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| Infect Immun, 1999 Jun, 67(6), 2720 - 8 Identification and characterization of a novel fibronectin-binding protein on the surface of group A streptococci; Rocha CL et al.; Understanding the role surface proteins play in the interaction of group A streptococci with epithelial cells is an important step toward the development of new strategies to fight infections . Fibronectin-binding proteins in streptococci and staphylococci have been described as important mediators for adherence to eukaryotic cells . In the present study we describe a new Streptococcus pyogenes fibronectin-binding protein (PFBP) . The gene encoding the PFBP protein (pfbp) was identified from an M12 strain genomic library . It encodes a protein of 127.4 kDa which contains the LPXTGX motif characteristic of cell wall-associated proteins in gram-positive organisms and is among the largest surface molecules described for group A streptococci . The pfbp gene is transcribed during cell growth and was present in several class I and II streptococcal strains tested . The deduced amino acid sequence of PFBP exhibits a variable N-terminal region and a conserved C-terminal region when compared to most fibronectin-binding proteins identified from other gram-positive bacteria . The N-terminal region presents a stretch of 105 amino acids with no homology with N-terminal regions of previously described fibronectin-binding molecules, while the C-terminal region contains three repeat domains that share significant similarity with the repeat regions of fibronectin-binding proteins from S . pyogenes, S . dysgalactiae, and S . equisimilis . The PFBP repeated region, when expressed on the surface of S . gordonii, a commensal organism, binds to soluble and immobilized fibronectin . This study also shows that, in addition to pfbp, a second gene homologous with that of protein F1 (which also codes for a fibronectin-binding protein) is transcribed during cell growth in the same S . pyogenes strain. J Biol Chem, 1999 May 28, 274(22), 15336 - 44 Protein GRAB of streptococcus pyogenes regulates proteolysis at the bacterial surface by binding alpha2-macroglobulin; Rasmussen M et al.; In the molecular interplay between pathogenic microorganisms and their host, proteolytic mechanisms are believed to play a crucial role . Here we find that the important human pathogen Streptococcus pyogenes (group A Streptococcus) expresses a surface protein with high affinity (Ka = 2.0 x 10(8) M-1) for alpha2-macroglobulin (alpha2M), the dominating proteinase inhibitor of human plasma . The immunoglobulin-binding protein G of group C and G streptococci also contains an alpha2M-binding domain and a gene encoding protein GRAB (protein G-related alpha2M-binding protein) was identified in the S . pyogenes Genome Sequencing data base . The grab gene is present in most S . pyogenes strains and is well conserved . Protein GRAB has typical features of a surface-attached protein of Gram-positive bacteria . It also contains a region homologous to parts of the alpha2M-binding domain of protein G and a variable number of a unique 28-amino acid-long repeat . Using Escherichia coli-produced protein GRAB and synthetic GRAB peptides, the alpha2M-binding region was mapped to the NH2-terminal part of protein GRAB, which is the region with homology to protein G . An isogenic S . pyogenes mutant lacking surface-associated protein GRAB showed no alpha2M binding activity and was attenuated in virulence when injected intraperitoneally in mice . Finally, alpha2M bound to the bacterial surface via protein GRAB was found to entrap and inhibit the activity of both S . pyogenes and host proteinases, thereby protecting important virulence determinants from proteolytic degradation . This regulation of proteolytic activity at the bacterial surface should affect the host-microbe relation during S . pyogenes infections. Heart Lung, 1999 May-Jun, 28(3), 219 - 21 Group A streptococcal necrotizing fasciitis of the psoas muscle; Anderson JF et al.; Group A streptococci are common colonizers of the skin and upper respiratory tract . Serious infections of the respiratory tract as well as the skin and soft tissue are common . Highly virulent Group A streptococci are not infrequently the cause of invasive, life-threatening infections . Necrotizing fasciitis is uncommon and rarely the result of Group A streptococci . Necrotizing fasciitis of the psoas from Group A streptococci has been reported as a complication in patients with colon cancer perforation or peritonitis . We report the first case of Group A streptococcal necrotizing fasciitis of the psoas muscle not associated with peritonitis or colon perforation. Arch Otolaryngol Head Neck Surg, 1999 May, 125(5), 552 - 4 Interference by aerobic and anaerobic bacteria in children with recurrent group A beta-hemolytic streptococcal tonsillitis; Brook I et al.; OBJECTIVE: To compare the frequency of recovery of aerobic and anaerobic bacteria with interfering capability of group A beta-hemolytic streptococci (GABHS) in the tonsils of children with and without a history of recurrent GABHS pharyngotonsillitis . PATIENTS AND METHODS: Tonsillar cultures were taken from a group of 20 children with and 20 without history of recurrent GABHS pharyngotonsillitis . RESULTS: Eleven aerobic and anaerobic isolates with interfering capability with GABHS were recovered from 6 (30%) of the 20 children with recurrent GABHS, and 40 such organisms were isolated from 17 (85%) of the 20 without recurrences (P<.01) . The interfering organisms included aerobic (alpha-hemolytic and nonhemolytic streptococci) and anaerobic organisms (Prevotella and Peptostreptococcus species) . CONCLUSIONS: The tonsils of children with a history of recurrent GABHS infection contain fewer aerobic and anaerobic bacteria with interfering capability of GABHS than those without the history of recurrent GABHS infection . The presence of these interfering bacteria may play a role in preventing GABHS infection. J Clin Microbiol, 1999 Jun, 37(6), 1876 - 80 Molecular relationships and antimicrobial susceptibilities of viridans group streptococci isolated from blood of neutropenic cancer patients; Wisplinghoff H et al.; From January 1995 to May 1998, 57 episodes of bacteremia due to viridans group streptococci were identified in 50 febrile neutropenic patients with hematologic malignancies . Four patients experienced two separate episodes of streptococcal bacteremia, and one patient had four separate episodes of streptococcal bacteremia . Strains were identified to species level as Streptococcus mitis (n = 37), Streptococcus oralis (n = 19), and Streptococcus salivarius (n = 1) . Epidemiologic relatedness of these strains was studied by using PCR-based fingerprinting with M13 and ERIC-2 primers and pulsed-field gel electrophoresis with restriction enzyme SmaI . All strains that were isolated from different patients exhibited unique fingerprint patterns, thus suggesting that viridans group streptococcal bacteremia usually derives from an endogenous source . Cross-transmission of strains between patients could not be established . Four S . mitis isolates recovered during four separate bacteremic episodes in a single patient had identical fingerprint patterns . Susceptibility testing was carried out by broth microdilution technique according to National Committee for Clinical Laboratory Standards guidelines . The MICs at which 90% of the isolates are inhibited were (in milligrams per liter) as follows: 0 . 5 (penicillin), 0.5 (amoxicillin), 0.25 (cefotaxime), 2 (chloramphenicol), 4 (erythromycin), 0.5 (clindamycin), >/=32 (tetracycline), >/=32 (trimethoprim-sulfamethoxazole), 4 (ciprofloxacin), 0.5 (sparfloxacin), 0.5 (vancomycin), 0.25 (teicoplanin), and 1 (quinupristin-dalfopristin) . High-level penicillin resistance (MIC, >/=4 mg/liter) was found in one isolate only, but intermediate penicillin resistance was noted in 11 isolates (19%) . Resistance rates to other drugs were as follows: 7% (amoxicillin), 4% (cefotaxime), 4% (chloramphenicol), 32% (erythromycin), 9% (clindamycin), 39% (tetracycline), 68% (trimethoprim-sulfamethoxazole), 23% (ciprofloxacin), 0% (sparfloxacin), 0% (vancomycin), 0% (teicoplanin), and 0% (quinupristin-dalfopristin). Burns, 1999 May, 25(3), 242 - 6 Beta-haemolytic Streptococcus infection in burns; Bang RL et al.; Group A beta haemolytic Streptococcus has been one of the most serious infections in the burn patients resulting in severe cellulitis and sepsis . Penicillin has been used ever since its introduction as prophylaxis against these conditions . Penicillin prophylaxis was used in our burn unit as well without any serious evaluation until December 1992 . This prospective study was therefore, undertaken to evaluate the incidence of beta haemolytic Streptococcus infection in burn patients, and its clinical outcome over a period of 5 years in the absence of prophylaxis with penicillin . 14 of the 1213 burn patients admitted to the Al-Babtain Centre for Plastic Surgery and Burns from January 1993 to December 1997 had either colonization or infection with Streptococcus spp . Their mean age was 15 years (range 1 month to 52 years) and the mean burn surface area was 20% (range 5 to 90%) . Streptococci were isolated from burn wounds in 10 patients, throat in 3 and blood culture in 1 . Group A Streptococcus was found in 5, group C in 3 and group D in 6 patients . In all patients except one the organisms were isolated > or =72 h post burn . The infections were successfully controlled by antibiotic and no detrimental effect was observed either on wound healing or skin graft take . There was no mortality amongst these 14 patients . The study showed that only 1.1% of the burn patients in our unit acquired Streptococcus of which only one third comprised of group A . This study thus demonstrates that the practice of penicillin prophylaxis during the first five post burn days may not be of any value and therefore, deserves discontinuation in units where the incidence of this organism is minuscule. Int Immunol, 1999 Apr, 11(4), 569 - 76 Functional analysis of IgA antibodies specific for a conserved epitope within the M protein of group A streptococci from Australian Aboriginal endemic communities; Brandt ER et al.; The mucosa is one of the initial sites of group A streptococcal (GAS) infection and salivary IgA (sIgA) is thought to be critical to immunity . However, the target epitopes of sIgA and the function of sIgA in GAS immunity, in particular the role of accessory cells and complement, is largely unknown . We studied the aquisition and the function of sIgA specific for a conserved region epitope, p145 (sequence: LRRDLDASREAKKQVEKALE) of the M protein . Peptide 145-specific sIgA is highly prevalent within an Aboriginal population living in an area endemic for GAS and acquisition of p145-specific sIgA increases with age, consistent with a role for such antibodies in immunity to GAS . Human sIgA and IgG specific for p145 were affinity purified and shown to opsonize M5 GAS in vitro . Opsonization could be specifically inhibited by the addition of free p145 to the antibodies during assay . Opsonization of GAS was totally dependent on the presence of both complement and polymorphonuclear leukocytes, and, moreover, affinity-purified p145-specific sIgA was shown to fix complement in the presence of M5 GAS . These data show that mucosal IgA to this conserved region peptide within the M protein has an important role in human immunity against GAS and may be useful in a broad-based cross-protective anti-streptococcal vaccine. J Endod, 1999 Mar, 25(3), 167 - 71 In vivo antimicrobial activity of 2% chlorhexidine used as a root canal irrigating solution; Leonardo MR et al.; The aim of the present study was to evaluate the in vivo antimicrobial activity of 2% chlorhexidine gluconate (FCFRP-USP) used as a root canal irrigating solution in teeth with pulp necrosis and radiographically visible chronic periapical reactions . Culture techniques and measurement of the inhibition zone were used . Twenty-two root canals of incisors and molars of 12 patients were used . After accessing the canal, the first root canal sample was collected with two sterile paper points that were transferred to a tube containing reduced transport fluid . The root canal was instrumented using chlorhexidine solution . A small sterile cotton pellet was placed at the root canal entrance, and the cavity was sealed with zinc oxide-eugenol cement . The canals were maintained empty for 48 h . Three sterile paper points were then introduced to absorb the root canal fluid (second sample) . One paper point was placed on an agar plate inoculated with Micrococcus luteus ATCC 9341 and incubated for 24 h at 37 degrees C, and the other two were submitted to microbiological evaluation . Present in 10 cases at baseline, mutans streptococci was reduced by 100% at the second assessment . Treatment showed an efficiency of 77.78% for anaerobic microorganisms at the second assessment . These data suggest that chlorhexidine prevents microbial activity in vivo with residual effects in the root canal system up to 48 h. Int J Syst Bacteriol, 1999 Apr, 49 Pt 2, 489 - 502 Recommended minimal standards for description of new staphylococcal species . Subcommittee on the taxonomy of staphylococci and streptococci of the International Committee on Systematic Bacteriology; Freney J et al.; In accordance with Recommendation 30b of the International Code of Nomenclature of Bacteria, minimal standards are proposed for the genus Staphylococcus and the description of newly recognized species in this genus . Assignment of a strain to the genus Staphylococcus requires that it is a Gram-positive coccus that forms clusters, produces catalase, has an appropriate cell wall structure (including peptidoglycan type and teichoic acid presence) and G + C content of DNA in a range of 30-40 mol% . The recommended minimal standards for describing a new Staphylococcus species are based on the results of phenotypic and genomic studies of at least five independently isolated strains . They include colony morphology and the results of the following conventional tests: pigment production, growth requirements, fermentative and oxidative activity on carbohydrates, novobiocin susceptibility, enzymic activities (nitrate reductase, alkaline phosphatase, arginine dihydrolase, ornithine decarboxylase, urease, cytochrome oxidase, staphylocoagulase in rabbit plasma, heat-stable nuclease, amidases, oxidases, clumping factor, and haemolytic activity on sheep or bovine blood agar) . DNA-DNA hybridization experiments may distinguish species when the difference between the binding in the homologous reaction and the binding in the heterologous reaction expressed as a percentage is less than 70% . In addition, rRNA signature sequence criteria, ribotyping characterization of the nomenclature type strain and other strains of the species, and reference strains of other species is recommended to describe the strains of the new species with sets of genetic attributes and reveal possible grouping errors . This proposal has been endorsed by the members of the Subcommittee on the taxonomy of staphylococci and streptococci of the international Committee on Systematic Bacteriology. Eur J Oral Sci, 1999 Apr, 107(2), 75 - 81 Quantitative determination of Streptococcus mutans by using competitive polymerase chain reaction; Rupf S et al.; Mutans streptococci are among the range of pathogens strongly related to human dental caries . The determination of total amounts of these pathogens as well as their proportion in relation to other oral bacteria is of interest for the assessment of the risk that a patient runs of developing dental caries . This paper presents a competitive polymerase chain reaction (PCR) method for the specific quantitative determination of Streptococcus mutans which uses a homologous DNA for internal standardisation . For quantification of these bacteria, calibration curves were obtained by coamplification of known amounts of S . mutans DNA in the presence of different known amounts of the competitor DNA . The same procedure was performed with known amounts of cultured S . mutans cells . In a clinical study, the reliability of the newly developed quantitative PCR method was assessed by comparing its results with those obtained in parallel with a standard chair side culture method . The described method enables a rapid and exact determination of unknown amounts of S . mutans and could provide an efficient tool for evaluating the caries risk in a patient and to monitor the efficiency of preventive and therapeutic measures. Pediatr Res, 1999 May, 45(5 Pt 1), 626 - 34 Group B streptococcal beta-hemolysin promotes injury of lung microvascular endothelial cells; Gibson RL et al.; Group B streptococci (GBS) are the leading cause of pneumonia and sepsis in human newborns . Exudative pulmonary edema and alveolar hemorrhage seen in GBS pneumonia indicate vascular damage, and we reported that GBS injure lung microvascular endothelial cells (LMvEC) both in vivo and in vitro . The specific GBS factors causing LMvEC injury are uncertain, but GBS beta-hemolysin activity is associated with lung epithelial cell injury . We hypothesized that GBS beta-hemolysin contributes to LMvEC injury and exudative pulmonary edema . To test this hypothesis we used isogenic nonhemolytic and hyperhemolytic GBS mutants derived by transposon insertional mutagenesis from three different wild-type strains . Hemolytic titers for each strain were calculated using live GBS and Tween 80/starch-stabilized extracts of log-phase GBS . All nonhemolytic mutants lacked detectable hemolytic activity, whereas hyperhemolytic mutants produced 4-16 times the hemolytic activity of their parent strains . LMvEC injury was assayed by light microscopy, the release of lactate dehydrogenase, trypan blue nuclear staining and Evans blue-albumin flux . Compared with the parent strains, all nonhemolytic mutants caused significantly reduced, and all hyperhemolytic mutants caused significantly greater lactate dehydrogenase release from and trypan blue nuclear staining of LMvEC . Moreover, a nonhemolytic mutant caused reduced and a hyperhemolytic mutant caused increased Evans-blue albumin flux across polar LMvEC monolayers . These findings were corroborated by light microscopic evidence of hemolysin-associated damage to the LMvEC monolayers . We conclude that GBS beta-hemolysin promotes LMvEC injury and increases permeability in vitro, and speculate that GBS beta-hemolysin contributes to the pathogenesis of alveolar edema and hemorrhage in early onset GBS pneumonia. Scand J Prim Health Care, 1999 Mar, 17(1), 46 - 8 Perianal streptococcal dermatitis . The possible protective role of alpha-streptococci against spread and recurrence of group A streptococcal throat infection; Roos K et al.; OBJECTIVE: To follow the spread of beta-haemolytic streptococci group A (GAS) within a family and examine the protective activity of normally occurring alpha-streptococci against GAS tonsillitis . DESIGN: Follow up of recurrent GAS throat infection within a family . SETTING: Intra familial spread of GAS . PATIENTS: A family of four, the mother suffering from recurrent streptococcal tonsillitis and a son with perianal streptococcal dermatitis . RESULTS: The strain of the GAS found in the perianal region of the boy was identical with that found in the throat of his mother . She had recurrent streptococcal tonsillitis, while the boy remained healthy in the throat . She lacked interfering alpha-streptococci in the throat, while the boy had a massive growth of alpha-streptococci in his throat with capacity to inhibit the growth of the streptococcal isolate . MAIN OUTCOME MEASURES: Infection with GAS within a family correlated with the growth-inhibiting activity of the alpha-streptococci in vitro . CONCLUSIONS: The study demonstrated the spread of GAS from a patient with streptococcal dermatitis to the throat of another person within the family, and the hindrance of induction of infection in patients carrying interfering alpha-streptococci. J Infect Dis, 1999 Jun, 179(6), 1410 - 5 Maternal peripartum complications associated with vaginal group B streptococci colonization; Krohn MA et al.; The study was done to determine the risk of clinically diagnosed intra-amniotic infection (IAI) and postpartum endometritis (PPE) associated with vaginal group B streptococci (GBS) colonization . Pregnant women were enrolled in a cross-sectional, observational study from 1992 to 1996 in Houston (n=908), Seattle (n=2676), and Pittsburgh (n=4338) . Swab samples were obtained from the lower vagina of participants at admission for delivery and inoculated into selective broth and onto blood agar media . At the combined centers, 2.9% of the women (231/7922) had IAI, and 2.0% (157/7922) had PPE . The risk of IAI was higher for women with heavy GBS colonization (odds ratio {OR}, 2.0; 95% confidence interval {95% CI}, 1.1-3.7) than for those with light colonization (OR, 1.2; 95% CI, 0.7-1.8) . The risk of GBS-associated PPE was not influenced by density of colonization (OR, 1.8; 95% CI, 1.3-2.7) . These findings provide further evidence that GBS is associated with maternal intrapartum complications. Microbiol Immunol, 1999, 43(2), 99 - 106 Intrafamilial distribution of mutans streptococci in Japanese families and possibility of father-to-child transmission; Kozai K et al.; The purpose of this study was to investigate the intrafamilial distribution of mutans streptococci in Japanese families using chromosomal DNA fingerprinting with three endonucleases; EcoRI, HindIII and HaeIII . The analysis of 1,908 isolates cultured from the dental plaque of 76 subjects from 20 families (20 married couples and 36 of their children) resulted in the identification of 144 genotypes containing 114 strains of Streptococcus mutans (serotype c, 66.7%; e, 12.5%) and 30 strains of S . sobrinus (d, 13.2%; g, 7.6%) . A mean of 1.89 genotypes (from one to four) was harbored in individual subjects, and a mean of 4.10 genotypes from two to seven was harbored in individual families . Among the 70 genotypes found in the children, 36 (51.4%) were in agreement with their mothers and 22 (31.4%) were in agreement with their fathers . The other genotypes (18.6%) did not correspond with the parents . Homologous strains between parents were found in only two couples . This result showed that fathers or others as well as mothers can be sources of transmission . Further, the serotype d, e and g strains showed significantly higher probabilities of transmission than serotype c. Biomaterials, 1999 May, 20(9), 899 - 903 Bactericidal activity and cytotoxicity of antibacterial monomer MDPB; Imazato S et al.; The aim of this study was to investigate bactericidal characteristics and cytotoxicity of the newly developed antibacterial monomer 12-methacryloyloxydodecylpyridinium bromide (MDPB) . To evaluate the bactericidal activity of MDPB against oral streptococci, the minimum bactericidal concentration (MBC) for seven species and time-kill kinetics against Streptococcus mutans were determined . The cytotoxic effects of MDPB on human pulpal cells were assessed by {3H}-thymidine uptake after contact with MDPB solutions at various concentrations . MDPB showed strong bactericidal activity against seven streptococci, the MBC value ranging from 31.1 to 62.5 micrograms ml-1 . Time-kill determination indicated a rapid killing effect of MDPB at 250 micrograms ml-1 or over, and all cells were killed within 1 min by MDPB at 500 micrograms ml-1 or over . No cytotoxic effect was observed on contact with MDPB at concentrations of 10 micrograms ml-1 or less, and the toxicity of MDPB was considered to be similar to those of other monomers used for dental materials . These results suggest that MDPB can be effectively incorporated in dental resin-based materials to provide bactericidal activity against oral bacteria. J Clin Invest, 1999 May, 103(9), 1261 - 8 New protective antigen of group A streptococci; Dale JB et al.; It is widely believed that the surface M protein of group A streptococci is the predominant surface protein of these organisms containing opsonic epitopes . In the present study, we identified a new surface protein, distinct from M protein, that evokes protective antibodies . A type 18 M-negative mutant was found to be both resistant to phagocytosis in human blood and virulent in mice . The wild-type strain, but not the M-negative mutant, was opsonized by antisera against purified recombinant M18 protein or a synthetic peptide copying the NH2-terminus of M18 . However, antisera raised against a crude pepsin extract of the M-negative mutant opsonized both strains, indicating the presence of a protective antigen in addition to type 18 M protein . This antiserum was used to identify and purify a 24-kDa protein fragment (Spa, streptococcal protective antigen) that evoked antibodies that opsonized the M18 parent and the M-negative mutant . The results of passive mouse protection tests confirmed the presence of protective epitopes within Spa . The deduced amino acid sequence of a 636-bp 5' fragment of the spa18 gene showed no homology with sequences in GenBank . These studies reveal the presence of a new protective antigen of certain strains of group A streptococci that may prove to be an important component of vaccines to prevent streptococcal infections. Infect Immun, 1999 May, 67(5), 2491 - 6 Alpha C protein as a carrier for type III capsular polysaccharide and as a protective protein in group B streptococcal vaccines; Gravekamp C et al.; The alpha C protein, a protective surface protein of group B streptococci (GBS), is present in most non-type III GBS strains . Conjugate vaccines composed of the alpha C protein and type III capsular polysaccharide (CPS) might be protective against most GBS infections . In this study, the type III CPS was covalently coupled to full-length, nine-repeat alpha C protein (resulting in III-alpha9r conjugate vaccine) or to two-repeat alpha C protein (resulting in III-alpha2r conjugate vaccine) by reductive amination . Initial experiments with the III-alpha9r vaccine showed that it was poorly immunogenic in mice with respect to both vaccine antigens and was suboptimally efficacious in providing protection in mice against challenge with GBS . Therefore, modified vaccination protocols were used with the III-alpha2r vaccine . Female mice were immunized three times with 0.5, 5, or 20 microgram of the III-alpha2r vaccine with an aluminum hydroxide adjuvant and bred . Ninety-five percent of neonatal mice born to dams immunized with the III-alpha2r vaccine survived challenge with GBS expressing type III CPS, and 60% survived challenge with GBS expressing wild-type (nine-repeat) alpha C protein; 18 and 17%, respectively, of mice in the negative control groups survived (P, <0.0001) . These protection levels did not differ significantly from those obtained with the type III CPS-tetanus toxoid conjugate vaccine and the unconjugated two-repeat alpha C protein, which protected 98 and 58% of neonates from infection with GBS expressing type III CPS or the alpha C protein, respectively . Thus, the two-repeat alpha C protein in the vaccine was immunogenic and simultaneously enhanced the immunogenicity of type III CPS . III-alpha vaccines may be alternatives to GBS polysaccharide-tetanus toxoid vaccines, eliciting additional antibodies protective against GBS infection. Infect Immun, 1999 May, 67(5), 2125 - 30 Bacterium-dependent induction of cytokines in mononuclear cells and their pathologic consequences in vivo; Jiang Y et al.; Viridans streptococci are a heterogeneous group of gram-positive bacteria that are normal inhabitants of the mouth . These organisms are thought to contribute significantly to the etiology of infective endocarditis, although recently they have been implicated in serious infections in other settings . Another group of oral bacteria, gram-negative anaerobes, is associated with chronic dental infections, such as periodontal diseases or endodontic lesion formation . We evaluated the ability of the oral pathogens Streptococcus mutans and Porphyromonas endodontalis to induce a pathogenic response in vivo, with the goal of quantifying the inflammatory response in soft tissue by measuring leukocyte recruitment and hard tissues by measuring osteoclastogenesis . S . mutans induced a strong inflammatory response and was a potent inducer of osteoclast formation, while P . endodontalis was not . To further study the mechanisms by which P . endodontalis and S . mutans elicit significantly different levels of inflammatory responses in vivo, we tested the capacity of each to induce production of cytokines by mononuclear cells in vitro . S . mutans stimulated high levels of interleukin-12 (IL-12), gamma interferon (IFN-gamma), and tumor necrosis factor alpha (TNF-alpha), all of which are associated with inflammation, enhanced monocyte function, and generation of a Th1 response . In contrast, P . endodontalis stimulated production of IL-10 but not of TNF-alpha, IL-12, or IFN-gamma . These results demonstrate that oral pathogens differ dramatically in their abilities to induce inflammatory and immunoregulatory cytokines . Moreover, there is a high degree of correlation between the cytokine profile induced by these bacteria in vitro and their pathogenic capacity in vivo. Clin Diagn Lab Immunol, 1999 May, 6(3), 425 - 6 Identification of a peptide from mammal albumins responsible for enhanced pigment production by group B streptococci; Rosa-Fraile M et al.; The peptide from peptones responsible for enhanced pigment production by Streptococcus agalactiae in culture media has been isolated from a peptic digest of human albumin and has been identified as Ile-Ala-Arg-Arg-His-Pro-Tyr-Phe . The related heptapeptide lacking the N-terminal Ile also had pigment-enhancing activity . A sequence similarity search showed that these sequences are present only in mammal albumins. Scand J Infect Dis, 1998, 30(6), 624 - 6 Pyomyositis due to non-haemolytic streptococci; Birgisson H et al.; We present a unique case of a multifocal non-tropical pyomyositis due to non-haemolytic streptococci in a 36-y-old woman . The initial infection was in an area of contused muscle in the left anterior thigh and spread to the contralateral femoral and gluteal musculature . There was a previous history of Staphylococcus aureus pyomyositis and colitis ulcerosa . The patient was treated successfully with surgical drainage and parenteral antibiotics. J Clin Periodontol, 1999 Apr, 26(4), 234 - 8 The effects of mouth rinses and dentifrice-containing magnesium monoperoxyphthalate (mmpp) on oral microflora, plaque reduction, and mucosa; Scully C et al.; The effects of a magnesium monoperoxyphthalate (MMPP) mouth-rinse, with or without sodium lauryl sulphate (SLS), and an MMPP dentifrice, on salivary counts of bacterial flora and yeasts, and on supragingival plaque scores were investigated in 131 healthy oral candida carriers over a 9 week double blind study . There were no changes in the salivary counts of bacteria studied (anaerobes, streptococci, fusobacteria, Actinomyces, Viellonella) in the test or placebo groups . A significant increase in salivary candida counts was seen in subjects using an MMPP rinse and dentifrice compared with placebo subjects and this phenomenon was not influenced by the presence of SLS . A significant reduction in plaque was seen in subjects using an MMPP rinse and dentifrice compared with placebo subjects . Frank candidosis was observed in only 2 subjects (1 in the placebo rinse group and 1 in the MMPP dentifrice group) but erythematous lesions, with subjective reports of soreness, dryness or burning sensation, were recorded and observed more frequently in the experimental groups than in the placebos, especially in those also using SLS . The substantial plaque reduction achieved with MMPP in the absence of tooth staining but with the increase in salivary Candida counts suggests that further studies of MMPP are warranted. APMIS, 1999 Mar, 107(3), 263 - 9 Comparison of three different methods in monoclonal antibody-based detection of Streptococcus agalactiae protein serotype markers; Moyo SR et al.; Surface-exposed proteins are important serotype markers in Streptococcus agalactiae (group B streptococci; GBS) . The proteins include the c proteins c(alpha) and c(beta), the R4 protein and a protein provisionally called P . For all of these markers, protein-specific monoclonal antibodies (MAbs) have been generated . We have compared whole-cell-based fluorescent antibody testing (FAT), ELISA, and dot blotting for MAb-based detection of these proteins by testing a panel of 52 GBS isolates of different capsular antigen types . Of a total of 208 observations with each of the tests, positive signalling in the dot assay was observed in 32.2%, with ELISA in 27.8%, and with FAT in 26.4% of the recordings . Discordant results were noted most frequently with the c(beta) and c(alpha) MAbs . In the case of c(alpha) the reason for the discordant test results was further examined and it appeared that this could be attributed to low level expression of the c(alpha) protein, although structural variations of c(alpha) proteins cannot be excluded . Our findings favour dot blotting as the method of choice although we consider all three methods acceptable for serotyping of GBS. Med Dosw Mikrobiol, 1998, 50(3-4), 171 - 7 {Evaluation of the usefulness of selected commercial systems for identification of Streptococcus species}; Fordymacki P et al.; The usefulness was assessed of three commercially available systems for rapid identification of streptococcal strains . The studied material comprised 68 strains of streptococci and enterococci (including 24 standard strains) belonging to serological groups: A (14 strains), B (10), C (11), D (10), F (3) and G (10), as well as 10 S . pneumoniae strains . The strains were isolated from throat, nasal, wound swabs, blood, pus of inpatients and throat and nasal swabs of outpatients . For the identification of streptococci 3 commercially available systems were used: API 20 STREP (bioMerieux, France), rapid ID 32 Strep (bioMerieux, France), Streptoplast PPL 18 (HTL, Poland) . The determinations were done according to producer's instructions . The highest percent of correctly identified strains was obtained with the rapid ID 32 Strep--80.9%, with the API 20 STREP--76.4% strains were identified correctly and with the PPL 18--61.8% . The study showed that the API 20 STREP and rapid ID 32 STREP are suitable for the identification of streptococcal strains from groups: A, B, C, D, F and enterococci--group D . The proportions of correctly identified strains from these groups with the Streptoplast PPL 18 were lower than those determined with the bioMerieux systems . Using of three identification systems streptococci from group G and S . pneumoniae strains cannot be identified. Emerg Infect Dis, 1999 Mar-Apr, 5(2), 247 - 53 emm typing and validation of provisional M types for group A streptococci; Facklam R et al.; This report discusses the following issues related to typing of group A streptococci (GAS): The development and use of the 5' emm variable region sequencing (emm typing) in relation to the existing serologic typing system; the designation of emm types in relation to M types; a system for validation of new emm types; criteria for validation of provisional M types to new M-types; a list of reference type cultures for each of the M-type or emm-type strains of GAS; the results of the first culture exchange program for a quality control testing system among the national and World Health Organization collaborating centers for streptococci; and dissemination of new approaches to typing of GAS to the international streptococcal community. FEMS Immunol Med Microbiol, 1999 Mar, 23(3), 195 - 204 Comparison of adherence to and penetration of a human laryngeal epithelial cell line by group A streptococci of various M protein types; Hagman MM et al.; Clinically isolated group A streptococci (GAS) of different M protein types were studied using aminoglycoside exclusion and {2,8-3H}adenine radiolabeled GAS assays to compare the abilities of different strains to adhere to and internalize within human laryngeal epithelial (HEp-2) cells . GAS isolated from patients with pharyngitis and GAS isolated from patients with more severe disease, such as necrotizing fasciitis, adhered to and penetrated HEp-2 cells equally well . M3, M4, M6, and M12 strains adhered to and were internalized within HEp-2 cells more than M1 strains . M18 GAS producing hyaluronic acid capsules were less adherent and less invasive than the M3, M4, M6, and M12 strains . An M3-producing GAS strain and its M protein-deficient isogenic strain adhered similarly to HEp-2 cells, but the M protein-deficient strain exhibited greater penetration . Preincubation of HEp-2 cells with an N-terminal synthetic M3 peptide did not alter the adherence or penetration by an M3 strain . In summary, this study demonstrates that GAS from invasive and non-invasive disease adhere to and penetrate HEp-2 cells equally well and that multiple strains of GAS with various M protein types have the ability to adhere to and penetrate HEp-2 cells. Acta Otolaryngol, 1999 Jan, 119(1), 102 - 6 Tonsillar microbial flora: comparison of recurrent tonsillitis and normal tonsils; Stjernquist-Desatnik A et al.; Tonsillar microbial flora was studied in cultures of tonsillar core specimens from 34 patients tonsillectomized due to recurrent group A streptococcal pharyngotonsillitis (n = 17) or sleep apnoea (n = 17) . Patients in the sleep apnoea subgroup, who had no history of recurrent tonsillitis and manifested no tonsillar hypertrophy at ENT examination, served as controls . Tonsillar core specimens were cultured for semi-quantitative estimation of growth of aerobic, anaerobic and facultative organisms . The recurrent tonsillitis and apnoea subgroups did not differ significantly in the mean number of isolates per patient, either of aerobic spp . (3.8 vs . 4.3) or anaerobic spp . (5.2 vs . 4.7) . Nor did the two subgroups differ significantly in the proportion of patients whose specimens manifested beta-lactamase producers (71% vs . 59%), in the isolation frequency of viridans (alpha) streptococci, or in the occurrence of semi-quantitative growth estimates of 3-4+ for aerobic, anaerobic or beta-lactamase-producing spp . Thus, the study provided no support for the hypothesis that inactivation of penicillin V by beta-lactamase-producing bacteria in oral or throat flora, or the eradication of viridans streptococci with their GAS-inhibitory capacity, is an important factor with regard to recurrent group A streptococcal tonsillitis . Other possible explanations, such as poor antibiotic penetration at the site of infection, are discussed. Arch Oral Biol, 1999 Mar, 44(3), 203 - 14 Action of agents on glucosyltransferases from Streptococcus mutans in solution and adsorbed to experimental pellicle; Wunder D et al.; Glucosyltransferase (Gtf) activity mediates sucrose-dependent adherence of mutans streptococci to the tooth surface, is essential for the cariogenicity of these micro-organisms, and contributes significantly to the exopolysaccharide component of the dental-plaque matrix . Clearly, agents that inhibit Gtfs could have therapeutic benefit . Here the effects of agents that inhibit Gtfs in solution and adsorbed to a surface were explored . Various classes of chemical reagents were tested for their ability to inhibit the enzymes responsible for insoluble-glucan synthesis (GtfB), insoluble/soluble glucan synthesis (GtfC), and soluble-glucan (GtfD) from Streptococcus mutans . Standard inhibition assays were done with Gtf enzyme in solution or with Gtf adsorbed to parotid saliva-coated hydroxylapatite (surface phase) . Reagents tested included the metallic cations Li+, Zn2+, Cu2+, Fe2+ and Fe3+; the oxidizing compounds hypochlorite, Rose Bengal, perborate, and sodium-meta-periodate; and a panel of sugars and sugar analogues including sorbitol, xylitol, 1',4',6' trideoxy-trichloro-galactosucrose (TGS), and 1-deoxynojirimycin (dNJ) . In solution, Gtf activity was inhibited significantly, at the highest concentrations tested: by the metal ions Zn2+, Cu2+, Fe2+ and Fe3+ (approx . 40-80% inhibition); by Rose Bengal and hypochlorite (approx . 80-90% inhibition); and by TGS and dNJ (approx . 