PB was 8.1/10,000/year . PB was most frequent in men (71.9%) aged below 60 years (60%), 76% of the patients acquired the infection in the community . An underlying disease of McCabe type II or III was found in 93% . Previous treatment with beta-lactam antibiotics was considered a risk factor for PRPB . Factors related to higher mortality were age above 60 years, nosocomial PB, McCabe type I underlying disease, an initially critical clinical situation, neutropenia, and inappropriate antibiotic treatment . When appropriate treatment was given, there were no significant differences between PS and PR groups in clinical course or mortality.

J Antimicrob Chemother, 1995 Dec, 36(6), 997 - 1004
Activity of fosfomycin in a rabbit model of experimental pneumococcal meningitis; Nau R et al.; Fosfomycin is an antibacterial substance of low molecular weight and negligible binding to plasma proteins exhibiting in-vitro activity against most pathogens involved in bacterial meningitis including pneumococci . Due to these properties the drug has been recommended for therapy of central nervous system (CNS) infections . For this reason, fosfomycin at doses of 10, 40, 80 and 160 mg/kg/h iv, was investigated in the rabbit model of pneumococcal meningitis . Bacterial counts in cerebrospinal fluid (CSF) before, and 2, 5 and 8 h after initiation of therapy were quantitated by plating on blood agar . Fosfomycin concentrations in serum and CSF were determined by the agar well diffusion method . The MIC and MBC of fosfomycin for the Streptococcus pneumoniae type 3 strain used was 4 and 32 mg/L, respectively . The MIC of ceftriaxone was 0.016 mg/L . In vitro, both drugs showed an additive effect (fractional inhibitory concentration index = 0.75) . In vivo at each dose tested, fosfomycin was less active than ceftriaxone (means +/- S.D.): delta log cfu/mL/h at 10 mg/kg/h + 0.130 +/- 0.062 (n = 2), at 40 mg/kg/h -0.217 +/- 0.185 (n = 3), at 80 mg/kg/h -0.270 +/- 0.121 (n = 3), at 160 mg/kg/h -0.331 +/- 0.118 (n = 3) vs -0.647 +/- 0.193 at 10 mg/kg/h ceftriaxone (n = 3) . CSF penetration of fosfomycin as estimated by the CSF-to-serum concentration ratio at 8 h was 0.55 +/- 0.22 (n = 11) . For bactericidal activity CSF concentrations of at least ten times the MIC were necessary . Coadministration of both drugs (1 mg/kg/h ceftriaxone + 40 mg/kg/h fosfomycin) tended to be more active than either drug alone (in-vivo drug interaction = 1.3) . In conclusion, fosfomycin at very high doses reduced bacterial counts in CSF . However, fosfomycin CSF concentrations usually observed in patients with meningitis receiving fosfomycin were not bactericidal in this model . At all doses tested the bactericidal rate was lower than that of ceftriaxone . Fosfomycin is therefore unsuitable as a single agent, but may be used as a reserve antibiotic in combination with a newer cephalosporin for pneumococcal meningitis unresponsive to conventional therapy.

J Vet Pharmacol Ther, 1995 Dec, 18(6), 422 - 8
Potency of antibacterial drugs in milk as analysed by beta-glucuronidase-based fluorometry; Fang W et al.; The potency of selected antibacterials on mastitis-causing Escherichia coli, Streptococcus agalactine and Streptococcus uberis in milk, whey and Iso-sensitest broth (ISB) was compared, based on the suppression of bacterial beta-glucuronidase production . The beta-glucuronidase activity in the samples was analysed by substrate-defined fluorometry where the turbidity of milk does not disturb the assay . In ISB, all four E . coli strains were susceptible to enrofloxacin and gentamicin, sulfadoxin-trimethoprim and tetracycline . S . agalactiae and S . uberis strains were susceptible in ISB to most of the antibacterials tested . The antibacterial potency of sulfadoxin-trimethoprim, tetracycline, novobiocin, gentamicin and enrofloxacin on E . coli and S . agalactiae were considerably decreased in milk as compared with that in ISB . However, S . uberis seemed to be more susceptible to antibacterials in milk or whey than in ISB . Regression analysis of the sigmoidal dose-response curves of sulfadoxin-trimethoprim showed that slopes of the linearized lines seemed to become less steep in milk than in the artificial broth medium, indicating a shift of the bactericidic effect in ISB towards a bacteriostatic effect in milk.

J Hand Surg {Br}, 1995 Dec, 20(6), 797 - 800
Soft tissue infections of the upper extremities with special consideration of abscesses in parenteral drug abusers . A prospective study; Simmen HP et al.; Despite surgical advances and new antibiotics, upper extremity infections continue to present a serious problem . Soft tissue infections of the upper extremities were prospectively examined to elucidate incidence, cause, bacterial pathogens involved, and treatment . Special attention was paid to infections associated with parenteral drug abuse . During an 18-month period all patients over 16 years of age presenting for treatment of an established infection were included in the study . Conservative treatment consisted of immobilization and antibiotics . Radical debridement with removal of all necrotic tissue was the guideline for operative care . In addition, for both regimens a penicillinase-resistant antibiotic was administered . A total of 415 patients (271 men and 144 women; mean age 36.7 +/- 14.5 years) were enrolled into the study, 55 of whom were parenteral drug abusers; 45 of these were HIV-reactive . Infections of fingers (excluding paronychia), paronychia and abscesses at injection sites were the most common diagnoses . Operative and conservative treatment were performed in 285 and 130 patients respectively . Staphylococcus and streptococcus species were the predominant organisms recovered from 212 specimens of pus . Anaerobic bacteria and yeasts were of minor importance . Therefore, a penicillinase-resistant antibiotic is a good initial choice.

Hybridoma, 1995 Dec, 14(6), 529 - 36
Immunochemical studies of streptococcal cell membrane antigens immunologically related to glomerular basement membrane; Zelman ME et al.; Pursuing an autoimmune model for the etiology of poststreptococcal glomerulonephritis, protein antigens isolated from the cytoplasmic membrane of nephritogenic group A Type 12 Streptococcus pyogenes were immunochemically characterized using antistreptococcal cell membrane (SCM) monoclonal antibody (MAb) cross-reactive with glomerular basement membrane (GBM) . Low molecular weight (9.2, 7.0, 4.7, 2.3 kDa) HPLC-purified SCM polypeptide antigens were characterized by competitive inhibition and equilibrium dialysis . Competitive inhibition of the MAb, by different sized SCM polypeptide antigens showed an inverse relationship between the size of these antigens and the molar amount required to obtain 50% inhibition of the MAb, confirming previous observations that suggested that these SCM antigens exhibit increasing epitope concentration with increasing size, that is constant epitope density . The observed changes in epitope concentration correlated with differences in the valence and affinity of the MAb as determined by equilibrium dialysis . The Kds of the MAb for 9.2-, 7.0-, 4.7-, and 2.3-kDa SCM antigens ranged from 7.42 x 10(-7) to 1.15 x 10(-5) . The experimentally determined MAb valence for these antigens was 2 for the 9.2-kDa antigen and approached 10 for the smaller antigens . Finally, the similarity of these SCM antigens was reflected in similar amino acid compositions; of note, these data agreed with the compositions previously reported for sized GBM antigens . Concentrations of Asp, Thr, Ser, Glu, Gly, Ala, Val, Ile, and Leu paralleled increasing epitope concentration . Apparent N-terminal blocking prevented sequencing of these peptides, but these immunochemical data suggest that intact SCM antigen recognized by the anti-SCM MAb consists of repeating epitopes, an observation consistent with the cytoplasmic membrane source of the antigen.

Bioorg Med Chem, 1995 Dec, 3(12), 1699 - 706
Synthesis and biological properties of substituted 1,4-dihydro-5-methyl-4-oxo-3-quinolinecarboxylic acids; Miyamoto H et al.; A series of substituted 1-cyclopropyl-6-fluoro-1, 4-dihydro-5-methyl-4-oxo-3-quinoline carboxylic acids was synthesized and tested for their in vitro and in vivo antibacterial activity . The introduction of a methyl group at the 5-position of quinoline nucleus enhanced characteristically the antibacterial activity against Gram-positive bacteria, including Streptococcus pneumoniae, which is a major pathogen in the respiratory tract infection, while retaining Gram-negative activity . Among them, 1-cyclopropyl-6-fluoro-1, 4-dihydro-5-methyl-7-(3-methyl-1-piperazinyl)-4-oxo-3-quinolinecarboxyli c acid hydrochloride (grepafloxacin) exhibited potent in vitro antibacterial activity against Gram-positive bacteria such as Streptococcus pneumoniae and high in vivo efficacy on the experimental systemic infections caused by the Gram-positive and -negative bacteria tested . It also showed a high distribution to the lung and bronchoalveolar lavage fluid in comparison to reference drugs and is now undergoing clinical evaluation.

Bangladesh Med Res Counc Bull, 1995 Dec, 21(3), 87 - 94
Prevalence of streptococcal sorethroat in the school children of Dhaka; Faruq QO et al.; Beta Haemolytic Streptococcal (BHS) infections and their sequelae Rheumatic Fever (RF) and Glomerulonephritis (GN) have a world wide distribution and so pose an important health problem . Reports show that there is considerable variation in the number of isolations from different groups . Present study intended to find out the health status of the school children in relation to streptococcal throat infection, in Dhaka Cantonment . It was a cross sectional, observational study . During one year period total six hundred and one (601) children were examined from one school of Dhaka Cantonment . Prevalence of streptococcus was found to be 22% among the study population with highest rate (67%) for group-G among BHS positive cases . True streptococcal infection was found in 8.7% cases & 2.2% cases were true GABHS positive cases . GABHS was significantly higher in large size families . Females and children from lower socioeconomic group were at higher risk . Females and children of large families may require special attention regarding prevention of streptococcal infection and RF/RHD prevention programme.

Clin Infect Dis, 1995 Dec, 21(6), 1469 - 70
Clinical usefulness of intravenous human immunoglobulins in invasive group A Streptococcal infections: case report and review; Lamothe F et al.; The spectrum of invasive Streptococcus pyogenes (group A streptococcus) infections includes bacteremia, toxic shock syndrome, and necrotizing fasciitis or myositis . We report the successful use of intravenous immunoglobulins in conjunction with antibiotics and surgery in a case of necrotizing myositis, toxic shock, and bacteremia . A literature review revealed that three other patients with invasive group A streptococcal infections had been treated with immunoglobulins: one adult patient had toxic shock syndrome, one had necrotizing fasciitis, and one child had septic arthritis . On the basis of this report and the review, we suggest that intravenous immunoglobulins may be useful in the treatment of all forms of invasive group A streptococcal infections associated with toxic shock syndrome.

Clin Infect Dis, 1995 Dec, 21(6), 1398 - 401
Antimicrobial resistance and type distribution of Streptococcus pneumoniae isolates causing systemic infections in Germany, 1992-1994; Reinert RR et al.; A prospective study of pneumococcal infections was performed in cooperation with 40 clinical microbiology laboratories in Germany . Minimal inhibitory concentration (MIC) values for 844 strains of Streptococcus pneumoniae, isolated from patients with systemic infections, were determined in tests with penicillin, tetracycline, erythromycin, chloramphenicol, cefotaxime, and clindamycin by a standard broth microdilution method; 1.8% of pneumococcal isolates exhibited reduced susceptibility to penicillin (MIC, > or = 0.1 micrograms/mL) . The Etest, which was used to confirm the level of resistance to penicillin, proved to be a reliable and easily performed method for determination of MICs . The rates of resistance to clindamycin, erythromycin, tetracycline, and chloramphenicol were 1.4%, 3.2%, 11.0%, and 1.9%, respectively . Resistance to cefotaxime was not observed . Typing of a randomly selected subgroup of all strains (n = 115) showed types 1 (9.6%), 14 (8.7%), 3 (7.8%), and 23F (7.8%) to be the most prevalent types in Germany . At least 86.1% of these pneumococcal strains belonged to capsular types included in the 23-valent vaccine.

Clin Infect Dis, 1995 Dec, 21(6), 1390 - 7
Pneumococcal meningitis in children: prognostic indicators and outcome; Kornelisse RF et al.; We studied the outcome of pneumococcal meningitis in 83 children who were admitted to a referral hospital and whose meningitis was diagnosed between 1970 and 1994 . The median age of the children was 8 months . The most frequently isolated capsular serotypes and/or serogroups of Streptococcus pneumoniae were 6, 14, 18, 19, and 23 . Twenty-nine children (35%) were referred by other hospitals . A mortality rate of 17% (primary referrals, 7%; secondary referrals, 35%) was observed . At discharge, 25 survivors (36%) had sequelae: hearing loss (> or = 30 dB) in 19% and neurological sequelae in 25% . During admission, the presence of coma, respiratory distress, shock, a cerebrospinal fluid (CSF) protein level of > or = 2.5 g/L, a peripheral white blood cell count of < 5 x 10(9)/L, and a serum sodium level of < 135 mmol/L were associated with mortality . Sequelae were associated with the presence of coma and a CSF glucose level of < 0.6 mmol/L . We conclude that the mortality rate of pneumococcal meningitis is lower among children than among adults . Children often die of neurological sequelae, while adults frequently die of cardiorespiratory failure due to underlying diseases . For children, coma, respiratory distress, and shock during admission were the clinical findings with the strongest predictive value for sequelae or death.

Pediatr Nephrol, 1995 Dec, 9(6), 690 - 3
Hepatocellular injury in Streptococcus pneumoniae-associated hemolytic uremic syndrome in children; Pan CG et al.; Streptococcus pneumoniae is an uncommon etiological organism in hemolytic uremic syndrome (HUS) . Production of neuraminidase by S . pneumoniae results in exposure of red blood cell T-antigen, resulting in hemolysis, thrombocytopenia, and acute renal failure . Hepatic involvement in this form of HUS has not been described in the literature . We report in three children with S . pneumoniae-associated HUS the presence of severely elevated transaminases and conjugated hyperbilirubinemia . Increases in asparagine transaminase ranged from 11 to 46 times normal values and an increase in alanine transaminase ranged from 1.6 to 8 times normal . In all patients the rise in total bilirubin was 7-15 times normal . Biliary tree obstruction and viral causes for liver dysfunction were absent . Hepatocellular injury in S . pneumoniae-associated HUS likely results from mechanisms involved in sepsis and pneumonia-induced jaundice, combined with severely increased bilirubin production following massive hemolysis . The hepatic injury in all three patients resolved within 9, 5, and 10 days . Our experience suggests that an extensive evaluation including liver biopsy is not indicated.

Pediatr Infect Dis J, 1995 Dec, 14(12), 1047 - 53
Clinical and diagnostic features of osteomyelitis occurring in the first three months of life; Wong M et al.; We report a retrospective study of 94 infants, ages < 4 months, who underwent investigation for possible osteomyelitis during a 9-year period . Of the 30 babies with proven osteomyelitis (radiographic changes or positive bone cultures or positive blood cultures plus a compatible clinical picture), 17 were preterm artificially ventilated babies and 4 were full term infants receiving intensive care . An etiologic organism was isolated from 28: methicillin-susceptible Staphylococcus aureus, 16; methicillin-resistant S . aureus (MRSA), 7; Escherichia coli, 3; and group B Streptococcus, 2 . MRSA occurred exclusively in the preterm group . Osteomyelitis was multifocal in 40% and associated with septic arthritis in 47% . The long bones were frequently affected (80%) whereas the flat bones were often sites of clinically silent disease . Twenty-five (83.3%) of the 30 babies with proven osteomyelitis had focal clinical signs or evidence of disseminated staphylococcal disease . Only 10 were febrile . Four of 27 babies investigated because of positive blood cultures for S . aureus but no focal signs had osteomyelitis, as did only 1 of 27 babies with suspected sepsis but no focal signs . The sensitivity of 99mTc bone scanning was 84%, specificity 89%, positive predictive value 79% and negative predictive value 92% . The addition of gallium scanning (in 39 of the 94 infants) improved the respective figures to 90, 97, 93 and 95% and was useful in interpreting equivocal bone scans.

FEMS Immunol Med Microbiol, 1995 Dec, 12(3-4), 205 - 12
Partial characterization of the cohemolytic factor produced by Streptococcus uberis and comparison with the CAMP-factor; Lopes MF et al.; Exosubstances (cohemolysins) produced by Streptococcus agalactiae (CAMP-factor) and Streptococcus uberis (Uberis-factor) showing hemolytic synergism with beta-lysin produced by Staphylococcus aureus were compared . Cohemolytic activity was evaluated in the supernatants of bacterial cultures, before and after ammonium sulfate precipitation . Sheep erythrocytes sensitized with beta-lysin were used as substrate . The assays were performed in microtiter plates and results were expressed as cohemolytic units/ml . Maximum cohemolytic activity was detected, respectively, after 8 h and 14 h of growth in Columbia broth in S . uberis and S . agalactiae cultures . Cohemolytic activities of both microorganisms showed similarities when submitted to various physical and chemical treatments . They were significantly decreased by heating at 60 degrees C and 100 degrees C, or in presence of trypsin, and were abolished in the presence of Tween 20 . Activities were found to be stable in crude supernatants and concentrated preparations maintained at -20 degrees C for 3 months . Differences were related to levels of activity and kinetics of detection during the growth cycle . The results indicate the proteic nature, at least in part, of the Uberis factor . Analysis by PAGE in the presence or absence of SDS allowed us to correlate Uberis activity with a protein band with apparent molecular mass of 42 kDa, while CAMP activity was associated with a protein band of 27 kDa.

Crit Care Nurse, 1995 Dec, 15(6), 59 - 64
Meleney's synergistic gangrene: a case study; Howse EA; Meleney's synergistic gangrene is caused by S aureus and streptococcus organisms . One of the identifying symptoms is the presence of extremely painful lesions, which usually form in the second week after surgery or minor trauma . The ulcers that form at the center of the lesion are usually covered by a black eschar and encircled by a gangrenous margin . With knowledge of the pathophysiology and characteristics of this process, nurses can aid in the recognition of this unexpected complication . Nursing interventions can be planned around the needs of these patients . The key to recovery is early identification of the infection and prompt treatment.

Am J Dent, 1995 Dec, 8(6), 308 - 12
Enhanced bactericidal activity of Arm and Hammer Dental Care; Drake DR et al.; PURPOSE: To compare and contrast antibacterial activities of a baking soda-containing dentifrice, Arm and Hammer Dental Care (AHDC) with two fluoride dentifrices without baking soda (Crest and Colgate) . MATERIALS AND METHODS: A biphasic approach was taken, utilizing newly-developed laboratory model systems to: (1) assess the activity of brief exposure to dentifrices on single and mixed cultures; and (2) determine the effect of multiple, short-term exposure of sucrose-colonized Streptococcus mutans to simulate cumulative activity against cariogenic plaque . RESULTS: The short-term exposure assays revealed that S . mutans was significantly more susceptible to AHDC than either Crest of Colgate (P<0.05) . Moreover, exposure of mixed suspensions of bacteria by AHDC resulted in complete killing of Actinomyces viscosus and significantly greater decreases in S . mutans (P<0.05) . This enhanced bactericidal effect was not due to an alkaline pH as pH-adjusted AHDC solutions exhibited similar activity . The comprehensive in vitro plaque studies showed that exposure of colonized S . mutans to AHDC resulted in significantly greater decreases in numbers of viable cells than Crest (P<0.05) . Under the conditions employed, the baking soda-containing AHDC exhibited greater antibacterial efficacy overall than the standard Crest or Colgate pastes . These studies suggest that the use of AHDC may provide additional clinical benefit as a result of the enhanced bactericidal activity.

Eur Heart J, 1995 Dec, 16(12), 1975 - 80
Infective endocarditis due to Streptococcus bovis . A report of 53 cases; Ballet M et al.; Fifty-three patients (42 men; 11 women) with Streptococcus bovis infective endocarditis attended a tertiary cardiology hospital between 1980 and 1991, and constituted 11% of the total number of infective endocarditis cases hospitalized there during that period . The mean age was 59 +/- 15 years; 15 had previously suffered valvular disease (12) or had a valvular prosthesis (3); one patient had had a previous infective endocarditis . The infective episode involved the aortic valve in 26 patients, both the aortic and mitral valves in 18 patients, the mitral valve only in six and other valves in three . Echocardiographic examination showed one or more vegetations in 44 patients . Cardiac failure was diagnosed in 35 patients and embolic episodes in 22, of whom 11 were cerebrovascular accidents . The patients became afebrile 19 +/- 39 days after starting antibiotic treatment . Valve replacement was performed in 37 patients during their initial hospitalization, and in four during follow-up . After a mean follow-up of 4.6 +/- 3.1 years with a 100% follow-up, 15 patients died: 1 preoperatively, one in the first 30 days after operation, 13 later (8141 operated patients and 5/12 non-operated patients) . Actuarial survival was 73% at 5 years . Gastrointestinal signs were present in 12 patients; 43 patients (81%) had a full colonic examination which showed polyps in 20 patients and adenocarcinomas in seven . Of 11 late deaths four were related to a malignant colonic tumour . This study confirms that Streptococcus bovis infective endocarditis is 'relatively benign', but it stresses the frequency and potential severity of the associated colonic lesions, requiring colonoscopy and making the treatment of high risk lesions mandatory.

Eur J Clin Microbiol Infect Dis, 1995 Dec, 14(12), 1102 - 5
Evaluation of the automicrobic system for the identification of Streptococcus mutans; de la Higuera A et al.; The performance of the Automicrobic System with the Vitek gram-positive identification card (bioMerieux, France) in identifying strains of Streptococcus mutans was studied . Of 160 strains assayed, 72.5% were confirmed to be Streptococcus mutans; the remainder were identified as other species of streptocci (Streptococcus bovis, Streptococcus uberis, Streptococcus anginosus, Streptococcus sanguis I and II, Streptococcus intermedius, and Streptococcus constellatus).

Int J Exp Pathol, 1995 Dec, 76(6), 419 - 24
In vivo and in vitro study of the primary and secondary antibody response to a bacterial antigen in aged mice; Borghesi C et al.; One of the most important manifestations of aging in both humans and laboratory animals is a gradual decline in immune effectiveness . However, it is not clear as to how general is this decline . We here report that aged BALB/c mice showed no decline in the magnitude of the in vivo primary antibody response to phosphorylcholine (PC), an immunodominant epitope of the Streptococcus pneumoniae R36a (Pn) . Often it appeared that aged mice responded better than young syngeneic mice . In contrast, the secondary antibody response had a different profile, with aged mice showing a marked decrease in PC-specific antibody . Further in vitro studies were conducted in order to determine the cause of the decline of the secondary antibody response in aging . We noted that B cells from young and aged donors, either primed or twice immunized with the antigen, when cultured without T cells and in the presence of antigen did not display any significant difference in their antibody response to PC . However, L3T4 cells from aged BALB/c mice, previously immunized twice with Pn, failed to augment the in vitro B cell response as compared to L3T4 cells from young mice . Moreover, we found that Lyt 2 cells from young and aged mice had no regulatory effects on the anti-PC response in vitro . Further in vivo experiments demonstrated that alteration of the idiotypic network may not be related to a decline in the secondary antibody response since two injections of the antigen are unable to elicit an anti-idiotypic antibody response in either young or aged mice . These data demonstrate that the decline of the anti-PC response after a secondary challenge with Pn is linked to defects in the T cell compartment.

J Dermatol, 1995 Dec, 22(12), 960 - 3
A case of subacute necrotizing fasciitis; Imamura Y et al.; We report a 48-year-old woman who developed necrotizing groin fasciitis with insidious onset . Before she visited us, she had been unsuccessfully treated with several kinds of antibiotics by other doctors for one month, because of a small ulcer covered by blackish necrotic tissue . She was referred to us because of high fever, an ulcer on the left labium majus, and a cellulitis-like lesion with severe pain on the lower abdomen . Methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus intermedius, and Bacteroides uniformis were isolated from the wound . After aggressive debridement on the eighth day after admission of the whole indurated area and the fascia of the underlying muscle, healthy granulation tissue covered the defect, and the wound was finally closed with a skin graft Long-term administration of antibiotics along with insufficient and delayed surgical treatment were considered to have caused the full development of this disease.

Curr Opin Obstet Gynecol, 1995 Dec, 7(6), 417 - 9
Antenatal Care; Breart G; Recently published papers on antenatal screening show that a policy of routine cervical examination does not lead to a reduction in preterm birth, perhaps because the results of the cervical examination do not influence the decisions umbilical Doppler ultrasonography shows that the systematic use of this method for high-risk pregnant women reduces the odds of perinatal mortality by 38% . Studies on antenatal screening for Group B Streptococcus followed by intrapartum treatment show that the antenatal screening can be effective in reducing the rate of infection.

Pediatr Res, 1995 Dec, 38(6), 988 - 92
Comparison of M and T type antigen testing to field inversion gel electrophoresis in the differentiation of strains of group A streptococcus; Shah R et al.; Recent clusters of patients with acute rheumatic fever and invasive group A Streptococcus (GAS) have stimulated renewed interest in the epidemiology of streptococcal infections . We compared conventional serotyping for M and T antigens and serum opacity factor with field inversion gel electrophoresis (FIGE) for distinguishing among GAS . Fifteen pairs of throat isolates obtained from children positive for GAS before and after therapy were evaluated by conventional serotyping and by FIGE after SmaI digestion . Ten of the 15 pairs were identical by serotyping . FIGE correctly identified the 10 concordant and 5 discordant pairs . Individual clones were identified within each M type tested, including analysis performed on additional isolates of M1 and M3 obtained from the Centers for Disease Control and Prevention . This preliminary experience suggests that FIGE can successfully determine whether serial isolates from a given patient represent persistence of one strain or acquisition of a new strain of GAS and that this method might provide an alternative typing system for GAS.

Pediatr Res, 1995 Dec, 38(6), 981 - 7
Biochemical mediators of meningeal inflammatory response to group B streptococcus in the newborn piglet model; Ling EW et al.; The meningeal inflammatory response to a heat-killed mutant unencapsulated strain of type III group B Streptococcus (GBS) was studied in a newborn piglet model . GBS (10(9) colony-forming unit equivalents) or saline (control) was inoculated intraventricularly . Serial cerebrospinal fluid measurements were done at baseline and over the course of the next 24 h for cytochemical changes and production of tumor necrosis factor (TNF) and prostaglandins . In separate experiments, we defined the time course of early changes during the first 6 h and dose response relationship over a range of inocula 10(6) to 10(9) colony-forming unit equivalents . The intraventricular inoculation of the heat-killed unencapsulated GBS induced marked leukocytosis and increased protein by 6 h . These changes were preceded by a several hundredfold increase in TNF (maximum at 2 h) and prostaglandins (maximum at 2-4 h) . The early and sharp rise in TNF suggests its pivotal role in initiating the inflammatory cascade . The magnitude of the inflammatory response increased with increasing bacterial dose over the range studied . To study the effect of encapsulation of GBS in the induction of meningeal inflammation, we compared the response to the unencapsulated mutant strain with that to the encapsulated parent strain . The encapsulated strain produced much smaller inflammatory changes, and only with high doses of bacteria . The GBS cell wall appeared to be the primary bacterial product triggering inflammation . Intraventricular injection of the heat-killed unencapsulated GBS with exposed cell wall can serve as a valid model for studying neonatal meningitis.

Oral Microbiol Immunol, 1995 Dec, 10(6), 360 - 4
Mechanism of inhibition of glycolysis in Streptococcus mutans NCIB 11723 by chlorhexidine; Iwami Y et al.; Inhibition of the rate of acid production from glucose by the cells of Streptococcus mutans NCIB 11723 was directly related to the concentrations of 0.075 to 0.20 mM chlorhexidine . Lactate production was inhibited to a greater extent than acetate and formate . Quantification of glycolytic intermediates revealed that the steps in glycolysis inhibited by chlorhexidine were the reactions catalyzed by phosphofructokinase and glyceraldehyde 3-phosphate dehydrogenase and/or phosphoglycerate kinase . However, the activities of these enzymes were not decreased in cells treated with the inhibitor . It was demonstrated that chlorhexidine caused leakage of metabolites from the cells . Our results indicate that the decreased rate of glycolysis caused by chlorhexidine is due to the leakage of metabolic intermediates and not to direct effects on enzymes involved in glycolysis by S . mutans NCIB 11723.

Oral Microbiol Immunol, 1995 Dec, 10(6), 355 - 9
Simultaneous monitoring of intracellular pH and proton excretion during glycolysis by Streptococcus mutans and Streptococcus sanguis: effect of low pH and fluoride; Iwami Y et al.; A system was developed by which 2',7'-bis(carboxyethyl)-4 or 5-carboxyfluorescein could be used to monitor intracellular pH at the same time that proton excretion was being measured . Streptococcal cells were loaded with the dye, and after the addition of glucose protons were excreted and the intracellular pH increased quickly and remained higher than the extracellular pH of 7.0 . The excretion of protons stopped and the intracellular pH returned to the original level when glucose was depleted . The intracellular level of ATP remained high during glucose metabolism and decreased with the depletion of glucose . At extracellular pH of 5.5, and 5.0, the intracellular pH of fasting cells was higher than the extracellular pH value . After addition of glucose there were initial lags of proton excretion and of increases in intracellular pH at the acidic extracellular pH values . In the presence of fluoride, a lag in proton excretion and a simultaneous decrease in intracellular pH were observed, indicating a partial and transient inhibition of proton-ATPase activity.

Oral Microbiol Immunol, 1995 Dec, 10(6), 342 - 8
Modulation of glycosidase and protease activities by chemostat growth conditions in an endocarditis strain of Streptococcus sanguis; Mayo JA et al.; The effects of growth conditions on the properties of the endocarditis-producing oral bacterium Streptococcus sanguis FSS2 were studied . This strain produces a variety of proteases and glycosidases, including a thrombin-like activity that is a potential virulence factor for endocarditis . Cultures were grown with limiting glucose or galactose in chemostats over a range of dilution rates and pH levels, and the following activities were measured at pH 7.5: thrombin-like, Hageman factor-like, N-acetyl-beta-D-galactosaminidase, beta-D-glucosidase, and beta-D-galactosidase . At growth pH 6.5, specific activities generally decreased as the dilution rate increased from 0.05 to 0.40 h(-1) . At a dilution rate of 0.1 h(-1), specific activities generally were highest at growth pH 6.5 and lower and approximately equal at growth pH 5.5 and 7.5 . The major exception was the thrombin-like activity, for which the specific activity at growth pH 7.5 was approximately 5-fold higher than at growth pH 5.5 . Hageman factor-like activity was apparently glucose catabolite repressible, as its activity was 3-fold higher in galactose cultures . The measured activities changed as functions of growth conditions and thus were modulated by environment . Environmental regulation of thrombin-like activity by pH is consistent with an activity that is less important on tooth surfaces than in tissues.

Antimicrob Agents Chemother, 1995 Dec, 39(12), 2798 - 800
In vitro antimicrobial effect against Streptococcus pneumoniae of adding rifampin to penicillin, ceftriaxone, or 1-ofloxacin; Giron KP et al.; Adding rifampin to penicillin or l-ofloxacin diminished the rate at which these antibiotics killed 21 clinical isolates isolates of Streptococcus pneumoniae in vitro . A less pronounced inhibitory effect was observed when rifampin was added to ceftriaxone . Synergy was not observed for any bacterial isolate . The in vitro demonstration of indifference or antagonism using these antibiotic combinations argues against the empirical addition of rifampin to beta-lactams or fluoroquinolones in treating serious pneumococcal infections.

Antimicrob Agents Chemother, 1995 Dec, 39(12), 2667 - 70
Emergence of multiple-antibiotic-resistant Streptococcus pneumoniae in Hong Kong; Kam KM et al.; Two hundred four strains of Streptococcus pneumoniae isolated in Hong Kong from January 1993 to May 1995 were analyzed for their antibiotic susceptibilities and epidemiological patterns . The ages of the patients from whom the strains were isolated from 1 month to 93 years (median, 53 years); the male-to-female ratio was 2.8, with a predominance of males in the pediatric group . Fifty-nine (28.9%) strains showed reduced penicillin susceptibility, including 40 (19.6%) with frank penicillin resistance (MIC > 1 microgram/ml) . Tetracycline resistance alone was found in 28.4% of strains . Isolates with reduced penicillin susceptibility were more common in children than adults (40 versus 23.9%, P = 0.02), and penicillin resistance rates were significantly higher in hospitalized patients than in outpatients (39.5 versus 12.5%; p < 0.001) . Penicillin resistance was significantly associated with resistance to ceftriaxone, erythromycin, and tetracycline (P < 0.01) but not with ofloxacin or vancomycin (P = 0.5) . Among eight different patterns of resistance to three or more antibiotics, the commonest one (14.2%) was multiple resistance to penicillin, chloramphenicol, ceftriaxone, erythromycin, and tetracycline . Emergence of multiple-antibiotic-resistant S . pneumoniae reflects changes in the pneumococcus itself and the general indiscriminate use of antibiotics in treatment of respiratory infections in Hong Kong.

J Clin Microbiol, 1995 Dec, 33(12), 3159 - 63
Antimicrobial susceptibilities and serotypes of invasive Streptococcus pneumoniae strains in Switzerland; Wust J et al.; In 1993 and 1994, 10 microbiological laboratories in Switzerland collected 351 strains of Streptococcus pneumoniae from invasive infections . Susceptibilities to the main representatives of the chemical classes were as follows: penicillin, 93%; chloramphenicol, 92%; erythromycin, 94%; sulfamethoxazole-trimethoprim, 86%; tetracycline, 92%; vancomycin, 100% . Forty-three strains showed resistance to one agent, and 35 strains showed resistance to two or more antimicrobial agents simultaneously; i.e., 22% of the strains were resistant to at least one antimicrobial agent . Four strains (1%) were fully resistant to penicillin, whereas 21 strains (6%) showed reduced susceptibility . Of these 25 strains not fully susceptible to penicillin, 10 were resistant to one, 3 were resistant to two, and 8 were resistant to three additional antimicrobial agents . Of the quinolones, sparfloxacin was the most active substance, with an MIC at which 90% of the strains are inhibited of 0.5 mg/liter . The most common serotypes were types 6 (13.6% of isolates), 7 (10.5%), 19 (10.5%), 14 (9.1%), and 1 (8.5%) as well as 3 and 23 (8.0% each) . Reduced susceptibility to penicillin was found mainly among serotypes 6, 14, 19, and 23 . The currently available 23-valent pneumococcal vaccine covers 320 (91%) of the pneumococci isolated . Regional differences within Switzerland with regard to serotypes and antimicrobial resistance were not observed.

Klin Monatsbl Augenheilkd, 1995 Dec, 207(6), 381 - 3
{Acute bilateral amaurosis in sphenoid empyema caused by Streptococcus pneumoniae}; Mardin CY et al.; PATIENT: A 14-year-old boy suffered from an acute bilateral blindness which occurred in 24-h time, accompanied by headache and raised temperature, with inconspicuous optic nerve head and fundus . After diagnosis of empyema with magnet resonance tomography (MRT) the sphenoid sinus was fenestrated and streptococcus pneumoniae isolated . Liquor and serology being inconspicuous, there was no evidence of leucaemic or autoimmune disease, intoxication or intracranial tumor . CLINICAL COURSE: The condition of the patient improved under systemic antibiotic therapy . The bilateral amaurosis remained and opticus atrophy developed . CONCLUSION: A bilateral amaurosis with descending opticus atrophy as a consequence of a sphenoiditis and spreading inflammation to the meninges and the optic nerve in the area of the chiasm is a rare event . The imaging technique of the MRT offers new opportunities for an early and more pointed diagnosis and therapy.

Indian J Med Res, 1995 Dec, 102, 258 - 60
C substance--specific latex agglutination for early & rapid detection of Streptococcus pneumoniae in blood cultures; Jesudason MV et al.; A slide agglutination test was developed using latex particles coated with antiserum against the C substance, a common antigen for all serotypes of Streptococcus pneumoniae . This test was used for the rapid identification of pneumococci in blood culture broths which contained Gram positive cocci (GPC) in pairs or short chains on smear examination . Of 238 consecutive blood cultures with GPC tested, 72 were positive for Strep . pneumoniae by the latex test and conventional methods . The remaining 166 cultures were negative for both these, indicating a 100 per cent specificity and sensitivity for the test.

Epidemiol Infect, 1995 Dec, 115(3), 387 - 97
A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire; Cartwright K et al.; We describe the first cluster of cases of necrotizing fasciitis (NF) in this century in the United Kingdom (UK) . Between 1 January and 30 June 1994 there were six cases (five confirmed, one probable) of Streptococcus pyogenes NF in west Gloucestershire, population 320,000 . Two cases died . The first two patients probably acquired their infections during the course of elective surgery performed in the same operating theatre, possibly from a nasopharyngeal carrier amongst the theatre staff . The remaining infections were community-acquired . Of 5 S . pyogenes isolates there were 2 M1 strains, 1 M3, 1 M5 and 1 M non-typeable strain . S . pyogenes NF had not been recorded in west Gloucestershire in the preceding 10 years and the incidence of S . pyogenes bacteraemia in England and Wales had not risen in the past 5 years . The two presumably theatre-acquired infections raised several issues . The need for detailed bacteriological investigation of all cases of post-surgical NF was confirmed . Clusters of S . pyogenes infection following surgery should be managed by closure of the operating theatre until all staff have been screened for carriage . Closure of an operating theatre and screening of staff following a sporadic case is probably not justified because of the infrequency of surgical cross-infection with S . pyogenes . Regular, routine screening of theatre staff is neither practical nor necessary.

