Infect Immun, 1995 Jul, 63(7), 2516 - 21 Expression, purification, and characterization of a novel G protein, SGP, from Streptococcus mutans; Wu J et al.; The sgp gene of Streptococcus mutans was recently detected immediately downstream from the dgk gene within the same operon . In this study, the sgp gene was subcloned into the pMAL-c2 vector and SGP (S . mutans G protein) was overexpressed in Escherichia coli as a fusion protein with the maltose-binding protein at a level of 40% of total cellular protein . One-step amylose affinity chromatography purification of this fusion protein yielded a product of approximately 95% purity . SGP was purified from this fusion protein following cleavage with protease factor Xa and DEAE-Sephacel chromatography . In nucleotide binding assays, recombinant SGP showed specific binding for GTP and GDP, but not ATP, CTP, and UTP, and also catalyzed efficient hydrolysis of GTP to GDP . Kinetic studies revealed that the SGP Km value for GTP in this reaction was approximately 5.9 microM . Mg2+ also served as a cofactor of SGP in this reaction . In vivo subcellular localization by immunogold labelling demonstrated that SGP was associated with both membrane and cytoplasmic fractions . SGP not only had structural similarities with other G proteins but also proved to have high-level intrinsic GTPase activity . Therefore, SGP appears to be a new member of the G protein superfamily and may participate in transmembrane signaling in the responses of S . mutans cells to environmental stimuli. Infect Immun, 1995 Jul, 63(7), 2493 - 8 Peptide permeases from Streptococcus pneumoniae affect adherence to eucaryotic cells; Cundell DR et al.; To gain access to tissues within the human host, Streptococcus pneumoniae initially colonizes the nasopharynx and then interacts with glycoconjugates on the surfaces of target cells at various sites of infection . Although pneumococcal adhesins are currently unknown, exported proteins on the bacterial surface are potential candidates . To identify bacterial elements involved in this process, mutants of S . pneumoniae with defects in exported proteins were screened for the inability to adhere to cells representative of three in vivo niches: (i) agglutination of bovine erythrocytes, which reflects adherence to cells which reside in the nasopharynx; (ii) human type II pneumocytes (lung cells {LC}), representing the alveolar site of infection; and (iii) human vascular endothelial cells (EC), representing the endovascular site . The capacity of the mutants to adhere during the course of pneumococcal disease was also assessed by using cytokine-activated LC and EC . All of the 30 mutants analyzed produced hemagglutination values comparable with those of the parent strain . Four independent mutants demonstrated a greater than 50% decrease in adherence to both LC and EC . Sequence analysis of the altered alleles from these strains showed that mutations had occurred in two previously identified loci, plpA and ami, which belong to the family of genes encoding protein-dependent peptide permeases . Mutations in the ami locus resulted in an inability to recognize the GalNAc beta 1-4Gal glycoconjugate receptor present on resting LC and EC, whereas mutations in plpA resulted in a failure to recognize a GalNAc beta 1-3Gal glycoconjugate receptor also present on resting cells . Mutations in neither allele affected recognition of GlcNAc receptors present on cytokine-activated LC and EC . These results suggest that peptide permeases modulate pneumococcal adherence to epithelial and endothelial cells either by acting directly as adhesins or by modulating the expression of adhesins on the pneumococcal surface during the initial stages of colonization of the lung or the vascular endothelium. Curr Microbiol, 1995 Jul, 31(1), 5 - 9 In vivo hemolytic activity of group B streptococcus is dependent on erythrocyte-bacteria contact and independent of a carrier molecule; Platt MW; Experiments were performed to determine the interaction between the hemolysin of group B streptococcus (GBS) and sheep erythrocytes . Growing GBS were shown to possess a potent hemolysin at a very early stage of the growth cycle . After separation of the cells from the growth medium, all the hemolytic activity remained with the bacterial cells, and no activity could be detected in the growth medium . When fetal calf serum was added to the media, some "soluble" activity was detected . This activity, however was completely removed by ultracentrifugation, the hemolytic activity being found solely in the pellet . After the hemolysin had formed, no new protein synthesis was needed to cause hemolysis because the addition of chloramphenicol to cells caused no difference in their hemolytic potential . For proof that no short-lived, soluble factors are produced by the bacteria, bacteria and sheep erythrocytes were incubated in contiguous media, separated by a 0.22-microns membrane . No hemolytic activity was detected on the erythrocyte side of the membrane, although high amounts of hemolysin could be extracted from the bacteria . Only when a detergent was added to the growth medium was hemolysis detected from the erythrocytes, showing that extracted hemolysin could indeed pass through the membrane . These results suggest that the hemolysin is attached to the surface of the cell and that contact is needed between the bacteria and erythrocyte to cause lysis . Where soluble activity was detected, it was connected to bacterial fragments. Head Neck, 1995 Jul-Aug, 17(4), 351 - 7 Fatal craniocervical necrotizing fasciitis in an immunocompetent patient: a case report and literature review; Henrich DE et al.; BACKGROUND . Craniocervical necrotizing fasciitis (CCNF) is a rapidly progressive, severe bacterial infection of the superficial fascial planes of the head and neck . Group A beta-hemolytic Streptococcus, staphylococcus aureus, and obligate anaerobic bacteria are common pathogens . The disease usually results from a dental source or facial trauma . Extensive fascial necrosis and severe systemic toxicity are common manifestations of CCNF . Recently the lay press has referred to necrotizing fasciitis in several articles about "flesh eating" bacteria, which have resulted in several deaths . METHODS . We report the first case of a fatality in an otherwise immunocompetent patient . The patient was a 66-year-old black man with no identifiable source of infection and no history or evidence of immunocompromising disorders . RESULTS . Despite aggressive surgical debridement and broad-spectrum antibiotic coverage, he died 30 hours after admission from multisystem organ failure secondary to overwhelming sepsis . CONCLUSION . Treatment consists of early recognition of CCNF combined with aggressive surgical debridement and drainage of the involved necrotic fascia and tissue along with broad-spectrum intravenous antibiotic coverage . Although 11 other fatal cases of CCNF have been previously reported, all had an underlying medical problem which created an immunocompromised state, usually diabetes mellitus or chronic alcoholism . We present a case report and literature review along with a discussion of the related anatomy. Br J Dermatol, 1995 Jul, 133(1), 128 - 31 A case of necrotizing fasciitis due to Streptococcus pneumoniae; Choudhri SH et al.; We report a patient suffering from necrotizing fasciitis . The principal pathogen was Streptococcus pneumoniae . As far as we are aware, this is the first reported case of necrotizing fasciitis (NF) attributable to this organism . We discuss the pathogenesis of NF, and review the literature relating to this disorder. J Clin Microbiol, 1995 Jul, 33(7), 1804 - 6 Detection of penicillin-resistant Streptococcus pneumoniae with commercially available broth microdilution panels; Nolte FS et al.; We compared penicillin MICs obtained with three different commercially available broth microdilution panels (MicroScan, Sensititre, and Pasco) with MICs obtained with reference microdilution panels for 20 well-characterized pneumococci with decreased susceptibilities to penicillin (7 resistant and 13 intermediate) . All panels were supplemented with 2 to 5% lysed horse blood (LHB) prepared in-house . Additional supplements included fastidious inoculum broth (FIB) for MicroScan panels and commercially prepared LHB (Difco) for Pasco panels . The percentages of penicillin-resistant strains (MIC 2 micrograms/ml) detected by the different methods follow: MicroScan-FIB, 0; MicroScan-LHB 0; Pasco in-house LHB, 71; and Sensititre-LHB, 100 . The percentages of intermediate strains (MIC = 0.1 to 1.0 micrograms/ml) detected by the different methods follow: MicroScan-FIB, 31; MicroScan-LHB 23; Pasco in-house LHB, 46; and Sensititre-LHB, 85 . Difco LHB supplement failed to support the growth of 86% of the strains in the Pasco panels . Of the commercially available panels evaluated, only Sensititre, supplemented with LHB prepared in-house could reliably detect penicillin-resistant pneumococci. Tijdschr Diergeneeskd, 1995 Jul 15-Aug 1, 120(14), 426 - 30 {Reliability of bacteriological studies of composite samples in the diagnosis of subclinical udder infections in cattle}; Morselt ML et al.; This study evaluated the reliability of making bacteriological cultures of composite milk samples for the diagnosis of subclinical udder infections in dairy herds . Quarter samples as well as composite samples were collected from 482 cows with suspected subclinical mastitis from 69 Dutch dairy farms . The samples were used to measured somatic cell counts and to prepare bacteriological cultures . The sensitivity and specificity of the bacteriological cultures of the composite samples were compared with those of the quarter samples . The sensitivity of Staphylococcus aureus, Streptococcus uberis, Streptococcus agalactiae and Streptococcus dysgalactiae was 57.9%, 65.2%, 86.6%, and 60.3%, respectively . The specificity was higher than 98% for all four bacteria . Although information is lost when composite samples are used, composite samples are useful, especially for large dairy herds . The advantage and disadvantages of the use of composite samples are discussed. Tijdschr Diergeneeskd, 1995 Jul 1, 120(13), 392 - 9 {Udder disinfection and mastitis in cattle: a literature review}; Lam TJ et al.; Postmilking teat disinfection is accepted as an important part of standard preventive measures against mastitis in dairy cattle . The efficacy of postmilking teat disinfection against infections with contagious pathogens such as Staphylococcus aureus and Streptococcus agalactiae is beyond doubt . However, the efficacy of teat disinfection against infections with environmental pathogens such as Escherichia coli is disputed, and a negative effect has even been described in some situations . This article reviews the practice of teat disinfection in dairy cattle . Premilking and postmilking teat disinfection are discussed, as is the efficacy, different ways of teat disinfection, and different disinfectants . It is concluded that post-milking teat disinfection is an effective management measure in most herds . Selection of teat