50-80%) . However, surface-adsorbed Gtfs displayed increased resistance to inhibition by the same metal cations and oxidizing compounds that inhibited them in solution . In contrast, both TGS and dNJ possessed similar inhibition profiles for both surface-bound Gtf and enzyme in solution . These data indicate that the nature of the inhibitor is important, and also whether the Gtf enzyme is in solution or adsorbed to saliva-coated hydroxylapatite. Mol Microbiol, 1999 Apr, 32(1), 89 - 98 Serum opacity factor is a major fibronectin-binding protein and a virulence determinant of M type 2 Streptococcus pyogenes; Courtney HS et al.; Serum opacity factor (SOF) is a fibronectin-binding protein of group A streptococci that opacifies mammalian sera and is expressed by some strains that cause impetigo, pharyngitis and acute glomerulonephritis . Although SOF is expressed by approximately 35% of known serotypes, its role in the pathogenesis of group A streptococcal infections has not been previously investigated . The sof genes from M types 2, 28 and 49 Streptococcus pyogenes were cloned, sequenced, and their deduced amino acid sequences were compared . The gene for FnBA, a fibronectin-binding protein from Streptococcus dysgalactiae, was also cloned and found to express an opacity factor . The leader sequences, the fibronectin-binding domains, and the membrane anchor regions of these proteins were highly conserved . Short spans of conserved sequences were interspersed throughout the remaining parts of the proteins . The sof2 gene was insertionally inactivated in an M type 2 S . pyogenes strain, T2MR . The resultant SOF-negative mutant (YL3) did not express SOF or opacify serum, and exhibited a 71% reduction in binding fibronectin . Complementation of the SOF-negative defect with sof28 in the recombinant strain YL3(pNZ28) fully restored fibronectin-binding activity and the ability to opacify serum . To determine whether sof plays a role in virulence, mice were challenged intraperitoneally with these strains . None of the 10 mice infected with YL3(pNZ28) survived and only 1 out of 15 mice challenged with T2MR survived, whereas 12 out of 15 mice infected with YL3 survived . These data clearly indicate that SOF is a virulence factor, and they provide the first direct evidence that a fibronectin-binding protein contributes to the pathogenesis of group A streptococcal infections in vivo. Rev Clin Esp, 1999 Feb, 199(2), 84 - 8 {Streptococcal gangrene and so-called "flesh-eating bacteria disease" . A rare and devastating disease}; Fernandez Guerrero ML et al.; Streptococcal gangrene, an unusual form of necrotizing fasciitis with fatal outcome, has been recently rediscovered and has gained popularity with the name "disease of flesh eating bacteria" . The incidence of this and other severe diseases caused by Streptococcus pneumoniae has been suggested to be increasing . Only three patients with this disease have been studied at our institution in the last 12 years and in a review of a bacteremic infections caused by beta-hemolytic streptococci a significant increase of these infections was not observed . We report here the clinical and pathological characteristics of streptococcal gangrene as well as a review of the more recent literature. Diagn Microbiol Infect Dis, 1999 Apr, 33(4), 283 - 97 Survey of blood stream infections attributable to gram-positive cocci: frequency of occurrence and antimicrobial susceptibility of isolates collected in 1997 in the United States, Canada, and Latin America from the SENTRY Antimicrobial Surveillance Program . SENTRY Participants Group; Pfaller MA et al.; The SENTRY Antimicrobial Surveillance Program was established in January, 1997 to monitor the predominant pathogens and antimicrobial resistance patterns of nosocomial and community-acquired infections via a network of sentinel hospitals in the United States (30 sites), Canada (eight sites), Latin America (10 sites), and Europe (24 sites) . During the first 12-month study period (January to December, 1997), a total of 9519 blood stream infections (BSI) were reported by SENTRY participants in the U.S . (6150), Canada (1727), and Latin America (1642) . The Gram-positive cocci, Staphylococcus aureus, coagulase-negative staphylococci (CoNS), enterococci, and streptococci accounted for 53.9% (5131 infections) of all BSI (56.5% U.S., 55.7% Canada, and 42.9% Latin America) . The staphylococci, Enterococcus spp., S . pneumoniae, beta-hemolytic streptococci, and viridans group streptococci accounted for 6 of the top 11 BSI pathogens in the U.S . and Canada, whereas only S . aureus (1st), CoNS (3rd), and Enterococcus spp . (9th) were among the top 11 pathogens in Latin American hospitals . The results of this survey affirm the importance of Gram-positive cocci as causes of BSI in both North America and Latin America and demonstrate that important antimicrobial resistance exists among isolates of staphylococci, streptococci, and enterococci from all three geographic regions . This includes oxacillin-resistance among S . aureus (26.9% U.S., 29.2% Latin America, and 4.0% Canada) and CoNS (71.5% U.S., 68.4% Latin America, and 65.6% Canada), penicillin resistance among viridans group streptococci (48.5% U.S., 45.1% Canada, and 33.3% Latin America) and pneumococci (36.1% U.S., 27.5% Canada, and 65.6% Latin America), high-level resistance (HLR) to aminoglycosides among enterococci (27.2 to 70.1% U.S., 33.3 to 75.7% Canada and 16.7 to 51.5% Latin America), and macrolide resistance among beta-hemolytic streptococci (12.4 to 14.2% U.S., 10.5 to 12.3% Canada, and 0.0 to 4.0% Latin America), viridans group streptococci (32.4 to 39.7% U.S., 22.5-35.2% Canada, and 20.0% Latin America), and pneumococci (10.0 to 10.6% U.S., 9.8-10.8% Canada, and 9.4-18.7% Latin America) . BSI isolates of Gram-positive cocci from the U.S . and Latin America were considerably more resistant than those from Canada . New agents with Gram-positive activity will be essential for optimal treatment of BSI attributable to Gram-positive cocci in both North and Latin America. Arch Dis Child, 1998 Dec, 79(6), 472 - 7 Complications of varicella in a defined central European population; Jaeggi A et al.; AIMS: To describe complications of varicella requiring hospitalisation in a defined population (canton of Bern) and to compare the hospitalisation rates for varicella with published data . METHODS: Retrospective analysis of hospital records of patients less than 16 years of age admitted with complications of varicella to the hospitals serving this population (University Children's Hospital of Bern and the Wildermeth Children's Hospital of Biel, Switzerland), and calculation of hospitalisation rates for varicella and its complications based on birth rates and varicella antibody prevalence rates . RESULTS: From 1986 to 1996, 113 cases (median age, 5.6 years) were identified . Younger siblings were overrepresented (odds ratio (OR), 1.42; 95% confidence interval (CI), 1.09 to 1.84) . Central nervous system (CNS) complications (26 patients; 23%) were found predominantly in previously healthy children (relative risk, 7.1; 95% CI, 1.01 to 49.86) . Group A beta haemolytic streptococci were recovered from only one of 35 patients with bacterial complications . The hospitalisation rates for primary varicella (9.2/10(4) cases; 95% CI, 7.4 to 11/10(4), skin infections (2.0/10(4) cases; 95% CI, 1.2 to 2.9/10(4), and pneumonia (0.8/10(4) cases; 95% CI, 0.3 to 1.3/10(4)) were significantly lower than reported previously . The CNS complication rate (2.2/10(4) cases; 95% CI, 1.3 to 3.1/10(4) was among the highest rates reported . CONCLUSIONS: The low hospitalisation rate in comparison with studies from elsewhere indicates that there is a large regional variability in complications associated with varicella . Such data should be taken into consideration when local varicella immunisation strategies are developed. Arch Oral Biol, 1999 Feb, 44(2), 119 - 27 The roles of histidine residues at the starch-binding site in streptococcal-binding activities of human salivary amylase; Tseng CC et al.; Human salivary alpha-amylase participates in the initial digestion of starch and may be involved in the colonization of viridans streptococci in the mouth . To elucidate the role of histidine residues located near the starch-binding site on the streptococcal-binding activity, the wild type and three histidine mutants, H52A, H299A and H305A were constructed and expressed in a baculovirus system . While His52 is located near the non-reducing end of the starch-binding pocket (subsite S3/S4), the residues His299 and His305 are located near the subsites S1/S1' . For the wild type, the cDNA encoding the leader and secreted sequences of human salivary amylase was amplified by polymerase chain reaction from a human submandibular salivary-gland cDNA library, and subcloned into the baculovirus shuttle vector pVL1392 downstream of the polyhedrin promoter . Oligonucleotide-based, site-directed mutagenesis was used to generate the mutants expressed in the baculovirus system . Replacing His52 or His299 or His305 to Ala residue did not alter the bacterial-binding activity significantly, but these mutants did show differences in their catalytic activities . The mutant H52A showed negligible reduction in enzymatic activity compared to that of wild type for the hydrolysis of starch and oligosaccharides . In contrast, the H299A and H305A mutants showed a 12 to 13-fold reduction (90-92%) in starch-hydrolysing activity . In addition, the k(cat) for the hydrolysis of oligosaccharides by H299A decreased by as much as 11-fold for maltoheptaoside . This reduction was even higher (40-fold) for the hydrolysis of p-nitrophenyl maltoside, with a significant change in K(M) . The mutant H305A, however, exhibited a reduction in k(cat) only, with no changes in the K(M) for the hydrolysis of oligosaccharides . The reduction in the k(cat) for the H305A mutant was almost 93% for maltoheptaoside hydrolysis . The pH activity profile for the H305A mutant was also significantly different from that of the wild type and the other two mutants . These results suggest that, although histidines at the starch-binding site of salivary amylase are involved in starch binding and catalysis, they may not participate in Streptococcus gordonii G9B binding. J Intern Med, 1999 Mar, 245(3), 261 - 7 Post-streptococcal reactive arthritis: a clinical and serological description, revealing its distinction from acute rheumatic fever; Jansen TL et al.; OBJECTIVE: To follow-up prospectively patients with arthritis after infection with beta-haemolytic streptococci of Lancefield group A (beta HSA), with emphasis on clinical characteristics and serological features . We additionally investigated whether these patients, though often fulfilling the Jones' criteria for acute rheumatic fever (ARF), had a disease with clinical characteristics different from ARF . DESIGN: We performed a systematic prospective observational study of consecutive patients at a Dutch Outpatient Clinic and Department of Rheumatology, with arthritis after throat infection with beta HSA presenting to rheumatologist or internist from September 1992 until September 1996 . Main outcome measures were clinical and biochemical characteristics with special reference to carditis . RESULTS: A total of 23 patients (21 Dutch, two Turkish; female/male ratio 15/8; mean (SD) age 42 (14) years) with predominantly non-migratory arthritis were included . A positive throat swab culture was obtained in 17% . All patients showed a significant rise of antistreptolysine-O (ASO; normal < 200 i.u . mL-1) and antideoxyribonuclease-B (anti-DNase-B; normal < 200 i.u . mL-1) titre . The mean (SEM) maximal ASO was 1305 (195) i.u . mL-1, and anti-DNase-B titre 980 (115) i.u . mL-1 . Arthritis was present in mean (SEM) 5.4 (0.9) joints: 2.2 (0.7) small, 3.2 (0.4) larger joints . The arthritis was monarticular in 23% of the patients, oligoarticular in 35%, and polyarticular in 43% . Skin abnormalities were present in 12 patients: erythema nodosum in seven patients (30%), and erythema multiforme in five patients (22%) . A transient cholestatic hepatitis was found in four patients (17%) . In two patients a transient first-degree conduction block was found; however, neither echocardiography nor clinical course supported carditis . All patients were advised to receive monthly penicillin prophylaxis during a period of 2 years . Two patients refused to follow medical advice: in one a non-migratory arthritis recurred 15 months after the first episode of arthritis . CONCLUSION: Commonly, arthritis secondary to beta HSA infection in the Netherlands, a prosperous West-European country with State Welfare, is not accompanied by carditis, contrary to literature on classical ARF . Other factors discriminating it from ARF are the age of onset, the non-migratory character of the arthritis, the high frequency of erythema nodosum and multiforme, as well as the presence of transient hepatitis . As arthritis is the hallmark of this syndrome, post-streptococcal reactive arthritis (PSRA) is the most proper name for this disease entity . Whether penicillin profylaxis is needed in PSRA, as it is in ARF, warrants further prospective investigation. Int J Antimicrob Agents, 1999 Mar, 11 Suppl 1, S23 - 9; discussion S31-2 Macrolides and changes in the oral flora; Sefton AM; Macrolides have been used in dental practice for many years, and may have a role in treating periodontal disease . Increased numbers of antibiotic-resistant oral streptococci have been reported after administration of both penicillins and macrolides . We confirm these findings for erythromycin, josamycin and azithromycin, and show that small numbers of macrolide-resistant streptococci are part of the normal oral flora at baseline . Resistant organisms fill the vacuum created by the removal of sensitive strains by antibiotic treatment . Following treatment with azithromycin, periodontal bacterial pathogens such as black pigmented anaerobes and spirochaetes decrease, whereas numbers of oral streptococci increase . These changes in the oral flora indicate a return to a healthier oral environment . In our studies, no clinical problems resulted from the transient increase in macrolide-resistant streptococci. Oral Microbiol Immunol, 1999 Feb, 14(1), 33 - 42 Identification of oral mitis group streptococci by arbitrarily primed polymerase chain reaction; Rudney JD et al.; "Mitis group" streptococci are commensal but may play some role in dental caries, septicemia or endocarditis . Rapid genotypic identification would aid studies of dental plaque ecology, or diagnostic use . AP-PCR with 58 unpaired arbitrary primers was used to characterize 7 Streptococcus gordonii, 11 Streptococcus sanguis, 2 Streptococcus crista, 5 Streptococcus parasanguis, 18 Streptococcus oralis, and 36 Streptococcus mitis (22 biovar 1 and 14 biovar 2) . S . parasanguis 16S rRNA variable region primer RR2 produced species-specific bands with all S . gordonii and S . sanguis . Human V beta 1 T-cell receptor primer 434 yielded concordant genotypic identification of all phenotypically defined S . crista and S . parasanguis, 83% of S . oralis, and 74% of S . mitis biovar 1 . Amplicon patterns for S . mitis biovar 2 were heterogeneous . Findings suggest that primers RR2 and 434 in succession will allow rapid identification of genotypic groups corresponding closely to mitis group species established by phenotype. Oral Microbiol Immunol, 1999 Feb, 14(1), 27 - 32 Effect of inactivation of gtf genes on adherence of Streptococcus downei; Colby SM et al.; The activity of glucosyltransferases (GTF), a group of enzymes that synthesize water-soluble and -insoluble glucans from sucrose, significantly contributes to the cariogenicity of mutans streptococci . Streptococcus downei produces four glucosyltransferases, GTFI, which produces insoluble glucan, and GTFS, GTFT, and GTFU, which synthesize soluble glucans . We have previously reported that inactivation of gtfS results in altered adherence and have now examined its interaction with other enzymes by constructing mutants which were gtfS, gtfS/gtfT, gtfS/gtfI and gtfI . The mutants were tested for their ability to accumulate on wires and on plastic microtiter trays in the presence of sucrose . The gtfS mutant displayed a reduced ability to adhere compared to the wild type but there was no further reduction of adherence in a gtfS/gtfT mutant . In contrast, the gtfS/gtfI double mutant showed a drastic reduction in adherence and when gtfI alone was inactivated, bacteria were unable to adhere to a hard surface . The results confirmed that insoluble glucan is required for strong adherence to a smooth surface but that the amount and structure of this glucan is dependent upon the availability of soluble glucans to act as primer molecules. Oral Microbiol Immunol, 1999 Feb, 14(1), 1 - 20 Current status of a mucosal vaccine against dental caries; Hajishengallis G et al.; The evidence of a specific bacterial cause of dental caries and of the function of the salivary glands as an effector site of the mucosal immune system has provided a scientific basis for the development of a vaccine against this highly prevalent and costly oral disease . Research efforts towards developing an effective and safe caries vaccine have been facilitated by progress in molecular biology, with the cloning and functional characterization of virulence factors from mutans streptococci, the principal causative agent of dental caries, and advancements in mucosal immunology, including the development of sophisticated antigen delivery systems and adjuvants that stimulate the induction of salivary immunoglobulin A antibody responses . Cell-surface fibrillar proteins, which mediate adherence to the salivary pellicle, and glucosyltransferase enzymes, which synthesize adhesive glucans and allow microbial accumulation, are virulence components of mutans streptococci, and primary candidates for a human caries vaccine . Infants, representing the primary target population for a caries vaccine, become mucosally immunocompetent and secrete salivary immunoglobulin A antibodies during the first weeks after birth, whereas mutans streptococci colonize the tooth surfaces at a discrete time period that extends around 26 months of life . Therefore, immunization when infants are about one year old may establish effective immunity against an ensuing colonization attempts by mutans streptococci . The present review critically evaluates recent progress in this field of dental research and attempts to stress the protective potential as well as limitations of caries immunization. J Clin Pediatr Dent, 1999 Winter, 23(2), 137 - 42 The clinical significance of beta hemolytic streptococci of the milleri group in oral abscesses; Schuman NJ et al.; Aspirated exudate from 50 patients with oral abscesses were cultured and bacterial growth was assessed qualitatively and semi-quantitatively . Bacteria were recovered from all specimens . The mean number of species isolated per specimen was 3.6 Both facultative and obligate anaerobes were isolated from 39 (78%) specimens . The most commonly isolated facultative anaerobic species was Streptococcus virdans group, while pigmented gram negative bacilli were the most commonly isolated obligate anaerobes . Beta-hemolytic Streptococci of the "milleri" groups were recovered from 11 (22%) of the abscesses . Eight of those isolates were determined to carry Lancefield group F antigen, 2 group C, and 1 isolate was not groupable for any Lancefield antigen . These abscesses may be sequelae of oral infectious disease or trauma . Patients with oral abscesses infected with beta hemolytic Streptococci are apt to be male, and less than 35 years old . They are also likely to have a more rapid onset of infection and to require hospitalization for intensive treatment of a life threatening condition. Pediatr Dent, 1999 Mar-Apr, 21(2), 86 - 90 Investigation of the role of human breast milk in caries development; Erickson PR et al.; PURPOSE: The objective of this study was to determine the caries-related risk associated with human breast milk (HBM) . METHODS: First, the plaque pH of 18 children (12-24 months) was monitored before and after a five-minute feeding with HBM to determine the pH drop and minimum pH obtained . Second, Streptococcus sobrinus 6715 was cultured for 3 hr in HBM, and the increase in the number of colony forming units (cfus) and the culture pH was measured . Third, HBM was incubated for 24 hr with powdered enamel to determine the solubility of mineral in the absence of bacteria . Fourth, HBM was mixed with acid to determine the buffering capabilities . Finally, enamel windows were created on extracted premolar crowns (N = 33) that were colonized with Mutans Streptococci and incubated with HBM . Caries was assessed visually and radiographically for 12 weeks . RESULTS: One- and two-way ANOVAs of these five assays demonstrated that HBM did not cause a significant drop in plaque pH when compared to rinsing with water; HBM supported moderate bacterial growth; calcium and phosphate were actually deposited onto enamel powder after incubation with HBM; the buffer capacity of HBM was very poor; and HBM alone did not cause enamel decalcification even after 12 weeks exposure . However, when supplemented with 10% sucrose, HBM caused dentinal caries in 3.2 weeks . CONCLUSION: It is concluded that human breast milk is not cariogenic. Minerva Pediatr, 1998 Oct, 50(10), 427 - 31 {Group A beta-hemolytic streptococcus infection and varicella}; La Placa G et al.; The case of a 3-year-old boy affected with varicella associated to acute cellulitis by group A beta-hemolytic streptococci is reported . The causes of hospitalization were: high fever, decline of condition, onset of scarlet exanthema and a severe swelling in the inguinoscrotal area, during varicella . The diagnosis of streptococcal infection was confirmed by positive pharyngeal tampon, scarlet exanthema and following rise of ASLO . Since the association of these two infections is reported in literature more and more frequently, the possible causes and precautionary measures are analysed. Nippon Jibiinkoka Gakkai Kaiho, 1999 Feb, 102(2), 226 - 35 {Analysis of serum antibodies to alpha-streptococci in patients with tonsil-related pustulosis palmaris et plantaris}; Murakata H et al.; To determine the systemic immune response to alpha-streptococci (Str . sanguis, Str . salivarius and Str . mitis) and beta streptococcus (Str . pyogenes T12) in patients with tonsil related pustulosis palmaris et plantaris (PPP), we measured serum antibody levels to whole cell body antigens of Streptococcus (Str.) sanguis, Str . salivarius, Str . mitis or Str . pyogenes by enzyme-linked immunosorbent assay (ELISA) . The serum IgG antibody levels to alpha-streptococci, Str . sanguis and Str . salivarius were significantly higher in patients with PPP (n = 44) than in patients with recurrent tonsillitis (RT: n = 25) and in healthy adults (n = 17) . Serum antibody IgG level to Str . pyogenes was not different among the 3 groups . The IgA antibody levels against any Streptococcus strain were not different among the 3 groups . The IgM antibody levels to Str . pyogenes were significantly higher in patients with RT than in patients with PPP . In western blot analysis, the serum IgG antibodies against 25-27 kDa protein from whole cell body of Str . sanguis, Str . salivarius and Str . mitis were found more frequently in patients with PPP than in healthy adults . However, the western blot profile in Str . pyogenes was not different between PPP and healthy adults . No significant difference was seen in the western blot profile of IgM or IgM antibodies to any streptococcal whole cell bodies . These data suggest that systemic hyper immune response to alpha-streptococci may be present in patients with tonsil-related PPP and the 25-27 kDa protein of the organism may be the target for this immunologic abnormality. Arch Biochem Biophys, 1999 Apr 15, 364(2), 286 - 93 Isolation of human salivary mucin MG2 by a novel method and characterization of its interactions with oral bacteria; Liu B et al.; Human salivary mucin MG2 was purified from submandibular/sublingual gland secretion by ultrafiltration and sequential gel filtration chromatography on Sephadex G-200, Superose 6 (prepgrade), and Superose 6 . This method differs from earlier procedures in that all steps are performed in the presence of 4 M guanidine hydrochloride and do not involve covalent modification of the mucin molecule . Electrophoretic analyses and Western blotting showed that purified MG2 did not contain detectable levels of other salivary proteins . Amino acid analysis showed that the composition of purified MG2 was in excellent agreement with the deduced sequence of MG2 apomucin encoded in the MUC7 gene . The yield of purified MG2 was 10-15 mg from 750 ml of salivary secretion . Binding of purified MG2 to Streptococcus mutans in vitro was not significantly affected by reductive methylation, but was nearly abolished by reduction and alkylation . These data identified a functional determinant for mucin-bacterial interactions in the N-terminal region where the only two cysteines (Cys45 and Cys50) in the MG2 apomucin occur . Additionally, purified MG2 bound to four strains of oral Streptococci, indicating that the binding is not dependent on complexing with other salivary proteins, such as secretory immunoglobulin A . The purification procedure described in this work will facilitate investigation of the role of MG2 in the oral environment . APMIS Suppl, 1999, 87, 1 - 54 Bacterial degradation of immunoglobulin A1 in relation to periodontal diseases; Gronbaek Frandsen EV; Periodontal diseases affect millions of people world wide . Prevention and treatment of these diseases require considerable attention from the individual as well as society and cause great expenses . Understanding disease etiology and mechanisms of pathogenesis is a prerequisite for optimal treatment strategies . The highly variable speed of periodontal destruction and in some sites persistence for years of deep pockets without further periodontal destruction points to the significance of individual bacterial species in the complex subgingival microflora for pathogenesis . Destruction of periodontal tissue occurs when the load of bacterial virulence factors overcomes the local immune defense . One way of doing this is by bacterially-induced degradation of IgA which is considered to mediate its protective functions in an anti-inflammatory way and to down-regulate inflammation through inhibition of IgG- and IgM-mediated activities . A competent IgA system may be of particular significance in chronic inflammatory diseases, as periodontal diseases, where the inflammatory reaction in itself probably is the main cause of destruction . In these cases, degradation of IgA may serve the purpose of immune evasion for the bacteria and at the same time may induce a relatively increased activity in the inflammation-stimulating part of the immune system which may aggravate periodontal destruction . Both gram-positive rods, streptococci, and Veillonella species from the subgingival microflora induce an altered immunoelectrophoretic mobility of IgA1 indicative of removal of terminally positioned sialic acid . Quantitative determination of residual carbohydrate content of IgA1 after incubation with bacterial cells of Gram-positive rods has confirmed that they remove sialic acid, and in addition to that, only minor amounts of carbohydrates . Apart from serving a nutritional purpose, desialylation of IgA may also serve a purpose of immune evasion . Glycosylation and, in particular sialic acid protects glycoproteins, including immunoglobulins, against proteolytic enzymes and deglycosylation of antibodies increase their sensitivity to proteolytic degradation and inhibit the Fc-mediated effector functions that mediate antigen disposal . Extensive proteolytic degradation of IgA1 is induced by a number of bacterial species often associated with periodontal diseases, including P . gingivalis, Pr . intermedia, and Pr . nigrescens . These species produce enzymes of broad proteolytic activity, that also may degrade immunoglobulins of other isotopes, complement factors, iron-containing plasma proteins etc . Extensive hydrolysis of immunoglobulins induced by these bacteria serve a nutritional purpose and is essential for growth of other bacteria in mixed cultures . It also has an obvious detrimental effect on the defence potential of the specific humoral immune system . These bacteria seem to be essential for the transmissibility of experimental infections in animals with mixtures of oral bacteria and a likely reason is their ability to provide the other bacteria with amino acids, peptides, and iron for growth and their ability to inhibit the immune defence . The hinge region of IgA1 is relatively resistant to proteolysis because of a high proline content and presence of several oligosaccharide side chains . It is therefore interesting that a number of taxonomically unrelated bacteria, including both commensals and overt pathogens, have evolved the capability to specifically cleave human IgA1 in the hinge region . These so-called IgA1 proteases leave Fab and Fc fragments intact for which reason a direct nutritional purpose of the enzymes may be excluded . In the oral cavity, specific IgA1 proteases are produced by the streptococcal species that constitute a considerable proportion of initial dental plaque and the flora on buccal and pharyngeal mucosa . In all three cases the flora is sparse and contact with saliva, including S-IgA1 antibodies is intimate . (ABSTRACT TRUNCATED) Hosp Formul, 1994 Aug, 29 Suppl 3, S13 - 7 Antibiotic therapy in 1994: mechanisms of resistance; Barg N; Drug-resistant organisms are appearing with increasing frequency . Of particular concern are drug-resistant strains of enterococci, streptococci, and pneumococci . Bacteria use several adaptive mechanisms to thwart the actions of antimicrobials, including enzymes, alterations in cell membrane permeability, export of antibiotics from the cell, alteration of molecular structures, and transfer of resistance to other species . Countering the effects of resistance requires judicious use of antibiotic therapy and a clear understanding of the biologic mechanisms involved. Antimicrob Agents Chemother, 1999 Apr, 43(4), 738 - 44 In vitro and in vivo antibacterial activities of a novel glycylcycline, the 9-t-butylglycylamido derivative of minocycline (GAR-936); Petersen PJ et al.; The 9-t-butylglycylamido derivative of minocycline (TBG-MINO) is a recently synthesized member of a novel group of antibiotics, the glycylcyclines . This new derivative, like the first glycylcyclines, the N,N-dimethylglycylamido derivative of minocycline and 6-demethyl-6-deoxytetracycline, possesses activity against bacterial isolates containing the two major determinants responsible for tetracycline resistance: ribosomal protection and active efflux . The in vitro activities of TBG-MINO and the comparative agents were evaluated against strains with characterized tetracycline resistance as well as a spectrum of recent clinical aerobic and anaerobic gram-positive and gram-negative bacteria . TBG-MINO, with an MIC range of 0.25 to 0.5 microgram/ml, showed good activity against strains expressing tet(M) (ribosomal protection), tet(A), tet(B), tet(C), tet(D), and tet(K) (efflux resistance determinants) . TBG-MINO exhibited similar activity against methicillin-resistant Staphylococcus aureus (MRSA), penicillin-resistant streptococci, and vancomycin-resistant enterococci (MICs at which 90% of strains are inhibited, < or = 0.5 microgram/ml) . TBG-MINO exhibited activity against a wide diversity of gram-negative aerobic and anaerobic bacteria, most of which were less susceptible to tetracycline and minocycline . The in vivo protective effects of TBG-MINO were examined against acute lethal infections in mice caused by Escherichia coli, S . aureus, and Streptococcus pneumoniae isolates . TBG-MINO, administered intravenously, demonstrated efficacy against infections caused by S . aureus including MRSA strains and strains containing tet(K) or tet(M) resistance determinants (median effective doses {ED50s}, 0.79 to 2.3 mg/kg of body weight) . TBG-MINO demonstrated efficacy against infections caused by tetracycline-sensitive E . coli strains as well as E . coli strains containing either tet(M) or the efflux determinant tet(A), tet(B), or tet(C) (ED50s, 1.5 to 3.5 mg/kg) . Overall, TBG-MINO shows antibacterial activity against a wide spectrum of gram-positive and gram-negative aerobic and anaerobic bacteria including strains resistant to other chemotherapeutic agents . The in vivo protective effects, especially against infections caused by resistant bacteria, corresponded with the in vitro activity of TBG-MINO. Aliment Pharmacol Ther, 1999 Feb, 13(2), 103 - 16 Review article: antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP); Subhani JM et al.; This review examines the evidence for antibiotic prophylaxis in endoscopic retrograde cholangiopan-creatography (ERCP), and provides detailed advice about suitable antibiotic regimens in appropriate high-risk patients . Ascending cholangitis and infective endocarditis are potential complications of endoscopic ERCP . The pathophysiology of these two complications is quite separate and different sub-groups of patients require prophylaxis with appropriate antibiotic regimens . Ascending cholangitis results from bacterial infection of an obstructed biliary system, usually from enteric Gram-negative microorganisms, resulting in bacteraemia . There is incomplete drainage of the biliary system after ERCP in up to 10% of patients who require stenting . Antibiotics started in these patients will probably reduce the frequency of cholangitis by 80% . If antibiotics are restricted to this group, approximately 90% of all patients having an ERCP will avoid antibiotics, but 80% of cholangitic episodes will be prevented . Infective endocarditis may result from the bacteraemia caused at the time of the ERCP in patients with an abnormal heart valve . Antibiotic prophylaxis, in particular covering alpha-haemolytic streptococci, should be started before the procedure in this defined high-risk group. J Public Health Dent, 1998 Summer, 58(3), 248 - 9 Colonization of mutans streptococci in 8- to 15-month-old children; Karn TA et al.; OBJECTIVE: The age at which a child becomes colonized with mutans streptococci (MS) is important for understanding early childhood caries . The aim of this study was to explore the relationship of age with MS colonization in infants . METHODS: Inner-city children (n = 149) between the ages of 8 months and 15 months, inclusive, who reportedly were still using a baby bottle, were sampled for MS . RESULTS: Evidence of MS colonization was seen as early at 10 months of age . For children 12 months old or younger (n = 80), 25 percent had detectable levels of MS; in the 15-month age group, 60 percent were colonized . CONCLUSION: This study suggests that prevention of MS colonization in some populations may need to be initiated prior to the child's first birthday. J Clin Periodontol, 1999 Mar, 26(3), 143 - 52 The microbiota of periodontal pockets with different depths in therapy-resistant periodontitis; Edwardsson S et al.; This study presents the composition of the cultivable microbiota colonising periodontal pockets of different depths among 2 patient-groups classified as non-responsive (NR-group; 11 participants) or responsive (R-group; 10 participants) to periodontal treatment . Microbiological samples from three types of pocket (< 4 mm deep A-samples; 4-5 mm B-samples; > 5 mm C-samples) were analysed by cultural methods for putative periodontitis pathogens, microbial groups constituting > or = 5% of the total cultivable flora and opportunistic pathogens . Actinomyces naeslundii, A . israelii, Bacteroides forsythus, Fusobacterium spp, Porphyromonas gingivalis, Prevotella intermedia, Peptostreptococcus micros, anaerobic streptococci and facultative anaerobic streptococci were most prevalent . Actinobacillus actinomycetemcomitans, Staphylococcus aureus, enteric rods and yeasts were less prevalent . The periodontitis pathogens Bacteroides forsythus, Fusobacterium spp, Porphyromonas gingivalis, Prevotella intermedia and Peptostreptococcus micros constituted together (on average) < or = 23% of the viable counts in the A- and B-samples of both patient groups and in the C-samples of the R-group . In the C-samples of the NR-group their mean counts were 45% . Correlations were found between smoking habits and the five pathogens in the C-samples and in pooled pocket depth samples . The results show that groups of periodontopathogens should be considered a causal factor in therapy-resistant periodontitis . Further, smoking and deep pockets can enhance a shift in the balance of the subgingival microflora predisposing a site to disease and a susceptible host may be the pre-requisite to therapy-resistant periodontitis. J Dent Res, 1999 Mar, 78(3), 759 - 68 Cumulative correlations of lysozyme, lactoferrin, peroxidase, S-IgA, amylase, and total protein concentrations with adherence of oral viridans streptococci to microplates coated with human saliva; Rudney JD et al.; Redundancy refers to the observation that many salivary proteins exhibit similar properties in vitro . It is possible that bacterial adherence to salivary pellicle occurs as a cumulative effect of multiple proteins . This study determined the joint and individual contributions of salivary amylase, S-IgA, lysozyme, salivary peroxidase, lactoferrin, and total protein concentrations to adherence by oral viridans streptococci in microplates coated with whole saliva from 123 persons . Strains used were: Streptococcus gordonii Blackburn, 10558, Streptococcus mitis 10712, 903, Streptococcus oralis 10557, 9811, and Streptococcus sanguis 10556, 13379 . Rabbit antibody against 13379 was used for the detection of adherence . This antibody cross-reacted with all strains . Absorbance was standardized against saliva pooled from five donors . All saliva samples had been previously assayed for amylase, lactoferrin, lysozyme, secretory IgA, peroxidase, and total protein . Adherence scores for all strains except 13379 were significantly and positively correlated . Salivas binding high or low levels of one strain tended to bind others correspondingly . Multiple regression indicated significant contributions to 10558 adherence from total protein and lactoferrin (positive), and peroxidase and lysozyme (negative) . Similar results were obtained for Blackburn and 903 . Significant individual correlations were seen for 9811 and total protein (positive), 10557 and peroxidase (negative), and 13379 and lactoferrin (negative) . Salivas with high adherence scores contained significantly more protein and lactoferrin, and significantly less peroxidase, than salivas with low adherence scores . These findings support the hypothesis that multiple proteins contribute to the adherence of streptococcal strains in vivo. Mol Microbiol, 1999 Feb, 31(4), 1051 - 64 Characterization of nra, a global negative regulator gene in group A streptococci; Podbielski A et al.; During sequencing of an 11.5 kb genomic region of a serotype M49 group A streptococcal (GAS) strain, a series of genes were identified including nra(negative regulator of GAS) . Transcriptional analysis of the region revealed that nra was primarily monocistronically transcribed . Polycistronic expression was found for the three open reading frames (ORFs) downstream and for the four ORFs upstream of nra . The deduced Nra protein sequence exhibited 62% homology to the GAS RofA positive regulator . In contrast to RofA, Nra was found to be a negative regulator of its own expression and that of the two adjacent operons by analysis of insertional inactivation mutants . By polymerase chain reaction and hybridization assays of 10 different GAS serotypes, the genomic presence of nra, rofA or both was demonstrated . Nra-regulated genes include the fibronectin-binding protein F2 gene (prtF2) and a novel collagen-binding protein (cpa) . The Cpa polypeptide was purified as a recombinant maltose-binding protein fusion and shown to bind type I collagen but not fibronectin . In accordance with nra acting as a negative regulator of prtF2 and cpa, levels of attachment of the nra mutant strain to immobilized collagen and fibronectin was increased above wild-type levels . In addition, nra was also found to regulate negatively (four- to 16-fold) the global positive regulator gene, mga . Using a strain carrying a chromosomally integrated duplication of the nra 3' end and an nra-luciferase reporter gene transcriptional fusion, nra expression was observed to reach its maximum during late logarithmic growth phase, while no significant influence of atmospheric conditions could be distinguished clearly. Oral Microbiol Immunol, 1998 Aug, 13(4), 217 - 24 Effect of low-molecular-weight chitosans on the adhesive properties of oral streptococci; Tarsi R et al.; It was previously shown that a low-molecular-weight chitosan and its derivatives N-carboxymethyl chitosan and imidazolyl chitosan inhibit Streptococcus mutans adsorption to hydroxyapatite . The ability of the same molecules to interfere with adhesive properties of other oral streptococci (Streptococcus sanguis, Streptococcus gordonii, Streptococcus constellatus, Streptococcus anginosus, Streptococcus intermedius, Streptococcus oralis, Streptococcus salivarius, Streptococcus vestibularis) was tested . When saliva-coated or -uncoated hydroxyapatite beads were treated with N-carboxymethyl chitosan, a reduction varying from 60% to 98% depending on strains was observed . Low-molecular-weight chitosans and imidazolyl chitosan did not have any effect . Growth in N-carboxymethyl chitosan-supplemented medium (final concentrations ranging from 20 to 500 micrograms.ml-1) caused a dose related reduction in the adsorption of all strains to hydroxyapatite and in their affinity towards xylene . No effect was observed with low-molecular-weight chitosans and imidazolyl chitosan . In contrast to what observed with S . mutans, the three polysaccharides did not affect detachment from hydroxyapatite beads and adherence to cheek epithelial cells of the other streptococci . These results suggest that low-molecular-weight chitosans and/or imidazolyl chitosan, selectively affecting S . mutans adsorption to hydroxyapatite, may be very interesting as potential anti-dental caries agents. Oral Microbiol Immunol, 1998 Aug, 13(4), 195 - 216 Current classification of the oral streptococci; Whiley RA et al.; The classification of the oral streptococci has long remained a difficult area of streptococcal taxonomy . This article reviews the current classification of these bacteria into four species groups, and each group is described in detail . The often confusing changes that have taken place in the classification, identification and nomenclature of the member species are reviewed against a historical background of gradually improving techniques and approaches, leading towards a natural classification based primarily on genotypic evidence . Identification schemes currently in use employing biochemical tests are also reviewed, together with alternative molecular approaches. Oral Microbiol Immunol, 1998 Jun, 13(3), 129 - 38 The importance of fimbriae in the virulence and ecology of some oral bacteria; Hamada S et al.; Cumulative evidence indicates that bacterial adherence to mucosal and tooth surfaces as well as bacterial coaggregation are essential steps for colonization of various oral bacterial species . Bacterial fimbriae have been shown to play an important role in the interaction between bacteria and host cells or among bacterial cells . The properties of fimbriae from selected species of oral bacteria are discussed in terms of virulence traits and ecological significance . Among others, Porphyromonas gingivalis fimbriae have been most extensively studied . The fimbrial structure is composed of 41-kDa fimbrillin proteins . DNA sequencing of the fimbrillin gene (fimA) from nine strains of P . gingivalis suggests intraspecies variation in the structure of fimA, while retaining common immunochemical specificities . P . gingivalis fimbriae exhibit a wide variety of biological activities including immunogenicity, binding to various host proteins, stimulation of cytokine production and promotion of bone resorption, Actinobacillus actinomycetemcomitans also possesses fimbriae; however, little is known concerning their chemical, genetical, and biological properties . Fimbriae of Prevotella intermedia are shown to induce hemagglutination reaction, while those of Prevotella loescheii are found to cause coaggregation with other bacteria, i.e., Actinomyces viscosus and sanguis streptococci . Fimbriae from gram-positive oral bacteria such as oral Actinomyces and sanguis streptococci are described . These fimbriae may participate in coaggregation, binding to saliva-coated hydroxyapatite or glycoprotein of the surface layer of oral epithelial cells . Taken together, fimbriae are key components in cell-to-surface and cell-to-cell adherence of oral bacteria and pathogenesis of some oral and systemic diseases. Diagn Microbiol Infect Dis, 1999 Feb, 33(2), 101 - 12 Epidemiologic trends in nosocomial and community-acquired infections due to antibiotic-resistant gram-positive bacteria: the role of streptogramins and other newer compounds; Jones RN et al.; The Gram-positive cocci have clearly re-emerged as important pathogens world-wide in the past two decades . Staphylococci, including the coagulase-negative staphylococci and Staphylococcus aureus, and the enterococci account for approximately one-third of all blood stream infections and as much as 50% of nosocomial blood stream infections . Although Streptococcus pneumoniae is often considered a community-acquired pathogen, it is also an important cause of nosocomial infection . The hallmark of these Gram-positive pathogens is increasing resistance to available antimicrobial agents . Of particular note is resistance to glycopeptides (vancomycin and teicoplanin), aminoglycosides (high-level), and penicillins among the enterococci (especially E . faecium), resistance to penicillinase-resistant penicillins (oxacillin and methicillin) and fluoroquinolones (ciprofloxacin and ofloxacin) among staphylococci, and resistance to penicillin, other beta-lactams and macrolides among the pneumococci . The recent detection of decreased susceptibility to vancomycin among S . aureus is also quite ominous . In many instances the ability of the clinical laboratory to accurately characterize these resistant isolates is suboptimal, further compounding the problem . Increased understanding of resistance mechanisms and correlations of resistance genes with the phenotypic expression of resistance has allowed for modifications and improvements of reference susceptibility tests and interpretive breakpoints . New compounds for effective therapy of infection with multi-resistant Gram-positive species are clearly needed . To this end, the streptogramin combination, quinupristin/dalfopristin, has demonstrated significant activity against oxacillin-resistant staphylococci, penicillin-resistant streptococci, and vancomycin-resistant E . faecium . Other candidate drugs including Gram-positive active fluoroquinolones (clinafloxacin, grepafloxacin, moxifloxacin, gatifloxacin, and trovafloxacin) and novel compounds such as the everninomicin derivatives (SCH27899), ketolides, and oxazolidinones (linezolid) have been shown to be active against these organisms and are under rapid clinical development. Am J Ophthalmol, 1999 Mar, 127(3), 346 - 7 Recurrent anterior uveitis associated with streptococcal pharyngitis in a patient with a history of poststreptococcal syndrome; Holland GN; PURPOSE: To provide additional evidence that anterior uveitis can be a manifestation of poststreptococcal syndrome . METHOD: A case report providing follow-up information on a previously described patient . RESULTS: An adolescent girl in whom anterior uveitis was the only manifestation of poststreptococcal syndrome subsequently developed recurrent anterior uveitis after another episode of streptococcal pharyngitis . CONCLUSION: Anterior uveitis can recur in a manner similar to other manifestations of poststreptococcal syndrome after reinfection with group A streptococci. Infect Immun, 1999 Apr, 67(4), 1866 - 70 Capsular sialic acid limits C5a production on type III group B streptococci; Takahashi S et al.; The majority of type III group B streptococcus (GBS) human neonatal infections are caused by a genetically related subgroup called III-3 . We have proposed that a bacterial enzyme, C5a-ase, contributes to the pathogenesis of neonatal infections with GBS by rapidly inactivating C5a, a potent pro-inflammatory molecule, but many III-3 strains do not express C5a-ase . The amount of C5a produced in serum following incubation with representative type III strains was quantitated in order to better understand the relationship between C5a production and C5a-ase expression . C5a production following incubation of bacteria with serum depleted of antibody to the bacterial surface was inversely proportional to the sialic acid content of the bacterial capsule, with the more heavily sialylated III-3 strains generating less C5a than the less-virulent, less-sialylated III-2 strains . The amount of C5a produced correlated significantly with C3 deposition on each bacterial strain . Repletion with type-specific antibody caused increased C3b deposition and C5a production through alternative pathway activation, but C5a was functionally inactivated by strains that expressed C5a-ase . The increased virulence of III-3 strains compared to that of III-2 strains results at least partially from the higher sialic acid content of III-3 strains, which inhibits both opsonophagocytic killing and C5a production in the absence of type-specific antibody . We propose that C5a-ase is not necessary for III-3 strains to cause invasive disease because the high sialic acid content of III-3 strains inhibits C5a production. J Infect Dis, 1999 Mar, 179 Suppl 2, S353 - 9 Penicillin-binding protein-mediated resistance in pneumococci and staphylococci; Chambers HF; Target alteration underlies resistance to beta-lactam antibiotics in both Staphylococcus species and Streptococcus pneumoniae . The penicillin-binding protein (PBP) targets in penicillin-resistant strains of S . pneumoniae are modified, low-binding-affinity versions of the native PBPs . Multiple PBP targets may be modified by transformation and homologous recombination with DNA from PBP genes of viridans streptococci . The level of resistance is determined by how many and to what extent targets are modified . In contrast, methicillin resistance in staphylococci is due to expression of PBP 2a, a novel, low-affinity PBP for which there is no homologue in methicillin-susceptible strains . PBP 2a is encoded by mecA, a highly conserved gene most likely acquired by a rare transposition from Staphylococcus sciuri or a closely related ancestor . Expression of resistance can be highly variable, but this seems not to be determined by PBP modifications . Several non-PBP factors are required for high-level resistance. J Infect Dis, 1999 Apr, 179(4), 1030 - 3 Serotypes VI and VIII predominate among group B streptococci isolated from pregnant Japanese women; Lachenauer CS et al.; Infection by group B streptococcus (GBS) is an important cause of bacterial disease in neonates, pregnant women, and nonpregnant adults . Whereas serotypes Ia, Ib, II, III, and V are most commonly associated with colonization and disease in the United States, strains of other serotypes have been isolated from patients in Japan . By use of an inhibition ELISA, the serotypes of 73 vaginal colonizing GBS strains isolated from healthy pregnant Japanese women were investigated . Twenty-six (35.6%) were type VIII, 18 (24.7%) were type VI, and the remaining 29 were distributed among more traditional serotypes . Strains were also tested by immunoblot for the presence of GBS surface proteins . Fifty-three (72.6%) of the 73 strains expressed one or more laddering GBS proteins . These data show that type VI and VIII GBS strains are common vaginal isolates in pregnant Japanese women and that one or more laddering proteins are present in most GBS strains. J Infect Dis, 1999 Apr, 179(4), 907 - 14 Interaction between group A streptococci and the plasmin(ogen) system promotes virulence in a mouse skin infection model; Li Z et al.; Group A streptococci are capable of acquiring a surface-associated, unregulatable plasmin-like enzymatic activity when incubated in human plasma . The effect of this enzymatic activity on virulence of group A isolate CS101 was examined in a mouse skin infection model . Initial studies demonstrated enhanced virulence for bacteria preincubated in human plasma but not in plasminogen-depleted plasma . A direct correlation between surface-associated enzymatic activity and virulence was not observed; however, an association between virulence and the assembly of a surface-associated plasminogen activator that could activate mouse plasminogen was noted . This activity enhanced virulence in wild type but not in plg-/- plasminogen-deficient mice . These results support the hypothesis that acquisition of a surface-associated plasmin(ogen)-dependent enzymatic activity can contribute to the virulence of group A streptococcal invasive infections. J Antimicrob Chemother, 1998 Dec, 42(6), 721 - 8 The in-vitro activity of linezolid (U-100766) and tentative breakpoints; Wise R et al.; The in-vitro activity of linezolid, a novel oxazolidinone, was investigated in comparison with those of amoxycillin, cefuroxime, quinupristin/dalfopristin, trovafloxacin and vancomycin against 420 recent Gram-positive and anaerobic clinical isolates . Linezolid was equally active (MIC90 1 mg/L) against methicillin-susceptible and -resistant Staphylococcus aureus . It demonstrated uniform activity against streptococci and enterococci and no cross-resistance with other agents . The time-kill kinetic data demonstrated that the in-vitro activity of linezolid was predominantly bacteriostatic; slow bactericidal activity was only observed at the higher concentration with streptococci . An increase in inoculum from 10(4) to 10(6) cfu on selected strains had little effect on the MICs (MIC90 within one dilution step) of linezolid and an increase in inoculum from 10(5) to 10(7) cfu/mL had no notable effect on the in-vitro bactericidal activity . A tentative linezolid breakpoint of 2 mg/L was chosen after analysis of distribution of susceptibilities. Biosci Biotechnol Biochem, 1999 Jan, 63(1), 73 - 7 Purification and properties of bacteriolytic enzymes from Bacillus licheniformis YS-1005 against Streptococcus mutans; Kim SY et al.; To find a novel lytic enzyme against cariogenic Streptococci, strains showing strong lytic activity have been screened from soil using Streptococcus mutans . A strain identified as Bacillus licheniformis secreted two kinds of lytic enzymes, which were purified by methanol precipitation, CM-cellulose chromatography, gel filtration, and hydroxyapatite chromatography . The molecular weights of these two enzymes, L27 and L45, were 27,000 and 45,000, respectively . Optimum pH and temperature of both enzymes for lytic activity were pH 8 and 37 degrees C . L27 and L45 digest the peptide linkage between L-Ala and D-Glu in peptidoglycan of Streptococcus mutans . The lytic activity was highly specific for Streptococcus mutans, suggesting their potential use as a dental care product. Drugs Exp Clin Res, 1998, 24(4), 173 - 84 Enhanced effects of amoxycillin/clavulanic acid compared with amoxycillin and clavulanic acid alone on the susceptibility to immunodefenses of a penicillin-resistant strain of Streptococcus pneumoniae; Cuffini AM et al.; The recent increase in the incidence of infections due to Streptococcus pneumoniae resistant to penicillin and other antibiotics, often associated with considerable morbidity and mortality, has been recognized as an alarming problem . From the recent medical literature data it emerges that among beta-lactam antibiotics used as an empiric treatment for infections caused by S . pneumoniae, amoxycillin and amoxycillin/clavulanic acid are the most active oral antibiotics and may be considered as a first-line therapeutic agent for the treatment of these infections . Since the therapeutic result of the treatment of an infection is determined by the combined effect of the antimicrobials and host defenses, we investigated the effect of amoxycillin, with and without clavulanic acid, upon the in vitro interaction between human polymorphonuclear leukocytes (PMNs) and a penicillin-resistant strain of S . pneumoniae . Amoxycillin significantly inhibited the streptococcal uptake by PMNs referred to the control system . Clavulanic acid did not have any significant effect upon the interaction PMNs-S . pneumoniae . The addition of amoxycillin/clavulanic acid to phagocytes and streptococci resulted in a synergystic potentiation of the activity of both drugs upon the PMN functions towards S . pneumoniae in such a manner that the bacteria became more susceptible to either the phagocytosis or the microbicidal activities of phagocytes . These effects came in addition to the intrinsic, excellent antimicrobial properties of this drug combination . Although the clinical significance of the observed enhanced effects of amoxycillin/clavulanate are far from elucidated, the possibility exists that they may play a contributory role, especially in patients with impaired host defense. Mol Microbiol, 1999 Feb, 31(3), 859 - 70 High-frequency intracellular invasion of epithelial cells by serotype M1 group A streptococci: M1 protein-mediated invasion and cytoskeletal rearrangements; Dombek PE et al.; A clonal variant of serotype M1 group A streptococcus (designated M1inv+) has been linked to severe and invasive infections, including sepsis, necrotizing fasciitis and toxic shock . High frequency internalization of cultured epithelial cells by the M1inv+ strain 90-226 is dependent upon the M1 protein . Invasion of HeLa cells was blocked by an anti-M1 antibody, invasion by an M1- strain (90-226 emm1::km) was greatly reduced, and latex beads bound to M1 protein were readily internalized by HeLa cells . Beads coated with a truncated M1 protein were internalized far less frequently . Scanning electron microscopy indicated that streptococci invade by a zipper-like mechanism, that may be mediated by interactions with host cell microvilli . Initially, internalized streptococci and streptococci undergoing endocytosis are associated with polymerized actin . Later in the internalization process, streptococcal-containing vacuoles are associated with the lysosomal membrane glycoprotein, LAMP-1. Curr Opin Microbiol, 1999 Feb, 2(1), 56 - 61 Streptococcal invasion; Molinari G et al.; The genus Streptococcus consists of large number of species many of which are pathogenic to humans and animals . Although streptococci have long been considered as extracellular pathogens, they are capable of causing serious invasive infections such as necrotizing fasciitis and meningitis . Streptococcal invasion, therefore, has been a focus of many studies in recent years . Streptococci are efficiently internalized by nonprofessional phagocytes and the current research interest has shifted to determine the role of this invasion in the natural infection process . Moreover, characterization of bacterial and eukaryotic components involved in the uptake process might be useful in developing new strategies for combating streptococcal infections. Epidemiol Infect, 1998 Dec, 121(3), 515 - 21 A community outbreak of invasive and non-invasive group A beta-haemolytic streptococcal disease in a town in South Wales; El-Bouri KW et al.; An increase in the incidence of invasive and non-invasive infections caused by group A beta-haemolytic streptococci (GAS) was noted in and around the town of Glynneath (population approx . 