Bull Tokyo Med Dent Univ, 1995 Dec, 42(3), 83 - 103
Experimental root surface caries in hamsters the development of the disease after inoculations of two types of cariogenic bacteria; de Oliveira Cordeiro JG; The aim of this study was to investigate the development of root surface caries in hamsters fed a high-sucrose diet over a 24-week period after inoculations of two types of cariogenic bacteria . Twenty-one day old male golden hamsters (n = 103) were divided into 5 groups . Four groups were given diet 2000, and one group was given a stock diet CE-2, Of the groups given diet 2000, three groups were infected with Actinomyces viscosus ATCC 15987 and Streptococcus mutans NTCC 10449 separately (AV and SM groups) or in combination (AVSM group), and one group remained uninfected . A grid method was used to evaluate the plaque accumulation, alveolar bone loss, and root surface caries . After 12 weeks, root surface caries developed mainly on the first mandibular molars in the three infected groups . At 24 weeks, the prevalence of root surface caries was highest in the AV group, but root caries scores were not significantly different among the three infected groups . In the groups SM and AVSM, the molar crowns were extensively destroyed by caries, while in the AV group the crowns were almost intact . It was concluded that challenge with Actinomyces viscosus may be appropriate to study root surface caries in hamsters.

Am J Ophthalmol, 1995 Dec, 120(6), 784 - 92
Streptococcal gangrene of the eyelids and orbit; Shayegani A et al.; PURPOSE: Streptococcal gangrene, also termed streptococcal necrotizing fasciitis, is resurgent but remains exceedingly rare . Ophthalmologists and dermatologists must be aware of streptococcal gangrene, as eyelids are the most commonly affected area of the head and neck . METHODS: We studied two cases of streptococcal gangrene of the orbit with clinical manifestations indistinguishable from common nonnecrotizing orbital cellulitis . RESULTS: Infection progressed with dramatic rapidity to produce eyelid necrosis, respiratory failure, sepsis, and severe permanent visual loss caused by ophthalmic artery occlusions . Histopathologic analysis disclosed vascular thrombosis, necrosis, acute inflammation, and the presence of gram-positive cocci . Cultures grew heavy group A beta hemolytic Streptococcus . The first patient was infected with M type 1 carrying exotoxins A and B . The second patient was also infected with Streptococcus carrying exotoxin A . CONCLUSION: Early diagnosis of this life-threatening infection is of paramount importance because survival may depend on early surgical debridement.

Microbiol Rev, 1995 Dec, 59(4), 591 - 603
Streptococcus pneumoniae: virulence factors, pathogenesis, and vaccines; AlonsoDeVelasco E et al.; Although pneumococcal conjugate vaccines are close to being licensed, a more profound knowledge of the virulence factors responsible for the morbidity and mortality caused by Streptococcus pneumoniae is necessary . This review deals with the major structures of pneumococci involved in the pathogenesis of pneumococcal disease and their interference with the defense mechanisms of the host . It is well known that protection against S . pneumoniae is the result of phagocytosis of invading pathogens . For this process, complement and anticapsular polysaccharide antibodies are required . Besides, relatively recent experimental data suggest that protection is also mediated by the removal of disintegrating pneumococci and their degradation products (cell wall, pneumolysin) . These structures seem to be major contributors to illness and death caused by pneumococci . An effective conjugate vaccine should therefore preferably include the capsular polysaccharide and at least one of these inflammatory factors.

J Thorac Cardiovasc Surg, 1995 Dec, 110(6), 1745 - 55
Surgical management of infective endocarditis associated with cerebral complications . Multi-center retrospective study in Japan; Eishi K et al.; To establish guidelines for the surgical treatment of patients with infective endocarditis who have cerebrovascular complications, we conducted a detailed retrospective study of 181 of 244 patients with cerebral complications among 2523 surgical cases of infective endocarditis of the Japanese Association of Thoracic Surgery . The results showed that 9.7% of all patients with infective endocarditis had associated cerebral complications: 108 (44.3%) had active native valve endocarditis, 96 (39.3%) had healed native valve endocarditis, and 40 (16.4%) had prosthetic valve endocarditis . The hospital mortality of the patients with cerebral complications was 11.0% in the group as a whole: 13.9% in active native valve endocarditis, 3.1% in healed native valve endocarditis, and 37.5% in prosthetic valve endocarditis . Diseased valves included the following aortic valve in 55.5%, mitral valve 49.8%, tricuspid valve in 1.3%, and pulmonary valve in 1.3% . In 181 patients with cerebral complications, organisms were detected as follows: gram-positive cocci in 133 (73.5% {Streptococcus in 85, Staphylococcus in 32}), gram-negative in 18 (9.9%), fungus in 11 (6.1%), and unknown in 64.6%, cerebral bleeding in 31.5%, cerebral abscess in 2.8%, and meningitis in 1.1% . Hospital mortality rate and an exacerbation rate of cerebral complications, including related death, according to the interval from onset of cerebral infarction to cardiac surgery, were as follows: 66.3% and 45.5% within 24 hours, 31.3% and 43.8% between 2 and 7 days, 16.7% and 16.7% between 8 and 14 days, 10.0% and 10.0% between 15 and 21 days, 26.3% and 10.5% between 22 and 28 days, and 7.0% and 2.3% over 4 weeks later, respectively . A significant correlation existed between the interval and the exacerbation of cerebral complications (tied p = 0.008) . Preoperative risk factors affecting exacerbation of cerebral complications were as follows: (1) severity of cerebral complications (p = 0.006), (2) intervals (p = 0.012), and (3) uncontrolled congestive heart failure as indications for cardiac surgery (p = 0.014) . One patient underwent a cardiac operation within 24 hours of the onset of cerebral hemorrhage and died of cerebral damage . No exacerbations occurred in 10 patients who underwent their operation between 2 and 28 days . Nevertheless, exacerbations occurred in 19.0% of patients whose operation was done more than 4 weeks later . These data suggest that cardiac operations can be done safely 4 weeks after cerebral infarction, and if the delay is more than 2 weeks, the exacerbation rate will be around 10% . The risk of progression of cerebral damage is still significant 15 days and even 4 weeks after cerebral hemorrhage.

J Pediatr, 1995 Dec, 127(6), 987 - 9
Congenital streptococcal toxic shock syndrome with absence of antibodies against streptococcal pyrogenic exotoxins; Mahieu LM et al.; Congenital infection with group A beta-hemolytic streptococcus was complicated by toxic shock syndrome in a neonate . We hypothesize that the severity of the clinical syndrome was related to the streptococcal pyrogenic exotoxin in the absence of corresponding antibodies . The outcome may have been favorably influenced by the antibodies to streptococcal pyrogenic exotoxin present in the immunoglobulins given as treatment.

J Bacteriol, 1995 Dec, 177(23), 7007 - 9
Properties of two sugar phosphate phosphatases from Streptococcus bovis and their potential involvement in inducer expulsion; Cook GM et al.; Streptococcus bovis possesses two sugar phosphate phosphatases (Pases) . Pase I is a soluble enzyme that is inhibited by the membrane fractions from lactose-grown cells and is insensitive to activation by S46D HPr, an analog of HPr(ser-P) of the sugar phosphotransferase system . Pase II is a membrane-associated enzyme that can be activated 10-fold by S46D HPr, and it appears to play a role in inducer expulsion.

Infect Immun, 1995 Dec, 63(12), 4695 - 703
An antigenic peptide inducing cross-reacting antibodies inhibiting the interaction of Streptococcus mutans PAc with human salivary components; Senpuku H et al.; A 190-kDa surface protein antigen (PAc) of Streptococcus mutans, in particular the A region of this molecule, may be implicated in the induction of dental caries via an interaction with salivary components . For this reason, it was probably used successfully as an antigenic component for experimental vaccination to prevent dental caries in animals . While developing a synthetic peptide vaccine for dental caries, as reported herein, we have identified a unique peptide, TYEAALKQYEADL, as a candidate vaccinal immunogen . The amino acid sequence of this peptide completely corresponds to the sequence of a B-cell epitope in the A region of PAc and additionally contains its own T-cell epitope for B10.D2 mice within the molecule . This peptide strongly induces the production of only cross-reacting antibodies against PAc . In addition, as demonstrated by surface plasmon resonance analysis using the BIAcore system, these cross-reacting antibodies inhibit approximately 50% of the binding of fluid-phase salivary components to immobilized recombinant PAc.

Infect Immun, 1995 Dec, 63(12), 4669 - 74
FimA, a major virulence factor associated with Streptococcus parasanguis endocarditis; Burnette-Curley D et al.; Adherence of microorganisms to damaged heart tissue is a crucial event in the pathogenesis of infective endocarditis . In the present study, we investigated the role of the FimA protein as a potential virulence factor associated with Streptococcus parasanguis endocarditis . FimA is a 36-kDa surface protein that is a recognized adhesin in the oral cavity where it mediates adherence to the salivary pellicle . An insertion mutant and a deletion mutant of S . parasanguis were employed in the rat model of endocarditis to determine the relevance of FimA in endocarditis pathogenesis . Catheterized rats were infected with either the fimA deletion mutant VT929, the fimA insertion mutant VT930, or the isogenic, wild-type S . parasanguis FW213 . Rats inoculated with FW213 developed endocarditis more frequently (50.9%) than animals inoculated with either the deletion mutant (2.7%) or the insertion mutant (7.6%) (P < 0.001) . A series of in vitro assays were performed to explore the mechanism(s) by which FimA enhanced the infectivity of S . parasanguis . FimA did not inhibit the uptake or the subsequent killing of S . parasanguis by phagocytic granulocytes . Similarly, FimA did not play a role in the adherence to or the aggregation of platelets . Significant differences were noted between FW213 and VT929 (P < 0.05) and FW213 and VT930 (P < 0.001) in their abilities to bind to fibrin monolayers . The mean percent adherence of FW213 to fibrin monolayers (2.1%) was greater than those of VT929 (0.5%) and VT930 (0.12%) . Taken together, these results indicate that FimA is a major virulence determinant associated with S . parasanguis endocarditis and further suggest that its role is associated with initial colonization of damaged heart tissue.

Int Arch Allergy Immunol, 1995 Dec, 108(4), 360 - 7
Streptococcus-mutans-induced nephritis in rabbits: rheumatoid factors and nephritogenicity; Miyata M et al.; The pathogenesis of streptococcus-induced nephritides (SIN) involves immune complex-mediated inflammation; however, specific mechanisms are still poorly understood . Using preparations of two strains of Streptococcus mutans (SM) in attempts to induce SIN in rabbits, one preparation was strongly and the other virtually not nephritogenic . The non-nephritogenic preparation provided a negative control for our studies . Streptococcal components were present in circulating immune complexes (CIC) as well as in tissue-bound immune complexes (TIC), especially early in the disease . CIC and TIC also contained rheumatoid factors (RF), which tended to predominate in late stages of the disease . The nephritogenic and the non-nephritogenic preparations of SM shared the same major tissue-binding components and induced similar titers of antimicrobial antibodies, but differed significantly in their ability to induce CIC and RF . It is proposed that kidney-binding microbial components, antimicrobial antibodies and high serum concentration of RF are necessary and sufficient determinants for the pathogenesis of SIN in this rabbit model.

J Biol Chem, 1995 Dec 1, 270(48), 28874 - 8
Purification of a galactosyl-alpha 1-4-galactose-binding adhesin from the gram-positive meningitis-associated bacterium Streptococcus suis; Tikkanen K et al.; Streptococcus suis causes meningitis, sepsis, and other serious infections in newborn and young pigs and in adult humans . The Gal alpha 1-4Gal-binding adhesin of S . suis was purified to homogeneity by ultrasonic treatment, fractional ammonium sulfate precipitation, and preparative polyacrylamide gel electrophoresis . Pigeon ovomucoid, a glycoprotein with Gal alpha 1-4Gal terminals, was used to detect the adhesin by blotting . The purified adhesin appeared as single band of an apparent size of 18 kDa and of a pI of 6.4; no disulfide bridges were present . The amount of adhesin as revealed by pigeon ovomucoid binding correlated with the hemagglutination activity of different S . suis strains . The purified adhesin bound to latex particles induced hemagglutination which was specifically inhibited with the same inhibitors as hemagglutination by the intact bacteria, thus demonstrating that the purified protein was the Gal alpha 1-4Gal-recognizing adhesin of S . suis . Two adhesin variants (PN and PO) with differing Gal alpha 1-4Gal binding specificity had the similar electrophoretic mobilities and the same N-terminal peptide sequences, indicating that they were closely related . This represents the first isolation of an adhesin with well-defined cell surface carbohydrate binding activity from Gram-positive bacteria associated with meningitis.

Chest, 1995 Dec, 108(6), 1742 - 3
A late sternal wound infection caused by hematogenous spread of bacteria; Stuesse DC et al.; A 56-year-old man presented with a sternotomy wound infection 6 months after coronary artery bypass grafting . The organism responsible was group B beta-hemolytic Streptococcus . This organism was simultaneously cultured from an infected diabetic ulcer on the patient's foot as well as from a total knee prosthesis . The Streptococcus apparently spread hematogenously to the sternum, an extremely rare cause of sternotomy wound infection.

CMAJ, 1995 Dec 1, 153(11), 1653 - 5
At one time, operations outside the hospital were not uncommon; Morton HS; Before World War II, it was not uncommon for a person with influenza caused by streptococcus to develop empyema . Retired surgeon Harry Morton recalls two well-known patients who had empyema-related operations outside the hospital.

J Med Microbiol, 1995 Dec, 43(6), 405 - 10
Potential pathogenic properties of members of the "Streptococcus milleri" group in relation to the production of endocarditis and abscesses; Willcox MD; The "Streptococcus milleri" (SMG) group have been shown to possess factors in vitro that may be involved in pathogenesis . All SMG strains are able to bind fibronectin via a cell-surface protein; the binding ranged from 12 to 198 mol/cell . Strains also bound to platelet-fibrin or fibrin clots and fibrinogen, giving maximum adhesion values of 16.5%, 21.8% and 151 mol/cell respectively . Members of the species S . constellatus produced thrombin-like activity . Lancefield group C SMG aggregated rat platelets, a bacterial cell-surface protein acting as mediator in the reaction . Most of the in-vitro factors did not correlate with each other, an indication that SMG strains possess a wide variety of pathogenic properties that may be involved in the production of abscesses or endocarditis . However, there was a correlation between the binding of large amounts of fibrinogen ( > 100 mol/cell) and the ability to aggregate platelets . This suggests that fibrinogen binding may aid in platelet aggregation.

Arch Intern Med, 1995 Nov 27, 155(21), 2336 - 40
Preventing pneumococcal bacteremia in patients at risk . Results of a matched case-control study; Farr BM et al.; BACKGROUND: Three randomized controlled trials of the effectiveness of pneumococcal vaccine in elderly and chronically ill adults in the United States have failed to show significant protective efficacy during 44,213 person-years of follow-up . Case-control studies have greater statistical power to detect significant prevention of rare diseases such as pneumococcal bacteremia, but they also have a greater susceptibility to bias, necessitating consistent results from multiple studies . Three case-control studies at two different universities have shown prevention of systemic infection, but another study found no benefit . METHODS: Patients with pneumococcal bacteremia who were at least 2 years old and had chronic illness indicating the need for pneumococcal vaccine, or who were at least 65 years old were compared with matched control subjects for frequency of prior vaccination . Matching variables included date of admission, age, sex, race, type and duration of chronic illness serving as the major vaccine indication, number of vaccine indications and number of medical hospitalizations since licensure of the pneumococcal vaccine in 1978, and type of primary medical care . RESULTS: Pneumococcal vaccination was documented in the records of six (7%) of 85 cases and 26 (17%) of 152 control subjects, suggesting 81% efficacy in conditional logistical regression analysis (95% confidence interval, 34% to 94%, P = .008) . CONCLUSIONS: Four case-control studies at three universities have now demonstrated significant protective efficacy of pneumococcal vaccine for preventing pneumococcal bacteremia . The development of antibiotic-resistant Streptococcus pneumoniae indicates an urgent need for an increased rate of vaccination among high-risk patients and for the development of more immunogenic conjugate vaccines that may enhance efficacy among elderly and immunocompromised patients as well as infants.

Proc Natl Acad Sci U S A, 1995 Nov 21, 92(24), 11140 - 4
An unmodified heptadecapeptide pheromone induces competence for genetic transformation in Streptococcus pneumoniae; Havarstein LS et al.; Competence for genetic transformation in Streptococcus pneumoniae has been known for three decades to arise in growing cultures at a critical cell density, in response to a secreted protease-sensitive signal . We show that strain CP1200 produces a 17-residue peptide that induces cells of the species to develop competence . The sequence of the peptide was found to be H-Glu-Met-Arg-Leu-Ser-Lys-Phe-Phe-Arg-Asp-Phe-Ile-Leu-Gln-Arg- Lys-Lys-OH . A synthetic peptide of the same sequence was shown to be biologically active in small quantities and to extend the range of conditions suitable for development of competence . Cognate codons in the pneumococcal chromosome indicate that the peptide is made ribosomally . As the gene encodes a prepeptide containing the Gly-Gly consensus processing site found in peptide bacteriocins, the peptide is likely to be exported by a specialized ATP-binding cassette transport protein as is characteristic of these bacteriocins . The hypothesis is presented that this transport protein is encoded by comA, previously shown to be required for elaboration of the pneumococcal competence activator.

J Ethnopharmacol, 1995 Nov 17, 49(1), 23 - 32
Anti-microbial activity and anti-complement activity of extracts obtained from selected Hawaiian medicinal plants; Locher CP et al.; Selected plants having a history of use in Polynesian traditional medicine for the treatment of infectious disease were investigated for anti-viral, anti-fungal and anti-bacterial activity in vitro . Extracts from Scaevola sericea, Psychotria hawaiiensis, Pipturus albidus and Eugenia malaccensis showed selective anti-viral activity against Herpes Simplex Virus-1 and 2 and Vesicular Stomatitis Virus . Aleurites moluccana extracts showed anti-bacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa, while Pipturus albidus and Eugenia malaccensis extracts showed growth inhibition of Staphylococcus aureus and Streptococcus pyogenes . Psychotria hawaiiensis and Solanum niger inhibited growth of the fungi Microsporum canis, Trichophyton rubrum and Epidermophyton floccosum, while Ipomoea sp., Pipturus albidus, Scaevola sericea, Eugenia malaccensis, Piper methysticum, Barringtonia asiatica and Adansonia digitata extracts showed anti-fungal activity to a lesser extent . Eugenia malaccensis was also found to inhibit the classical pathway of complement suggesting that an immunological basis for its in vivo activity was identified . This study has confirmed some of the ethnobotanical reports of Hawaiian medicinal plants having curative properties against infections using biological assays in vitro.

Tidsskr Nor Laegeforen, 1995 Nov 10, 115(27), 3382 - 6
{The end of antibiotics? Increasing bacterial resistance in global and Norwegian perspective}; Jensenius M et al.; During the last 20 years there has emerged a growing world-wide problem with regard to multidrug-resistant microbes . The most serious examples so far are vancomycin-resistant strains of Enterococcus faecium, totally resistant isolates of Mycobacterium tuberculosis and multiple-resistant Staphylococcus aureus and Streptococcus pneumoniae . With the exception of some few strains of methicillin-resistant S . aureus and vancomycin-resistant enterococci, such bacteria have not been found in Norway . In this article we discuss possible ways of preventing further selection and spread of multiple-resistant microbes . We stress the importance of infection control programmes and restrictive use of antibiotics.

Carbohydr Res, 1995 Nov 7, 277(1), 1 - 9
Structural elucidation of the novel type VII group B Streptococcus capsular polysaccharide by high resolution NMR spectroscopy; Kogan G et al.; The type VII capsular polysaccharide isolated from the newly discovered group B Streptococcus (GBS) strain contains D-glucose, D-galactose, N-acetyl-D-glucosamine and N-acetylneuraminic acid in the molar ratio 2:2:1:1 . High-resolution one- and two-dimensional (1D and 2D) 1H and 13C NMR spectroscopy of the native and desialylated polysaccharides showed the type VII GBS capsular polysaccharide to contain the following branched hexasaccharide repeating unit: {formula: see text} Despite extensive structural similarity with the previously described GBS polysaccharides, the type VII polysaccharide showed no cross-reaction with the heterologous antisera.

East Afr Med J, 1995 Nov, 72(11), 739 - 41
Severity of varicella infection in Saudis with diabetes mellitus: a possible role of acyclovir in treatment; Kubeyinje EP; Severity of varicella infection in 54 patients with diabetes mellitus seen in Arar Central Hospital, Saudi Arabia, between January 1992 and December 1994 was compared with that in 55 apparently healthy controls, seen during the same period . Persistent fever, defined as fever lasting more than five days; extensive skin eruption, defined as affecting more than 50% of the body surface; and secondary bacterial skin infection evidenced by a positive skin culture of Staphylococcus aureus or Streptococcus pyogenes occurred significantly more in diabetics than in healthy controls . The mean duration of the illness in diabetics was 16.8 +/- 3.24 days as compared to 13.6 +/- 3.32 days in healthy controls . These findings suggest that varicella runs a more aggressive course in diabetic patients compared to otherwise healthy individuals . Treatment with the anti-viral agent, acyclovir may be indicated in diabetics with varicella infection.

Microb Pathog, 1995 Nov, 19(5), 299 - 315
Biological properties of a Streptococcus pyogenes mutant generated by Tn916 insertion in mga; Kihlberg BM et al.; The mga regulon of Streptococcus pyogenes contains genes which contribute to the pathogenicity and virulence of this significant human pathogen . Transposon insertional inactivation of the regulatory mga gene in a S . pyogenes strain of the clinically important M1 serotype, blocked the expression of four genes located downstream of mga . These genes encode the M1 protein, the IgG-binding protein H, protein SIC which is an extracellular inhibitor of complement, and the C5a peptidase which interferes with granulocyte migration . The wild-type strain is resistant to phagocytosis and adheres to human skin tissue sections; properties that were lost in the transposon mutant . Moreover, the mutant was less virulent to mice but more cytolytic to human lymphocytes, the latter due to an increased activity of streptolysin S, whereas the production of streptolysin O, another toxin of S . pyogenes, was not affected . The mga mutation was complemented in trans with an intact mga gene which restored the phenotype of the wild-type strain.

Zhonghua Kou Qiang Yi Xue Za Zhi, 1995 Nov, 30(6), 329 - 31, 383
{Adherent mechanism of the mutans of Actinomyces viscosus T14V}; Guan W et al.; Three mutans of Actionmyces viscous T14V lacking type1 (5951), type 2 (5519) and both types of fimbriae (147) were selected in this study . We compared the ability of their adsorption to the test-tube wall, the result of the cellular coaggregation between these mutant strains and Streptococcus sanguis 34, Streptococcus sanguis black bova, Streptococcus mutans ingbritte, Streptococcus sobrinus 6715 and analysed the chemical characterization of cell walls of the three mutans . We found that the specific fimbriae and cell hydrophobicities had great effect on the bacteria adsorption or coaggregation.

Genome Res, 1995 Nov, 5(4), 408 - 18
Differential subsequence conservation of interspersed repetitive Streptococcus pneumoniae BOX elements in diverse bacteria; Koeuth T et al.; Evolutionary conservation of an interspersed repetitive DNA sequence, BOX, from Streptococcus pneumoniae was investigated to explore the mosaic nature of these elements . BOX elements consist of various combinations of three subunits, boxA, boxB, and boxC . Eight oligonucleotide probes were designed based on consensus DNA sequences of boxA, boxB, and boxC subunits . DNA hybridization studies and PCR using these probes/primers demonstrate that oligonucleotide sequences within the boxA subunit appear to be conserved among diverse bacterial species . The boxB and boxC subunits show only limited, if any, sequence conservation in bacteria other than S . pneumoniae . Intact BOX elements with boxA, boxB, and boxC subunits were only present in high copy number in pneumococcal strains . This pattern of differential conservation lends support to the modular nature of BOX repetitive elements in that boxA-like subsequences are effectively independent of boxB-like or boxC-like subunits in bacteria other than S . pneumoniae . Furthermore, dendrograms derived from repetitive sequence-based PCR (rep-PCR) fingerprints of S . pneumoniae isolates using the BOXA1R primer yielded clustering patterns that were similar to those obtained previously by other methods, suggesting that these repetitive sequence-based DNA fingerprints represent intrinsic properties of an S . pneumoniae strain's genome . Our results indicate widespread conservation of boxA-like subsequences in the bacterial kingdom, lend support to the mosaic nature of BOX in S . pneumoniae, and demonstrate the utility of boxA-based primers for rep-PCR fingerprinting of many microorganisms.

J Dairy Sci, 1995 Nov, 78(11), 2496 - 501
Efficacy of barrier-type postmilking teat germicides against intramammary infection; Nickerson SC et al.; Two barrier teat dips were evaluated for efficacy in preventing new IMI by Staphylococcus aureus and Streptococcus agalactiae during experimental exposure trials, and two barrier dips were evaluated during natural exposure trials . Dipping in an experimental product containing nicin as a germicide using experimental exposure demonstrated no difference in rate of new Staph . aureus IMI (10.2%) compared with that of controls (7.1%) or in the rate of new Strep . agalactiae IMI (13.6%) compared with that of controls (11%) . Testing of an experimental .55% chlorhexidine gluconate barrier dip using experimental exposure resulted in an increased rate of new Staph . aureus IMI compared with that of controls (4.8 vs . 1.7%, respectively), but no difference in the rate of new Strep . agalactiae IMI in dipped quarters (6.1%) compared with that of controls (3.3%) . Dipping with a commercial .3% iodine barrier dip during natural exposure increased the number of new coagulase-negative staphylococcal and total IMI by 56.6 and 30.6%, respectively, compared with a 1% iodophor dip without barrier . Use of an experimental .3% iodine barrier dip during natural exposure demonstrated no difference in total rate of new IMI (18.4%) compared with that of controls (20.3%); however, after germicide concentration was increased to .5% iodine and further tested, the reformulated product reduced new IMI by 43.1% . Under the conditions of these trials, the barrier teat dips tested were no more efficacious than no teat dip or using a nonbarrier product.

Arch Mal Coeur Vaiss, 1995 Nov, 88(11), 1583 - 11
{Has life expectancy of patients after surgery for aortic valve endocarditis improved over the last twelve years?}; Milon C et al.; Between 1983 and 1991, 104 patients (average age: 52 +/- 13 years) with aortic endocarditis (94 on native and 10 on prosthetic valves), were operated, 81 before the end of antibiotic therapy . Blood cultures were negative in 17 patients, identified a streptococcus in 49 patients, a staphylococcus in 16 patients, and a Gram negative or other organism in 22 patients . The following complications were observed before surgery: severe cardiac failure in 67 patients, renal failure in 24 patients, conduction defects in 13 patients, neurological complications in 13 patients, systemic or coronary embolism in 12 patients . Aortic valve replacement was performed in all patients, associated with mitral valve replacement in 25 patients and tricuspid valve replacement in 1 patient . Twelve patients died after surgery (11/81 of early operations, 1/23 operated later; NS) . During a follow up of 3.5 +/- 2.8 years, there were 24 late deaths, 12 of non cardiovascular causes . Of the 20 variables tested, 3 were related to perioperative and late mortality (age, cardiac and renal failure) . The 5 year survival (58.1 +/- 5.7%) is identical to that of the period 1970-1982 despite a very significant drop in perioperative mortality . Some of the causes of late mortality (older age of patients, changes in the infecting organisms) provide little hope of improving the prognosis in the near future . Others suggest that earlier surgery could improve the long term prognosis.

Compr Ther, 1995 Nov, 21(11), 658 - 62
Penicillin and multiply antibiotic-resistant Streptococcus pneumoniae; Estrada B et al.; The emergence of multiply antibiotic-resistant pneumococci has become a worldwide problem . To document resistance among clinical or surveillance isolates, there are a number of excellent laboratory techniques and these can be used to guide clinical decisions . All pneumococci are currently susceptible to vancomycin, an important consideration in managing patients with serious, or life threatening infection.

Eur J Clin Microbiol Infect Dis, 1995 Nov, 14(11), 1002 - 4
Deep soft-tissue infections caused by Streptococcus pneumoniae; Kragsbjerg P et al.; Three cases of deep soft-tissue infections caused by Streptococcus pneumoniae are presented . All patients were previously healthy adults . The first case was a man with a protracted illness in whom pelvic and inguinal abscesses developed at the site of a scar from a traumatic injury several years earlier . The second patient, a woman, had mastitis with systemic symptoms . The third patient was a woman who developed a gluteal abscess after an intramuscular injection of a contraceptive . Cellulitis and deep soft-tissue infections caused by Streptococcus pneumoniae are uncommon, but may occur even in immunocompetent adults.

J Antimicrob Chemother, 1995 Nov, 36(5), 833 - 7
Susceptibility of Streptococcus pneumoniae strains isolated in Italy to penicillin and ten other antibiotics; Marchese A et al.; The susceptibility of 312 Streptococcus pneumoniae strains isolated during 1993 in Italy has been studied . Overall resistance to penicillin, erythromycin and co-trimoxazole was 5.5, 6 and 18% respectively . The penicillin resistant isolates (nine displaying low- and eight high-level resistance) were further tested against cefotaxime, ceftriaxone, cefepime, cefodizime, ceftazidime, imipenem, meropenem and rifampicin . The low-level penicillin resistant strains were inhibited by all these drugs . Among the eight high-level penicillin resistant pneumococci, four were resistant to one or more cephalosporins . Imipenem and rifampicin remained effective against all isolates . In comparison with other European Mediterranean countries, penicillin resistance is a minor threat at present in Italy.

J Antimicrob Chemother, 1995 Nov, 36(5), 781 - 6
Tests for susceptibility of Streptococcus pneumoniae to cefdinir: proposed interpretive criteria and quality control parameters for both microdilution and disc diffusion methods; Fuchs PC et al.; Proposed quality control (QC) parameters for susceptibility testing of Streptococcus pneumoniae to cefdinir were developed following the procedure recommended by the National Committee for Clinical Laboratory Standards . The proposed QC MIC range for microdilution susceptibility testing of S . pneumoniae ATCC 49619 is 0.06-0.25 mg/L . The proposed QC limits for inhibitory zone diameters of S . pneumoniae ATCC 49619 around 5 micrograms cefdinir disks is 26-31 mm . We recommend the following for tentative interpretive criteria for determining the susceptibility of S . pneumoniae to cefdinir: susceptible, MIC < or = 0.5 mg/L or inhibition zone diameter > or = 23 mm; intermediate, MIC 1.0 mg/L or inhibition zone, 20-22 mm; resistant, MIC > or = 2.0 mg/L or inhibition zone diameter, < or = 19 mm for broth microdilution and disc diffusion tests, respectively.

Infect Control Hosp Epidemiol, 1995 Nov, 16(11), 648 - 57
Molecular aspects of bacterial colonization; Bisno AL; Bacteria have developed a wide variety of molecular mechanisms that permit firm adherence to a biologic surface . This review summarizes basic principles involved in this process, as exemplified by adherence of the group A streptococcus to oral epithelium, staphylococci to indwelling prostheses, and Escherichia coli to uroepithelium and enterocytes.

J Oral Pathol Med, 1995 Nov, 24(10), 462 - 7
Inverse correlation between the proportion of salivary bacteria inhibiting Streptococcus mutans and the percentage of untreated carious teeth; Goyette N et al.; To evaluate the role of inhibitory substances produced by bacteria in the oral cavity, we estimated, by a deferred test on Todd-Hewitt agar enriched with hemin and vitamin K, the proportion of bacteria that inhibited or stimulated the growth of Streptococcus mutans and Porphyromonas gingivalis, from the saliva of 109 patients (54 males and 55 females) attending our dental clinics . The patients, aged from 8 to 75 years old (mean: 31 +/- 18 years), were randomly selected whatever the reason for their visit . The results, evaluated with the Spearman rank test, indicated that there was no statistically significant (P > 0.05) correlation between the proportion of salivary bacteria inhibiting or stimulating P . gingivalis with the Community Periodontal Index of Treatment Needs (CPITN), the number of carious, missing and filled teeth, or with the decayed, missing and filled teeth index (DMFT) . Also, no statistically significant correlation was observed between the proportion of salivary bacteria stimulating the growth of S . mutans and the above mentioned health indexes . However, a statistically significant (P < 0.005) negative correlation was found between the percentage of cultivated bacteria that inhibit S . mutans and the percentage of untreated carious teeth as well as with the CPITN . The results thus indicate a possible role for inhibitory substances produced by bacteria in the maintenance of oral health.

Australas J Dermatol, 1995 Nov, 36(4), 211 - 3
Streptococcal septic vasculitis; O'Brien TJ et al.; A case of invasive streptococcal disease is presented . Bacteraemic spread from a peritonsillar abscess produced acral purpuric plaques that blistered and ulcerated . Histology showed a vasculitic picture . Group A beta-haemolytic Streptococcus was cultured from the skin biopsy and seen on Gram stain.

J Anim Sci, 1995 Nov, 73(11), 3341 - 50
Influence of dietary beta-glucan on growth performance, nonspecific immunity, and resistance to Streptococcus suis infection in weanling pigs; Dritz SS et al.; Three experiments, using 344 pigs, were conducted to evaluate the influence of beta-glucan on growth performance, neutrophil and macrophage function, haptoglobin production, and resistance to Streptococcus suis challenge in weanling pigs . In Exp . 1, 144 pigs were used to evaluate the influence of .1% dietary beta-glucan in a soybean meal- or milk protein-based diet on growth performance and neutrophil function . Pigs fed beta-glucan from d 7 to 14 after weaning had lower ADFI (P < .01) and, although not significant, ADG was lower for pigs fed beta-glucan than for pigs fed control diets . However, no differences were observed in growth performance or neutrophil function for pigs fed control or diets containing beta-glucan from d 7 to 35 after weaning . Experiment 2 was a 28-d growth assay in which pigs were fed a diet with or without .1% beta-glucan, containing 7.5% spray-dried plasma protein and 25% dried whey from d 0 to 14 after weaning . Pigs then were fed corn-soybean mealbased diets containing 2.5% spray-dried blood meal and 10% dried whey . No differences in growth performance were observed . Experiment 3 was a 35-d assay to evaluate growth performance, neutrophil and macrophage function, and plasma haptoglobin concentration . Pigs were challenged on d 28 postweaning with intravenous S . suis . In Exp . 3, pigs were fed diets without or with .025 or .05% beta-glucan . Dietary beta-glucan did not influence neutrophil or macrophage function . However, pigs fed diets containing .025% beta-glucan had increased (P < .05) ADG and ADFI and were heavier (P < .05) on d 28 after weaning than pigs fed the control diet . No differences in feed efficiency (G/F) were detected between treatments . Pigs fed beta-glucan had decreased (P < .10) plasma haptoglobin on d 14, 21, and 28 after weaning . However, Fisher's Exact test revealed that more (P < .04) pigs fed a diet containing .025% beta-glucan died by d 12 after challenge with S . suis . In conclusion, these data suggest the existence of a complex interaction involving growth performance and resistance to S . suis in pigs fed .025% beta-glucan.

Chin Med J (Engl), 1995 Nov, 108(11), 864 - 9
Pentoxifylline ameliorates pulmonary damage caused by Streptococcus pneumoniae infection in mouse; Cui X et al.; Streptococcus pneumoniae stimulated mouse peritoneal macrophage to release tumor necrosis factor-alpha (TNF alpha) in vitro . When penicillin was added into the medium with bacteria, TNF alpha release was accelerated . Pentoxifylline (PTX), a phosphodiesterase inhibitor, significantly attenuated TNF alpha release caused either by Streptococcus pneumoniae or by its lysates . In this experiment, 150 Kunming mice were infected with Streptococcus pneumoniae through inspiration . Dynamic changes of TNF alpha concentration in serum and bronchoalveolar lavage fluid were determined, and pulmonary pathological changes were also observed . It was found that PTX significantly attenuated TNF alpha activity in serum and bronchoalveolar lavage fluid, and inhibited white blood cell chemotaxis, emigration and infiltration . In conclusion, Streptococcus pneumoniae infection stimulates the release of TNF alpha which is probably the major mediater that causes tissue damage during Streptococcus pneumoniae infection . The mechanism is probably that Streptococcus pneumoniae and its lysates activate TNF alpha gene transcription . As penicillin accelerates TNF alpha release, treatment with penicillin alone may aggravate the tissue damage . Combined treatment with PTX may be more reasonable.

Antimicrob Agents Chemother, 1995 Nov, 39(11), 2560 - 3
Killing activity of cefpirome against penicillin-resistant Streptococcus pneumoniae isolates from patients with meningitis in a pharmacodynamic model simulating the cerebrospinal fluid concentration profile; Fitoussi F et al.; An in vitro pharmacodynamic model was used to determine the killing kinetics of cefpirome against 20 Streptococcus pneumoniae strains (penicillin G MICs, > 0.125 to 2 micrograms/ml) isolated from patients with meningitis . The concentration of cefpirome was adjusted dynamically to simulate the median concentration profile obtained in the cerebrospinal fluid of adults after the infusion of a single dose of 2 g . The cefpirome MIC at which 90% of isolates are inhibited was 0.5 microgram/ml . Bactericidal activity was observed at 6 h, with mean killing of 3.51 +/- 0.34 log10 CFU/ml for all strains for which the cefpirome MIC was < 0.5 microgram/ml . In contrast, for strains for which the cefpirome MIC was > or = 0.5 microgram/ml, killing was significantly less (P < 0.05), with a mean reduction of only 2.86 +/- 0.57 log10 CFU/ml.