disinfectants should be based on proven efficacy, which is required for registration of the preparation as a veterinary medical product in the Netherlands. J Pediatr, 1995 Jul, 127(1), 98 - 9 Appearance of resistance to beta-lactam antibiotics during therapy for Streptococcus pneumoniae meningitis; Munoz M et al.; A young boy had meningitis caused by Streptococcus pneumoniae that was relatively resistant to penicillin and susceptible to cefotaxime . After 10 days of therapy with penicillin and cefotaxime, fever recurred and a second lumbar puncture revealed a pneumococcus that was resistant to all beta-lactam antibiotics . We now add vancomycin to empiric third-generation cephalosporin therapy for meningitis in children when gram-positive cocci are seen on the cerebrospinal fluid smear. J Pediatr, 1995 Jul, 127(1), 147 - 51 A randomized, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infections in children; Rackoff WR et al.; OBJECTIVE: To determine whether adding vancomycin to central venous catheter (CVC) flush solution would significantly reduce the incidence of bacteremia attributable to luminal colonization with vancomycin-susceptible organisms . STUDY DESIGN: Fifty-five children with cancer and eight children given total parenteral nutrition by the surgery or nutrition support services were randomly assigned to receive a heparin CVC flush solution (n = 31) or a heparin-vancomycin CVC flush solution (n = 32) . RESULTS: During 9158 catheter days, 6.5% of the patients in the heparin group and 15.6% of the patients in the heparin-vancomycin group had bacteremia attributable to luminal colonization with vancomycin-susceptible organisms (p = 0.43) . The mean rates of bacteremia attributable to luminal colonization with vancomycin-susceptible organisms were 0.6/1000 catheter days in the heparin group and 1.4/1000 catheter days in the heparin-vancomycin group (p = 0.25) . There was no significant difference between the groups when the time to the first episode of bacteremia attributable to luminal colonization with a vancomycin-susceptible organism was compared by means of Kaplan-Meier survival estimates . Streptococcus viridans infection was not attributable to luminal colonization . CONCLUSION: The addition of vancomycin to heparin CVC flush solution did not reduce bacteremia with vancomycin-susceptible organisms . Bacteremia with Streptococcus viridans was not related to the use of a CVC. Laryngoscope, 1995 Jul, 105(7 Pt 1), 708 - 13 Heat shock proteins in acute otitis media; Egusa K et al.; Heat shock proteins (hsps) are essential for the survival of cells under an environmental insult . To elucidate the relationship between these intracellular proteins and acute otitis media (AOM), the authors studied hsp production in guinea pigs with AOM induced by inoculation of Streptococcus pneumoniae into the middle ear . Animals were sacrificed 1, 3, or 5 days after inoculation . Immunocytochemical study showed localization of hsp70 within the epithelium of infected ears, while the normal control epithelium showed very light staining . Western blot tests of the mucosal extraction confirmed the presence of hsp70 in otitis media . Enzyme-linked immunosorbent assay (ELISA) showed that hsp levels were higher in the infected mucosa than in the normal control mucosa . In contrast, hsp60 was not stimulated in infected ears . This study showed that hsp70, and not hsp60, was produced in the AOM model. J Bacteriol, 1995 Jul, 177(13), 3641 - 6 Lethal and mutagenic actions of N-methyl-N'-nitro-N-nitrosoguanidine potentiated by oxidized glutathione, a seemingly harmless substance in the cellular environment; Kumaresan KR et al.; Both the lethal and the mutagenic actions of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) on cells of Streptococcus pneumoniae were greatly potentiated by a component of yeast extract added to the cellular environment . This component was found to be an oxidation product of glutathione, glutathione disulfide (GSSG) . At low concentrations in the medium, both GSSG and glutathione potentiated MNNG action, but at high concentrations, glutathione (and other sulfhydryl compounds) abolished the effect . Point mutations in a cellular gene conferred resistance to the potentiating effect, and they blocked uptake of either GSSG or glutathione into the cells as well . This gene apparently encodes a component of the system for glutathione transport in S . pneumoniae . The mechanism by which GSSG, an apparently innocuous substance in the environment, renders low levels of MNNG genotoxic and cytotoxic thus depends on its transport into the cell, where it is reduced by glutathione reductase and then activates intracellular MNNG . Also, it was observed that mutants of S . pneumoniae defective in DNA mismatch repair are more resistant to MNNG than are wild-type cells by a factor of 2.5. J Dairy Sci, 1995 Jul, 78(7), 1637 - 48 Antimicrobial susceptibility of microorganisms isolated from the mammary glands of dairy heifers; Watts JL et al.; Minimum inhibitory concentrations were determined with 1494 microorganisms isolated from the mammary glands of dairy heifers . The antimicrobial agents tested were penicillin, cloxacillin, cephapirin, ceftiofur, novobiocin, enrofloxacin, erythromycin, and pirlimycin . All minimum inhibitory concentrations were expressed as micrograms per milliliter . The isolates tested included 135 Staphylococcus aureus, 1222 Staphylococcus sp., 42 Streptococcus sp., 15 Enterococcus sp., 60 enteric species, and 20 miscellaneous organisms . The minimum inhibitory concentrations for 90% of isolates for the various antimicrobial agents with Staph . aureus were as follows: penicillin, .13; cloxacillin, .5; cephapirin, .5; ceftiofur, 1; novobiocin, .5; enrofloxacin, .5; erythromycin, .5, and pirlimycin, .5 . In comparison, the minimum inhibitory concentrations for 90% of isolates for the Staphylococcus sp . were 1, 1, .5, 1, .5, .5, 1, and .5 for penicillin, cloxacillin, cephapirin, ceftiofur, novobiocin, enrofloxacin, erythromycin, and pirlimycin, respectively . The minimum inhibitory concentrations for 90% of isolates for the Streptococcus sp . were 2, 32, 2, 2, 8, 1, 64, and 32 for the respective antimicrobial agents; the minimum inhibitory concentrations for 90% of isolates were 4, 64, 32, 64, 4, 1, 4, and 4 for the enterococci . Against the Gram-negative enteric bacilli, only ceftiofur and enrofloxacin were active; minimum inhibitory concentrations for 90% of isolates were 1 microgram/ml for ceftiofur and .25 microgram/ml for enrofloxacin . Results indicated that the majority of staphylococcal strains were susceptible to the antimicrobial agents tested but that antimicrobial susceptibility varied for Streptococcus sp . Compounds currently available in intramammary infusion products demonstrated poor activity against the enteric organisms. J Dairy Sci, 1995 Jul, 78(7), 1607 - 18 Mastitis in dairy heifers: initial studies on prevalence and control; Nickerson SC et al.; Initial studies to determine the prevalence of mastitis in heifers of breeding age and in pregnant dairy heifers demonstrated that IMI were present in 97% of heifers and 75% of quarters . The most common isolates were Staphylococcus aureus, Staphylococcus hyicus, and Staphylococcus chromogenes; SCC ranged from 12.4 to 17.3 x 10(6)/ml . Approximately 29% of heifers and 15% of quarters exhibited clinical mastitis at breeding age, as evidenced by clots or flakes in mammary secretions . Histologic examination of mammary tissues demonstrated significant reductions in alveolar epithelial and luminal areas and increases in connective tissue stroma and leukocytosis, illustrating limited development and marked inflammation of infected tissues . A one-time infusion of antibiotic for nonlactating cows into infected quarters > or = 45 d prepartum reduced incidence of IMI by 59% at calving compared with the pretreatment level; the cure rate for Staph . aureus IMI was > 90% . Prophylactic treatment of uninfected quarters > or = 45 d prepartum reduced new Streptococcus sp . IMI by 93% . The mean SCC was 50% lower at calving for treated heifers, and milk yield over the first 2 mo of lactation was 10% greater than that of untreated controls . Heifers from herds using fly control had a lower prevalence of IMI than herds without fly control . Prevalences of IMI and SCC in dairy heifers were higher than previously realized, but mastitis at calving was controlled by use of therapeutic products for nonlactating cows during pregnancy. Clin Diagn Lab Immunol, 1995 Jul, 2(4), 478 - 83 Distinct profiles of immunoglobulin G-binding-protein expression by invasive serotype M1 isolates of Streptococcus pyogenes; Raeder R et al.; Analysis of immunoglobulin G (IgG)-binding-protein expression by invasive group A streptococcal isolates of the M1 serotype collected as part of a Centers for Disease Control and Prevention surveillance study revealed two distinct phenotypes . One group of type M1 isolates expressed a surface protein reactive with all four human IgG subclasses (type IIo), while a second group expressed a surface protein demonstrating significant reactivity only with human IgG3 (type IIb) . The functional forms of IgG-binding protein were antigenically related, and both were recognized by a rabbit polyclonal antiserum to serotype M1 but not by normal rabbit serum . While the quantities of antigenic M1 protein present in the extracts of representative isolates displaying each phenotype differed, the functional differences were found to be qualitative and not solely quantitative . The IgG-binding properties of these antigenically related M1 proteins could be readily distinguished from those of another IgG-binding protein, protein H . Type M1 isolates of the IIb phenotype differed from those of the IIo phenotype by secreting larger amounts of a casein-hydrolyzing protease into culture supernatants. Am J Vet Res, 1995 Jul, 56(7), 880 - 4 Microorganisms isolated from the corneal surface before and during topical cyclosporine treatment in dogs with keratoconjunctivitis sicca; Salisbury MA et al.; The effect that topical administration of cyclosporine would have on the number and type of microorganisms isolated from the corneal surface of dogs with keratoconjunctivitis sicca was studied . Schirmer tear test wear performed on and corneal swab specimens were collected from 61 eyes of 31 dogs with keratoconjunctivitis sicca prior to and after 3, 6, and 12 months of treatment with cyclosporine . In eyes that responded to cyclosporine treatment (Schirmer tear test value increased by > or = 5 mm/min, compared with pretreatment value), the percentage of eyes from which bacteria were isolated 3, 6, and 12 months of treatment was significantly (P < 0.001) less than the percentage from which bacteria were isolated prior to treatment . However, among eyes that did not respond to treatment, we did not detect a significant change over time in prevalence of bacteria or type of bacteria isolated . The percentage of eyes from which fungi were isolated decreased during treatment; however, the small number of eyes in which fungal culture results