4000) in West Glamorgan, South Wales between 1 January and 30 June 1995 . A total of 133 cases was ascertained with 127 (96%) occurring between 1 March and 30 June 1995 . Six patients had invasive disease (one died) and all presented at the peak of the outbreak . There were 127 non-invasive cases of whom 7 were hospitalized . The outbreak was investigated to determine its extent and whether it was caused by a single M-serotype of GAS . Serotyping showed that 13 different M-serotypes were involved with the M1 serotype predominating . The overall incidence of GAS invasive disease in West Glamorgan (population 365,000) increased sevenfold from a crude incidence of 0.5/10(5) per year in 1994 to 3.5/10(5) per year in 1995, but fell back to 0.75/10(5) per year in 1996 . Eighty-two (80%) out of 102 individuals affected by GAS replied to a health questionnaire; sore throat was the commonest symptom reported (97%) . Thirty-nine of these index cases identified at least one other member of their household who had experienced similar symptoms . The interval between the onset of illness in members of a single household was 0-83 days with a mean of 22 days . The mean duration of illness was 13.5 days and 61% of patients were treated with penicillin V for a mean duration of 9.3 days . Twenty-one per cent of GAS isolates were erythromycin-resistant and the M4 and M6 serotypes were especially resistant to erythromycin (87.5 and 100% resistance, respectively) . Penicillin V failed to eradicate GAS from the throats of 25% of assessable patients . In this community, an outbreak of non-invasive disease caused by GAS was linked in time and place with an outbreak of serious invasive disease. Pediatr Dent, 1999 Jan-Feb, 21(1), 9 - 11 Topical antimicrobial therapy in the prevention of early childhood caries; Lopez L et al.; PURPOSE: Early childhood caries (ECC) is microbiologically characterized by heavy infection of mutans streptococci (ms) on dental surfaces . Accordingly, it is reasonable to speculate that suppression of dental ms levels would decrease risk for ECC . On this basis, randomized double blind, placebo controlled pilot study was performed to test this concept . METHODS: The study population consisted of 31 subjects (age: 12 to 19 mos; sex: 18F/13M) who were clients of a Women, Infants, and Children (WIC) clinic in Puerto Rico . Inclusion criteria included: (1) unremarkable medical history; (2) presence of 4 maxillary primary incisors (PMI) with no visible defects; (3) clinically caries free; (4) use of a nursing bottle at naptime and/or bedtime which contained a cariogenic substrate; (5) two consecutive ms positive cultures (utilizing Mitis-Salivarius-Bacitracin (MSB) agar) from pooled PMI plaque . The subjects were randomized into 2 groups . The 15 subjects in the experimental group and the 16 subjects in the control group were evaluated every 2 months during the study period . At each evaluation, the subjects had 10% povidone iodine (experimental group) or placebo (control group) applied to their dentition . The placebo was commercial instant tea (without lemon or sweetener) and deionized water . Treatment failure was defined as the appearance of a white spot lesion(s) on any of the PMI during the study period . RESULTS: The mean duration of observation to treatment failure was 155 days; the mean duration of observation for treatment success was 217 days . Five of the 16 control subjects and 0 of the 15 experimental subjects experienced treatment failure (Fisher's exact test: P = 0.04) . The Kaplan-Meier estimate for incidence of treatment failure in the placebo group was 48% over 357 days (P = 0.02) . CONCLUSION: These observations suggest that topical antimicrobial therapy reduces risk for the development of ECC in high-risk children. Pediatr Dermatol, 1999 Jan-Feb, 16(1), 23 - 4 Febrile perianal streptococcal dermatitis; Velez A et al.; We describe a child with an unusual presentation of perianal streptococcal dermatitis which included fever, acral scarletiniform desquamation, and extension of erythema to involve the genitalia and proximal thighs, as well as the commonly seen well-defined erythema of the perianal area . We suggest that isolated group A beta-hemolytic streptococci (GAS) in our patient produced a pyrogenic exotoxin similar to that which appears in scarlet fever. Diagn Microbiol Infect Dis, 1999 Jan, 33(1), 27 - 31 In vitro activity of the new quinolone moxifloxacin (Bay 12-8039) against resistant gram-positive clinical isolates; Alcala L et al.; The novel 8-methoxyquinolone, moxifloxacin (Bay 12-8039), was compared with ciprofloxacin and eight other antimicrobials for activity against 425 strains Gram-positive clinical isolates, including 73 methicillin-resistant staphylococci, 35 vancomycin-resistant enterococci, and 80 penicillin- or eythromycin-resistant streptococci . Overall, 82% of the strains were inhibited at < or = 2 micrograms/mL . Moxifloxacin was more active than ciprofloxacin against staphylococci (8- to 32-fold), enterococci (0- to 16-fold), pneumococci (16-fold) and other streptococci (4- to 16-fold) when MIC90 results were compared . Moxifloxacin demonstrated good activity against all Gram-positive isolates tested except for ciprofloxacin-resistant enterococci (MIC90, 32 micrograms/mL) and methicillin-resistant staphylococci (MIC90, 8 micrograms/mL) . Clinical trials should be initiated to define the role of this new quinolone. Diagn Microbiol Infect Dis, 1999 Jan, 33(1), 19 - 25 Antimicrobial activity of SCH27899 (Ziracin), a novel everninomicin derivative, tested against Streptococcus spp.: disk diffusion/etest method evaluations and quality control guidelines . The Quality Control Study Group; Marshall SA et al.; To combat the increasing rates of penicillin resistance among pneumococci and viridans group streptococci, new Gram-positive active agents are needed to avoid the overuse of vancomycin . SCH27899 is an everninomicin derivative with strong activity against glycopeptide-resistant enterococci, oxacillin-resistant staphylococci, and penicillin-resistant streptococci . This study tests the in vitro activity of SCH27899 against 304 strains of streptococci and evaluates the quality of the agar dilution, broth microdilution, disk diffusion, and Etest methods for this antimicrobial agent . Quality-control (QC) ranges for SCH27899 are also proposed . SCH27899 broth microdilution MICs among the penicillin-susceptible and -resistant streptococci tested ranged from < or = 0.008-0.5 microgram/mL . Organism groups with their respective MIC90s were as follows: Streptococcus pneumoniae (100 strains) and beta-haemolytic streptococci (70 strains), 0.12 microgram/mL; Streptococcus bovis (10 strains), 0.25 microgram/mL; and viridans group streptococci (124 strains), 0.5 microgram/mL . Etest SCH27899 MICs correlated well with broth microdilution MICs (92% +/- one log2 dilution, 98% +/- two log2 dilutions) . Agar dilution SCH27899 MICs correlated well with broth microdilution MICs, but a shift toward slightly higher agar dilution MICs was attributed to difficulties in reading trailing endpoints with this method . Three concentrations (2.5, 5, and 10 micrograms) of SCH27899 were used for the disk diffusion method with small inhibition zone diameters (range, 11 to 19 mm) and limited variation between diameters (+/- 2 mm) as a result, both products of this compound's high molecular weight and poor diffusion through agar mediums . Proposed control ranges for SCH27899 when testing S . pneumoniae ATCC 49619 from a nine-center (30 tests per center) quality-control trial are < or = 0.016 to 0.032 microgram/mL for Etest, and 0.008 to 0.032 microgram/mL for broth microdilution tests from an earlier study . Because of the limited diffusion ability and bacteriostatic nature of SCH27899, MICs should be read at 80% of inhibition with agar in vitro systems (Etest, agar dilution), and the disk diffusion method is not recommended. Br J Dermatol, 1998 Dec, 139 Suppl 53, 30 - 6 The clinician's choice of antibiotics in the treatment of bacterial skin infection; Veien NK; The development of modern antibiotics has vastly improved the therapy of cutaneous bacterial infections, particularly those caused by Staphylococcus aureus . This organism and beta-haemolytic streptococci are the most common cutaneous pathogens . A growing body of evidence suggests that proteins from S . aureus and some strains of streptococci can act as superantigens and cause polyclonal T-cell activation by binding directly to antigen-presenting cells . This process is a likely explanation of Kawasaki's syndrome as well as staphylococcal and streptococcal toxic shock syndrome . Sudden aggravation of atopic dermatitis, contact dermatitis and some cases of psoriasis can be similarly explained . Bacterial toxins can precipitate the staphylococcal scalded skin syndrome . Specific and effective eradication of bacteria and programmes to prevent recurrences are important, particularly in immune suppressed persons . Topical antibiotics used primarily for superficial infections of limited extent and for the prevention of recurrences in carriers of S . aureus should be combined with the use of topical disinfectants . The treatment of selected bacterial skin infections based on clinical examples will be discussed . These include secondarily infected dermatoses, cellulitis and streptococcal carriage in the ano-genital region and staphylococcal folliculitis and nasal carriage. Br J Dermatol, 1998 Dec, 139 Suppl 53, 17 - 29 The role of superantigens in human diseases: therapeutic implications for the treatment of skin diseases; Leung DY et al.; Although it is well established that immune mechanisms contribute to the pathogenesis of chronic inflammatory skin diseases such as atopic dermatitis (AD) and psoriasis, the actual events that trigger the immunological pathways resulting in these skin diseases are not well understood . Colonization and infection with Staphylococcus aureus and streptococci has been reported to exacerbate AD and psoriasis . Recent studies demonstrating that bacterial toxins can act as superantigens provide mechanism(s) by which S . aureus and streptococci could mediate an inflammatory skin lesion that consists predominantly of activated T-cells and monocytes . This review will explore the diverse mechanisms by which bacterial superantigens can induce skin inflammation following systemic or local infection . These observations provide a new direction for the development of novel approaches for the treatment of skin inflammation. Br J Dermatol, 1998 Dec, 139 Suppl 53, 4 - 8 Resistance to antibiotics used in dermatological practice; Espersen F; The increased prevalence of bacterial resistance is one of the major problems of medicine today . Antibiotic resistance can be defined as the situation where the minimal inhibitory concentration is greater than the concentration obtainable in vivo . Resistance genes are easily transferred among bacteria, especially bacteria on skin and mucous membranes . In dermatological patients the most important resistance problems are found among staphylococci, Propionibacterium acnes and, to some extent, streptococci . Staphylococcus aureus strains have developed worldwide resistance to penicillin due to betalactamase production in > 90% of cases, and methicillin resistance is now a major problem with resistance levels of > 50% in certain areas of the world . These resistant strains are often multiresistant, and include resistance to erythromycin and tetracycline, with resistance to quinolone developing rapidly . Group A streptococci are still susceptible to penicillin, but increasing problems with erythromycin and tetracycline have been reported . After treatment with both systemic and oral antibiotics, P . acnes develops resistance in more than 50% of cases, and it is estimated that one in four acne patients harbours strains resistant to tetracycline, erythromycin, and clindamycin . To limit the development of antibiotic resistance, it is necessary to establish an antibiotic policy (prescription rules, reimbursement strategy, development of both national and local guidelines, and limitations on non-medical use) . Clinicians also need access to rapid diagnostic methods, including resistance testing . This may provide further data for surveillance systems, reporting both antibiotic consumption and resistance levels . The involvement of clinical doctors in teaching and research in this area is probably the most important aspect, along with their involvement in the formulation of national and local guidelines . In the future we may consider it more important to ensure that future patients can be offered antibiotic treatment, rather than focusing on the patient presenting today. Am J Trop Med Hyg, 1999 Jan, 60(1), 150 - 6 Isolation of Fusobacterium necrophorum from cancrum oris (noma); Falkler WA Jr et al.; A study of the predominant microflora in active sites of noma (cancrum oris) lesions was carried out in eight noma patients 3-15 years of age in Sokoto State in northwestern Nigeria . Paper point sampling and conventional anaerobic microbiologic techniques were used . Fusobacterium necrophorum was recovered from 87.5% of the noma lesions . Oral microorganisms included Prevotella intermedia, alpha-hemolytic streptococci, and Actinomyces spp . which were isolated from 75.0%, 50.0%, and 37.5% of the patients, respectively . Peptostreptococcus micros, Veillonella parvula, Staphylococcus aureus, and Pseudomonas spp . were each recovered from one lesion . The F . necrophorum and P . intermedia isolates were tested for antibiotic sensitivity to clindamycin, tetracycline, metronidazole, and penicillin using the E-test, and all strains were observed to be sensitive to all of the antibiotics tested with the exception of one strain of P . intermedia, which showed resistance to penicillin . The first reported isolation from human noma lesions of F . necrophorum, a pathogen primarily associated with animal diseases, may have important etiologic and animal transmission implications. Zentralbl Bakteriol, 1998 Dec, 288(4), 479 - 89 Influence of growth conditions on expression of immunoglobulin G binding in group A streptococci; Burova LA et al.; Many group A streptococci (GAS) bind the Fc part of IgG . In the present work, the possible influence of growth time and incubation atmosphere on the expression of the IgG binding activity by GAS of various serotypes was studied . Among 13 GAS reference strains, two categories were distinguished on aerobic incubation at 37 degrees C, one expressing similar IgG binding activity at 6 h and 18 h (types M1, M4, M13, M15), and a second one which showed higher binding at 6 h than at 18 h (M9, M14, M22, M25, M48, M49) . Only one strain (M36) bound less IgG at 6 h than at 18 h . Seven of the strains (M5, M6, M22, M25, M36, M48, M49) showed higher binding of IgG when grown in a 5% CO2 atmosphere than in air, whereas one strain (M14) showed a reverse pattern and in the remaining five strains, no influence was found . Protease activity was detected in the growth supernatant of most of the strains . For five selected strains, the time of appearance of supernatant protease activity coincided with a decay of surface IgG binding activity . Purified streptococcal cysteine protease was found to reduce or abolish the binding of IgG by each of three studied strains (M1, M13 and M15) and of type M1 or M15 purified IgG binding material . When tested in the stationary phase, a majority of 62 clinical GAS isolates belonging to 6 different M types showed high protease activity but low binding of IgG . We conclude that streptococcal IgG binding is often better expressed on growth in 5% CO2 atmosphere than in air . Furthermore, due to its sensitivity to streptococcal protease, the IgG binding activity is mostly higher during the logarithmic than during the stationary phase of growth. J Biol Chem, 1999 Feb 19, 274(8), 4786 - 93 Characterization of a two-component system in Streptococcus pyogenes which is involved in regulation of hyaluronic acid production; Bernish B et al.; Hyaluronic acid production by group A streptococci is regulated by transcriptional control . In this study, transposon mutagenesis of an unencapsulated strain yielded an encapsulated mutant . Two genes homologous to sensors and response regulators of bacterial two-component systems were identified downstream of the transposon insertion . Inactivation of the putative sensor gene, csrS, in three different unencapsulated strains yielded encapsulated mutant strains . Electrophoretic mobility shift assays determined factor(s) in a cytoplasmic extract of an unencapsulated group A streptococcal strain was binding to a double-stranded DNA fragment derived from the has operon promoter . In contrast, similarly prepared cytoplasmic extracts from a csrS deletion mutant did not shift the fragment . The putative response regulator, CsrR, was partially purified and was shown to bind the has operon promoter fragment . The affinity and specificity of CsrR for the fragment were increased significantly after incubation with acetyl phosphate . DNase I footprinting determined that the acetyl phosphate-treated CsrR was binding to key sequences in the promoter and the coding region of hasA . Therefore, a two-component system is repressing the production of hyaluronic acid in group A streptococci using a phosphorylation-dependent binding interaction between the response regulator CsrR and the promoter region of the has operon. Vestn Ross Akad Med Nauk, 1998, (12), 49 - 54 {Genetic analysis of pathogenic streptococci groups A and B}; Suvorov AN et al.; The study deals with the genetic mapping of chromosomal DNA of groups A (AS) and B (BS) pathogenetic Streptococci . Its stages are presented and considered . The maps of these microorganisms are compared . A collection of epidemic AS and BS was analyzed by employing pulsed field gel electrophoresis . AS and BS were found to show heterogeneity of DNA sequences and the common pattern of gene location on the chromosomes. Vaccine, 1999 Jan, 17(2), 193 - 200 Multivalent group A streptococcal vaccine designed to optimize the immunogenicity of six tandem M protein fragments; Dale JB; One of the major challenges in the development of group A streptococcal M protein-based vaccines is the multiplicity of M types expressed by these organisms . Previous studies have shown that multivalent vaccines containing as many as eight M protein fragments in tandem were immunogenic and evoked opsonic antibodies . It was also noted that the C-terminal fragments of these hybrid proteins were often not immunogenic or evoked only low levels of opsonic antibodies, suggesting that the C-terminus of the molecule may have been preferentially degraded or altered in vivo . In the present studies, we designed a hexavalent vaccine containing protective M protein peptides from types 24, 5, 6, 19, 1, and 3 group A streptococci . In order to "protect" the carboxy-terminal components, the amino-terminal M24 fragment was reiterated on the carboxy-terminal end of the construct . The hexavalent vaccine was immunogenic in laboratory animals and evoked high titers of antibodies against each of the native M proteins represented in the vaccine and bactericidal antibodies against all six sterotypes of group A streptococci . The vaccine was equally immunogenic when delivered in alum or in complete Freund's adjuvant . None of the immune sera contained antibodies that crossreacted with human heart tissue . Our results show that complex multivalent group A streptococcal vaccines can be designed in such a way that each M protein fragment is immunogenic and evokes protective antibodies. J Clin Microbiol, 1999 Mar, 37(3), 769 - 71 Isolation of Abiotrophia adiacens from a brain abscess which developed in a patient after neurosurgery; Biermann C et al.; We report the case of a patient who developed a large brain abscess after neurosurgery . Cerebrospinal fluid from the abscess drainage yielded Abiotrophia adiacens-specific PCR products and microorganisms that were identified by conventional microbiological methods and by 16S ribosomal DNA analysis as Abiotrophia adiacens, which was formerly classified as a member of nutritionally variant streptococci. Tokai J Exp Clin Med, 1998 Mar, 23(1), 45 - 7 Anti-streptococcal activity of homologous polymorphonuclear neutrophils from patients with surgically treated oral infections; Kaneko A et al.; The phagocytic bactericidal activity of homologous polymorphonuclear neutrophils (PMN), obtained from patients with severe, moderate and mild oral infections with Streptococci, was investigated . The drop in viable bacterial cell counts in PMNs from 3 patients with a severe infection, after 4 hours of incubation, was much greater than in PMNs from moderate or mild infections . We conclude that the phagocytic bactericidal activity of PMNs is stronger in patients suffering from severe oral infections with Streptococci. J Infect Dis, 1999 Mar, 179(3), 627 - 36 Genetic linkage of exotoxin alleles and emm gene markers for tissue tropism in group A streptococci; Bessen DE et al.; In group A streptococci, genetic markers for principal tissue reservoir are located within emm genes, which encode surface proteins that have a role in virulence . A worldwide collection of 160 isolates was evaluated for two traits: chromosomal emm gene markers for tissue tropism (designated patterns A-E), and bacteriophage-associated genes (speA and speC) encoding pyrogenic exotoxins . The speA and speC alleles of organisms harboring the emm marker for a pharyngeal reservoir (pattern A-C) differ from spe alleles that predominate in organisms with the emm marker for impetigo (pattern D) . However, organisms that display the emm marker for both tissue sites (pattern E) are not intermediate for the distribution of either speA or speC alleles, but instead resemble pattern A-C isolates for speA and pattern D strains for speC . Statistically significant nonrandom associations between exotoxin alleles and emm patterns were observed but cannot be readily explained by niche separation alone. Gene, 1999 Jan 21, 226(2), 243 - 51 Integrational plasmids for the tetracycline-regulated expression of genes in Streptococcus pneumoniae; Stieger M et al.; Plasmids for the tetracycline regulated gene expression in Streptococcus pneumoniae have been developed . The plasmids were used for the tetracycline-dependent production of firefly luciferase in streptococci . The production of luciferase can be induced fivefold by the addition of tetracycline . By using two promoters of different strength and depending on the presence or absence of tetracycline, an 80-fold range of luciferase activities can be covered . The system was also used to construct strains that depend on the addition of tetracycline for the production of the A subunit of DNA gyrase, an essential streptococcal protein . The growth of such a strain depends on the addition of tetracycline to the medium . In the absence of tetracycline, the cells cease to grow and are not viable . The system presented in this report should be useful for the characterization of gene networks in S . pneumoniae . It especially allows one to study the function of essential genes that can not be investigated by standard knock-out techniques. Oral Oncol, 1998 Nov, 34(6), 476 - 83 The effect of chemotherapy on the supragingival plaque of pediatric cancer patients; Sixou JL et al.; The anaerobic cultivable flora of the dental plaque was investigated in 16 cancer children at days 0, 7, 14 and 21 of a first cure of chemotherapy . Results were compared with those obtained in 16 healthy children . Diseased children showed more quantitative variations of the flora than the controls, especially during the first week of chemotherapy . Whatever the day of sampling, the flora of the diseased children was significantly less complex than that of the controls . Viridans streptococci, Capnocytophaga, and to a lesser extent staphylococci, appeared to be the most strongly affected in diseased children . This could be explained by different mechanisms, uncontrolled recolonization of the dental plaque, selection of multidrug-resistant strains or nosocomial acquisition . These results indicate that variations in quantity, complexity and quality of the oral flora occur during chemotherapy, leading to a major imbalance of the ecosystem. Lung, 1999, 177(2), 101 - 10 Lipid peroxidation of lung surfactant by bacteria; Bouhafs RK et al.; The epithelium of the lung is lined with extracellular pulmonary surfactant . This is the surface that invading bacteria first come into contact with when they enter the alveoli . As bacteria become established and interact with this layer, various characteristics of surfactant may become altered . We studied free radical production by three bacterial species, group B streptococci, Escherichia coli, and Pseudomonas aeruginosa, as well as the effect of two concentrations of lung surfactant (Curosurf at 0.04 and 0.4 mg/ml) on this production estimated by the nitro blue tetrazolium reduction test . We also measured the lipid peroxidation of surfactant at various incubation times (0-20 h), using a LPO-586 test kit . In addition, the effect of vitamin E as an antioxidant in a concentration of 0.5 microM was determined by the lipid peroxidation test . We found that the nitro blue tetrazolium reduction by the three bacterial species and lipid peroxidation of lung surfactant increased with time . Vitamin E reduced the lipid peroxidation of this surfactant . By measuring bacterial growth at various incubation times we showed that lung surfactant was bactericidal to group B streptococcal and E . coli strains and that P . aeruginosa strains were resistant to surfactant . We conclude that bacteria, probably by their production of reactive oxygen species, cause lipid peroxidation of lung surfactant. Support Care Cancer, 1999 Jan, 7(1), 28 - 30 Activity of quinolones against viridans group streptococci isolated from blood cultures of patients with haematological malignancy; Kerr KG et al.; Use of fluoroquinolones for antimicrobial prophylaxis during neutropenia is often cited as a significant predisposing factor for viridans group streptococcus (VGS) bacteraemia . Newer compounds in this class are reputed to have enhanced activity against Gram-positive bacteria, and we determined the minimal inhibitory concentrations (MICs) for ciprofloxacin and three of the newer compounds: trovafloxacin, fleroxacin and clinafloxacin, against 44 isolates of VGS . On a gravimetric basis, clinafloxacin was most active (MIC90 0.19 mg/l), whereas ciprofloxacin and fleroxacin were the least active (both MIC90 16 mg/l) . Clinafloxacin warrants further study as an agent of prophylaxis against bacterial infection in neutropenic patients. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1998 Nov-Dec, 39(6), 415 - 8 Group A streptococcal necrotizing fasciitis after varicella: report of two cases; Lin PC et al.; The most common complication in children with varicella is cutaneous superimposed infection with pyogenic bacteria . The association between varicella and group A beta-hemolytic streptococci (GABHS) necrotizing fasciitis has been recorded for over 50 years . Two cases with the specific problems are presented here together with a review of the literature . This infection is caused by GABHS superinfection of the skin lesions due to chickenpox . It can be unrecognized or late-diagnosed, with fatal consequences . Because of prompt recognition and aggressive surgical and medical treatment, the two patients survived without loss of the affected limb. J Med Microbiol, 1999 Jan, 48(1), 103 - 5 Aerobic and anaerobic microbiology of axillary hidradenitis suppurativa; Brook I et al.; A retrospective review of the microbiological and clinical data of 17 specimens obtained from axillary hidradenitis suppurativa (HS) over a period of 6 years was undertaken to study the aerobic and anaerobic microbiology of this condition . A total of 42 bacterial isolates (2.5 per specimen) were obtained, 12 aerobic or facultative (0.7 per specimen) and 30 anaerobic or micro-aerophilic (1.8 per specimen) . Aerobic and facultative bacteria only were isolated in six (35%) cases, anaerobic bacteria only in seven (41%) and mixed aerobic and anaerobic bacteria in four (24%) . The predominant aerobic bacteria were Staphylococcus aureus (six isolates), Streptococcus pyogenes (three) and Pseudomonas aeruginosa (two) . The most frequently isolated anaerobes were Peptostreptococcus spp . (10), Prevotella spp . (seven), micro-aerophilic streptococci (four), Fusobacterium spp . (three) and Bacteroides spp . sensu stricto (three) . This study highlights the polymicrobial nature and predominance of anaerobic bacteria in axillary HS and the need for antimicrobial thereby to reflect this. FEMS Microbiol Lett, 1999 Jan 1, 170(1), 151 - 8 Presence of erm gene classes in gram-positive bacteria of animal and human origin in Denmark; Jensen LB et al.; A classification of the different erm gene classes based on published sequences was performed, and specific primers to detect some of these classes designed . The presence of ermA (Tn554), ermB (class IV) and ermC (class VI) was determined by PCR in a total of 113 enterococcal, 77 streptococcal and 68 staphylococcal erythromycin resistant isolates of animal and human origin . At least one of these genes was detected in 88% of the isolates . Four isolates contained more than one erm gene . ermB dominated among the enterococci (88%) and streptococci (90%) and ermC among staphylococci (75%) with ermA (Tn554) present in some isolates (16%) . Variations in the presence of the different genes when comparing staphylococcal isolates of human and animal origin were observed. Int J Antimicrob Agents, 1998 Nov, 10(4), 313 - 6 Aetiology, cost of antimicrobial therapy and outcome in neutropenic patients who developed bacteraemia during antimicrobial prophylaxis: a case-control study; Krupova Y et al.; Sixty four episodes of bacteraemia that appeared during antimicrobial prophylaxis with an oral quinolone plus an azole in neutropenic cancer patients were compared with 128 cases of bacteraemia in a cohort of controls matched for age, sex, underlying disease, neutropenia and vascular catheter in situ to assess differences in aetiology, cost of therapy and outcome . Patients who received prophylaxis had breakthrough bacteraemias of a different aetiology compared with the control group: they had significantly fewer multiply-resistant strains (21.9 vs . 51.5, P < 0.04) and a longer afebrile neutropenic period (9.55 days vs . 4.1, P < 0.001) . Patients who received prophylaxis also had bacteraemias that were significantly more frequently caused by viridans streptococci (9.4%, vs . 1.7%, P < 0.01), enterococci (15.6% vs . 7.2%, P < 0.05) and Stenotrophomonas maltophilia (17.2% vs . 3.4%, P < 0.01) . The cost of antimicrobial therapy per case (37401 SKK (1091 USD) vs . 31808 SKK (899 USD), P < 0.05) was also significantly higher in cases than controls; however, the number of administered antibiotics (4.18 vs . 3.21 per case, P = NS) was similar in both groups . There were no differences in outcome between both groups . However patients who received prophylaxis had significantly longer periods of afebrile neutropenia (9.55 days vs . 4.1, P < 0.001) and bacteraemia developed later than in controls . Also, the incidence of polymicrobial bacteraemia caused by multiresistant strains was lower among cases (21.9 vs . 51.5, P < 0.04). Zentralbl Veterinarmed B, 1998 Dec, 45(10), 585 - 93 Subtyping of Streptococcus dysgalactiae and Streptococcus uberis isolated from bovine mammary secretions by DNA fingerprinting; Gillespie BE et al.; Streptococcus dysgalactiae and Streptococcus uberis isolated from mammary secretions of cows from Tennessee and New Zealand were subtyped using polymerase chain reaction-based DNA fingerprinting . Such DNA fingerprinting using primer 8.6d (5'-GTAACGCC3') resulted in categorizing 116 S . dysgalactiae isolates into 25 different subtypes, with 17 subtypes observed in isolates from Tennessee and eight in isolates from New Zealand . All S . dysgalactiae DNA fingerprint profiles, regardless of origin, contained 700- and 330-base pair fragments . The majority of S . dysgalactiae isolates (73%) from Tennessee belonged to two subtypes . The remaining 23 isolates belonged to 15 different DNA fingerprint subtypes . Streptococcus dysgalactiae isolates from New Zealand (n = 32) were grouped into eight different subtypes; 66% belonged to two subtypes . A characteristic feature of S . dysgalactiae isolates from New Zealand was the presence of a 270-base pair DNA fragment seen infrequently in S . dysgalactiae isolates from Tennessee . When primer OPE-4 (5'-GTGACATGCC-3') was used, DNA fingerprinting differentiated S . uberis from Tennessee (n = 28) and New Zealand (n = 30) into 20 subtypes; 14 subtypes were observed in isolates from Tennessee, and six in isolates from New Zealand . All S . uberis DNA fingerprint profiles, regardless of origin, contained 1100-, 640-, and 450-base pair fragments . A characteristic feature of S . uberis isolates from New Zealand was the presence of a 300-base pair DNA fragment seen infrequently in S . uberis isolates from Tennessee . The most common subtypes of S . dysgalactiae and S . uberis from Tennessee herds were isolated in milk from lactating cows during monthly herd surveys, in milk from cows with clinical mastitis, and in mammary secretions from cows during the periparturient period, and thus were not confined to one particular stage of lactation . These data suggest that S . dysgalactiae and S . uberis from New Zealand are distinct from those isolated from the USA, and that DNA fingerprinting can be used as an epidemiological tool to differentiate streptococci and identify important sources of these mastitis pathogens on dairy farms. J Dairy Sci, 1998 Dec, 81(12), 3293 - 9 Intramammary infections in primiparous Holsteins: heritabilities and comparisons of bovine leukocyte adhesion deficiency carriers and noncarriers; Wanner JM et al.; The objective of this study was to determine the impact of bovine leukocyte adhesion deficiency on intramammary infection (IMI) in Holstein cows at first calving . Quarter milk samples were collected between 3 d prepartum and 4 d postpartum from 756 Holstein cows in first lactation . These samples were frozen and subsequently cultured using National Mastitis Council recommendations . Sixty-eight carriers of bovine leukocyte adhesion deficiency were identified (9.0% of cows) from an additional milk sampling collected in early lactation . Binary variables (infected or uninfected) for each quarter were defined as dependent variables to evaluate IMI incidence from all bacterial species and major species groups: coliforms, coagulase-negative staphylococci, and streptococci other than Streptococcus agalactiae . The model included herd-season of calving, days in milk when samples were collected, age at calving, quarter, cow (random effect), and bovine leukocyte adhesion deficiency . Sire was included as a random effect (instead of cow), and bovine leukocyte adhesion deficiency was dropped from the model to estimate heritabilities . Heritabilities for IMI incidence from the various groups of organisms ranged from 0.02 to 0.66 (0.21 from all bacterial species) . No differences were observed between carriers of bovine leukocyte adhesion deficiency and homozygous normal noncarriers for IMI from coliform, coagulase-negative staphylococci, streptococci other than Streptococcus agalactiae, or all bacterial species combined. J Dermatol Sci, 1999 Jan, 19(1), 17 - 22 Streptococci isolated from various skin lesions: the interaction with Staphylococcus aureus strains; Akiyama H et al.; We isolated 73 streptococcus strains (41 from infections, and 32 from colonization) from various skin diseases between March, 1994, and June, 1998 . In 29 out of 41 cases of infective origin, Staphylococcus aureus strains were simultaneously isolated . Twenty-four out of 28 patients with impetigo were suffering from atopic dermatitis . We confirmed that impetigo lesions where Streptococcus pyogenes was dominant in number always showed thick-walled pustules on an erythematous base; these skin lesions were considered to be an early manifestation of streptococcal impetigo . We further confirmed that thick-crusted lesions in streptococcal impetigo, where S . aureus exceeded S . pyogenes in number, were a late manifestation . Antimicrobial agents such as minocycline, fusidic acid, ofloxacin and tosufloxacin, were more effective against S . aureus strains than against beta-hemolytic streptococcal strains . In contrast, ampicillin, cefdinir, imipenem, erythromycin and vancomycin were more effective against beta-hemolytic streptococcal strains. Int J Dermatol, 1998 Dec, 37(12), 922 - 4 Microbiology of perianal cellulitis in children: comparison of skin swabs and needle aspiration; Brook I; OBJECTIVE: To establish the aerobic and anaerobic microbiology of perianal cellulitis in children, comparing skin swab and needle aspirate methodology . METHOD: Swabs of involved skin and needle aspirates of cellulitis were studied for aerobic and anaerobic bacteria . RESULTS: Specimens obtained from 10 patients with perianal cellulitis showed bacterial growth . Polymicrobial aerobic-anaerobic flora was found in all skin surface cultures, where the predominate isolates were Peptostreptococcus spp., Escherichia coli, and alpha hemolytic streptococci . The number of isolates in needle aspirates varied between one and two . The predominant ones were E . coli (3), Peptostreptococcus spp . (3), Staphylococcus aureus (2), and Bacteroides fragilis group (2) . Complete or partial concordance in microbiology between skin swabs and needle aspirates was present in six instances . In four instances, isolates recovered from needle aspirates were not isolated from the skin surface . CONCLUSIONS: This study demonstrates the diversity of aerobic and anaerobic organisms isolated from perianal cellulitis, and the superiority of needle aspirates in establishing the microbiology of the infection. J Cataract Refract Surg, 1999 Jan, 25(1), 137 - 9 Keratitis with loss of useful vision after photorefractive keratectomy; Malling S; A 30-year-old man was referred as an acute case for keratitis . Two days earlier he had had photorefractive keratectomy for myopia at another clinic; a bandage contact lens was placed over the eye, but prophylactic antibiotics were not prescribed . The keratitis was treated with gentamicin sulfate (Garamycin) and chloramphenicol eyedrops . Scrapings from the cornea showed nonhemolytic streptococci . Two and a half months later, visual acuity was finger counting because of gross distortion of the corneal contour . The combination of a bandage contact lens and the lack of prophylactic antibiotics may have been the source of bacterial keratitis. J Appl Physiol, 1999 Jan, 86(1), 61 - 5 Influence of group B streptococci on piglet pulmonary artery response to bradykinin; Whitehurst RM et al.; To study whether a sepsis-induced increase in des-Arg9-bradykinin (des-Arg9-BK) and bradykinin (BK) B1-receptor activity participates in the observed increase in pulmonary vascular resistance in neonatal group B streptococcal sepsis (GBS), isometric force bioassays of pulmonary artery (PA) rings were studied, after 4-h exposure to either Krebs or GBS, by using the following protocols: 1) BK dose-response curve, 2) vascular response to BK with NG-nitro-L-arginine methyl ester (L-NAME), and 3) response to des-Arg9-BK (BK metabolite and B1 agonist) . PA rings exposed to BK resulted in contraction in the GBS group and a decrease in resting tension in the Control group (P = 0.034) at a concentration of 10(-5) M . GBS-treated PA rings contracted more to des-Arg9-BK than did Controls (P < 0.001) . BK (10(-6) M) relaxed preconstricted PA rings incubated in GBS less than BK relaxed Controls (P < 0.001), and preincubation with L-NAME decreased relaxation in both . These results suggest that GBS decreased endothelium-dependent BK relaxation and increased contractile response to des-Arg9-BK . We speculate that this occurs secondary to upregulation of B1 receptors reflected by B1-agonist-mediated PA contraction. Pediatr Emerg Care, 1998 Dec, 14(6), 396 - 8 Evaluation of a new rapid antigen detection kit for group A beta-hemolytic streptococci; Pitetti RD et al.; OBJECTIVE: To evaluate the use of a new rapid antigen-detection kit for group A beta-hemolytic streptococcus and compare results with previously published studies . METHODS: Throat swabs were obtained prospectively from patients, aged one to 18 years, presenting to the emergency department, acute concerns clinic, and walk-in clinic of an urban tertiary care children's hospital . Throat swabs were first inoculated on a 5% sheep blood agar plate and then used for the streptococcus A optical immunoassay (OIA) kit . Results of both the throat culture and the rapid antigen-detection test were then compared . RESULTS: Two-hundred thirty-three patients were enrolled . Seventy-three patients had a positive culture and 63 patients had a positive OIA . Fifteen patients had a false negative result for the OIA kit and five patients had a false positive result . Test sensitivity was 79.5%, specificity was 96.9%, positive predictive value was 92.1%, and negative predictive value was 91.2% CONCLUSION: Although previous studies have demonstrated OIA kit sensitivities as high as 98.9% and authors have, as a result, recommended that the performance of a backup throat culture for a negative OIA test is unnecessary, our results do not support this . A sensitivity of 79.5% is not sufficiently high to justify omission of a standard throat culture . Accordingly, all OIA tests that are negative should be confirmed by the performance of a throat culture. J Biochem (Tokyo), 1999 Jan, 125(1), 27 - 30 Unique synthetic peptides stimulating streptolysin S production in streptococci; Akao T et al.; A peptide has been isolated from pronase digest of bovine serum albumin as the stimulatory factor of streptolysin S (SLS) production by Streptococcus pyogenes, and its primary structure has been deduced {Akao et al . (1992) Infect . Immun . 