J Clin Microbiol, 1995 Nov, 33(11), 2850 - 5
Molecular subtyping of prevalent M serotypes of Streptococcus pyogenes causing invasive disease; Stanley J et al.; Reproducible methodologies and a scheme for high-resolution genotyping of Streptococcus pyogenes were defined with respect to a study of six predominant M serotypes causing invasive group A streptococcal disease in the United Kingdom . Serotype reference strains were compared with nine clinical isolates of each serotype from patients with diseases such as pneumonia, puerperal sepsis, toxic shock-like-syndrome, cellulitis, or necrotizing fasciitis . Four enzymes were evaluated for their discriminatory power in 16S rRNA gene-specific ribotyping . Discriminatory power was greatest with EcoRI, which generated serotype-specific ribotypes, and with SacI, which could subdivide strains of the same M serotype . Twenty-five combined ribotypes were found among the 60 strains, and the indices of discriminatory power (D values) of this method varied from 0.51 within serotype M1 to 0.98 within strains of serotype M5 . Macrorestriction with the rarely cutting endonuclease SmaI and pulsed-field gel electrophoresis gave D values varying from 0.37 within serotype M1 to the maximal 1.0 within serotype M5 . Comparison of macrorestriction profiles revealed various degrees of genetic heterogeneity within M serotypes . Strains of M1, M3, M6, and M11 exhibited clonally related macrorestriction profiles, while those of R28 and M5 strains were consistent with polyphyletic origin.

Cornea, 1995 Nov, 14(6), 628 - 33
Cytomegalovirus keratitis after penetrating keratoplasty; Wehrly SR et al.; We report the development of cytomegalovirus (CMV) keratitis in the penetrating keratoplasty of a 59-year-old human immunodeficiency virus-negative woman after uncomplicated corneal transplantation . Immunosuppression with topical cyclosporine A 2% in corn oil and topical prednisolone acetate 1% suspension was used postoperatively . The 15-month postoperative course was complicated by multiple episodes of endothelial rejection, medically controlled elevated intraocular pressure, polymicrobial bacterial (coagulase-negative staphlococcus and alpha-hemolytic streptococcus) keratitis, and endothelial plaque formation with associated hypopyon and epithelial defect . The graft failed and penetrating keratoplasty was repeated . Cytomegalovirus infection of superficial keratocytes in a region of scarring was identified in histological sections stained with hematoxylin and eosin and confirmed using mouse monoclonal anti-cytomegalovirus antibodies . Excision of the diseased corneal button with no additional treatment appears to have been curative . Low-grade keratitis was the only manifestation of the CMV infection, and it has not recurred 6 months postoperatively.

Cornea, 1995 Nov, 14(6), 591 - 4
Late microbial keratitis after corneal transplantation; Tseng SH et al.; Infectious keratitis after penetrating keratoplasty can be devastating to the survival of the graft and its visual outcome . From November 1989 to October 1994, we treated 41 episodes of late microbial keratitis among 354 consecutive penetrating keratoplasty patients and reviewed their medical records retrospectively . The time interval between the corneal transplantation and the onset of graft infection was averaged 10.4 +/- 10.9 months (range: 1-52 months) . The precipitating factors of keratitis included epithelial defect (49%), suture-related problems (41%), use of contact lenses (17%), trichiasis (17%), dry eye (12%), and lid abnormalities (10%) . Gram-positive cocci and gram-negative bacilli were associated with 51 and 40%, respectively, of the infectious keratitis, with Streptococcus being the most common species . Despite fortified antibiotic treatments, major complications such as graft failure and wound dehiscence could result . The overall result was that clarity was retained in only 43% of our grafts . We conclude that to prevent infectious keratitis there is a need to implement appropriate preventive measures as well as close monitoring of the graft after operation.

Clin Diagn Lab Immunol, 1995 Nov, 2(6), 689 - 92
Effect of xanthine derivates and dexamethasone on Streptococcus pneumoniae-stimulated production of tumor necrosis factor alpha, interleukin-1 beta (IL-1 beta), and IL-10 by human leukocytes; van Furth AM et al.; The present study concerns the release of the proinflammatory cytokines interleukin-1 beta (IL-1 beta) and tumor necrosis factor alpha and of the anti-inflammatory cytokine IL-10 by human leukocytes in whole blood during stimulation with Streptococcus pneumoniae and the effects of various xanthine derivates, i.e., pentoxifylline (PTX), caffeine, and theofylline, and of dexamethasone (DXM) . All three xanthine derivates and DXM inhibited the release of tumor necrosis factor alpha, PTX being the most effective . PTX, theofylline, and DXM inhibited the release of IL-1 beta, but caffeine did not affect IL-1 beta release . The release of IL-10 was significantly reduced by PTX at 24 h and by caffeine at 48 h, but DXM increased the release of this cytokine . In sum, the results of this study demonstrate that DXM inhibits only the release of proinflammatory cytokines but not of the anti-inflammatory cytokine IL-10 by human leukocytes, while PTX is the most potent inhibitor of both proinflammatory and anti-inflammatory cytokines.

Equine Vet J, 1995 Nov, 27(6), 416 - 21
Equine pulmonary disease: a case control study of 300 referred cases . Part 1: Examination techniques, diagnostic criteria and diagnoses; Dixon PM et al.; Three-hundred adult horses, referred from 1990 to 1993 inclusively, for pulmonary examination were assessed using standardised history taking and clinical, intrapleural pressure, arterial blood gases and pH, bronchoscopic and tracheal and broncho-alveolar lavage fluid (BALF) cytological examinations . Two-hundred and thirty-five cases were referred with overt signs of pulmonary disease and the remaining 65 cases were referred for pulmonary examination because of reduced exercise (usually racing) performance or prolonged dyspnoea after racing . No pulmonary disease was detected in 30 cases . The 270 horses with pulmonary disease included 148 cases (54.8%) of chronic obstructive pulmonary disease (COPD), 45 (16.7%) of infectious or post infectious pulmonary disease, 7 (2.6%) of Streptococcus zooepidemicus pulmonary infection, 7 (2.6%) of lungworm infection, 16 (5.9%) of primary exercise induced pulmonary haemorrhage (EIPH), 9 (3.3%) of chronic idiopathic hypoxaemia, 20 (7.4%) of miscellaneous identified pulmonary disorders and 18 (6.7%) of undifferentiated pulmonary disorders . Two cases of primary summer associated obstructive pulmonary disease (SPAOPD) were observed, but 9.5% of COPD affected horses additionally suffered from SPAOPD.

Support Care Cancer, 1995 Nov, 3(6), 409 - 13
Postoperative infections in immunocompromised patients after oncological surgery; Ranchere JY et al.; Immunodeficiency secondary to cancer chemotherapy (chemotherapy for less than 3 months, or intensive chemotherapy with bone marrow transplant) may be responsible for postoperative infections . To estimate the value of this hypothesis, a prospective study was done over a period of 18 months in patients who had undergone pulmonary surgery . Antibiotic prophylaxis was by pefloxacin, one tablet (400 mg) 1 h before surgery then 11 h after . Clinical examination, a chest X-ray and blood cell count were carried out every day for 10 days and on the 15th day . All the drain-tips were cultured . In a case of infection, samples were obtained and cultured . One group comprised 22 immunodeficient patients (group A), and 33 patients (group B) had received no prior chemotherapy (bone-marrow transplantation = 36.7%) . There were differences between the two groups in age (A:33.5 +/- 12.3 years; B:50.8 +/- 18.4 years), and type of tumour (A: metastasis = 95.5%; B: lung cancer = 51.5%) . Surgical operation was bilateral for 36.4% of the patients in group A . There was more anatomical resection (pneumonectomy and lobectomy) in group B . Lung function did not differ between the two groups (abnormalities: A = 54.6%; B = 63.6%) . In group A, there were 3 pulmonary infections (13.7%), but in group B 10 infections (30.3%) with 9 pulmonary infections (4 with bacteraemia) and 1 wound infection . The bacteriological finding showed two pathogens in 7 cases and no bacteriological isolates in 2 cases . With broad-spectrum antibiotherapy all the patients were cured except 1 . There was one postoperative death in group B . This patient died of respiratory distress after pneumonectomy complicated by pneumonia and septicaemia (Streptococcus pneumoniae) in the remaining lung . Surgical procedures are performed with increasing frequency on patients with immunocompromised status . Classically the risk of infection is more important for these patients . In this study prior cancer chemotherapy or bone marrow transplantation did not seem to be an aggravating factor of the risk of infection . But further methodological analysis would not allow us to distinguish between a real impact of chemotherapy and the influence of group heterogeneity.

J Antibiot (Tokyo), 1995 Nov, 48(11), 1273 - 9
Assays to detect and characterize synthetic agents that inhibit the ErmC methyltransferase; Clancy J et al.; High throughput chemical file screening with an enzymatic assay to detect inhibitors of the ErmC methyltransferase enzyme from macrolide-lincosamide-streptogramin B (MLSB) resistant pathogenic bacteria identified low molecular weight compounds that had IC50S (50% inhibitory concentration) in the nMolar to microMolar range . These same inhibitors were assessed in vitro for their capacity to inhibit the liver enzyme, cathechol-O-methyltransferase and the prokaryotic enzyme, EcoRI methylase . Selective inhibitors of the ErmC methyltransferase were tested in tertiary assays to determine their minimal inhibitory concentrations (MICs), as single agents and in combination with the macrolide, azithromycin, against strains of pathogenic bacteria expressing MLSB-resistance . Compounds that were active in vitro, alone or in combination with azithromycin, against strains of macrolide-resistant pathogens were tested in a mouse model of infection using an MLSB-resistant strain of Staphylococcus aureus or a macrolide-susceptible strain of Streptococcus pyogenes.

Int J Pediatr Otorhinolaryngol, 1995 Nov, 33(3), 249 - 55
Investigation of oral alpha-streptococcus showing inhibitory activity against pathogens in children with tonsillitis; Fujimori I et al.; The incidence of oral alpha-streptococcus with inhibitory activity against group A streptococcus, as a defense mechanism against bacterial infection in the oral cavity, was investigated in pediatric individuals with tonsillitis . Infection by group A streptococcus appeared to be common in children, because the detection rate of inhibitory alpha-streptococcus in healthy children as well as pediatric patients with tonsillitis was lower than in adults and elderly patients . In particular, the detection rate of these strains was predominantly low in patients with beta-streptococcus . Among pediatric patients scheduled for tonsillectomy, the detection rate of inhibitory alpha-streptococcus was low preoperatively . However, the rate was markedly increased after surgery . The high postoperative detection rate of these strains reflected the decreased incidence of group A streptococcal infection . The results of this investigation of bacterial interference between oral alpha-streptococcus and group A streptococcus suggested that surgical treatment is a more effective approach for improving the oral bacterial flora in children with recurrent tonsillitis.

J Laryngol Otol, 1995 Nov, 109(11), 1061 - 2
Intracranial complications of sinusitis: the need for aggressive management; Jones RL et al.; Sinus-induced intracranial sepsis can represent a genuine medical and surgical emergency . We review 12 cases presenting to our hospitals over a five-year period . Nine were male and three were female with an age range of 16 to 74 years (mean 35.5 years) . Four patients had their sinusitis diagnosed prior to admission and eight did not . Nine patients had bilateral sinus disease, the most common sinus involved was the frontal followed by the ethmoid, maxillary and sphenoid . Neurosurgical drainage was via a craniotomy in seven cases and burr hole in three . Nine patients underwent sinus surgery and three did not . Of the nine who had sinus surgery three had frontal drainage, four fronto-ethmoidal and two trans-sphenoidal drainage . The most common organism was Streptococcus milleri . Our series confirms that sinus-induced intracranial sepsis is a serious problem needing early diagnosis and aggressive treatment . We would recommend a high index of suspicion of sinusitis in patients with intracranial infection.

Microbiology, 1995 Nov, 141 ( Pt 11), 2929 - 36
Insertional inactivation of the Streptococcus mutans dexA (dextranase) gene results in altered adherence and dextran catabolism; Colby SM et al.; Streptococcus mutans is able to synthesize extracellular glucans from sucrose which contribute to adherence of these bacteria . Extracellular dextranase can partially degrade the glucans, and may therefore affect virulence of S . mutans . In order to isolate mutants unable to produce dextranase, a DNA library was constructed by inserting random Sau3AI-digested fragments of chromosomal DNA from S . mutans into the BamHI site of the streptococcal integration vector pVA891, which is able to replicate in Escherichia coli but does not possess a streptococcal origin of replication . The resultant plasmids were introduced into S . mutans LT11, allowing insertional inactivation through homologous recombination . Two transformants were identified which did not possess dextranase activity . Integration of a single copy of the plasmid into the chromosome of these transformants was confirmed by Southern hybridization analysis . Chromosomal DNA fragments flanking the plasmid were recovered using a marker rescue technique, and sequenced . Comparison with known sequences using the BLASTX program showed 56% homology at the amino acid level between the sequenced gene fragment and dextranase from Streptococcus sobrinus, strongly suggesting that the S . mutans dextranase gene (dexA) had been inactivated . The colony morphology of the dextranase mutants when grown on Todd-Hewitt agar containing sucrose was altered compared to the parent strain, with an apparent build-up of extracellular polymer . The mutants were also more adherent to a smooth surface than LT11 but there was no apparent difference in sucrose-dependent cell-cell aggregation.(ABSTRACT TRUNCATED AT 250 WORDS)

Rev Esp Enferm Dig, 1995 Nov, 87(11), 821 - 3
{Liver abscess caused by Streptococcus anginosus}; Gil Lasa I et al.; Pyogenic liver abscess is a relatively rare disease, often concerning elderly patients in bad general condition and with underlying diseases . We report the case of a 77-year-old female with gastric cancer and liver abscesses by Streptococcus anginosus.

Gastroenterol Hepatol, 1995 Nov, 18(9), 474 - 6
{Streptococcus bovis in a surgical wound and a colonic neoplasm}; Martinez Mas E et al.; The association of colorectal carcinoma and septicemia or endocarditis by Streptococcus bovis is well known . Nonetheless, other localizations of infection by Streptococcus bovis have not been associated with colorectal carcinoma . The case of association of colon neoplasm with infection by Streptococcus bovis localized in the surgical wound of resection of a prostate adenoma by the transvesical route carried out four months previously is presented . Possible intraoperative bacteremia colonizing the surgical wound due to colic compression during surgery may have been the cause . This localization of infection by Streptococcus bovis should be taken into account in screening of colorectal carcinoma.

J Bacteriol, 1995 Nov, 177(22), 6619 - 24
Specific binding of the activator Mga to promoter sequences of the emm and scpA genes in the group A streptococcus; McIver KS et al.; Transcription of the surface-associated virulence factors of the group A streptococcus (GAS) Streptococcus pyogenes, M protein (emm) and the C5a peptidase (scpA), is activated by a protein called Mga (formerly Mry or VirR) . To determine whether Mga binds directly to the promoters of the genes it regulates, a protein resulting from the fusion of Mga to the C-terminal end of maltose-binding protein was purified from Escherichia coli . Specific binding to the promoter regions of the scpA and emm alleles of the type M6 GAS strain JRS4 was demonstrated by electrophoresis of the DNA-protein complex . Competition studies showed that the region upstream of scpA bound MBP-Mga with a slightly higher affinity than did the region upstream of emm . DNase I protection experiments identified a single 45-bp binding site immediately upstream of and overlapping the -35 region of both promoters . Sequences homologous to the protected regions were found in the promoters of many emm, scp, and emm-like genes from strains of different serotypes of GAS, and a consensus Mga binding site was deduced.

Infect Immun, 1995 Nov, 63(11), 4238 - 43
Evidence of recombination and an antigenically diverse immunoglobulin A1 protease among strains of Streptococcus pneumoniae; Lomholt H; The genetic relationships among 114 isolates of Streptococcus pneumoniae representing mainly nine serotypes that frequently cause severe childhood disease in Northern Europe were examined by use of multilocus enzyme electrophoresis . A comparison was made of the corresponding antigenic variations of excreted immunoglobulin A1 (IgA1) proteases detected by enzyme neutralization assays . Allelic variation at 13 gene loci among 70 electrophoretic types disclosed a comparatively low mean genetic diversity per locus (H = 0.319) . In contrast, IgA1 proteases showed extensive antigenic diversity as 17 different inhibition types were distinguished . A lack of overall clonality was apparent from the linkage equilibrium of alleles harbored by 28 isolates chosen to represent the genetic diversity of the study population . However, certain clones, such as those marked by identical electrophoretic type, serotype, and IgA1 protease type, persisted for a sufficiently long time to enable clonal spread between distant geographic areas . Among clonally related isolates, examples illustrating a shift of capsular serotype or IgA1 protease type supported the view that recombination occurs in vivo in corresponding genes . In conclusion, over time, horizontal genetic exchange appears to be sufficiently frequent to disrupt the clonal structure otherwise generated by binary fission in natural populations of S . pneumoniae . The clonal instability combined with considerable antigenic heterogeneity renders the pneumococcal IgA1 protease less attractive as a potential component of future vaccines.

Lett Appl Microbiol, 1995 Nov, 21(5), 292 - 7
A gene-targeting suicide vector for Streptococcus bovis; Brooker JD et al.; A gene-targeting suicide vector for Streptococcus bovis has been constructed using the Escherichia coli/Streptococcus shuttle plasmid, pMU1328, and a region derived from the broad host-range, Gram-positive transposon, Tn916 . This suicide plasmid replicates autonomously in E . coli, but not in Strep . bovis or Strep . bovis Tn916 . Under positive selection, the plasmid was shown to integrate into Strep . bovis Tn916 chromosomal DNA at a frequency of 3 x 10(-8) cell-1 and was stably maintained for at least 100 generations in the absence of selection . This is the first report of a recombination system in ruminal bacteria . The ability to target genes, knock out specific functions or introduce novel genes into these micro-organisms will allow ruminal species to be manipulated and may eventually lead to improved animal production.

J Med Microbiol, 1995 Nov, 43(5), 377 - 85
Penicillin-resistant Streptococcus pneumoniae in Germany: genetic relationship to clones from other European countries; Reichmann P et al.; Penicillin-resistant Streptococcus pneumoniae strains isolated in different parts of Germany between 1982 and 1992 were compared with penicillin-resistant isolates, mainly of serogroups 6, 9, 14, 19 and 23, from other European countries . The main clones were recognised by their serotypes, antibiotic resistance patterns and penicillin-binding protein properties, and this typing was confirmed by multi-locus enzyme electrophoresis for a sample of 43 selected isolates . Eleven of the 14 resistant German isolates could be assigned to five genotypes isolated also in other countries . These included representatives of two distinct serotype 23F lineages predominant in Spain and France; a cluster of three serotype 6B isolates identical to clones in Spain, France, Finland and Hungary; and a serotype 9V clone of a type prevalent in Spain and now also in France . Serotype 19A clones of the type found in Hungary were not collected in Germany . The data suggest that two 23F lineages, represented by seven isolates from different locations, have become disseminated in Germany . Several resistant types found in the former West Germany resembled those found elsewhere in Western Europe whereas those from East Germany were distinct or, in one case, resembled a clone from Hungary . These data may reflect pre-unification travel patterns.

Can J Microbiol, 1995 Nov, 41(11), 955 - 64
Antimicrobial actions of fluoride for oral bacteria; Marquis RE; Fluoride is widely used as a highly effective anticaries agent . Although it is felt that its anticaries action is related mainly to effects on mineral phases of teeth and on the process of remineralization, fluoride also has important effects on the bacteria of dental plaque, which are responsible for the acidification of plaque that results in demineralization . The results of recent studies have shown that fluoride can affect bacterial metabolism through a set of actions with fundamentally different mechanisms . It can act directly as an enzyme inhibitor, for example for the glycolytic enzyme enolase, which is inhibited in a quasi-irreversible manner . Direct action seems also to occur in inhibition of heme-based peroxidases with binding of fluoride to heme . The flavin-based peroxidases of many oral bacteria are insensitive to fluoride . Another mode of action involves formation of metal-fluoride complexes, most commonly AlF4- . These complexes are responsible for fluoride inhibition of proton-translocating F-ATPases and are thought to act by mimicking phosphate to form complexes with ADP at reaction centers of the enzymes . However, the actions of fluoride that are most pertinent to reducing the cariogenicity of dental plaque are those related to its weak-acid character . Fluoride acts to enhance membrane permeabilities to protons and compromises the functioning of F-ATPases in exporting protons, thereby inducing cytoplasmic acidification and acid inhibition of glycolytic enzymes . Basically, fluoride acts to reduce the acid tolerance of the bacteria . It is most effective at acid pH values . In the acidic conditions of cariogenic plaque, fluoride at levels as low as 0.1 mM can cause complete arrest of glycolysis by intact cells of Streptococcus mutans . Overall, the anticaries actions of fluoride appear to be complex, involving effects both on bacteria and on mineral phases . The antibacterial actions of fluoride appear themselves to be complex but to be dominated by weak-acid effects.

J Pediatr, 1995 Nov, 127(5), 685 - 90
Discontinuing penicillin prophylaxis in children with sickle cell anemia . Prophylactic Penicillin Study II; Falletta JM et al.; OBJECTIVE: To evaluate the consequences of discontinuing penicillin prophylaxis at 5 years of age in children with sickle cell anemia who had received prophylactic penicillin for much of their lives . DESIGN: Randomized, double-blind, placebo-controlled trial . SETTING: Eighteen teaching hospitals throughout the United States . PATIENTS: Children with sickle cell anemia (hemoglobin SS or hemoglobin S beta 0-thalassemia) who had received prophylactic penicillin therapy for at least 2 years immediately before their fifth birthday and had received the 23-valent pneumococcal vaccine between 2 and 3 years of age and again at the time of randomization . Of 599 potential candidates, 400 were randomly selected and followed for an average of 3.2 years . INTERVENTIONS: After randomization, patients received the study medication twice daily--either penicillin V potassium, 250 mg, or an identical placebo tablet . Patients were either seen in the clinic or contacted every 3 months thereafter for an interval history and dispensing of the study drug . A physical examination was scheduled every 6 months . MAIN OUTCOME MEASURES: The primary end point was a comparison of the incidence of bacteremia or meningitis caused by Streptococcus pneumoniae in children continuing penicillin prophylaxis versus those receiving the placebo . RESULTS: Six children had a systemic infection caused by S . pneumoniae, four in the placebo group (2.0%; 95% confidence interval 0.5%, 5.0%) and two in the continued penicillin prophylaxis group (1.0%; 95% confidence interval 0.1%, 3.6%) with a relative risk of 0.5 (95% confidence interval 0.1, 2.7) . All invasive isolates were either serotype 6(A or B) or serotype 23F . Four of the isolates were penicillin susceptible, and two (one from each treatment group) were penicillin and multiply antibiotic resistant . Adverse effects of the study drug were reported for three patients (nausea, vomiting, or both), one of whom was in the placebo group . CONCLUSION: Children with sickle cell anemia who have not had a prior severe pneumococcal infection or a splenectomy and are receiving comprehensive care may safely stop prophylactic penicillin therapy at 5 years of age . Parents must be aggressively counseled to seek medical attention for all febrile events in children with sickle cell anemia.

Tidsskr Nor Laegeforen, 1995 Oct 20, 115(25), 3131 - 6
{Increased incidence of severe Streptococcus group A infections in Noway during the last 10 years . New outbreak 1993-94}; Hoiby EA et al.; The article summarizes the epidemiology of disease caused by Streptococcus pyogenes in Norway during the last two decades, with emphasis on trends since the late 1980s . The description is based on the National Notification System for Infectious Diseases, and on microbiological data . The nationwide outbreak in 1987-88, caused mainly by M-1 organisms, was followed by several years with remarkably low incidences of invasive disease . However, since late in 1992 there has again been a nationwide outbreak that reached even higher numbers of invasive cases than the one in 1988 . While 106 cases of systemic group A streptococcal disease were recorded in 1988, the numbers for 1993 and 1994 were 143 and 188 respectively (population 4.3 million) . No change has taken place in the laboratory-based notification system that could explain the observed phenomena . Previously seldom observed clinical manifestations, such as fulminant septicaemia, necrotising fasciitis and pneumonia with empyema, were again recorded; as during the 1988 outbreak.

J Biol Chem, 1995 Oct 20, 270(42), 25178 - 84
The role of N-glycosylation for functional expression of the human platelet-activating factor receptor . Glycosylation is required for efficient membrane trafficking; Garcia Rodriguez C et al.; Streptococcus pneumoniae has been shown to utilize the platelet activating factor receptor for binding and invasion of host cells (Cundell, D . R., Gerard, N . P., Gerard, C., Idanpaan-Heikkila, I., and Tuomanen, E . I . (1995) Nature, in press) . Because bacterial binding is in part carbohydrate dependent, and the human platelet-activating factor (PAF) receptor bears a single N-linked glycosylation sequence in the second extracellular loop, we undertook studies to determine the role of this epitope in PAF receptor function . Binding of pneumococci to COS cells transfected with the human PAF receptor is greatly reduced for a receptor mutant that bears no N-linked glycosylation site . Immunohistochemical and binding analyses show decreased expression of the non-glycosylated molecule on the cell membrane relative to the wild type receptor; however, metabolic labeling and immunopurification indicate it is synthesized intracellularly at a level similar to the native molecule . A mutant receptor encoding a functional glycosylation site at the NH2 terminus is better expressed at the cell surface compared with the non-glycosylated form, indicating that trafficking to the cell surface is facilitated by glycosylation, but its location is relatively unimportant . The binding affinity for PAF is not significantly effected by the presence or location of the carbohydrate, and variations in cell surface expression have little influence on signal transduction, as the non-glycosylated PAF receptor is equally effective for activation of phospholipase C as the native molecule . These data are supportive of pneumococcal binding on protein moiety(ies) of the PAF receptor and indicate that N-glycosylation facilitates expression of the protein on the cell membrane.

J Biol Chem, 1995 Oct 20, 270(42), 24686 - 92
Kinetic mechanism of aminoglycoside phosphotransferase type IIIa . Evidence for a Theorell-Chance mechanism; McKay GA et al.; Bacterial resistance to aminoglycoside-aminocyclitol antibiotics is mediated primarily by covalent modification of the drugs by a variety of enzymes . One such modifying enzyme, the 3'-aminoglycoside phosphotransferase, which is produced by Gram-positive cocci such as Enterococcus and Streptococcus inactivates a broad range of aminoglycosides by ATP-dependent phosphorylation of specific hydroxyl residues on the antibiotics . Through the use of dead-end and product inhibitor studies, we present the first detailed examination of the kinetic mechanism for the 3'-aminoglycoside phosphotransferase-IIIa . Initial velocity patterns deduced from steady-state kinetics indicate a sequential mechanism with ordered binding of ATP first followed by aminoglycoside . Dead-end inhibition by AMP and adenylyl-imidodiphosphate is competitive versus ATP and noncompetitive versus kanamycin A . Dead-end inhibition by tobramycin, a kanamycin analogue lacking a 3'-OH, is competitive versus both kanamycin A and uncompetitive versus ATP, indicative of ordered substrate binding where ATP must add prior to aminoglycoside addition . Product inhibition by kanamycin phosphate is noncompetitive versus ATP when kanamycin A is held at subsaturating concentrations (Km(kanA)), whereas no inhibition is observed when the concentration of kanamycin A is held at 10Km(kanA) . This is consistent with kanamycin phosphate being the first product released followed by ADP release . The patterns of inhibition observed support a mechanism where ATP binding precedes aminoglycoside binding followed by a rapid catalytic step . Product release proceeds in an ordered fashion where kanamycin phosphate is released quickly followed by a slow release of ADP . Aminoglycoside substrates, such as kanamycin A, show substrate inhibition that is uncompetitive versus ATP . This indicates binding of the aminoglycosides to the slowly dissociating (E-ADP) complex at high drug concentrations . These experiments are consistent with a Theorell-Chance kinetic mechanism for 3'-aminoglycoside phosphotransferase-IIIa.

Biochemistry, 1995 Oct 17, 34(41), 13688 - 98
Structure and stability of protein H and the M1 protein from Streptococcus pyogenes . Implications for other surface proteins of gram-positive bacteria; Nilson BH et al.; M proteins and other members of the M protein family, expressed on the surface of Streptococcus pyogenes, bind host proteins such as immunoglobulins, albumin, and fibrinogen . Protein H and the M1 protein are expressed by adjacent genes and both belong to the M protein family . In this work, the structure and stability of these two proteins have been investigated . As judged from sequence analysis and circular dichroism spectroscopy, the proteins are almost entirely in an alpha-helix conformation . The amino acids are arranged in a seven-residue (heptad) repeat pattern along the greater part of the proteins . These observations support the previously accepted model of M proteins as coiled-coil dimers . However, it was also found that the structures of both proteins were thermally unstable; i.e., the content of helix conformation was greatly reduced at 37 degrees C as compared to 25 degrees C or below . Together with previous findings that these proteins appear as monomers at 37 degrees C and dimers at low temperatures, the results suggest that the coiled-coil dimers are unfolded at 37 degrees C . The heptad patterns of protein H and the M1 protein showed a nonoptimal distribution of residues expected for a coiled-coil conformation . This is a possible explanation for the low thermal stability of the proteins . It was also demonstrated that the proteins were stabilized in the presence of the ligands IgG and/or albumin . Protein H and M1 protein show a high degree of sequence similarity in their C-terminal regions, and a fragment from this region displayed a high content of helix conformation, whereas fragments from the nonsimilar N-terminal parts did not adopt any stable folded structure . Thus, the C-terminal parts, which are conserved within the M protein family, may constitute a framework for the formation of the parallel helical coiled-coil structure, and we propose that the less stable N-terminal part may also participate in antiparallel interaction with M proteins on adjacent bacteria . The results suggest that temperature fluctuations in the environment could change the properties of bacterial surface proteins, thereby affecting the molecular interactions between the bacterium and its host.

Biochemistry, 1995 Oct 17, 34(41), 13672 - 81
Transferred nuclear Overhauser enhancement experiments show that the monoclonal antibody strep 9 selects a local minimum conformation of a Streptococcus group A trisaccharide-hapten; Weimar T et al.; Transferred nuclear Overhauser enhancement (TRNOE) experiments have been performed to investigate the bound conformation of the trisaccharide repeating unit of the Streptococcus Group A cell-wall polysaccharide . Thus, the conformations of propyl 3-O-(2-acetamido-2-deoxy-beta-D-glucopyranosyl)-2-O-(alpha-L-rhamnopyran osyl)- alpha-L-rhamnopyranoside {C(A')B} (1) as a free ligand and when complexed to the monoclonal antibody Strep 9 were examined . Improved insights about the conformational preferences of the glycosidic linkages of the trisaccharide ligand showed that the free ligand populates various conformations in aqueous solution, thus displaying relatively flexible behavior . The NOE HNAc-H2A', which was not detected in previous work, accounts for a conformation at the beta-(1-->3) linkage with a phi angle of approximately 180 degrees . Observed TRNOEs for the complex are weak, and their analysis was further complicated by spin diffusion . With the use of transferred rotating-frame Overhauser enhancement (TRROE) experiments, the amount of spin diffusion was assessed experimentally, proving that all of the observed long-range TRNOEs arose through spin diffusion . Four interglycosidic distances, derived from the remaining TRNOEs and TRROEs, together with repulsive constraints, derived from the absence of TRROE effects, were used as input parameters in simulated annealing and molecular mechanics calculations to determine the bound conformation of the trisaccharide . Complexation by the antibody results in the selection of one defined conformation of the carbohydrate hapten . This bound conformation, which is a local energy minimum on the energy maps calculated for the trisaccharide ligand, shows only a change from a +gauche to a -gauche orientation at the psi angle of the alpha-(1-->2) linkage when compared to the global minimum conformation . The results infer that the bound conformation of the Streptococcus Group A cell-wall polysaccharide is different from its previously proposed solution structure (Kreis et al., 1995).

Gene, 1995 Oct 16, 164(1), 123 - 8
Construction and evaluation of new drug-resistance cassettes for gene disruption mutagenesis in Streptococcus pneumoniae, using an ami test platform; Claverys JP et al.; Although drug-resistance markers have been used frequently for gene-disruption mutagenesis in Streptococcus pneumoniae, none has yet been shown to be free of dependence on local transcription for its expression . Indeed, the erythromycin-resistance marker (erm), originating in pAM beta 1, has been used as an indicator of local transcription on several occasions . A procedure is demonstrated for evaluation of the autonomous expression of such a marker by placing it in a consistent background, at the pneumococcal ami (aminopterin resistance) locus, in combination with active or inactive alleles of the ami promotor (pA) . Using this test platform, a chloramphenicol-resistance marker (cat) and a spectinomycin-resistance marker used in streptococcal gene disruption studies and derived from pJS3 and pDL269, respectively, were shown to depend on local transcriptional signals for expression when placed in the pneumococcal chromosome as single-copy genes . To overcome this limitation, new drug-resistance cassettes were designed and constructed, using pA as a model for synthetic promoters for the erm and cat genes . Both new cassettes were shown, by the same procedure, to be expressed after insertion in the pneumococcal chromosome, independent of local transcription . A new insertion-duplication vector, pEVP3, incorporating the new cat cassette and a lacZ reporter derived from pTV32, was also constructed . The ami test platform was used to demonstrate both the autonomous expression of cat and the reporter function of lacZ in chromosomal copies of pEVP3.

FEMS Microbiol Lett, 1995 Oct 15, 132(3), 233 - 7
High sensitivity of Mycobacterium species to the bactericidal activity by polylysine; Delihas N et al.; Bactericidal effects of polylysine on different bacterial species were measured . Marked differences in sensitivity were observed . Based on the concentration of polylysine required to reduce cell viability by 50%, Mycobacterium smegmatis and Mycobacterium tuberculosis were found to be the most sensitive and Escherichia coli the most resistant . In addition, two Gram-positive organisms, Staphylococcus epidermidis and Streptococcus salivarius exhibited significant differences in sensitivity which suggests that the relationship between sensitivity towards polylysine and bacterial cell type is not necessarily a function of the overall cell envelope structure . The high sensitivity of mycobacteria suggests the possible use of polylysine, or a conjugate of polylysine and another agent in anti-mycobacterial drug design.

FEMS Microbiol Lett, 1995 Oct 15, 132(3), 209 - 13
High level expression of Streptococcus pyogenes erythrogenic toxin A (SPE A) in Escherichia coli and its rapid purification by HPLC; Yamamoto M et al.; The speA gene encoding streptococcal erythrogenic toxin A (SPE A) from Streptococcus pyogenes bacteriophage T12 was overexpressed in Escherichia coli under the control of the T7 promoter . Since most of the expressed protein was found in the periplasmic space, an osmotic shock extraction with 0.5 M sucrose resulted in a highly enriched preparation of SPE A . An additional two-step purification employing high pressure liquid chromatography resulted in a purified SPE A protein.

MMWR Morb Mortal Wkly Rep, 1995 Oct 13, 44(40), 741 - 4
Increasing pneumococcal vaccination rates among patients of a National Health-Care Alliance--United States, 1993.
{Community acquired pneumonias in the region of Montpellier . Increase of pneumococci with reduced sensitivity to penicillins}
Paganin F, Chanez P, Brousse C, Lilienthal F, Darbas H, Jonquet O, Godard P, Michel FB.

Cliniques des Maladies respiratoires, Hopital Gui de Chauliac, CHU MontpellierOBJECTIVES: Bacteriological data indicate that there is an increased incidence of Streptococcus pneumoniae strains with an intermediate sensitivity to penicillin . The goals of the present study was i) to investigate the profile of sensitivity of Streptococcus pneumoniae isolated from patients with bacterial pneumonia in the area of Montpellier and ii) to compare this profile with the findings of the national center registry to better appreciate geographical specificity . METHODS: Fifty-six patients with bacterial pneumonia were enrolled into the study . From September 1989 to March 1994, we performed bacterial sampling including blood cultures, protected brushes and bronchoalveolar lavage specimens . We examined the antibiotic sensitivity of the germs which were isolated . All patients were followed using clinical and radiological criteria . RESULTS: A precise bacteriological diagnosis was established in 83.6% of the population . Streptococcus pneumoniae was found in 47.2% of the samples . In 19%, the strains displayed an intermediate sensitivity to penicillin . All patients recovered . CONCLUSION: We found a higher rate of resistance to penicillin in Montpellier than the common rate of the national reference center in France . The location of Montpellier closed to the Spanish border might, at least in part, explain this difference.

Nature, 1995 Oct 5, 377(6548), 435 - 8
Streptococcus pneumoniae anchor to activated human cells by the receptor for platelet-activating factor; Cundell DR et al.; The Gram-positive bacterium Streptococcus pneumoniae is a major cause of pneumonia, sepsis and meningitis . Although the invasive disease is severe, some 40% of individuals harbour the pneumococcus in the nasopharynx asymptomatically . Here we investigate the molecular elements of the encounter between host and pathogen that distinguish these different outcomes . We show that inflammatory activation of human cells shifts the targeting of the pneumococcus to a new receptor, that for the G-protein-coupled platelet-activating factor (PAF) . Only virulent pneumococci engage the PAF receptor . Attachment of the bacterial phosphorylcholine to the PAF receptor enhanced adherence, which was coupled to invasion of endothelial, epithelial and PAF-receptor-transfected cells . This progression could be arrested in vitro and in vivo by PAF-receptor-specific antagonists, suggesting a possible approach to therapy.

Roum Arch Microbiol Immunol, 1995 Oct-Dec, 54(4), 241 - 54
Antibiotics and bacterial resistance . A few elements of genetic basis for this relationship; Straut M et al.; In the preantibiotic era, many people died of bacterial infections caused by such pathogens as Staphylococcus aureus and Streptococcus pyogenes, Streptococcus pneumoniae and Mycobacterium tuberculosis . Antibiotics have reduced the mortality from infectious diseases but not the prevalence of these diseases . It was not long after the clinical introduction of the first antibiotics in the 1950s that the first reports of bacterial resistance began to appear . Use, and often abuse or misuse, of antimicrobial agents has encouraged the evolution of bacteria toward resistance, resulting often in therapeutic failure . In the beginning, new antibiotics have always appeared in plenty of time to provide new cures for diseases caused by resistant bacterial pathogens . Also, some clinically important groups of bacteria showed no signs of major increases in resistance . For example, S . pneumoniae strains remained susceptible to penicillin long after other bacteria had become resistant to it . Recent developments of bacteria resistance to antibiotics are indeed disquieting.