were initially positive precluded demonstration of a significant differences over time in the frequency with which specific bacterial genera were isolated, with the exception of beta-hemolytic Streptococcus spp . Opportunistic corneal infections were not detected even though none of the dogs received antibiotics . An increase in production of tears, which contain anti-infection, proteins, was believed to be the primary factor responsible for the decrease in the percentage of eyes from which microorganisms could be isolated. Acta Otolaryngol, 1995 Jul, 115(4), 548 - 52 Application of polylactic acid polymer in the treatment of acute maxillary sinusitis in rabbits; Min YG et al.; To evaluate the therapeutic effects of topical antibiotic delivered by polylactic acid (PLA) polymer on paranasal sinusitis, we induced maxillary sinusitis in 32 New Zealand white rabbits by obstructing the maxillary sinus ostium and inoculating the sinus cavity with Streptococcus pneumoniae . The rabbits were divided into three groups: a control group (group 1) treated only by reopening the ostium, a group (group 2) treated by both reopening the ostium and injecting ampicillin (40 mg/kg/day), and a group (group 3) in which ampicillin in the PLA carrier (0.326 mg) was placed within the sinus after ostial patency was reestablished . The number of colony forming units (CFU) was lowest in group 3, followed by groups 2 and 1 . Ampicillin concentration in the maxillary sinus secretion of group 3 was significantly higher than in group 2 . The results suggest that treatment with PLA-ampicillin polymer may maintain high therapeutic concentrations of ampicillin in maxillary sinus secretion. Vet Microbiol, 1995 Jul, 45(2-3), 157 - 69 Intracellular survival and multiplication of virulent and less virulent strains of Streptococcus bovis in pigeon macrophages; De Herdt P et al.; The intracellular fate of pigeon S . bovis strains ingested by macrophages was studied in vivo and in vitro . During in vivo experiments, histological and electron microscopical examinations demonstrated numerous cocci, which appeared to be actively multiplying, within splenic macrophages of pigeons experimentally inoculated with a highly virulent S . bovis serotype 1 strain . In pigeons inoculated with a low virulence serotype 3 strain, intracellular cocci were only occasionally observed . For in vitro experiments, pigeon peritoneal macrophages were inoculated with a S . bovis serotype 1 or serotype 3 strain and incubated . Following an initial decrease, an increase in the number of intracellular bacteria was observed in tests performed with the S . bovis serotype 1 strain, demonstrating intracellular multiplication . Macrophages in these experiments had all died after 7 h of incubation, possibly indicating that the intracellular replication of S . bovis resulted in the release of substances toxic for macrophages . In experiments performed with the S . bovis serotype 3 strain, the number of intracellular bacteria continuously decreased, reflecting killing of organisms . Significant changes in the number of adhering macrophages in S . bovis serotype 3 inoculated cultures were not observed . These results indicate S . bovis in pigeons is a facultative intracellular bacterium and intracellular multiplication may be involved in virulence. Vet Microbiol, 1995 Jul, 45(2-3), 151 - 6 Properties of a Streptococcus suis isolate of serotype 2 and two capsular mutants; Salasia SI et al.; Encapsulation is thought to be a critical virulence factor of Streptococcus suis . In the present study two capsular type 2 mutants of S . suis (M42 and M2) and their S . suis parent strain (89-1591) were further characterized . All three cultures reacted with group D specific antiserum whereas parent strain 89-1591 and mutant M42 but not mutant M2 reacted with specific antiserum against capsular type 2 . Both mutants had higher surface hydrophobicity and showed an increased adherence to human epithelial cells and to lung macrophages of rabbits as compared to the parent strain . In phagocytosis experiments with polymorphonuclear leucocytes the encapsulated parent strain was more resistant to phagocytosis than both mutant strains . These findings might help to understand the role of encapsulation of S . suis in the process of infection. Pediatr Infect Dis J, 1995 Jul, 14(7), 588 - 94 Group A streptococcal necrotizing fasciitis complicating primary varicella: a series of fourteen patients; Brogan TV et al.; We retrospectively reviewed the clinical course of group A Streptococcus necrotizing fasciitis complicating primary varicella in children admitted to Children's Hospital and Medical Center, Seattle, WA, during a 18-month period . The potential benefit of various therapeutic interventions was examined . Fourteen children ages 6 months to 10 years were treated for group A Streptococcus necrotizing fasciitis as a complication of primary varicella . Eight patients experienced a delay in initial diagnosis as a result of nonspecific, early clinical findings of necrotizing fasciitis . Each patient underwent surgical exploration with fasciotomies and debridement . Initial antibiotic therapy was broad spectrum and included clindamycin . Hyperbaric oxygen therapy for as many as 6 treatments was used as adjunctively therapy in 12 patients, with subjective benefit in 6 patients . All 14 patients were discharged home with good function and no long term sequelae . This potentially fatal bacterial infection of the deep fascial layers requires early recognition by primary care physicians and an intensive, multidisciplinary therapeutic approach, including thorough surgical debridement and appropriate antibiotic therapy. Jpn J Antibiot, 1995 Jul, 48(7), 887 - 920 {Susceptibilities of bacteria isolated from patients with respiratory infectious diseases to antibiotics (1990)}; Ikemoto H et al.; These investigations have been continued since 1981 . In this year the isolation frequencies and sensitivities to antibiotics were investigated for 654 bacterial strains isolated from respiratory tract infections in 20 institutions during the period of October 1990 to September 1991 . Among Staphylococcus aureus isolated from inpatients, many were methicillin-resistant S . aureus (MRSA), and the frequency of their isolation was 56.3% for inpatients and 4.3% for outpatients . Of the relation to antibiotic administration, the isolation frequency of MRSA before administration of antibiotics was 19.6% (10/51), and after administration was 75.0% (27/36) . The sensitivities of S . aureus to imipenem and clindamycin (MIC80) decreased from 0.2 microgram/ml to 64 micrograms/ml and from 0.2 micrograms/ml to 128 micrograms/ml, respectively . We investigated year to year changes in the backgrounds of patients with respiratory tract infections . Bacterial pneumonia was 31.6% among respiratory tract infections in the period of the study, this trend has increase from 1989 . Frequencies of different etiological bacteria in respiratory tract infections did not change appreciably from year to year, and S . aureus, Streptococcus pneumoniae and Pseudomonas aeruginosa were the most showing some frequent pathogens. J Obstet Gynecol Neonatal Nurs, 1995 Jul-Aug, 24(6), 562 - 6 Group B streptococcus during the perinatal period; Shermer RH; The beta hemolytic streptococcus group B (GBS) emerged as a major pathologic threat to infants in the 1960s and continues to be the leading cause of maternal and neonatal morbidity in the 1990s . Current approaches to prevention are directed toward eliminating exposure to the pathogen through chemoprophylaxis or enhancing host resistance through immunoprophylaxis . Because research is advancing rapidly in this area, perinatal nurses should keep abreast of changes in prevention and treatment strategies to enhance patient education and improve care. Eur J Pediatr, 1995 Jul, 154(7), 563 - 6 Streptococcus pneumoniae invasive disease in the neonatal period: an increasing problem? Simpson JM, Patel JS, Ispahani P. A series of 11 cases of invasive infection with Streptococcus pneumoniae, occurring over an 11-year period, is reported . Eight of the 11 cases occurred during the final 2 years of the study suggesting that the incidence of infection may be increasing . Infection carries a high mortality (3/11) . Morbidity includes meningitis, convulsions and respiratory failure . In one case S . pneumoniae meningitis occurred in both mother and newborn . Most mothers who carried the organism were asymptomatic at the time of delivery . CONCLUSION: S . pneumoniae should be specifically sought in swabs taken from the pregnant mother and newborn and if isolated, even in the absence of symptoms, antibiotic therapy against the organism should be strongly considered. Acta Paediatr, 1995 Jul, 84(7), 831 - 3 Failure of cefotaxime treatment in two children with meningitis caused by highly penicillin-resistant Streptococcus pneumoniae; Guibert M et al.; Two infants, aged 8.5 and 11 months, were admitted for meningitis caused by Streptococcus pneumoniae . Failure of cefotaxime led to the identification of highly penicillin-G-resistant strains . Minimum inhibitory concentrations (MICs) for penicillin were > 2 micrograms/ml, and cefotaxime MICs were 2 micrograms/ml . Both patients rapidly responded to a combination of i.v . imipenem and rifampicin . It is now mandatory to test in-vitro susceptibilities of Streptococcus pneumoniae to penicillin G and other beta-lactam agents when meningitis is diagnosed in infants. Intern Med, 1995 Jul, 34(7), 643 - 5 Streptococcal toxic shock syndrome: report of two cases; Kaneita Y et al.; Two Japanese cases of streptococcal toxic shock syndrome (STSS) are reported . The first patient was a 45-year-old male who developed necrotizing fasciitis and myositis of the left thigh, refractory hypotension, hepatic dysfunction and acute renal failure; the patient died despite treatment . Streptococcus pyogenes was isolated from the inflamed fascia . The second patient was a 69-year-old female who had coagulopathy, polymyositis and hepatic function abnormality . Streptococcus pyogenes was isolated from blood culture . She was immediately placed on high-dose ampicillin as well as other supportive measures, and she survived. Antimicrob Agents Chemother, 1995 Jul, 39(7), 1636 - 42 In vitro evaluation of DV-7751a, a new fluoroquinolone with an enhanced spectrum of activity against gram-positive aerobic organisms and anaerobes; Biedenbach DJ et al.; DV-7751a is an investigational fluoroquinolone with improved spectrum and potency against gram-positive bacteria . We studied the in vitro activity of this compound against 771 recent clinical isolates by the reference agar and broth microdilution methods . Its activity was compared with those of ciprofloxacin, levofloxacin, and ofloxacin and with those of ceftazidime, oxacillin, and gentamicin where relevant . DV-7751a was four- to eightfold more active than the comparison fluoroquinolones against Enterococcus spp . (including vancomycin-resistant strains), Staphylococcus spp . (including oxacillin-resistant Staphylococcus aureus), Streptococcus