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