60, 4777-4780} . To determine the essential structure for the stimulation, a peptide (P-1) having the deduced structure, in which three peptide fragments are linked by two disulfide bonds, and shorter analogs (P-2 to P-4) of peptide P-1 were chemically synthesized . Another peptide (P-5), in which Ala is inserted between the two Cys residues in the middle peptide chain of P-1, was also synthesized . These synthetic peptides were identified by mass spectrometry and analysis of amino acid compositions . The synthetic P-1 stimulated SLS production in a dose-dependent manner . Other peptide analogs also showed remarkable stimulation of SLS production . Treatment of P-1 with performic acid resulted in loss of its stimulatory activity, indicating that disulfide bridges of the peptides are necessary for their activity on SLS production . These results suggest that the unique primary structure of three peptide chains linked by two disulfide bridges is requisite for the stimulatory effect on SLS production. J Periodontal Res, 1998 Nov, 33(8), 460 - 8 Preparation and characterization of an Actinomyces naeslundii aggregation factor that mediates coaggregation with Porphyromonas gingivalis; Yamaguchi T et al.; Intergeneric coaggregation is responsible for the complexity of the microbiota in human dental plaque and is believed to be important in the initial bacterial colonization of the human oral cavity . Actinomyces naeslundii, an early colonizer of the tooth surface, may enhance subsequent colonization by Porphyromonas gingivalis which is associated with adult periodontitis . The purpose of this study was to isolate and characterize the A . naeslundii aggregation factor (AnAF) that mediates coaggregation with P . gingivalis . AnAF was isolated from A . naeslundii sonic extract (SE) by gel filtration on a Sephacryl S-400HR, by hydrophobic interaction chromatography on a HiTrap Octyl Sepharose 4FF, and by ion exchange chromatography on a HiTrap Q . The specific activity increased 12-fold with a yield of 2.5% . SDS-PAGE analysis of AnAF revealed a protein band of high molecular weight in excess of 200 kDa . Carbohydrate was detected as the only material coinciding with the protein band, indicating that the AnAF was a glycoprotein . Immunoblotting analysis indicated that AnAF directly bound to P . gingivalis cells . AnAF was sensitive to sodium metaperiodate treatment but not to heat or protease treatments . These results suggest that the AnAF carbohydrate component mediated coaggregation with P . gingivalis cells . AnAF also inhibited coaggregation with other periodontal disease-associated bacteria such as Prevotella intermedia, Fusobacterium nucleatum, Capnocytophaga ochracea, but not streptococci. Presse Med, 1998 Dec, 27 Suppl 5, 42 - 6 {Bacterial resistance and new therapeutic perspectives}; Muller-Serieys C; A PROGRESSING PHENOMENON: Concern about bacterial resistance to antibiotics is growing steadily as new mechanisms of resistance are regularly detected . Cocci have generally remained very antibiotic-sensitive, but resistance is developing . MACROLIDE-RESISTANT STREPTOCOCCI: Streptococci resistance to macrolides is related either to a change in the target, the bacterial ribosome (usually the case), or to an efflux mechanism pushing the antibiotic out of the bacteria before it reaches the target (a mechanism which has been confirmed in different parts of the world) . QUINOLONE RESISTANCE: Resistance to quinolones results from a modification of the target, bacterial topo-isomerases, or via an efflux mechanism described in several Gram positive and Gram negative bacteria . HOPES FOR THE FUTURE: New families of antibiotics are currently under evaluation, particularly compounds directed against bacteria resistant to classically used antibiotics . Likewise, several fluoroquinolones are under development . Most have a wide spectrum including Gram positive cocci, particularly enterococci and strict anaerobic bacteria . A rigorously applied antibiotic prescription policy is however required to control bacterial resistance to antibiotics. J Med Microbiol, 1998 Aug, 47(8), 717 - 23 Role of group B streptococcal capsular polysaccharides in the induction of septic arthritis; Tissi L et al.; The ability of different serotypes of group B streptococci (GBS) to induce septic arthritis in mice was compared . Types II, III, IV, V, VI and VII GBS were investigated . A highly capsulate strain of type III GBS, COH1, and its mutants, COH1-11 (lacking capsular sialic acid) and COH1-13 (non-capsulate), obtained by transposon insertional mutagenesis, were used to assess the role of type-specific polysaccharide on the induction of arthritis . At an intravenous dose of 10(7) cfu/mouse, reference strains of types II, III, IV, VI and VII and type III strain COH1 induced arthritis with an incidence ranging from 70 to 90% . For type V and strain COH1-11, 10(8) cfu/mouse was required to obtain a 50% incidence of arthritis; lesions were not evident with strain COH1-13 . The presence of the capsule played a major role in the induction of GBS septic arthritis . The presence and amount of sialic acid in capsular polysaccharide influenced the incidence of articular lesions . The bacterial dose affected the manifestations of arthritis; the less virulent strains of GBS also induced articular lesions when an adequate number of micro-organisms reached the joints. Heart, 1998 Sep, 80(3), 276 - 80 Clinical and morphological characteristics in Streptococcus bovis endocarditis: a comparison with other causative microorganisms in 177 cases; Kupferwasser I et al.; AIM: To compare the clinical and morphological characteristics of patients with Streptococcus bovis endocarditis with those of patients with endocarditis caused by other microorganisms . METHODS: 177 consecutive patients (Streptococcus bovis, 22; other streptococci, 94; staphylococci, 44; other, 17) with definite infective endocarditis according to the Duke criteria were included . All patients underwent transthoracic and transoesophageal echocardiography . In 88 patients, findings from surgery/necropsy were obtained . RESULTS: S bovis endocarditis was associated with older patients, with a higher mortality (p = 0.04), and with a higher rate of cardiac surgery (p < 0.001) than other microorganisms, although embolic events were observed less often (p = 0.02) . Pathological gastrointestinal lesions were detected in 45% of the patients . Multiple valves were affected in 68% of the patients with S bovis endocarditis and in 20% of those with other organisms (p < 0.001) . Moderate or severe regurgitation occurred more often in S bovis endocarditis than with other microorganisms (p = 0.05) . When surgery or necropsy was performed, infectious myocardial infiltration of the left ventricle was confirmed histopathologically in 36% of the patients with S bovis endocarditis and in 10% of those with other organisms (p = 0.002) . CONCLUSIONS: S bovis endocarditis is a severe illness because of the more common involvement of multiple valves, and of the frequent occurrence of haemodynamically relevant valvar regurgitation and infectious myocardial infiltration. Lancet, 1998 Dec 19-26, 352(9145), 1974 - 7 Prevalence of internalisation-associated gene, prtF1, among persisting group-A streptococcus strains isolated from asymptomatic carriers; Neeman R et al.; BACKGROUND: The failure of antibiotic treatment to eradicate group-A streptococci in up to 30% of patients with pharyngotonsillitis is unexplained . Some strains of group-A streptococci can enter respiratory epithelial cells, where they would be inaccessible to antibiotics unable to penetrate the cell membrane, such as penicillins . The fibronectin-binding proteins, F1 and SfbI, are needed for this process . We hypothesised, therefore, that an intracellular reservoir of group-A streptococci could account, at least partly, for failure to eradicate throat carriage, and that the presence of the gene for fibronectin-binding protein (F1) might be linked to the ability of a strain to persist in the throat after therapy . METHODS: We investigated the frequency of prtF1-containing strains among 67 patients with pharyngotonsillitis . All patients were clinically cured, although 13 of them continued to carry group-A streptococci in the throat during or after therapy . To distinguish between persisting and recolonising strains, isolates from the 13 patients were serologically tested and compared by polymorphic DNA-amplification technique . FINDINGS: 12 (92%) of the 13 patients with symptomless carriage had prtF1-containing strains in the throat, compared with 16 (30%) of the 54 patients with successful eradication (p=0.0001) . Three of the 13 eradication-failure patients were recolonised with strains that differed from the pretreatment strains . Nine of the ten (90%) persisting strains carried prtF1 (p=0.0009) . INTERPRETATION: Our findings suggest that protein-F1-mediated entry to cells is involved in the causative process of the carriage state. Oral Microbiol Immunol, 1998 Dec, 13(6), 337 - 40 Actinomyces serovar WVA963 coaggregation-defective mutant strain PK2407 secretes lactose-sensitive adhesin that binds to coaggregation partner Streptococcus oralis 34; Klier CM et al.; Actinomyces serovar WVA963 strain PK1259 mediates intergeneric coaggregation with several oral streptococci . These lactose-inhibitable coaggregations appear to involve a 95-kDa putative actinomyces adhesin in complex with type 2 fimbriae . A coaggregation-defective strain PK2407 lacking type 2 fimbriae synthesizes the putative adhesin but appears unable to present it properly on its surface . Antiserum was raised against surface sonicates of PK2407 and was absorbed with a different coaggregation-defective mutant PK3092 that synthesizes type 2 fimbriae but no adhesin . This absorbed antiserum specifically blocked lactose-inhibitable coaggregation of wild-type strain PK1259 and Streptococcus oralis 34 and identified a 95-kDa protein in ammonium sulfate precipitates of culture supernatant of the coaggregation-defective mutant PK2407 . The 95-kDa secreted protein was bound to the streptococcal partner cells and to lactose-agarose affinity beads and was released by lactose from both the affinity beads and partner, indicating that the secreted and precipitated protein is biochemically active and may mediate coaggregation with streptococci. Oral Microbiol Immunol, 1998 Dec, 13(6), 327 - 36 Actinomyces naeslundii genospecies 1 and 2 express different binding specificities to N-acetyl-beta-D-galactosamine, whereas Actinomyces odontolyticus expresses a different binding specificity in colonizing the human mouth; Hallberg K et al.; A total of 102 strains of Actinomyces were isolated from teeth, buccal mucosa and tongue in eight individuals . The isolates were characterized by multivariate statistical analyses of phenotypic characteristics, serotyping and binding to beta-linked galactosamine (N-acetyl-beta-D-galactosamine) and acidic proline-rich protein structures . Based on these characteristics, isolates were classified into three major groups: (i) Isolates of Actinomyces naeslundii genospecies 2 were the dominant species on teeth and buccal mucosa and bound commonly to N-acetyl-beta-D-galactosamine (63 of 63 isolates) and acidic proline-rich proteins (63 of 63 isolates), regardless of tissue origin . They all exhibited a N-acetyl-beta-D-galactosamine binding specificity signified by N-acetyl-beta-D-galactosamine-inhibitable coaggregation with the streptococcal strains LVG1, GVE1, 24892 and MPB1; (ii) Isolates of A . naeslundii genospecies 1 were prevalent on teeth in certain individuals and bound commonly to N-acetyl-beta-D-galactosamine (20 of 20 isolates), but less commonly to acidic proline-rich proteins (5 of 20 isolates) . They all possessed another N-acetyl-beta-D-galactosamine specificity, i.e . N-acetyl-beta-D-galactosamine-inhibitable coaggregation with the same streptococcal strains except for strain MPB1; (iii) Isolates of Actinomyces odontolyticus, the dominant species on the tongue (17 of 19 isolates), bound commonly to unknown structures on streptococci (17 of 19 isolates) but rarely to N-acetyl-beta-D-galactosamine (2 of 19 isolates) or acidic proline-rich proteins (3 of 19 isolates) . In conclusion, A . naeslundii genospecies 1 and 2 exhibit different patterns of N-acetyl-beta-D-galactosamine and acidic proline-rich protein specificities to colonize dental and buccal mucosa surfaces, whereas A . odontolyticus utilizes another specificity to colonize the tongue. Curr Microbiol, 1999 Feb, 38(2), 126 - 31 Identification of the high-virulence clone of group B streptococci in Mexican isolates by growth characteristics at 40 degrees C; Palacios GC et al.; Group B streptococci (GBS) colonizing the vagina and rectum of pregnant women cause invasive disease of the offspring in a small number of cases . The immune status of the host and differences in virulence among strains appear to be the main determinants for neonatal infection . A high-virulence clone (HVC) was proposed to cause much of the morbidity and mortality when a collection of GBS isolates was examined by multilocus enzyme electrophoresis . HVC isolates could be further distinguished by their inability to grow at 40 degrees C . This characteristic was used in the present study to examine a collection of 57 GBS isolates from Mexico City for the HVC . Three serotype III invasive strains were classified in the HVC . The other eleven invasive strains and all carrier isolates had growth curves unaffected at 40 degrees C . These results demonstrate the presence of the HVC in Mexico . Such a low prevalence could explain in part the low rate of GBS invasive neonatal disease in Mexico. Community Dent Oral Epidemiol, 1998 Dec, 26(6), 412 - 7 Association of salivary mutans streptococci with discoloured pits and fissures; Steiner M et al.; Experimental studies have demonstrated that mutans streptococci play a major role in caries etiology . Several previous epidemiologic studies found a positive association of salivary mutans streptococci with caries prevalence . The present epidemiologic study aimed at detecting a possible association of salivary mutans streptococci with brown discoloured pits and fissures, supposing that discolouration indicates caries . In the Canton of Zurich 1035 schoolchildren, aged 6.5-12.5, were examined with regard to caries prevalence and presence of discolourations in pits and fissures . A commercially available, semi-quantitative test was used to estimate the salivary level of mutans streptococci in each child . The salivary level (low/high) of mutans streptococci was significantly associated with the presence of slightly brown discoloured (C1), clearly brown discoloured (C2) and cavitated (C3) pits and fissures . The odds ratios were 1.5 (P<0.01) for C1, 2.5 (P<0.001) for C2 and 5.0 (P<0.001) for C3 pits and fissures . The findings are consistent with the hypothesis that brown discolouration indicates caries . Furthermore, the findings suggest that this type of discolouration at elementary school age indicates increased caries activity. Antimicrob Agents Chemother, 1999 Jan, 43(1), 178 - 80 Antimicrobial resistance of 914 beta-hemolytic streptococci isolated from pharyngeal swabs in Spain: results of a 1-year (1996-1997) multicenter surveillance study . The Spanish Surveillance Group for Respiratory Pathogens; Baquero F et al.; A nationwide susceptibility surveillance study of beta-hemolytic streptococcal isolates from pharyngeal swabs obtained in 11 Spanish hospitals between May 1996 and April 1997 against 12 antibiotics was carried out . Of the isolates 86% (786 of 914 isolates) were group A and 8.4% (77 of 914 isolates) were group C . No resistance was found to beta-lactam antibiotics, but significant differences (P < 0.001) with respect to lack of susceptibility to macrolides were found between groups (27% for group A and 12% for group C) and between seasons (13.2% in summer and 31.7% in winter) . Most of these isolates displayed the M phenotype (low-level resistance to erythromycin and susceptibility to clindamycin). Antimicrob Agents Chemother, 1999 Jan, 43(1), 77 - 84 Efficacy of trovafloxacin in treatment of experimental staphylococcal or streptococcal endocarditis; Entenza JM et al.; The efficacy of trovafloxacin against Staphylococcus aureus and viridans group streptococci was investigated in vitro and in an experimental model of endocarditis . The MICs at which trovafloxacin and ciprofloxacin inhibited 90% of clinical isolates of such bacteria (MIC90s) were (i) 0.03 and 2 mg/liter, respectively, for 30 ciprofloxacin-susceptible S . aureus isolates, (ii) 32 and 128 mg/liter, respectively, for 20 ciprofloxacin-resistant S . aureus isolates, and (iii) 0.25 and 8 mg/liter, respectively, for 28 viridans group streptococci . Rats with aortic vegetations were infected with either of two ciprofloxacin-susceptible but methicillin-resistant S . aureus strains (strains COL and P8), one penicillin-susceptible Streptococcus sanguis strain, or one penicillin-resistant Streptococcus mitis strain . Rats were treated for 3 or 5 days with doses that resulted in kinetics that simulated those achieved in humans with trovafloxacin (200 mg orally once a day), ciprofloxacin (750 mg orally twice a day), vancomycin (1 g intravenously twice a day), or ceftriaxone (2 g intravenously once a day) . Against the staphylococci, the activities of both trovafloxacin and ciprofloxacin were equivalent to that of vancomycin, and treatment of endocarditis with these drugs was successful (P < 0.05) . However, ciprofloxacin selected for resistant derivatives in vitro and in vivo, whereas trovafloxacin was 10 to 100 times less prone than ciprofloxacin to select for resistance in vitro and did not select for resistance in vivo . Against the two streptococcal isolates, trovafloxacin significantly (P < 0.05) decreased bacterial counts in the vegetations but was less effective than the control drug, ceftriaxone . Thus, a simulated oral dose of trovafloxacin (200 mg per day) was effective against ciprofloxacin-susceptible staphylococci and was less likely than ciprofloxacin to select for resistance . The simulated oral dose of trovafloxacin also had some activity against streptococcal endocarditis, but optimal treatment of infections caused by such organisms might require higher doses of the drug. Antimicrob Agents Chemother, 1999 Jan, 43(1), 48 - 52 Erythromycin resistance genes in group A streptococci in Finland . The Finnish Study Group for Antimicrobial Resistance; Kataja J et al.; Streptococcus pyogenes isolates (group A streptococcus) of different erythromycin resistance phenotypes were collected from all over Finland in 1994 and 1995 and studied; they were evaluated for their susceptibilities to 14 antimicrobial agents (396 isolates) and the presence of different erythromycin resistance genes (45 isolates) . The erythromycin-resistant isolates with the macrolide-resistant but lincosamide- and streptogramin B-susceptible phenotype (M phenotype) were further studied for their plasmid contents and the transferability of resistance genes . Resistance to antimicrobial agents other than macrolides, clindamycin, tetracycline, and chloramphenicol was not found . When compared to our previous study performed in 1990, the rate of resistance to tetracycline increased from 10 to 93% among isolates with the inducible resistance (IR) phenotype of macrolide, lincosamide, and streptogramin B (MLSB) resistance . Tetracycline resistance was also found among 75% of the MLSB-resistant isolates with the constitutive resistance (CR) phenotype . Resistance to chloramphenicol was found for the first time in S . pyogenes in Finland; 3% of the isolates with the IR phenotype were resistant . All the chloramphenicol-resistant isolates were also resistant to tetracycline . Detection of erythromycin resistance genes by PCR indicated that, with the exception of one isolate with the CR phenotype, all M-phenotype isolates had the macrolide efflux (mefA) gene and all the MLSB-resistant isolates had the erythromycin resistance methylase (ermTR) gene; the isolate with the CR phenotype contained the ermB gene . No plasmid DNA could be isolated from the M-phenotype isolates, but the mefA gene was transferred by conjugation. Bull Soc Sci Med Grand Duche Luxemb, 1998, 135(1), 51 - 8 {The threat of premature labor: new aspects for management}; Wertz JP et al.; Genital inflammation may play a major role in the pathogenesis of preterm labor . Screening and early treatment of subclinical genital tract infections (bacterial vaginosis, heavy group B streptococci colonization, primary genital HSV infection and other silent intra-uterine infections) seem to offer promise for the prevention of preterm labor . New factors have been studied in order to appreciate their benefit in the evaluation of the risk of preterm labor . None of these biologic markers (fetal-fibronectin, maternal interleukin-6, vaginal pH measuring) have enough sensitivity to permit efficient screening . Home uterine activity monitoring seems to be interesting for early identification of women with increased risk of preterm delivery, but can't be used on a large scale because of its costs . New tocolytic agents are investigated in order to protect from an adverse outcome . Atosiban exhibits more oxytocin selective and antagonistic activity without side-effects, and nimesulide seems to have a lack of effects on fetal functions. Clin Infect Dis, 1998 Dec, 27(6), 1470 - 4 Ceftriaxone once daily for four weeks compared with ceftriaxone plus gentamicin once daily for two weeks for treatment of endocarditis due to penicillin-susceptible streptococci . Endocarditis Treatment Consortium Group; Sexton DJ et al.; This randomized, multicenter, open-label study compared the efficacy and safety of monotherapy with 2 g of intravenous ceftriaxone once daily for 4 weeks with those of combination therapy with 2 g of intravenous ceftriaxone and 3 mg of intravenous gentamicin/kg once daily for 2 weeks as therapy for endocarditis due to penicillin-susceptible streptococci . Sixty-one patients were enrolled in the study . Clinical cure was observed for 51 evaluable patients both at termination of therapy and at the 3-month follow-up: 25 (96.2%) of 26 monotherapy recipients and 24 (96%) of 25 combination therapy recipients . Of the 23 patients in each treatment group who were microbiologically evaluable, 22 (95.7%) in each group were considered cured . No patient had evidence of relapse . Fourteen patients (27.5%) required cardiac surgery after initiation of treatment, including five monotherapy recipients and nine combination therapy recipients . Adverse effects were minimal in both treatment groups . We conclude that 2 g of ceftriaxone once daily for 4 weeks and 2 g of ceftriaxone in combination with 3 mg of gentamicin/kg once daily for 2 weeks are both effective and safe for the treatment of streptococcal endocarditis. Pediatr Dent, 1998 Nov-Dec, 20(7), 395 - 403 Estimation of the caries-related risk associated with infant formulas; Erickson PR et al.; PURPOSE: Baby bottle tooth decay (BBTD) affects 6% of children under three years of age and is associated with inappropriate bottle use . The objective of this study was to estimate the caries-related risk associated with 26 infant formulas and whole milk . METHODS: First, the plaque pH of adult volunteers was monitored before and after an oral rinse with infant formula to determine the minimum pH obtained in response to each formula . Second, Streptococcus sobrinus 6715 was cultured in each infant formula, and the increase in the number of colony forming units was measured . Third, each infant formula was incubated with powdered enamel and the solubility of enamel mineral was calculated in the absence of bacteria . Fourth, each formula was mixed with standardized concentrations of acid to determine the buffering capabilities . Finally, enamel windows were created on extracted permanent molars and exfoliated primary incisor crowns that were then colonized with mutans streptococci and incubated with infant formula . Caries was assessed visually and radiographically for 18 weeks . The length of time required for the development of enamel caries, dentinal caries and pulpal involvement was recorded . RESULTS: One-way or two-way ANOVA of these five assays demonstrated that 1 . Plaque pH varied in response to oral rinsing with infant formula and most formulas did have the ability to reduce the pH significantly below the pH obtained after rinsing with water 2 . Some infant formulas supported significant bacterial growth 3 . Enamel mineral was dissolved by incubation with certain infant formula 4 . The buffer capacity varied among the infant formulas tested 5 . The length of time required for caries to reach dentin or pulp differed for the formulas, with some formulas causing dentinal caries by 3.4 weeks and pulpal involvement by 7.2 weeks. Infect Immun, 1999 Jan, 67(1), 271 - 8 An extracellular protease of Streptococcus gordonii hydrolyzes type IV collagen and collagen analogues; Juarez ZE et al.; Streptococcus gordonii is a frequent cause of infective bacterial endocarditis, but its mechanisms of virulence are not well defined . In this study, streptococcal proteases were recovered from spent chemically defined medium (CDM) and fractionated by ammonium sulfate precipitation and by ion-exchange and gel filtration column chromatography . Three proteases were distinguished by their different solubilities in ammonium sulfate and their specificities for synthetic peptides . One of the enzymes cleaved collagen analogs Gly-Pro 4-methoxy-beta-naphthylamide, 2-furanacryloyl-Leu-Gly-Pro-Ala (FALGPA), and p-phenylazobenzyloxycarbonyl-Pro-Leu-Gly-Pro-Arg (pZ-peptide) and was released from the streptococci while complexed to peptidoglycan fragments . Treatment of this protease with mutanolysin reduced its 180- to 200-kDa mass to 98 kDa without loss of enzymatic activity . The purified protease cleaved bovine gelatin, human placental type IV collagen, and the Aalpha chain of fibrinogen but not albumin, fibronectin, laminin, or myosin . Enzyme activity was inhibited by phenylmethylsulfonyl fluoride, indicating that it is a serine-type protease . Maximum production of the 98-kDa protease occurred during growth of S . gordonii CH1 in CDM containing 0.075% total amino acids at pH 7.0 with minimal aeration . Higher initial concentrations of amino acids prevented the release of the protease without reducing cell-associated enzyme levels, and the addition of an amino acid mixture to an actively secreting culture stopped further enzyme release . The purified protease was stored frozen at -20 degreesC for several months or heated at 50 degreesC for 10 min without loss of activity . These data indicate that S . gordonii produces an extracellular gelatinase/type IV collagenase during growth in medium containing minimal concentrations of free amino acids . Thus, the extracellular enzyme is a potential virulence factor in the amino acid-stringent, thrombotic, valvular lesions of bacterial endocarditis. Infect Immun, 1999 Jan, 67(1), 50 - 6 Characterization of emb, a gene encoding the major adhesin of Streptococcus defectivus; Manganelli R et al.; Streptococcus defectivus is one of the nutritionally variant streptococci, a class of viridans group streptococci first isolated from patients with endocarditis and otitis media . In previous studies, NVS-47, a clinical isolate of S . defectivus, was shown to bind to the extracellular matrix . A high-molecular-weight surface protein was identified and proposed to be responsible for mediating this binding . In the present study, the gene encoding this protein was identified by transposon mutagenesis and characterized . The gene (emb) was found to be larger than 14 kb and was partially sequenced . It encodes a protein containing at least 50 repeats of 77 amino acids predicted to assume an alternating coiled-coil conformation . The domain responsible for extracellular matrix binding was mapped to the N terminus of the protein . From sequence analysis, Emb is proposed to be the prototype of a new family of streptococcal fibrillar proteins. Infection, 1998 Nov-Dec, 26(6), 375 - 8 Is there an effect of immunoglobulins and G-CSF on neutrophil phagocytic activity in preterm infants? Bialek R, Bartmann P. The percentage of neutrophils phagocytosing group B streptococci (GBS) in vitro was determined in ten healthy preterm infants (< 32 weeks of gestation) and adult controls by using an acridine orange fluorescence whole blood assay . When GBS were opsonized with adult serum, no difference in phagocytic activity was found between both groups after 10 and 30 min (preterms: 40% and 68%, adults: 32% and 56%, respectively) . Phagocytosis rates in preterm infants decreased significantly to 6% and 18% (at 10 and 30 min) when pool serum of preterm infants was used instead . Supplementation of the preterm serum with either intravenous immunoglobulin or IgM-enriched immunoglobulin did not change the results significantly . The addition of granulocyte colony-stimulating factor (G-CSF) accelerated phagocytosis significantly after 10 min, but did not increase the overall phagocytic activity after 30 min in either group . Hence the potential benefits of intravenous immunoglobulins and G-CSF in neonatal sepsis may not be attributable to an immediate increase in and direct effect on neutrophil phagocytic activity. Postgrad Med, 1998 Dec, 104(6), 31 - 4, 39, 43-4 Another toxic shock syndrome . Streptococcal infection is even more dangerous than the staphylococcal form; Hauser AR; In the battery of diseases caused by group A streptococci, streptococcal toxic shock syndrome is among the most severe . Its nonspecific presentation and rapid progression require that the treating physician be both knowledgeable and vigilant . Certain signs and symptoms suggest that caution is in order: Pain out of proportion to physical findings may herald deep tissue involvement in a patient who at first glance appears to have cellulitis . Streptococcal infection accompanied by hypotension, confusion, or unexplained acute renal insufficiency is a clue to streptococcal toxic shock syndrome . Treatment consists of antibiotic and supportive care, with aggressive surgical debridement of soft-tissue foci of infection when necessary . Anecdotal evidence suggests that intravenous immunoglobulin may have a place in neutralizing the secreted streptococcal toxins that are thought to mediate features of the disease . At present, even with aggressive therapy, the mortality rate of streptococcal toxic shock syndrome can exceed 50% . Understanding of its pathogenesis is progressing . However, until effective interventions are developed, early detection appears to be the best weapon. Aviakosm Ekolog Med, 1998, 32(4), 25 - 8 {Peculiarities of cosmonauts fauces flora}; Bochkov IA et al.; In the course of the work done the specific and quantitative composition of the streptococcal autoflora of the fauces of the cosmonauts and the members of backup drew was investigated . In populations of isolated microorganisms the non-pathogenic streptococci have dominated among which S . salivarius prevailed . The same species has constantly been isolated in all the cosmonauts, pre- and postflight . Observation of the microflora state of the fauces at different stages of their professional activity made it possible to reveal the peculiarities of an individual dynamics in the number of nonpathogenic streptococci isolated from tampon depending on the participation of the test-subjects in the previous space missions . This is evidently a reflection of the effect of psychoemotional tension on the state of colonization resistance (CR) of the fauces mucosa and, as result of this, on its microflora . In turn, the occurrence of the individual species of conditionally-pathogenic streptococci after the mission points to a decrease in the CR under effect of unfavourable factors of space mission. Am J Obstet Gynecol, 1998 Dec, 179(6 Pt 1), 1568 - 71 Impact of a risk-based prevention policy on neonatal group B streptococcal disease; Factor SH et al.; OBJECTIVE: Neonatal group B streptococcal infections can be prevented by intrapartum antibiotic prophylaxis . Beginning in 1992, women with obstetric risk factors at University of Miami-Jackson Memorial Medical Center were targeted to receive intrapartum antibiotic prophylaxis . We evaluated these preventive efforts . STUDY DESIGN: A case was defined as isolation of group B streptococci from a sterile site in an infant <7 days old born during the study period, 1992-1995 . We reviewed systematic samples of women with preterm delivery and prolonged rupture of membranes to assess use of intrapartum antibiotic prophylaxis . RESULTS: Group B streptococcal cases declined from 1.7 cases/1000 live births to 0.2 cases/1000 live births (Poisson regression, P =.002) . Intrapartum antibiotic prophylaxis use increased from 13% of preterm deliveries in 1992 to 42% in 1995, and from 20% of deliveries with prolonged rupture of membranes in 1992 to 72% in 1995 (chi2 test for linear trend P =.007 and P <.001, respectively) . CONCLUSION: Provision of intrapartum antibiotic prophylaxis on the basis of risk factors was associated with decreased group B streptococcal disease. Scanning Microsc, 1996, 10(4), 1005 - 13; discussion 1014 Paleomicrobiological study in dental calculus: Streptococcus mutans; Linossier A et al.; Morphological types of bacterial remains preserved in ancient tartar of teeth from extinct human groups, which included some communities of coastal gatherers, fishermen, hunters, and farmers, and those practicing a mixed economy, were analyzed . Previous studies have shown the presence of bacteria in ancient tartar . The aim of this work was to determine whether Streptococcus mutans was present in ancient populations (500-12,000 years old) . Teeth samples were from ancient skulls obtained from different anthropological collections: the north and south of Chile (before the Spanish conquest), Palencia, Spain, and an eastern Mediterranean region (Levant) . Optical microscopy showed Gram positive and Gram negative bacteria . Scanning electron microscopy identified morphological types of bacteria . Transmission electron microscopy enabled categorization of bacterial structures . Fluorescence microscopy helped label and identify S . mutans, using polyclonal antibodies . Bacterial morphotypes were related to different subsistence patterns . Hunters, fishermen, and gatherers had a less diverse flora with bacillary and coccal morphotypes . Agricultural groups showed greater diversity with additional filamentous and spiral morphotypes . The best preserved ultrastructural feature was the cell wall . The existence and colonization capacity of the mutans-like streptococci preserved in tartar was established for the ancient populations studied, with the exception of Cerro Sotta (south of Chile) . Hence, their occurrence could not be related to diet or subsistence pattern. J Clin Microbiol, 1999 Jan, 37(1), 255 - 7 Evaluation of the oxoid dryspot streptococcal grouping kit for grouping beta-hemolytic streptococci; Petts DN; The latex agglutination kits that are widely used for grouping of beta-hemolytic streptococci in clinical laboratories use liquid latex suspensions . The Oxoid Dryspot kit (Oxoid Ltd., Basingstoke, Hampshire, United Kingdom) uses predispensed latex dried onto reaction cards or cardboard strips . All streptococci of groups A (85 strains), B (87 strains), C (30 strains), D (38 strains), F (23 strains), and G (65 strains) were correctly grouped by using these reagents . The Oxoid Dryspot Streptococcal Grouping kit is a reliable method for grouping of the beta-hemolytic streptococci encountered in clinical laboratories. J Clin Microbiol, 1999 Jan, 37(1), 26 - 30 E test versus agar dilution for antimicrobial susceptibility testing of viridans group streptococci; Rosser SJ et al.; Viridans group streptococci (VGS) are commonly isolated from the blood of hospitalized patients . The E test represents a convenient method for determining the MICs for VGS, but for this purpose it has not been well validated against reference methods . In this study, 180 unselected VGS isolates were identified to a species level, and the MICs of penicillin, cefuroxime, cefotaxime, and vancomycin were determined by both agar dilution and the E test . Available data regarding demographic and laboratory variables for each VGS bacteremic episode were collected, the significance of each VGS isolate was assessed, and the associations between and among laboratory and clinical variables were investigated . Among all VGS isolates, 68.3% (median of three runs) were found to be fully susceptible to penicillin by agar dilution . The E test and agar dilution showed average agreements (within +/-1 dilution) of 92.2% for penicillin, 95.7% for cefuroxime 91.3% for cefotaxime, and 86.7% for vancomycin . Agreements over serial E tests and serial agar dilutions were excellent for beta-lactam agents (intraclass correlation coefficients, >0.9) but less impressive for vancomycin . Very major error rates for the E test were </=0.7%, and combined major and minor error rates were within acceptable limits for all antimicrobial agents tested . Lysis-centrifugation culture methods were more often associated with clinically insignificant VGS isolates; otherwise, no associations between clinical and laboratory variables were noted. Zentralbl Veterinarmed B, 1998 Nov, 45(9), 561 - 6 Properties of serological group B streptococci of dog, cat and monkey origin; Lammler C et al.; This study was designed to identify and characterize further Streptococcus agalactiae isolated during routine diagnostics from three diseased dogs and a cat, as well as from the inner organs of a monkey which died on a sepsis with beta-haemolytic streptococci . The cultures could be identified as streptococci of serological group B by cultural, biochemical and serological properties and by restriction fragment length polymorphism analysis of polymerase chain reaction (PCR)-amplified 16S ribosomal DNA . A further characterization of the isolates by serotyping and by determination of antibiotic resistances revealed a close relationship of these isolates to the human biotype of this species. Int J Mol Med, 1998 Apr, 1(4), 761 - 5 Keratinocyte growth inhibition by streptococcal proteins; Wollina U et al.; M proteins are receptor proteins and one of the virulence factors of streptococci . M proteins seem to play a role in inflammatory skin disorders such as psoriasis . It is however unknown whether M proteins have a direct influence on proliferative activity of human keratinocytes . In the present study human HaCaT keratinocytes were exposed to M proteins (M1, M3, M5, M12) and the proliferative and proinflammatory response was analyzed . We found a dose-dependent inhibition of keratinocyte proliferation with crude extract of strain M3 4/55 . Following affinity chromatography we found inhibitory activity for keratinocyte proliferation with a maximum of 80% at 10-8 M in the M protein . Additionally tested M1 protein preparation showed an inhibitory activity of 55% whereas other M preparations (5 and 12) did not show any effect . In supernatants from HaCaT cultures IL-1alpha, IL-1beta, IL-6, IL-8, TNFalpha and ICAM-1 were measured by ELISA . The levels of IL-8 were high and TNFalpha was upregulated, whereas ICAM-1 was decreased from around 20 ng/ml to almost zero . In contrast to the streptococcal-derived M3 protein preparation the recombinant M3 did not interfere with the proliferation of HaCaT cells . Because neither recombinant M3 protein nor M3 protein purified by ion exchange chromatography on a Q-resource column had any antiproliferative activity on keratinocytes we suggest, that a component different from M3 protein was responsible. Swed Dent J, 1998, 22(4), 133 - 41 Fissure penetration and antibacterial effect in vitro of a glass ionomer cement containing chlorhexidine gluconate; Hoszek A et al.; Chlorhexidine has been incorporated in different varnishes to provide a slow release system on the tooth surface in order to reduce mutans streptococci . To provide an alternative vehicle for chlorhexidine with better adhesion properties compared to resin-based varnishes, glass ionomer cement (GI) has been suggested . However, one disadvantage for glass ionomers is a longer setting time compared to the resin-based varnishes . The aim with this study was to compare the fissure penetration and antibacterial characteristics of a glass-ionomer cement (GI) with a GI containing chlorhexidine gluconate (GI-CHX), and GI-CHX with added tataric acid (GI-CHX-TA) to reduce its setting time . Antibacterial properties against mutans streptococci were assessed by agar diffusion . GI, GI-CHX and GI-CHX-TA were applied with a microbrush on the occlusal surfaces of 4, 4 and 6 extracted molars respectively . After setting of cements, sections were ground with 1 mm intervals and photographed . The fissure penetration and adaptation of the cements were scored excellent, acceptable or unacceptable under blind conditions according to a standard . Seventy percent scored excellent with GI-CHX-TA (n = 54) compared with 40% with GI-CHX (n = 48) and 38% with GI (n = 40), (p < 0.05) . GI-CHX and GI-CHX-TA had significant better antibacterial properties compared to GI or GI with added tataric acid only. J Pediatr Ophthalmol Strabismus, 1998 Nov-Dec, 35(6), 323 - 6 Sarcoidosis presenting as multilobular limbal corneal nodules; Hegab SM et al.; PURPOSE: To review reported external ocular manifestations of sarcoidosis and to present bilateral, multilobular, nodular, limbal, corneal nodules as being a unique manifestation of the disease . PATIENTS AND METHODS: A 16-year-old Saudi girl presented with bilateral, multilobular, solid, limbal nodules, with a vascular supply from the conjunctival vessel, and associated membraneous conjunctivitis and healed trachoma . The Schirmer's test revealed less than 2 mm in both eyes with tear meniscus less than 2 mm . Biopsy of an associated palpebral conjunctival nodule was performed, in addition to a gallium scan, chest X-ray, and a serum angiotensin-converting enzyme (SACE) level . RESULTS: The culture showed beta-hemolytic streptococci . Gallium scan showed intake by both lacrimal glands . Her chest X-ray results were normal, as was the SACE level . Biopsy of the excised conjunctival nodule disclosed a noncaseating granulomatous reaction with epithelioid and giant cells, and chronic inflammatory cell infiltrate confirming a diagnosis of sarcoidosis . CONCLUSION: A multilobular, nodular, perilimbal mass as a unique manifestation of sarcoidosis is presented . A streptococcal membraneous conjunctivitis and healed trachoma superimposed . A review of sarcoidosis of the external eye is included. FEMS Immunol Med Microbiol, 1998 Nov, 22(3), 247 - 56 Gamma globulin, Evan's blue, aprotinin A PLA2 inhibitor, tetracycline and antioxidants protect epithelial cells against damage induced by synergism among streptococcal hemolysins, oxidants and proteinases: relation to the prevention of post-streptococcal sequelae and septic shock; Ginsburg I et al.; An in vitro model was employed to study the potential role of streptococcal extra-cellular products, rich in streptolysin O, in cellular injury as related to streptococcal infections and post-streptococcal sequelae . Extra-cellular products (EXPA) rich in streptolysin O were isolated from type 4, group A hemolytic streptococci grown in a chemostat, in a synthetic medium . EXPA induced moderate cytopathogenic changes in monkey kidney epithelial cells and in rat heart cells pre-labeled with 3H-arachidonate . However very strong toxic effects were induced when EXP was combined with oxidants (glucose oxides generated H2O2, AAPH-induced peroxyl radical (ROO.), NO generated by sodium nitroprusside) and proteinases (plasmin, trypsin) . Cell killing was distinctly synergistic in nature . Cell damage induced by the multi-component cocktails was strongly inhibited either by micromolar amounts of gamma globulin, and Evan's blue which neutralized SLO activity, by tetracycline, trasylol (aprotinin), epsilon amino caproic acid and by soybean trypsin inhibitor, all proteinase inhibitors as well as by a non-penetrating PLA2 inhibitor A . The results suggest that fasciitis, myositis and sepsis resulting from infections with hemolytic streptococci might be caused by a coordinated 'cross-talk' among microbial, leukocyte and additional host-derived pro-inflammatory agents . Since attempts to prolong lives of septic patients by the exclusive administration of single antagonists invariably failed, it is proposed that the administration of 'cocktails' of putative inhibitors against major pro-inflammatory agonizes generated in inflammation and infection might protect against the deleterious effects caused by the biochemical and pharmacological cascades which are known to be activated in sepsis. J Antimicrob Chemother, 1998 Nov, 42(5), 651 - 5 Susceptibility to RPR 106,972, quinupristin/dalfopristin and erythromycin among recent clinical isolates of enterococci, staphylococci and streptococci from North American medical centres; Barry AL et al.; An orally administered streptogramin (RPR 106,972) and a parenteral streptogramin (quinupristin/dalfopristin) were evaluated against a collection of 2481 recent clinical isolates of gram-positive cocci . The isolates were gathered from ten North American medical centres