spp., other gram-positive pathogens, and some anaerobes . The DV-7751a activity against most gram-negative species was similar to that of ofloxacin and ciprofloxacin . DV-7751a appears to be a candidate for the therapy of some mixed-flora infections and the treatment of bacteria resistant to the current fluoroquinolones. Pediatr Med Chir, 1995 Jul-Aug, 17(4), 307 - 9 {Obstetric prevention of neonatal infections caused by group B beta-hemolytic Streptococcus}; Diani F et al.; While our understanding of Group B Streptococcal infections has progressed with impressive measure, their prevention has not been accompanied by an effective means . Chemoprophylaxis for selected colonized women at rupture of membranes or at onset of labour, enhances benefit and minimizes adverse effects . Two or more maternal risk factors are special circumstances for routine use of chemoprophylaxis in asymptomatic neonates . Immunoprophylaxis by IgG antibodies directed against the type-specific polysaccharide antigen of GBS may be provided by passive or active immunization . Hyperimmune i.v . globulins or vaccination of adult women with low levels of antibodies in their sera have been demonstrate to be protective in vivo. Pediatr Med Chir, 1995 Jul-Aug, 17(4), 305 - 6 {Therapy of neonatal infection caused by group B beta-hemolytic Streptococcus}; Aabas A et al.; Expectant therapy for early Group B Streptococcus onset septicemia must provide coverage against other microorganism, such as L . Monocytogenes, H . Influenzae and S . Pneumoniae . It is possible to administer a combination of antimicrobial agents with activity against all or the most likely pathogens . Thus initial expectant therapy includes a broad spectrum semisynthetic penicillin (e.g . ampicillin) and an aminoglycoside (e.g . netilmicin) . Vancomicin, teicoplanin and cefotaxime may also be used . Supportive therapy consists on temperature control, i.v . administration of fluids, acid-base balance and electrolytes monitoring, seizures control and ventilation . IV immunoglobulins, granulocyte and serum transfusion are also used . The G-Colony Stimulating Factor (G-CSF, filgastrim) usage is also reported. Pediatr Med Chir, 1995 Jul-Aug, 17(4), 299 - 302 {Clinical aspects and diagnosis of neonatal infections caused by group B beta-hemolytic Streptococcus}; Bellettato M et al.; Early-onset infection findings caused by Group B Streptococcus occur within 24 hours of birth (60 per cent of cases) but they may appear anytime during the first 5 days of life . In our experience early-onset infection affects both preterm and term neonates . The Authors report the usual clinical signs described for bacterial infections . Unusual findings are also reported: among 34 infants with early-onset infection, the congenital diaphragmatic hernia was associated with GBS septicemia in two neonates; beads of perspiration were the first only clinical finding in one neonate too . Two cases of late-onset infection are also reported. Pediatr Med Chir, 1995 Jul-Aug, 17(4), 293 - 4 {Neonatal infections caused by group B beta-hemolytic Streptococcus}; Demi M et al.; The aim of the Asiago Congress is to illustrate the progress in Group B Streptococcal neonatal disease management . It is of primary importance the obstetricians and neonatologists should think alike and should not allow their interest to develop along separate lines . The themes of the Congress were the incidence, the clinical and diagnostic new features, the old and the new therapeutic trends and the obstetrician's prevention . Contributions from twenty-four Neonatologist Groups are included; they are summarized in four main articles and all together they form a synopsis of modern clinical practice and recent research in neonatal medicine. J Comp Pathol, 1995 Jul, 113(1), 29 - 43 Pathology of equine respiratory disease occurring in association with transport; Oikawa M et al.; Eight young thoroughbred horses, taken 1858 km by road (travelling time, 41 h), were examined to assess the pathological nature of respiratory disease associated with transport . Three of the horses showed clinical abnormalities including pyrexia, coughing, leucocytosis and neutrophilia after the first 20 h of transportation . Endoscopical examination of the trachea revealed exacerbation of airway inflammation as a result of transport in two of the three affected horses . A consistent finding in the affected horses was focal serous neutrophilic pneumonia affecting the cranio-ventral portion of the caudal lung lobe with a propensity to affect the right lung . Streptococcus equi subspecies zooepidemicus was isolated from the pneumonic areas, in which corresponding bacterial antigens were identified immunohistochemically . Viral cultures from the pneumonic lesions proved negative for respiratory viruses . It is suggested that transport predisposes the upper respiratory tract and the lower airways to invasion by the bacterium, with episodic pyrexia and acute pneumonia. J Chromatogr A, 1995 Jun 30, 705(2), 363 - 8 Purification of preparative quantities of group B Streptococcus type III oligosaccharides; Paoletti LC et al.; Many bacterial capsular polysaccharides are regularly repeating units of oligosaccharides . Bacterial oligosaccharides have been used in neoglycoconjugate vaccines and as reagents in the study of specific antibody binding . Unfortunately, separation methods have not been adequate for the purification of preparative quantities of bacterial oligosaccharides . Here we describe a size-exclusion procedure that resulted in the resolution of group B Streptococcus type III oligosaccharides composed of 4-25 sugars. Mol Gen Genet, 1995 Jun 25, 247(6), 749 - 58 Complex transcriptional control of the streptokinase gene of Streptococcus equisimilis H46A; Gase K et al.; On the Streptococcus equisimilis H46A chromosome, the divergent coding sequences of the genes for the plasminogen activator streptokinase (skc) and a leucine-rich protein (lrp), the function of which is unknown, are separated by a 328 bp intrinsically bent DNA region rich in AT tracts . To begin to understand the expression control of these two genes, we mapped their transcriptional initiation sites by S1 nuclease analysis and studied the influence of the bent intergenic region on promoter strength, using promoter-reporter gene fusions of skc' and lrp' to 'lacZ from Escherichia coli . The major transcriptional start sites, in both S . equisimilis and E . coli, mapped 22 bases upstream of the ATG start site of lrp (G), and 24 and 32 bases upstream of the translational initiation codon of skc (A and G, respectively), indicating the existence of two overlapping canonical skc promoters arranged in tandem on opposite faces of the helix . The reporter gene fusions were cloned in E . coli on a vector containing a 1.1 kb fragment of the S . equisimilis dexB gene, thus allowing promoter strength to be measured in multiple plasmid-form copies in the heterologous host and in single-copy genomic form following integration into the skc region of the homologous host . In S . equisimilis, skc'-'lacZ was expressed about 200-fold more strongly than the corresponding lrp'-'lacZ fusion . In contrast, in E . coli, the corresponding levels of expression differed by only about 11-fold . Deletion of the 202 bp bent region upstream of the skc and lrp core promoters caused a 13-fold decrease in skc promoter activity in S . equisimilis but did not alter lrp promoter strength in this host . In contrast, when studied in E . coli, this deletion did not alter the strength of the skc-double promoter and even increased by 2.4- to 3-fold the activity of the lrp promoter . This comparative promoter analysis shows that skc has a complex promoter structure, the activity of which in the homologous genomic environment specifically depends on sequences upstream of the two core promoters . Thus, the skc promoter structure resembles that of an array of promoters involved in a transcriptional switch; however, the nature of the potential switch factor(s) remains unknown. Commun Dis Rep CDR Rev, 1995 Jun 23, 5(7), R106 - 8 Boarding school outbreak of group A streptococcal pharyngitis; Rushdy AA et al.; In an outbreak of pharyngitis caused by group A beta-haemolytic Streptococcus pyogenes in a boarding school of 261 pupils and 45 staff, 14 cases and 16 asymptomatic carriers were identified in pupils and one case was a member of staff . One symptomatic pupil had negative swabs . Two pupils had recurrent S . pyogenes pharyngitis before the outbreak . The attack rate was significantly greater in two dormitories than in the other seven . Swabs were taken from all staff and pupils, and the outbreak was controlled by treating all carriers and cases . Environmental factors enhancing airborne transmission were considered . The two dormitories with the most cases were poorly ventilated. Presse Med, 1995 Jun 3, 24(20), 939 - 40 {Pubic symphysitis secondary to fistula . Physiopathological hypothesis}; Laroche F et al.; Symphysitis of the pubis due to Streptococcus occurred after endoscopic resection of the prostate in a 69-year-old man . Despite a well conducted antibiotic regimen, signs persisted one year later and required arthrography that showed a prostato-symphysis fistula . This procedure might be used to find an explanation of certain persistent cases of symphysitis . Fistulization between the prostate and the pubic symphysis would be a new pathogenic hypothesis for symphysitis of the pubis. Lijec Vjesn, 1995 Jun, 117 Suppl 2, 90 - 1 A case of fatal sepsis in a child due to highly resistant Streptococcus pneumoniae; Vukelic D et al.; Infection with Streptococcus pneumoniae continues to be a significant cause of morbidity and mortality . Most of the pneumococci remain exquisitely sensitive to penicillin . However, S . pneumoniae with a reduced susceptibility to penicillin has been reported . To our knowledge, we present the first case in Croatia of fatal sepsis in a child due to Streptococcus pneumoniae that was highly resistant to penicillin. Mol Microbiol, 1995 Jun, 16(6), 1111 - 21 Regulation of ptsH and ptsI gene expression in Streptococcus salivarius ATCC 25975; Gagnon G et al.; The transcriptional regulation of the Streptococcus salivarius ptsH and ptsI genes coding for the general energy-coupling proteins HPr and enzyme I of the phosphoenolpyruvate:sugar phosphotransferase system were investigated . These genes form an operon with the gene order ptsH-ptsI . Three distinct mRNA species were detected: a 0.5 kb transcript specific for ptsH, and two long transcripts (2.2 and 2.4 kb) covering the whole pts operon . Transcription of all these mRNAs initiated at the same nucleotide located 9 bp downstream from a promoter located immediately upstream from the ptsH gene . The presence of a high-energy stem-loop structure (T0) located at the beginning of ptsI was responsible for the premature transcription termination generating the 0.5 kb ptsH-specific transcript . The long transcripts ended in the poly(U) region of two rho-independent-like terminators (T1 and T2) at the 3' end of ptsI . Studies with a 2-deoxyglucose-resistant