Ann Pharmacother, 1995 Oct, 29(10), 1035 - 40
Recent advances: antiinfectives; Briceland LL et al.; OBJECTIVE: To update readers on the significant changes in infectious diseases pharmacotherapy . DATA SOURCES: An Index Medicus and Iowa Drug Information Service search (1993-1994) of English-language literature pertaining to the selected topic areas was performed . Additional information from abstracts presented at scientific meetings were identified by the authors . STUDY SELECTION AND DATA EXTRACTION: All identified studies were screened and those judged relevant to the update were evaluated . DATA SYNTHESIS: New or clinically significant data since 1992 that related to peptic ulcer disease, microbial resistance (e.g., Enterococcus spp., Streptococcus pneumoniae, Mycobacterium tuberculosis, Candida albicans), immunomodulators, and AIDS were evaluated and compared with previous data . CONCLUSIONS: There have been several exciting and significant changes in infectious diseases pharmacotherapy evident from this review.

Clin Infect Dis, 1995 Oct, 21(4), 948 - 53
Incidence, capsular types, and antibiotic susceptibility of invasive Streptococcus pneumoniae in Sweden; Hedlund J et al.; The number of reported cases of invasive pneumococcal infections in Sweden increased more than threefold from 1988 through 1992 . We studied the capsular types and the antibiotic susceptibility of 619 pneumococcal strains isolated from blood or CSF at 18 Swedish microbiological laboratories in 1987 and in 1992 . These strains belonged to 35 of the 84 recognized capsular types . We noted a remarkable increase in the prevalence of invasive infections with type 14 from 1987 (8.2%) to 1992 (18%) (P = .001), which correspond to a sevenfold increase in absolute numbers . The most prominent increase in infections was seen among elderly people; in 1992, type 14 accounted for 22.5% of the isolates from infected persons who were >64 years of age . The majority of the strains were susceptible to all antibiotics tested . However, there was a significant increase in trimethoprim-sulfamethoxazole resistance from 1.4% in 1987 to 7.1% in 1992 . Nine multiresistant isolates (1.5%) were found.

Antimicrob Agents Chemother, 1995 Oct, 39(10), 2282 - 8
Identification of multiple clones of extended-spectrum cephalosporin-resistant Streptococcus pneumoniae isolates in the United States; McDougal LK et al.; We characterized 12 isolates of Streptococcus pneumoniae with various levels of susceptibility of penicillin and extended-spectrum cephalosporins by antimicrobial susceptibility patterns, serotypes, ribotypes, chromosomal DNA restriction patterns by pulsed-field gel electrophoresis, multilocus enzyme electrophoresis patterns, penicillin-binding protein (PBP) profiles, and DNA restriction endonuclease cleavage profiles of pbp1a, pbp2x, and pbp2b . Seven cefotaxime-resistant (MIC, > or = 2 micrograms/ml) serotype 23F isolates were related on the basis of ribotyping, pulsed-field gel electrophoresis, and multilocus enzyme electrophoresis, but they had two slightly different PBP patterns: one unique to strains for which the MIC of penicillin is high (4.0 micrograms/ml) and one unique to strains for which the MIC of penicillin is low (0.12 to 1.0 micrograms/ml) . The pbp1a and pbp2x fingerprints were identical for the seven isolates; however, the pbp2b fingerprints were different . An eighth serotype 23F isolate with high-level resistance to cephalosporins was not related to the other seven isolates by typing data but was a variant of the widespread, multiresistant serotype 23F Spanish clone . The PBP profiles and fingerprints of pbp1a, pbp2x, and pbp2b were identical to those of the Spanish clone isolate . An additional serotype 6B isolate with high-level resistance to cephalosporins had unique typing profiles and was unrelated to the serotype 23F cephalosporin-resistant isolates but was related on the basis of genetic typing methods to a second serotype 6B isolate that was cephalosporin susceptible . The serotype 6B isolates had different PBP profiles and fingerprints for pbp1a, but the fingerprints for pbp2x and pbp2b were the same.

Antimicrob Agents Chemother, 1995 Oct, 39(10), 2239 - 42
Decreased activity of erythromycin against Streptococcus pyogenes in Taiwan; Hsueh PR et al.; A total of 78 clinical isolates of Streptococcus pyogenes were collected from January 1992 through December 1993 from patients in southern Taiwan . The in vitro activities of 10 antimicrobial agents were determined by the agar dilution method . Penicillin, cephalothin, cefotaxime, vancomycin, and ofloxacin were shown to be active against S . pyogenes isolates, with MICs at which 90% of isolates are inhibited (MIC90s) being < or = 0.03, < or = 0.13, < or = 0.13, < or = 0.13, and < or = 0.25 microgram/ml, respectively . Erythromycin and azithromycin both had poor activities (MIC50s, 16 and >128 micrograms/ml, respectively; MIC90s, >128 and >128 micrograms/ml, respectively) . The activities of tetracycline, clindamycin, and chloramphenicol against a significant number of these isolates were also limited . As the MICs of clindamycin and chloramphenicol for the isolates increased, the MICs of the two macrolides also increased . Clindamycin, chloramphenicol, and the two macrolides were less potent against isolates recovered form throat swab samples than against those from blood or other sources . Isolates of the T12 and T1 serotypes accounted for 53.8% of all isolates . The majority (87.5%) of the isolates recovered from throat swab samples were of the T12 serotype, whereas 19.2% of the isolates recovered from blood were of the T12 serotype . In contrast, 66.7% of the isolates of the T1 serotype were derived from blood but none were derived from throat swab samples . Of the 33 T12 serotype isolates, erythromycin MICs for 78.8% of the isolates were >128 micrograms/ml . Because of the poor activities of erythromycin and azithromycin against S . pyogenes isolates from patients in southern Taiwan, these drugs should no longer be considered the drugs of choice for the management of group A streptococcal infections among patients who live in this area.

Antimicrob Agents Chemother, 1995 Oct, 39(10), 2210 - 6
In vivo efficacy of trovafloxacin (CP-99,219), a new quinolone with extended activities against gram-positive pathogens, Streptococcus pneumoniae, and Bacteroides fragilis; Girard AE et al.; The interesting in vitro antimicrobial activity and pharmacokinetics of the new quinolone trovafloxacin (CP-99,219) warranted further studies to determine its in vivo efficacy in models of infectious disease . The significance of the pharmacokinetic and in vitro antimicrobial profiles of trovafloxacin was shown through efficacy in a series of animal infection models by employing primarily oral therapy . Against acute infections, trovafloxacin was consistently more effective than temafloxacin, ciprofloxacin, and ofloxacin against Streptococcus pneumoniae and other gram-positive pathogens while maintaining activity comparable to that of ciprofloxacin against gram-negative organisms . In a model of murine pneumonia, trovafloxacin was more efficacious than temafloxacin, while ciprofloxacin failed against S . pneumoniae (50% protective doses, 2.1, 29.5, and >100 mg/kg, respectively) . In addition to its inherent in vitro potency advantage against S . pneumoniae, these data were supported by a pharmacokinetic study that showed levels of trovafloxacin in pulmonary tissue of S . pneumoniae-infected CF1 mice to be considerably greater than those of temafloxacin and ciprofloxacin (twice the maximum drug concentration in serum; two to three times the half-life, and three to six times the area under the concentration-time curve) . Against localized mixed anaerobic infections, trovafloxacin was the only agent to effectively reduce the numbers of recoverable CFU of Bacteroides fragilis ( >1,000-fold), Staphylococcus aureus (1,000-fold), and Escherichia coli ( >100-fold) compared with ciprofloxacin, vancomycin, metronidazole, clindamycin, cefoxitin, and ceftriaxone . The in vitro and in vivo antimicrobial activities of trovafloxacin and its pharmacokinetics in laboratory animals provide support for the ongoing and planned human phase II and III clinical trials.

Antimicrob Agents Chemother, 1995 Oct, 39(10), 2193 - 6
In vitro activities of cefotaxime, ceftriaxone, ceftazidime, cefpirome, and penicillin against Streptococcus pneumoniae isolates; Barry AL et al.; The in vitro activities of four extended-spectrum cephalosporins and benzyl penicillin were evaluated against 698 clinical isolates of Streptococcus pneumoniae, including 130 (19%) penicillin-intermediate and 84 (12%) penicillin-resistant strains . Cefotaxime and ceftriaxone were essentially identical in their antipneumococcal activities: both were active against penicillin-susceptible strains and most penicillin-intermediate strains . Cefpirome was twice as potent as cefotaxime and ceftriaxone against penicillin-resistant strains . Ceftazidime was 8- to 16-fold less active than cefotaxime and ceftriaxone against S . pneumoniae in vitro, and thus, its spectrum included only penicillin-susceptible strains.

Antimicrob Agents Chemother, 1995 Oct, 39(10), 2183 - 6
In vivo therapeutic efficacies of PD 138312 and PD 140248, two novel fluoronaphthyridines with outstanding gram-positive potency; Shapiro MA et al.; PD 138312 and PD 140248 are novel broad-spectrum 7-pyrrolidinyl fluoronaphthyridines with a cyclopropyl or a difluorophenyl substitution at the 1 positions, respectively . They have been demonstrated to have excellent in vitro activity against gram-positive organisms . These compounds were evaluated for their in vivo potencies against acute systemic infections in mice and in a mouse pneumococcal pneumonia model . They were very effective by both the oral and subcutaneous routes of administration . Most remarkable were their comparative median protective values against methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes . In general, these compounds were 28- to 100-fold more active than ciprofloxacin against these clinically significant organisms when the drugs were given orally and 10- to 38-fold more active when the drugs were given parenterally . Average ratios of drug concentrations in mice after drug administration by the oral route to that after administration by the subcutaneous route indicate 34 to 44% greater bioavailabilities of PD 138312 and PD 140248 compared with that of ciprofloxacin . In a multidose pneumococcal mouse pneumonia model these new quinolones were extremely effective, with median curative doses of 2 to 2.8 mg/kg of body weight per dose . Ciprofloxacin was ineffective (median curative dose, >100 mg/kg per dose) in this model . Comparative pharmacokinetic studies in mice revealed a relative superiority of PD 140248 . Peak levels of PD 140248 in blood after the administration of a single oral 50-mg/kg dose were twice those of PD 138312 and ciprofloxacin, with PD 140248 having a substantially longer half-life . These results indicate that PD 138312 and PD 140248 have excellent therapeutic potential against clinically important gram-positive pathogens when the drugs are administered both orally and parenterally.

J Endod, 1995 Oct, 21(10), 513 - 5
Antimicrobial and toxic effects of established and potential root canal irrigants; Yesilsoy C et al.; Three dilutions of the commonly used irrigant sodium hypochlorite (0.5%, 2.5%, and 5.25%) and the potential irrigants Peridex, chlorhexidine gluconate (0.12%), and Therasol were tested . Alcohol and saline served as controls also . The in vitro portion of this study used four different microorganisms (Streptococcus mutans, Peptostreptococcus micros, Prevotella intermedius, and Porphyromonas gingivalis) to determine antimicrobial effect . Presterilized 7-mm diameter Whatman paper disks soaked with the test solution were prepared, and disks were placed onto the previously seeded agar petri dishes . Each dish was incubated aerobically or anaerobically according to the microorganisms used . An in vivo animal model (guinea pig) was used to examine subcutaneous local tissue reactions using the same materials; 0.1 ml of each test solution was injected subcutaneously into predetermined locations on the animal dorsum . Test site histological examination was done 2 h, 2 days, and 2 wk after the injections . The results of this comparative study indicate Peridex (chlorhexidine gluconate) and Therasol may have good potential for endodontic usage.

FEMS Immunol Med Microbiol, 1995 Oct, 12(2), 159 - 64
Cross-reactivity between human sialyl Lewis(x) oligosaccharide and common causative oral bacteria of infective endocarditis; Hirota K et al.; The expression of sialy-Lewis(x) (sLe(x); Neu5Ac alpha 2-3 Gal beta 1-4) (Fuc alpha 1-3) GlcNAc-R) on oral bacteria producing infective endocarditis was determined by a whole-cell enzyme linked immunosorbent assay and an immunoelectron microscopy using the well-characterized anti-sLe(x) monoclonal antibody SNH-3 (mAb SNH-3; IgM class) . mAb SNH-3 reacted strongly with whole cells of oral bacteria: Streptococcus sanguis, Streptococcus mutans, Streptococcus mitis, Streptococcus salivarius, Streptococcus intermedius, Streptococcus constellatus, Streptococcus anginosus, Streptococcus pyogenes, Actinobacillus actinomycetemcomitans, Eikenella corrodens and Porphyromonas gingivalis . The negatively stained immuno-electron micrograph of Streptococcus pyogenes showed many reactive gold particles on the cell surface . Our findings demonstrated the existence of immunologic mimicry between the sLe(x) oligosaccharide and cell surface antigens of many species associated with infective endocarditis . We propose the hypothesis that if these bacteria escape their normal habitats, the surface components that mimic the sLe(x) oligosaccharide might bind to host antigens of the selectin family which could promote binding to endothelial cells and, consequently, initiation of the events leading to infective endocarditis.

Pneumologie, 1995 Oct, 49(10), 546 - 55
{Diagnostic value of protected bronchoalveolar lavage in HIV-associated pneumonia}; Ewig S et al.; OBJECTIVE: The concept of the protected bronchoalveolar lavage (PBAL) is to improve the diagnostic yield in bacterial pneumonia by unifying the high sensitivity of bronchoalveolar lavage (BAL) and specificity of the protected specimen brush (PSB) . HIV-infected patients have been shown to have a high incidence of bacterial pneumonia as well as bacterial colonisation of the tracheobronchial tree . We therefore studied the value of PBAL in this population . METHODS: During a period of twelve months 40 episodes in 36 patients with symptoms suggestive of pneumonia were investigated retrospectively . In all cases without infiltrates on chest radiograph a CT-scan of the chest was performed . Patients without infiltrates also in CT-scan served as controls . Bronchoscopic investigation included a PSB and a PBAL in the same lung segment most prominently affected . Microbiological workup was performed for bacterial agents, mycobacteria, fungi, viruses and parasites . Quantitative cultures for bacteria were considered significant in case of > or equal to 10(3) cfu/ml in PSB and > or equal to 10(4) cfu/ml in PBAL . RESULTS: 32 episodes in 28 patients were identified as pneumonia . A definite diagnosis could be established in 19/32 (59%) of cases . Bacteria accounted for 10/19 (53%) . Pneumocystis carinii for 9/19 (47%) of cases including one case that revealed mixed infection with Streptococcus pneumoniae and Pneumocystis carinii . Another pneumonia was due to Aspergillus fumigatus . The sensitivity for bacterial pneumonia was 44% for PSB and 56% for PBAL, the specificity 100% . The overall diagnostic accuracy was 60% and 68%, respectively . The yield for Pneumocystis carinii was 8/9 (89%) . CONCLUSIONS: PBAL as compared to PSB had a superior diagnostic yield for bacterial pneumonia . As PBAL additionally conserved the yield of BAL reported for Pneumocystis carinii, it may represent a rational diagnostic technique for pneumonia in HIV-infected patients.

Pediatr Infect Dis J, 1995 Oct, 14(10), 879 - 84
Colonization with penicillin-resistant Streptococcus pneumoniae in a child-care center; Boken DJ et al.; We obtained nasopharyngeal cultures for Streptococcus pneumoniae from 54 children ages 2 to 24 months attending an Omaha child-care center (CCC) in April 1994 . Thirty-two (59%) of the 54 children were colonized with S . pneumoniae belonging to serotypes 23, 19, 6 and 11 . Seventeen (53%) of the pneumococcal isolates were highly resistant to penicillin (minimal inhibitory concentration > or = 2.0 micrograms/ml; HR-SP) and 7 (22%) were intermediately resistant to penicillin (0.12 < or = minimal inhibitory concentration < or = 1.0 microgram/ml; IR-SP) . Within each pneumococcal capsular serotype, there were 1 to 3 DNA subtypes based on pulsed field gel electrophoresis analysis . A single pulsed field gel electrophoresis strain predominated in most CCC rooms, suggesting horizontal transmission among cohorted children . Nasopharyngeal cultures obtained 4 months later revealed similar S . pneumoniae colonization rates (28 of 52, 54%); however, only 2 (7%) of 28 isolates were HR-SP and 11 (39%) were IR-SP . Colonization with resistant pneumococci persisted after 4 months in 4 (12%) of 34 children cultured on both occasions . Antibiotic use by attendees had decreased notably between the two sampling periods, suggesting that selective pressure within the CCC might contribute to seasonal variation in colonization rates with HR-SP and IR-SP . We conclude that multiple genetic clones of penicillin-resistant pneumococci can occur simultaneously in a single CCC, especially during periods of heavy antibiotic selection pressure . However, individual clones of penicillin-resistant S . pneumoniae may be spread from child to child, suggesting that colonization with penicillin-resistant S . pneumoniae should now be considered a CCC-associated phenomenon.

J Clin Microbiol, 1995 Oct, 33(10), 2789 - 91
Distribution of serotypes of Streptococcus pneumoniae isolated from invasive infections over a 16-year period in the greater São Paulo area, Brazil; Brandileone MC et al.; Capsular types of pneumococci from normally sterile body sites of 1,622 patients in Brazil were analyzed . Of 1,477 isolates from cerebrospinal fluid, 76.1% were of types represented in the currently available pneumococcal vaccine . The importance of age, time, and place in determining the optimal formulation of pneumococcal vaccine is considered.

J Clin Microbiol, 1995 Oct, 33(10), 2759 - 62
Six newly recognized types of Streptococcus pneumoniae; Henrichsen J; The serological properties of six new pneumococcal capsular types are described . A table listing all 90 pneumococcal types and their cross-reactions is included.

J Clin Microbiol, 1995 Oct, 33(10), 2704 - 6
Identification of "Streptococcus milleri" group isolates to the species level with a commercially available rapid test system; Flynn CE et al.; Clinical isolates of the "Streptococcus milleri" species group were examined by conventional methods and a rapid, commercially available method for the identification of these strains to the species level . The levels of agreement between the identifications obtained with the commercially available system (Fluo-Card Milleri; KEY Scientific, Round Rock, Tex.) and conventional methods were 98% for 50 Streptococcus anginosus strains, 97% for 31 Streptococcus constellatus strains, and 88% for 17 isolates identified as Streptococcus intermedius . Patient records were also studied in order to gain information on the frequency and sites of isolation of each of the three "S . milleri" group species.

J Clin Microbiol, 1995 Oct, 33(10), 2576 - 81
Characterization of Streptococcus agalactiae strains by multilocus enzyme genotype and serotype: identification of multiple virulent clone families that cause invasive neonatal disease; Quentin R et al.; The chromosomal genotypes of 277 isolates of 16 serotypes of Streptococcus agalactiae were characterized by analysis of electrophoretically demonstrable allele profiles at 12 metabolic enzyme loci . The collection comprised the type strain and 276 strains recovered from French symptomatic and asymptomatic subjects . Sixty-one distinctive electrophoretic types (ETs), representing multilocus clonal genotypes, were identified . Cluster analysis of the ETs revealed two primary phylogenetic divisions separated by a genetic distance of 0.62, Division I contained 67 isolates which could be assigned to 13 ETs . Twenty-seven of these isolates were from samples of cerebrospinal fluid (CSF) from neonatal meningitis patients . Two ETs, separated by a genetic distance of 0.217, contained 26 of these 27 isolates . Division II contained 210 isolates, of which 27 were isolated from CSF . This division was more polymorphic and included 48 ETs . Spanning a genetic distance of 0.3, three clusters and one ET were identified within this group . Twenty-four of 27 strains isolated from CSF belonged to one cluster, and 19 of them belonged to two adjacent ETs with a genetic distance of 0.083 . Fifty-five of the 68 serotype Ia strains and 24 of the 26 serotype Ib strains were each confined to one of the evolutionary lineages, and 85 of the 86 strains which carried protein antigen c belonged to phylogenetic division II . Most of the type III organisms were assigned to two clone families . The characteristics of this French population argue for the existence of particular groups of strains responsible for neonatal meningitis and demonstrate that serotyping can supply information about the genetic distribution of strains.

Vet Microbiol, 1995 Oct, 46(4), 427 - 34
Bactericidal activity of the bovine myeloperoxidase system against bacteria associated with mastitis; Cooray R et al.; Myeloperoxidase (MPO) is a lysosomal enzyme found in the primary granules of mammalian neutrophils . Together with MPO, peroxide and halide form a system of defense against bacteria . The present investigation was undertaken to study the bactericidal effects of the bovine-MPO/peroxide/halide system on pathogenic bacteria associated with bovine mastitis . We demonstrated that MPO together with oxidizing agents generated by xanthine oxidase, hypoxanthine and chloride form a potent antibacterial system against the common udder pathogens Staphylococcus aureus, Streptococcus uberis, Streptococcus agalactiae, Streptococcus dysgalactiae and Escherichia coli in a synthetic medium . However, when milk was added to the reaction mixture, the bactericidal properties of this enzyme system were completely inhibited . Loss of bactericidal activity in the milk-containing cultures was unable to be restored by increasing the concentration of MPO . Nor did an increase in concentrations of hypoxanthine and xanthine oxidase, or the replacement of the above-mentioned peroxidase generating system with a high concentration of hydrogen peroxide, significantly elevated the bactericidal activity that was inhibited by milk . The addition of bovine serum albumin to the synthetic medium reduced the bactericidal activity of the MPO/peroxide/chloride system in a dose-dependent manner . Therefore, milk proteins probably form adducts with strong bactericidal agents that are generated by the MPO system and thereby reduce the bactericidal potential of this system.

Vet Microbiol, 1995 Oct, 46(4), 415 - 26
Phenotypic characterization of Streptococcus dysgalactiae isolates from bovine mastitis by their binding to host derived proteins; Rantamaki LK et al.; The binding of 80 Streptococcus dysgalactiae mastitis isolates from 51 farms to plasma and connective tissue proteins fibronectin (29 kDa N-terminal fragment), vitronectin, collagen type I, fibrinogen, alpha 2-macroglobulin, IgG, and albumin was studied . All isolates boiund the bovine 29 kDa fibronectin fragment and the binding of bovine fibrinogen, caprine albumin, bovine alpha 2-macroglobulin-trypsin complexes and caprine IgG was also very frequent (92.5, 92.5, 72.5% and 87.5%, respectively) . Binding to human vitronectin was observed in 55% of the isolates, whereas only 20% of the isolates bound human type I collagen . None of the isolates bound native alpha 2-macroglobulin . Nearly all isolates (91%) bound more than 3 ligands . The bacterial binding sites for these proteins (termed here receptors) occurred in different combinations of which the combination fibronectin-, albumin-, fibrinogen-, vitronectin-, alpha 2-macroglobulin- and IgG-receptor was the most common . More than one isolate was obtained from 10 farms . The isolates from 5 farms showed close similarity of binding profiles within the farm, indicating that they were of similar origin and suggesting that the binding characteristics were relatively stable . Wider variation among the isolates obtained from other 5 farms was detected . The different isolates of the same farm origin varied mostly in the binding of albumin, IgG and fibrinogen . Interestingly, a difference in the number of receptors between isolates from two different sampling areas was observed . The binding profiles offer a new phenotypic method for epidemiological studies and may also when combined with genetical studies provide more insight both into the role of the bacterial plasma and connective tissue protein receptors in the infection process and the regulation of receptor expression.

Vet Microbiol, 1995 Oct, 46(4), 361 - 7
A fluorometric beta-glucuronidase assay for analysis of bacterial growth in milk; Fang W et al.; The growth of common mastitis-causing bacteria in milk was followed by a fluorometric technique based on the release of fluorescent 4-methylumbelliferone (4-MU) from 4-methylumbelliferyl-beta-D-glucuronide by the beta-glucuronidase of bacterial or milk origin . Three of four Escherichia coli strains, all four strains of Streptococcus uberis (4/4) and Streptococcus agalactiae (4/4) produced beta-glucuronidase . Four Staphylococcus aureus strains (4/4) and one E . coli strain, though unable to produce the enzyme, activated the milk beta-glucuronidase most probably by lowering the pH of bacterial cultures in milk for optimum activity of the indigenous enzyme . The beta-glucuronidase of milk, Str . uberis and Str . agalactiae origin had similar optimum pH ranges (5.3-6.6) while E . coli beta-glucuronidase was more active at neutral or slightly alkaline pH (6.8-7.7) . The increase of beta-glucuronidase activity in milk cultures of E . coli, Str . uberis, Str . agalactiae and S . aureus seemed to parallel the increase of colony forming units and were dependent on the inoculum size . The time to reach a predetermined enzyme threshold in E . coli-milk cultures showed excellent linear relationship with the inoculum size.

Pediatr Res, 1995 Oct, 38(4), 551 - 4
Antibodies to tumor necrosis factor-alpha: use as adjunctive therapy in established group B streptococcal disease in newborn rats; Givner LB et al.; Group B Streptococcus (GBS) is the leading cause of neonatal sepsis . Adjunctive therapies are being sought to improve the outcome . Because increased blood levels of tumor necrosis factor (TNF)-alpha may play a role in the development of sepsis and an adverse outcome thereof, we evaluated the potential use of antibodies against TNF-alpha as adjunctive therapy of GBS sepsis . Using a neonatal rat model of GBS sepsis, we measured serum levels of TNF-alpha . Levels of TNF-alpha were significantly increased beginning 12 h after GBS inoculation and remained significantly increased at 30-36 h . We then examined the use of adjunctive therapy with antibody to TNF-alpha in animals with established GBS sepsis using polyclonal rabbit antirecombinant mouse TNF-alpha antiserum . Twelve hours after GBS inoculation, animals received a single dose of antibody to TNF-alpha or normal rabbit serum, and penicillin therapy (twice a day for 3 d) was begun . Animals receiving penicillin and antibody to TNF-alpha had a survival rate of 52% (13 of 25) versus 29% (7 of 24) for animals receiving penicillin and normal rabbit serum . Thus, the use of antibodies directed against TNF-alpha may have a role as adjunctive therapy of established GBS sepsis in the newborn infant.

Curr Opin Pediatr, 1995 Oct, 7(5), 513 - 22
Management of acute and chronic otitis media in pediatric practice; Berman S; This article reviews recent publications related to the epidemiology, pathogenesis, diagnosis, and management of otitis media . Otitis media is a continuum of conditions that includes acute otitis media, otitis media with residual or persistent effusion, unresponsive otitis media, recurrent otitis media, otitis media with complications, and chronic suppurative otitis media . The pathogenic mechanisms of otitis media involve interactions among host characteristics, virulence factors of viral and bacterial pathogens, and environmental factors . Recent studies document the emergence and rapid spread of drug-resistant Streptococcus pneumoniae in acute and unresponsive otitis as well as persistent effusions and chronic suppurative otitis . Few issues in clinical medicine are as controversial as the efficacy and risks associated with antibiotic treatment of otitis media . It is best to avoid the antibiotic treatment dilemma as much as possible by not overdiagnosing otitis media.

Biosci Biotechnol Biochem, 1995 Oct, 59(10), 1966 - 7
Antibacterial substance produced by Streptococcus faecium under anaerobic culture; Park SC et al.; A facultative anaerobe isolated from Korean domestic soil produced an antibacterial substance under strict anaerobic conditions . Based on the morphological and biochemical tests, and cellular fatty acid profiles, the anaerobe was identified as Streptococcus faecium . An antimicrobial compound produced from the S . faecium was identified as 3,7,12-trihydroxy-24-cholanic acid methylester on the basis of its physico-chemical analysis . This substance had potent antibacterial activities against a test organism harboring multiple antibiotic resistance markers, and a variety of pathogenic bacteria . The isolated S . faecium produced lactic acid as well as the antibiotic compound under the anaerobic conditions.

Biosci Biotechnol Biochem, 1995 Oct, 59(10), 1861 - 5
Inhibition of dextran and mutan synthesis by cycloisomaltooligosaccharides; Kobayashi M et al.; Novel cyclic isomaltooligosaccharides, cyclodextran, strongly inhibited the dextransucrase reaction . The inhibition was dependent on the cyclodextran concentration and greatly enhanced by the first incubation at 30 degrees for 30 min . Cyclodextran-heptaose and -octaose were competitive inhibitors for sucrose yielding Ki's of 0.25 and 0.64 mM, respectively . Both reducing sugar and dextran producing activities of dextransucrase were almost equally inhibited by the cyclodextrans . Although gamma-cyclodextrin, palatinose, sucrose-monocaprate, and maltitol gave 5-35% inhibition, cyclodextran-heptaose gave 95% inhibition . Moreover, water-insoluble glucan (mutan) synthesis by the glucosyltransferase from Streptococcus mutans was significantly repressed by the addition of cyclodextran.

APMIS, 1995 Oct, 103(10), 731 - 6
A Streptococcus agalactiae R protein analysed by polyclonal and monoclonal antibodies; Bevanger L et al.; Unexpected cross-reactivity between two Streptococcus agalactiae (GBS) isolates formed the basis for purification of a GBS protein called the Ra antigen, and raising of murine monoclonal antibody (MAb) against Ra . The Ra protein was resistant to trypsin digestion, susceptible to pepsin digestion, formed a ladder-like pattern of lines with a periodicity of approximately 8 kD on immunoblotting, was surface-localized in GBS strains, and was variably expressed by GBS . These characteristics provided evidence that the Ra antigen belonged to the R proteins of GBS . By testing of reference GBS isolates and antiserum, including an anti-R4 protein serum, cross-reactivity was recorded consistent with the assumption that Ra is a R4 protein . The Ra/R4 protein also showed cross-reactivity with a previously described GBS protein called protein Rib (J . Exp . Med . 177: 1593-1603, 1993) . Several characteristics of the Ra/R4 protein were similar to those of the GBS protein c alpha, but the two proteins showed no cross-reactivity . The anti-Ra/R4 MAb has proved useful in serosubtype determination of GBS of known serotype and should be a valuable tool for studying the immunobiological function of antibodies targetting the surface-localized Ra/R4 protein.

Ear Nose Throat J, 1995 Oct, 74(10), 701 - 4
Retropharyngeal abscess: clinical review; Pontell J et al.; Retropharyngeal abscess, once a relatively common entity in children, is uncommon today . From 1981 to 1991, we treated 20 cases . Abscesses secondary to upper respiratory infection in children were seen only in three (15%) cases . Trauma and foreign bodies were the most common etiologic factors in the adult subgroup . Streptococcus viridans and Klebsiella pneumoniae were the most common pathogens . The use of contrast-enhanced computed tomography has had a significant impact on the diagnostic work-up . The choice of initial antibiotic therapy is discussed . There were no deaths in this series.

Bone Marrow Transplant, 1995 Oct, 16(4), 565 - 70
Cytosine arabinoside as a major risk factor for Streptococcus viridans septicemia following bone marrow transplantation: a 5-year prospective study; Engelhard D et al.; The incidence and clinical course of nosocomial septicemia with Streptococcus viridans was evaluated prospectively in 242 consecutive bone marrow transplant (BMT) recipients throughout their 15-213 days' (median 47) hospitalization, including 4-58 days (median 18) of neutropenia . Initial empiric therapy for febrile neutropenia consisted of mezlocillin, gentamicin and cefazolin; glycopeptide was excluded . S . viridans septicemia occurred in 23/209 (11%) subjects with underlying malignant disease, and only during neutropenia with concomitant mucositis: in 20 subjects (four with ampicillin-resistant strains), S . viridans septicemia occurred at onset of febrile neutropenia, 1-5 days (median 4.5) post-BMT . All survived with an uncomplicated clinical course . Thus, glycopeptide seems unnecessary in the initial empiric antibiotic regimen . The other three subjects demonstrated S . viridans septicemia (two with ampicillin-resistant strains) on day 11 post-BMT; two died . The major risk identified was cytosine arabinoside administration in the conditioning regimen (P < 0.01).

Arch Oral Biol, 1995 Oct, 40(10), 973 - 4
Detection of binding of denatured salivary alpha-amylase to Streptococcus sanguis; Bergmann JE et al.; Native alpha-amylase, either solubilized, or immobilized and tested with an overlay immunotechnique, was bound in a species-specific manner to Streptococcus mitis and to one of the Streptococcus gordonii strains . However, only insignificant amounts of alpha-amylase were bound to Streptococcus sanguis and all other strains tested . When alpha-amylase was denatured before immobilization, Streptococcus sanguis bound strongly to the protein while binding of other strains was insignificant.

Am Surg, 1995 Oct, 61(10), 856 - 61
Operative site bacteriology as an indicator of postoperative infectious complications in elective colorectal surgery; Grant SW et al.; Toward the completion of elective colorectal operations, 75 patients had qualitative aerobic and anaerobic cultures of specimens obtained from peritoneal irrigation fluid, anastomoses sites, and abdominal wound irrigation fluid to determine if a correlation exists between intraoperative flora and postoperative infectious complications . Patients enrolled in this prospective study received a mechanical bowel prep and a 12-18 hour course of perioperative intravenous antibiotics . Comparisons were made between the 60 (80%) patients who had no postoperative infections and the 15 (20%) who developed postoperative infectious complications (9 wound infections, 6 intraabdominal infections) . There were significantly more low anterior resections in patients who developed postoperative infection compared to those who had no postoperative infection (26% vs 2%), while there were more colocolostomies in the group with no infections (38% vs 7%) . Streptococcus spp., Bacteroides fragilis group, and Escherichia coli were the most commonly isolated organisms from each of the three sites sampled . Isolation of > or = 3 organisms from incisional wound cultures (P = 0.017) and < or = 4 organisms from peritoneal irrigation (P = 0.009) or anastomotic culture (P = 0.004) correlated with development of postoperative infectious complications . Thus, patients with infectious complications had significantly more isolates than those without infectious complications, and were more likely to have had a low anterior resection . These data suggest that future clinical studies should reexamine the duration of perioperative antimicrobials based on early laboratory reports of qualitative and quantitative operative site bacteriology.

FEMS Microbiol Lett, 1995 Oct 1, 132(1-2), 165 - 70
Rapid identification of Streptococcus pneumoniae by PCR amplification of ribosomal DNA spacer region; Saruta K et al.; Streptococcus pneumoniae is one of the important human pathogens in clinical microbiology . A polymerase chain reaction assay was designed to detect and identify S . pneumoniae through amplification of the ribosomal DNA spacer regions between the pneumococcal 16S-23S ribosomal RNA genes . Thirty-two Streptococcus and non-Streptococcus strains were tested to verify the specificity of the assay, and only S . pneumoniae strains gave a positive reaction . This method is a powerful technique for the rapid identification of S . pneumoniae.

Arch Ophthalmol, 1995 Oct, 113(10), 1324 - 9
Effect of intravitreal dexamethasone in treatment of pneumococcal endophthalmitis in rabbits; Park SS et al.; PURPOSE: To investigate whether corticosteroid therapy would decrease the inflammation and tissue damage associated with pneumococcal endophthalmitis . METHODS: Albino rabbits were injected intravitreally with 1000 live organisms of Streptococcus pneumoniae and randomized after 24 hours to treatment with intravitreal vancomycin hydrochloride alone (n = 10), combination intravitreal vancomycin and intravitreal dexamethasone (n = 10), or no treatment (n = 10) . After 2 weeks, the eyes were examined clinically and enucleated for histopathologic examination . RESULTS: Eyes treated with vancomycin and dexamethasone had significantly less intraocular inflammation and more preservation of retinal tissue than untreated eyes or eyes treated with vancomycin alone (P < .05, Fisher's exact test) . Untreated and vancomycin-treated eyes were indistinguishable on clinical and histologic examination . Marked anterior and posterior segment inflammation with total retinal necrosis was noted in eyes from both groups . CONCLUSION: Intravitreal corticosteroid therapy may play an important role in minimizing the inflammation and tissue damage associated with pneumococcal endophthalmitis.

Am J Med Sci, 1995 Oct, 310(4), 150 - 5
Emergence of penicillin-resistant invasive pneumococci in a single American community; Stanek RJ et al.; Three decades ago, penicillin-resistant strains of Streptococcus pneumoniae were first reported . Since then, myriad penicillin resistant strains of S . pneumoniae have been identified worldwide and in the United States . No resistant or intermediate resistant strains have been reported in West Virginia because testing has not been done . Between 1983 and 1994, the authors' surveillance of invasive pneumococcal disease in metropolitan Huntington, West Virginia, identified 356 pneumococcal strains from blood and other usually sterile sites, including 110 strains belonging to serotypes 6, 9, 14, 19, and 23, the main serotypes exhibiting penicillin resistance . The authors tested these serotypes for penicillin susceptibility by the E-test . Sixteen (14.5%) strains of types 6, 9, 14, 19, and 23 exhibited intermediate resistance to penicillin . No highly resistant strains were identified . Most of the intermediate resistant strains of types 9, 14, and 23 were detected in epidemiologic years 1992-1994 . The increasing number of intermediate resistant penicillin strains signals the need for routine testing of invasive pneumococcal strains for penicillin susceptibility and necessitates appropriate antibiotic usage.