during the winter months of 1996-1997 . In spite of minor differences, both streptogramins had essentially identical spectra of activity which included many erythromycin-resistant isolates . Previously proposed interpretative criteria for quinupristin/dalfopristin disc diffusion susceptibility tests were confirmed. J Intern Med, 1998 Nov, 244(5), 379 - 86 The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection; Leibovici L et al.; OBJECTIVES: To test whether empirical antibiotic treatment that matches the in vitro susceptibility of the pathogen (appropriate treatment) improves survival in patients with bloodstream infections; and to measure the improvement . DESIGN: Observational, prospective cohort study . SETTING: University hospital in Israel . SUBJECTS: All patients with bloodstream infections detected during 1988-94 . INTERVENTIONS: None . MAIN OUTCOME MEASURES: In-hospital fatality rate and length of hospitalization . RESULTS: Out of 2158 patients given appropriate empirical antibiotic treatment, 436 (20%) died, compared with 432 of 1255 patients (34%) given inappropriate treatment (P = 0.0001) . The median durations of hospital stay for patients who survived were 9 days for patients given appropriate treatment and 11 days for patients given inappropriate treatment . For patients who died, the median durations were 5 and 4 days, respectively (P < 0.05), for both comparisons . In a stratified analysis, fatality was higher in patients given inappropriate treatment than in those given appropriate treatment in all strata but two: patients with infections caused by streptococci other than Streptococcus gr . A and Streptoccocus pneumoniae (odds ratio (OR) of 1.0, 95% confidence interval (95% CI) 0.4-2.5); and hypothermic patients (OR = 0.9, 95% CI = 0.3-2.4) . Even in patients with septic shock, inappropriate empirical treatment was associated with higher fatality rate (OR = 1.6, 95% CI = 1.0-2.7) . The highest benefit associated with appropriate treatment was observed in paediatric patients (OR = 5.1, 95% CI = 2.4-10.7); intra-abdominal infections (OR = 3.8, 95% CI = 2.0-7.1); infections of the skin and soft tissues (OR = 3.1, 95% CI = 1.8-5.6); and infections caused by Klebsiella pneumoniae (OR = 3.0, 95% CI = 1.7-5.1) and S . pneumoniae (OR = 2.6, 95% C = 1.1-5.9) . On a multivariable logistic regression analysis, the contribution of inappropriate empirical treatment to fatality was independent of other risk factors (multivariable adjusted OR = 1.6, 95% CI = 1.3-1.9) . CONCLUSION: Appropriate empirical antibiotic treatment was associated with a significant reduction in fatality in patients with bloodstream infection. Singapore Med J, 1998 Aug, 39(8), 353 - 6 Bacterial skin infections at a tertiary dermatological centre; Tan HH et al.; BACKGROUND: Bacterial skin infections are common clinical problems encountered in most fields of clinical medicine . Staphylococcus aureus and group A streptococci are common invaders of eczematous, traumatised or immunocompromised skin . Advances in pharmacology have introduced a wide array of new antibiotics into the physician's armamentarium, but the rising incidence of bacterial resistance continues to be a problem . A retrospective study was carried out on 331 patients at the National Skin Centre, Singapore, to establish the causes of common primary and secondary pyodermas, as well as to determine the antibiotic sensitivities of the microorganisms responsible . METHODS: A retrospective study of the medical records of 331 patients seen at the Centre for skin infections between October 1995 and May 1996 was done . Skin cultures and antibiotic sensitivity testing was carried out and the data analysed . Both primary pyodermas (impetigo, folliculitis, furuncles/carbuncles and cellulitis) and secondary pyodermas (infected ulcers and infected eczemas) were included . The results of bacterial isolation cultures and sensitivity of the organisms isolated to the commonly used antibiotics such as cloxacillin, penicillin, erythromycin and the tetracyclines were analysed . RESULTS: Staphylococcus aureus was the commonest organism isolated from both primary and secondary pyodermas, accounting for 67% and 46.7% of the organisms isolated, respectively . There was no significant difference in the racial representation in each of the various skin infections, but there was a significantly greater female representation in the infected ulcers . The secondary pyodermas had a significantly higher incidence of gram negative organisms causing infections, as well as culture results showing multiple bacterial pathogens . The methicillin resistant strains of S . aureus were commoner in the secondary pyodermas, and accounted for 4.2% of the total organisms isolated and 7% of the total strains of S . aureus . The S . aureus had a high rate of resistance (89.5%) to penicillin and ampicillin, but was very sensitive (93%) to cloxacillin, cephalexin and cotrimoxazole . The incidence of erythromycin resistance was 18.7% . CONCLUSIONS: In patients with primary pyodermas, cloxacillin should be the first line antibiotic used, with erythromycin as a useful but less preferred alternative . The favoured combination of ampicillin and cloxacillin has little place in routine treatment of skin infections, except for cellulitis and infected eczemas . A cephalosporin can also be used in these conditions if single drug therapy is desired . The secondarily infected ulcers are difficult to treat and would probably require the use of combination therapy in view of frequent mixed infections. Microbiol Mol Biol Rev, 1998 Dec, 62(4), 1021 - 45 Inorganic cation transport and energy transduction in Enterococcus hirae and other streptococci; Kakinuma Y; Energy metabolism by bacteria is well understood from the chemiosmotic viewpoint . We know that bacteria extrude protons across the plasma membrane, establishing an electrochemical potential that provides the driving force for various kinds of physiological work . Among these are the uptake of sugars, amino acids, and other nutrients with the aid of secondary porters and the regulation of the cytoplasmic pH and of the cytoplasmic concentration of potassium and other ions . Bacteria live in diverse habitats and are often exposed to severe conditions . In some circumstances, a proton circulation cannot satisfy their requirements and must be supplemented with a complement of primary transport systems . This review is concerned with cation transport in the fermentative streptococci, particularly Enterococcus hirae . Streptococci lack respiratory chains, relying on glycolysis or arginine fermentation for the production of ATP . One of the major findings with E . hirae and other streptococci is that ATP plays a much more important role in transmembrane transport than it does in nonfermentative organisms, probably due to the inability of this organism to generate a large proton potential . The movements of cations in streptococci illustrate the interplay between a variety of primary and secondary modes of transport. Obstet Gynecol, 1998 Dec, 92(6), 923 - 5 Effect of delayed inoculation of selective media in antenatal detection of group B streptococci; Crisp BJ et al.; OBJECTIVE: To determine accuracy of group B streptococcal culture swabs immediately inoculated after sampling compared with swabs transported to the laboratory and inoculated subsequently . METHODS: Lower genital tract specimens were collected by sweeping two rayon-tipped swabs across the lower vagina and rectum of gravidas at 35-37 weeks' gestation . One swab was placed immediately in selective growth medium (immediate inoculation group) . The other was placed in standard transport media, sent routinely to the clinical laboratory, and transferred subsequently to selective growth medium within 2 hours (delayed inoculation group) . RESULTS: Matched specimens were collected from 374 women during the study period . Ninety-three women had positive cultures, a colonization rate of 24.9% . Concordant results were found in 364 of 374 (97.3%) . Six women had negative results by the immediate method but positive by the delayed method, and four women had positive immediate cultures but negative by the delayed method . There was no statistically significant difference between the two methods in the detection of positive cultures . CONCLUSION: Use of immediate inoculation instead of delayed inoculation in culturing group B streptococcus specimens does not result in an improved detection rate. J Immunol Methods, 1998 Nov 1, 220(1-2), 151 - 9 Self-sampled and air-dried cervicovaginal secretions can be used for analyses of mucosal antibodies; Hordnes K et al.; Cervicovaginal secretions were collected from 26 women (13 premenopausal and 13 postmenopausal) using a new sampling device (MucoSafeTM) with an absorbent which was introduced into the vagina and retrieved by the women themselves, after which it was air-dried and stored for months at room temperature until extraction of immunoglobulins . Cervical secretions were also collected by absorbent cylindrical wicks (Polyfiltronics) which were introduced into the cervical canal during speculum examination and thereafter kept frozen until extraction . The concentrations of specific IgA and IgG antibodies (to group B streptococci) in extracts from both methods were corrected by reference to total immunoglobulin levels . Three pairs of samples, all from postmenopausal women, were excluded from analysis due to undetectable levels of antibodies in the MucoSafeTM specimen . In the remaining 23 pairs, corrected concentrations of IgA and IgG antibodies in samples obtained by MucoSafeTM correlated well with the corresponding concentrations in wick samples, R = 0.84 (p < 0.0001) and R = 0.69 (p = 0.0002), respectively . Thus, cervicovaginal secretions for antibody measurements can be obtained by this novel method for self-sampling, obviating the need for speculum examination and storage of frozen samples. J Dairy Res, 1998 Nov, 65(4), 599 - 607 Concentrated bovine colostral whey proteins from Streptococcus mutans/Strep . sobrinus immunized cows inhibit the adherence of Strep . mutans and promote the aggregation of mutans streptococci; Loimaranta V et al.; The aim of this study was to examine the effect of bovine colostral whey proteins from cows immunized with Streptococcus mutans/Strep . sobrinus on the adherence and aggregation of caries-inducing bacteria, i.e., mutants streptococci . Both adherence and aggregation are important phenomena in the bacterial colonization of the human oral cavity . In all adherence experiments there was a significant difference between treatments by immune product (IP; from immunized cows) and a control product (CP; a similar product from non-immunized cows) . The adherence of 35S-labelled Strep . mutans cells (serotype c) to parotid saliva-coated hydroxyapatite (SHA) was dose-dependently inhibited by both IP and CP if SHA was coated with either product before exposure to bacteria, but markedly lower concentrations of IP than CP were effective . When instead of SHA the bacterial cells were pretreated with IP or CP, only IP strongly and dose-dependently inhibited streptococcal adherence . When bacteria, IP or CP, and SHA were incubated simultaneously, a significant difference between IP and CP treatments was again found . Further, IP effectively aggregated both Strep . mutans and Strep . sobrinus cells, whereas hardly any effect was seen with CP . Both IP and CP aggregated the control bacterium Strep . sanguis, which affected the adherence of the pretreated bacteria. Minerva Stomatol, 1998 Sep, 47(9), 367 - 71 {Alpha-hemolytic streptococci and root canal irrigants . An evaluation of the bactericidal efficacy of sodium hypochlorite and chlorhexidine gluconate plus cetrimide}; D'Arcangelo C et al.; BACKGROUND AND AIMS: The main bacterial species present in pulpal and periapical microbic flora is alpha-hemolytic streptococci . They are regarded as facultative anaerobes which prefer to grow in anaerobiosis . Canal irrigation plays an important role in the success of endodontic treatment given that, on the one hand, it encourages the gradual elimination of the smear layer, and on the other it neutralises microbic flora in the root canal . The aim of this study was to test the microbiological efficacy of sodium hypochlorite 1% and s new generation irrigant based on chlorhexidine 0.2% and cetrimide 0.2% . METHODS: The test was performed on the following alpha-hemolytic streptococci bacteria (Dasit, Cornaredo, Italy): Streptococcus mitis ATCC 9811; Streptococcus mutans ATCC 35668; Streptococcus salivarius ATCC 13419; Streptococcus sanguis ATCC 10556 . The working concentration (CFU/ml) was defined as 0.5 Mc Farland which corresponds to a concentration of microorganisms of approximately 1.5 x 10(8) bacteria . The following canal irrigants were used: 1) cetrimide 0.2% + chlorhexidine 0.2% (Cetrexidin Vebas, S . Giuliano Milanese, Italy); 2) NaOCl 1% (Ogna, Milan, Italy) . Each individual substance remained in contact with the bacterial species used in the test for 10'-20'-30' . RESULTS: The results obtained show the bactericidal efficacy of both the irrigants used, even after a short period of contact . CONCLUSIONS: This does not mean that all irrigants are equal and/or promise the same results . This was a microbiological study, but it is nonetheless important to take other variables into account, such as contact time . Moreover, in order to increase the probabilities for the success of endodontic treatment, canal irrigants must also present other characteristics, namely: biocompatibility, scarce toxicity, high proteolytic power. Eur J Pediatr, 1998 Nov, 157(11), 901 - 3 What is the infection risk of oesophageal dilatations? Bautista-Casasnovas A, Varela-Cives R, Estevez Martinez E, Jardon Bahia JA, Barca PR, Dargallo Carbonell T, Villanueva Jeremias A, Cadranel S, Tojo R. Oesophageal dilatation is the most widely used treatment option for the management of oesophageal strictures . Complications include bleeding, a slight increase in body temperature, thoracic or abdominal pain, oesophageal perforation, brain abscess and bacteraemia . We performed a prospective study to evaluate the frequency of post-dilatation bacteraemia in nine patients subjected to a total of 50 dilatations . Bacteraemia was detected in 36 cases (72%), In all but three cases, however, it was transient and not associated with fever or other clinical complications . The organisms most commonly responsible (64%) were alpha-haemolytic streptococci (Streptococcus viridans), probably originating as contaminants from the oropharynx and oesophagus and introduced into the bloodstream during dilatation . Despite the relatively low incidence of bacteraemia-related postdilatation complications, the potential severity of such complications argues for the use of antibiotic prophylaxis as a routine measure prior to oesophageal dilatation . CONCLUSION: Oesophageal dilatation is associated with a high incidence of bacteraemia . The organisms most commonly responsible were alpha-haemolytic streptococci . We recommend the use of antibiotic prophylaxis as a routine measure prior to oesophageal dilatation. Antimicrob Agents Chemother, 1998 Dec, 42(12), 3251 - 5 The oxazolidinone linezolid inhibits initiation of protein synthesis in bacteria; Swaney SM et al.; The oxazolidinones represent a new class of antimicrobial agents which are active against multidrug-resistant staphylococci, streptococci, and enterococci . Previous studies have demonstrated that oxazolidinones inhibit bacterial translation in vitro at a step preceding elongation but after the charging of N-formylmethionine to the initiator tRNA molecule . The event that occurs between these two steps is termed initiation . Initiation of protein synthesis requires the simultaneous presence of N-formylmethionine-tRNA, the 30S ribosomal subunit, mRNA, GTP, and the initiation factors IF1, IF2, and IF3 . An initiation complex assay measuring the binding of {3H}N-formylmethionyl-tRNA to ribosomes in response to mRNA binding was used in order to investigate the mechanism of oxazolidinone action . Linezolid inhibited initiation complex formation with either the 30S or the 70S ribosomal subunits from Escherichia coli . In addition, complex formation with Staphylococcus aureus 70S tight-couple ribosomes was inhibited by linezolid . Linezolid did not inhibit the independent binding of either mRNA or N-formylmethionyl-tRNA to E . coli 30S ribosomal subunits, nor did it prevent the formation of the IF2-N-formylmethionyl-tRNA binary complex . The results demonstrate that oxazolidinones inhibit the formation of the initiation complex in bacterial translation systems by preventing formation of the N-formylmethionyl-tRNA-ribosome-mRNA ternary complex. Caries Res, 1999, 33(1), 4 - 15 Secretory immunity in defense against cariogenic mutans streptococci; Russell MW et al.; Specific immune defense against cariogenic mutans streptococci is provided largely by salivary secretory IgA antibodies, which are generated by the common mucosal immune system . This system is functional in newborn infants, who develop salivary IgA antibodies as they become colonized by oral microorganisms . The mechanisms of action of salivary IgA antibodies include interference with sucrose-independent and sucrose- dependent attachment of mutans streptococci to tooth surfaces, as well as possible inhibition of metabolic activities . The goal of protecting infants against colonization by mutans streptococci might be accomplished by applying new strategies of mucosal immunization that would induce salivary IgA antibodies without the complications of parenteral immunization . Strategies of mucosal immunization against mutans streptococci currently under development include the use of surface adhesins and glucosyltransferase as key antigens, which are being incorporated into novel mucosal vaccine delivery systems and adjuvants . The oral application of preformed, genetically engineered antibodies to mutans streptococcal antigens also offers new prospects for passive immunization against dental caries. Int J Syst Bacteriol, 1998 Oct, 48 Pt 4, 1231 - 43 Genetic relationships among the different phenotypes of Streptococcus dysgalactiae strains; Vieira VV et al.; The species Streptococcus dysgalactiae was proposed to accommodate a heterogeneous group of streptococci associated with infections in animals and human beings . This taxon is now considered to include animal isolates of alpha-haemolytic group C streptococci, previously called S . dysgalactiae; animal and human isolates of beta-haemolytic group C streptococci, previously called 'S . equisimilis'; beta-haemolytic group L strains associated with infections in animals and, rarely, in humans; and beta-haemolytic group G strains isolated from humans . DNA-DNA reassociation experiments (hydroxyapatite method) and multilocus enzyme electrophoresis (MEE) were performed on reference strains and clinical isolates to determine the genetic relationships among these different phenotypic categories . DNA-DNA hybridization tests showed that they were related at the species level, despite the phenotypic and host heterogeneity . Both genotypic and phenotypic characterization indicated that S . dysgalactiae could be separated into two major sub-groups . The first sub-group contained alpha-haemolytic strains that showed levels of DNA relatedness with the type strain of S . dysgalactiae ranging from 84 to 90% and from 82 to 88% under optimal (55 degrees C) and stringent (70 degrees C) conditions, respectively . The second sub-group contained beta-haemolytic strains showing levels of relatedness ranging from 71 to 79% (55 degrees C) and from 62 to 73% (70 degrees C) . Percentage divergence varied from 0.5 to 1.0% (alpha-haemolytic group) and from 2.0 to 3.5% (beta-haemolytic group) . A dendrogram based on phenotypic similarity between the enzyme bands produced by MEE showed a Jaccard similarity coefficient of 0.45 between the subclusters formed by the two sub-groups . The results of phenotypic and genotypic characterization were consistent with a published proposal to divide S . dysgalactiae into two subspecies, S . dysgalactiae subsp . dysgalactiae and S . dysgalactiae subsp . equisimilis, with a few modifications. Bone Marrow Transplant, 1998 Oct, 22(8), 795 - 800 Bacteraemia during the aplastic phase after allogeneic bone marrow transplantation is associated with early death from invasive fungal infection; Sparrelid E et al.; Episodes of bacteraemia during the aplastic phase were studied in 500 allogeneic bone marrow (BMT) recipients, regarding incidence, microbial aetiology, risk factors, mortality and causes of death . One hundred and sixty-four patients (33%) had at least one positive blood culture . Gram-positive cocci (alpha-streptococci and coagulase-negative staphylococci) were found in 146/164 cases (89%) . Gram-negative bacteria were present in only seven cases . Receiving marrow from an unrelated donor was the only significant risk factor for bacteraemia in univariate regression analysis . Within 60 days after BMT, 69/500 patients died . The mortality rate was significantly higher among those with positive blood cultures during the aplastic phase, 44/164 (27%) than in those without bacteraemia, 25/336 (7%) . Death directly caused by sepsis was unusual in patients with alpha-streptococci or CNS-bacteraemia (8/146, 5%) . In contrast, three of seven patients with gram-negative bacteraemia died of the infection . However, in patients with bacteraemia, 21 of 44 deaths were attributable to invasive fungal infections (18 candida, three aspergillus; autopsy findings) . Among patients with negative blood cultures during the aplastic phase, 6/25 died of invasive fungal infection (three candida, one saccharomyces and two aspergillus) . This indicates that early bacteraemia is associated with death from invasive fungal infection . Therefore, efforts to shorten the neutropenic period after BMT, prevention, early detection of invasive fungal infections and adjustments of immunosuppressive regimens when marrow from an unrelated donor is used, may improve the outcome after BMT. Med Hypotheses, 1998 Oct, 51(4), 337 - 46 Could synergistic interactions among reactive oxygen species, proteinases, membrane-perforating enzymes, hydrolases, microbial hemolysins and cytokines be the main cause of tissue damage in infectious and inflammatory conditions? Ginsburg I. The mechanisms of cellular damage caused by infectious and inflammatory processes are complex and are still not fully understood . There is, however, a consensus that reactive oxygen species (ROS) generated by phagocytes migrating to injured tissues might be the main agents responsible for cellular damage in inflammatory processes . However, because both activated phagocytes and catalase-negative, peroxide-producing, toxigenic bacteria (Streptococci, Clostridiae) secrete a near-identical array of proinflammatory agonists, including reactive oxygen species (ROS), and because these microbial species might kill their targets by a synergism among several of their secreted enzymes (a multicomponent system), we postulated that activated phagocytes might also function in the same way . Using radiolabeled targets, in culture, we demonstrated that subtoxic amounts of a variety of oxidants (H2O2, radicals produced by xanthine-xanthine-oxidase, peroxyl radical, NO) acted synergistically with subtoxic amounts of a large series of membrane-perforating agents (microbial hemolysins, phospholipases, fatty acids, cationic proteins, proteinases, bile salts, the attack complex of complement, the xenobiotics, lindane, ethanol, methanol) to kill cells in culture and to release large amounts of arachidonic acid and metabolites . Membrane perforators might act primarily to overcome the potent antioxidant systems present in all mammalian cells and scavengers of ROS and inhibitors of the additional agonists might act to abolish the synergism among ROS and the membrane-damaging agents . It is also proposed that protection against tissue damage in vivo should also include 'cocktails' of appropriate antagonists . It is enigmatic that those publications which do describe both in-vitro and in-vivo models proposing that a synergism among a multiplicity of agonists might truly represent the mechanisms by which tissues are injured, in vivo, are hardly ever quoted in the current literature. J Infect, 1998 Sep, 37(2), 127 - 35 Infective endocarditis and glycopeptides; Pittet D et al.; BACKGROUND: Despite the number of antibacterial agents currently available, endocarditis remains a difficult disease to treat and the mortality rate has not fallen in recent years . The glycopeptides have good activity against the Gram-positive bacteria commonly implicated in endocarditis (staphylococci, both coagulase-positive and negative; enterococci and streptococci) . OBJECTIVES: To assess the impact of the glycopeptides vancomycin and teicoplanin on the therapy of infectious endocarditis caused by Gram-positive bacteria . METHODS: A retrospective review of all major published or recently conducted studies using vancomycin or teicoplanin to treat endocarditis . RESULTS: Cure rates obtained with vancomycin and teicoplanin are similar, but there are no controlled studies to investigate this . Vancomycin nephrotoxicity limits its use in endocarditis, in particular when used in combination with an aminoglycoside . By contrast, teicoplanin shows little nephrotoxic potential, even in patients with some degree of renal impairment or when given in combination with an aminoglycoside . Teicoplanin should be used at doses of 6 mg/kg/day or higher to achieve satisfactory cure rates . CONCLUSIONS: Clinical data on the use of glycopeptides in endocarditis suffer from a lack of controlled trials . Although teicoplanin appears to offer some advantages over vancomycin in the therapy of endocarditis, there is an urgent need for randomized, clinical trials before definitive conclusions can be drawn. Int Endod J, 1998 Sep, 31(5), 348 - 53 Polymicrobial coronal leakage of super EBA root-end fillings following two methods of root-end preparation; Chailertvanitkul P et al.; The aim of this study was to compose in vitro coronal leakage of a super EBA root-end filling material after two root-end cavity preparation techniques . A mixed anaerobic microbial marker was used . Forty-five extracted human teeth with straight, single root canals were prepared chemo-mechanically to a size 40 master apical file . The teeth were divided into experimental groups (35 teeth) and control groups (10 teeth) . Forty teeth (35 experimental teeth and five negative control teeth) were obturated by lateral condensation of cold gutta-percha with Tubliseal EWT sealer . The remaining five teeth were not obturated and served as positive controls . These teeth were stored for 6 months in artificial saliva . The apical 3-4 mm of each root was resected perpendicular to the long axis of the root and a root-end cavity prepared to a depth of 3 mm using either a size 008 rosehead burr or an ultrasonic retroprep tip . Freshly mixed EBA cement was placed into the root-end cavity . The entire root surface of each tooth, except the cutting surface of the apical end, was sealed with nail varnish . The coronal part of each root canal was sealed with the cut end of a tube and placed in a bottle containing sterile Brain Heart Infusion Broth (BHIB) . A marker consisting of Anaerobic streptococci and Fusobacterium nucleatum in BHIB was placed in each coronal chamber at 7-day intervals and daily observations were made for bacterial growth in the apical chamber for 60 days . All positive control teeth exhibited bacterial leakage within 48 h, whilst the apical chamber of negative control teeth remained uncontaminated throughout the test period . Fifty-nine percent (n = 10) of the specimens prepared with a burr showed leakage after 90 days, whilst only 22% (n = 4) of the ultrasonically prepared group showed leakage after the same time . The group prepared with ultrasonic tips showed statistically significant less specimens with leakage (P < 0.05) than the group prepared with burrs. J Infect, 1998 Jan, 36 Suppl 1, 39 - 47 Chickenpox in childhood . A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection; Tarlow MJ et al.; Chickenpox in childhood is a milder condition than in older patients, but serious and even fatal complications may occur . These occur especially in immunosuppressed individuals, but can also be seen in normal children . The commonest of these is secondary bacterial infection with staphylococci or streptococci . Reye's syndrome is now rare in chickenpox, since aspirin no longer used in treatment . Aciclovir and VZIG (varicella zoster immune globulin) have a role in the management of chickenpox in the immunosuppressed or immunodeficient child, and aciclovir may be valuable in managing some normal children . Chickenpox should not always be considered a trivial illness. J Am Dent Assoc, 1998 Nov, 129(11), 1567 - 77 Using a biological indicator to detect potential sources of cross-contamination in the dental operatory; Hackney RW Jr et al.; The authors conducted a study using surveillance monitoring methodology to identify operatory contamination and to evaluate the effectiveness of infection control procedures . Viridans streptococci were evaluated as biological indicators of oral contamination . Viridans streptococci, abundant in human saliva, were detected on operatory surfaces after dental treatments were finished and surfaces were disinfected . The findings validate current concepts of infection control as demonstrated in barrier methods. J Clin Microbiol, 1998 Dec, 36(12), 3468 - 73 Streptococcal pharyngitis: impact of a high-sensitivity antigen test on physician outcome; Needham CA et al.; The purpose of the present study was to determine whether the availability of results from a high-sensitivity, rapid test for group A streptococci (Strep A OIA; BioStar, Inc., Boulder, Colo.) improves physician outcome . The study population included 465 consecutive patients with symptoms of acute pharyngitis seen in two outpatient clinics in a large suburban medical center; one clinic, a walk-in clinic (WIC), primarily saw adult patients, and one clinic, a pediatric and adolescent medicine clinic (PED), primarily saw pediatric patients . We measured improvement in physician outcome by comparing physician intent for prescribing an antibiotic based on clinical impression with physician practice once the results of the Strep A OIA were known . Based upon intent, the physicians seeing WIC patients (WIC physicians) would have prescribed an appropriate antibiotic course for 42% of patients with cultures positive for group A beta-hemolytic streptococci (GABHS) and 61% of patients with cultures negative for GABHS . After receiving the results of the Strep A OIA, WIC physicians prescribed an appropriate antibiotic course for 81% of patients with positive cultures and 72% of patients with negative cultures . Based upon intent, the physicians seeing PED patients (PED physicians) would have prescribed an appropriate antibiotic course for 35% of patients with positive cultures and 77% of patients with negative cultures . After receiving the results of the Strep A OIA, PED physicians prescribed an appropriate antibiotic course for 90% of patients with positive cultures and 81% of patients with negative cultures . Based on a 14.5% prevalence of GABHS among WIC patients, Strep A OIA improved the overall WIC physician outcome from 58 to 74% . Based on a 31.5% prevalence of GABHS among PED patients, Strep A OIA improved the PED physician outcome from 64 to 84% . Had Strep A OIA alone guided therapeutic choice, physicians would have prescribed an appropriate antibiotic course for 95% of the patients at the time of the initial encounter . We conclude that the use of Strep A OIA improves physician outcome. Biochim Biophys Acta, 1998 Nov 19, 1408(2-3), 296 - 302 Surfactant protein A (SP-A) gene targeted mice; Korfhagen TR et al.; Mice lacking surfactant protein A (SP-A) mRNA and protein in vivo were generated using gene targeting techniques . SP-A (-/-) mice have normal levels of SP-B, SP-C and SP-D mRNA and protein and survive and breed normally in vivarium conditions . Phospholipid composition, secretion and clearance, and incorporation of phospholipid precursors are normal in the SP-A (-/-) mice . Lungs of SP-A (-/-) mice have markedly decreased tubular myelin figures and clear Group B streptococci and Pseudomonas aeruginosa less efficiently than SP-A wild type mice . These studies of SP-A (-/-) mice demonstrate that SP-A has an important role in the innate immune system of the lung in vivo. Ugeskr Laeger, 1998 Oct 26, 160(44), 6354 - 5 {Endocarditis and normal cell meningitis caused by group B streptococci}; Lindberg JA; Bacterial meningitis usually presents with cerebrospinal pleocytosis with neutrophil predominance . Cases without pleocytosis are known from the literature . A case of group B streptococcal endocarditis with concomitant meningitis without cerebrospinal pleocytosis is described in a 40 year old woman . Finding the cerebrospinal fluid normocellular might mislead the physician and cause a delay in treatment. Contracept Fertil Sex, 1998 Jul-Aug, 26(7-8), 593 - 7 {Chlamydia trachomatis endometritis}; Judlin P; Endometritis are upper genital tract infections . They are part of the Pelvic Inflammatory Diseases and are often difficult to differentiate from salpingitis . C . trachomatis, a sexually transmitted micro-organism, is a major pathogen of the genital tract . Most of the time, the upper genital tract infections are polymicrobial and C . trachomatis can be combined with other aerobes (E . coli, streptococci...) and anaerobes . Diagnosis of chlamydial endometritis is difficult since the clinical symptoms--lower abdominal pain, cervical discharge--often lack specificity or can be completely absent . Bacteriological studies from intra-uterine or intra-cervical samples are necessary . A laparoscopy can be useful to ascertain the integrity of Fallopian tubes . The treatment requires broad spectrum antibiotics effective against C . trachomatis and other probable pathogens, for 2 to 3 weeks. Oral Microbiol Immunol, 1998 Oct, 13(5), 278 - 85 Association of salivary immunoglobulin A antibody and initial mutans streptococcal infection; Smith DJ et al.; We explored the relationship between mutans streptococcal infection and the development of salivary IgA antibody during initial colonization . Repetitive swabbing (n = 292) of the teeth of 33 children revealed that 45% became infected with mutans streptococci between 13 and 36 months of age . In contrast, mutans streptococci could not be detected in 18 children whose last sample was taken at 39-81 months of age (median age = 62 months) . During the period of mutans streptococcal infectivity, immunoglobulin A (IgA) antibody to several mutans streptococcal antigens appeared in most children, whether or not infection had been demonstrated . Robust responses to mutans streptococcal components occurred during or shortly after, but not before the period of mutans streptococcal infectivity . No consistent differences were observed among the summarized patterns of response of infected and uninfected groups of children, although the IgA Western blot patterns of individual subjects were often quite distinct . For example, sets of siblings, who would be presumed to be challenged with similar maternal mutans streptococcal clonotypes, were shown to develop qualitatively different salivary IgA responses to mutans streptococcal components . These results support a discrete period for mutans streptococcal infection and may suggest that the level of maternal infection is a factor in the success of infection of the child during this period . The data also suggest that exposure to mutans streptococci is a sufficient condition for robust mucosal IgA responses to mutans streptococcal antigens during the period of infectivity and that these responses may be different, even among siblings. Oral Microbiol Immunol, 1998 Oct, 13(5), 271 - 7 Genotyping shows different strains of mutans streptococci between father and child and within parental pairs in Swedish families; Emanuelsson IR et al.; The purpose of this study was to investigate whether there was an intrafamilial similarity of mutans streptococcal strains in some Swedish families using chromosomal DNA fingerprinting . Plaque samples were obtained from buccal and occlusal surfaces of 25 three-year-old children, their mothers and 18 fathers . The colonization levels of mutants streptococci were estimated with the "Strip mutans" test, and caries experience was scored by decayed, missing and filled teeth or decayed, extracted and filled teeth . Interviews about medical history, diet regimes, breastfeeding and care of the child were performed . In 11 families isolates of mutans streptococci were detected in all three individuals . These isolates were serotyped by immunofluorescent technique and genotyped using the restriction endonuclease Hae III . The results showed that 5 children harbored mutans streptococci genotypes different from their parents . Six children showed genotypes identical to their mothers . None of the children harbored genotypes similar to their fathers, even though two thirds of the fathers had high or very high mutans streptococci levels . No matching of genotypes was observed within the 11 parental pairs . Mothers as primary caregivers with high "Strip mutans" scores were more often observed in the group with identical genotypes within the mother-child pairs, the "matching group", than in the "no-matching group" . These data indicate that the fathers and the children had not acquired each others' strains of mutans streptococci nor had the spouses . The results suggest that the children acquired mutans streptococci both from outside and inside the family. Plasmid, 1998 Nov, 40(3), 247 - 51 A medium-copy-number plasmid for insertional mutagenesis of Streptococcus mutans; Sanchez R; We have constructed a plasmid useful for insertional mutagenesis in Streptococcus mutans . The molecule, pSU20Erm, is based on a derivative of pACYC184 known as pSU20 . The plasmid described here is approximately 3.7 kb in size and has the following properties: it replicates in Escherichia coli, does not replicate in S . mutans, contains an erythromycin-resistance marker which can be selected in E . coli or the streptococci, contains a multiple cloning site with few restriction sites in the remainder of the molecule, and can be screened on X-Gal-containing medium for the presence of insertions into the multiple cloning site . We have used the plasmid to construct a library of S . mutans DNA in E . coli and show that the clones can be reintegrated into the S . mutans chromosome via homologous recombination, thereby interrupting native genes . The plasmid has been used to clone part of a homologue of the E . coli drpA gene, encoding a global regulatory element for RNA synthesis . Further, we have identified an element closely linked to drpA in S . mutans with high homology to IS861 . Clin Rheumatol, 1998, 17(5), 387 - 9 Recurrent group B streptococcal arthritis; Schattner A et al.; Bacterial arthritis caused by group B beta-hemolytic streptococci (GBS) is uncommonly encountered . We report a woman who had three documented isolated recurrences of GBS arthritis (right hip, right knee x 2) over a period of three years which were successfully treated . One year before the first episode, the patient was found to have squamous cell carcinoma of the cervix stage IIIB and underwent extensive combined oncological treatment . The extensive chemoradiotherapy and anatomical changes resulting from cancer of the cervix are believed to have contributed to the occurrence and recurrence of invasive group B streptococcal infection in this patient which is the first one reported with recurrent GBS arthritis. Rinsho Byori, 1998 Sep, 46(9), 893 - 7 {Gram-positive cocci isolated from blood}; Kobayashi Y; Between 1994 and 1997, the main organisms isolated from the blood of patients examined in our laboratory were staphylococci . Namely 216 strains of Staphylococcus epidermidis, 194 strains of Staphylococcus aureus and 81 strains of other coagulase-negative staphylococci were isolated from patient blood . Regarding S . aureus, MRSA strains were predominant and 140 strains of MRSA were isolated from patient blood . S . epidermidis and MRSA were mainly isolated from patients will indwelling intravenous catheters . In some cases showing positive culture of S . epidermidis, however, the probability of contamination while taking the blood samples could not be excluded . A survey of infective endocarditis between April 1987 and March 1997 revealed that the main causative organism of native valve endocarditis was still streptococci . Of 33 cases of native valve endocarditis, 18 cases were due to viridans streptococci. Antimicrob Agents Chemother, 1998 Nov, 42(11), 2792 - 8 Fluoroquinolone resistance mutations in the parC, parE, and gyrA genes of clinical isolates of viridans group streptococci; Gonzalez I et al.; The nucleotide sequences of the quinolone resistance-determining regions (QRDRs) of the parC and gyrA genes from seven ciprofloxacin-resistant (Cpr) isolates of viridans group streptococci (two high-level Cpr Streptococcus oralis and five low-level Cpr Streptococcus mitis isolates) were determined and compared with those obtained from susceptible isolates . The nucleotide sequences of the QRDRs of the parE and gyrB genes from the five low-level Cpr S . mitis isolates and from the NCTC 12261 type strain were also analyzed . Four of these low-level Cpr isolates had changes affecting the subunits of DNA topoisomerase IV: three in Ser-79 (to Phe or Ile) of ParC and one in ParE at a position not previously described to be involved in quinolone resistance (Pro-424) . One isolate did not show any mutation . The two high-level Cpr S . oralis isolates showed mutations affecting equivalent residue positions of ParC and GyrA, namely, Ser-79 to Phe and Ser-81 to Phe or Tyr, respectively . The parC mutations were able to transform Streptococcus pneumoniae to ciprofloxacin resistance, while the gyrA mutations transformed S . pneumoniae only when mutations in parC were present . These results suggest that DNA topoisomerase IV is a primary target of ciprofloxacin in viridans group streptococci, DNA gyrase being a secondary target. Eur J Clin Microbiol Infect Dis, 1998 Aug, 17(8), 556 - 60 Prospective study of Streptococcus milleri hepatic abscess; Corredoira J et al.; Thirty-seven cases of microbiologically demonstrated pyogenic hepatic abscess were observed in a prospective study over a seven-year period . Biliary disease was the most common source of liver abscess (42%) . Streptococcus milleri was the most common cause of hepatic abscess, accounting for 51% of the cases . Hepatic abscess is due to Streptococcus milleri clinically distinct from other forms of pyogenic liver abscess due to its torpid nature and the longer duration of its symptoms {42 vs . 11 days} . Occult hepatic abscess should be suspected if the blood culture is positive for Streptococcus milleri, since 28% of bacteremia cases due to Streptococcus milleri stem from hepatic abscesses . It is important to distinguish Streptococcus milleri from other members of the viridans streptococci group, which are frequently isolated as contaminants, but only exceptionally cause hepatic abscess . Unlike other pyogenic hepatic abscesses, those caused by Streptococcus milleri are frequently monomicrobial (79%) . In the present study, empirical therapy of pyogenic hepatic abscess always included a drug that is effective against Streptococcus milleri. Res Microbiol, 1998 Sep, 149(8), 539 - 48 A secreted streptococcal cysteine protease can cleave a surface-expressed M1 protein and alter the immunoglobulin binding properties; Raeder R et al.; Previous studies of recent clinical isolates of serotype M1 group A streptococci indicated that they display two patterns of non-immune human IgG subclass binding reactivity associated with their M1 protein . One group reacted with all four IgG subclasses (type IIo), while the second group expressed an M1 protein reacting preferentially with human IgG3 (type IIb) . In this study, we have demonstrated that a cysteine protease, SpeB, present in culture supernatants of M1 serotype group A streptococcal isolates expressing type IIb IgG binding protein, can convert a recombinant Emm1 protein from a type IIo functional profile to a type IIb profile by removal of 24 amino acids from the N-terminus of the mature M1 protein . Furthermore, SpeB can convert bacteria expressing IgG binding proteins of the type IIo phenotype into those expressing type IIb proteins . The role of the cysteine protease as the central bacterial enzyme in this posttranslational modification event was confirmed by generation of an isogenic SpeB-negative mutant. J Immunol, 1998 Nov 1, 161(9), 4894 - 901 Role of the hypervariable region in streptococcal M proteins: binding of a human complement inhibitor; Johnsson E et al.; Antigenic variation allows pathogenic microorganisms to evade the immune system of the infected host . The variable structure must play an important role in pathogenesis, but its function is in most cases unknown . Here, we identify a function for the surface-exposed hypervariable region of streptococcal M5 protein, a virulence factor that inhibits phagocytosis . The hypervariable region of M5 was found to bind the human complement inhibitor FHL-1 (factor H-like protein 1), a 42-kDa plasma protein . Plasma absorption experiments with M5-expressing bacteria showed that the interaction with FHL-1 occurs also under physiologic conditions . Studies of another extensively characterized M protein, M6, indicated that this protein also has a binding site for FHL-1 in the hypervariable region . The complement-inhibitory function of FHL-1 was retained after binding to streptococci, suggesting that bound FHL-1 protects bacteria against complement attack . All available data now indicate that FHL-1, or another human complement inhibitor, binds to the hypervariable region of M proteins . These findings provide insights into the forces that drive antigenic variation and may explain why the hypervariable region of M protein is essential for phagocytosis resistance . Moreover, these data add to a growing body of evidence that human complement inhibitors are major targets for pathogenic microorganisms. Am J Obstet Gynecol, 1998 Oct, 179(4), 879 - 83 Potential consequences of widespread antepartal use of ampicillin; Towers CV et al.; OBJECTIVE: Recommendations for the use of antenatal antibiotics in obstetrics have increased in the past few years, especially for prophylaxis against group B streptococci, for prolongation of the latency time in patients with preterm premature rupture of the membranes, and as an adjuvant treatment in preterm labor . Our objective was to determine whether the use of antenatal ampicillin affects the incidence of and resistance of early-onset neonatal sepsis with organisms other than group B streptococci . STUDY DESIGN: A prospective cohort study was performed between January 1, 1991, and December 31, 1996 . Every case of blood culture-proven neonatal sepsis was prospectively surveyed . The type of bacteria isolated, drug resistance, antenatal antibiotic use and treatment indication, gestational age at delivery, and other antenatal and outcome variables were gathered . Early-onset neonatal sepsis was defined as disease onset within 7 days after birth . RESULTS: A total of 42 cases of early-onset neonatal sepsis among 29,897 neonates delivered were found during the 6-year period . Of these, 15 cases were due to group B streptococci and 27 were the result of non-group B streptococcal organisms (21 gram-negative rods and 6 gram-positive cocci) . Among the 27 non-group B streptococcal cases, 15 mothers had received antenatal ampicillin and 13 of the 15 bacterial isolates from these neonates (87%) were resistant to ampicillin, versus only 2 ampicillin-resistant isolates (17%) among the 12 cases in which no antenatal antibiotics were administered (P = .0004) . Of the 15 mothers who were treated with ampicillin, 13 received more than 1 dose . In evaluating each year of the study, the overall administration of antibiotics to pregnant women in the antenatal period increased from <10% in 1991 to 16.9% in 1996 . The incidence of early-onset neonatal sepsis with group B streptococci decreased during this time, whereas the incidence of early-onset sepsis with non-group B streptococcal organisms, especially Escherichia coli, increased . CONCLUSIONS: The increased administration of antenatal ampicillin to pregnant women may be responsible for the increased incidence of early-onset neonatal sepsis with non-group B streptococcal organisms that are resistant to ampicillin . At this time penicillin G, rather than ampicillin, is therefore recommended for prophylaxis against group B streptococci . In addition, future studies are needed to determine whether alternate approaches, such as immunotherapy or vaginal washing, could be of benefit. Scand J Infect Dis, 1998, 30(3), 245 - 51 Blood culture isolates during 6 years in a tertiary neonatal intensive care unit; Ronnestad A et al.; Blood culture results obtained in a single tertiary neonatal intensive care unit are reviewed . In 4416 admissions occurring over 6 y we identified 206 positive cultures (4.7/100 admissions) growing 234 bacterial and fungal isolates in 182 infants . Very early and early onset positive cultures comprised 17% and 22% each . Gram-positive bacteria dominated in very early (61%), early (91%) and late onset (78%) cultures with coagulase-negative staphylococci (CONS) as the most frequent isolate in all groups (22%, 46% and 55%, respectively) . The 3 most frequent isolates following CONS were in very early onset cultures Escherichia coli (19%), anaerobic bacteria (17%) and group B streptococci (GBS) (14%), in early onset cultures Staphylococcus aureus (28%), Enterococci (7%), E . coli (6%) and Viridans streptococci (6%) and in late onset cultures S . aureus (15%), Candida species (8%) and E . coli (5%) . Infants < or = 999 g birthweight, representing 6% of the admissions, contracted 37% of the positive blood cultures and nearly half (44%) of the CONS isolates . In these patients, a significant increase (p < 0.001) in the number of positive cultures/100 admissions and in the proportion of positive cultures in conjunction with an intravascular catheter were seen (p < 0.001) . An intravascular catheter was more often present when CONS were isolated as compared to other organisms (p < 0.05) . 