spontaneous mutant of S . salivarius (L26) that produces an HPr-EI fusion protein suggest that the regulation of HPr and EI expression involves transcriptional as well as translational mechanisms. J Leukoc Biol, 1995 Jun, 57(6), 875 - 82 Dual function of human IgA antibodies: inhibition of phagocytosis in circulating neutrophils and enhancement of responses in IL-8-stimulated cells; Nikolova EB et al.; We have sought to elucidate the responses of human peripheral blood neutrophils to antigenic surfaces complexed with human specific IgA antibodies obtained either as myeloma proteins that recognize staphylococcal alpha-toxin, or from the serum of patients with subacute bacterial endocarditis due to Streptococcus mutans, or from colostrum . In contrast to IgG, IgA antibodies bound to antigen-coated fluorescent microspheres, and subsequently exposed to complement (or not), did not promote phagocytosis, as measured by flow cytometric enumeration of cell-associated microspheres . Instead, IgA antibodies interfered with complement-dependent phagocytosis mediated by IgG antibodies . These properties were shown by different forms of IgA antibodies, including serum and secretory IgA, as well as by monoclonal or polyclonal antibodies . Neutrophils did not respond to the production of superoxide to IgA antibodies complexed with antigen-coated microspheres or with antigen deposited on a solid surface and IgA antibodies suppressed IgG antibody- and complement-mediated superoxide release . However, neutrophils pretreated with interleukin-8 ingested IgA-opsonized microspheres and released superoxide when exposed to IgA antibody-antigen complexes . IgG antibody-antigen complexes did not stimulate increased superoxide release in interleukin-8-treated neutrophils . These findings were consistent with a selective increase in the surface expression of Fc alpha R by interleukin-8-treated neutrophils . We conclude that IgA antibodies interfere with the phagocytic activities of normal circulating human neutrophils and may promote these activities in inflammatory neutrophils activated by interleukin-8 in which Fc alpha R is up-regulated. J Dent, 1995 Jun, 23(3), 171 - 6 Bacterial adhesion to dental amalgam and three resin composites; Suljak JP et al.; OBJECTIVES: The ability of three oral bacteria to adhere to hydrophobic amalgam (water contact angle 60 degrees) and hydrophobic resin composites (Prisma-AP.H 56 degrees . Herculite XRV 82 degrees and Z100 89 degrees) was compared using an in vitro assay . METHODS AND RESULTS: Following preincubation of the materials with human saliva, X-ray photoelectron spectroscopy showed the surfaces to adsorb carbon and nitrogen-containing compounds in a conditioning film that appeared to block the detection of Na and others in 2100 resin . Hg and Ag in amalgam, Si and Zn in Prisma AP.H resin and Ag and Na in Herculite resin . The precoating of the substrata by a proteinaceous conditioning film led to decreased binding of viable cells of Streptococcus sanguis CH3, Streptococcus salivarius HB and Actinomyces viscosus WG as compared with the adhesion to bare composites . With and without salivary coating, there was a correlation between increased bacterial hydrophobicity and increased retention on the substrata . However, there was no statistical difference in binding to the amalgam compared with the resin composites . In vitro studies showed that the bacteria autoaggregated in the presence of saliva . CONCLUSION: The results indicate the potential ability of normal oral flora to colonize resin composite. J Bacteriol, 1995 Jun, 177(11), 3316 - 9 Selective lysis of cultures and cell walls of penicillin-resistant but not penicillin-susceptible Streptococcus pneumoniae strains by a murein hydrolase complex; Severin A et al.; A murein hydrolase complex selectively lysed cultures of penicillin-resistant pneumococci and their cell walls in which the majority of muropeptide subunits were indirectly cross-linked through oligopeptide substituents (alanyl-alanine or alanyl-serine) on the epsilon-amino group of the stem peptide lysine residues . Walls of penicillin-susceptible strains were not hydrolyzed. J Immunol, 1995 Jun 1, 154(11), 5896 - 906 Sequence analysis of the gene for a novel superantigen produced by Yersinia pseudotuberculosis and expression of the recombinant protein; Ito Y et al.; We previously reported that the Gram-negative bacterium Yersinia pseudotuberculosis produces a superantigen (YPM, Y . pseudotuberculosis-derived mitogen) that expands T cells bearing V betas 3, 9, 13.1, and 13.2 in an MHC class II-dependent manner . Based on the previously determined N-terminal 23 amino acids of YPM (T-D-Y-D-N-T-L-N-S-I-P-S-L-R-I-P-N-I-A-T-Y-T-G- (one-letter code)), we cloned the ypm gene and analyzed the nucleotide sequence . The gene encodes a 151-amino acid protein with a 20-amino acid signal peptide at its N terminus . The recombinant YPM expressed by the cloned gene exerted a mitogenic activity on human PBMC at a concentration of approximately 1 pg/ml . T cells bearing V beta 13.3 were preferentially expanded as well as T cells bearing the same V beta repertoires stimulated by native YPM . T cells were stimulated by the recombinant YPM in the presence of either fixed or unfixed HLA class II-transfected mouse fibroblasts . Furthermore, sequence diversity in the junctional region of the TCR beta-chain containing the V beta 3 element could be observed after stimulation by the recombinant YPM . These results indicate that YPM belongs to the category of superantigens and should be included as a novel member . The amino acid sequence of the mature protein showed no significant homology to other superantigens derived from Gram-positive bacteria such as Staphylococcus aureus and Streptococcus pyogenes . This observation, together with the substantially smaller m.w . suggest that ypm must have evolved from a different ancestral gene. J Dairy Sci, 1995 Jun, 78(6), 1310 - 7 Invasion of bovine mammary epithelial cells by Streptococcus dysgalactiae; Almeida RA et al.; Two strains of Streptococcus dysgalactiae, isolated from cows with mastitis, were assayed for their ability to invade, multiply, and induce damage to a bovine mammary epithelial cell line, MAC-T . Invasion of S . dysgalactiae into MAC-T cells was time-dependent, and invasion was inhibited in a dose-dependent manner by cytochalasin B and D, but not by colchicine . The invasion process did not appear to affect viability of mammary epithelial cells, but cellular damage was induced, as indicated by a time-dependent release of increasing amounts of lactate dehydrogenase . No net intracellular bacterial growth was observed, but S . dysgalactiae survived inside MAC-T cells . These results indicated that S . dysgalactiae invaded epithelial cells, induced cellular damage, and was capable of persisting inside bovine mammary epithelial cells. J Anim Sci, 1995 Jun, 73(6), 1552 - 8 Subclinical mastitis and milk production in primiparous Simmental cows; Simpson RB et al.; The prevalence of subclinical mastitis in beef cows was investigated and its relationship with milk production and 205-d adjusted calf weaning weights (ADJWW) determined . Primiparous Simmental cows (n = 25) were milked six times at approximately 30-d intervals . Before each milking, milk samples were aseptically collected from each quarter for bacteriological analyses . After recording milk weights, samples were obtained for determination of somatic cell counts (SCC), butterfat (BF), and protein (PRO) . Somatic cell counts were transformed to Dairy Herd Improvement Association linear scores for statistical analyses . Cows were retrospectively assigned to one of two groups based on their SCC linear score being either less than (LOSCC) or more than (HISCC) 4.5, which corresponded to a SCC of 292 x 10(3) cells/mL . Milk samples from 32% (8/25) of the cows and 18% (18/100) of the quarters were culture-positive for bacteria (Staphylococcus aureus, Streptococcus dysgalactiae, Streptococcus species, Actinomyces pyogenes, and{or} coagulase-negative Staphylococcus) at one or more times . Milk production was higher in LOSCC than in HISCC cows (6.3 +/- .2 vs 5.4 +/- .3 kg/24 h; P = .004) . Mean SCC linear score tended to be negatively correlated with mean milk production over the entire study (r = -.36; P = .08) . Adjusted weaning weights were similar between calves suckling LOSCC and HISCC cows (243 +/- 5 vs 236 +/- 10 kg; P = .57) . In summary, milk SCC concentrations in primiparous Simmental cows were highly variable . Higher SCC concentrations were associated with lower milk production in cows. Pediatr Infect Dis J, 1995 Jun, 14(6), 503 - 10 Potential interventions for the prevention of childhood pneumonia: geographic and temporal differences in serotype and serogroup distribution of sterile site pneumococcal isolates from children--implications for vaccine strategies; Sniadack DH et al.; Streptococcus pneumoniae is a leading cause of fatal bacterial pneumonia in young children . Pneumococcal polysaccharide vaccines have not been promoted for use in young children because many constituent serotypes are not immunogenic in children < 2 years old . Conjugating pneumococcal polysaccharide epitopes to a protein carrier would likely increase vaccine immunogenicity in children . We reviewed published and unpublished pneumococcal serotype and serogroup data from 16 countries on 6 continents to determine geographic and temporal differences in serotype and serogroup distribution of sterile site pneumococcal isolates among children and to estimate coverage of proposed and potential pneumococcal conjugate vaccine formulas . The most common pneumococcal serotypes or groups from developed countries were, in descending order, 14, 6, 19, 18, 9, 23, 7, 4, 1 and 15 . In developing countries the order was 6, 14, 8, 5, 1, 19, 9, 23, 18, 15 and 7 . Development of customized heptavalent vaccine formulas, one for use in all developed countries and one for use in all developing countries, would not provide substantially better coverage against invasive pneumococcal disease than two currently proposed heptavalent formulas . An optimal nanovalent vaccine for global use would include serotypes 1, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F . Geographic and temporal variation in pneumococcal serotypes demonstrates the need for a species-wide pneumococcal vaccine. Pediatr Infect Dis J, 1995 Jun, 14(6), 490 - 4 Beneficial effects of dexamethasone in children with pneumococcal meningitis; Kanra GY et al.; Fifty-six children older than 2 years with meningitis caused by Streptococcus pneumoniae were enrolled in a prospective, double blind, placebo-controlled trial to evaluate the efficacy of dexamethasone therapy in addition to antimicrobial therapy . Twenty-nine of 56 received dexamethasone (0.6 mg/kg/day iv, divided into 4 daily doses for 4 days) and the remaining 27 received placebo . At the beginning of therapy the clinical and laboratory characteristics of the patients in the treatment groups were comparable, except for the Glasgow coma score (P = 0.004), which was lower in the dexamethasone group . Patients were examined daily during hospitalization and 6 weeks after discharge from the hospital . Hearing was assessed 6 weeks after discharge by means of pure tone audiometry . Two patients in the dexamethasone group and one patient in the placebo group died . There were no differences between the two groups with regard to the duration of fever, the incidence of secondary fever and electrolyte imbalance, seizure activities occurring during hospitalization and rash . Although the differences were statistically insignificant, moderate or severe unilateral or bilateral sensorineural hearing loss at 6 weeks and the overall neurologic sequelae, including hearing loss, at 1 year were higher in the placebo group, at 23% vs . 