J Pediatr, 1995 Oct, 127(4), 533 - 7
Streptococcus pneumoniae colonization in the young child: association with otitis media and resistance to penicillin; Zenni MK et al.; OBJECTIVE: To determine the nasopharyngeal colonization rate of penicillin-susceptible and penicillin-resistant strains of Streptococcus pneumoniae in young children, and to assess its relationship with the incidence of otitis media . DESIGN: Observational study in 215 children younger than 6 years of age who received care in the Vanderbilt Vaccine Clinic from September 1, 1992, to August 31, 1993 . RESULTS: Of 842 nasopharyngeal cultures obtained, results for 44% of the cultures were positive for S . pneumoniae; 73% of the isolates were serotypes 6, 14, 19, or 23 . Younger children had significantly higher rates of pneumococcal colonization than older children, with a peak at 1 year of age . By microdilution susceptibility testing, 37% of the cultures with positive results were intermediately or highly resistant to penicillin . Significantly more serotype 19 and 23 isolates were penicillin resistant than organisms of other serotypes . Children younger than 2 years of age had a twofold higher percentage of resistant isolates than those older than 2 years of age . A significant association was noted between nasopharyngeal carriage of S . pneumoniae and acute otitis media (p = 0.0002); however, the incidence of acute otitis media did not differ significantly between children colonized with penicillin-susceptible or penicillin-resistant strains . Unresolved otitis media was diagnosed more often in children who were colonized with resistant organisms than in children colonized with susceptible strains (p = 0.04) . CONCLUSIONS: There was a high rate of nasopharyngeal carriage of penicillin-resistant S . pneumoniae in this population of young children . Nasopharyngeal colonization was associated with an increased incidence of acute otitis media, and penicillin resistance was associated with an increased incidence of unresolved otitis media.

J Pediatr, 1995 Oct, 127(4), 526 - 32
Penicillin- and cephalosporin-resistant strains of Streptococcus pneumoniae causing sepsis and meningitis in children with sickle cell disease; Chesney PJ et al.; OBJECTIVE: We investigated the possibility that antimicrobial-resistant pneumococci were causing invasive disease in children with sickle-cell disease (SCD) . STUDY DESIGN: Records of all children with SCD observed at the Mid-South Sickle Cell Center (MSSCC) at LeBonheur Children's Medical Center were reviewed from January 1990 to June 1994 . Children with SCD and pneumococcal sepsis were identified . The Streptococcus pneumoniae isolates from these children were examined for serotype and antimicrobial susceptibilities . Two additional children not observed in the MSSCC had pneumococcal sepsis caused by penicillin-resistant isolates and were also included . RESULTS: Antimicrobial susceptibility testing of the six penicillin-resistant isolates revealed that four were resistant to trimethoprim-sulfamethoxazole, two to erythromycin, and one to clindamycin . The two isolates that were resistant to ceftriaxone also were multiply resistant . From the MSSCC, 26 children had pneumococcal sepsis during the 4 1/2-year period studied . Five of these children (19%) died . Four (15%), including one who died, were infected with penicillin-resistant strains . CONCLUSION: Pneumococcal sepsis, meningitis, and infections of other foci in children with SCD may be caused by S . pneumoniae that is resistant to one or more antimicrobial agents, including penicillin . The addition of vancomycin to the antibiotics currently used for initial management should be considered in areas where the antibiotic resistance of S . pneumoniae is prevalent.

J Infect Dis, 1995 Oct, 172(4), 983 - 7
Characterization of Streptococcus pneumoniae from human immunodeficiency virus--seropositive patients with acute and recurrent pneumonia; Jordens JZ et al.; Thirty-two isolates of clinically significant Streptococcus pneumoniae from 11 human immunodeficiency virus (HIV)-seropositive patients with single or multiple episodes of pneumonia were characterized by antibiotic susceptibility testing, serotyping, ribotyping, and repetitive extragenic palindromic polymerase chain reaction (REP-PCR) . The isolates comprised 10 serotypes, 12 ribotyping patterns, and 12 REP-PCR patterns . There was close but not absolute correlation between techniques . By combining these characterization methods, 14 strains were identified . Five strains were found in > 1 patient, suggesting their frequent occurrence in this population . Two isolates of different serotype from 1 patient were highly related by ribotyping and REP-PCR, suggesting possible in vivo serotype change . Acute infection was associated with single strains or coinfection by distinct strains . Recurrent pneumonia was identified as relapse with the same strain or reinfection with new strains . The molecular characterization of pneumonococci from HIV-seropositive persons refines our understanding of pneumonococcal infection in these patients.

J Bacteriol, 1995 Oct, 177(19), 5704 - 6
Regulation of sugar transport via the multiple sugar metabolism operon of Streptococcus mutans by the phosphoenolpyruvate phosphotransferase system; Cvitkovitch DG et al.; In this report, we provide evidence that the transport of sugars in Streptococcus mutans via the multiple sugar metabolism system is regulated by the phosphoenolpyruvate phosphotransferase system . A ptsI-defective mutant (DC10), when grown on the multiple sugar metabolism system substrate raffinose, exhibited reduced growth, transport, and glycolytic activity with raffinose relative to the parent strain BM71 . Inhibition of {3H}raffinose uptake was also observed in both BM71 and DC10 with increasing concentrations of glucose and the glucose analogs alpha-methyl glucoside and 2-deoxyglucose.

Am J Respir Crit Care Med, 1995 Oct, 152(4 Pt 1), 1309 - 15
Community-acquired pneumonia: impact of immune status; Mundy LM et al.; This cross-sectional and prospective one year study evaluated adults admitted to an inner city hospital with community-acquired pneumonia . The study used extensive diagnostic methods to evaluate the etiologies of community-acquired pneumonia in hospitalized patients with differing immunologic status . Of 385 study patients, concurrent problems associated with immunosuppression were noted in 221 (57%) patients, 180 of whom were human immunodeficiency virus (HIV)-infected . The five most common causes of community-acquired pneumonia were: Streptococcus pneumoniae, Pneumocystis carinii, aspiration, Hemophilus influenzae, and gram-negative bacilli . Only 8.3% of patients had either Legionella, Chlamydia pneumoniae or Mycoplasma pneumoniae . Despite use of state-of-the-art diagnostic techniques, no diagnosis was made in 46 of 180 (25.6%) HIV-infected patients, 56 of 164 (34.1%) immunocompetent patients, and 20 of 41 (48.8%) non-HIV-infected immunosuppressed patients . The diagnostic yield of pre-antibiotic sputum culture for conventional bacteria was 99/155 (63.9%) compared to 52 of 169 patients (32.7%) with adequate post-antibiotic sputum culture (p < 0.0001) . Although S . pneumonia continues to be the most commonly identified etiologic agent of community-acquired pneumonia, it is surpassed by P . carinii in the HIV-infected patient population . The apparent decline in the frequency of S . pneumoniae in our series presumably reflects administration of antibiotics prior to procurement of sputum culture . The paucity of atypical agents in this study support the current American Thoracic Society guidelines for selective use of macrolide therapy in immunocompetent adults hospitalized with community-acquired pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

Curr Microbiol, 1995 Oct, 31(4), 251 - 9
Identification, cloning, and sequencing of DNA essential for encapsulation of Streptococcus pneumoniae; Watson DA et al.; This paper reports the cloning and sequencing of a region of DNA from Streptococcus pneumoniae serotype 3 surrounding transposon Tn916, insertion of which was previously shown to result in lack of expression of the extracellular capsule . Sequence analysis revealed that the transposon inserted into a consensus insertion site 71 bp from the 5' end of the cloned fragment . Within the clone, 3' downstream regions from two different pneumococcal lytA genes were identified, as well as a putative 194 AA open reading frame (ORF1) . Moreover, two copies of the repeat element BOX, oriented in opposite directions, were located immediately 3' of orf1 . Within the region bounded by the first pair of internal sequencing primers, analysis revealed that the fragment amplified by PCR was always of the same size . Moreover, Southern blotting showed that for all serotypes examined to date, homology exists with the cloned fragment . These results indicate that this region of the chromosome is highly conserved and, taken together with other independently derived data, suggest that interruptions or deletions within this DNA lead to unencapsulation.

Kansenshogaku Zasshi, 1995 Oct, 69(10), 1093 - 102
{Serotypes and antimicrobial susceptibility of Streptococcus pneumoniae from clinical specimens}; Ikeda N; Studies were made on 66 strains of Streptococcus pneumoniae which were obtained from clinical specimens in 1991 through 1993 and showed 19 mm or less of disk inhibition zone diameter (DIZD) against 1 microgram oxacillin (MPIPC) disk . The studies included the determination of their serotypes, antimicrobial susceptibility, and comparison between microbroth dilution (MD) method and Kirby-Bauer (K-B) method . In the study of distribution of serotypes, additional 32 strains which showed 20 mm or more in DIZD were included for study . The results were as follows . 1) About 70% of 98 strains of S . pneumoniae were serotyped by 6 kinds of antisera . Among penicillin-susceptible S . pneumoniae (PSSP), type 3 were 20.6%, type 19, 15.9%, type 6, 14.3%, type 18, 9.5%, type 14, 7.9%, and type 4, 1.6% . Among penicillin-intermediate S . pneumoniae (PISP), and penicillin-resistant S . pneumoniae (PRSP), type 19 were 60%, and type 18, 8.6% . In PISP and PRSP, more than half were type 19, which indicates they are distinctly different from PSSP in serotypical distribution . 2) As to the difference between screening by MPIPC disk and minimum inhibitory concentration (MIC) by benzylpenicillin (PCG), among 66 MPIPC resistant strains, PSSP strains were 31 in number (47%) . 3) MIC showed that PISP and PRSP strains were more resistant than PSSP against cefaclor (CCL), cefazolin (CEZ), cefotiam (CTM), cefotaxime (CTX), imipenem (IPM), minocycline (MINO), and erythromycin (EM), but no difference was found in the 2 groups of strains in MIC with clindamycin (CLDM) and ofloxacin (OFLX) . 4) All type 3 strains formed mucoid colonies and were resistant to MINO and highly resistant to EM and CLDM . 5) By NCCLS, category of antimicrobial susceptibility is determined against CCL, EM, OFLX, in MD method and K-B method . Against these antibiotics, the complete agreement rates were 75.8%, 92.4% and 86.4% respectively.

Int J Pediatr Otorhinolaryngol, 1995 Oct, 33(2), 127 - 39
Treatment of experimental acute otitis media with ibuprofen and ampicillin; Diven WF et al.; The efficacy of concurrent treatment of experimental acute otitis media with ibuprofen and ampicillin was evaluated in chinchillas with respect to clearance of the effusion and resolution of mucosal inflammation . Sixty-four chinchillas were infected with Streptococcus pneumoniae and randomly assigned to treatment with either IM ampicillin (control) or ampicillin plus ibuprofen (experimental) beginning on day 2 post inoculation . On days 3, 6, 9 and 12, 8 animals from each group were killed, effusions recovered for biochemical assay and the right middle ears prepared for histological study . Between group differences in the number of ears with effusion and effusion volume were not statistically significant . Mucosal thickness and the frequencies of ears with histopathological signs of inflammation were significantly less in the experimental group when compared to the control group . Differences in the effusion concentrations of total protease, 3 of 4 hydrolytic enzymes and free fatty acids favoring the experimental group were observed at the 6, 9 and 12 day endpoints . Also, at those times the levels of the 3 measured products of the cyclooxygenase pathway were less in the experimental group . These results suggest that the addition of ibuprofen to ampicillin for the treatment of acute otitis media decreases production of select eicosonoids, reduces mucosal inflammation and alters the course of the disease in this model of bacterial infection.

Thorax, 1995 Oct, 50(10), 1093 - 6
Streptococcus milleri pulmonary disease: a review and clinical description of 25 patients; Wong CA et al.; BACKGROUND--Streptococcus milleri is increasingly being recognised as an important pulmonary pathogen which may lead to the development of empyema or lung abscess . Although several small series have been reported, the clinical and laboratory features have yet to be fully characterised . METHODS--Twenty five cases were identified and the clinical and laboratory data from case records were analysed . RESULTS--There were 16 empyemas, five lung abscesses, and four with both lung abscess and empyema . The mean age of the patients was 61 years (range 36-89) and 84% were men . The most common symptoms at presentation were shortness of breath, chest pain, cough, and weight loss; only 36% had a fever . Four of the nine patients with lung abscess required a diagnostic lobectomy because of suspected malignancy . Predisposing factors were present in 80% of patients and included the following: pneumonia, periodontal disease, excess alcohol intake, previous thoracic surgical procedures, and malignancy . Laboratory features of S milleri infection were leucocytosis, neutrophilia, anaemia, abnormal liver function tests, and hypoalbuminaemia . In the group with empyema five patients had a pneumothorax on initial presentation and pleural loculation occurred in 10 of these patients . The median stay in hospital was 34 days (range 11-88) . Six patients died, five of whom had significant underlying illnesses . CONCLUSIONS--Pulmonary infection with S milleri may result in considerable morbidity and mortality, and is characterised by a strong male predominance, non-specific symptoms (often without toxicity), the presence of predisposing factors, pleural loculation, pneumothorax, and a protracted stay in hospital.

J Antibiot (Tokyo), 1995 Oct, 48(10), 1141 - 7
In vivo evaluation of three acid-stable azalide compounds, L-701,677, L-708,299 and L-708,365 compared to erythromycin, azithromycin and clarithromycin; Gill CJ et al.; L-701,677, L-708,299 and L-708,365 are novel azalide derivatives of erythromycin that exhibit improved acid stability over erythromycin, azithromycin and clarithromycin . The half-life in aqueous solution at pH = 2.1 of these compounds ranged from 0.3 hour for erythromycin to 16.2 hours for L-708,299 . The rank order of half-life in acid solution from most to least stable was L-708,299 > L-701,677 > L-708,365 > azithromycin = clarithromycin > erythromycin . In a disseminated Streptococcus pyogenes mouse infection model, azithromycin and L-708,365 were slightly more efficacious than clarithromycin, L-701,677 and L-708,299; all 5 compounds being more active than erythromycin . In a Klebsiella pneumoniae pulmonary challenge mouse model, azithromycin, L-701,677, L-708,299 and L-708,365 were all equal in efficacy and at least four-fold more active than clarithromycin and erythromycin . Clarithromycin, L-708,365 and interestingly erythromycin, showed greater bacterial clearance than azithromycin, L-701,677 and L-708,299 in a localized infection model that measured clearance of Staphylococcus aureus from mouse thigh tissues . Our results indicate that L-701,677, L-708,299 and L-708,365 exhibit improved acid stability and were at least equally efficacious as presently marketed macrolide/azalide antibiotics.

Am J Obstet Gynecol, 1995 Oct, 173(4), 1325 - 8
The accuracy and patient preference for self-collected group B Streptococcus cultures; Mercer BM et al.; OBJECTIVE: Our purpose was to determine the accuracy of and patient attitudes regarding self-collected group B Streptococcus cultures . STUDY DESIGN: Women seen for prenatal care at 24 to 42 weeks' gestation were asked to collect distal vaginal and anal samples for group B Streptococcus . Subsequently, distal vaginal and anal samples were obtained by the nurse . The patients were then asked their preference toward self-sampling . RESULTS: A total of 251 women participated in the study . The incidence of positive group B Streptococcus cultures was 12.7%, 9.6%, 10.0%, and 7.6% for the patient-collected vaginal and anal and nurse-collected vaginal and anal specimens, respectively . The incidence of group B Streptococcus carriage was 17.5% and 13.5% for any positive patient- or provider-collected specimens, respectively, and 19.1% for any positive culture . Single patient-collected vaginal and anal and nurse-collected vaginal and anal samples were insensitive for group B Streptococcus carriage (67%, 50%, 52%, 40%, respectively) . The combination of patient-collected samples was more sensitive than nurse-collected samples (sensitivity 91.7% vs 70.8%, p < 0.05) . Repeat sampling of the vagina or anal canal did not offer significant additional benefit to a single culture . Overall, patient-collected samples were 98.4% accurate in predicting group B Streptococcus carriage versus 94.4% for nurses . A total of 58% of women preferred obtaining their own specimens, whereas 9.6% found the technique difficult . Ninety percent desired the option of self-sampling in the future . CONCLUSIONS: Single vaginal or anal cultures were insensitive in detecting group B Streptococcus carriage . Combined patient-collected cultures were more sensitive than provider-collected specimens . On the basis of accuracy and patient preference, women should be given the opportunity of combined vaginal-anal self-sampling for group B Streptococcus when indicated.

Proc Natl Acad Sci U S A, 1995 Sep 26, 92(20), 9052 - 6
Homeologous recombination and mismatch repair during transformation in Streptococcus pneumoniae: saturation of the Hex mismatch repair system; Humbert O et al.; The ability of the Hex generalized mismatch repair system to prevent recombination between partially divergent (also called homeologous) sequences during transformation in Streptococcus pneumoniae was investigated . By using as donor in transformation cloned fragments 1.7-17.5% divergent in DNA sequence from the recipient, it was observed that the Hex system prevents chromosomal integration of the least and the most divergent fragments but frequently fails to do so for other fragments . In the latter case, the Hex system becomes saturated (inhibited) due to an excess of mismatches: it is unable to repair a single mismatch located elsewhere on the chromosome . Further investigation with chromosomal donor DNA, carrying only one genetically marked divergent region, revealed that a single divergent fragment can lead to saturation of the Hex system . Increase in cellular concentration of either HexA, the MutS homologue that binds mismatches, or HexB, the MutL homologue for which the essential role in repair as yet remains obscure, was shown to restore repair ability in previously saturating conditions . Investigation of heterospecific transformation by chromosomal DNA from two related streptococcal species, Streptococcus oralis and Streptococcus mitis, also revealed complete saturation of the Hex system . Therefore the Hex system is not a barrier to interspecies recombination in S . pneumoniae . These results are discussed in light of those described for the Mut system of Escherichia coli.

Gene, 1995 Sep 22, 163(1), 53 - 7
Secretion of streptokinase fusion proteins from Escherichia coli cells through the hemolysin transporter; Kern I et al.; The hemolysin (HlyA) secretion system was used to achieve the sec-independent secretion of streptokinase (Skc) originating from Streptococcus equisimilis into the medium by Escherichia coli cells . The in-frame fusions of the skc gene, either possessing or lacking a region encoding the signal peptide (SP) with the 3'-end of the hlyA gene of various lengths were analysed . All hybrids retained Skc activity . Hybrid proteins devoided of the N-terminal SP, regardless of length of the hlyA secretion signal (62 vs . 194 amino acids), were secreted into the medium by the E . coli HlyA transporter at similar levels . Considerable amounts of hybrid proteins were still, however, associated with E . coli cells, mainly in the degraded form.

FEMS Microbiol Lett, 1995 Sep 15, 131(3), 255 - 61
DnaK expression in response to heat shock of Streptococcus mutans; Jayaraman GC et al.; The oral pathogen, Streptococcus mutans, persistently colonizes human hosts and initiates oral disease despite extreme variations in environmental conditions . To begin to investigate the role of the stress protein, DnaK (Hsp70), in environmental stress responses by S . mutans, pulse-chase experiments were initially used to establish that a functional heat shock response existed in this organism . A C-terminal fragment of the S . mutans dnaK gene was cloned and engineered to be expressed with a histidine tag . Using the recombinant DnaK protein that had been purified by nickel affinity chromatography, an antibody specific for the S . mutans DnaK protein was generated to analyse DnaK expression under homeostatic and heat shock conditions . Western blot analysis indicated that the anti-recombinant DnaK antibody specifically recognized a protein (molecular mass approx . 68 kDa) which was induced in response to thermal stress . Elucidating the role of DnaK in responses by S . mutans to various environmental stressors will provide a better understanding of how DnaK is involved in survival of extreme environments and the contribution of the DnaK protein to the virulence of S . mutans.

Acta Otolaryngol, 1995 Sep, 115(5), 685 - 8
Intracellular penetration and survival of Streptococcus pyogenes in respiratory epithelial cells in vitro; Osterlund A et al.; Recurrence of pharyngotonsillitis caused by S . pyogenes after seemingly adequate antibiotic treatment has puzzled scientists for many years . We investigated the ability of S . pyogenes to invade HEp-2 cells and survive intracellularly . Five strains were tested, of which two were isolated from patients with recurrent pharyngotonsillitis, two without recurrent infection, while one was a reference strain . All five strains were found capable of penetrating the cells and surviving intracellularly for between 4 and 7 days . In this manner, an intracellular reservoir of bacteria was created, with the potential to cause recurrent infections.

Diagn Microbiol Infect Dis, 1995 Sep-Oct, 23(1-2), 1 - 9
Optimizing detection of microbial sepsis: a comparison of culture systems using packaged sets with directions for blood collection; Boschman CR et al.; Detection of microbial sepsis is an important aspect of medical practice . To facilitate the recovery of bacteria and fungi we evaluated 10,933 complete blood culture sets integrating the automated ESP system (Difco) with a manual system using the Isolator (Wampole) and Thiol broth bottle (Difco) . To improve compliance with the recommended procedure for submitting specimens, we packaged the three components as a unit that included brief instructional material . A three-component (one ESP bottle, one Thiol bottle, and one Isolator tube) package containing specific instructions was used . The aerobic ESP performance was compared with the Isolator, and the anaerobic ESP with the Thiol bottle . A hypothetical assessment involving all three components was also made . The cultures were processed under routine laboratory conditions . Charts were reviewed from specimens with discrepant results to ascertain true positives versus contaminant cultures in the discordant culture sets . There were 896 organisms recovered from 393 patients . Of these, 421 were in the aerobic compared with 475 in the anaerobic portion of the study . ESP enhanced the recovery of Streptococcus pneumoniae (P < .05) . The Isolator was superior for the recovery of yeasts (.05 < P < .1) . Using the packaged system, the compliance rate for complete three-component culture sets was 95.2%, with a 34.4% resultant increase in positive blood cultures from only a 5.7% increase in sets . Packaged culture media including instructions enhance appropriate collection of complete sets, increase the number of recovered organisms, and improve medical practice.

Pediatr Med Chir, 1995 Sep-Oct, 17(5), 427 - 9
{Early neonatal manifestations of group B Streptococcus infection: case series and preventive strategy}; Moscatelli P et al.; Group B Streptococcus (GBS) is, so far, one of the most important causes of neonatal morbidity and mortality . In order to elucidate the extent of this problem a screening for GBS has been performed on a group of pregnant women and their neonates . Maternal vaginal and rectal swabs were obtained on admission to the labor area . In these infants throat swabs at birth and throat and rectal swabs on day 4th and 6th were obtained . In the 14,248 pairs mother/infant examined, the rate of colonization was, respectively, 9 (7%) and 4 (1%) . 6 among 569 colonized newborn show evidence of the early onset type infection (respiratory form: 2 cases; meningitic form: 4 cases) . Fatal outcome and severe neurologic impairment were observed respectively in 3 and 1 patient . Risk factors (prematurity) were present only in two patients . In all cases clinic evidence was observed before that laboratory findings were disposable . The Authors remark the importance of the bacteriological screening in pregnancy, and of antibiotic therapy intrapartum in women with risk factors and in colonized newborn in the first hour of life when acute phase reactants are positive.

J Prosthodont, 1995 Sep, 4(3), 178 - 82
Antibacterial activity of three dental liners; Eli I et al.; PURPOSE: The purpose of the present study was to assess the antibacterial activity of the following three dental liners: Vitrebond (3M, St Paul, MN), Dycal (LD Caulk, Dentsply International, Milford, DE), and Life (Kerr, Romulus, MI) . MATERIALS AND METHODS: The test was based on a modification of the agar diffusion test in which samples were placed on agar plates previously inoculated with Streptococcus mutans and were removed after predetermined time periods . The material's effect on bacterial growth was evaluated . RESULTS: Results show that Vitrebond has a strong antibacterial effect that was evident after 1 minute of direct contact with the inoculated bacteria . It was significantly more effective (P<.0001) than Dycal or Life . CONCLUSIONS: This method allows for the evaluation of the antibacterial effect of dental materials.

Mol Microbiol, 1995 Sep, 17(5), 945 - 51
Asymmetric distribution of the Listeria monocytogenes ActA protein is required and sufficient to direct actin-based motility; Smith GA et al.; Listeria monocytogenes is a Gram-positive facultative intracytoplasmic bacterial pathogen that exhibits rapid actin-based motility in eukaryotic cells and in cell-free cytoplasmic extracts . The protein product of the actA gene is required for bacterial movement and is normally expressed in a polarized fashion on the bacterial surface . Here we demonstrate that the ActA protein is sufficient to direct motility in the absence of other L . monocytogenes gene products, and that polarized localization of the protein is required for efficient unidirectional movement . We have engineered a fusion protein combining ActA with the C-terminal domain of the LytA protein of Streptococcus pneumoniae, which mediates high-affinity binding to DEAE-cellulose and to choline moieties present in the S . pneumoniae cell wall . DEAE-cellulose fragments or S . pneumoniae coated uniformly with the ActA/LytA fusion protein nucleate actin filament growth in cytoplasmic extracts, but do not move efficiently . However, when ActA/LytA-coated S . pneumoniae is grown to polarize the distribution of the fusion protein, the bacteria exhibit unidirectional actin-based movement similar to the normal movement of L . monocytogenes.

FEMS Immunol Med Microbiol, 1995 Sep, 12(1), 33 - 41
Deficient antipneumococcal polysaccharide responses in HIV-seropositive patients; Loeliger AE et al.; In a prospective study, serological responses and opsonic activity towards Streptococcus pneumoniae were measured in 60 HIV-infected patients and 25 controls after the administration of the 23-valent pneumococcal vaccine (PneumovaxR) . Serum samples were collected before vaccination and at weeks 1, 2, 4, and 12 after vaccination and were tested for the presence of antibodies against a mixture of capsular polysaccharide antigens (pool) and against type 3 and type 4 antigens (PS3 and PS4), using an ELISA . A serological response was defined as a two-fold or greater increase in serum titer after vaccination . Opsonophagocytosis was measured in patients with a definite response against PS3 . Generally, prevaccination antipneumococcal antibody titers were clearly higher in HIV-infected patients than in healthy controls . After vaccination, antipool antibody responses were found in 76% of vaccinated patients; 24% of the patients were non-responders . In patients with more than 0.300 x 10(9) CD4 + cells per liter the percentage of responders was 94%; in patients with fewer than 0.300 x 10(9) CD4 + cells per liter this percentage was 68% (P < 0.05) . The antipool response in control subjects was 92% . A serological response to PS3 and PS4 was found in 29% and 49% of the patients, respectively, and was correlated with CD4 + cell count . In controls, these percentages were 48% and 92%, respectively . In 30% of responding patients, antibody titers dropped already to prevaccination levels by week 12 after vaccination . Opsonophagocytosis was not significantly improved by vaccination, probably because of a relatively high preexisting opsonic activity . Although prevaccination conditions may have had an important influence on the study outcome, the results are not in favor of a significant beneficial effect of vaccination with PneumovaxR on antibody formation in HIV-infected patients . This raises further questions as to the relevance of pneumococcal vaccination in this population.

FEMS Immunol Med Microbiol, 1995 Sep, 12(1), 1 - 7
Determination of 16S ribosomal RNA gene copy number in Streptococcus uberis, S . agalactiae, S . dysgalactiae and S . parauberis; Bentley RW et al.; Species-specific oligonucleotide probes and a universal oligonucleotide probe derived from sequences of 16S rRNA were hybridised to chromosomal DNA from Streptococcus agalactiae, S . dysgalactiae, S . parauberis and S . uberis following digestion with EcoRI . Due to the presence of a unique EcoRI site in each 16S rRNA gene, the number of hybridised fragments was indicative of the number of 16S rRNA genes . Southern hybridisation indicated six 16S rRNA genes in ten isolates of S . agalactiae, five genes in ten isolates of S . uberis, five genes in six isolates and six in another isolate of S . dysgalactiae, and six genes in four isolates of S . parauberis . For a fifth isolate of S . parauberis, six 16S rRNA genes were indicated by the universal probe but only five when hybridised to the species-specific probe, indicating sequence variation (microheterogeneity) within the probe target region.

J Reprod Med, 1995 Sep, 40(9), 649 - 51
Streptococcus pneumoniae pelvic inflammatory disease . A case report; Chudacoff RM et al.; BACKGROUND: Single-agent causes of pelvic inflammatory disease (PID) are uncommon . Streptococcus pneumoniae, as the suspected sole causative bacterium, has been reported since the 1800s . In the postantibiotic era, 46 cases have been reported, with a high mortality rate . CASE: We report a case of S pneumoniae as a single bacterial etiology of PID . This single bacterial species was documented by separate cervicovaginal, culdocentesis and laparoscopic cultures . CONCLUSION: It is unusual to identify an uncommon, single organism as the causative bacterial species in PID in an immunocompetent patient without evidence of a primary infectious pneumococcal source.

Rinsho Shinkeigaku, 1995 Sep, 35(9), 1044 - 7
{An adult case of bacterial meningitis caused by penicillin-resistant Streptococcus pneumoniae}; Yamawaki M et al.; Recently the incidence of infectious diseases caused by penicillin-resistant Streptococcus pneumoniae (PRSP) is increasing . Patients with meningitis caused by PRSP have been reported with high mortality especially in the field of pediatrics, and it is crucial to treat with accurate and precise choice of antibiotics . We report the first adult case of bacterial meningitis caused by PRSP in Japan . A 32-year-old male without immunological abnormalities developed acute pneumococcal meningitis . Empiric therapy with ampicillin and cefotaxime was not effective and the S . pneumonia from CSF showed resistance to multiple antibiotics such as penicillin and cefotaxime . He was treated successfully with the combination of panipenem/betamipron, vancomycin, and chloramphenicol . We assume that panipenem/betamipron is recommended to be added to empiric therapy of bacterial meningitis, considering an increasing incidence of PRSP infection.

Prenat Diagn, 1995 Sep, 15(9), 809 - 16
Pregnancy outcome after transcervical CVS with a flexible biopsy forceps: evaluation of risk factors; Lunshof S et al.; The pregnancy outcome of 1936 women who had transcervical chorionic villus sampling (CVS) with a flexible biopsy forceps was evaluated . Follow-up until 4 weeks after delivery was 99.4 per cent . Various patient- and procedure-related risk factors for spontaneous loss (fetal or neonatal death) were analysed using stepwise logistic regression analysis . The overall spontaneous loss rate was 4.5 per cent . Factors found to be significantly associated with spontaneous loss were quantity of villi < or = 15 mg (relative risk (RR) 2.13), a history of first-trimester miscarriage (RR 1.87) or delivery between 16 and 27 weeks (RR 3.87), cervical culture positive for anaerobes (RR 4.52) or group B streptococcus (RR 3.62), post-procedural bleeding > 3 days (RR 1.99), and multiple insertions (RR 2.64) . Significant differences in loss rates between individual operators were found . A learning effect was not present . There were no infants born with terminal transversal limb anomalies in our series . We conclude that knowledge about significant risk factors for spontaneous loss after CVS is important both for obstetricians carrying out CVS procedures and for women seeking prenatal diagnosis.

Pediatr Infect Dis J, 1995 Sep, 14(9), 760 - 7
Effect of antibiotic therapy on the outcome of outpatients with unsuspected bacteremia; Harper MB et al.; The records of 559 consecutive outpatient children with unsuspected bacteremia (467 Streptococcus pneumoniae) were reviewed . When compared with patients receiving oral or parenteral antibiotics, those patients who received no antibiotics at the initial visit were in follow-up: (1) less likely to be improved (32% vs . 86%, P < 0.01); (2) more likely to be febrile (75% vs . 28%, P < 0.01); (3) more likely to be hospitalized (67% vs . 22%, P < 0.01); (4) more likely to have persistent bacteremia (28% vs . 3%, P < 0.01); and (5) more likely to have new focal infections (13% vs . 5%, P < 0.01) . Compared with patients receiving parenteral antibiotics at the initial visit, patients receiving oral antibiotics were in follow-up: (1) less likely to be improved (81% vs . 89%, P < 0.05); and (2) more likely to have persistent bacteremia (5% vs . 0%, P < 0.05) . There was no statistical difference between patients receiving parenteral or oral therapy in the development of focal infections, although children with new focal infections receiving oral antibiotics more often had persistent or new positive cultures . No patients receiving parenteral antibiotics at the initial visit had positive blood or spinal fluid cultures at the follow-up visit . Analyses of the subgroups with (1) occult bacteremia with all organisms, (2) unsuspected bacteremia S . pneumoniae and (3) occult bacteremia with S . pneumoniae show results similar to those for the entire group.(ABSTRACT TRUNCATED AT 250 WORDS)

Pediatr Infect Dis J, 1995 Sep, 14(9), 751 - 9
Penicillin-resistant Streptococcus pneumoniae in acute otitis media: risk factors, susceptibility patterns and antimicrobial management; Block SL et al.; From January, 1992, to January, 1994, penicillin-resistant (minimal inhibition concentration (MIC) > 0.06 microgram/ml) Streptococcus pneumoniae (PRSP) isolates accounted for 48 (17%) of 283 isolates from acute otitis media (AOM) or recurrent AOM in 246 ambulatory patients in rural Kentucky . By broth microdilution, relatively penicillin-resistant (MIC > 0.06 to 1.0 microgram/ml) and highly penicillin-resistant (MIC > or = 2.0 micrograms/ml) strains were detected in 25 (16%) and 23 (15%), respectively, of 157 pneumococcal middle ear isolates . Using 1994 National Committee for Clinical Laboratory Standards breakpoints for pneumococci (unavailable for oral cephalosporins except cefuroxime), highly PRSP strains were almost uniformly susceptible to clindamycin and vancomycin . In contrast highly PRSP strains were resistant to most oral antimicrobials customarily used for AOM with one-third of strains highly resistant (MIC > or = 2.0 micrograms/ml) to ceftriaxone . Serotypes 6B, 19F and 23F accounted for 95% of highly PRSP strains and serotype 9V for 48% of relatively PRSP strains . By multivariate analysis, otitis-prone condition (P = 0.0008) and number of antibiotic courses before day of culture (P < 0.0001) were independently predictive of PRSP . Highly PRSP isolates were more commonly isolated from patients recently treated within 3 days (30%) vs . those who completed therapy more than 3 days earlier (2%) (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Pediatr Infect Dis J, 1995 Sep, 14(9), 745 - 50
High prevalence of multidrug-resistant Streptococcus pneumoniae among children in a rural Kentucky community; Duchin JS et al.; In 1992 drug-resistant Streptococcus pneumoniae was cultured with increasing frequency from aspirates of middle ear fluid from children with acute otitis media in a rural Kentucky community . To determine the prevalence of carriage of drug-resistant S . pneumoniae in the community, we obtained nasopharyngeal swabs from 158 (70%) of 227 children attending a child daycare center and from 82 children attending the county health center . S . pneumoniae was isolated from 126 children . Among 123 isolates tested 65 (53%) were penicillin-resistant, including 41 (33%) strains that were highly resistant; 61 (50%) were multidrug-resistant . Serotypes 19F, 6B, 23F and 6A comprised 89% of the penicillin-resistant isolates . Detection of a variety of serotypes and drug resistance patterns among nasopharyngeal isolates of S . pneumoniae suggests that multidrug-resistant pneumococcal strains are endemic in this community . Surveillance for drug-resistant pneumococci with the use of respiratory secretions obtained by nasopharyngeal swab may provide useful information on the prevalence of drug-resistant strains causing invasive disease and otitis media . Such information could be used to guide empiric therapy of pneumococcal infections.

Microb Pathog, 1995 Sep, 19(3), 129 - 37
Fibronectin binding by Streptococcus milleri group strains and partial characterisation of the fibronectin receptor of Streptococcus anginosus F4; Willcox MD et al.; The Streptococcus milleri group were shown to bind fibronectin (Fn) to their cell-surface and this binding increased the adhesion of cells to hydroxyapatite . The binding of Fn to Streptococcus anginosus F4 was studied in more detail . Fn binding to bacterial cells increased the association of the bacteria with the polymorphonuclear leukocytes obtained from the peritoneal cavity of rats but did not increase killing of the bacteria . The cell-surface receptor was a protein of M(r) 14,000 which was released from cells after mutanolysin digestion . The binding was specific, with cells having a maximum number of binding sites per cell of 770 . Electron microscopy, using gold-labelled Fn, localised the receptor to areas between daughter cells.

Clin Diagn Lab Immunol, 1995 Sep, 2(5), 590 - 7
Assignment of weight-based antibody units to a human antipneumococcal standard reference serum, lot 89-S; Quataert SA et al.; A human reference serum pool, lot 89-S, has been developed for use in quantitating concentrations of antibody to Streptococcus pneumoniae . Weight-based units have been assigned to antibodies to 11 pneumococcal polysaccharide (PnPs) serotypes (1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F) by using enzyme-linked immunosorbent assay methodology and a human standard reference serum, USNRP IS 1644 . The experimentally derived assignments for anti-PnPs antibodies of the immunoglobulin G (IgG), IgM, and IgA isotypes in lot 89-S correlate well to the separately determined immunoglobulin assignment . These assignments for this antipneumococcal standard serum were used to quantitate IgG, IgM, and IgA isotype levels and the total immunoglobulin level in pediatric samples from a pneumococcal conjugate vaccine trial . The data indicate that these assignments may be used to assess levels of antibody to PnPs serotypes in human serum.

Antimicrob Agents Chemother, 1995 Sep, 39(9), 2158 - 60
Influence of dexamethasone on efficacy of ceftriaxone and vancomycin therapy in experimental pneumococcal meningitis; Cabellos C et al.; Using a rabbit model of meningitis, we sought to determine whether concomitant use of dexamethasone affects the penetration and efficacy of ceftriaxone or vancomycin in cerebrospinal fluid . Rabbits were inoculated with a penicillin-sensitive strain of Streptococcus pneumoniae and treated with ceftriaxone or vancomycin with or without dexamethasone . In the ceftriaxone-treated groups, no statistically significant differences were seen between the group treated with dexamethasone and that without dexamethasone; however, in the vancomycin-treated groups we found statistically significant lower cerebrospinal fluid vancomycin levels at 2 h in the dexamethasone-treated rabbits and differences in bacterial killing.