23 positive cultures (11.2%), most frequently E . coli, were associated with a fatal outcome . Our microbiological pattern is dominated by a gram-positive flora, which is in agreement with recent European and North American reports, but differs from earlier Scandinavian studies in the proportion of CONS and GBS reported. Ther Umsch, 1998 Sep, 55(9), 586 - 8 {Erythema and fever after diclofenac i.m.}; Schaad HJ et al.; We describe a patient with a streptococcal myositis/fasciitis and toxic shock syndrome following an intramuscular injection with diclofenac . A patient complaining of sore throat and headaches for two days and fever up to 38.5 degrees C for one day consulted her family physician . 75 mg of diclofenac were injected intramuscularly for symptomatic treatment . On the next day massive pain at the injection site and a generalized erythema occurs and fever up to 38.5 degrees C persists . She is admitted to the local hospital for suspected abscess formation . Despite rapid antibiotic treatment a septic shock develops . The patient is transferred to a tertiary care hospital . An extensive debridement is performed and the antibiotic regimen changed to high dose penicillin and clindamycin . The association of life threatening diseases due to Group A streptococci and non-steroidal anti-inflammatory drugs (NSAID) is well documented by several case reports . We believe there is no longer any need for intramuscular injections of NSAID . The rare but severe complications preclude further use of the intramuscular dosage in view of the availability of oral alternatives. J Med Microbiol, 1998 Oct, 47(10), 899 - 906 Ability of clinical isolates of group A streptococci to adhere to and invade HEp-2 epithelial cells; Bennett-Wood VR et al.; Individual strains of group A streptococci (GAS) differ in virulence, but the reasons for these differences are incompletely understood . To determine if the ability of GAS to cause invasive disease corresponded with their capacity to adhere to or invade epithelial cells, 63 clinical isolates of GAS (40 from patients with systemic infection and 23 from superficial disease) were examined in quantitative assays of bacterial adhesion to and invasion of HEp-2 cells, a continuous line of human pharyngeal epithelial cells . The results showed that individual isolates of GAS varied considerably in their ability to adhere to and penetrate HEp-2 cells . However, on the whole, strains from patients with invasive disease adhered to cells in numbers c.1.5 greater than those from superficial infection . Paradoxically, strains from patients with invasive disease invaded HEp-2 cells to a significantly lesser extent than those from superficial sites, with a two-fold difference in invasion index (defined as the percentage of cell-associated bacteria located intracellularly) . To determine if these differences were caused by differences in the production of hyaluronic acid capsule or M protein by the two groups of bacteria, the adherence and invasive capacities of bacteria carrying defined mutations in the genes for these factors were examined . Although M6-protein-deficient {corrected} bacteria were less adherent to HEp-2 cells than the wild-type, neither the hyaluronic acid capsule nor the M protein had a significant influence on the ability of GAS to adhere to or invade HEp-2 cells . The results of this study demonstrate that there are biological differences between GAS isolates associated with invasive and superficial diseases and that these differences can be demonstrated by an assay of bacterial adherence to and invasion of HEp-2 epithelial cells. J Med Microbiol, 1998 Oct, 47(10), 893 - 8 Streptococcal emm types associated with T-agglutination types and the use of conserved emm gene restriction fragment patterns for subtyping group A streptococci; Beall B et al.; The T-agglutination types were determined for a diverse collection of 1531 group A streptococci for which the 5' M protein gene (emm) sequences had been analysed . The majority of the T-agglutination types correlated with previously seen M/emm/T-type associations; however, several new associations were found . Analysis of a subset of this collection -- which included 1157 clinical isolates with multiply encountered emm types -- found that emm amplicon restriction profiles of isolates sharing identical T types and opacity factor phenotypes are useful for detecting groups of isolates with identical emm genes . Many emm genes of known 5' sequence display a highly conserved restriction pattern amongst clinical isolates widely separated both geographically and temporally. Conn Med, 1998 Sep, 62(9), 515 - 7 Group B streptococcal bacteremia in adults at Hartford Hospital 1991-1996; Cooper BW et al.; Invasive disease due to Group B streptococci has been increasingly recognized as a problem in chronically ill adults . We studied all adults presenting with bacteremia due to Group B streptococci at Hartford Hospital over a period of more than five years . Fifty-nine episodes of septicemia occurred with a mortality rate of 15.3% . Markers for mortality included cirrhosis, azotemia, transaminase elevation, respiratory distress on admission, and ionized hypocalcemia Although commonly thought of as a maternal and pediatric pathogen, nonpregnant, chronically ill adults make up the vast majority of patients with Group B streptococcal sepsis. Infect Immun, 1998 Nov, 66(11), 5592 - 7 A globally disseminated M1 subclone of group A streptococci differs from other subclones by 70 kilobases of prophage DNA and capacity for high-frequency intracellular invasion; Cleary PP et al.; The M1inv+ subclone of M1 group A streptococci that spread globally in the late 1980s and early 1990s was previously identified by restriction fragment length polymorphism (RFLP), M protein, and SpeA exotoxin sequence analyses . Strains representing this subclone were characterized with regard to carriage of bacteriophage and capacity to invade cultured human epithelial cells . The M1inv+ subclone was found to harbor two entirely different prophages, phage T13 and phage T14, which together supplement its genome with nearly 70 kb of DNA . Phage T14 encodes the SpeA exotoxin and is closely related to the classic converting phage T12 . Plaque-forming characteristics and RFLP analyses of phages T13 and T14 were compared to each other and to phage T12 . Other subclones of M1, isolated in the 1970s to the early 1980s, lacked both prophages . The M1inv+ subclone was previously reported to be efficiently internalized by human epithelial cells . This potential was confirmed and expanded by comparing a variety of clinical isolates . The capacity for high-frequency invasion of epithelial cells was not transmitted to a laboratory strain of group A streptococci by the above-mentioned bacteriophages. Infect Immun, 1998 Nov, 66(11), 5399 - 405 Impact of M49, Mrp, Enn, and C5a peptidase proteins on colonization of the mouse oral mucosa by Streptococcus pyogenes; Ji Y et al.; Resistance to phagocytosis is a hallmark of virulent Streptococcus pyogenes (group A streptococcus) . Surface-bound C5a peptidase reduces recruitment of phagocytes to the site of infection, and hyaluronic acid capsules and/or the M protein limit the uptake of streptococci . In this study the relative impact of M and M-like proteins and the C5a peptidase on the virulence of a serotype M49 strain was assessed . The capacities of isogenic strains with an insertion mutation in emm49; with a deletion mutation in scpA49 (C5a peptidase gene); and with a deletion that removes all three M-like genes, mrp49, emm49, and enn49, to colonize mice and resist phagocytosis were compared . Experiments confirmed results obtained in an earlier study, which showed that the M49 protein was not required for in vitro resistance to phagocytosis, and also showed that the M protein was not required for colonization of mice . Failure to produce all three M-like proteins, M49, Mrp, and Enn49, significantly reduced the ability of these streptococci to resist phagocytosis in vitro but did not significantly alter the persistence of streptococci on the oral mucosa . In vitro experiments indicate that M+ streptococci are phagocytized by polymorphonuclear leukocytes that have been activated with phorbol-12-myristate 13-acetate or recombinant human C5a . This observation may explain the finding that expression of M49 protein is not essential for short-term colonization of the mouse oral mucosa. Infect Immun, 1998 Nov, 66(11), 5388 - 92 A streptococcal adhesion system for salivary pellicle and platelets; Gong K et al.; A Streptococcus sanguis 133-79 adhesin identified by the monoclonal antibody 1.1 (MAb 1.1) binds both saliva-coated hydroxylapatite (sHA) and platelets . The complementary binding site(s) for the adhesin was identified by the anti-idiotypical MAb 2.1 . To learn if this adhesion system, marked by the antiadhesin MAb 1.1 and anti-binding site MAb 2.1, is commonly used by strains within the sanguis group and other viridans group streptococci, 42 strains from seven species were tested . Strains that bind to both sHA and platelets use the same adhesin and binding site epitopes . Strains that do not adhere to platelets rely on other adhesin specificities to bind to sHA. Ann Med, 1998 Aug, 30(4), 375 - 8 Occurrence of HLA-B27 tissue antigen in patients with purulent arthritis caused by Staphylococcus aureus or beta-haemolytic streptococci; Valtonen JM et al.; The HLA-B27 tissue antigen is associated with reactive arthritis caused by different bacterial infections but its occurrence in purulent arthritis has not been studied earlier . We analysed the frequency of HLA-B27 in patients with culture proven purulent arthritis caused by Staphylococcus aureus or beta-haemolytic streptococci . The study included 41 patients treated during the years 1979-96 (15 female and 26 male) with a mean age of 52 years (range 16-80 years) . HLA-B27 was found in 24% (9/37) of the tested patients compared with 14% in the healthy Finnish population, but the difference was not statistically significant (P < 0.50) . No statistical difference in disease activity according to febrile days or duration of the disease could be found between HLA-B27 positive and negative patients . We conclude that HLA-B27 is not a risk factor for purulent arthritis, and when present it has no significant modifying effect on the clinical picture of purulent arthritis. Pediatr Dent, 1998 Jul-Aug, 20(4), 273 - 7 Effect of restorative treatment on mutans streptococci and IgA antibodies; Gregory RL et al.; PURPOSE: Streptococcus mutans has been implicated as the major causative agent of dental caries . Although restorative treatment for caries is thought to temporarily eliminate the carious challenge, there are few reports of alterations in salivary mutans streptococci (MS) numbers and no reports of changes in salivary IgA antibody to S . mutans following restorative treatment . METHODS: This study investigated the effects of treatment in 12 caries-active children . RESULTS: Numbers of MS decreased slightly from pre- to postrestoration levels in six subjects and increased in five subjects . However, there were no significant differences in pre-to postrestoration numbers of total oral streptococci, MS, the percentage of MS/total oral streptococci, salivary IgA antibody levels to S . mutans, or correlations between bacterial counts and IgA antibody levels . CONCLUSIONS: These results indicate that successful restorative treatment does not alter mutans streptococcal numbers and suggest the need for more effective methods for reducing the cariogenic challenge. Rev Prat, 1998 Mar 1, 48(5), 502 - 5 {The microbiology of infectious endocarditis}; Mainardi JL; If streptococci and staphylococci remain the main bacteria responsible for infective endocarditis (80%), the emergence of Streptococcus bovis associated with intestinal lesions, the confirmation of the role of Coxiella burnetii, and the discovery of the responsibility of Bartonella sp in case of negative blood culture endocarditis have been the principal microbiological modifications during the last few years . Blood cultures performed under the best technical conditions and the examination and culture of the valve after surgery remain the better means for diagnosing infective endocarditis . In case of negative blood culture (11% of the infective endocarditis), the serologic tests against C . burnetii and Bartonella should decrease the rate of diagnostic uncertainty . The development of bacteriological techniques, particularly molecular methods, should improve the microbiology of infective endocarditis lead to the discovery new aetiological agents. Rev Prat, 1998 Mar 1, 48(5), 486 - 90 {Epidemiology of infectious endocarditis}; Delahaye F et al.; The incidence of infective endocarditis (20 to 160 cases per million inhabitants yearly) increases with age; it does not seem to be decreasing over time . There is no previously known heart disease in 30% of the patients, a native valve disease in 30 to 60%, a prosthetic valve in 15-20% . Streptococci remain the leading microorganisms . Digestive streptococci and staphylococci are increasing . Iatrogenic portals of entry are in progression . During the hospital stay, case fatality ratio varies from 13 to 20% . After endocarditis, the patient remains at risk of late cardiac surgery and of recurrence . Survival after 5 years is approximately 85%. Arch Intern Med, 1998 Oct 12, 158(18), 2043 - 50 Influence of human immunodeficiency virus 1 infection and degree of immunosuppression in the clinical characteristics and outcome of infective endocarditis in intravenous drug users; Ribera E et al.; BACKGROUND: Immunosuppression caused by human immunodeficiency virus 1 (HIV) infection appears to modify the clinical characteristics and to increase the severity of several bacterial infections . The impact of HIV infection and the degree of immunosuppression on the clinical characteristics and outcome of infective endocarditis (IE) in intravenous (IV) drug users has not been well characterized . METHODS: Prospective cohort study among 292 consecutive IV drug users with IE diagnosed in 2 academic institutional hospitals in Barcelona, Spain, from January 1, 1984, to October 31, 1995 . Serostatus of HIV infection was documented in 283 patients . We measured demographics, clinical and biological data, cause, echocardiographic findings, HIV serostatus and classification, CD4 cell count, complications, and mortality . RESULTS: Among the 283 episodes of IE, 216 (76.3%) were in HIV-infected patients and 67 (23.7%) in non-HIV-infected patients . Rate of IE per 1000 admissions ranged from 0.17 to 0.82 per year, peaking in 1989 . Characteristics of IE independently associated with HIV infection were right-side involvement (odds ratio {OR}, 7.6; 95% confidence interval {CI}, 3.5-16.7), a micro-organism different from viridans streptococci (OR, 2.5; 95% CI, 1.1-5.9), duration of drug abuse longer than 5 years (OR, 5.0; 95% CI, 2.4-10.3), and white blood cell count of no more than 10 X 10(9)/L (OR, 2.2; 95% CI, 1.1-4.2) . There were no significant differences in mortality due to IE according to HIV serostatus . Among the 216 patients with HIV infection, the variables independently associated with worse outcome were CD4 cell count lower than 0.200 x 10(9)/L and left-sided or mixed IE . CONCLUSIONS: Although there is a difference in clinical presentation in IE in IV drug users, outcome was similar according to their HIV status . However, among HIV-infected patients, severe immunosuppression and mixed or left-side valvular involvement were strong risk factors for mortality. Rev Med Interne, 1998 Aug, 19(8), 568 - 70 {2 cases of iatrogenic oral streptococcal infection: meningitis and spondylodiscitis}; Molinier S et al.; INTRODUCTION: The multiplication of invasive spine investigations for either diagnostic or therapeutical purposes increases the risk for iatrogenic infections . We report two cases of iatrogenic infections, one case of meningitidis and one case of spondylodiscitis due to Streptococcus viridans . EXEGESIS: The two cases included a 42-year-old male patient presenting with spondylodiscitis due to Streptococcus oralis following nucleolysis for discal node and a 51-year-old female patient with purulent meningitidis due to Streptococcus salivarius following hysteroscopy with spinal anesthesia . According to the disease chronology and bacterial results, iatrogenesis was evidenced . The streptococci originate from the patient's skin or from the operators' endobuccal flora . CONCLUSION: Simple aseptic rules, including wearing a surgical mask during any spinal tap, would definitely avoid iatrogenic infections. Clin Infect Dis, 1998 Sep, 27(3), 430 - 3 Numerous eruptive lesions of panniculitis associated with group A streptococcus bacteremia in an immunocompetent child; Pao W et al.; A previously healthy 13-month-old boy developed group A beta-hemolytic streptococcus bacteremia coinciding with numerous eruptive subcutaneous lesions primarily on his extremities . Skin biopsy revealed infectious panniculitis; gram-positive cocci were present within both fat lobules and septa . Molecular genetic analysis of an isolate from the patient's blood revealed an emm type 4 organism displaying the emm chromosomal pattern E that is characteristic of opacity factor-producing strains; the organism also harbored the gene encoding for streptococcal pyrogenic exotoxin C (speC) . To our knowledge, this clinical presentation has not yet been described in the spectrum of infections directly caused by group A beta-hemolytic streptococci. Rev Cubana Med Trop, 1992, 44(2), 137 - 40 {Identification of strains of beta-hemolytic streptococci of groups A, B, C, and G by coagglutination}; Tamargo Martinez I et al.; A study was conducted on the coagglutination (CoA) technique in the serogrouping of betahemolytic streptococci of the groups A, B, C and G, previously identified by physiological tests and the agar immunodiffusion technique . This technique was used as a reference test and, according to its results, it can be stated that the CoA technique allowed for the serological grouping in 95.7% of the strains . The CoA technique was assessed by using reactions prepared in our laboratories and the commercial kit Phadebact. Acta Odontol Scand, 1998 Aug, 56(4), 197 - 201 Effect of NaF-, SnF2-, and chlorhexidine-impregnated birch toothpicks on mutans streptococci and pH in approximal dental plaque; Kashani H et al.; The antimicrobial effect of birch toothpicks impregnated with 4% NaF, 8% SnF2, or 2% chlorhexidine was studied both in vitro and in vivo . A non-impregnated toothpick served as a control . In vitro, suspensions of Streptococcus mutans were exposed to the various toothpicks for 20 min and then cultured on blood agar . The results of this susceptibility test revealed the following ranking order with respect to inhibition: chlorhexidine > SnF2 > NaF and non-impregnated; with significant differences in colony-forming units (CFU) between these three groups . In vivo, 12 individuals used the 4 types of toothpick 3 times a day for 5 days in a procedure with a crossover design . Saliva and approximal plaque samples were collected at baseline and on various occasions up to 23 days after the treatment . At the same time, plaque-pH was measured at approximal sites 10 min after rinsing with 10% sucrose . The results of these in vivo experiments revealed lower proportions of mutans streptococci after using all four types of toothpick, but the reduction was significant only after 2 days for the toothpicks impregnated with SnF2 and chlorhexidine (P< 0.05) . On the sampling occasions 9 and 23 days after the treatment, the mutans streptococci were more or less back to baseline levels again . In saliva no significant differences in the number of mutans streptococci were found either within or between the four treatments . No significant differences were found regarding decline in the plaque-pH between the NaF-, SnF2-, chlorhexidine-, and non-impregnated toothpicks on any of the sampling occasions. Cleft Palate Craniofac J, 1998 Sep, 35(5), 460 - 4 Transmission of mutans streptococci between mothers and children with cleft lip and/or palate; de Soet JJ et al.; OBJECTIVE: The aim of this study was to investigate the transmission of Streptococcus mutans between children with cleft lip and/or palate and their mothers . DESIGN: Saliva samples of 21 mother-child pairs were collected and cultured on plates containing a selective growth medium for mutans streptocci . At least five separate colonies of each colony morphotype were isolated . A polymerase chain reaction (PCR) with randomly chosen primers was used to type the isolates . RESULTS: The number of morphotypes and PCR types was significantly lower in the children than in the mothers . Significant correlations were found between the number of morphotypes and PCR types, in the children as well as in the mothers . In only 38% of the mother-child pairs were the same PCR types found in mother and child . CONCLUSIONS: This suggests that S . mutans had been transmitted from mother to child in one-third of the population studied . No correlations were found among the number of colony-forming units, the number of colony-colony-morphotypes, and the number of PCR types of the mothers and transmission . Similar PCR types in mother and child were found significantly more often in children who had more than one PCR type . The results indicate that transmission of S . mutans from mother to child is not frequent in children with oral cleft . This may have consequences for preventive treatment of cleft lip and/or palate children and their mothers. Am J Obstet Gynecol, 1998 Sep, 179(3 Pt 1), 677 - 81 Group B streptococci during pregnancy: a comparison of two screening and treatment protocols; Hafner E et al.; OBJECTIVE: The objective was to evaluate whether the rate of neonatal group B streptococcal infection could be reduced by screening for group B streptococci during the third trimester of pregnancy . STUDY DESIGN: Two periods in which different screening and treatment protocols were applied were compared . In period A all mothers showing high-risk factors were given peripartal antibiotic coverage . In period B vaginal and rectal smears were routinely obtained in gestational week 34 and cultured for group B streptococci . If culture results were positive, the woman received peripartal antibiotics . The incidence of group B streptococcal infections and the number of peripartal antibiotic doses were established by comparing 3700 neonates (3623 mothers) in period A with 3648 neonates (3569 mothers) in period B . RESULTS: In period A, 20 group B streptococcal infections were recorded . Of these, 5 were severe to life-threatening . In period B, 4 group B streptococcal infections were observed . Two were severe and occurred in neonates born before the mothers could be screened . Another 2 were mild and occurred in neonates whose mothers had negative screening test results . The reduction was significant by the chi2 test (chi2 = 9.19, Yates' corrected P = .0024) . The rates of peripartal antibiotic treatment were 11.9% in period A and 14.5% in period B . CONCLUSION: Although no neonate died of group B streptococcal sepsis in either of the 2 periods, the protocol used in period B clearly reduced the incidence of group B streptococcal infection . The number of peripartal antibiotic doses required was not much higher than in period A . Screening for group B streptococci in week 34 seems to be a valuable contribution to further improvement of neonatal outcome. Am J Obstet Gynecol, 1998 Sep, 179(3 Pt 1), 635 - 9 International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term . Premature Rupture of the Membranes; Seaward PG et al.; OBJECTIVE: Our objective was to determine significant predictors for the development of neonatal infection in infants born to patients with premature rupture of membranes at term . STUDY DESIGN: Multivariate analysis was used to determine the significant predictors of neonatal infection in infants born to women with premature rupture of the membranes who were enrolled in the Term PROM Study . In a randomized, controlled trial, the Term PROM Study recently compared induction of labor with expectant management for premature rupture of membranes at term . RESULTS: The following variables were identified as independent predictors of neonatal infection: clinical chorioamnionitis (odds ratio 5.89, P < .0001), positive maternal group B streptococcal status (vs negative or unknown, odds ratio 3.08, P < .0001), 7 to 8 vaginal digital examinations (vs 0 to 2, odds ratio 2.37, P = .04), 24 to < 48 hours from membrane rupture to active labor (vs < 12 hours, odds ratio 1.97, P = .02), > or = 48 hours from membrane rupture to active labor (vs < 12 hours, odds ratio 2.25, P = .01), and maternal antibiotics before delivery (odds ratio 1.63, P = .05) . CONCLUSIONS: Among infants born to patients with premature rupture of membranes at term, clinical chorioamnionitis and maternal colonization with group B streptococci are the most important predictors of subsequent neonatal infection. Otolaryngol Pol, 1997, 51 Suppl 25, 168 - 70 {Diagnostic value of rapid streptococcal antigen test provided by Abbott "test pack strep A": current report}; Gajos A et al.; The upper respiratory tract infections are the most frequent infectious diseases in human . Beta haemolytic streptococcus group A is the most common etiologic factor of bacterial pharyngitis . Delayed or inadequate treatment of streptococcal pharyngitis can cause serious subsequent complications . Only a part of patients show typical features of the disease so that the diagnosis can be based on clinical appearance alone . For this reason we propose direct antigen test as a rapid useful method which allows detection of group A streptococci in throat swabs . The aim of the study is to estimate clinical value of rapid antigen test in differential diagnosis of pharyngitis in children and adults . We have performed 50 tests using commercial kit--Abbott Test Pack Strep A . Simultaneously conventional bacterial throat cultures were performed . The comparison of results acquired by both methods did not revealed any differences. Antimicrob Agents Chemother, 1998 Oct, 42(10), 2626 - 9 Rifampin concentrations in various compartments of the human brain: a novel method for determining drug levels in the cerebral extracellular space; Mindermann T et al.; Antimicrobial therapy for brain infections is notoriously difficult because of the limited extent of knowledge about drug penetration into the brain . Therefore, we determined the penetration of rifampin into various compartments of the human brain, including the cerebral extracellular space (CES) . Patients undergoing craniotomy for resection of primary brain tumors were given a standard dose of 600 mg of rifampin intravenously before the operation . A microdialysis probe (10 by 0.5 mm) was inserted into the cortex distantly from the resection and was perfused with two different rifampin solutions . Rifampin concentrations in the CES were calculated by the no-net-flux method . Intraoperatively, samples were taken from brain tumor tissue, perifocal tissue, and normal brain tissue in the case of pole resections . Rifampin concentrations in the various samples were determined by using a bioassay with Sarcinea lutea . In the various compartments, rifampin concentrations were highest within tumors (1.37 +/- 1.34 microg/ml; n = 8), followed by the perifocal region (0.62 +/- 0.67 microg/ml; n = 8), the CES (0.32 +/- 0.11 microg/ml; n = 6), and normal brain tissue (0.29 +/- 0.15 microg/ml; n = 7) . Rifampin concentrations in brain tumors do not adequately reflect concentrations in normal brain tissue or in the CES . Rifampin concentrations in the CES, as determined by microdialysis, are the most reproducible, and the least scattered, of the values for all compartments evaluated . Rifampin concentrations in all compartments exceed the MIC for staphylococci and streptococci . However, CES concentrations may be below the MICs for some mycobacterial strains. Am J Physiol, 1998 Oct, 275(4 Pt 1), G854 - 61 Localization and secretion of tissue kallikrein in peptidoglycan-induced enterocolitis in Lewis rats; Stadnicki A et al.; The plasma kallikrein-kinin system is a mediator of intestinal inflammation induced by peptidoglycan-polysaccharide from group A streptococci (PG-APS) in rats . In this study we investigated the participation of intestinal tissue kallikrein (ITK) . Lewis rats were injected intramurally with PG-APS . ITK was visualized by immunohistochemical staining . Cecal ITK concentration was measured by radioimmunoassay, and gene expression was evaluated by RNase protection assay . Kallikrein-binding protein (KBP) was evaluated in plasma by ELISA . Tissue kallikrein was identified in cecal goblet cells in both control and PG-APS-injected rats and in macrophages forming granulomas in inflamed tissues . Cecal ITK was significantly lower in acute and chronic phases of inflammation and in supernatant from in vitro cultures of inflamed cecum . ITK mRNA levels were not significantly different . Plasma KBP levels were significantly reduced in inflamed rats . The presence of tissue kallikrein in macrophages suggests participation in experimental colitis . The decrease of ITK in the inflamed intestine associated with unchanged mRNA levels suggests ITK release during intestinal inflammation. Stomatologiia (Mosk), 1998, 77(4), 17 - 9 {A comparative evaluation of modern antibacterial preparations in the treatment of a severe degree of periodontitis at a stage of exacerbation}; Dmitrieva LA et al.; Sensitivities of peptostreptococci, streptococci, Actinomyces, bacteroid, and fusobacterial strains pathogenic for the periodontium to wide-spectrum penicillines, cephalosporines, lincomycin, macrolides, metronidasole, and nitasole are compared . New macrolide antibiotics rulide . Macropene, gramicidin C, levomycetin, and rifampicin are highly effective . Some narrow-spectrum drugs, e.g . augmentin, cephalexin, and vancomycin (towards actinomycetes) were highly effective, too. Ann Fr Anesth Reanim, 1998, 17(3), 257 - 72 -Curative and preventive antibiotic therapy in infective endocarditis-; Seguin P et al.; Durack's criteria, including echocardiographic manifestations, are the current standard for the diagnosis of infective endocarditis (IE) . The most common microorganisms known to cause IE are streptococci and staphylococci, and therapeutic principles are based on an association of parenteral antibiotics, as far as possible bactericidal and prolonged . Treatment also includes the search for the source of infection and its eradication . IE with negative blood cultures requires special techniques to obtain the causal microorganisms . In about half of the cases, a nosocomial bacteriaemia results in IE in patients with a prosthetic valve . Surgery is mandatory in IE with complications and/or caused by particular microorganisms; surgery is essential in most patients with a prosthetic valve . Although the presence of specific links between some procedures and the occurrence of IE has not been clearly proven, a prevention policy is nevertheless justified, considering the morbidity and mortality . Prophylaxis is indicated in patients with the cardiac conditions at risk for IE . IE prophylaxis prevails over prophylactic antibiotics usually administered for surgery. Infect Immun, 1998 Oct, 66(10), 4932 - 41 Characterization of group B streptococcal invasion of human chorion and amnion epithelial cells In vitro; Winram SB et al.; Group B streptococci (GBS) have been cultured from the chorioamnionic membrane of pregnant women, usually in association with chorioamnionitis and premature labor (K . A . Boggess, D . H . Watts, S . L . Hillier, M . A . Krohn, T . J . Benedetti, and D . A . Eschenbach, Obstet . Gynecol . 87:779-784, 1996) . Colonization and infection of placental membranes can be a prelude to neonatal GBS infections even in the presence of intact membranes (R . L . Naeye and E . C . Peters, Pediatrics 61:171-177, 1978), suggesting that GBS cause chorioamnionitis or establish amniotic fluid infections by partial or complete penetration of the placental membranes . We have isolated and grown cultures of primary chorion and amnion cells from human cesarean-section placentas . This has provided a biologically relevant model for investigating GBS adherence to and invasion of the two epithelial barriers of the placental membrane . GBS adhered to chorion cell monolayers to a high degree . Pretreatment of GBS with trypsin reduced adherence up to 10-fold, which suggested that the bacterial ligand(s) was a protein . GBS invaded chorion cells at a high rate in vitro, and invasion was dependent on cellular actin polymerization . GBS could be seen within intracellular vacuoles of chorion cells by transmission electron microscopy . We also demonstrated that GBS were capable of transcytosing through intact chorion cell monolayers without disruption of intracellular junctions . GBS also adhered to amnion cells; in contrast, however, these bacteria failed to invade amnion cells under a variety of assay conditions . GBS interactions with the chorion epithelial cell layer shown here correlate well with epidemiological and pathological studies of GBS chorioamnionitis . Our data also suggest that the amnion cell layer may provide an effective barrier against infection of the amniotic fluid. Infect Immun, 1998 Oct, 66(10), 4593 - 601 Streptococcus pyogenes serotype M1 encodes multiple pathways for entry into human epithelial cells; Cue D et al.; The ability of a serotype M1 strain of Streptococcus pyogenes to efficiently invade A549 human lung epithelial cells was previously shown to be dependent on bacterial exposure to human or bovine serum proteins or synthetic peptides containing the sequence RGD . In this study, stimulation by invasion agonists was determined to be dependent on expression of the streptococcal cell surface protein, M1 . Fetal bovine serum (FBS), fibronectin (Fn), the extracellular matrix protein laminin (Lm), and RGD-containing peptides were tested for their abilities to promote epithelial cell invasion and adherence by isogenic M1(+) and M1(-) strains of S . pyogenes . In the absence of an agonist, invasion and adherence were comparable for the two bacterial strains . FBS, Fn, and Lm stimulated invasion of the M1(+) strain as much as 70-fold but failed to significantly affect invasion by the M1(-) mutant . Adherence of the wild-type strain was stimulated by these same agonists . Epithelial cell adherence by the M1(-) strain, however, was unaffected by the presence of Fn or Lm . Several RGD-containing peptides were found to promote invasion independently of M1 expression . Binding of 125I-Fn was reduced 88% by the M1(-) mutation and Fn was found to bind purified M1 protein, suggesting that Fn mediates invasion by direct binding to M1 . To determine if host integrins might be involved in internalization of streptococci, several anti-integrin monoclonal antibodies (MAbs) were tested for their abilities to inhibit invasion . Antibody directed against integrin beta1 inhibited FBS-, Fn-, and Lm-mediated invasion but did not abrogate RGD-peptide-stimulated invasion . MAb directed against the epithelial cell Fn receptor, integrin alpha5beta1, inhibited Fn and FBS-mediated invasion but did not specifically inhibit Lm-mediated invasion . These results indicate that S . pyogenes has evolved multiple mechanisms for invasion of eukaryotic cells, at least two of which involve interactions between M1 protein, host integrins, and integrin ligands. Ann Dermatol Venereol, 1997, 124(5), 384 - 9 {Pristinamycin versus oxacillin in the treatment of superficial pyoderma . A multicenter randomized study in 293 outpatients}; Bernard P et al.; BACKGROUND: Superficial pyoderma occurs frequently . Generally, the benign infection is caused by Staphylococcus aureus and/or a group A streptococci . The subject is controversial, but treatment usually is based on narrow-spectrum antibiotics active against both germs . PATIENTS AND METHODS: A multicentric, randomized, double-blind, double-placebo study was conducted to compare pristinamycin (1 g b.i.d.) with a reference antibiotic, oxacillin (1 g b.i.d.) for 10 days . Inclusion criteria were: both sexes, age 15-80 years, clinical diagnosis of superficial pyoderma (impetigo, wound infection within the last 15 days, furunculosis, carbuncle, perionyxis), informed consent . The general practitioner investigators (n = 52) were assisted by 9 dermatologist-coordinators . Clinical diagnosis was validated by a committee of experts at the end of the study after analyzes of the photos and bacteriological results obtained on samples taken at the practitioner's office on visit 1 (D0), visit 3 (D14 +/- 3) and visit 4 (D25 +/- 3) . Successful treatment was defined by clinical, bacteriological and photographic efficacy at visit 3 (equivalence analysis: one-way 95 p . 100 confidence interval) . RESULTS: There were 293 included patients given pristinamycin (n = 151) or oxacillin (n = 142) . Mean age of analyzed patients was 40 +/- 17 years . Diagnosis was confirmed in 255 patients in accordance with the protocol: furunculosis or carbuncle (n = 100), recently superinfected wound (n = 97), impetigo (n = 41), acute perionyxis (n = 17) . Thirty-five patients (12 p . 100) were considered to have been wrongly included . The germs most often isolated were: Staphylococcus aureus (n = 126), group A streptococci (n = 13), group B streptococci (n = 5) and P . multocida (n = 3) . At visit 3, the two treatments were found to be equivalent with a success rate of 86.7 p . 100 for pristinamycin and 89.8 p . 100 for oxacillin (CI {*9.97}) . Tolerance was statistically comparable between the two treatments (27 to 32 percent minor side effects) . DISCUSSION: This study is the first performed in outpatients attended by general practitioners with diagnostic confirmation on both bacteriological and photographic evidence of superficial pyoderma . The results obtained demonstrate the good reliability of such studies although 12 p . 