7.4% (P = 0.11) and 26.9% vs . 7.4% (P = 0.062), respectively . At 3 months after discharge, because of the improvement in hearing loss in one dexamethasone-treated patient the incidence of hearing impairment was significantly less than that in the placebo group, at 3.7% vs . 23%, respectively (P = 0.044) . No improvement in hearing loss was observed after 3 months.(ABSTRACT TRUNCATED AT 250 WORDS) J Pediatr Surg, 1995 Jun, 30(6), 813 - 5 Use of extracorporeal membrane oxygenation in the septic neonate; Horwitz JR et al.; Extracorporeal membrane oxygenation (ECMO) is widely used for cardiopulmonary support in neonates with cardiopulmonary failure secondary to overwhelming sepsis . The purpose of this study was to examine the effects of culture status on the eventual outcome of septic neonates requiring ECMO support . Data from the Extracorporeal Life Support Organization (ELSO) for the tears 1990 through 1992 inclusive were collected and analyzed for all neonates with a primary diagnosis of sepsis . Records were reviewed for gestational age, birth weight, culture status and isolated organism, last arterial blood gas before beginning ECMO, hemorrhagic complications during bypass, and overall survival . Gram-positive sepsis accounted for 85% of positive cultures . Group B streptococcus (GBS) and Escherichia coli were the most commonly isolated organisms (GBS: 95% of all gram-positive sepsis; E coli: 76% of all gram-negative sepsis) from culture-positive patients . Culture-negative patients were found to have a significantly lower mortality rate compared with culture positive patients (16.6% versus 26.9%, P < .001) . The incidence of intracranial hemorrhage (ICH) was greater in culture-positive neonates when compared with culture negative (27.6% versus 20.1%, P < .05) . There was no difference in the incidence of ICH or eventual outcome between gram-positive and gram-negative sepsis . The culture-positive, septic neonate who requires ECMO support appears to be at an increased risk for intracranial hemorrhage and death . Intracranial hemorrhage appears to be the primary factor affecting survival in these patients . The etiologic organism does not affect the incidence of ICH or outcome . Frequent head ultrasounds and strict control of coagulation parameters are recommended in this patient population. Kokubyo Gakkai Zasshi, 1995 Jun, 62(2), 281 - 6 {A morphological study of interactions of Candida albicans and Streptococcus mutans}; Shinada K et al.; Denture stomatitis is caused mainly by infection of Candida albicans and Streptococcus mutans, the most predominant members of the bacterial flora on denture surfaces . The purpose of this study was to investigate the adhesion in vitro of C . albicans and of S . mutans to acrylic surfaces and their interactions . Concentrations of C . albicans and of S . mutans (mutational phase I and III in which activities of glucosyltransferases are higher and lower respectively) were of high levels (> or = 5.0 x 107 colony-forming-units per ml; CFU/ml) . The colonies in brain-heart-infusion (BHI) broth added 5% sucrose incubated at 37 degrees C for 18 and 72 hours . Then the samples were dried and evaporated, and examined by S-700 and S-4100 SEM (HITACHI) . It was found that S . mutans (mutational phase I) synthesized water-insoluble glucans concomitantly with the adhesion of both S . mutans and C . albicans to the acrylic surfaces . Also, adhesion of C . albicans, mediated by cell-to-cell interactions with S . mutans (especially mutational phase III), to the surfaces was observed. Curr Opin Pediatr, 1995 Jun, 7(3), 278 - 82 New developments in pediatric pneumonia and empyema; Campbell PW 3rd; A number of important developments concerning childhood pneumonia and empyema have received recent attention in the literature . Drug-resistant strains of the most common bacterial pathogen for childhood pneumonia, Streptococcus pneumoniae, have emerged in diverse geographic regions within the United States . Studies regarding the epidemiology, diagnosis, and treatment of these penicillin-resistant S . pneumoniae strains have now been published . Promising new diagnostic methods for detecting difficult to culture pathogens in sputum using polymerase chain reaction technology are now available and undergoing critical evaluation in clinical use . The debate on how to best manage empyema continues, and the role of fibrinolytic therapy and thoracoscopy as a possible alternative to traditional thoracotomy and decortication are reviewed. J Clin Microbiol, 1995 Jun, 33(6), 1592 - 5 Species identification of members of the Streptococcus milleri group isolated from the vagina by ID 32 Strep system and differential phenotypic characteristics; Ahmet Z et al.; The importance of bacterial vaginosis as a risk factor in obstetric and gynecological infections has recently been recognized . The bacterial vaginosis group of organisms includes members of the Streptococcus milleri group, the identification of which has caused much confusion . We prospectively surveyed the rates of carriage of S . milleri group organisms in 397 high vaginal swabs received in our laboratory . For the identification of 99 clinical isolates and 23 control strains, we compared the results obtained by the rapid ID 32 Strep system (Analytab Products) and by a scheme utilizing six differential phenotypic characteristics (presence of beta-N-acetylglucosaminidase, alpha-glucosidase, beta-D-fucosidase, beta-galactosidase, beta-N-acetylgalactosaminidase, and beta-glucosidase) as described by Whiley et al . (R . A . Whiley, H . Fraser, J . M . Hardie, and D . Beighton, J . Clin . Microbiol . 28:1497-1501, 1990) . We identified Streptococcus anginosus in 18% and Streptococcus constellatus in 0.05% of the specimens examined . Of the isolates of S . anginosus that reacted with grouping antisera, 20 of 25 belonged to Lancefield group F . The incubation conditions for bacterial cultures and for reaction mixtures affected the results of phenotypic characterization in the production of alpha-glucosidase, beta-galactosidase, and beta-glucosidase . However, by using bacterial cultures grown under hypercapnic conditions and incubating the reaction mixtures aerobically, consistent phenotypic characteristics were obtained, allowing identification similar to that obtained by the ID 32 Strep system . We therefore recommend the phenotypic scheme as an inexpensive, reliable, and convenient method for the initial identification of species of the S . milleri group. J Clin Microbiol, 1995 Jun, 33(6), 1471 - 2 Multiple strains of Streptococcus pyogenes in skin sores of aboriginal Australians; Carapetis J et al.; A molecular technique (random amplification of polymorphic DNA) was used to characterize group A streptococcal (GAS) strains among 194 isolates from 55 swabs from 12 Australian Aboriginal children and adults with multiple pyoderma lesions . Ninety-three percent of the lesions contained only one strain of GAS, but 8 of 12 individuals were infected with more than one strain . We conclude that accurate epidemiologic surveys require that more than one swab specimen be obtained from each person, whereas typing of more than one colony per swab is less informative . Characterization of GAS strains by random amplification of polymorphic DNA analysis should help to provide important insights into the epidemiology of GAS, particularly in tropical populations where many isolates are M nontypeable, and into the mechanisms of genetic variation of GAS in such populations. Acta Paediatr Jpn, 1995 Jun, 37(3), 381 - 3 Acute rheumatic fever and poststreptococcal acute glomerulonephritis caused by T serotype 12 Streptococcus; Imanaka H et al.; We present a rare case of a 10 year old Japanese boy with acute rheumatic fever accompanied with poststreptococcal acute glomerulonephritis . We isolated group A Streptococcus serotype T 12, a strain that was thought to be nephritogenic but not rheumatogenic, from throat culture . Although rare, physicians should be aware that acute renal disease may accompany rheumatic fever. Endod Dent Traumatol, 1995 Jun, 11(3), 142 - 9 Bacteremia in conjunction with endodontic therapy; Debelian GJ et al.; This study characterizes oral microorganisms believed to have spread from the root canal into the blood stream during and after endodontic therapy of teeth with Asymptomatic apical periodontitis . Microbiological samples were taken under aseptic conditions from the root canal of 26 single-rooted teeth in 26 patients . In the endodontic treatment of 13 of the patients (Group 1), the first 3 reamers, sizes 15, 20 and 25, were used to a level 2 mm beyond the apical foramen . In the other 13 patients (Group 2), the instrumentation ended inside the root canal 1 mm short of the apical foramen . Blood samples were taken from the patients during the instrumentation and 10 min after the treatment was completed . Anaerobic microorganisms were isolated from all root canals . In 7 patients of Group 1, Propionibacterium acnes, Peptostreptococcus prevotii, Fusobacterium nucleatum, Prevotella intermedia and Saccharomyces cerevisiae were recovered from the blood . In 4 patients of Group 2, P . intermedia, Actinomyces israelii, Streptococcus intermedius and Streptococcus sanguis were isolated from the blood . Biochemical tests and antibiograms revealed that the isolates from the root canal and blood had identical profiles within the patients, strongly suggesting that the microorganisms isolated from the blood had the root canal as their source. J Trop Pediatr, 1995 Jun, 41(3), 185 - 8 Empyema thoracis in hospitalized children in Kelantan, Malaysia; Maziah W et al.; In this study, 31 cases of childhood empyema thoracis admitted over 4 1/2 years to the Hospital Universiti Sains Malaysia, in Kelantan, Malaysia, were retrospectively reviewed . Twenty-two males and nine females were included, with a mean age of 1.9 years (range: 26 days to 7 years) . Frequent symptoms were fever, cough, and dyspnoea, while common signs were temperature above 38 degrees C, decreased breath sounds, dullness to chest percussion, and intercostal recession . Radiography demonstrated unilateral moderate to large effusions in 68 per cent of cases, while consolidated lung was seen in 45 per cent of patients . Pleural fluid cultures were positive for Staphylococcus aureus (48 per cent), Streptococcus pneumoniae (7 per cent), while