Antimicrob Agents Chemother, 1995 Sep, 39(9), 1988 - 92
Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis; Klugman KP et al.; There are reports of failure of extended-spectrum cephalosporin treatment in pneumococcal meningitis . On the basis of in vitro and animal experimental studies, the addition of vancomycin or rifampin to an extended-spectrum cephalosporin has been recommended for empiric treatment of these patients . Cerebrospinal fluid (CSF) was taken from 31 children with bacterial meningitis randomized to receive ceftriaxone alone (n = 11), ceftriaxone plus rifampin (n = 10), or ceftriaxone plus vancomycin (n = 10) . The CSF from children receiving ceftriaxone alone was unable to kill intermediately ceftriaxone-resistant or fully resistant strains when the concentration of ceftriaxone in the CSF was less than 5 micrograms/ml . At higher concentrations bactericidal activity was present . We have shown that vancomycin penetrates reliably into the CSF of children with acute meningitis, which is in contrast to previous studies with adults . The addition of vancomycin or rifampin to ceftriaxone resulted in significantly enhanced CSF bactericidal activity compared with that of ceftriaxone alone against these resistant strains . Our data suggest that the addition of rifampin or vancomycin to ceftriaxone may be useful for the treatment of cephalosporin-resistant pneumococcal meningitis.

Eur J Clin Microbiol Infect Dis, 1995 Sep, 14(9), 818 - 20
Hydrolytic enzymes of Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedius in relation to infection; Jacobs JA et al.; A collection of 518 'Streptococcus milleri' strains was tested for the presence of hydrolytic enzymes, and the results were related to the clinical significance of the strains . Ribonuclease activity was equally distributed among the three species while hyaluronidase activity was linked to Streptococcus intermedius and Streptococcus constellatus . Both enzymes were not significantly associated with infection-related strains . Deoxyribonuclease and chondroitin sulfatase activity tended to be present more frequently in Streptococcus intermedius and Streptococcus constellatus and was associated with infection-related strains (p < 0.001).

Eur J Clin Microbiol Infect Dis, 1995 Sep, 14(9), 799 - 801
Neonatal infection with Streptococcus milleri; Raymond J et al.; Streptococcus milleri is a known commensal of the female genitourinary tract, but its pathogenicity in neonates has been reported in only a few cases . During a period of one year in an obstetrical unit, Streptococcus milleri was isolated from nine neonates and from one foetus after a spontaneous abortion . In seven of the nine newborns, neonatal infection was assessed and Streptococcus milleri was the lone pathogen involved, associated with positive blood or vaginal cultures in four mothers . Because Streptococcus milleri requires special conditions for identification, it is probably underestimated as a cause of neonatal infection and septic abortion.

Vet Immunol Immunopathol, 1995 Sep, 48(1-2), 139 - 54
An assessment of mucosal immunisation in protection against Streptococcus equi ('Strangles') infections in horses; Wallace FJ et al.; The ability of mucosally administered antigen to provide protection against Streptococcus equi ('Strangles') infections in horses was examined . First, an enzyme linked immunosorbent assay (ELISA) was developed to detect the immune status of horses to S . equi . This assay was used to select Strangles-naive horses for the study and also to monitor their response to immunisation . Potential vaccine candidates were: (a) orally administered paraformaldehyde killed S . equi; (b) intraperitoneally (IP) administered paraformaldehyde killed S . equi in a non-inflammatory adjuvant; (c) orally administered live avirulent S . equi; (d) orally administered microencapsulated streptococcal M protein . The latter three preparations were first assessed in a rat model, using rate of lung bacterial clearance following intratracheal inoculation of live virulent bacteria as an indication of efficacy . Candidates (a) and (b) were then assessed in an equine model . IP immunisation of horses was shown to effectively induce production of specific antibody in mucosal and systemic sites . Four weeks after initial immunisation, horses were challenged intranasally with live virulent S . equi . Both groups of immunised horses demonstrated partial protection following vaccination . Of the IP immunised horses, only two out of four developed clinical signs of Strangles following live challenge . The orally immunised horses all developed submandibular abscesses containing S . equi . However, none of the immunised horses became as ill as the control horses in terms of fever, anorexia, loss of condition and general malaise.

Zh Mikrobiol Epidemiol Immunobiol, 1995 Sep-Oct, (5), 23 - 6
{Streptococcus pneumoniae adhesion}; Kvetnaia AS et al.; The adhesive capacity of 425 S.pneumoniae strains (S- and R-forms) isolated from children with various clinical forms of pneumococcal infection was studied with the use of the epithelium of oral cavity as a model . The strains isolated from patients with meningitis and otitis appeared to be less adhesive than the strains isolated from mucous membrane of respiratory tracts . In all clinical forms of infections the adhesive capacity of S.pneumoniae S-forms was significantly lower than that of R-forms . The hyaluronidase activity and the adhesive capacity of S.pneumoniae strains were found to be inversely related.

Arch Surg, 1995 Sep, 130(9), 946 - 50; discussion 951
Pneumococcal clearance function of the intact autotransplanted spleen; Zhao B et al.; OBJECTIVE: To determine if the venous drainage of the spleen into the portal circulation is essential for its ability to protect against encapsulated bacterial challenge . DESIGN AND INTERVENTIONS: Three groups of dogs were randomly assigned to undergo either sham laparotomy, splenectomy, or splenectomy with autotransplantation of the intact spleen into the pelvis and formation of vascular anastomoses to the iliac vessels . Two weeks post-operatively, the dogs received a sublethal intravenous injection of Streptococcus pneumoniae type 25 . OUTCOME MEASURES: Bacterial clearances and inflammatory damage to the liver . Bacterial clearance of the autotransplanted spleen should be no different from that of a sham-operation spleen and significantly different from that of a splenectomized animal . In addition, immunologic function of the autotransplanted spleen should not differ from that of a sham-operation spleen in the degree of inflammatory damage to the liver . RESULTS: No differences in bacterial clearance function were found between the animals that had undergone sham laparotomy or splenic autotransplantation . However, bacterial clearance in the splenectomized animals was significantly impaired . Histologic examination of the liver 2 weeks after the bacterial challenge revealed high-grade inflammatory damage to the livers of splenectomized dogs, intermediate liver damage in dogs that underwent autotransplantation, and essentially no damage in dogs that underwent sham laparotomy . Autotransplanted spleens were essentially nonreactive, lacking actively proliferating germinal centers, whereas splenic tissue from sham-operation animals showed reactivity . CONCLUSION: Although bacterial clearance function is unchanged in autotransplanted spleens, this method still does not fully protect the liver from inflammatory damage.

J Infect Dis, 1995 Sep, 172(3), 805 - 9
The limited role of pneumolysin in the pathogenesis of pneumococcal meningitis; Friedland IR et al.; The aim of this study was to determine the role of pneumolysin, an intracellular toxin of Streptococcus pneumoniae, in the pathogenesis of pneumococcal meningitis . Recombinant pneumolysin (1 microgram), when injected intracisternally into rabbits, resulted in a brisk inflammatory response . However, a pneumolysin-deficient strain of S . pneumoniae caused meningeal inflammation in rabbits indistinguishable from that induced by the parent pneumolysin-producing strain . Furthermore, similar enhancement of meningeal inflammation occurred after ampicillin therapy in animals infected with either the parent strain or the pneumolysin-deficient mutant . These results suggest that although pneumolysin can stimulate the inflammatory cascade in the central nervous system, it is not necessary for the pathogenesis of meningeal inflammation nor does it play a role in postantibiotic enhancement of meningeal inflammation.

J Immunol, 1995 Sep 1, 155(5), 2557 - 63
Human C-reactive protein is protective against fatal Streptococcus pneumoniae infection in transgenic mice; Szalai AJ et al.; C-reactive protein (CRP) is an acute phase protein with a well known association with infection and other inflammatory conditions . Studies with use of purified CRP in in vitro assays provided early evidence that CRP has antibacterial activity . Subsequently it was shown that passively administered human CRP can protect mice from lethal infection with Streptococcus pneumoniae . In this study, we extend these observations to an in vivo model of host resistance by using human CRP transgenic mice . CRP transgenic mice experimentally infected with S . pneumoniae lived longer and had significantly lower mortality than their nontransgenic littermates . This increased resistance to infection was associated with q 10- to 400-fold reduction of bacteremia . Furthermore, male transgenics exhibited longer survival time than females, and this difference could be attributed to increased expression of CRP by males, which was mediated by testosterone . This study provides the first unequivocal evidence that CRP plays an important role in vivo in host defense against pneumococcal infections, and shows that sex hormones can affect expression of the human CRP transgene in mice.

Infect Immun, 1995 Sep, 63(9), 3649 - 58
T-cell, adhesion, and B-cell epitopes of the cell surface Streptococcus mutans protein antigen I/II; Kelly CG et al.; The T-cell and antibody responses to a cell surface streptococcal antigen (SA I/II) were investigated in naturally sensitized humans . Serum antibody responses were directed predominantly to the N-terminal (residues 39 to 481) and central (residues 816 to 1213) regions of SA I/II which may be involved in bacterial adhesion to salivary receptors . T-cell responses were also directed predominantly towards the central region . The linear peptide relationship of the immunodominant and minor T- and B-cell as well as adhesion epitopes was mapped within residues 816 to 1213 . Immunodominant T-cell and B-cell epitopes were identified within residues 803 to 853, which were separated in linear sequence from the adhesion epitopes (residues 1005 to 1044) . Adhesion epitopes overlapped with minor B- and T-cell epitopes (residues 1005 to 1054 and 1085 to 1134) . An immunodominant promiscuous T-cell epitope (residues 985 to 1004) was adjacent to an adhesion epitope (residues 1005 to 1024) . The limited B-cell response to adhesion epitopes is consistent with the success of Streptococcus mutans in colonizing the oral cavity . The strategy of T-cell, adhesion, and B-cell epitope mapping has revealed a general approach for identifying components of subunit vaccines which may focus responses to critical functional determinants . Such epitopes of SA I/II may constitute the components of a subunit vaccine against dental caries.

Infect Immun, 1995 Sep, 63(9), 3628 - 33
Platelet receptors for the Streptococcus sanguis adhesin and aggregation-associated antigens are distinguished by anti-idiotypical monoclonal antibodies; Gong K et al.; Platelets aggregate in response to an adhesin and the platelet aggregation-associated protein (PAAP) expressed on the cell surfaces of certain strains of Streptococcus sanguis . We sought to identify the corresponding PAAP receptor and accessory adhesin binding sites on platelets . Since the adhesion(s) of S . sanguis for platelets has not been characterized, an anti-idiotype (anti-id) murine monoclonal antibody (MAb2) strategy was developed . First, MAb1s that distinguished the adhesin and PAAP antigens on the surface of S . sanguis I 133-79 were selected . Fab fragments of MAb1.2 (immunoglobulin G2b {IgG2b}; 70 pmol) reacted with 5 x 10(7) cells of S . sanguis to completely inhibit the aggregation of human platelets in plasma . Under similar conditions, MAb1.1 (IgG1) inhibited the adhesion of S . sanguis cells to platelets by a maximum of 34%, with a comparatively small effect on platelet aggregation . Together, these two MAb1s inhibited S . sanguis-platelet adhesion by 63% . In Western immunoblots, both MAb1s reacted with S . sanguis 133-79 87- and 150-kDa surface proteins and MAb1.2 also reacted with purified type I collagen . The hybridomas producing MAb1.1 and MAb1.2 were then injected into BALB/c mice . Enlarged spleens were harvested, and a panel of MAb2 hybridomas was prepared . To identify anti-ids against the specific MAb1s, the MAb2 panel was screened by enzyme-linked immunosorbent assay for reaction with rabbit polyclonal IgG antibodies against the 87- and 150-kDa antigens . The reactions between the specific rabbit antibodies and anti-ids were inhibited by the 87- and 150-kDa antigens . When preincubated with platelets, MAb2.1 (counterpart of MAb1.1) inhibited adhesion to platelets maximally by 46% and MAb2.2 (anti-MAb1.2) inhibited adhesion to platelets maximally by 35% . Together, both MAb2s inhibited the adhesion of S . sanguis to platelets by 81% . MAb2.2 also inhibited induction of platelet aggregation . MAb2.2 immunoprecipitated a biotinylated platelet membrane antigen of 170 kDa (unreduced); MAb2.1 precipitated membrane antigens of 175- and 230-kDa (unreduced) . Therefore, platelet binding sites and the receptor for the S . sanguis adhesin and PAAP, respectively, are distinguished by the anti-id MAb2s.

Infect Immun, 1995 Sep, 63(9), 3422 - 7
Deposition of complement components on Streptococcus agalactiae in bovine milk in the absence of inflammation; Rainard P et al.; Bovine milk is generally considered to be almost devoid of complement, on the basis of undetectable hemolytic activity, unless inflammation recruits plasma components . This study examines the deposition of complement components on a mastitis-causing isolate of Streptococcus agalactiae by enzyme-linked immunosorbent assay (ELISA) . Neat milk from mid-lactating, uninflamed mammary glands (normal milk) effected marked C3 deposition on bacteria . Kinetic studies showed a protracted lag period (30 to 45 min) preceding C3 deposition, which required about 2 h to reach a maximum . Experiments with diluted serum suggested that this slow C3 deposition resulted mainly from the low concentration of certain components of complement in milk . Bacteria incubated in neat milk readily bound bovine conglutinin, indicating the presence of iC3b . Elution of covalently bound C3 fragments with hydroxylamine confirmed the deposition of C3b and iC3b on bacteria . Deposition of C4 on bacteria was not detected in neat milk, suggesting that C3 deposition did not result from the activation of the classical pathway . This was not the result of a lack of antibodies . However, C4 deposition could be obtained by adding purified bovine C1q to normal milk, and C3 deposition was accelerated, suggesting the participation of the classical pathway . The deposition of C1q on antibody-sensitized bacteria was impeded by milk compared with that of C1q diluted in phosphate-buffered saline . Concentrations of C1q in normal milk were very low, ranging from 150 to 250 ng/ml . Overall, these findings indicate that C1q was a limiting factor of the classical pathway in normal milk . The capacity of milk to deposit C3 fragments on mastitis-causing S . agalactiae prompts further studies to investigate its role in opsonophagocytosis.

Infect Immun, 1995 Sep, 63(9), 3287 - 96
Characterization of inhibitory effects of suspected periodontopathogens on osteogenesis in vitro; Loomer PM et al.; By using an in vitro bone-forming culture system, the chick periosteal osteogenesis (CPO) model, the direct effects on osteogenesis of sonicated extracts derived from oral bacteria were examined . Both extracts from bacterial species having strong associations with periodontal diseases (Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, and Prevotella intermedia, hereinafter referred to as suspected periodontopathogens) and extracts from species not correlated with periodontal disease (Streptococcus sanguis, Veillonella atypica, and Prevotella denticola, hereinafter referred to as nonpathogenic bacteria) were tested . All bacterial cultures were grown under standard anaerobic culture conditions . Sonicated bacterial extracts were prepared from the bacterial pellet . These were added in various proportions to the CPO cultures . Parameters of osteogenesis, including alkaline phosphatase activity, calcium and P(i) accumulation, and collagen synthesis, were measured in 6-day-old cultures . Compared with controls grown in the absence of bacterial products, osteogenesis was inhibited significantly in cultures treated with extracts derived from the suspected periodontopathogens . No osteogenic inhibition was observed in cultures treated with extracts from the nonpathogenic bacteria . These results suggest that the ability to inhibit osteogenesis in vitro may be a pathogenic property shared by a limited group of species . Further characterization of the P . gingivalis extracts revealed that both proteinaceous and nonproteinaceous products, including lipopolysaccharide, were able to inhibit osteogenesis . P . gingivalis extract-mediated inhibition of osteogenesis in CPO cultures was blocked by indomethacin, implicating prostaglandins in the regulation of the bacterial effects . The bacterial extracts had either reversible or irreversible inhibitory effects on osteogenesis when added after differentiation or before/during differentiation of bone cells, respectively.

Kansenshogaku Zasshi, 1995 Sep, 69(9), 1012 - 6
{A case of toxic shock-like syndrome due to Streptococcus pyogenes}; Okabe T et al.; A case of toxic-shock syndrome due to Streptococcus pyogenes is reported . A 76-year-old female was admitted with complaints of fevers and chills . She had been suffering from cellulitis on her right dorsum pedis for 7 months . Laboratory data on admission showed elevated values of WBC, CRP, and dysfunction of the liver and kidney . She was diagnosed as sepsis due to the cellulitis, and was treated with PIPC and FMOX . However, several hours after admission, her blood pressure decreased and oliguria appeared . Bacteriological examinations from the blood and the cellulitis revealed group A beta-hemolytic Streptococcus which gave streptococcal pyrogenic exotoxin (T-28, SPE.B + C) . She died 23 hours after her admission in spite of changing antibiotics to a high-dose of PC-G therapy . This is one of the rare cases of toxic shock-like syndrome due to Streptococcus pyogenes from the cellulitis of the dorsum pedis.

J Pediatr Orthop, 1995 Sep-Oct, 15(5), 661 - 5
Poststreptococcal reactive arthritis mimicking acute septic arthritis: a hospital-based study; Birdi N et al.; Poststreptococcal reactive arthritis (PSRA) is an inflammatory arthritis that follows group A streptococcal pharyngitis . The clinical presentation of PSRA can mimic acute septic arthritis . We present 12 children with PSRA seen between December 1991 and September 1993 . Most children had only mild pharyngitis by history . The pattern of arthritis was variable and included migratory polyarthritis, additive polyarthritis, and monoarthritis, and was accompanied by fever in seven children . In four patients, the presentation of fever and acute onset of painful monoarthritis mimicked septic arthritis, and synovial fluid cultures were negative in all four cases . All 12 patients demonstrated an immune response to group A streptococcus . PSRA should be in the differential diagnosis of any child presenting with acute onset of painful arthritis, including those cases of presumed septic arthritis with negative synovial fluid cultures.

Jpn J Cancer Res, 1995 Sep, 86(9), 791 - 4
Presence of Streptococcus DNA sequence in surgical specimens of gastric cancer; Sasaki H et al.; In Southern blot analysis using Mycoplasma 16S ribosomal DNA (rDNA) as a probe, positive signals were detected in DNA samples from surgical specimens of gastric cancers . The DNA that hybridized to Mycoplasma 16S rDNA was eluted from the gel, cloned and sequenced . The cloned sequence was identical to 16S rDNA of Streptococcus anginosus . In Southern blot analysis with the S . anginosus 16S rDNA fragment as a new probe, positive signals were detected in 9 (20%) out of 43 cases of gastric cancer.

Can J Microbiol, 1995 Sep, 41(9), 785 - 91
Weak acid effects and fluoride inhibition of glycolysis by Streptococcus mutans GS-5; Belli WA et al.; Fluoride and a variety of other weak acids acted to reduce reversibily the acid tolerance of glycolysis by intact cells of Streptococcus mutans GS-5 as shown by higher final pH values in acid-drop experiments with glucose in excess . The order of effectiveness was fluoride > indomethacin > ibuprofen > ketoprofen > salicylate > sorbate > cinnamate > p-hydroxybenzoate > benzoate > ascorbate . Only fluoride also acted as an inhibitor of the glycolytic enzyme enolase . However, enolase in permeabilized cells was also inhibited by acidification with a sharp drop-off in activity between pH 6 and 5 . It was proposed that the weak acids, including fluoride, acted to reduce glycolytic acid tolerance by enhancing cytoplasmic acidification and thereby inhibiting enzymes such as enolase . The potencies of the acids could not be predicted accurately from knowledge of pKa values, octanol-water partition coefficients, and molecular weights . It was concluded that their modes of action in acid sensitization involved perturbations of membrane function in addition to their acting as transmembrane carriers of protons . Methylparaben (methyl ester of p-hydroxybenzoate) was also a sensitizer but was less effective than the parent acid.

Am J Obstet Gynecol, 1995 Sep, 173(3 Pt 1), 842 - 6
Prenatal screening for group B Streptococcus . II . Impact of antepartum screening and prophylaxis on neonatal care; Mercer BM et al.; OBJECTIVES: Our purpose was to evaluate the current practice of antimicrobial prophylaxis of preterm and low-birth-weight infants and to determine the impact of intrapartum fever, group B Streptococcus carriage, intrapartum antimicrobial therapy, and duration of membrane rupture on neonatal therapy . STUDY DESIGN: A total of 1356 members of the American Academy of Pediatrics were asked their practice regarding neonatal screening and antimicrobial prophylaxis . Respondents were asked to define how maternal fever, group B Streptococcus carriage, intrapartum antimicrobial therapy, and prolonged membrane rupture would affect their decisions regarding neonatal therapy . RESULTS: A total of 982 responses were obtained (72.4%) . Routine antimicrobial prophylaxis is given to asymptomatic preterm neonates by 33.7% of pediatricians . Prophylaxis is inconsistently given at 32 to 36 weeks but is nearly universal after intrapartum fever, regardless of intrapartum therapy . If empiric intrapartum prophylaxis was given before a preterm birth, both the incidence (47.1% vs 29.1%) and frequency of prolonged neonatal therapy (30.1% vs 17.4% > or = 7 days) would be increased . Knowledge of maternal group B Streptococcus carriage would lead to a 2.6-fold increase in treatment (75.1% vs 29.1%) and 1.8-fold increase in the incidence of prolonged therapy of preterm infants (30.9% vs 17.4%), with 45.3% giving antibiotics for > or = 1 week if intrapartum treatment had been instituted . Surprisingly, 18% of pediatricians would treat term neonates without any risk factors other than maternal group B streptococcal carriage, and 32.7% would continue treatment for > or = 7 days . The majority of pediatricians (82.6%) felt that intrapartum prophylaxis would reduce early-onset group B streptococcal sepsis, but only 46.0% felt overall neonatal sepsis would be decreased by such therapy . CONCLUSIONS: Antepartum screening and intrapartum prophylaxis against group B Streptococcus by obstetricians may lead to an increased incidence and duration of treatment of preterm and term neonates by the pediatrician . The efficacy, cost, and risk of such treatment in broadly applied screening and treatment programs should be considered before a standard of care is established.

Am J Obstet Gynecol, 1995 Sep, 173(3 Pt 1), 837 - 41
Prenatal screening for group B Streptococcus . I . Impact of antepartum screening on antenatal prophylaxis and intrapartum care; Mercer BM et al.; OBJECTIVE: Our purpose was to evaluate current obstetric practice regarding screening and prophylaxis for group B Streptococcus and to evaluate the impact of screening on antepartum and intrapartum care . STUDY DESIGN: A total of 1232 members of the Society of Perinatal Obstetricians were asked to indicate their practices regarding screening for group B Streptococcus . Respondents were then asked their practices regarding antepartum and intrapartum prophylaxis on the basis of screening cultures, prior antimicrobial treatment, and other risk factors for neonatal sepsis . RESULTS: Of the 925 respondents (75.1%), 30.8% performed routine screening in all pregnancies: first prenatal visit (42.3%), 26 to 28 weeks (41.3%), and 34 to 38 weeks (22.1%) . In addition, 65.9% would screen patients only under high-risk situations . Although 70.5% sample multiple sites, respondents were inconsistent regarding the sites from which cultures are obtained: distal vagina (64.2%), cervix (53.9%), proximal vagina (40.0%), anal canal (38.5%), and urethra (4.3%) . A total of 34.7% of respondents would treat the patient at the time of a positive culture . Knowledge of maternal group B Streptococcus carriage would significantly alter intrapartum prophylaxis in low-risk (60.3% vs 0.5%) and various high-risk populations (74.0% to 98.4% vs 11.3% to 55.0%) . However, no consensus as to optimal practice was identified . CONCLUSIONS: This survey demonstrates significant inconsistencies in screening and prophylaxis for group B Streptococcus by specialists in maternal-fetal medicine . In addition, it reveals that the recommendations of The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics are not routinely followed by these specialists . Knowledge of group B Streptococcus carriage significantly increases antepartum and intrapartum treatment regardless of the presence of other risk factors for neonatal sepsis . The impact of this practice on neonatal therapy warrants further evaluation.

J Dent Res, 1995 Sep, 74(9), 1613 - 7
Effect of sucrose monolaurate on acid production, levels of glycolytic intermediates, and enzyme activities of Streptococcus mutans NCTC 10449; Iwami Y et al.; We studied the mechanism by which the antimicrobial compound sucrose monolaurate inhibits Streptococcus mutans NCTC 10449 by determining its effect on the rate of acid production from glucose and sucrose and the intracellular and extracellular levels of glycolytic intermediates . Sucrose monolaurate was more effective than either sodium laurate or sodium fluoride in inhibiting acid production at pH 7.0 from glucose . Inhibition of acid production was the same when either glucose or sucrose was the carbon source and in the presence or absence of oxygen . Quantitative analysis of various glycolytic intermediates revealed that the steps inhibited by sucrose monolaurate were the reactions catalyzed by phosphofructokinase and glyceraldehyde 3-phosphate dehydrogenase and/or phosphoglycerate kinase . Since the activities of these enzymes in cell-free extracts were not decreased by the addition of sucrose monolaurate, the inhibition of acid production could not be ascribed to direct effects on the enzymes . A decrease in the rate of acid production with corresponding elevations in the extracellular levels of glycolytic intermediates indicates that sucrose monolaurate inhibits S . mutans by altering the permeability of the cell membrane, which causes a loss of important metabolites.

Vestn Otorinolaringol, 1995 Sep-Oct, (5), 40 - 3
{Dirithromycin, a new antibiotic in the treatment of pharyngeal inflammation}; Riazantsev SV et al.; The trial of a new antibiotic dirithromycin against acute pharyngitis and tonsillitis for safety and efficacy included 28 patients with acute tonsillitis and pharyngitis . Microbiological, biochemical, clinical and laboratory tests were conducted throughout the treatment and 2-3 weeks after the end of dirithromycin administration . The results support dirithromycin clinical potential in acute, chronic pharyngeal inflammation due to its high selective activity in relation to beta-hemolytic streptococcus A and the absence of side effects.

Microbiology, 1995 Sep, 141 ( Pt 9), 2261 - 9
Regulation of the lactose phosphotransferase system of Streptococcus bovis by glucose: independence of inducer exclusion and expulsion mechanisms; Cook GM et al.; Streptococcus bovis had a diauxic pattern of glucose and lactose utilization, and both of these sugars were transported by the sugar phosphotransferase system (PTS) . Lactose catabolism was inducible, and S . bovis used the tagatose pathway to ferment lactose . Since a mutant that was deficient in glucose PTS activity transported lactose as fast as the wild-type, it appeared that S . bovis has separate enzyme IIs for glucose and lactose . The nonmetabolizable glucose analogue 2-deoxyglucose (2-DG) was a noncompetitive inhibitor of methyl beta-D-thiogalactopyranoside (TMG) transport, and cells that were provided with either glucose or 2-DG were unable to transport TMG or lactose . Because the glucose-PTS-deficient mutant could ferment glucose, but could not exclude TMG, it appeared that enzyme IIGlc rather than glucose catabolism per se was the critical feature of inducer exclusion . Cells that had accumulated TMG as TMG 6-phosphate expelled free TMG when glucose was added, but 2-DG was unable to cause TMG expulsion . The glucose-PTS-deficient mutant could still expel TMG in the presence of exogenous glucose . Membrane vesicles also exhibited glucose-dependent TMG exclusion and TMG expulsion . Membrane vesicles that were electroporated with phosphoenolpyruvate (PEP) and HPr retained TMG for more than 3 min, but vesicles that were electroporated with PEP plus HPr and fructose 1,6-diphosphate (FDP) (or glycerate 2-phosphate) lost their ability to retain TMG . Because FDP was able to trigger the ATP-dependent phosphorylation of HPr, it appeared that inducer expulsion was mediated by an FDP-activated protein kinase.(ABSTRACT TRUNCATED AT 250 WORDS)

Microbiology, 1995 Sep, 141 ( Pt 9), 2047 - 52
A murC gene in Porphyromonas gingivalis 381; Ansai T et al.; The gene encoding a 51 kDa polypeptide of Porphyromonas gingivalis 381 was isolated by immunoblotting using an antiserum raised against P . gingivalis alkaline phosphatase . DNA sequence analysis of a 2.5 kb DNA fragment containing a gene encoding the 51 kDa protein revealed one complete and two incomplete ORFs . Database searches using the FASTA program revealed significant homology between the P . gingivalis 51 kDa protein and the MurC protein of Escherichia coli, which functions in peptidoglycan synthesis . The cloned 51 kDa protein encoded a functional product that complemented an E . coli murC mutant . Moreover, the ORF just upstream of murC coded for a protein that was 31% homologous with the E . coli MurG protein . The ORF just downstream of murC coded for a protein that was 17% homologous with the Streptococcus pneumoniae penicillin-binding protein 2B (PBP2B), which functions in peptidoglycan synthesis and is responsible for antibiotic resistance . These results suggest that P . gingivalis contains a homologue of the E . coli peptidoglycan synthesis gene murC and indicate the possibility of a cluster of genes responsible for cell division and cell growth, as in the E . coli mra region.

J Clin Microbiol, 1995 Sep, 33(9), 2492 - 5
Streptococcus pneumoniae types 19A and 19F and Streptococcus suis capsular type 8 share common capsular epitopes; Gottschalk M et al.; Two monoclonal antibodies (MAbs) to Streptococcus pneumoniae types 19A and 19F were tested with the 35 reference strains and 334 field strains of Streptococcus suis by dot blotting . Both MAbs reacted with the capsular type 8 reference strain, and one reacted with 69% and one reacted with 100% of 81 S . suis capsular type 8 field strains tested . Epitopes recognized by both MAbs are capsular in origin.

J Clin Microbiol, 1995 Sep, 33(9), 2334 - 7
Evaluation of accuracy and reproducibility of E test for susceptibility testing of Streptococcus pneumoniae to penicillin, cefotaxime, and ceftriaxone; Skulnick M et al.; We evaluated the reproducibility with which technologists perform and interpret the E test (AB Biodisk, North America, Inc., Piscataway, N.J.) for determining the susceptibility of Streptococcus pneumoniae to penicillin, cefotaxime, and ceftriaxone . Four technologists prepared E test assays to test 124 isolates of S . pneumoniae . Each technologist then interpreted the results of the E test blinded to the interpretation of the other technologists . In addition, E test results were compared with the reference method of broth microdilution . Intraobserver and interobserver agreement were assessed by use of the kappa statistic . Interpretation of the E test and broth microdilution results showed substantial to excellent agreement, with kappa values ranging from 0.878 to 0.987 . Compared with broth microdilution, no very major errors and only four major errors were made with the E test . Most minor errors with penicillin and ceftriaxone occurred for isolates with intermediate or high-level resistance, whereas for cefotaxime the minor errors were more evenly distributed between susceptible and intermediate resistance and between intermediate and high-level resistance . These results indicate that there is good agreement between technologists for the interpretation of the E test when testing the susceptibility of S . pneumoniae to penicillin, cefotaxime, and ceftriaxone and that the results of the E test agree with those of broth microdilution.

Bull Group Int Rech Sci Stomatol Odontol, 1995 Sep-Oct, 38(3-4), 87 - 93
Antibacterial action of dental cements: an in vitro study; Morrier JJ et al.; The antibacterial activity of seven commercially available dental cements (Eugespad, Dentical, Dycal, Expaliner, PR . Scell, PR . Base Cement, PR . Lining Cement) against 1) bacterial species implicated in carious lesions or in dental plaque (Actinomyces israelii ATCC 10048, Actinomyces viscosus ATCC 19246, Streptococcus mutans ATCC 25175, Streptococcus sanguis ATCC 10557) and 2) bacterial samples of stimulated saliva was studied, in vitro, using a modification of the method of McComb and Ericson (1987) . Dycal and Expaliner did not affect bacteria whereas the other dental cements displayed some antibacterial properties . Eugespad was the most active followed by PR . Base Cement + PR . Scell + Dentical and by PR . Lining Cement . Associated with mechanical and biocompatibility properties, these differences could be taken into account when choosing a dental cement for clinical use.

J Nihon Univ Sch Dent, 1995 Sep, 37(3), 170 - 7
Adsorption of saliva-coated and just-harvested Streptococcus sanguis to saliva-coated hydroxyapatite beads; Tamura M et al.; It is possible that salivary proteins on bacterial cells have some influence on the adsorption of oral bacteria to the surface of oral tissues . The aim of this study was to clarify the influence of salivary proteins attached to the surface of Streptococcus sanguis ATCC 10556 (S . sanguis) on bacterial adsorption to hydroxyapatite beads treated with salivary proteins (S-HA beads) . Just-harvested cells (N-system) and saliva-coated cells (C-system) were used . The results showed that adsorption to S-HA beads was gradually reduced by a covering of salivary proteins . No influence was observed on the adsorption of cells due to the presence of divalent cations, phosphate or EDTA when the N-system and C-system were compared . Though it was evident that hydrophobic bonding was involved in adsorption in the N-system, few such effects were observed in the C-system . Adsorption was inhibited to varying degrees by sugars in both systems . Pretreatment of cells with heat affected adsorption differently in the N-system and C-system . These findings suggest that salivary proteins attached to the bacterial cell surface may influence its adsorption to oral tissues.

J Clin Pathol, 1995 Sep, 48(9), 803 - 6
Detection of C-polysaccharide in serum of patients with Streptococcus pneumoniae bacteraemia; Gillespie SH et al.; AIM--To investigate the fate of Streptococcus pneumoniae C-polysaccharide antigen in serum in patients with S pneumoniae bacteraemia . METHOD--In vitro dissociation experiments were performed to demonstrate that C-polysaccharide was masked by ligands in normal and acute phase serum . Serum samples from 22 patients with S pneumoniae bacteraemia were treated to dissociate immune complexes and then tested for C-polysaccharide by enzyme linked immunosorbent assay (ELISA) . RESULTS--C-polysaccharide antigen was masked in normal and acute phase serum but could be released by EDTA treatment and detected by ELISA . Antigen was found in six patients ranging in concentration from 2.5 to 200 ng/ml . Patients with detectable antigen were more likely to die than those in whom antigen was not detected . CONCLUSION--This study demonstrates that C-polysaccharide antigen commonly circulates in patients with S pneumoniae bacteraemia but its presence is masked by ligands present in serum.

J Okla State Med Assoc, 1995 Sep, 88(9), 392 - 7
Acute necrotizing fasciitis in childhood; Hardzog-Britt C et al.; Acute necrotizing fasciitis is a rare but frequently catastrophic infection of the subcutaneous tissues and fascial sheaths . It is rare in infants and children . The case of a 3 1/2-year-old boy with acute necrotizing fasciitis caused by group A beta hemolytic streptococcus is described.

N Engl J Med, 1995 Aug 24, 333(8), 481 - 6
The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta; Hofmann J et al.; BACKGROUND . Streptococcus pneumoniae is a major cause of illness, and the emergence of drug-resistant strains threatens to complicate the management of pneumococcal infections . We conducted a laboratory-based surveillance for drug-resistant S . pneumoniae among patients with invasive pneumococcal infections in Atlanta . METHODS . From January through October 1994, pneumococcal isolates from 431 patients with invasive disease in metropolitan Atlanta were serotyped and tested to determine their susceptibility to various antimicrobial agents . Susceptibility to the antimicrobial agents was defined according to guidelines established by the National Committee for Clinical Laboratory Standards . RESULTS . The annual incidence of invasive pneumococcal infection was 30 cases per 100,000 population . Isolates from 25 percent of the patients were resistant to penicillin (7 percent were highly resistant), and isolates from 26 percent were resistant to trimethoprim-sulfamethoxazole (7 percent highly resistant) . Fifteen percent of the isolates were resistant to erythromycin, 9 percent to cefotaxime (4 percent were highly resistant), and 25 percent to multiple drugs . Drug-resistant pneumococci were found in both children and adults . Children under six years of age were more likely than older children and adults to have isolates resistant to multiple drugs or cefotaxime . Whites were more likely than blacks to have invasive pneumococcal infections caused by drug-resistant organisms . Among white children younger than six years, 41 percent of the S . pneumoniae isolates were resistant to penicillin . CONCLUSIONS . Drug-resistant strains of S . pneumoniae are common among both children and adults in Atlanta . Although blacks had a higher incidence of invasive pneumococcal infections than whites, whites were more likely to be infected with a drug-resistant isolate . Control of drug-resistant pneumococci will require more judicious use of antimicrobial agents and wider use of the pneumococcal polysaccharide vaccine.