100 of the patients were wrongly included, a factor which should be taken into account for future studies . The efficacy and tolerance of pristinamycin were statistically equivalent to those of oxacillin for all the patients with superficial pyoderma . Nevertheless, the subgroup of patients with folliculitis gave rather heterogeneous bacteriology and therapeutic results. Laryngoscope, 1998 Sep, 108(9), 1325 - 8 Efficacy of tonsillectomy for recurrent throat infection in adults; Mui S et al.; OBJECTIVE/HYPOTHESIS: Sore throats result in health care visits, use of oral antibiotics, and days off work or school for many patients who do not meet American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for tonsillectomy . We sought to determine whether tonsillectomy would benefit this group . STUDY DESIGN: Retrospective analysis of the medical records of all patients aged 16 years or older who had tonsillectomy at our institution between 1988 and 1993 . METHODS: Number of clinic visits, number of throat cultures positive for streptococci, and number of prescriptions for oral antibiotics recorded for 147 patients during the 2-year periods before and after tonsillectomy were tabulated . Statistical comparisons were made using the Student's t test . Mean number of clinic visits and oral antibiotics prescribed for throat infection before tonsillectomy were significantly higher than after tonsillectomy . RESULTS: Patients who had throat cultures positive for streptococci had more preoperative clinic visits and use of oral antibiotics than patients whose throat cultures were not positive for streptococci . When surveyed by telephone, most (>87%) of the respondents reported that they had fewer and less severe sore throats, required fewer days off work or school, and would recommend the procedure . CONCLUSIONS: Our results suggest that early tonsillectomy in patients with recurrent throat infection may result in improved patient satisfaction, better health, and improved utilization of medical resources. Arch Otolaryngol Head Neck Surg, 1998 Sep, 124(9), 993 - 5 Persistence of group A beta-hemolytic streptococci in toothbrushes and removable orthodontic appliances following treatment of pharyngotonsillitis; Brook I et al.; OBJECTIVE: To investigate the persistence of group A beta-hemolytic streptococci (GABHS) in toothbrushes and removable orthodontic appliances (ROAs) in children who suffer from acute GABHS pharyngotonsillitis and the association with penicillin treatment failure . SETTING: Private practice setting . PATIENTS AND METHODS: Pharyngotonsillar and toothbrush cultures were obtained from 104 children with acute GABHS pharyngotonsillitis before and after 10 days of penicillin V potassium therapy . Cultures of ROAs were also obtained from 21 children . The persistence of GABHS in 10 daily rinsed and 10 nonrinsed toothbrushes was studied in vitro . RESULTS: Group A beta-hemolytic streptococci were isolated from 11 (11%) of the toothbrushes and 18 (17%) of the patients after the completion of penicillin therapy . Toothbrushes of 5 (28%) of the 18 children who harbored GABHS were colonized with the organism . Group A beta-hemolytic streptococci were also isolated from 4 (19%) of 21 ROAs after therapy . In vitro studies illustrated the persistence of GABHS in nonrinsed toothbrushes for up to 15 days . In contrast, the organism was not isolated from rinsed toothbrushes beyond day 3 . CONCLUSION: Toothbrushes and ROAs that harbor GABHS may contribute to the persistence of GABHS in the oropharynx and may account for the failure of penicillin therapy in some cases of pharyngotonsillitis. J Clin Microbiol, 1998 Oct, 36(10), 2844 - 6 PCR for detection and identification of Abiotrophia spp; Roggenkamp A et al.; Members of the genus Abiotrophia, formerly known as nutritionally variant streptococci, are important pathogens causing septicemia and endocarditis . Cultivation and biochemical differentiation of Abiotrophia spp . are often difficult . Based on 16S rRNA sequences, two PCR assays for detection and identification of Abiotrophia spp . were developed . The first PCR assay was positive for all Abiotrophia spp . Subsequently performed restriction fragment length polymorphism analysis allowed the verification of the PCR amplicons and the differentiation of the three species . The second PCR assay was positive only for A . elegans, the most fastidious species of Abiotrophia . Both PCR assays were shown to be specific and sensitive and should facilitate the identification of Abiotrophia spp. Rev Clin Esp, 1998 Jul, 198(7), 413 - 9 {Brain abscess . Clinicomicrobiologic study and prognostic analysis of 59 cases}; Blanco Garcia A et al.; INTRODUCTION: Clinical, microbiological, therapeutic and prognostic characteristics of brain abscesses were analyzed as well as the influence of CT in their evolution . MATERIALS AND METHODS: Retrospective study of 59 patients with the diagnosis of brain abscess of bacterial source before (group A) and after (group B) the introduction of CT (25 and 34 patients, respectively) . RESULTS: The most common symptom was headache (76.3%) and the most common abnormality in physical examination was a decrease in the level of consciousness (61%) and this abnormality was associated with a higher mortality rate (13% versus 41.6%; p < 0.05) and also a higher proportion of neurologic sequelae (50% versus 85.7%; p < 0.05) . The diagnosis was obtained earlier in group B . The hematogenous source predominated (32.2%); an adjacent source was identified in 28.8% and an apparent source was not recognized in 27.2% (40% in group A versus 17.6% in group B) . Anaerobic and microaerophilic streptococci were the bacteria recovered most frequently . Gram-negative aerobic bacteria were the most common in otogenic abscesses . The use of corticosteroids had no influence upon mortality, but it was associated with a lower percentage of neurological sequelae (40% versus 14%; p < 0.05) . The introduction of CT decreased mortality (40% in group A versus 23.5% in group B, although this difference was not significant) and also sequelae (86.6% in group A versus 57.6% in group B; p < 0.05) . Leaving apart cases of bacterial endocarditis, in which death was due to the underlying heart disease and a systemic sepsis picture, mortality attributed to brain abscess was 20.3% . CONCLUSIONS: The introduction of CT has meant a significant breakthrough for the diagnosis, treatment and follow-up of these patients and has contributed to improvement in survival . In our series, the diagnosis of brain abscess was obtained earlier and the number of brain abscesses with no apparent source has decreased since the introduction of CT . Moreover, CT sensitivity is really good for locating multiple abscesses . Overall, the prognosis of these patients has improved since the introduction of this technique . Nevertheless, brain abscess is still associated with a relevant morbi-mortality rate. Antimicrob Agents Chemother, 1998 Sep, 42(9), 2452 - 5 In vitro activity of the new glycopeptide LY333328 against multiply resistant gram-positive clinical isolates; Garcia-Garrote F et al.; The in vitro activity of LY333328 was compared with those of vancomycin and teicoplanin against 425 gram-positive clinical isolates, including a variety of multiply resistant strains . LY333328 at </=4 microgram/ml inhibited all microorganisms tested, including methicillin- and teicoplanin-resistant staphylococci, glycopeptide-resistant enterococci, penicillin- and multiply resistant pneumococci, and viridans and beta-hemolytic streptococci. Antimicrob Agents Chemother, 1998 Sep, 42(9), 2188 - 92 Pharmacodynamic analysis of the activity of quinupristin-dalfopristin against vancomycin-resistant Enterococcus faecium with differing MBCs via time-kill-curve and postantibiotic effect methods; Aeschlimann JR et al.; Quinupristin-dalfopristin (Q-D) is a new water-soluble, semisynthetic antibiotic that is derived from natural streptogramins and that is combined in a 30:70 ratio . A number of studies have described the pharmacodynamic properties of this drug, but most have investigated only staphylococci or streptococci . We evaluated the relationship between Q-D, quinupristin (Q), and/or dalfopristin (D) susceptibility parameters and antibacterial activities against 22 clinical isolates of vancomycin-resistant Enterococcus faecium (VREF) by using the concentration-time-kill-curve method and by measuring postantibiotic effects . Q-D, Q, and D MICs and minimum bactericidal concentrations (MBCs) ranged from 0.125 to 1 and 0.25 to 64, 8 to 512 and >512, and 2 to 8 and 8 to 512 microgram/ml, respectively . There were no significant relationships between susceptibilities to the individual components and the susceptibilities to the Q-D combination product . In the time-kill-curves studies, Q-D at a concentration of 6 microgram/ml was at least bacteriostatic against all VREF tested . There was increased activity against more susceptible isolates when the isolates were grouped either by Q-D MBCs or by Q MICs . By multivariate regression analyses, the percent change in the inoculum from that at the baseline was significantly correlated with the Q MIC (R = 0.74; P = 0.008) and the Q-D concentration-to-MBC ratio (R = 0.58; P = 0.02) and was inversely correlated with the Q-D MBC-to-MIC ratio (R = 0.68; P = 0.003) . A strong correlation existed between the killing rate and the Q-D concentration-to-MBC ratio (R = 0.99; P < 0.0001) . Time to 99.9% killing was best correlated with the Q-D MBC (R = 0.96; P < 0.0001) . The postantibiotic effect ranged from 0.2 to 3.2 h and was highly correlated with the Q-D concentration-to-MBC ratio (R = 0.96; P < 0.0001) and was less highly correlated with the Q MIC (R = 0.42; P = 0.04) . Further study of these relationships with in vitro or in vivo infection models that simulate Q-D pharmacokinetics should further define the utility of these pharmacodynamic parameters in the prediction of Q-D activity for the treatment of VREF infections in humans. Kidney Int, 1998 Sep, 54(3), 819 - 26 Immunohistochemical and serological evidence for the role of streptococcal proteinase in acute post-streptococcal glomerulonephritis; Cu GA et al.; BACKGROUND: We have previously demonstrated the preferential secretion of streptococcal proteinase or streptococcal pyrogenic exotoxin B (SPEB) by nephritic strains of Group A streptococci isolated from the skin or throat of patients with acute poststreptococcal glomerulonephritis (APSGN) . METHODS: To further explore the possible role of SPEB in APSGN, we performed ELISA studies to detect anti-SPEB antibodies in the sera of patients with APSGN, acute rheumatic fever (ARF), scarlet fever (SF) and normal children . Using ELISA, anti-SPEB titers on acute and convalescent APSGN sera were measured to determine immunity to APSGN . We also performed immunofluorescence studies on APSGN and non-APSGN kidney biopsies to probe for the presence and localization of SPEB . RESULTS: Our data show that anti-SPEB antibodies are present in APSGN sera and antibody titers are significantly higher than in ARF, SF and normal sera . Anti-SPEB titers tend to rise acutely and decrease with time but do not reach baseline after one year . When kidney biopsies were probed with rabbit anti-SPEB antibody, 12 of 18 (67%) of the APSGN cases were positive while only 4 of 25 (16%) of the non-APSGN cases were positive . CONCLUSIONS: In summary, we were able to demonstrate unique reactivity to SPEB in human sera and kidney biopsies of APSGN suggesting a significant role of this toxin in the pathogenesis of acute post-streptococcal glomerulonephritis. Int J Syst Bacteriol, 1998 Jul, 48 Pt 3, 921 - 7 Streptococcus peroris sp . nov . and Streptococcus infantis sp . nov., new members of the Streptococcus mitis group, isolated from human clinical specimens; Kawamura Y et al.; Taxonomic studies were performed on eight strains of alpha-haemolytic streptococci that showed very low DNA-DNA hybridization similarity values with all established members of the mitis group of the genus Streptococcus . These strains were isolated from the tooth surface and pharynx of humans . 16S rRNA gene sequence analysis showed that these strains belonged to the mitis group, but that they fell into two new branches . DNA-DNA hybridization demonstrated two new similarity groups . From the results of the present study, the names Streptococcus peroris sp . nov . and Streptococcus infantis sp . nov . are proposed for these new groups . The type strains are O-66T (= GTC 848T = JCM 10158T) and O-122T (= GTC 849T = JCM 10157T), respectively. J Biol Chem, 1998 Sep 18, 273(38), 24420 - 4 Kringle 2 mediates high affinity binding of plasminogen to an internal sequence in streptococcal surface protein PAM; Wistedt AC et al.; Many cells express receptors for plasminogen (Pg), although the responsible molecules in most cases are poorly defined . In contrast, the group A streptococcal surface protein PAM contains a domain with two 13-amino acid residue long repeated sequences (a1 and a2) responsible for Pg binding . Here we identify the region in Pg that interacts with PAM . A radiolabeled proteolytic plasminogen fragment containing the first three kringles (K1-K3) interacted with streptococci expressing PAM or a chimeric surface protein harboring the a1a2 sequence . In contrast, plasminogen fragments containing kringle 4 or kringle 5 and the activable serine proteinase domain failed to bind to PAM-expressing group A streptococci . A synthetic and a recombinant polypeptide containing the a1a2 sequence both bound to immobilized recombinant K2 (rK2) but not to rK1 or rK3 . The interaction between the a repeat region and rK2 was reversible, and rK2 completely blocked the binding of Pg to the a1a2 region . The binding of the a repeat containing polypeptide to K2 occurred with an equilibrium association constant of 4.5 x 10(7) M-1, as determined by surface plasmon resonance, a value close to that (1.6 x 10(7) M-1) calculated for the a1a2-Pg interaction . Inhibition experiments suggested involvement of the lysine-binding site of K2 in the interaction . These data demonstrate that K2 contains the major Pg-binding site for PAM, providing the first well defined example of an interaction between an internal Pg-binding region in a protein and a single kringle domain. J Bacteriol, 1998 Sep, 180(18), 4955 - 9 Molecular analysis of the capsule gene region of group A Streptococcus: the hasAB genes are sufficient for capsule expression; Ashbaugh CD et al.; Enzymes directing the biosynthesis of the group A streptococcal hyaluronic acid capsule are encoded in the hasABC gene cluster . Inactivation of hasC, encoding UDP-glucose pyrophosphorylase in the heavily encapsulated group A streptococcal strain 87-282, had no effect on capsule production, indicating that hasC is not required for hyaluronic acid synthesis and that an alternative source of UDP-glucose is available for capsule production . Nucleotide sequence and deletion mutation analysis of the 5.5 kb of DNA upstream of hasA revealed that this region is not required for capsule expression . Many (10 of 23) group A streptococcal strains were found to contain insertion element IS1239' approximately 50 nucleotides upstream of the -35 site of the hasA promoter . The presence of IS1239' upstream of hasA did not prevent capsule expression . These results elucidate the molecular architecture of the group A streptococcal chromosomal region upstream of the has operon, indicate that hasABC are the sole components of the capsule gene cluster, and demonstrate that hasAB are sufficient to direct capsule synthesis in group A streptococci. Cell Immunol, 1998 Aug 1, 187(2), 145 - 50 Protein I/II of oral viridans streptococci increases expression of adhesion molecules on endothelial cells and promotes transendothelial migration of neutrophils in vitro; Vernier-Georgenthum A et al.; As accumulation of leukocytes in perivascular tissues is a key step in inflammatory disorders, we have analyzed in the present work the up-regulation of expression of adhesion molecules, such as E-selectin, ICAM-1, and VCAM-1, on human endothelial cells, in response to protein I/II, a modulin from Streptococcus mutans OMZ 175 . Using cultured human saphenous vein endothelial cells (HSVEC), we demonstrated that protein I/II directly and specifically up-regulated E-selectin, ICAM-1, and VCAM-1 expression . We confirmed also that the up-regulation of adhesion molecules in HSVEC is mediated by lectin activity for NANA- and fucose-containing receptors . The ability of protein I/II to promote the transendothelial migration of neutrophils was then examined . Using Transwell inserts, we found that protein I/II, in promoting the up-regulation of adhesion molecule expression, stimulates neutrophil migration through endothelial cells . These events may play a role in the etiology of inflammatory responses leading to the various pathologies associated with oral viridans streptococci. Zentralbl Bakteriol, 1998 Jul, 288(1), 13 - 21 Influence of the phosphorylation state on the biological activity of a low-molecular mitogen from group A streptococci; Ozegowski JH et al.; A low molecular weight mitogen (LMP) from Streptococcus pyogenes strain NY 5 was successively purified by adsorption on phenylsepharose, chromatography on Resource S and Superdex G 30 and finally by affinity chromatography on antiphosphothreonine agarose . The N-terminal protein sequence of the mitogen was determined . The occurrence of phosphoamino acids was investigated by immunoassay using monoclonal antibodies . The LMP is a threonine-phosphorylated protein different of HPR protein of PTS-system, its mitogenic activity was lost after treatment with streptococcal protein phosphatase or alkaline phosphatase . The inactivated LMP was activated by phosphorylation with phosphokinase and ATP . The active LMP was also inactivated in streptococcal cultures secreting acid protein phosphatase during the phase of phosphate limitation. J Infect Dis, 1998 Sep, 178(3), 875 - 8 Interferon-gamma-induced activation of indoleamine 2,3-dioxygenase in cord blood monocyte-derived macrophages inhibits the growth of group B streptococci; MacKenzie CR et al.; Neonatal sepsis is most often caused by group B streptococci (GBS) and is a major cause of death in the neonatal period . The response of the immune system in the newborn child has received much attention and is thought to be deficient in a number of ways . The effector response of neonatal monocyte-derived macrophages (MDM) was investigated . Interferon-gamma induced the activation of indoleamine 2,3-dioxygenase in MDM and inhibited the growth of GBS . Both effects were enhanced by the addition of tumor necrosis factor-alpha to the culture conditions . The coincident supplementation of L-tryptophan with the bacteria abrogated the bacterial growth inhibition, thus confirming the causative role of L-tryptophan depletion . Control of the extracellular as well as intracellular L-tryptophan levels may thus be one of the effector mechanisms with which the immune system defends the host against GBS dissemination and disease. Pediatr Infect Dis J, 1998 Aug, 17(8 Suppl), S62 - 7 Microbial factors leading to recurrent upper respiratory tract infections; Brook I; The treatment or prophylaxis of upper respiratory tract infections such as otitis media, sinusitis and tonsillitis with penicillins can generate bacterial resistance caused by production of beta-lactamase or changes in the penicillin-binding proteins . This resistance can spread in the community even to untreated individuals . The prevalence of resistant organisms tends to increase in the winter months . Beta-lactamase-producing bacteria may interfere with the eradication of penicillin-susceptible organisms and may account for substantial numbers of therapeutic failures among cases of otitis media, sinusitis and tonsillitis . The presence of normal flora that possess interfering capabilities against potential pathogens is beneficial to the host . Such flora may enhance recovery and prevent infections of the tonsils by group A beta-hemolytic streptococci . Therapeutic use of antimicrobial agents that preserve the normal flora but overcome penicillin-susceptible or -resistant pathogens may enhance recovery from upper respiratory tract infections. Antibiot Khimioter, 1998, 43(7), 26 - 30 {Susceptibility of beta-hemolytic streptococci to antibiotics and alternative drugs}; Kondrakova OA et al.; Antibiotic susceptibility of the circulating beta-hemolytic streptococci of serogroups A, B, C and G isolated from healthy and sick children and adults within 1987-1996 (more than 900 cultures) was studied . It was shown that the MICs of betalactam antibiotics did not change (within the susceptibility levels) with respect to the serogroup A, C and G streptococci . The number of the strains resistant to erythromycin and lincomycin increased the same as the frequency of the strains simultaneously resistant to chloramphenicol, tetracycline and gentamicin . Tomicid and solkarmon, drugs alternative to antibiotics, were found to be active against the above streptococci groups and efficient in the treatment and prophylaxis of streptococcoses . A suggestion that betalactams are not safe in the treatment of the toxic shock syndrome due to the group A streptococci is discussed. J Neuroimmunol, 1998 Aug 14, 89(1-2), 191 - 7 Inhibition of group B streptococcal growth by IFN gamma-activated human glioblastoma cells; Mackenzie CR et al.; Group B streptococci are the most important bacteria inducing neonatal septicemia and meningitis . The aim of this study was to assess the role of IFNgamma in the induction of anti-microbial effector mechanisms in human brain tumor cells . Different human glioblastoma/astrocytoma cell lines, stimulated with IFNgamma, restricted the growth of group B streptococci . In addition, we found that TNF alpha is able to enhance the IFNgamma-mediated anti-microbial effect . In contrast to group B streptococci, other bacteria which are also capable of inducing meningitis, like E . coli and all but one of the tested Streptococcus pneumoniae strains, were not influenced by the IFNgamma treated cells . We found that the IFNgamma or the IFNgamma/TNF alpha induced activation of indoleamine 2,3-dioxygenase is responsible for the inhibition of streptococcal growth, since the addition of supplemental L-tryptophan completely blocks the IFNgamma induced bacteriostasis. J Biol Chem, 1998 Sep 11, 273(37), 23668 - 73 An ectoprotein kinase of group C streptococci binds hyaluronan and regulates capsule formation; Nickel V et al.; A 56-kDa protein had been isolated and cloned from protoplast membranes of group C streptococci that had erroneously been identified as hyaluronan synthase . The function of this protein was reexamined . When streptococcal membranes were separated on an SDS-polyacrylamide gel and renatured, a 56-kDa protein was detected that had kinase activity for a casein substrate . When this recombinant protein was expressed in Escherichia coli and incubated in the presence of {32P}ATP, it was responsible for phosphorylation of two proteins with 30 and 56 kDa that were not present in the control lysate . The 56-kDa protein was specifically phosphorylated in an immunoprecipitate of a detergent extract of the recombinant E . coli lysate with antibodies against the 56-kDa protein, indicating that it was autophosphorylated . The E . coli lysate containing the recombinant protein could bind hyaluronan, and hyaluronan binding was abolished by the addition of ATP . Kinetic analysis of hyaluronan synthesis and release from isolated protoplast membranes indicated that phosphorylation by ATP stimulated hyaluronan release and synthesis . Incubation of membranes with antibodies to the 56-kDa protein increased hyaluronan release . The addition of {32P}ATP to intact streptococci led to rapid phosphorylation of two proteins, 56 and 75 kDa each at threonine residues . This phosphorylation was neither observed with {32P}phosphate nor in the presence of trypsin, indicating that the kinase was localized extracellularly . The addition of ATP to growing group C streptococci led to increased hyaluronan synthesis and release . However marked differences were found between group A and group C streptococci . Antibodies against the 56-kDa protein from group C streptococci did not recognize proteins from group A strains, and a homologous DNA sequence could not be detected by polymerase chain reaction or Southern blotting . In addition, Group A streptococci did not retain a large hyaluronan capsule like group C strains . These results indicated that the 56-kDa protein is an ectoprotein kinase specific for group C streptococci that regulates hyaluronan capsule shedding by phosphorylation. Med Pregl, 1998 May-Jun, 51(5-6), 275 - 8 {Significance of normal oropharyngeal flora in the development of streptococcal pharyngitis and outcome of penicillin therapy}; Mihajlovic-Ukropina M et al.; Pharyngitis is one of the most frequent diseases in children . The most important of the bacterial infections is due to Streptococcus pyogenes . For many years, penicillin is considered to be the drug of choice for streptococcal pharyngitis, although failure rates of up to 20% have been reported . One of possible explanations for penicillin treatment failure is presence of other species of bacteria in the normal oropharyngeal flora that can interfere with colonization and growth of Streptococcus pyogenes and influence the development of pharyngitis . A wide variety of microorganisms, including alpha-haemolytic streptococci and anaerobic bacteria, are present within the oropharynx (table 1) . The strain of alpha-haemolytic streptococci is in interference with Streptococcus pyogenes . By producing bacteriocins, they inhibit colonization and growth of Streptococcus pyogenes and assist in its eradication . Anaerobic bacteria may play a direct or indirect role in development of pharyngitis . They may be directly responsible for specific forms of pharyngitis or contribute indirectly with possibility of synergy between them and Streptococcus pyogenes . Beta-lactamase-producing aerobic and anaerobic organisms may contribute to penicillin treatment failure . By producing beta-lactamase within the tonsillar tissue, they destroy penicillin and protect streptococci from the antibacterial effect of penicillin . Pharyngeal bacterial flora may vary according to the state of the patient (Figure 1) . During an acute infection and in the cases of treatment failure and recurrent pharyngitis the number of alpha-haemolytic streptococci declines, while there is an increase in the number of anaerobic and beta-lactamase-producing organisms . After successful treatment the number and type of bacteria is similar to those found within normal tissue . Knowing the distribution and changes in pharyngeal bacterial flora is important for choosing the optimal drug for treatment of streptococcal pharyngitis . Although penicillin reduces the number of interfering beta-haemolytic streptococci, because of its advantages, if remains the drug of choice for the treatment of streptococcal pharyngitis . In cases of treatment failure and recurrent infections cephalosporins and macrolides may be a useful alternative to penicillin because they possess relatively poor activity against alpha-haemolytic streptococci, resistance to beta-lactamase and because of better penetration into tonsilar tissue. Microbiology, 1998 Aug, 144 ( Pt 8), 2025 - 35 Site-directed mutagenesis of streptococcal plasmin receptor protein (Plr) identifies the C-terminal Lys334 as essential for plasmin binding, but mutation of the plr gene does not reduce plasmin binding to group A streptococci; Winram SB et al.; Plasmin(ogen) binding is a common property of many pathogenic bacteria including group A streptococci . Previous analysis of a putative plasmin receptor protein, Plr, from the group A streptococcal strain 64/14 revealed that it is a glyceraldehyde-3-phosphate dehydrogenase and that the plr gene is present on the chromosome as a single copy . This study continues the functional characterization of Plr as a plasmin receptor . Attempts at insertional inactivation of the plr gene suggested that this single-copy gene may be essential for cell viability . Therefore, an alternative strategy was applied to manipulate this gene in vivo . Site-directed mutagenesis of Plr revealed that a C-terminal lysyl residue is required for wild-type levels of plasmin binding . Mutated Plr proteins expressed in Escherichia coli demonstrated reduced plasmin-binding activity yet retained glyceraldehyde-3-phosphate dehydrogenase activity . A novel integration vector was constructed to precisely replace the wild-type copy of the plr gene with these mutations . Isogenic streptococcal strains expressing altered Plr bound equivalent amounts of plasmin as wild-type streptococci . These data suggest that Plr does not function as a unique plasmin receptor, and underscore the need to identify other plasmin-binding structures on group A streptococci and to assess the importance of the plasminogen system in pathogenesis by inactivation of plasminogen activators and the use of appropriate animal models. J Indian Med Assoc, 1998 Feb, 96(2), 46 - 50 A clinicobacteriological study on leucorrhoea; Chaudhuri M et al.; The pathogens like Trichomonas vaginalis (4.5%), N gonorrhoeae (2.7%) and C albicans (6.7%) were exclusively present in leucorrhoea . The other potential agents with their respective percentages in normal women and cases of leucorrhoea were U urealyticum (21.2% and 50.2%), actinomyces (29.7% and 41.6%), Chlamydia trachomatis (17% and 48.8%), candida-like organisms (CLO) (1.2% and 9.5%) and non-group B streptococci (4.2% and 16.7%) . The percentages of urethral syndrome (65.8%), vaginal irritation (63.4%), sore vulva (17%), cervicitis (13.4%), cervical erosion (11%) of the STD clinic were more than those of gynaecological cases . The latter group more often revealed infertility (15.8%) and pelvic inflammatory disease (13.6%) . The exclusive isolation rate of N gonorrhoeae (7.3%) and prevalence of G vaginalis (19.5%) and Trichomonas vaginalis (8.5%) in the STD clinic were notable . The cases of gynaecological clinic more commonly showed C albicans (8%) and CLO (13.6%) . Significant differences pertaining to U urealyticum (leucorrhoea and inapparent group p < 0.01; leucorrhoea and normal cases p < 0.01), M hominis (leucorrhoea and inapparent group p < 0.05; leucorrhoea and normal cases p < 0.01), Chlamydia trachomatis (leucorrhoea and normal cases p < 0.01) and also actinomyces (leucorrhoea and normal cases p < 0.01; inapparent and normal cases p < 0.05) were recorded . There was conspicuous association of U urealyticum, M hominis, G vaginalis, Chlamydia trachomatis, CLO and actinomyces with leucorrhoea . An almost exclusive presence of Staph aureus, Esch coli and Klebsiella in cases of leucorrhoea appeared meaningful. Am Fam Physician, 1998 Aug, 58(2), 405 - 8, 411 Henoch-Schönlein purpura: a review; Kraft DM et al.; Henoch-Schonlein purpura is an IgA-mediated, autoimmune, hypersensitivity vasculitis of childhood that results in a triad of symptoms, including a purpuric rash occurring on the lower extremities, abdominal pain or renal involvement, and arthritis . However, any of the triad may be absent, which often leads to confusion in diagnosing the condition . Although the cause is unknown, Henoch-Schonlein purpura is often associated with infectious agents such as group A streptococci and Mycoplasma . It has also been associated with food reactions, exposure to cold, insect bites and drug allergies . Treatment is supportive, and children affected by this disorder need close follow-up of renal status. Infect Immun, 1998 Sep, 66(9), 4418 - 24 Immunological relationship between the class I epitope of streptococcal M protein and myosin; Quinn A et al.; The class I epitope of streptococcal M protein is an epidemiological marker for acute rheumatic fever (ARF)-associated serotypes of group A streptococci and is recognized by anti-M protein monoclonal antibody (MAb) 10B6 . Using MAb 10B6, we determined the relationship between the class I epitope of M protein and the alpha-helical coiled-coil protein myosin . MAb 10B6 reacted by enzyme-linked immunosorbent assay and Western blotting with human cardiac myosin and rabbit skeletal myosin and its heavy meromyosin (HMM) subfragment . Overlapping synthetic peptides of M5 protein were used to identify the region of M5 protein recognized by MAb 10B6 . Two C repeat peptides (C2A and C3) containing the amino acid sequence KGLRRDLDASREAK reacted with MAb 10B6 . Partial sequence identity, RRDL, was found in the HMM fragment of myosin, which reacted with MAb 10B6 . However, not all peptides of M5 protein and myosin containing the RRDL sequence reacted with MAb 10B6 . ARF sera and sera from uncomplicated pharyngitis (UNC) reacted with C repeat region peptides of M protein, while acute glomerulonephritis sera were not as reactive . Affinity-purified human antibody to peptide C3 reacted with myosin . The data demonstrate that the class I epitope of M protein is immunologically cross-reactive with myosin and the HMM subfragment, and antibodies to peptide C3 and myosin were present in ARF and UNC sera. Infect Immun, 1998 Sep, 66(9), 4347 - 54 Deletion of repeats in the alpha C protein enhances the pathogenicity of group B streptococci in immune mice; Gravekamp C et al.; The alpha C protein is a protective surface-associated antigen of group B streptococci (GBS) . The prototype alpha C protein of GBS (strain A909) contains nine identical tandem repeats, each comprising 82 amino acids, flanked by N- and C-terminal domains . Clinical isolates of GBS show variable numbers of repeats with a normal distribution and a median of 9 to 10 repeats . Here, we show that escape mutants of GBS expressing one-repeat alpha C protein were 100-fold more pathogenic than GBS expressing wild-type nine-repeat alpha C protein in neonatal mice whose dams were immunized with antiserum elicited to nine-repeat alpha C protein (50% lethal doses of 1.6 x 10(3) and 1.8 x 10(5), respectively; P = 0.0073) . There was no difference in pathogenicity in nonimmune mice . Enzyme-linked immunosorbent assay inhibition showed that nine-repeat but not one-repeat alpha C protein is readily available for antibody binding on the surface of intact GBS . Immune electron microscopy studies with antibodies to the capsular polysaccharide (CPS) and to the alpha C protein demonstrated localization of the nine-repeat alpha C protein and the CPS at similar distances from the cell wall . The one-repeat alpha C protein was visualized poorly and only in close proximity to the cell wall, thus suggesting that antibody binding to the protein was hindered by CPS or other cell surface components . We concluded that deletion in the repeat region of the alpha C protein enhanced the pathogenicity of GBS in immune mice by (i) loss of a protective (conformational) epitope(s) and (ii) loss of antibody binding to the alpha C protein due to a decrease in antigen size relative to cell wall components and/or CPS. Infect Immun, 1998 Sep, 66(9), 4274 - 82 Deletion of the central proline-rich repeat domain results in altered antigenicity and lack of surface expression of the Streptococcus mutans P1 adhesin molecule; Brady LJ et al.; Members of the family of surface adhesins of oral streptococci, including P1 of Streptococcus mutans, contain two highly conserved repeat domains, one rich in alanine (A region) and the other rich in proline (P region) . To assess the contribution of the P region to the biological properties of P1, an internal deletion in spaP was engineered . In addition, the P region was subcloned and expressed as a fusion partner with the maltose binding protein of Escherichia coli and liberated by digestion with factor Xa . Results of Western blot experiments in which recombinant polypeptides were probed with a panel of 11 monoclonal antibodies indicated that the P region is a necessary component of conformational epitopes within the central portion of P1 . Antibodies reactive with the P region were detected in a polyclonal rabbit antiserum generated against whole S . mutans cells but not in two rabbit antisera generated against purified P1 (Mr approximately 185,000), suggesting that this domain is immunogenic on the surface of intact bacteria but not as part of a soluble full-length molecule . Finally, transformation of a spaP-negative mutant with a shuttle vector containing an internally deleted spaP lacking P-region DNA resulted in a complete absence of surface-localized P1 and substantially less P1 in sonicated cells compared to the case for the mutant complemented with the full-length gene . These results suggest that the P region is an integral component contributing to the conformation of the central region of P1 and indicate that its presence is necessary for surface expression of the molecule on S . mutans. FEMS Microbiol Lett, 1998 Aug 1, 165(1), 117 - 22 Streptococcus salivarius urease expression: involvement of the phosphoenolpyruvate:sugar phosphotransferase system; Chen YY et al.; Urease expression in Streptococcus salivarius 57.1 is induced by acidic pH, and further enhanced at high growth rate and with excess carbohydrate . Notably, the phosphoenolpyruvate (PEP):sugar phosphotransferase system (PTS) activity is repressed in oral streptococci under the same conditions . To test the hypothesis that the PTS may be involved in urease regulation, spontaneous mutants (PTS-1 and PTS-4) that were resistant to 2-deoxyglucose were isolated . When compared to wild-type, PTS-1 was devoid of enzyme IIAManH (EIIAManII) and synthesized low amounts of EIIAManL, and PTS-4 was devoid of EIIAManL, but produced wild-type levels of EIIAManH . Urease expression was examined in continuous chemostat cultures at steady state . Induction by acidic pH was still observed in both mutants, but at lower levels compared to wild-type, under carbohydrate limiting conditions . Conversely, the lower level of expression in PTS-4 could be overcome in excess carbohydrate . The data indicated evidence of a molecular link between the PTS, sugar metabolism, and regulation of urease expression. Aust N Z J Psychiatry, 1998 Aug, 32(4), 579 - 81 Obsessive-compulsive disorder in post-streptococcal infection; Monasterio E et al.; OBJECTIVE: We describe the sudden onset of obsessive-compulsive symptoms following a peritoneal infection with alpha-haemolytic streptococci . CLINICAL PICTURE: A 35-year-old woman with no past history or family history of obsessions or compulsions developed these symptoms 2 weeks after a peritoneal infection . TREATMENT: The patient received 80 mg fluoxetine daily . OUTCOME: She responded to treatment with a progressive reduction in symptoms . CONCLUSIONS: It is suggested that these obsessions and compulsions may be related to an autoimmune response to the streptococcal infection. J Antibiot (Tokyo), 1998 Jun, 51(6), 560 - 9 Novel glycopeptide antibiotics: N-alkylated derivatives active against vancomycin-resistant enterococci; Rodriguez MJ et al.; LY264826 (A82846B) is a naturally-occurring glycopeptide antibiotic, differing from vancomycin in the stereochemistry of the amino-sugar of the disaccharide function, and the presence of a third sugar attached at the benzylic position of amino acid residue 6 . Despite these seemingly subtle differences, LY264826 is approximately 10 times more active than vancomycin against the enterococci . In the pursuit of new antibiotics active against multiresistant Gram-positive organisms, an extensive side chain SAR was developed focusing on the reductive alkylation of LY264826 at the amino function of the disaccharide moiety . A new series of derivatives having varying degrees of structural diversity in the side chain (e.g . varying lengths and degrees of rigidity) was found to have potent activity against vancomycin-resistant enterococci (MIC's < 1.0 microgram/ml) as well as activity against staphylococci and streptococci as good or better than vancomycin. Eur J Oral Sci, 1998 Aug, 106(4), 827 - 34 Effects of an oral health program on selected clinical parameters and salivary bacteria in a long-term care facility; Mojon P et al.; The aim of this study was to evaluate clinically and microbiologically the effects of a preventive oral health program in a long-term care facility . A total of 116 dentate elderly residents agreed to participate, and half of them were included in an experimental group . Almost all of the residents were mentally or physically handicapped, and many were dependent on care-givers for daily living activities . Oral examination and microbiological sampling were performed at baseline and 18 months later . The experimental group benefited from a preventive program, including an oral hygiene course for the health care providers and regular recalls by dental hygienists of the residents . After 18 months, the plaque indices were statistically similar to those at baseline in both groups . Mutans streptococci counts and active root caries at 18 months were lower compared to baseline in the experimental group but did not change significantly in the control group . Thus, it seems that, while the preventive program failed to decrease plaque indices, it was effective in reducing mutans streptococci colonisation and caries prevalence. Am J Obstet Gynecol, 1998 Jul, 179(1), 77 - 9 Compliance with the Centers for Disease Control and Prevention antenatal culture protocol for preventing group B streptococcal neonatal sepsis; Cheon-Lee E et al.; OBJECTIVE: Our purpose was to measure the compliance with the Centers for Disease Control and Prevention antenatal culture protocol for preventing group B streptococcal sepsis after extensive education of physicians and staff . STUDY DESIGN: After 2 months of educational activities to familiarize attending physicians, nurses, and laboratory staff with the guidelines, a retrospective chart review of all vaginal deliveries over a 6-month period were analyzed for protocol compliance and failures either of culturing or antibiotic use . RESULTS: Overall, there was a 20% prevalence rate of group B streptococci found at > or = 35 weeks' gestation . The enhanced broth preincubation did not significantly increase this rate . Compliance with the protocol was 80% for appropriately timed cultures and 84% for use of antibiotics; 0.7% received unindicated antibiotics . CONCLUSION: The area of greatest compliance failure was neglecting to treat women with antepartum risk factors that did not require antepartum cultures: previously affected neonates with group B streptococcal sepsis, antepartum group B streptococcal bacteriuria, and preterm labor and delivery . Twenty-one percent (14/66) of women having these antepartum risk factors were not treated . Protocol failure resulting in no cultures being done occurred in 9% of the women studied (87/956) . Further education and quality assurance activities can lower these numbers . There were no cases of group B streptococcal sepsis during the 6 months of this study. Caries Res, 1998, 32(5), 319 - 23 Association between caries prevalence and clinical, microbiological and dietary variables in 1.0 to 2.5-year-old Brazilian children; Mattos-Graner RO et al.; The association between caries prevalence and clinical (presence of visible plaque in the labial surfaces of maxillary incisors), microbiological (salivary levels of mutans streptococci) and dietary variables was evaluated in 142 1.0- to 2.5-year-old children attending public day-care nurseries in the city of Piracicaba - Sao Paulo . A significant difference in caries prevalence was observed between those children with and without visible plaque (chi2 = 12.08, p < 0.001) . The mean ds (decayed surfaces) was significantly higher in children with visible plaque on the maxillary incisors than in children without it (p < 0.001) . Mutans streptococci were detected in 114 (80.3%) of the children . A significantly higher caries prevalence was observed in children with high levels of mutans streptococci compared to children with low levels (chi2 = 28.67, p < 0.001) . The mean ds was significantly higher in children with levels of mutans streptococci greater than 50 CFU when compared to children with 0 CFU or 1-50 CFU of mutans streptococci (p < 0.05) . Children who were either never breast-fed or only until 3 months exhibited a significantly higher caries prevalence than those breast-fed for a longer time (chi2 = 4.11, p < 0.05) . A significantly higher caries prevalence was also observed between children that used bottle containing milk with sucrose and cereal than children using bottle with milk with or without sucrose (chi2 = 6.24, p < 0.05) . Children who started to eat salty meals at or after 7 months of age showed a significant higher caries prevalence than children who started earlier (chi2 = 10.30, p < 0.01) . These data support the evidence of an association between caries prevalence in young children and mutans streptococci levels, clinical and dietary factors. Pediatr Res, 1998 Aug, 44(2), 181 - 6 Effects of nebulized nitroprusside on pulmonary and systemic hemodynamics during pulmonary hypertension in piglets; Meadow W et al.; We tested the effects of nebulized nitroprusside (Neb-NP) on pulmonary and systemic hemodynamics during pulmonary hypertension induced by hypoxia or group B streptococci infusion in piglets . Twenty-three anesthetized and mechanically ventilated piglets received Neb-NP under four experimental conditions: 1) normoxia; 2) 15 and 60 min of pulmonary hypertension induced by hypoxia; 3) after pretreatment with dipyridamole; 4) pulmonary hypertension induced by infusion of group B streptococci . In addition, Neb-NP was contrasted to nebulization of tolazoline . During hypoxia-induced pulmonary hypertension, Neb-NP significantly reduced pulmonary artery pressure {PAP; -8.4+/-0.9 (SEM) mm Hg} and pulmonary vascular resistance (-25+/-2.1%) (both p < 0.001), whereas neither systemic arterial pressure nor cardiac output changed significantly . Selective pulmonary vasodilation began within 2 min of the onset of Neb-NP, and did not wane over 1 h . In contrast, within 5 min after Neb-NP was discontinued while hypoxia persisted, PAP rose significantly . Pretreatment with dipyridamole did not enhance the pulmonary vasodilation induced by Neb-NP, but did reduce systemic arterial pressure . Nebulized tolazoline did not reduce PAP significantly, but did lower systemic arterial pressure . Selective pulmonary vasodilation induced by Neb-NP was significantly smaller during group B streptococci-induced versus hypoxia-induced pulmonary hypertension . In sum, Neb-NP produced prompt, significant, selective reduction of PAP in piglets with pulmonary hypertension . Cautious extrapolation of these findings to selected clinical conditions in human infants may be warranted. Arch Intern Med, 1998 Aug 10-24, 158(15), 1704 - 8 Group B streptococcal necrotizing fasciitis and streptococcal toxic shock-like syndrome in adults; Gardam MA et al.; Necrotizing fasciitis, which is a severe and uncommon infection involving the subcutaneous tissues, is usually caused by group A streptococci . To our knowledge, however, group B streptococci (Streptococcus agalactiae) have been reported to cause necrotizing fasciitis in only 4 instances (2 involving neonates) over the past 4 decades . We report 3 cases of group B streptococcal necrotizing fasciitis in adults that occurred in southern Ontario and Quebec within a 10-month period . All 3 patients had significant underlying illness, and all required surgical debridement in addition to antibiotic therapy . One of the cases fulfilled the criteria for streptococcal toxic shock-like syndrome . Group B streptococcus has been recognized as a frequent cause of serious disease in adults . It has become evident over the past decade that invasive streptococcal infections are on the increase . We speculate that group B streptococcus has recently acquired an increased ability to cause necrotizing fasciitis and suggest that this may represent the emergence of a new clinical syndrome in adults. Obstet Gynecol, 1998 Aug, 92(2), 258 - 61 Frequent resistance of clinical group B streptococci isolates to clindamycin and erythromycin; Pearlman MD et al.; OBJECTIVE: To determine both the frequency of reported penicillin allergy in parturients and the frequency of resistance in vitro of clinical isolates of group B streptococci to clindamycin and erythromycin . METHODS: One hundred clinical isolates of group B streptococci were tested to determine the frequency of resistance to clindamycin, erythromycin, penicillin G, vancomycin, and cefazolin . The frequency of beta-lactam allergy and reported allergic reaction also were recorded for all consecutive laboring women during the 4-month study . RESULTS: The frequency of group B streptococcal resistance to clindamycin was 15% and to erythromycin was 16% . No isolates were resistant to penicillin G, vancomycin, or cefazolin . Twelve percent of the 963 women who delivered during the study reported a penicillin allergy, but only 30% of those could describe their allergic reaction . CONCLUSION: In vitro resistance of group B streptococci to clindamycin and erythromycin occurred frequently in this population . Whereas the importance of this finding in vivo is uncertain, it raises concern about the possibility of inadequate prophylaxis using currently recommended alternatives in penicillin-allergic patients . Artful questioning of women reporting penicillin allergy may lessen the likelihood of using these less desirable agents in the setting of intrapartum antimicrobial prophylaxis. Eur J Epidemiol, 1998 Jun, 14(4), 351 - 7 Prevalence of dental caries in schoolchildren in Italy; Angelillo IF et al.; The caries experience and its potential risk indicators such as socioeconomic status, sweets consumption, toothbrushing habits, dental visit attendance pattern and salivary mutans streptococci (in 12 year old only), were assessed in schoolchildren raised and living in low fluoridated areas (Catanzaro, Italy) . Caries-free prevalence in the 6-year-old was 52.9% in their primary dentition; the dmft and dmfs were 2.1 and 5.1, and both DMFT and DMFS were 0.1 . Almost 91% of the dmft was attributable to active decay . The proportion of children with a dmft+DMFT > or = 1 and the dmft and dmfs were significantly higher in those with low socio-economic status . In the 12-year-old, 52.7% had a history of caries and the DMFT and DMFS were 1.5 and 2.6; the filled component was the dominant proportion . The more likely they visited a dentist for routine checkup, the higher socio-economic status (it was not associated with DMFT), the less frequently they had sweets, and the low level of Streptococcus mutans, the more likely they were caries-free and the less likely they were to have a high DMFT, DMFS, and DT . In the 15-year-old, 68.8% had a history of caries and the DMFT and DMFS were 2.8 and 4.8, with a higher prevalence of the F component . The children who visited a dentist for routine checkup had a significantly lower caries experience, DMFT, DMFS, and DT than the irregular attenders, and those with low socio-economic background were more likely to have a high DMFS. Gen Pharmacol, 1998 Aug, 31(2), 283 - 5 Cefaclor concentration in radicular granuloma after a single oral administration; Akimoto Y et al.; 1 . Cefaclor concentrations in radicular granuloma and serum in nonfasting patients after a single oral administration of 500-mg cefaclor were assayed . 2 . The mean peak concentrations in radicular granuloma and serum were 2.57 mcg/g and 7.41 mcg/ ml, respectively . The mean ratio of granuloma/serum concentration at the peak time was 0.35 . 