no growth was seen in 42 per cent of cases . Ninety-four per cent of children had a blood leukocytosis above 10 000 cell/mm3, but blood cultures were negative in 21 out of 26 patients (81 per cent) . Most cases were treated with a combination of intravenous antibiotics and chest tube drainage . Antibiotics and pleural tap(s) were used in the remainder . Patients stayed in hospital for an average of 20.7 days (range: 4-52 days) . Surgical intervention was necessary in only four children . The mortality rate at the time of discharge was zero, with 100 per cent radiographic resolution among the 23 patients who were followed-up. Eur J Oral Sci, 1995 Jun, 103(3), 182 - 5 Inhibitory effect on S . mutans by fluoride-treated conventional and resin-reinforced glass ionomer cements; Seppa L et al.; The aim of the present study was to study the effect of fluoride gel treatment on fluoride release and inhibition of acid production of Streptococcus mutans by different glass ionomer cements . Test slabs of four glass ionomer materials were fitted into the bottom of a test tube . A layer of S . mutans cells was centrifuged onto the test slabs, and the specimens were incubated for 4 h in 1.7% sucrose solution . Incubations were made using fresh, aged (29 d), aged and F-treated (1.25% F-gel), and aged, F-treated and aged samples (n = 15 per group) . After each incubation, pH and F contents of the fluid phase were determined . The freshly mixed glass ionomer samples released large amounts of fluoride, and the pH fall in the fluid phase was significantly inhibited . For aged samples, the fluoride release decreased strongly and no inhibitory effect on acid production by S . mutans was seen . After application of fluoride gel, fluoride release and inhibitory effect were significantly higher than initially for all glass ionomer cements . In conclusion, all glass ionomer cements were able to take up fluoride and subsequently release it, which resulted in reestablishment of their antibacterial effect . The patterns of fluoride release and antibacterial action were virtually the same for conventional and resin-reinforced glass ionomer cements. J Dent Res, 1995 Jun, 74(6), 1272 - 9 Anticariogenicity of calcium phosphate complexes of tryptic casein phosphopeptides in the rat; Reynolds EC et al.; Casein phosphopeptides (CPP) stabilize calcium phosphate through the formation of casein-phosphopeptide amorphous calcium-phosphate complexes (CPP-CP) . The ability of CPP-CP to reduce caries activity was investigated by use of specific-pathogen-free rats inoculated with Streptococcus sobrinus . The animals consumed a defined cariogenic diet free of dairy products . Solutions (100 microL) of the CPP-CP (0.1, 0.2, 0.5, 1.0% w/v) were applied to the animals' molar teeth twice daily . Other groups of animals received solutions containing 500 ppm F, the non-phosphorylated peptides of a casein tryptic digest (0.5% w/v), or the calcium-phosphate complex of a synthetic octapeptide, Ac-Glu-Ser(P)-Ile-Ser(P)-Ser(P)-Ser(P)-Glu-Glu-NHMe, corresponding to the common sequence in the CPP . The CPP-CP significantly reduced caries activity in a dose-response fashion, with 1.0% CPP-CP producing 55% and 46% reductions in smooth surface and fissure caries activity, respectively, being similar to that of 500 ppm F . The anticariogenic effects of CPP-CP and fluoride were additive, since animals receiving 0.5% CPP-CP plus 500 ppm F had significantly lower caries activity than those animals receiving either CPP-CP or fluoride alone . The tryptic digest of casein with the phosphopeptides selectively removed showed no anticariogenic activity . The synthetic octapeptide-calcium phosphate complex significantly reduced caries activity, confirming that this calcium-phosphate-stabilizing portion of the casein phospho-peptides is associated with anticariogenicity . The CPP-CP did not significantly affect the level of S . sobrinus in fissure plaque.(ABSTRACT TRUNCATED AT 250 WORDS) J Can Dent Assoc, 1995 Jun, 61(6), 511 - 6 Contaminated toothbrushes and their disinfection; Caudry SD et al.; Twenty toothbrushes used by healthy subjects were screened for the presence of microorganisms . Microbes were dislodged from the brushes by vortexing, and an average of 4 x 10(3) CFU/mL were recovered from the suspending fluid . Bristles removed from the vortexed brushes still yielded confluent bacterial growth on brain-heart infusion agar medium . Virkon (one per cent), Listerine, Cepacol, Scope, and Plax were tested for their bactericidal effects on microorganisms sedimented from the suspending fluid, on toothbrush bristles and proxabrushes, and on various test species including Candida albicans, Mycobacterium smegmatis, M . bovis, and Streptococcus mitis . Virkon and Listerine killed all the test species and virtually all the microorganisms on the toothbrush bristles and proxabrushes . Six volunteers tested the efficacy of a Listerine soaking regime to prevent the bacterial contamination of toothbrushes . Soaking the toothbrush head (bristles) in Listerine for 20 minutes after brushing was sufficient to eliminate bacterial contamination. Eur J Clin Microbiol Infect Dis, 1995 Jun, 14(6), 528 - 31 Capsular types and antimicrobial resistance of Streptococcus pneumoniae isolated in Korea; Chong Y et al.; The capsular types and the MICs of penicillin G and other antimicrobial agents were determined for 89 isolates of Streptococcus pneumoniae . MICs of penicillin G ranged from 0.015 to 2 mg/l, with 29% and 48% of the isolates exhibiting intermediate resistance and complete resistance, respectively . All isolates were susceptible to teicoplanin and vancomycin, but 81% and 43% of the penicillin G-resistant strains were intermediately resistant to cefotaxime and imipenem, respectively . Strains belonged to 16 different capsular types: 73% belonged to types 19F and 23F, and 97% of strains belonging to these two types exhibited either intermediate or complete resistance to penicillin G. Eur J Clin Microbiol Infect Dis, 1995 Jun, 14(6), 526 - 8 Recurrent Streptococcus pneumoniae endocarditis; Cunningham R et al.; A case of recurrent endocarditis due to Streptococcus pneumoniae, a rare cause of endocarditis, is reported . The first episode of infection resulted in valvular damage, necessitating replacement of the aortic and mitral valves, and the second episode was treated successfully with antibiotics alone . Recurrence occurred even though the organism was fully susceptible to the antibiotics used and the patient showed no evidence of immune deficiency. Eur J Clin Microbiol Infect Dis, 1995 Jun, 14(6), 491 - 7 Molecular analysis by pulsed-field gel electrophoresis of penicillin-resistant Streptococcus pneumoniae from Toulouse, France; Lefevre JC et al.; A sample of 28 penicillin-resistant Streptococcus pneumoniae strains isolated between 1991 and 1993 in a large hospital in Toulouse, France, was characterized by pulsed-field gel electrophoresis of genomic DNA . Also included were 6 penicillin-susceptible clinical isolates from Toulouse and 12 penicillin-resistant strains from different parts of the world . The restriction endonucleases ApaI and SmaI were used to digest intact chromosomes, and the fragments were resolved by field-inversion gel electrophoresis . Seven major pattern types could be recognized among the penicillin-resistant isolates from Toulouse . Nine of these isolates could be assigned to two clones that were also found in Spain and were associated with serotypes 6B and 9V . A third clone was isolated in South Africa and in Spain and contained serotype 23F isolates . The profiles obtained by field-inversion gel electrophoresis suggested that 15 of the 16 penicillin-resistant serogroup 23 isolates from Toulouse belonged to the same Spanish 23F clone . The molecular test profiles of penicillin-susceptible strains differed from those of resistant strains of the same serotype except those of 9V strains . These data underline the importance of the geographic spread of resistant clones from Spain in the emergence of penicillin-resistant pneumococci in France. Eur J Clin Microbiol Infect Dis, 1995 Jun, 14(6), 479 - 90 Pneumococcal virulence factors and host immune responses to them; Watson DA et al.; The principal virulence determinant of most encapsulated bacterial pathogens is the possession of an extracellular capsule . This paper discusses biological aspects of the Streptococcus pneumoniae capsule, putative roles played by accessory virulence factors of this pathogen and prospects for improvement of the currently available pneumococcal vaccine . Even though the interruption of genes encoding selected proteins has been shown to attenuate virulence to some degree, the physical removal of the pneumococcal capsule or the interruption of encapsulation genes completely abolishes virulence in mice . The role of the capsule in pathogenesis is not completely clear, however, since it is not known whether this structure is important in colonization, the obligatory first step in the process . In addition, a number of proteins have been implicated as possible accessory virulence factors . These include pneumolysin, two distinct neuraminidases, an IgA1 protease and two surface proteins, pspA and psaA . While interruption of the expression of some of these proteins examined to date has been shown to attenuate virulence, so far it has not proven possible to completely abolish virulence in this fashion . Proteinaceous accessory virulence factors may prove important to the development of second-generation pneumococcal vaccines, however . Pneumococcal and other proteins conjugated to pneumococcal polysaccharides are currently being evaluated as carriers in attempts to improve the immunogenicity of polysaccharide vaccines, primarily in small children. FEMS Immunol Med Microbiol, 1995 Jun, 11(3), 219 - 30 Development and characterization of monoclonal antibodies specific for the genus Listeria; Loiseau O et al.; Monoclonal antibodies were obtained by the classic hybridoma technique with lymphocytes of BALB/c mice immunized with formalin killed Listeria monocytogenes cells . Among 1000 hybridomas issued from the fusion, four monoclonal antibodies (mAbs A6 A E4, C10 A F7, G4 A D6, G7 A D5) gave interesting results . By Western-blot analysis with various soluble extracts of different Listeria species, the four mAbs reacted with two major antigens of 38 and 41 kDa, with all Listeria species tested . The mAb A6 A E4 is an IgG2b with kappa light chains and reacted only with Listeria antigens without any cross reaction with other organisms tested by ELISA, dot-blotting and Western-blotting . With the same conditions, the three other mAbs reacted with Listeria and with other genus extracts, particularly with Streptococcus and Enterococcus . mAb A6 A E4-reactive antigens are proteins, and glycoprotein immunoassay indicated that the epitope is devoid of carbohydrate moiety . This mAb A6 A E4-reactive protein was neither expressed on cell surface nor released outside the bacteria; immunogold electron microscopy showed that these antigens were localized in the cytoplasma area. Int J Biol