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,