N Engl J Med, 1995 Aug 24, 333(8), 474 - 80
Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain; Pallares R et al.; BACKGROUND . Penicillin-resistant strains of Streptococcus pneumoniae are now found worldwide, and strains with resistance to cephalosporin are being reported . The appropriate antibiotic therapy for pneumococcal pneumonia due to resistant strains remains controversial . METHODS . To examine the effect of resistance to penicillin and cephalosporin on mortality, we conducted a 10-year, prospective study in Barcelona of 504 adults with culture-proved pneumococcal pneumonia . RESULTS . Among the 504 patients, 145 (29 percent) had penicillin-resistant strains of S . pneumoniae (minimal inhibitory concentration {MIC} of penicillin G, 0.12 to 4.0 micrograms per milliliter), and 31 patients (6 percent) had cephalosporin-resistant strains (MIC of ceftriaxone or cefotaxime, 1.0 to 4.0 micrograms per milliliter) . Mortality was 38 percent in patients with penicillin-resistant strains, as compared with 24 percent in patients with penicillin-sensitive strains (P = 0.001) . However, after the exclusion of patients with polymicrobial pneumonia and adjustment for other predictors of mortality, the odds ratio for mortality in patients with penicillin-resistant strains was 1.0 (95 percent confidence interval, 0.5 to 1.9; P = 0.84) . Among patients treated with penicillin G or ampicillin, the mortality was 25 percent in the 24 with penicillin-resistant strains and 19 percent in the 126 with penicillin-sensitive strains (P = 0.51) . Among patients treated with ceftriaxone or cefotaxime, the mortality was 22 percent in the 59 with penicillin-resistant strains and 25 percent in the 127 with penicillin-sensitive strains (P = 0.64) The frequency of resistance to cephalosporin increased from 2 percent in 1984-1988 to 9 percent in 1989-1993 (P = 0.002) . Mortality was 26 percent in patients with cephalosporin-resistant S . pneumoniae and 28 percent in patients with susceptible organisms (P = 0.89) . Among patients treated with ceftriaxone or cefotaxime, mortality was 22 percent in the 18 with cephalosporin-resistant strains and 24 percent in the 168 with cephalosporin-sensitive organisms (P = 0.64) . CONCLUSIONS . Current levels of resistance to penicillin and cephalosporin by S . pneumoniae are not associated with increased mortality in patients with pneumococcal pneumonia . Hence, these antibiotics remain the therapy of choice for this disease.

Biochim Biophys Acta, 1995 Aug 17, 1245(1), 94 - 8
Competitive binding of calcium and magnesium to streptococcal lipoteichoic acid; Rose RK et al.; Equilibrium dialysis was used to investigate the binding capacity and affinity of lipoteichoic acid (LTA) from the Gram-positive bacterium Streptococcus sanguis for calcium and magnesium by a competitive method . LTA was shown to bind approx . 1 mol of either calcium or magnesium per mole phosphate . Calcium and magnesium dissociation constants were found to be 8.39 +/- 0.31 mmol/l and 15.01 +/- 2.01 mmol/l respectively, indicating that S . sanguis LTA will preferentially bind calcium . LTA may act as a calcium buffer by reducing the free calcium concentration to which the cell is exposed . The capacity to produce large quantities of LTA could thus be as important as aciduricity in selection of species at caries-prone sites.

Biochem J, 1995 Aug 15, 310 ( Pt 1), 177 - 84
Equilibrium and pre-equilibrium fluorescence spectroscopic studies of the binding of a single-immunoglobulin-binding domain derived from protein G to the Fc fragment from human IgG1; Walker KN et al.; A single-immunoglobulin-binding protein based upon the C2 domain of Protein G from Streptococcus has been shown to bind tightly to the Fc fragment of IgG1 . The binding interaction results in a decrease in the fluorescence intensity from the sole Trp residue (Trp-48) in this domain . This spectral change has been used to monitor the binding interactions between the two proteins using equilibrium and pre-equilibrium fluorescence spectroscopy . Comparison of the data from the two techniques suggests that a conformational change occurs after the initial formation of the complex . Mutagenesis studies have shown that the Trp residue is important for binding and that replacement by a Phe residue is important for binding and that replacement by a Phe residue leads to a 300-fold decrease in the affinity for Fc gamma 1 . Determination of the rate constants kon and koff at different values of pH between 4.0 and 9.0 suggest that variations in Kd are mediated predominantly by changes in kon . Competition experiments between SpG1 and a single-IgG-binding domain from Protein A from Staphylococcus aureus have been used to determine the affinity of the latter for Fc gamma 1.

Tijdschr Diergeneeskd, 1995 Aug 15, 120(16), 458 - 63
{The dairying veterinary approach to a high bulk milk cell count caused by Streptococcus agalactiae}; Loeffler SH et al.; The herd health approach for dairy herds with a high bulk milk somatic cell count, in which Streptococcus agalactiae plays a major role, was evaluated . After introduction of the standard mastitis prevention programme, all quarters of infected cows were treated during lactation . In three of the four herds investigated, the bulk milk somatic cell count dropped below the limit of 400,000 cells/ml for a long period of time . The herd in which there were many infections with Staphylococcus aureus and Streptococcus agalactiae was an exception . The management, somatic cell count, and prevalence of subclinical mastitis in the different herds is discussed . It is concluded that for infection with Streptococcus agalactiae at the herd level, treatment during lactation can be an effective method to lower the bulk milk somatic cell count . In essence, however, the approach to the problem lies in the standard mastitis prevention programme.

Arch Intern Med, 1995 Aug 7-21, 155(15), 1678 - 80
Pneumococcal aortitis in the antibiotic era; Ioannidis JP et al.; The pneumococcus remains in the antibiotic era a formidable pathogen, capable of atypical, lethal clinical presentations . We report two fatal cases of thoracic aortitis caused by Streptococcus pneumoniae in the setting of bacteremic illness from this pathogen . One case occurred in an aortic graft and the other arose in a native aorta . We also discuss the indolent clinical presentation and the diagnostic failure of transesophageal echocardiography and leukocyte scintigraphy . Persistent pyrexia with atypical chest pain and unexplained blood loss should alert clinicians to the possibility of this uncommon, yet lethal complication of pneumococcal disease.

Singapore Med J, 1995 Aug, 36(4), 383 - 5
Genital Group B Streptococcus carriage in the antenatal period: its role in prom and preterm labour; Chua S et al.; Of 326 high vaginal swabs taken during the antenatal period, Group B Streptococcus (GBS) was isolated from the birth canal in 46 women, giving a carrier rate of 14.1%, which is within the often quoted range of between 5% - 25% in different parts of the world . Carriage rates were similar at different gestations . In a subgroup of 34 women, 2 swabs taken at least 5 weeks apart yielded results which were discordant in over one fifth of the time . This knowledge of the natural history of GBS carriage questions the practice of treating asymptomatic carriers of GBS in the antenatal period to prevent transmission of GBS to the neonate . The group of women with positive swabs in the antenatal period did not have a significantly higher incidence of preterm labour and/or prelabour rupture of membranes (PROM) compared with the group of women with negative swabs . Routine screening of the antenatal population for GBS carrier status prior to 32 weeks gestation may not identify women at high risk of PROM or preterm labour.

Antibiot Khimioter, 1995 Aug, 40(8), 46 - 9
{Use of unified methods in microbiologic monitoring of penicillin resistance in Pneumococcus}; Shevchuk MS et al.; The microbiological surveillance of pneumococci according to the Protocols for the International Surveillance of Pneumococci Resistant to Penicillin and Other Antimicrobial Agents developed by Prof . M . Jacobs (USA) and Prof . P . Appelbaum (USA) made it possible for the first time in Russia to detect the strains with moderate resistance to penicillin . It is necessary to revise the current Russian recommendations for the laboratory diagnosis of pneumococcal infection and the determination of antibiotic susceptibility so as to participate in the united programme of the International Surveillance of Penicillin Resistance in Streptococcus pneumoniae.

Oral Microbiol Immunol, 1995 Aug, 10(4), 241 - 6
The action of thymol on oral bacteria; Shapiro S et al.; Several effects of thymol, a plant-derived antimicrobial agent, on Porphyromonas gingivalis, Selenomonas artemidis and Streptococcus sobrinus were examined . The extremely rapid efflux of intracellular constituents evoked by thymol is consistent with its postulated membranotropic effects . Correlations between leakage-inducing concentrations of thymol and minimal inhibitory concentrations and minimal bactericidal concentrations suggest that membrane perforation is a principal mode of action of this substance . The thymol-induced decline in intracellular ATP in S . sobrinus appears to be entirely attributable to leakage, whereas in P . gingivalis thymol may also inhibit ATP-generating pathways . Relative changes in the transmembrane potential of resting cells of S . sobrinus pulsed with glucose are as sensitive to thymol as is leakage from this organism . The effects of thymol on transmembrane potential are probably secondary to those arising from leakage of intracellular substances.

Int J Periodontics Restorative Dent, 1995 Aug, 15(4), 363 - 75
Postoperative healing complications associated with Gore-Tex Periodontal Material . Part I . Incidence and characterization; Murphy KG; Guided tissue regeneration procedures with Gore-Tex Periodontal Material are associated with a unique set of postoperative healing characteristics . Five healing complications are described in this study examining 102 sites . The occurrence of pain and purulence were the most common . In purulent sites, the majority of bacteria cultured were Actinomyces and Streptococcus spp . Resistance to antibiotics was common . Prevention and treatment of the healing complications are discussed.

Diagn Microbiol Infect Dis, 1995 Aug, 22(4), 321 - 4
Detection of group B Streptococcus by immunoassay following enrichment in LIM-selective broth medium; Heelan JS et al.; Rapid immunoassays have been developed to decrease the time to detection of Group B Streptococcus (GBS) carriage in pregnant women . In this study, a total of 162 pregnant women, considered to be high-risk obstetric patients, were seen in the Family Care Center at Memorial Hospital of Rhode Island, a 300-bed teaching hospital associated with Brown University Medical School . Vaginal and rectal specimens were taken and tested for GBS by using two rapid enzyme immunoassays (EIAs) that were compared with culture . Quidel and Hybritech ICON Group B strep tests were run following 4 h incubation in the selective enrichment LIM Group B strep broth; cultures were done both directly and after enrichment . Results with both EIAs were identical, with overall sensitivity, specificity, and positive and negative predictive values of 38%, 98%, 88%, and 84% respectively . However, when women having positive cultures were separated into moderately to heavily colonized (> or = 3 +) and lightly colonized (< or = 2 +) populations, the sensitivities were 82% and 19%, respectively . Although GBS assays are useful in the rapid diagnosis of heavily colonized women, culture following enrichment remains the most sensitive method for a lightly colonized population.

Zentralbl Veterinarmed B, 1995 Aug, 42(6), 331 - 7
Phagocytosis of Streptococcus uberis by bovine mammary macrophages: opsonizing effect of bovine antiserum; Almeida RA et al.; Five encapsulated and five non-encapsulated strains of Streptococcus uberis were tested for their ability to resist phagocytosis and intracellular killing by bovine mammary macrophages obtained during the non-lactating period . The percentage of phagocytosis and intracellular killing of encapsulated strains ranged from 43 to 51 and from 25 to 40, respectively . By contrast, the percentage of phagocytosis and intracellular killing of non-encapsulated strains ranged from 66 to 74 and from 65 to 75, respectively . Two encapsulated and two non-encapsulated strains were opsonized with homologous and heterologous pre-immune and immune bovine sera . Phagocytosis and intracellular killing of encapsulated strains increased significantly when opsonized with serum of cows vaccinated with a homologous and heterologous encapsulated strain . By contrast, no significant differences were observed when serum from cows vaccinated with a non-encapsulated strain was used . These results suggest that resistance to phagocytosis is a common feature among encapsulated strains of S . uberis, and that cross-reactivity exists between encapsulated strains.

J Chemother, 1995 Aug, 7(4), 277 - 85
Etiology and risk factors of adult pneumonia; Ginesu F et al.; The authors point out the remarkable importance that pneumonia has today among infectious diseases, and survey the main risk factors and etiological agents both of the forms acquired in the community and in the hospital, also considering the data from the international literature . The authors stress the high incidence of gram-positive microorganisms, among which Streptococcus pneumoniae is the most widespread in the forms acquired in the community, and the absolute prevalence of the gram-negatives in the nosocomial forms and, among the gram-positives, the pre-eminence of Staphylococcus aureus; these are "difficult" bacterial species, whose prevalence has been determined mainly by induced selective pressure through the inadequate use of antibiotics . The authors also point out the principal factors that favor the onset of pneumonia; they are connected to the host and to the environment; their combination with the infectious agent causes the infective event.

Eur J Clin Microbiol Infect Dis, 1995 Aug, 14(8), 724 - 6
Criteria for testing the susceptibility of Streptococcus pneumoniae to cefotaxime and its desacetyl metabolite using 1 microgram or 30 micrograms cefotaxime disks; Barry AL et al.; In vitro susceptibility tests were performed with 350 selected strains of Streptococcus pneumoniae to evaluate disk diffusion tests with 30 micrograms and 1 microgram cefotaxime disks . Zones were compared to MICs of cefotaxime with and without its desacetyl metabolite . Cefotaxime was two to eight times more active than desacetyl cefotaxime, but the two compounds were additive when combined in vitro . For 30 micrograms disks, zone size breakpoints were < or = 27 mm, 28-30 mm and > or = 31 mm for resistant, intermediate and susceptible, respectively . For 1 microgram disks, those zone size criteria were reduced to < or = 13 mm, 14-16 mm and > or = 17 mm . The 30 micrograms disk that is currently available for testing other species can be used for testing pneumococci; however, the 1 microgram disk has some important advantages.

Intern Med, 1995 Aug, 34(8), 785 - 9
Rhabdomyolysis associated with bacteremia due to Streptococcus viridans; Asao K et al.; A 25-year-old man was admitted with complaints of fever and macrohematuria . Laboratory tests showed a substantial increase in serum creatine phosphokinase and creatinine in association with myoglobinuria and proteinuria . Blood culture grew Streptococcus salivarius and Streptococcus oralis . Findings of renal biopsy were compatible with IgA nephropathy . The glomeruli had a mild mesangial proliferation without crescentic lesions . Changes of the interstitium and tubules were not evident . The clinical course and laboratory results strongly suggested a possible link between Streptococcus salivarius/oralis infection, and rhabdomyolysis . Rhabdomyolysis is rarely seen as a complication of bacterial infection, and the present case emphasizes the importance of suspecting bacteremia due to Streptococcus salivarius/oralis in the presence of rhabdomyolysis.

Clin Infect Dis, 1995 Aug, 21(2), 333 - 40
Clinical and microbiological characteristics of severe group A streptococcus infections and streptococcal toxic shock syndrome; Forni AL et al.; We have monitored all cases of invasive group A streptococcus (GAS) infection that have occurred at the New York Hospital (New York) since 1989 . Five cases of GAS infection and shock were identified between 1990 and 1991, and an additional case was recently identified at an affiliated hospital . Five of the six patients met the case definition for streptococcal toxic shock syndrome (strep TSS) . Three were bacteremic, and four had aggressive soft-tissue infections . Patients with shock, for whom the mortality was higher, had fewer underlying illnesses than did patients who had GAS bacteremia without shock . Although the M1 serotype and production of streptococcal pyrogenic exotoxin A were more common in patients with GAS infection and shock, several patients with strep TSS were infected with a nontypable strain of GAS that produced only streptococcal pyrogenic exotoxin B . In addition, we observed a distinctive early hemodynamic profile for patients with strep TSS that was unlike that for patients who had typical gram-negative septic shock; this profile was consistent with toxic cardiomyopathy (i.e., relatively low cardiac output, low-to-normal systemic vascular resistance, and striking reduction in ventricular performance.

Can J Ophthalmol, 1995 Aug, 30(5), 251 - 5
Microbial etiology and predisposing factors among patients hospitalized for corneal ulceration; Cheung J et al.; OBJECTIVE: To report the spectrum of microorganisms causing corneal ulceration in patients treated on an inpatient basis and to characterize the predisposing factors . DESIGN: Case series . SETTING: Large university-affiliated hospital in Toronto . PATIENTS: All inpatients with corneal ulcers managed between February 1991 and February 1993 (n = 95) . RESULTS: Coagulase-negative staphylococci (30% of the 60 culture-positive cases), Staphylococcus aureus (23%), Streptococcus pneumoniae (12%), Pseudomonas aeruginosa (12%) and Moraxella (7%) were the predominant isolates . Previous eye surgery (cataract extraction in 30 cases {32%}, penetrating keratoplasty in 12 {13%} and both procedures in 9 {9%}) was a common predisposing factor . Eleven cases (12%) were associated with the use of contact lenses, in all cases extended-wear soft contact lenses; six patients wore bandage lenses and five wore contact lenses for cosmetic reasons . Pseudomonas was the predominant isolate among contact lens wearers (four cases) . Most of the 95 cases involved older patients (average age 62.5 years) with concomitant eye or systemic disease . Sixteen patients (17%) ultimately required penetrating keratoplasty . CONCLUSIONS: Recognition of the risk factors for corneal ulceration and prompt, intensive therapy are important to decrease the morbidity associated with this potentially blinding disease.

Biotechniques, 1995 Aug, 19(2), 282 - 5
Use of Multiscreen plates for the preparation of bacterial DNA suitable for PCR; Reek FH et al.; A rapid and inexpensive method for isolating bacterial DNA for use in PCR is described . The method is based on the guanidinium thiocyanate (GuSCN)-lysis method of Boom et al . (J . Clin . Microbiol . 28:495-503, 1990) and enables a multiple of 96 samples to be prepared in only one hour . We use Multiscreen plates and a vacuum manifold from Millipore . Clinical samples are lysed and washed in the wells of a Multiscreen plate, and DNA is eluted in a standard microplate . Purified DNA was recovered with high yields (over 25%) . The method allows multichannel or robotic pipetting for both the sample preparation as well as for the PCR step . The method has been applied successfully to detect pathogenic Streptococcus suis type 2 in nasal and tonsil swab specimens of pigs.

J Arthroplasty, 1995 Aug, 10(4), 554 - 5
Streptococcus bovis-infected total hip arthroplasty; Emerton ME et al.; The case of a 51-year-old man who underwent a total hip arthroplasty following failed AO screw fixation of a subcapital femoral neck fracture is reported . Infection of the prosthesis with Streptococcus bovis type 1 followed a febrile illness . Further investigation revealed an occult premalignant polyp in the proximal colon . Colonic neoplasia and S . bovis bacteremia are associated with endocarditis; however, S . bovis is a rare pathogen infecting joint prostheses and should raise the possibility of a gastrointestinal lesion.

J Antimicrob Chemother, 1995 Aug, 36(2), 417 - 23
In-vitro development of resistance to beta-lactam antibiotics in Streptococcus pneumoniae; Carsenti-Etesse H et al.; Selection of resistant mutants was induced in broth by exposing pneumococci to serial sub-inhibitory concentrations of various beta-lactam antibiotics . Aminopenicillins selected for resistance to themselves and to cephalosporins although cephalosporins tended to select for resistance to their own class, with the exception of cefixime which seems to select cross-resistant organisms.

FEMS Microbiol Lett, 1995 Aug 1, 130(2-3), 201 - 4
NAD(+)-glycohydrolase from Streptococcus pyogenes shows cyclic ADP-ribose forming activity; Karasawa T et al.; NAD(+)-glycohydrolase from Streptococcus pyogenes was purified by successive chromatography on CM Sepharose CL-6B, Sephacryl S-200 HR and hydroxyapatite . The purified enzyme possessed synthesis and hydrolysis activities of cyclic ADP-ribose (cADPR), a newly found second messenger for Ca2+ mobilisation, along with cleavage activity of the ribose-nicotinamide bond in NAD+.

FEMS Microbiol Lett, 1995 Aug 1, 130(2-3), 145 - 9
A single emm gene-specific oligonucleotide probe does not recognise all members of the Streptococcus pyogenes M type 1; Penney TJ et al.; Serological typing of the streptococcal M protein has recently been challenged by a number of unique molecular methodologies based on oligonucleotide recognition of allelic variations within the M protein (emm) gene . In these methods, stringent hybridization of an oligonucleotide probe to a polymerase chain reaction amplified emm gene is used as confirmation of specific M type identity . A sample of 17 isolates from 7 previously defined distinct genotypes were tested using a single M1 oligonucleotide probe . Isolates from only three of the genotypes hybridized with the probe . The results demonstrate that a single emm-specific oligonucleotide probe can not identify all members of M type 1, as defined by conventional serotyping using polyclonal antisera.

FEMS Microbiol Lett, 1995 Aug 1, 130(2-3), 121 - 7
Alterations in penicillin-binding proteins in strains of Streptococcus suis possessing moderate and high levels of resistance to penicillin; Cain D et al.; We examined the penicillin-binding proteins (PBPs) of certain field strains of Streptococcus suis, as well as those from laboratory variants having different degrees of resistance to penicillin . Results indicated that (i) S . suis possesses three distinct groups of PBPs, arbitrarily named here PBP 1, PBP 2, and PBP 3, with approximate molecular weights of 97, 82, and 45 kDa respectively; (ii) PBP profiles of field strains of S . suis having different MICs (< or = 0.03) to 16.0 micrograms/ml) were not uniform (PBP 2 being difficult to detect in strains whose MICs exceeded 0.10 micrograms/ml, and PBP 3 which exhibited shifts in molecular weight of approximately 5 kDa); (iii) laboratory variant PBPs 1 and 2 showed decreased affinity for penicillin as compared to the parent strain in antibiotic competition experiments, even though the PBP profiles of both were similar . We suggest that PBP modifications (altered molecular weight and/or decreased affinity for penicillin) are involved in the mechanism of resistance to penicillin by S . suis.

Ann Allergy Asthma Immunol, 1995 Aug, 75(2), 125 - 31
Selective deficiency in pneumococcal antibody response in children with recurrent infections; Epstein MM et al.; BACKGROUND: Impaired ability to respond to polysaccharide capsular antigens of Streptococcus pneumoniae may be associated with an IgG subclass deficiency and recurrent respiratory infections . OBJECTIVE: To identify children over three years of age with recurrent otitis media, sinusitis, or pneumonia who had low or absent pneumococcal antibody titers as their sole manifestation of immune deficiency and to determine their response to the 23-valent pneumococcal vaccine . RESULTS: Of 100 children with low pneumococcal antibody titers, 87 generated a protective antibody response to the pneumococcal vaccine (> 300 ng/mL to the majority of the antigen serotypes), while 13 responded poorly or not at all . Repeated vaccination of nonresponders failed to produce a normal response . CONCLUSION: We have identified two clinically distinct subpopulations of children with recurrent respiratory infections characterized by their responsiveness to pneumococcal antigens: one group did not respond to pneumococcal vaccination, whereas the other group responded both clinically and serologically . The nonresponding 6.5% subpopulation has an apparent isolated defect in anti-pneumococcal antibody production associated with recurrent respiratory infections despite normal IgG2 subclass levels.

Virology, 1995 Aug 1, 211(1), 21 - 32
Nucleotide sequence and transcription of the left early region of Streptococcus pneumoniae bacteriophage Cp-1 coding for the terminal protein and the DNA polymerase; Martin AC et al.; Cp-1 is a small virulent bacteriophage infecting Streptococcus pneumoniae . It has a linear, double-stranded genome of about 19 kb that replicates by a protein-priming mechanism . We have determined the nucleotide sequence of the leftmost 4780 bp of the DNA of this bacteriophage; computer analysis revealed that this fragment contains seven open reading frames (ORFs) which could encode polypeptides containing more than 50 amino acids . The ORFs are clustered in two groups separated by noncoding intergenic regions . Two of these ORFs code for the terminal protein and a specific DNA polymerase that participate in the replication of the DNA . The predicted amino acid sequence of the terminal protein shows significant similarity with the terminal protein of Bacillus subtilis phage phi 29, and Cp-1 DNA polymerase is homologous to the subgroup of eukaryotic-type DNA polymerases that use a protein as a primer . Combined Northern blots and primer extension experiments have allowed us to map the 5' initiation sites of left early transcripts . These studies revealed that transcripts elongate from left to right and identified the left early promoters.

Lett Appl Microbiol, 1995 Aug, 21(2), 69 - 74
A defined medium for rumen bacteria and identification of strains impaired in de novo biosynthesis of certain amino acids; Nili N et al.; A completely defined growth medium has been developed to determine the nitrogen requirements for several species of ruminal bacteria, and has revealed two strains which are impaired in de novo biosynthesis of certain amino acids . Using NH4Cl as a sole nitrogen source, the medium supported growth of Butyrivibrio, Selenomonas, Prevotella and Streptococcus species . One strain of B . fibrisolvens (E14) and one strain of P . ruminicola (GA33) did not grow in the presence of NH4Cl until the medium was supplemented with amino acids or peptides . For B . fibrisolvens strain E14, methionine was identified as the specific growth-limiting amino acid although methionine alone did not support growth in the absence of NH4Cl . For P . ruminicola strain GA33, any individual amino acid other than methionine or cysteine could supplement the medium and support growth . Enzyme assays confirmed a lack of NADH and NADPH-dependent glutamate dehydrogenase (GDH) activities in this strain.

Am J Ophthalmol, 1995 Aug, 120(2), 250 - 1
Premacular hemorrhage as a sign of subacute bacterial endocarditis; Kim JE et al.; PURPOSE/METHODS: We examined a patient with mitral valve insufficiency, a sudden decrease in vision in the right eye, and premacular hemorrhage, which was a sign of subacute bacterial endocarditis . RESULTS/CONCLUSION: The patient was hospitalized and treated with intravenous antibiotics . Blood cultures grew Streptococcus viridans . Ocular symptoms and signs improved over two months . Premacular hemorrhage may be a sign of subacute bacterial endocarditis and may obscure other classic signs . Subacute bacterial endocarditis should be included in the differential diagnosis of premacular hemorrhage.

Scand J Immunol, 1995 Aug, 42(2), 269 - 74
Systemic and secretory humoral immunity in the normal human vaginal tract; Hocini H et al.; The molecular status of Abs in the vaginal fluid is reconsidered as a basis for immunization strategies for women' vaccination against HIV . Analysis of separated immunoglobulins (Igs) shows a large proportion of uncleaved IgG, whereas the low amount of IgA includes SIgA, monomers and fragments . SIgM is at a very low level, while free SC molecules are abundant . In addition to the already documented local synthesis, vaginal IgG contains serum-derived tetanus antitoxins . The IgG could reach the lumen by diffusion, and/or be transported by an Fc receptor-associated mechanism as suggested by the subclass imbalance in favour of the IgG1 isotype . VAginal SIgA contains very low levels of antibodies o the cell-well carbohydrates from a dental caries-associated streptococcus confirming the participation of the secretory immune system . IN addition, the low percentage of IgA2 suggests tha a proportion of vaginal SIgA can also derive from actively transported serum polymers . In agreement with our previous studies showing induction of vaginal tetanus antitoxins by intramuscular immunization, these results are in favour of classical, parenteral vaccinations to induce protection of the human vagina.

Laryngoscope, 1995 Aug, 105(8 Pt 1), 835 - 42
Mucociliary activity and histopathology of sinus mucosa in experimental maxillary sinusitis: a comparison of systemic administration of antibiotic and antibiotic delivery by polylactic acid polymer; Min YG et al.; To evaluate the efficacy of antibiotic delivered by polyactic acid (PLA) polymer in sinusitis, we induced maxillary sinusitis in 32 New Zealand white rabbits by occluding the sinus ostium and inoculating the sinus cavity with Streptococcus pneumoniae . The rabbits were divided into three groups consisting of group 1 (control group, 8 rabbits), which was treated only by reopening the ostium; group 2, which was treated by both reopening the ostium and injecting ampicillin intramuscularly (40 mg/kg/day in three divided doses, 12 rabbits); and group 3 (12 rabbits) in which a piece of PLA-polymer ampicillin (0.326 mg) sheet (1.5 x 1.5 cm) was placed within the sinus after re-establishing ostial patency . The light microscopic findings such as epithelial ulceration, loss of cilia, infiltration of inflammatory cells, and edema were less pronounced in group 2 and minimal in group 3 . The electron microscopic findings such as swelling of mitochondria and endoplasmic reticulum and protruded cytoplasm were severest in the control group, followed by groups 2 and 3 . The mucociliary transport speed measured at the medial wall of the maxillary sinus was highest in group 3 . The results of this study suggest that treatment with PLA-polymer ampicillin may have a better efficacy in maxillary sinusitis than that with systemic administration of ampicillin.

J Infect Dis, 1995 Aug, 172(2), 566 - 70
Impact of Streptococcus pneumoniae bacteremia and human immunodeficiency virus type 1 on oral mucosal immunity; Opstad NL et al.; To determine whether defects in mucosal immunity were associated with invasive disease caused by a mucosal pathogen, Streptococcus pneumoniae, levels of salivary immunoglobulins and nonspecific immune factors were compared in subjects with human immunodeficiency virus type 1 (HIV-1) infection and in HIV-1-seronegative subjects with and without pneumococcal bacteremia . The IgA2 subclass may be of particular importance because S . pneumoniae produces IgA1 protease, which cleaves IgA1 but not IgA2 . Levels (37-56 micrograms/mL) and proportions (11%-17%) of IgA2 were similar among groups . Serotype-specific capsular salivary IgA was present in a minority of patients with acute bacteremia . Levels of lactoferrin were increased with bacteremia . Neither selective mucosal IgA2 deficiency nor impaired nonspecific upper respiratory mucosal responses were associated with invasive pneumococcal disease during HIV-1 infection; thus, other defects in mucosal cellular responses and systemic immunity may predispose HIV-1-infected patients to invasive pneumococcal disease.

J Infect Dis, 1995 Aug, 172(2), 562 - 5
Anti-polysaccharide immunoglobulin isotype levels and opsonic activity of antisera: relationships with protection against Streptococcus pneumoniae infection in mice; Alonso De Velasco E et al.; Relationships between in vitro parameters (opsonic activity and anti-pneumococcal polysaccharide {PS} antibody subclasses) and in vivo mouse protection were established by logistic regression analysis . Data were from 158 mice challenged with pneumococci after vaccination with synthetic oligosaccharide- and PS-protein conjugates in combination with the adjuvant Quil A . The hypothesis that serum opsonic activity has predictive value for protection against pneumococcal infection was tested . Serum opsonic activity was well correlated with protection (chi 2 = 35.5, P < 0.001), although a stronger correlation was observed for anti-PS IgM and IgG . The combined use of IgG and opsonic activity as predictor variables yielded the best fitting model for predicting protection (chi 2 = 74.1, P < 0.001) . When opsonic activity data were added to models that included various antibody isotypes, the statistical significance of the models was enhanced . Thus, the opsonic activity of antisera induced by pneumococcal vaccines can predict mouse protection.

J Infect Dis, 1995 Aug, 172(2), 551 - 3
Equal IgG antibody response to pneumococcal vaccination in all stages of human immunodeficiency virus disease; Vandenbruaene M et al.; To evaluate the immunogenicity and safety of a 23-valent pneumococcal vaccine in human immunodeficiency virus (HIV)-seropositive patients, 80 men and 18 women received 1 dose of the vaccine (Pneumo 23; Pasteur Merieux MSD, Brussels) . The total IgG antibody response against all 23 Streptococcus pneumoniae capsular antigens was measured . Antibody levels were expressed in arbitrary units per microliter, referring to a standard curve . Geometric mean titers of the total IgG capsular antibodies on the day of vaccination and 30-45 days later were compared . The ratios of titers after and before vaccination in patients with > 500, 200-500, and < 200 CD4 lymphocytes/microL were 10, 10, and 12.6, respectively . Nonresponse (ratio < 4) occurred in 17% of patients and was unrelated to CD4 cell count . The vaccine was well tolerated; no serious side effects occurred . In 83% of the patients with HIV infection, the total antipneumococcal IgG level was higher after vaccination.

Infect Immun, 1995 Aug, 63(8), 3015 - 20
Analysis of a second bacteriophage hyaluronidase gene from Streptococcus pyogenes: evidence for a third hyaluronidase involved in extracellular enzymatic activity; Hynes WL et al.; The hyaluronidase gene (hylP2) from a second group A streptococcal bacteriophage was isolated from ATCC T-type-22 hyaluronidase-producing strain 10403, a strain known to produce increased amounts of extracellular hyaluronidase . Sequence analysis of hylP2 and alignment with the previously described bacteriophage hyaluronidase gene (hylP) showed a high degree of similarity; however, hylP2 had deletions of regions specifying 34 amino acids . Twenty-eight of the deleted amino acids were in a region of HylP containing a series of collagen-like Gly-X-Y repeating units . By employing primers for both hylP and hylP2, PCR amplification resulted in fragments of appropriate sizes in 97% of the strains tested, with some strains producing two fragments, indicating the presence of at least two phages . When the hylP2 gene was introduced via a plasmid vector into a non-hyaluronidase-producing Streptococcus pyogenes strain, this strain was still unable to produce extracellular hyaluronidase, although intracellular hyaluronidase was present . These results, along with the absence of a typical N-terminal signal peptide, indicate that HylP2 is unable to be secreted into the extracellular milieu . Examination of more than 100 strains for production of hyaluronidase showed that only 23% of the strains produced extracellular hyaluronidase . One of these strains (strain 10403) contains a single bacteriophage hyaluronidase gene (hylP2) which, when inactivated by allelic replacement, still produces large amounts of extracellular hyaluronidase . These results suggest the presence of a different hyaluronidase gene encoding a protein that is actively secreted into the extracellular milieu.

Kansenshogaku Zasshi, 1995 Aug, 69(8), 884 - 9
{Eight cases of infection caused by the Streptococcus milleri group--significance of serum antibody titer and a comparative investigation of the backgrounds and factors of infections caused by Streptococcus milleri and Streptococcus pneumoniae}; Kimura M et al.; Eight cases of infection caused by Streptococcus milleri were studied clinically, and a comparative study was made of the backgrounds and factors influencing the development of infectious diseases caused by Streptococcus milleri and Streptococcus pneumoniae . The patients (six males and two females) with infectious diseases caused by Streptococcus milleri ranged in age from 21 to 81 years old with an average age of 62.0 years . The infectious diseases encountered among the patients were pyothorax in three patients, and in one patient each pyothorax and lung abscess, pleurisy, a secondary infection of pulmonary emphysema, skin infection related to a tracheostomy, a subdural abscess and a brain abscess, respectively . Six out of the eight cases had infections which formed pus . An underlying disease existed in seven cases, and, in five of these seven cases, it influenced the general condition of these patients . Six serum antibody titers for the S . milleri groups were examined in the First Department of Internal Medicine, University of the Ryukyus . Three cases for S . anginosus, two cases for S . intermedius, and one case for S . constellatus showed high titers of X1024 or X2048 . Therefore, the examination of the serum antibody titer seems useful for the diagnosis of infections caused by the S . milleri group . We also carried out a comparative investigation of the backgrounds and factors of infectious diseases caused by S . milleri and S . pneumoniae . There are more underlying diseases in infections caused by S . milleri than in those caused by S . pneumoniae . There were more smokers among the patients with infections caused by S . milleri than among those with S . pneumonia infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Kansenshogaku Zasshi, 1995 Aug, 69(8), 873 - 7
{A clinical study of six cases of toxic shock-like syndrome by group A Streptococcus}; Ishida T et al.; We have encountered six cases with toxic shock-like syndrome (TSLS) by Group A Streptococcus since 1978 . Every patient had from the onset flu-like symptoms or high fever and immediately developed some of the following clinical signs: hypotension, acute renal failure, disseminated intravascular coagulation (DIC), and adult respiratory distress syndrome (ARDS) . Three of the six patients died with rapid clinical courses and three survived . As for the surviving patients, early administration of antibiotics and anti-DIC therapy were effective . Streptococcus pyogenes were isolated from the blood in five of the patients, ascites from another, and necrotizing tissue in one patient . The serovars of the isolated strains were typed as T1/M1 in three, T8 in one, and T28 in another . The toxin-type of the strains were typed as B in four and B + C in one . Though there have been few reports of TSLS before 1992 in Japan, it is supposed that many TSLS cases may have potentially occurred.

J Dairy Res, 1995 Aug, 62(3), 395 - 404
Physical characteristics of the bovine teat canal and their influence on susceptibility to streptococcal infection; Lacy-Hulbert SJ et al.; Physical characteristics of the bovine teat canal were examined for their influence on susceptibility to intramammary infection . All quarters of 18 cows were inoculated with 2 x 10(5) cfu Streptococcus agalactiae (Trial 1) and 20 cows with 10(5) cfu Str . uberis (Trial 2) 3-4 mm into the teat canal every 3 d for 12 d . Incidence of quarter infection was similar for both pathogens, 30/72 (42%) in Trial 1 and 32/80 (40%) in Trial 2 . Logistic regression analysis showed that probability of infection by Str . agalactiae increased significantly with an increase in quarter peak flow rate (P < 0.05) whereas probability of infection increased for Str . uberis with a decrease in teat canal length (P < 0.05) . A significantly higher (P < 0.001) incidence of infection by Str . uberis was observed in quarters that contained a low wet weight (< 1.8 mg) of removable keratin compared with those that contained > 1.8 mg keratin, but there was no correlation between weight of keratin and length of the teat canal . Infections by Str . uberis took significantly less (P < 0.05) time to show a rise in somatic cell count above 7.5 x 10(5) cells/ml than Str . agalactiae . The results provide evidence that these pathogens use different mechanisms to pass through the teat canal.

J Paediatr Child Health, 1995 Aug, 31(4), 317 - 22
Invasive pneumococcal infection in children, 1981-92: a hospital-based study; Davis CW et al.; OBJECTIVE: To document the pattern and sequelae of invasive pneumococcal infection in hospitalized children . METHODOLOGY: Retrospective review of Streptococcus pneumoniae (Sp) isolates from normally sterile sites from 1981 to 1992 at three paediatric centres in Sydney for demographic data, spectrum of disease, predisposing conditions, mortality, and sequelae from meningitis . RESULTS: Four hundred and thirty-one episodes in 417 patients were identified . Foci of infection were: meningitis, 34%; pneumonia, 29%; bacteraemia without apparent focus, 30%; and other foci, 7% . Sixty-one per cent of all cases and 64% of cases with meningitis were less than 2 years old . Predisposing conditions were present in 37%, were significantly more common in patients over age 2 years and were more common with foci other than meningitis . Overall mortality was 6.6% whereas the mortality for those with meningitis was 8% . Neurological sequelae were identified in 34% of previously normal children, and severe hearing loss occurred in 11.5% . CONCLUSIONS: The high morbidity and mortality from invasive pneumococcal infection in children justifies further evaluation of preventive strategies.