3 . All cefaclor concentrations in radicular granuloma at the peak time exceeded the minimal inhibitory concentration for 90% of oral streptococci (1 mcg/ml) isolated from odontogenic infection. J Antimicrob Chemother, 1998 Jun, 41 Suppl D, 7 - 11 The changing pattern of infection in neutropenic patients; Oppenheim BA; Over the past 20 years there has been a dramatic shift in the pattern of infection in neutropenic patients . During the 1970s Gram-negative organisms caused approximately 70% of all bacteraemias, but by the late 1980s the situation had reversed and approximately 70% of bacteraemias were due to Gram-positive organisms . The main contributors to this increase in Gram-positive infections have been the coagulase-negative staphylococci and the viridans streptococci . More recently, enterococci have emerged as significant pathogens in this patient group, and the development of glycopeptide resistance in the enterococci is of particular concern since this class of antibiotics is widely used in neutropenic patients . Among Gram-negative organisms, the emergence of resistance to fluoroquinolones, particularly in Escherichia coli, is a worrying feature which may lead to a reassessment of the use of quinolone prophylaxis in this setting. J Antimicrob Chemother, 1998 Jun, 41(6), 621 - 7 Antimicrobial susceptibility of viridans group streptococci in Taiwan with an emphasis on the high rates of resistance to penicillin and macrolides in Streptococcus oralis; Teng LJ et al.; The in-vitro susceptibilities of 13 antimicrobial agents were determined for 207 isolates of viridans group streptococci recovered from patients with significant infections in Taiwan during 1995 and 1997 . Variable degrees of susceptibility existed among nine species . High-level penicillin resistance (MIC > or = 4.0 mg/L) was found most frequently in Streptococcus oralis (35%), followed by Streptococcus mitis (20%) and Streptococcus salivarius (8%) . However, S . salivarius showed the lowest rate of susceptibility to penicillin (50%) . Macrolide resistance also occurred most frequently in S . oralis isolates (55%) but in none of Streptococcus mutans . Penicillin and macrolides tended to be less active against isolates recovered from non-invasive sites than against those isolated from invasive sites . Imipenem was the most active beta-lactam against penicillin-resistant isolates . Ofloxacin, vancomycin and teicoplanin showed good in-vitro activity against all isolates, with MIC90s of 2, 1 and 0.25 mg/L, respectively . None of these isolates displayed high-level resistance to gentamicin and most isolates were susceptible to chloramphenicol . These results indicate the species-related variability of susceptibility, especially to penicillin, macrolides and tetracycline . In addition to S . mitis, S . oralis also displayed high rates of resistance to penicillin and macrolides . The difference in susceptibilities between species of viridans streptococci indicates the importance of accurate identification and the need for continuing surveillance of antimicrobial resistance. J Am Dent Assoc, 1998 Jul, 129(7), 871 - 7 Caries prevention during pregnancy: results of a 30-month study; Brambilla E et al.; The purpose of this 30-month study was to explore the effectiveness of a caries-preventive regimen in lowering the salivary mutans streptococci level in pregnant women and, subsequently, in inhibiting the growth of these bacteria in their young children . Beginning at the end of the sixth month of pregnancy and continuing until delivery, subjects rinsed daily with 0.05 percent sodium fluoride and 0.12 percent chlorhexidine . The authors monitored the salivary mutans streptococci levels during the last six months of pregnancy and every six months thereafter for 24 months . They also measured bacterial levels in the children every six months until they reached age 24 months . The results show that treatment significantly reduced salivary mutans streptococci levels in mothers and delayed the colonization of bacteria in their children for about four months. FEMS Immunol Med Microbiol, 1998 Jun, 21(2), 159 - 68 Identification of two genes, cpsX and cpsY, with putative regulatory function on capsule expression in group B streptococci; Koskiniemi S et al.; Two divergently transcribed open reading frames: cpsX and cpsY separated by a common regulatory region was identified upstream of the cpsA-D genes involved in polysaccharide capsule biosynthesis in group B streptococci (GBS) . We suggest that these genes are involved in the regulation of capsule expression in GBS, since the CpsX protein shares sequence similarities with LytR of Bacillus subtilis, an attenuator of transcription while CpsY has similarity to a wide variety of members of the LysR family of transcriptional regulators . No deletions, insertions, DNA rearrangements, or apparent differences were discovered in the postulated regulatory genes when the gene region was compared in GBS with different capsule phenotypes . Thus, other yet unidentified gene loci may control capsule phase variation in GBS. Wien Klin Wochenschr, 1998 Jun 26, 110(12), 446 - 8 Extensive necrotizing fasciitis in a diabetic patient; Mundigler G et al.; Necrotizing fasciitis is a rare but life-threatening infection of the subcutaneous tissue . In addition to Group A streptococci, polymicrobial infection with various aerobic and anaerobic gram positive or gram negative bacteria is frequently observed . The present case illustrates that a high level of clinical suspicion is necessary for early diagnosis of this disease and confirms the value of computed tomography in patients with sepsis of unknown origin . Because of rapid progression of the disease early debridement of necrotic tissue is mandatory for survival. Clin Infect Dis, 1998 Jul, 27(1), 28 - 32 Pharmacodynamics of macrolides, azalides, and streptogramins: effect on extracellular pathogens; Carbon C; The efficacy of macrolides against extracellular pathogens depends on extracellular levels of free drug and the organisms' patterns of susceptibility to the macrolides . The effect of macrolides against most bacteria is considered time-dependent . The size of inoculum affects erythromycin's activity against streptococci and, moreover, against staphylococci . The optimal effect is observed at a pH of 8 . A significant postantibiotic effect (PAE), lasting approximately 9 hours, has been shown with erythromycin and roxithromycin against gram-positive cocci . Azalides share the same properties . For the streptogramin synercid, a dose-dependent bactericidal activity within a range of low concentrations has been demonstrated . The serum area under the curve appeared to be the best predictor of in vivo effect on the mouse thigh model . Synercid also exhibited a prolonged PAE (approximately 10 hours) against the main pathogens of its spectrum . A better knowledge of the pharmacodynamic properties of macrolides and streptogramins is essential for definition of proper dosing regimens. Infect Immun, 1998 Aug, 66(8), 3841 - 7 Production of stabilized virulence factor-negative variants by group A streptococci during stationary phase; Leonard BA et al.; Many of the virulence factors associated with fulminant group A streptococci (GAS) infection are expressed under in vitro exponential growth conditions . However, the survival of GAS in tissue and intracellularly, as well as colonization of asymptomatic carriers, has been reported for GAS . The bacteria associated with these niches may encounter high-density, low-nutrient-flowthrough conditions that may more closely mimic in vitro stationary-phase conditions than exponential growth . Therefore, the behavior of GAS in stationary-phase culture was examined . We observed that after 24 h in stationary phase, GAS serotypes M49 and M2 developed a unstable colony dimorphism of typical large and atypical small colonies . Between days 4 and 5, we isolated stabilized atypical small colonies which remained stable for up to nine passages (approximately 200 generations) on fresh medium before fully reverting to the large-colony phenotype . Upon analysis, the small colonies showed no difference in cell number per colony, growth rate, survival in prolonged stationary-phase culture, or antibiotic sensitivity . However, the small colonies showed decreased transcription of hyaluronic acid capsule, the global positive virulence factor regulator gene mga, the mga-regulated emm mRNA (M-protein structural gene), and speB (cysteine protease) . Accordingly, the small colonies were completely sensitive in a traditional phagocytosis assay . The production of virulence factors and phagocytosis resistance of the small-colony isolates was recovered when, after several passages on fresh medium, the colony morphology began to revert. Am J Emerg Med, 1998 Jul, 16(4), 376 - 8 Disseminated herpes simplex virus infection in a neonate; D'Andrea CC et al.; The emergency department (ED) evaluation of the neonate with sepsis or symptoms suggesting sepsis usually includes a complete blood count, catheterized urinalysis with culture, blood cultures, cerebrospinal fluid analysis and culture, and possibly a chest radiograph . Admission for observation for neonates at high risk for sepsis is universal . Depending on the patient's presentation and the preference of the admitting physician, intravenous antibiotics are started . Typically, ampicillin and either an aminoglycoside or cefotaxime are chosen because they cover the likely pathogens in this age group, ie, group B streptococci, Escherichia coli and other gram-negative enterics, and Listeria monocytogenes . Coverage for viral infection, most notably herpes simplex virus (HSV), is only rarely instituted in the ED and is usually considered if the patient has obvious ulcerative lesions or if the mother has known HSV infection . Unfortunately, antiviral therapy with acyclovir or vidaribine has to be started in the early stages of infection to be effective . If antiviral therapy is started after viral entry into cells, morbidity is severe and mortality approaches 80% . Neonates who survive are usually severely disabled . Broadening the indications for initiating antiviral therapy to include the neonate whose mother has any history of a sexually transmitted disease may prevent the sequelae of untreated or inadequately treated HSV infection . A case is reported of an 8-day-old girl who developed disseminated HSV infection and died as a result of hepatic failure. Eur J Oral Sci, 1998 Jun, 106(3), 788 - 94 Demonstration of identical strains of mutans streptococci within Chinese families by genotyping; Redmo Emanuelsson IM et al.; The aim of this study was to investigate the intra-familial distribution of mutans streptococci in some Chinese families . Eighteen families consisting of mother, father and a 3-yr-old child without any older siblings participated . Clinical examination and interview were performed to obtain information about level of mutans streptococci in saliva, caries prevalence scored by DMFT or deft, general health, diet regimens, breast-feeding time, principal caretaker of the child and the parents' profession . At the same appointment, two pooled plaque samples from each subject were collected with the tips of sterile tooth picks . From these plaque samples, mutans streptococci were isolated on MSB-agar plates and identified by serotyping . Pure isolates were obtained from all subjects of 11 families . These isolates were genotyped using restriction endonuclease HaeIII . The results showed that in 4 families the mothers shared genotype with the child, and in 3 families it was the father and the child who harboured a similar genotype . In 2 families, all subjects harboured an identical genotype . Further, the spouses in one parental pair showed an identical genotype, and, finally, in one family all subjects harboured their unique genotypes . None of the investigated factors could explain the differences in the intra-familial distribution of mutans streptococci . The pattern of similar genotypes in these Chinese families differs from that reported for western families. Community Dent Oral Epidemiol, 1998, 26(1 Suppl), 106 - 16 Early childhood caries--a synopsis; Davies GN; All the papers presented at the conference are reviewed and comparisons are made with past beliefs on the topic . Early childhood caries (ECC) is a serious public health problem in disadvantaged communities in both developing and industrialized countries in which under-nutrition is common . ECC involves the maxillary primary incisors within months after their eruption and spreads rapidly to involve other primary teeth . The early implantation of mutans streptococci, the use of a feeding bottle containing sugary solutions and prolonged breast-feeding, especially at night, are important predisposing factors . Attention is drawn to the need for more research into the factors which determine the resistance of the enamel and particularly the elucidation of the relationship established in several countries between early enamel caries, enamel hypoplasia, and perinatal under- or malnutrition . Primary preventive measures should be applied during the ante- and immediate post-natal periods . Secondary preventive measures include the use of chemotherapeutic agents such as fluoride, and antimicrobials . The most appropriate tertiary preventive measure is the atraumatic restorative technique (ART) . Broadly based committees should be established by governments to address the issues of caries risk in young children . Parents and all personnel involved in infant health and welfare should be shown how to recognize early signs of the condition, as well as to promote early intervention and referral. Community Dent Oral Epidemiol, 1998, 26(1 Suppl), 67 - 81 Research issues in early childhood caries; Horowitz HS; Research is needed to establish what nomenclature and case definition for early childhood caries (ECC) are most relevant to health care professionals and to the public . Profiles or indexes for predicting the prevalence of ECC in communities should be developed on the basis of the socioeconomic factors, immigrant status and ethnic/racial backgrounds of populations . Future research should target risk factors of ECC, particularly prenatal and perinatal histories, nutritional status and microbiologic factors . Determining the relation of malnutrition of infants and young children, low birthweight, complicated pregnancies and traumatic births with the development of enamel linear hypoplasia deserves research attention . Factors that affect how and when infants and young children are colonized by mutans streptococci also need further study . The evaluation of chemotherapeutic preventive agents will likely yield more fruitful interventions for prevention than trying to change behaviors . Research in young children to prevent ECC, however, has particular ethical considerations . Withholding treatments or administering placebos to vulnerable subjects is not acceptable . Consequently, future clinical research likely will determine the relative rather than the absolute effectiveness of preventive regimens; the former requires large sample sizes and may necessitate multi-center studies . Human studies may be hampered by problems of recruitment, compliance and transiency of subjects . Because federal support for research on dental caries has declined in recent years, a special initiative that focuses specifically on ECC may be necessary to obtain adequate funding for research on the disease. Community Dent Oral Epidemiol, 1998, 26(1 Suppl), 28 - 31 Response to Seow: biological mechanisms of early childhood caries; Bowen WH; For more than three decades, it has been recognized that dental caries is an infectious and transmissible disease in which diet plays a key role . Nevertheless, in treating patients with early childhood caries, scant attention is placed on exploring the source of infection and the prevalence of caries in other family members . Results from studies conducted in animals clearly show that the virulence of mutans streptococci can be enhanced by a highly cariogenic environment . For example, offspring from a highly caries-active dam develop significantly more caries than pups from a low caries-active dam . Considerable attention has been placed on the role of the nursing bottle in early childhood caries . Milk and some infant formulas do not promote caries and the role of the remainder of the diet has been largely ignored . The nursing bottle can effectively block salivary access to tooth surfaces, thereby increasing the cariogenicity of any food remaining in the mouth . Recent evidence shows that salivary gland function is impaired by iron deficiency and by prenatal exposure to lead . Clearly, early childhood caries is a complex disease that requires careful and extensive investigation. Community Dent Oral Epidemiol, 1998, 26(1 Suppl), 8 - 27 Biological mechanisms of early childhood caries; Seow WK; The present paper reviews biological issues in early childhood caries (ECC) in light of the current understanding of the field . Despite the general global decline in dental caries in the past decades, ECC has become a significant problem in many developing countries and some minority communities in western industrialized nations . Like other types of caries, ECC is caused by mutans streptococci that ferment dietary carbohydrates to produce acid attacks on susceptible teeth over a period of time . However, while the general etiology of ECC appears similar to that of other types of caries, the predisposing factors are still unclear . The biology of ECC may be modified by several factors unique to young children, related to the implantation of cariogenic bacteria, immaturity of the host defense systems, as well as behavioral patterns associated with feeding and oral hygiene in early childhood. Bull Tokyo Dent Coll, 1998 May, 39(2), 103 - 7 Semiquantitative bacteriology of closed odontogenic abscesses; Sakamoto H et al.; Pus samples from twenty-three dentoalveolar abscesses were collected by needle aspiration and examined by direct inoculation technique using 6 different aerobic and anaerobic agar plates . For aerobic culture, sheep blood agar and chocolate agar (Kyokuto Pharmaceutical Co., Tokyo, Japan) were used . For anaerobic culture, four different media, 1) brucella HK agar with hemolyzed rabbit blood and defibrillated sheep blood, 2) paramomycin-vancomycin brucella HK agar with hemolyzed rabbit blood, 3) phenylethyl alcohol brucella HK agar with hemolyzed rabbit blood, 4) bacteroides bile esculin agar (Kyokuto Pharmaceutical Co., Tokyo, Japan) were prepared in an anaerobic jar prior to inoculation . The aerobic agar plates were incubated for 24 h at 37 degrees C, and the anaerobic plates at least 48 h at 37 degrees C in anaerobic jars . From 23 closed odontogenic abscess samples, a total of 112 bacterial strains were isolated; 81 strains (72.3%) were strict anaerobes, and 31 strains (27.7%) were aerobes . The mean number of bacterial strains per positive sample was 4.86 . Oral Streptococci, Prevotella, Fusobacterium, Peptostreptococcus and Veillonella were common isolates . The combination of Oral Streptococci and Prevotella was found in 11 patients (47.8%), and that of Prevotella and Peptostreptococcus in 12 patients (52.2%) . The present study demonstrated that closed odontogenic abscesses are polymicrobial infections by aerobes and anaerobes . Application of a direct inoculation technique for bacterial culture made it possible to isolate more anaerobes than our commonly used technique using transport medium and to delineate the semiquantitative bacteriology of closed odontogenic abscess. Bull Tokyo Dent Coll, 1998 Feb, 39(1), 15 - 24 The effectiveness of the "Clean-Area-System" for infection control in the dental clinic; Noro A et al.; The use of effective infection control procedures and universal precautions in dental clinics, prevents cross contamination that could extend to dental health care workers and patients . The present study was initiated to investigate airborne environmental contamination in the dental clinic by viable cell count of oral streptococci grown on Mitis-Salivarius and blood agar plates . The reduction of the contamination by the "Clean-Area-System" was evaluated . "Andersen-Microbe-Sampler-Apparatus" and "Laser-Particle-Counter-System" were used for sampling and counting the bacterial cells and airborne dust, respectively . Numbers of viable cells counted as total colony forming units (CFUs) in the dental clinic were found to be significantly higher than those in the waiting room and the research laboratory . We found that the "Clean-Area-System" significantly reduced the CFUs grown on blood agar plates (p < 0.05), and that using the "Clean-Area-System" combined with the "Extra-Oral-Vacuum-Aspirator" is desirable in dental procedures such as cavity preparation . The "Extra-Oral-Vacuum-Aspirator" reduced airborne environmental contamination during tooth cutting and ultrasonic scaling procedures . In non-grinding procedures, this system proved to be very useful for infection control in the operative area . The authors concluded that the combined use of "Clean-Area-System" (dust collection ablation) and "Extra-Oral-Vacuum-Aspirator" (absorb dust ablation) was effective to reduce airborne environmental contamination in the dental clinic . We also fully confirmed that oral streptococci were an adequate indicator in the assessment for infection control in dental institutions. Antimicrob Agents Chemother, 1998 Jul, 42(7), 1745 - 50 Entry of sanfetrinem into human polymorphonuclear granulocytes and its cell-associated activity against intracellular, penicillin-resistant Streptococcus pneumoniae; Cuffini AM et al.; The entry of antibiotics into phagocytes is necessary for activity against intracellular pathogens . The ability of sanfetrinem, the first member of a new class of antibiotics, to penetrate human polymorphonuclear granulocytes and its consequences upon subsequent phagocytosis and killing of ingested penicillin-resistant Streptococcus pneumoniae have been evaluated . Sanfetrinem penetrated into human polymorphonuclear leukocytes (PMNs) at all concentrations tested, with cellular concentration/extracellular concentration ratios of 6.6 to 5.03 and 4.21 when sanfetrinem was used at 0.25 to 0.5 and 1 microgram/ml, respectively, within 30 min of incubation . The uptake was complete within 5 min and was not energy dependent, since it was not affected by cell viability, environmental temperature, or the addition of a metabolic inhibitor . At a concentration of one-half the MIC, sanfetrinem significantly enhanced human PMN phagocytosis and increased intracellular bactericidal activity against penicillin-resistant S . pneumoniae . Following preexposure of PMNs to a concentration of one-half the MIC of sanfetrinem, there was a significant increase in both phagocytosis and killing compared with that for the controls, indicating the ability of sanfetrinem to interact with biological membranes and remain active within PMNs . Preexposure of streptococci to sanfetrinem made penicillin-resistant S . pneumoniae more susceptible to the bactericidal mechanisms of human PMNs than untreated organisms. Pediatr Infect Dis J, 1998 Jun, 17(6), 499 - 503 Maternal carriage of group B streptococci in developing countries; Stoll BJ et al.; BACKGROUND: Group B streptococcus (GBS) is a leading cause of neonatal sepsis in many industrialized countries, but reports from the developing world infrequently identify this pathogen among newborns with sepsis . Studies of GBS colonization among women living in developing countries were reviewed to determine whether lower colonization rates might account for these findings . METHODS: Literature was reviewed with the use of Medline Express (1980 to 1996) and Abstracts on Tropical Agriculture and Rural Development in the Tropics (1975 to 1995) . The methods of each report were considered adequate if specimens were collected from the vagina and if selective broth media were used . RESULTS: Thirty-four studies reported results of cultures from 7730 women; overall colonization was 12.7% . Among only those studies in which methods were adequate, 17.8% (675 of 3801) women were identified as colonized . Studies with adequate methods found significantly higher colonization rates (relative risk, 2.3; 95% confidence interval, 2.0 to 2.6) than those using inadequate methods . When analysis was restricted to reports with adequate methods, the prevalence of colonization by region was as follows: Middle East/North Africa, 22%; Asia/Pacific, 19%; Sub-Saharan Africa, 19%; India/Pakistan, 12%; and Americas, 14% . CONCLUSION: Although there is significant geographic variation in the proportion of women colonized with GBS, the range of colonization reported from developing countries is similar to that identified in populations studied in the United States . Specimen collection and microbiologic methods are important factors in identification of women colonized with GBS. Pediatr Infect Dis J, 1998 Jun, 17(6), 452 - 7 Short course therapy with cefuroxime axetil for group A streptococcal tonsillopharyngitis in children; Mehra S et al.; BACKGROUND: Tonsillopharyngitis caused by group A beta-hemolytic streptococci (GABHS) is common in pediatric clinical practice . Standard penicillin therapy may be associated with poor compliance, penicillin tolerance in GABHS and microbial copathogenicity . Alternative treatments are available (e.g . oral cephalosporins), and data suggest that shorter courses of these agents may be effective . OBJECTIVE: This open, randomized, multicenter study compared a conventional 10-day course of the broad spectrum oral cephalosporin, cefuroxime axetil, with a shorter 5-day course . METHODS: Cefuroxime axetil suspension, 10 mg/kg, was given twice daily to children (ages 3 to 13 years) screened for GABHS tonsillopharyngitis . Patients were assessed clinically and bacteriologically 4 to 7 days after completing the course and followed up at 21 to 28 days . Among 651 patients recruited 520 had throat cultures positive for GABHS and were randomized to treatment . RESULTS: In the 406 patients with microbiologically confirmed GABHS infection, eradication of the initial pathogen was recorded in 177 of 201 (88%) and 189 of 205 (92%) of patients in the 5- and 10-day groups, respectively, at posttreatment . At follow-up, 137 of 162 (85%) of patients in the 5-day group and 145 of 167 (87%) in the 10-day group maintained bacteriologic eradication . All posttreatment isolates of GABHS were susceptible to cefuroxime, and reinfection with a different serotype of GABHS was rare (< or =2%) in both groups . The rates of recurrence of the pretreatment serotype were 10 and 7% in the 5- and 10-day groups, respectively . CONCLUSIONS: Short course therapy with cefuroxime axetil suspension may offer an effective alternative treatment to conventional regimens, with potential for better compliance and reduced costs. Acta Otolaryngol, 1998 Jun, 118(3), 443 - 6 Microbiology of cervical lymphadenitis in adults; Brook I et al.; The microbiology of needle aspirates from 40 inflamed cervical lymph glands was studied for aerobic and anaerobic bacteria, fungi and mycobacteria . Forty-two bacterial, 11 mycobacterial and six fungal isolates were isolated . Aerobic bacteria only were recovered in 11 (27.5%), anaerobes alone in five (12.5%) and mixed aerobic and anaerobic bacteria in seven (17.5%) . Mycobacterium sp . were recovered in 11 (27.5%) and fungi in six (15%) . The recovery of anaerobes was associated with dental infection . Eighteen aerobic bacteria were isolated and the predominant ones were Staphylococcus aureus (eight isolates) and group A streptococci (four) . Twenty-four anaerobic bacteria were recovered and the predominant ones were: Prevotella sp . (six), Peptostreptococcus sp . (five), Propionibacterium acnes (four) and Fusobacterium sp . (three) . These findings demonstrate the role of anaerobic organisms in cervical lymphadenitis and the need to culture aspirated material from the glands for both aerobic and anaerobic microorganisms. J Dermatol Sci, 1998 May, 17(1), 45 - 53 Increasing incidence of streptococcal impetigo in atopic dermatitis; Adachi J et al.; Streptococcal impetigo associated with atopic dermatitis has dramatically increased from 1989 to 1994 in outpatients visiting our hospital, totalling 174 cases . The most frequent causative agents were group A streptococci (Streptococcus pyogenes, 70.7%) followed by group G (19.5%) and group B (9.8%) . Streptococcus was isolated singly in 28.2% of cases and in concomitant with Staphylococcus aureus (S . aureus) in 71.8% . Major clinical features of streptococcal impetigo, especially caused by group A streptococci, were non-bullous pustules with thick crusted ceiling . Impetigo caused by group G or B streptococci generally formed smaller sized pustules of fewer numbers . Impetigo was usually present, associated with severe eczematous lesions . Various degrees of fever were noticed in 32.8% (group A, 39.8%; group G, 17.6%; group B, 11.8%) during active stages . The lesions on the face often resembled Kaposi's varicelliform eruption in any group . Systemic antimicrobial agents were administered in 71.3% of cases and the remainder were treated with topical antibiotics (oxytetracycline hydrochloride) or disinfectants (povidone-iodine) . Recurrence occurred within a month in 38.0% of cases treated with topical agents only and in 17.7% treated with systemic antimicrobial agents . Antimicrobial susceptibility tests and the results of treatment seem to indicate that cephems, as well as penicillins, are the first choice of treatment for streptococcal impetigo. Pediatrics, 1998 Jul, 102(1 Pt 1), 67 - 72 Occult bacteremia with group B streptococci in an outpatient setting; Pena BM et al.; OBJECTIVES: We undertook this study to determine the relative frequency of occult bacteremia with group B streptococci (GBS) and to define the clinical features of infants with occult bacteremia attributable to GBS at the time of initial clinical contact . DESIGN: The logs of the microbiology laboratory were reviewed for blood and cerebrospinal fluid isolates of GBS from 1982 to 1996 . Records of patients identified with GBS were abstracted . Patients were classified as having occult bacteremia if GBS were isolated from their blood and they seemed nontoxic and had no apparent clinical or laboratory evidence of focal infection . All other patients were diagnosed with sepsis, meningitis, or nonmeningeal foci . RESULTS: We reviewed the medical records of 147 children with GBS and identified 108 outpatients, including 47 (44%) with occult bacteremia, 42 (39%) with meningitis, 11 (10%) with nonmeningeal foci, and 8 (7%) with sepsis . Compared with patients with sepsis or focal infections, those with occult bacteremia were older (61.1 vs 39.1 days) and had slightly, although not significantly, higher white blood cell (WBC) counts (13 280 +/- 6854 vs 10 688 +/- 8574), but similar degrees of fever . Among the 47 patients with occult bacteremia, none died, as compared with 2 of 61 with serious infections, and fewer had neurologic sequelae (0/47 vs 11/61) . Patients with occult bacteremia >90 days of age generally had temperatures >39 degreesC (9/11, mean 39.3 degreesC) and WBC counts >15 000/mm3 (7/10, mean 19 070/mm3), both of which differed significantly compared with those who were <90 days of age . Thirty of the 47 patients with occult bacteremia received intravenous antibiotics and recovered . One of 8 patients discharged without antibiotics and none of 8 with antibiotics developed a focal complication; 1 discharged patient was lost to follow-up . CONCLUSIONS: Almost one-half of the children with GBS disease beyond the immediate neonatal period had occult bacteremia . Among 8 untreated patients with bacteremia, 1 developed a focal complication . Although the small proportion of children with GBS occult bacteremia who were >90 days of age usually had the risk factors of temperature >39 degrees C and WBC >15 000/mm3, as seen with occult bacteremia attributable to other organisms, the majority of the patients who were younger did not have a characteristic clinical syndrome . Prevention of sequelae in these young infants will require a low threshold for diagnosis and treatment. Microb Drug Resist, 1998 Summer, 4(2), 123 - 8 Antimicrobial susceptibility profiles of oropharyngeal viridans group streptococci isolates from cystic fibrosis and non-cystic fibrosis patients; Alvarez M et al.; The antimicrobial susceptibility profile of 77 oropharyngeal viridans streptococci isolates from 34 cystic fibrosis (CF) patients and 58 isolates from 43 healthy non-CF patients were studied by the E-test and the standard disk diffusion methods . Overall penicillin and cefotaxime resistances (intermediate plus resistant isolates) were significantly higher (p < 0.05) among CF isolates (72.7% and 45.5%, respectively) than among non-CF isolates (51.7% and 15.5%, respectively) . No significant difference was observed in overall (intermediate plus resistant) erythromycin resistance rates, although high-level erythromycin resistance (> or =32 microg/mL) was more frequently found in CF isolates (24.6%) than in non-CF isolates (12.1%) . An unexpected high percentage of isolates showed low level erythromycin resistance (MIC range, 0.5-15 microg/mL): 41.5% in cystic fibrosis and 46.5% in non-CF isolates . No significant differences were observed regarding the percentage of colonized patients with at least one penicillin-resistant isolate . On the contrary, colonization with cefotaxime (p < 0.001) or erythromycin (p = 0.014) resistant isolates were significantly more prevalent in CF patients . Similar tetracycline and chloramphenicol resistance rates were observed for both groups . Viridans isolates resistant to a single antibiotic were more prevalent among non-CF patients and multiple resistance was higher among CF patients . Prior antibiotic exposure could result in differences in beta-lactam resistance and colonization rates with resistant isolates between both groups . None of the non-CF patients was previously treated with antimicrobials for a period of three months before sampling . In contrast, 94.1% of CF patients were treated with antimicrobials within the same period; 65.6% with beta-lactam antibiotics . Patients with CF disease, frequently exposed to antimicrobials, may be a reservoir of viridans streptococci isolates with resistance determinants, particularly to beta-lactam antibiotics. J Clin Microbiol, 1998 Jul, 36(7), 2115 - 6 Sudden increase in isolation of group B streptococci, serotype V, is not due to emergence of a new pulsed-field gel electrophoresis type; Elliott JA et al.; Until recently, group B streptococcus, serotype V (GBS-V), was an infrequent cause of disease . It is now recognized as a significant cause of infections in both children and adults . To determine if this increase was due to the recent introduction and spread of a single clone of GBS-V, we analyzed, by pulsed-field gel electrophoresis (PFGE), the SmaI chromosomal DNA digests of 45 bacteria: 41 isolated from human infections between 1986 and 1996 in the United States, 2 from human infections in Argentina, and 2 from naturally infected mice . Seventeen patterns were found and arbitrarily designated patterns A to Q . Pattern N constituted 24 (53%) of the isolates and was found in all of the years tested and from all surveillance areas, as well as in both isolates from Argentina, and was very similar to the GBS-V isolated from a mouse . Pattern P was found in three isolates, pattern F was found in two, and the remaining patterns were found in one isolate each . We concluded that the majority of isolates of GBS-V are of one PFGE subtype and that this subtype was predominate before the increase in disease caused by GBS-V and that GBS-V disease is caused by several different subtypes. J Clin Microbiol, 1998 Jul, 36(7), 1902 - 6 Identification and molecular characterization of beta-hemolytic streptococci isolated from harbor porpoises (Phocoena phocoena) of the North and Baltic Seas; Swenshon M et al.; The present study was designed to identify and comparatively investigate 35 beta-hemolytic streptococci isolated from stranded harbor porpoises or from animals caught in fishing nets of the North and Baltic seas . According to biochemical and serological data and to lectin agglutination tests with the lectin of Arachis hypogaea, all 35 isolates could be classified in Lancefield's serological group L and could be identified as Streptococcus dysgalactiae subsp . dysgalactiae . All 35 group L streptococci were uniformly sensitive to most of the antibiotics tested . To further analyze the epidemiological relationship, the isolates were subjected to macrorestriction analysis of their chromosomal DNA by pulsed-field gel electrophoresis . Digestion of the chromosomal DNA with the restriction enzymes SmaI and ApaI revealed that most of the group L streptococci seemed to be apparently identical or related . These results indicate that one clone or at least related group L streptococcal clones play an important role for infections of harbor porpoises of the North and Baltic seas . This might possibly be caused by a direct transfer of the bacteria from animal to animal. Vet Microbiol, 1998 Mar 15, 61(1-2), 121 - 35 The interaction of Streptococcus dysgalactiae with plasmin and plasminogen; Leigh JA et al.; The activation of plasminogen and the binding of plasmin by bacteria may have many effects which promote infection . The occurrence of such activities in streptococci is well documented; however, these are yet to be demonstrated for S . dysgalactiae . Consequently, the ability of this bacterium to activate mammalian plasminogen and bind either plasmin or its zymogen was investigated . Activation of bovine plasminogen was dependent on both the strain and the growth medium used for cultivation . Eighteen strain were able to activate bovine and ovine plasminogen and some of these also activated plasminogen from the horse, rabbit and pig . None activated human plasminogen and one strain (CE127) did not activate plasminogen from any source . Tricine-SDS PAGE and zymographic analysis of culture supernatants showed that bovine plasminogen was activated by four out of six strains at two locations corresponding to 16 kDa and 10 kDa . Following the growth of five strains in the presence of bovine plasminogen, all but strain CE127 bound high levels of plasmin activity . In contrast, following growth in human plasminogen none of the strains exhibited bound plasmin activity although all could bind human plasmin directly . All strains were also able to bind bovine and human plasminogen in such a way as to allow its activation by urokinase . We conclude that S . dysgalactiae is capable of activating mammalian plasminogen in a species-specific fashion and that the bacterium is also capable of binding plasmin and plasminogen with an apparent preference for bovine plasmin over human plasmin and/or plasminogen from either species. Swed Dent J Suppl, 1998, 126, 1 - 48 Studies on fluoridated toothpicks; Kashani H; The aim of this thesis was to evaluate the wooden toothpick as a vehicle for the delivery of fluoride to the approximal area . After two minutes use in vivo, the release of fluoride from the pointed section of a toothpick impregnated in 4% NaF was estimated to 0.15 mg . Toothpicks produced similar or somewhat higher fluoride concentrations in the approximal area compared with other fluoride-containing products, like dentifrice, mouthrinse solution and tablet . The mean fluoride concentration in an approximal area treated for two minutes with a toothpick impregnated in 4% NaF was around 11 mM/l . Toothpicks impregnated in 4% NaF, 8% SnF2 or 2% chlorhexidine had an effect on the proportion of mutans streptococci and on the decline of pH in dental plaque, but it was small and only of short duration . The recolonization of mutans streptococci was, however, slower after using the SnF2- and chlorhexidine-impregnated toothpicks than after using the NaF- and non-impregnated toothpicks . The effect of fluoridated toothpicks on the degree of de- and remineralization of enamel and dentine was measured using transversal microradiography in an in situ study . Four weeks' use of toothpicks, especially of NaF-impregnated toothpicks, reduced the degree of demineralization of enamel and dentine at approximal sites . Secondary ion mass spectrometry was also used to determine the fluoride content in the outer surface of dentine, which increased more than 10 times after using fluoride toothpicks compared with non-impregnated toothpicks . In a second in situ study, 4% NaF-, 2% chlorhexidine- and non-impregnated toothpicks had a similar effect on sound and demineralized enamel and on demineralized dentine . However, the NaF toothpicks were superior in terms of their effect on sound dentine . The effect on mutans streptococci and plaque-pH, on the other hand, was the same for all three types of toothpicks . The main conclusion from this thesis is that the wooden toothpick is a suitable vehicle for the delivery of fluoride to the approximal area. Int J Dermatol, 1998 Jun, 37(6), 426 - 8 Aerobic and anaerobic microbiology of chronic venous ulcers; Brook I et al.; BACKGROUND: The role of bacteria in the pathogenesis of chronic venous leg ulcers (CVLU) is unclear . The objective of the study was to establish the aerobic and anaerobic bacteriology of CVLU . METHODS: A retrospective review was carried out of the clinical and microbiological laboratory records obtained from patients with CVLU . Microorganisms were grown from 43 specimens obtained from 41 patients . RESULTS: Aerobic or facultative bacteria alone were present in 18 (42%) specimens, anaerobic bacteria only in three (7%), and mixed aerobic-anaerobic flora in 22 (51%) . In total, there were 97 isolates, 64 aerobic or facultative and 33 anaerobic, an average of 2.3 isolates per specimen (1.5 aerobes and 0.8 anaerobes) . The predominant aerobic organisms were Staphylococcus aureus (26 isolates), group D streptococci (5), and Escherichia coli(5) . The predominant anaerobes were Peptostreptococcus spp . (15), Bacteroides fragilis group (6), Propionibacterium acnes (4), and Prevotella spp . (3) . CONCLUSIONS: CVLU have a polymicrobial aerobic-anaerobic flora. Zentralbl Veterinarmed B, 1998 May, 45(4), 235 - 43 Studies on biochemical, serological and further characteristics of Streptococcus porcinus; Lammler C et al.; In the present study 70 Streptococcus porcinus isolates could be identified and further characterized by cultural and biochemical properties, by determination of their antibiotic susceptibility and by serological classifications . The S . porcinus included serogroup- and serotype-reference strains, presumptive group candidates and isolates obtained from routine diagnostics . All cultures investigated appeared with a broad zone of beta-haemolysis on sheep blood agar showed a CAMP-like reactivity in the zone of staphylococcal beta-lysin and had the typical biochemical properties of this species . Determination of antibiotic susceptibility revealed a high number of cultures to be susceptible to ampicillin, bacitracin, chloramphenicol, penicillin and vancomycin . Resistances could be observed for erythromycin, minocycline, sulfamethoxazole-trimethoprim, streptomycin and tetracycline . Serogrouping and serotyping could be performed with autoclaved extracts of the bacteria and group- and type-specific antisera prepared against reference strains and group candidates by immunodiffusion reactions . By serogrouping almost all cultures could be classified into serogroup E, U, V or P . Some group E streptococci could additionally be serotyped with type II, VI, VII and group X specific antiserum indicating that group X represents an additional type antigen of serogroup E . None of the antigen preparations reacted with serotype IV, V or group candidate NG1 specific antiserum . The described properties might help to identify and further characterize isolates of the species . S . porcinus, possibly useful in epidemiological aspects. Prev Vet Med, 1998 Apr 16, 35(1), 1 - 9 Clinical, bacteriological and epidemiological aspects of clinical mastitis in Israeli dairy herds; Shpigel NY et al.; A 4-year retrospective study was performed to determine the clinical, bacteriological and epidemiological aspects of acute clinical mastitis in seven Israeli dairy herds . A total of 1124 clinical mastitis cases were detected by abnormal changes in the milk and udder with concurrent decrease of at least 25% in daily milk production . A total of 1190 quarters were affected with clinical mastitis in 1089 cows . The rear quarters had a higher incidence risk (64.7% of quarter cases) than the front quarters . The annual herd-year-incidence varied from 4.2 to 126.8 cases/100 cows/year . The whole-lactation incidence risk (LIR) was 20.8 per 100 lactations . LIR increased from the first to fifth lactation and then decreased . Most clinical mastitis cases were associated with coliform bacteria (60.2% of cases), environmental streptococci (18.6%), coagulase-negative staphylococci (8.7%) and samples from which no bacterial growth was detected (8.1%) . Most cases of clinical mastitis occurred in the early stages of lactation, with 51.4% of all cases, 52.3% of coliform cases and 54.6% of environmental streptococci mastitis cases occurring during the first 4 months of lactation . The median days in milk at diagnosis was 118 days . The incidence was lower in the dry summer months . The ratio of peak to low incidence was 1.62 with a calculated peak incidence in January. Clin Pediatr (Phila), 1998 Jun, 37(6), 341 - 6 Randomized, single-blinded comparative study of the efficacy of amoxicillin (40 mg/kg/day) versus standard-dose penicillin V in the treatment of group A streptococcal pharyngitis in children; Gopichand I et al.; A 10-day course of amoxicillin at a dosage of 40 mg per kilogram per day was compared with conventional (lower dosage) penicillin V therapy in the treatment of culture-proven Group A streptococcal pharyngitis in children 3 to 18 years of age in a prospective, randomized, and single-blinded study . Children had to have signs and symptoms compatible with the diagnosis of streptococcal pharyngitis and to have a throat swab positive for Group A streptococci . A second throat culture was obtained 10 to 14 days after the completion of therapy . Serotyping was performed to help differentiate carrier states from reinfections . Of 161 children enrolled, 113 were evaluable; 55 received penicillin and 58 received amoxicillin . At the completion of therapy 70.9% (39/55) of patients in the penicillin group vs 87.9% (51/58) of patients in the amoxicillin group were asymptomatic (clinical cure, P = 0.025) . At the completion of therapy, 54.5% (30/55) of patients in the penicillin group vs 79.3% (46/58) of patients in the amoxicillin group had negative throat cultures (bacteriologic cure, P = 0.005) . The carrier rate (children who were well but who were still carrying the same serotype of Group A streptococcus) also differed between the groups: 13 (23.6%) in the penicillin group compared with six (10.3%) in the amoxicillin group . Amoxicillin at 40 mg/kg/day was significantly more effective than lower dosages of penicillin V for clinical and bacteriologic cure in the treatment of Group A streptococcal pharyngitis in children . The current perception that penicillin is declining in effectiveness may be due to inadequate dosingPublication Types:
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