J Clin Microbiol, 1995 Aug, 33(8), 2220 - 1
Agglutination of Streptococcus suis by sialic acid-binding lectins; Charland N et al.; The 35 Streptococcus suis capsular-type reference strains as well as 45 field strains of type 2 were tested with sialic acid-binding lectins from Sambucus nigra (SNA I), Triticum vulgaris, Maackia amurensis, Homarus americanus, and Limax flavus . Only types 1, 1/2, 2, 14, 15, and 16 agglutinated with SNA I and/or the T . vulgaris lectin . All field strains agglutinated only with SNA I . Reaction with SNA I was probably due to the sialic acid moiety since it disappeared after sialidase treatment . These results confirm the presence of sialic acid in S . suis with the possible terminal sequence N-acetylneuraminic acid-alpha(2,6)GalNAc.

Immun Infekt, 1995 Aug, 23(4), 134 - 6
{Streptococcus B screening with GBS medium in obstetrics}; Milatovic D et al.; Pregnant women and newborn infants were screened for group B streptococcal (GBS) colonization by obtaining paired swabs from the cervix and urethra for the former group and from the ear, nose, umbilical cord, gastric juice and membranes for the latter . One swab was cultured on blood agar; the other was inoculated into serum-starch broth (GBS medium), which allows identification of GBS by production of a characteristic orange-colored pigment . From the 2105 paired swabs obtained, a total of 158 were GBS positive by either method; of these, 154 (97.5%) were recovered by the GBS medium and 89 (56.3%) by blood agar plate . No false positive color reactions were observed with GBS medium . 75% of the positive GBS media could be read within 24 h of incubation . The use of GBS medium proved to be an easy and reliable method for screening of maternal and neonatal GBS colonization.

Arch Oral Biol, 1995 Aug, 40(8), 685 - 90
Streptococcus oralis previously identified as uncommon 'Streptococcus sanguis' in Behçet's disease; Narikawa S et al.; The relation between the biochemical and serological properties of 'Streptococcus sanguis' was studied to characterize the strains isolated from dental plaque of patients with Behcet's disease and controls . Seven reference and 100 clinical strains preserved by the Behcet's Disease Research Committee of Japan were identified using established criteria and differentiated with antisera against Strep . oralis ATCC 10557, Strep . sanguis ATCC 10556 and 'Strep . sanguis' ST7, compatible with the criteria . Uncommon serovars (serotypes) KTH-1 (= ATCC 49298), KTH-2 (= ATCC 49296), KTH-3 (= ATCC KTH-4 (= ATCC 49297) and B220 (serovar KTH-1) with both IgA1 protease and neuraminidase (sialidase) were identified as Strep . oralis, whereas common serovars ST3 with IgA1 protease alone and ST7 without both enzymes were identified as Strep . sanguis and Strep . gordonii, respectively . Isolates previously ranked as uncommon serovars were identified as Strep . oralis, whereas the rest ranked as common serovars were identified as the same species as those of the grouping strains . A soft-agar technique was available for species identification except for Strep . oralis serovar KTH-1 reacting with the antiserum against Strep . gordonii ST7 . The frequency of isolation of Strep . oralis was higher in Behcet's disease (52%) than in controls (38%), but no difference was observed between the properties of the two groups of isolates . Strep . oralis virulence factors may be involved in breach the mucosal barrier in patients with specific reactivity to these antigens and inducing Behcet's disease.

Antimicrob Agents Chemother, 1995 Aug, 39(8), 1896 - 8
Timing of penicillin treatment influences the course of Streptococcus pneumoniae-induced middle ear inflammation; Sato K et al.; Penicillin treatment timing, using the chinchilla pneumococcal otitis media model, was investigated . Early treatment (when approximately 10(3) pneumococcal CFU/ml was present in middle ear fluid) significantly accelerated inflammatory-cell influx, whereas late treatment (with approximately 10(7) pneumococcal CFU/ml present in middle ear fluid) did not . Therefore, antiinflammatory interventions will be needed early in the course of inflammation.

Antimicrob Agents Chemother, 1995 Aug, 39(8), 1842 - 7
Protein binding and serum bactericidal activities of vancomycin and teicoplanin; Dykhuizen RS et al.; In a randomized crossover study, the protein binding and serum bactericidal activities (SBAs) of vancomycin and teicoplanin against Staphylococcus aureus and Streptococcus pyogenes were investigated in six healthy volunteers . Total concentrations in serum 1 h postadministration of vancomycin and teicoplanin were 25.5 +/- 2.7 and 10.8 +/- 8.9 mg/liter, respectively; mean free concentrations were 14.6 +/- 2.0 and 0.6 +/- 0.9 mg/liter, respectively . Protein binding for vancomycin was 36.9% +/- 2.87%, and that for teicoplanin was 97.4% +/- 2.6% . SBA determined in pooled human serum at 1 h against S . aureus ranged from 1:8 to 1:32 for both vancomycin and teicoplanin . Against S . pyogenes SBA at 1 h ranged from 1:16 to 1:128 for vancomycin and 1:256 to 1:2,048 for teicoplanin . In vitro kill curve studies showed that vancomycin is slowly bactericidal and that teicoplanin is bacteriostatic . Despite having less in vitro cidal activity against the study isolates and having low or unrecordable levels of free drug in serum, teicoplanin demonstrated a similar or better SBA than vancomycin . SBA was more closely related to the total drug level (r = 0.77 for S . aureus and r = 0.79 for S . pyogenes) than the free level of teicoplanin (r = 0.59 for S . aureus and r = 0.56 for S . pyogenes) . The high level of protein binding of teicoplanin did not seem to impair its antibacterial activity as measured by its SBA.

Antimicrob Agents Chemother, 1995 Aug, 39(8), 1736 - 43
In vivo activity and pharmacodynamics of cefotaxime or ceftriaxone in combination with fosfomycin in fibrin clots infected with highly penicillin-resistant Streptococcus pneumoniae; Chavanet P et al.; Using a clinical pneumococcal strain for which MICs were 2, 0.5, 0.5, and 16 mg/liter for penicillin, cefotaxime, ceftriaxone, and fosfomycin, respectively, we studied the efficacies of these antibiotics alone and in combination in one or two doses or in continuous infusion over 6 h in the treatment of the prolonged (48-h) experimental fibrin clot infections in rabbits . Doses were chosen to obtain low antibiotic concentrations . We observed the highest bacterial reductions (change in log10 CFU per gram) with the following five regimens: combination of cefotaxime plus fosfomycin given in two divided doses 6 h apart (each at 50 mg/kg of body weight given intravenously (4.2 +/- 0.7 CFU/g), ceftriaxone (8 mg/kg given once intravenously) along with one or two doses of fosfomycin (3.79 +/- 0.6 and 3.95 +/- 0.5 CFU/g), cefotaxime alone administered in two divided doses (3.6 +/- 0.4 CFU/g), and a 6-h continuous infusion of cefotaxime (100 mg/kg) with fosfomycin (100 mg/kg) (3.5 +/- 0.4 CFU/g) . The bacterial reductions obtained with these five regimens were all higher than those obtained with the other regimens tested (P < 0.05) . The time of bacterial regrowth was significantly delayed with the two doses of the cefotaxime-fosfomycin regimens (23.2 +/- 11 h) compared with those with the other combinations (P < 0.05) . The rate of bacterial regrowth with this regimen was even lower than that observed with cefotaxime alone given in two doses (P < 0.05) . By a multivariate analysis, the most important independent parameters for efficacy were the maximal concentrations of beta-lactam antibiotics and the residual concentration of fosfomycin and, for the combinations, the log of the area under the concentration-time curve/MIC ratio for beta-lactam antibiotics . From these findings, the combinations cefotaxime or ceftriaxone plus fosfomycin could be proposed for the treatment of infections caused by highly penicillin-resistant pneumococci.

J Pediatr Surg, 1995 Aug, 30(8), 1211 - 5
Thoracoscopy in the management of pediatric empyema; Stovroff M et al.; The surgical management of empyema consists of (1) aggressive therapy with thoracotomy and decortication or (2) conservative treatment with chest tube drainage and intravenous antibiotics . Recently, Kern and Rodgers introduced thoracoscopic debridement as an adjunct to the management of children with empyema, with promising results . Hence, the authors report their experience with thoracoscopy in the management of pediatric patients with empyema . In the last years, 10 children have undergone thoracoscopic debridement (TD) for empyema . The average age was 6.9 years (range, 2 to 16) . Children underwent TD an average of 14 days (range, 8 to 16) after initial presentation and 4 days (range, 2 to 6) after admission to the authors' hospital . Indications for TD were persistent requirement of supplemental oxygen and failure of conservative medical management that consisted of antibiotics and tube thoracostomy . Three children had positive pleural fluid cultures for Streptococcus pneumoniae . In all cases, preoperative ultrasound or chest computed tomography examination showed dense pleural fluid with septation . During surgery, TD allowed for lung expansion and precise chest tube placement in all patients except one who required conversion to minithoracotomy and decortication for persistent encasement with a thick pleural peel . There were no postoperative complications related to the procedure . After TD, all children had prompt clinical improvement . The patients were weaned from supplemental oxygen by postoperative day 2, and following early chest tube removal, nine children were discharged home by postoperative day 7 (range, 3 to 10) . One child required further hospitalization for underlying renal failure . In the authors' hands, TD was effective in producing prompt clinical improvement in children with empyema.(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemistry, 1995 Jul 25, 34(29), 9532 - 40
Binding of cephalothin and cefotaxime to D-ala-D-ala-peptidase reveals a functional basis of a natural mutation in a low-affinity penicillin-binding protein and in extended-spectrum beta-lactamases; Kuzin AP et al.; Two clinically-important beta-lactam antibiotics, cephalothin and cefotaxime, have been observed by X-ray crystallography bound to the reactive Ser62 of the D-alanyl-D-alanine carboxypeptidase/transpeptidase of Streptomyces sp . R61 . Refinement of the two crystal structures produced R factors for 3 sigma (F) data of 0.166 (to 1.8 A) and 0.170 (to 2.0 A) for the cephalothin and cefotaxime complexes, respectively . In each complex, a water molecule is within 3.1 and 3.6 A of the acylated beta-lactam carbonyl carbon atom, but is poorly activated by active site residues for nucleophilic attack and deacylation . This apparent lack of good stereochemistry for facile hydrolysis is in accord with the long half-lives of cephalosporin intermediates in solution (20-40 h) and the efficacy of these beta-lactams as inhibitors of bacterial cell wall synthesis . Different hydrogen binding patterns of the two cephalosporins to Thr301 are consistent with the low cefotaxime affinity of an altered penicillin-binding protein, PBP-2x, reported in cefotaxime-resistant strains of Streptococcus pneumoniae, and with the ability of mutant class A beta-lactamases to hydrolyze third-generation cephalosporins.

MMWR Morb Mortal Wkly Rep, 1995 Jul 21, 44(28), 535 - 7
Pneumonia and influenza death rates--United States, 1979-1994; Mucosal and systemic immune responses to a recombinant protein expressed on the surface of the oral commensal bacterium Streptococcus gordonii after oral colonization; Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, NY 10021, USATo circumvent the need to engineer pathogenic microorganisms as live vaccine-delivery vehicles, a system was developed which allowed for the stable expression of a wide range of protein antigens on the surface of Gram-positive commensal bacteria . The human oral commensal Streptococcus gordonii was engineered to surface express a 204-amino acid allergen from hornet venom (Ag5.2) as a fusion with the anchor region of the M6 protein of Streptococcus pyogenes . The immunogenicity of the M6-Ag5.2 fusion protein was assessed in mice inoculated orally and intranasally with a single dose of recombinant bacteria, resulting in the colonization of the oral/pharyngeal mucosa for 10-11 weeks . A significant increase of Ag5.2-specific IgA with relation to the total IgA was detected in saliva and lung lavages when compared with mice colonized with wild-type S . gordonii . A systemic IgG response to Ag5.2 was also induced after oral colonization . Thus, recombinant Gram-positive commensal bacteria may be a safe and effective way of inducing a local and systemic immune response.

Blood, 1995 Jul 15, 86(2), 776 - 83
Clinical events in the first decade in a cohort of infants with sickle cell disease . Cooperative Study of Sickle Cell Disease; Gill FM et al.; Within the Cooperative Study of Sickle Cell Disease, 694 infants with confirmed sickle cell disease were enrolled at less than 6 months of age . Information about the nature and frequency of complications was collected prospectively over a 10-year period . Painful crises and acute chest syndrome were the most common sickle cell-related events in homozygous sickle cell anemia (SS), hemoglobin SC disease (SC), and S beta thalassemia patients (overall incidence in SS patients of 32.4 and 24.5 cases per 100 person-years, respectively) . Bacteremia occurred most frequently in SS children under 4 years of age and in SC patients less than 2 years of age . The mortality rate was low in this cohort compared with that found in previous reports . Twenty children, all with Hb SS, died (1.1 deaths per 100 person-years among SS patients) . Infection, most commonly with Streptococcus pneumoniae and Hemophilus influenzae, caused 11 deaths . Two children died of splenic sequestration, 1 of cerebrovascular accident, and 6 of unclear causes . Two patients underwent cholecystectomies, and 17 underwent splenectomies after one or more splenic sequestration crises . The experience of this cohort should reflect closely the true clinical course of those children with Hb SS and Hb SC disease who are observed in sickle cell centers in the United States.

FEMS Microbiol Lett, 1995 Jul 15, 130(1), 31 - 5
Drastic changes in the peptidoglycan composition of penicillin resistant laboratory mutants of Streptococcus pneumoniae; Severin A et al.; The penicillin MIC of 2 Streptococcus pneumoniae clinical isolates was increased 100-fold (from 0.02 to 2.0 micromilligrams) and 20-fold (from 0.5 to 10.0 micromilligrams) through gradual exposure of the bacteria to increasing concentrations of penicillin in the laboratory . In both mutants the affinity of all four high molecular mass penicillin binding proteins (PBPs) for penicillin was drastically reduced accompanied by major changes in the composition of peptidoglycan as resolved by HPLC . The ratio of crosslinked to monomeric peptides became virtually inverted in the resistant cell walls with monomers representing two-thirds of the muropeptide species . The proportion of the crosslinked tri-tetra dimer, a major component of the cell wall of the original isolates, decreased to one-third or one-sixth of its normal representation, while the amounts of tripeptide monomers with an alanyl-serine substitution on the lysine epsilon amino group increased by close to a factor of two . The growth rates of both mutants decreased by a factor of approximately two, as compared to the original bacteria.

J Mol Biol, 1995 Jul 7, 250(2), 144 - 55
An extended -10 promoter alone directs transcription of the DpnII operon of Streptococcus pneumoniae; Sabelnikov AG et al.; The genetic cassette encoding the DpnII restriction-modification system of Streptococcus pneumoniae gave transcription products of approximately 2.7 and 1.8 kilobases . The larger, mRNA1, covered both of the methylase genes, dpnM and dpnA, and the endonuclease gene dpnB; the smaller, mRNA2, covered only the dpnA and dpnB genes . Transcription of mRNA1 was shown to begin at the translation start site for dpnM, thereby producing an mRNA without any apparent ribosome-binding site for translation of the DpnM methylase . The promoter for mRNA1 was shown by base substitution and deletion analysis to consist of an extended -10 site, TaTGgTATAAT, with no required -35 site . A possible promoter further upstream with close matches to a -35 site and a nonextended -10 site was not used . A survey of 36 proven and putative promoters used by S . pneumoniae revealed that 61% of them contained the full -10 extension, although, other than the dpnM promoter, they matched at a -35 site, as well . It appears that, unlike those found in Escherichia coli, S . pneumoniae promoters frequently require an extended -10 site, and such a site can function naturally without a -35 site.

Gene, 1995 Jul 4, 160(1), 41 - 6
Two domains with amino-acid sequence similarity are required for dihydroneopterin aldolase function in the multifunctional folic acid synthesis Fas protein of Pneumocystis carinii; Volpe F et al.; The folic acid synthesized gene (fas) of Pneumocystis carinii (Pc) codes for a multifunctional enzyme (Fas) known to catalyse three consecutive steps leading to the production of dihydropteroate in the de novo folate synthesis pathway . Previously, we predicted that a domain, designated FasB (amino acids (aa) 161-280), of the 740-aa multifunctional protein contains the first of the three enzyme activities in the pathway, namely dihydroneopterin aldolase (DHNA), since it shares 23% aa identity with the DHNA of Streptococcus pneumoniae (Sp) . We now extend these findings to show that a second domain, FasA (aa 39-160), whose function was previously unknown, shares 27% sequence identity with the adjacent FasB domain, indicative of functional similarity . FasA is also 18% identical with the DHNA from Sp . Recombinant baculoviruses were constructed which directed the production of either FasA, FasB or FasAB polypeptide species in cultured Spodoptera frugiperda (SF9) insect cells . No DHNA activity is associated with either fasA or fasB when produced as single domains in the insect-baculovirus system . However, DHNA activity was detected in SF9 extracts containing the overproduced FasAB polypeptide . The results of aa sequence alignments and expression studies suggest that FasA and FasB may be two subunits of the DHNA enzyme moiety within the multifunctional Fas protein of Pc . An alternative interpretation of the results is also discussed.

Ugeskr Laeger, 1995 Jul 3, 157(27), 3904 - 8
{Acute injection-induced injuries in drug addicts . A review of 146 consecutive admissions}; Henriksen BM et al.; Admissions of drug abusers with acute soft tissue lesions at the injection site increased in number over the period 1985-1989 . There were 146 admissions in 90 patients . The diagnoses were: 58 superficial abscesses, 27 deep abscesses, 57 cellulitis, one tenosynovitis, one purulent arthritis, one not further categorised abscess and one case of arterial spasm . The commonest location was the groin (25%) . Serious complications occurred in 17 cases, including four femoral amputations due to arterial lesions . Ultrasonic examination is recommended before surgery if central vessels can be involved, especially in the groin . Sufficient microbiological examination was performed in 78 cases . There was a predominance of polybacterial infections (53% polybacterial, 38% monobacterial, 9% sterile) . The most common bacteria were Streptococcus spp . with a preponderance of oropharyngeal bacteria, Staphylococcus aureus, and anaerobes, especially Bacteroides spp . Typical intestinal bacteria were rare . We recommend that aerobic and anaerobic culturing with susceptibility testing always be carried out, that primary antibacterial therapy should be with an antistaphylococcal agent like dicloxacillin plus metronidazole and that free injection paraphernalia with disinfection swabs should be made easily available.

Microb Drug Resist, 1995 Summer, 1(2), 185 - 9
Effects of combination of benzylpenicillin and fosfomycin on penicillin-resistant Streptococcus pneumoniae; Kikuchi K et al.; The in vitro activity of benzylpenicillin in combination with fosfomycin against 51 clinical isolates of penicillin-resistant Streptococcus pneumoniae {minimal inhibitory concentrations (MICs) of benzylpenicillin > or = 0.5 mg/liter} was investigated . The fractional inhibitory concentration (FIC) index using the checkerboard method ranged from 0.38 to 0.75 (mean: 0.63) . A synergy was also demonstrated in the killing curve on S . pneumoniae TW-1303 (MIC of benzylpenicillin, 2 mg/liter; MIC of fosfomycin, 32 mg/liter: FIC index, 0.38) . Fosfomycin inhibited the production of all penicillin-binding proteins (PBP) except PBP 2B of S . pneumoniae TW-1303 and it decreased that of PBP 2B when it was combined with benzylpenicillin . These results suggest that the combination of benzylpenicillin and fosfomycin could be considered as the alternative treatment of penicillin-resistant pneumococcal infections.

Microb Drug Resist, 1995 Summer, 1(2), 169 - 76
Penicillin-resistant and multidrug-resistant Streptococcus pneumoniae in a pediatric hospital in Zagreb, Croatia; Tarasi A et al.; Sixty-four penicillin-resistant Streptococcus pneumoniae isolates {benzylpenicillin minimal inhibitory concentrations (MICs) between 0.05 and 1.6 micrograms/ml} recovered at the Pediatric Hospital "Dr . Fran Mihaljevic" in Zagreb, Croatia between October 1990 and March 1993 were analyzed for serotype, antibiotic susceptibility patterns, and chromosomal relatedness using pulsed-field gel electrophoretic (PFGE) analysis of chromosomal DNA fragmented by digestion with the SmaI endonuclease . Hospital "Dr . Fran Mihaljevic" services the capital of Croatia and its vicinity . Most of the isolates were from nasopharyngeal carriage, but several isolates were from otitis media, sinusitis, and meningitis . Most isolates belonged to either serotype 23F (36/64) or 19F (12/64); the rest, including three 15C isolates, were in 11 additional distinct serotypes . The overwhelming majority (25/36) of the serotype 23F isolates had penicillin MIC values of 1-2 micrograms/ml and shared variants of a common PFGE pattern, closely related to the PFGE identified in multiresistant pneumococci of the same serotype with wide geographic spread to Spain, Portugal, France, and the United States . This group of bacteria was also resistant to tetracycline, chloramphenicol, and sulfamethoxazole/trimethoprim . In contrast to the relative genetic and phenotypic homogeneity of the more highly penicillin resistant isolates, pneumococci with penicillin MICs between 0.5 and 0.4 microgram/ml (29/64) were distributed in 13 different serotypes and as many as 20 distinct PFGE patterns.

Microb Drug Resist, 1995 Summer, 1(2), 127 - 30
Epidemiology of resistant pneumococci in Hungary; Marton A; Data on resistance in Streptococcus pneumoniae was analyzed in cohorts of isolates from nasal carriers without respiratory tract infection, nose-throat swabs, and ear fluid specimens of children, from sputum and bronchoalveolar lavage of adults and central spinal fluid, blood, and pleural fluid of patients without a distinction of age group . Colonizing strains in infant carriers showed a higher resistance rate (47.5%) to penicillin than in other children (24.2%) . Isolates of inpatients, predominantly infants with respiratory tract infection, presented a higher prevalence of resistance than outpatients in all age groups . Adults showed the lowest resistance rates . Resistance was rarer among S . pneumoniae isolates from patients with systemic infection . The few cases caused by resistant S . pneumoniae should raise concern . Resistance among strains from ear fluid was more prevalent in all investigated population groups than among isolates from throat-nose swabs . The similarity of resistance rates to erythromycin and penicillin was associated with frequent combined resistance . While the prevalent serotype among the resistant strains was 19A, no predominant serotype was found among the susceptible strains.

Microb Drug Resist, 1995 Summer, 1(2), 115 - 20
Pneumococcal resistance to beta-lactam antibiotics: a global geographic overview; Baquero F; beta-Lactam resistance in Streptococcus pneumoniae has spread over the entire world . The 10 main foci of resistant organisms are located in the following areas: (1) southwest Europe (Spain, France, Portugal), (2) central-east Europe (Hungary, Roumania, Bulgaria, Turkey) and Israel, (3) northwest Russia, (4) South Africa, (5) Japan and South Korea, (6) Papua-New Guinea, (7) Alaska, (8) southeast North America, (9) southwest North America, and (10) south cone in South America . A comparison of the presumed factors influencing the increase of pneumococcal resistance in these foci with those occurring in low incidence areas, such as central-north Europe, Scandinavia, north and western Africa, or middle-north Mediterranean countries (Italy, Greece) should provide the clues to predict and prevent further spread of resistant pneumococci.

Ophthalmology, 1995 Jul, 102(7), 1026 - 30
Microbial keratitis in patients infected with the human immunodeficiency virus; Hemady RK; BACKGROUND: Posterior segment complications of systemic infection with the human immunodeficiency virus (HIV) are well recognized . The anterior segment complications often are, however, overlooked . The author treated 20 episodes of nonherpetic infectious keratitis in 17 eyes of 13 patients infected with HIV who presented between August 1990 and May 1994 . METHODS: Review of records . RESULTS: Nine patients were women, and four were men . Mean age was 35.2 years . The keratitis was bilateral in four patients, polymicrobial in four, and recurrent in two . The most common infecting organism was Candida albicans (5 eyes), a rare cause of keratitis in immunocompetent individuals . Other organisms included Staphylococcus aureus in four eyes, Staphylococcus epidermidis in four, Bacillus sp in two, and one each Pseudomonas aeruginosa, alpha-hemolytic Streptococcus, Micrococcus sp, and Capnocytophaga sp . Seven eyes retained 20/30 or better visual acuity after treatment, eight had visual acuity of 20/50 or worse, and two were eviscerated . Classic predisposing factors for infectious keratitis were found in only two patients and included contact lens wear and atopy in one patient each . Twelve patients had a history of intravenous drug abuse . CONCLUSION: Infectious keratitis should be recognized as a complication of systemic HIV infection, especially in the context of drug abuse . The prognosis for recovery of vision in these patients often is poor.

Diagn Microbiol Infect Dis, 1995 Jul, 22(3), 253 - 9
Effect of specimen storage, antibiotics, and feminine hygiene products on the detection of group B Streptococcus by culture and the STREP B OIA test; Ostroff RM et al.; Agar culture from vaginal swabs is the routine method for diagnosis of maternal Group B Streptococcus (GBS) colonization . Swab specimens are often transported to a clinical laboratory for processing . In these studies, specimen transport was simulated by inoculating swabs with GBS and storing them at selected temperatures and with or without transport medium . The recovery of viable GBS was assessed by agar culture . GBS antigen was detected immunologically with an Optical ImmunoAssay (OIA) method . Swabs that were stored with transport medium harbored viable but rapidly declining numbers of GBS . In contrast, a strong OIA signal was maintained . Recovery of viable GBS organisms declined more quickly when swabs were stored in the absence of transport medium, whereas detection of GBS antigen remained consistent . Both methods were tested for interference from either antibiotics or feminine hygiene products . These compounds inhibited the detection of GBS by culture but had no detrimental effect on the OIA result.

Arq Bras Cardiol, 1995 Jul, 65(1), 37 - 42
{Surgical treatment of infective endocarditis}; Jorge Sdo C et al.; PURPOSE--To analyse, retrospectively, 83 patients with infective endocarditis (IE) that were operated during the acute phase of the disease and to identify possible subgroups with distinct mortality . METHODS--Between 1985 to 1990, 83 patients comprised the subject of this analysis . Fifty-one (61%) were male, aged between 3 months to 71 years, mean of 31.4 +/- 16.7 years . RESULTS--We could identify two subgroups that were most frequently operated on: the left side IE and the Staphylococcus aureus; and 77 (43%) had left sided IE (p < 0.001) . When discriminated accordingly to the specifically etiologic agent (Staphylococcus aureus) this difference continues to be statistically significant: of 29 left sided IE by this agent 13 (45%) were operated on, whereas from 22 right sided IE by the same agents, just 3 (14%) were operated on (p < 0.05) . The two major etiologic agents did not show any statistically significant difference in the number of patients that needed to be operated on: on those 51 patients with Staphylococcus aureus IE, 16 (31%) were treated surgically, while from the 60 patients with Streptococcus viridans, 22 (37%) underwent to surgical procedure (p- NS) . The mortality in the patients treated by surgery was 32%, and those with Staphylococcus aureus IE were responsible for 46% of the total surgical deaths . CONCLUSION--Surgical treatment were most frequently used in the patient with left sided IE independently of the etiologic agent.

Minerva Stomatol, 1995 Jul-Aug, 44(7-8), 369 - 75
{A new device for the disinfection of handpieces and turbines}; Simonetti D'Arca AS et al.; Dental handpieces are often difficult to disinfect . This is one of the main reasons for the considerable risk of cross-infections in dental offices . The aim of the present study was the evaluation of the disinfectant property of a recent, commercially available, automatic instrument, described as capable to clean, disinfect and lubricate dental handpieces . The following experimental evaluations were made: 1) antimicrobial activity of the disinfectant (glyoxalaldehyde) used . The method described by the European Committee for Standardization was followed . Test microorganisms were Pseudomonas aeruginosa and Staphylococcus aureus . 2) disinfection of dental handpieces (69 contra-angles and 97 turbines of different marks) . They were naturally infected using them on patients for 30 minutes at least . 3) disinfection of dental handpieces infected with bacterial suspensions of Staphylococcus aureus, Streptococcus pyogenes (beta-haemolyticus, group A), Candida albicans and Pseudomonas aeruginosa . The results of the first experiment showed a strong bactericidal power of the disinfectant with both the tested strains, after a contact time of only 1 minute . A great proportion of the dental handpieces tested during the second experiment were found disinfected: from 84% through 89% out of the various models of turbine handpieces; from 89% through 100% out of the models of contra-angle handpieces . Even though bacterial contamination level was low (about 10(3) microorganisms per handpiece), a satisfactory disinfectant ability in natural conditions was found . The results of the third experiment were unclear . The tested instrument reduced 10(5)-10(8) times the original bacterial count when the gram positive microorganisms (Staphylococcus aureus, Streptococcus pyogenes) were used . On the other hand, when Pseudomonas aeruginosa and Candida albicans were used, the results were different: the bacterial count was reduced 10(6)-10(7) times in some cases, and only 10(2) times in other cases . This difference was found in the tests made using the same attachment and in those made using various attachments . In conclusion, the tested instrument showed, in most cases, a good disinfectant property, but the presence of unclear results suggests that some technical modifications are required.

J Antimicrob Chemother, 1995 Jul, 36(1), 225 - 30
Susceptibility of enterococci, methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae to the glycylcyclines; Weiss WJ et al.; The in-vitro activities of two glycylcyclines, DMG-MINO and DMG-DMDOT, and several comparative agents were determined against 263 enterococci, 102 methicillin-resistant Staphylococcus aureus and 55 Streptococcus pneumoniae recent clinical isolates . The glycylcyclines and teicoplanin were the most active agents against the enterococcal isolates . All methicillin-resistant S . aureus were susceptible to the glycylcyclines . Only DMG-DMDOT, ciprofloxacin, teicoplanin and vancomycin exhibited comparable activity against penicillin-susceptible, -intermediate and -resistant S . pneumoniae strains.

Klin Oczna, 1995 Jul-Sep, 97(7-8), 252 - 4
{Bacterial flora in the conjunctival sac of patients before cataract surgery}; Kecik T et al.; Retrospective analysis of 2365 cultures from conjunctival sac of patients was done . The most frequent bacteria included Staphylococcus epidermidis (48.7%), Staphylococcus aureus (11%) and Streptococcus (1%) . The sensibility of the bacterial cultures for the most frequently applied chemotherapeutics was evaluated . Our results were compared with those in the literature.

West Afr J Med, 1995 Jul-Sep, 14(3), 127 - 33
Open clinical trial of roxithromycin amongst patients of Jos University Teaching Hospital with lower and upper respiratory tract infections; Idoko JA et al.; An open non-comparative clinical study to determine the efficacy and tolerance of Roxithromycin 150 mg twice daily was carried out amongst Nigerian patients with acute upper and lower respiratory tract infections . Twenty-four (24) patients (mean age 21.6 years, male 13; females 11 who completed the study presented with acute tonsillitis (33.3%, acute bronchitis (12.5%), lober pneumonia (12.5%), Otitis media (8%), acute pharyngitis (4%) and acute sinusitis (4%) . Most of the patients had normal bacterial flora isolated (50.3%) . Pathogens isolated included streptococcus pyogenes (21%), moraxella catarhalis (8.3%), streptococcus pneumonia (8.3%) and Klebsiella pneumonia (4%) . The quick clinical response, lack of major adverse drug reactions and susceptibility of the bacterial isolates to Roxithromycin were very significant attributes of the drug . In addition, there was complete recovery in 95.8% of the patients . Roxithromycin is therefore a well tolerated and effective drug for the treatment of acute respiratory tract infections in Nigerian patients.

J Infect Dis, 1995 Jul, 172(1), 124 - 31
Epidemic streptococcal disease among Army trainees, July 1989 through June 1991; Gunzenhauser JD et al.; Outbreaks of group A streptococcal infection occurred at four of seven US Army basic training installations between 1 July 1989 and 30 June 1991 . Study data were collected through a respiratory disease surveillance program and on-site epidemiologic investigations . Although hospitalizations were frequent (range, 191-334) during each outbreak, average rates of hospitalization were low (2.4-4.8 hospitalizations/1000 trainees/week) . Outbreak-associated morbidity included streptococcal toxic shock syndrome (2 cases, 1 fatal), acute rheumatic fever (6), acute glomerulonephritis (1), scarlet fever (1), and numerous other invasive sequelae . Four serotypes of Streptococcus pyogenes (M-1, -3, -5, and -18) were identified; M-18 caused significant disease at 2 installations . Disease control was rapidly achieved through prophylaxis programs using benzathine penicillin G in nonallergic trainees . These outbreaks extend other reports that document an evolution of the nature and severity of circulating S . pyogenes in the United States.

Mayo Clin Proc, 1995 Jul, 70(7), 662 - 4
Chronic cough associated with subacute bacterial endocarditis; Martin L et al.; Although the literature on subacute bacterial endocarditis from both the preantibiotic and antibiotic eras mentions cough as a symptom, neither bacteremia nor endocarditis is listed in reviews on chronic cough . Herein we describe a 74-year-old man who underwent an extensive workup as an outpatient because of chronic cough of 7 months' duration . Chest roentgenography, chest and sinus computed tomography, fiberoptic bronchoscopy, gallium scan, transthoracic echocardiography, and other studies revealed no apparent cause for his nonproductive cough . Because of a persistently increased erythrocyte sedimentation rate and associated weight loss, blood cultures were obtained, all of which grew Streptococcus constellatus . A transesophageal echocardiogram revealed mitral valve vegetation . After antibiotic therapy was administered, the patient's cough completely resolved . He has experienced no coughing for more than 14 months . Bacteremia in conjunction with endocarditis should be added to the list of uncommon causes of chronic cough . The mechanism of cough is unknown.

Infect Immun, 1995 Jul, 63(7), 2776 - 9
Different forms of streptolysin O produced by Streptococcus pyogenes and by Escherichia coli expressing recombinant toxin: cleavage by streptococcal cysteine protease; Pinkney M et al.; To resolve apparent discrepancies in the literature, N-terminal sequences of the active high- and low-molecular-weight (high- and low-M(r)) forms of native streptolysin O (nSLO) purified from Streptococcus pyogenes culture supernatants and of the similar-size high- and low-M(r) forms of recombinant SLO (rSLO) found in the periplasm of Escherichia coli expressing a cloned slo gene were determined . The high-M(r) forms of nSLO and rSLO are identical, reflecting removal of a 31-residue signal peptide, but the similar-size low-M(r) forms are very different . Removal of C-terminal sequences by proteases in the E . coli periplasm produces an inactive low-M(r) form of rSLO . In contrast, an active low-M(r) form of nSLO is produced by proteolytic cleavage between the N-terminal residues Lys-77 and Leu-78, which was shown to correspond to an extremely sensitive cleavage site for the pyrogenic exotoxin B-derived streptococcal cysteine protease.

Infect Immun, 1995 Jul, 63(7), 2706 - 13
Characterization of a recombinant pneumolysin and its use as a protein carrier for pneumococcal type 18C conjugate vaccines; Kuo J et al.; Pneumolysin from Streptococcus pneumoniae was expressed in Escherichia coli as a glutathione S-transferase fusion protein and purified by affinity and hydroxylapatite chromatography . The purified recombinant pneumolysin (rPL), with a molecular mass of 53 kDa, had a specific activity of 3 x 10(5) hemolytic units per mg of protein on rabbit erythrocytes and reacted identically in immunodiffusion with the antisera against native pneumolysin . The rPL was used as a protein carrier to prepare conjugate vaccine with pneumococcal type 18C polysaccharide (PS18C) . The PS18C was directly coupled to rPL by reductive animation or was indirectly coupled to rPL via a spacer molecule, adipic acid dihydrazide . The conjugates were nontoxic for mice and guinea pigs at 100 micrograms per dose . The immunogenicity and protective efficacy of both conjugates were tested in mice . A single dose of either of the vaccines elicited a rise in immunoglobulin G antibody production; after two booster injections of the vaccines, statistically significant booster responses (P < 0.001) to both rPL and PS18C were produced . The sera containing the antibodies to rPL were capable of neutralizing the hemolytic activity of rPL to rabbit erythrocytes and the cytotoxicity of rPL to bovine pulmonary endothelial cells . Immunization with the conjugate vaccines conferred statistically significant protection in mice against lethal challenge with type 18C pneumococci.

Infect Immun, 1995 Jul, 63(7), 2556 - 63
A Streptococcus mutans mutant that synthesizes elevated levels of intracellular polysaccharide is hypercariogenic in vivo; Spatafora G et al.; We used the streptococcal transposon, Tn916 to identify and isolate mutants of Streptococcus mutans with altered intracellular polysaccharide (IPS) accumulation . We report on the isolation and characterization of S . mutans SMS202, a transposon mutant which accumulated the glycogen-like IPS in excess of wild-type levels . Southern blot analysis confirmed a single Tn916 insertion into the SMS202 chromosome . Moreover, quantitative ultrastructural analysis revealed significantly increased concentrations of IPS in SMS202 relative to those of the wild-type progenitor strain, UA130 . The activities of ADPglucose pyrophosphorylase (GlgC) and glycogen synthase (GlgA), enzymes required for the biosynthesis of bacterial IPS, were also elevated in the IPS excess mutant . Furthermore, SMS202 was significantly more cariogenic on the molar surfaces of germ-free rats than the wild type (P < 0.01), thus confirming a central role for IPS in S . mutants-induced caries formation . We propose that the increased cariogenic potential of SMS202 is due to constitutive expression of genes which encode glycogen biosynthesis in this oral pathogen . The coordinate expression of GlgC and GlgA along with the results of ongoing nucleotide sequence analysis and Northern hybridization experiments support an operon-like arrangement for the glg genes of this oral pathogen.

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