Macromol, 1995 Jun, 17(3-4), 117 - 30 Application of two-dimensional NMR spectroscopy and molecular dynamics simulations to the conformational analysis of oligosaccharides corresponding to the cell-wall polysaccharide of Streptococcus group A; Kreis UC et al.; This paper describes the use of a protocol for conformational analysis of oligosaccharide structures related to the cell-wall polysaccharide of Streptococcus group A . The polysaccharide features a branched structure with an L-rhamnopyranose (Rhap) backbone consisting of alternating alpha-(1-->2) and alpha-(1-->3) links and D-N-acetylglucosamine (GlcpNAc) residues beta-(1-->3)-connected to alternating rhamnose rings: {formula: see text} Oligomers consisting of three to six residues have been synthesized and nuclear magnetic resonance (NMR) assignments have been made . The protocol for conformational analysis of the solution structure of these oligosaccharides involves experimental and theoretical methods . Two-dimensional NMR spectroscopy methods (TOCSY, ROESY and NOESY) are utilized to obtain chemical shift data and proton-proton distances . These distances are used as constraints in 100 ps molecular dynamics simulations in water using QUANTA and CHARMm . In addition, the dynamics simulations are performed without constraints . ROE build-up curves are computed from the averaged structures of the molecular dynamics simulations using the CROSREL program and compared with the experimental curves . Thus, a refinement of the initial structure may be obtained . The alpha-(1-->2) and the beta-(1-->3) links are unambiguously defined by the observed ROE cross peaks between the A-B',A'-B and C-B,C'-B' residues, respectively . The branch-point of the trisaccharide CBA' is conformationally well-defined . Assignment of the conformation of the B-A linkage (alpha-(1-->3)) was problematic due to TOCSY relay, but could be solved by NOESY and T-ROESY techniques . A conformational model for the polysaccharide is proposed. Antimicrob Agents Chemother, 1995 Jun, 39(6), 1306 - 13 Genetic analysis of clinical isolates of Streptococcus pneumoniae with high-level resistance to expanded-spectrum cephalosporins; Coffey TJ et al.; Streptococcus pneumoniae CS109 and CS111 were isolated in the United States in 1991 and have high levels of resistance to expanded-spectrum cephalosporins (MICs of 8 and 32 micrograms of cefotaxime per ml, respectively) . CS109, but not CS111, also showed high-level resistance to penicillin . As both strains expressed the serotype 23F capsule, were very closely related in overall genotype, and possessed identical or closely related mosaic pbp1a, pbp2x, and pbp2b genes, it is likely that they have arisen from a recent common ancestor . High-level resistance to expanded-spectrum cephalosporins was entirely due to alterations of penicillin-binding proteins (PBPs) 1a and 2x, since a mixture of the cloned pbp1a and pbp2x genes from the resistant strains could transform the susceptible strain R6 to the full level of cephalosporin resistance of the clinical isolates . Both PBP1a and PBP2x of these strains were more resistant to inhibition by cephalosporins than those of typical highly penicillin-resistant isolates . The pbp1a genes of CS109 and CS111 were identical in sequence, and the fourfold difference in their levels of resistance to cephalosporins was due to a Thr-550-->Ala substitution at the residue following the conserved Lys-Ser-Gly motif of PBP2x . This substitution was also the major cause of the 16-fold-lower resistance of CS111 to penicillin . The pbp2x gene of CS111, in an appropriate genetic background, could provide resistance to 16 micrograms of cefotaxime per ml but only to 0.12 microgram of benzylpenicillin per ml . Removal of the codon 550 mutation resulted in a pbp2x gene that provided resistance to 4 microgram of cefotaxime per ml and 4 microgram of benzylpenicillin per ml . The Thr-550-->Ala substitution in CS111 therefore appears to provide increased resistance to expanded-spectrum cephalosporins but a loss of resistance to penicillin. Antimicrob Agents Chemother, 1995 Jun, 39(6), 1253 - 8 Experimental Streptococcus pneumoniae infection in mice for studying correlation of in vitro and in vivo activities of penicillin against pneumococci with various susceptibilities to penicillin; Knudsen JD et al.; The purpose of the study was to investigate the correlation of in vitro activity with the in vivo effect and the pharmacokinetics of penicillin in the treatment of infections with pneumococci with various susceptibilities to penicillin . We used 10 pneumococcal strains for which penicillin MICs ranged from 0.016 to 8 micrograms/ml . Time-kill curve experiments were performed with all strains . We found that the effect of penicillin in vitro is concentration independent, with a maximum effect at two to four times the MIC for penicillin-susceptible as well as penicillin-resistant pneumococci . The mouse peritonitis model with an inoculum of approximately 10(6) CFU, to which mucin was added, resulted in a reproducible lethal infection with the pneumococci . The 50% effective dose was determined for each strain, and we found a highly significant correlation between the log MIC and the log 50% effective dose of penicillin against these strains (P < 0.01) . Furthermore, it was shown that the most important pharmacokinetic parameter determining the effect of penicillin in vivo was the time that the concentration of penicillin in serum was greater than the MIC. Antimicrob Agents Chemother, 1995 Jun, 39(6), 1243 - 6 Evaluation of CP-99,219, a new fluoroquinolone, for treatment of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis; Paris MM et al.; CP-99,219 is a new fluoroquinolone that has excellent activity against gram-positive organisms including penicillin- and cephalosporin-resistant Streptococcus pneumoniae strains . In our well-established rabbit model of meningitis, we conducted experiments to determine the concentrations of CP-99,219 in cerebrospinal fluid (CSF) after intravenous administration and its ability to eradicate two penicillin-resistant pneumococcal isolates . The peak and trough concentrations of CP-99,219 in the CSF were from 19 to 25% of the concentrations simultaneously obtained in serum and were unaffected by concomitant dexamethasone administration . Compared with untreated (control) animals, three doses of CP-99,219 given 5 h apart significantly reduced the bacterial count in CSF by 5 to 6 log10 CFU at 10 h . Although 47% of the dexamethasone-treated animals and 18% of those not given the steroid had positive cultures at 24 h (14 h after administration of the last antibiotic dose), the mean bacterial counts did not change from those observed at 10 h . Additionally, only results for animals infected with one of the two pneumococcal strains appeared to be affected by concomitant dexamethasone therapy. Oral Microbiol Immunol, 1995 Jun, 10(3), 188 - 92 Primer extension analysis of Streptococcus mutans promoter structures; Smorawinska M et al.; To characterize the promoter structures of Streptococcus mutans genes, primer extension analysis was carried out with 4 genes previously isolated in this laboratory . An analysis of the transcription start sites for the gtfB, gtfC, gtfD and ftf genes revealed that each transcript was initiated at a purine residue . Based on these sites, the -10 and -35 sequences for each transcript were deduced and compared . For all 4 transcripts, the -10, but not the -35, sequences were homologous to the Escherichia coli promoter consensus sequences. Oral Microbiol Immunol, 1995 Jun, 10(3), 183 - 7 Characterization of glutamine transport in Streptococcus mutans; Dashper SG et al.; Glutamine transport in glucose-energized cells of Streptococcus mutans Ingbritt exhibited Michaelis-Menten-type kinetics with a Vmax of 13.4 nmol/mg dry weight/min and a Kt of 4.1 microM . Diffusion of glutamine into de-energized cells of S . mutans displayed similar type kinetics, with a Kt of 6.8 microM but with a markedly reduced Vmax of 53.9 pmol/mg dry weight/min . Glutamine transport in S . mutans is not proton motive force-driven, as the intracellular accumulation of glutamine by energized cells far exceeded the thermodynamic limits of the proton motive force, and the dissipation of this proton motive force by gramicidin in a high K+ medium did not decrease the intracellular glutamine concentration . Glutamine transport is therefore likely to be energized by ATP hydrolysis . The activity of the transporter was maximal between pH 6.0 and 7.0 and decreased rapidly above pH 7.0 . The transport of glutamine was not competitively inhibited by asparagine, glutamate or aspartate, indicating a specific glutamine transport system . Reversed-phase high-pressure liquid chromatography of cell extracts revealed that approximately 26% of the glutamine taken into the cell was converted to glutamate within 10 min . The results are consistent with transported glutamine being converted to glutamate and ammonia by the action of an intracellular glutaminase . Glutamine therefore may be an important source of nitrogen for the cell. J Hosp Infect, 1995 Jun, 30 Suppl, 472 - 82 Penicillin-resistant pneumococci--an emerging threat to successful therapy; McGowan JE Jr et al.; Pneumococci highly resistant to penicillin G {minimum inhibitory concentration (MIC) > or = 2 mg L-1} have become prevalent in many parts of the world since their emergence and spread in the late 1970s . In the USA, such organisms are seen primarily in two populations: infants and children, and adults with AIDS . Surveys in both rural and urban areas have revealed presence of these organisms, as well as an increasing frequency of Streptococcus pneumoniae strains relatively resistant to penicillin (MIC 0.1-1.0 mg L-1--now defined by some as 'intermediate' resistance) . Predisposing factors are not yet clear . Prior antimicrobial therapy was given to some of the children and most of the adults who are colonized or infected with resistant strains . Prior or concurrent use of cotrimoxazole prophylaxis for Pneumocystis carinii pneumonia has been frequent in our cases in adults, most of whom had a concurrent diagnosis of AIDS . Children with disease often have a history of long-term prophylaxis with a beta-lactam drug (for sickle cell disease, etc) . Many strains are also resistant to newer cephalosporins like cefotaxime and ceftriaxone (MIC > or = 2 mg L-1) . The organisms are frequently multi-resistant, with high MIC values common as well for chloramphenicol and variable for tetracycline, macrolides, cotrimoxazole, and fluoroquinolones . Only to vancomycin are the organisms consistently susceptible . These findings raise alarms about the future of pneumococcal disease in both community and nosocomial disease . Increasing prevalence in otitis and pneumonia in children and in community-acquired pneumonia in adults may lead to use of vancomycin as empirical therapy for these clinical situations . This would increase the selective pressure for emergence of vancomycin-resistant organisms, whether S . pneumoniae or others . Moreover, the pneumococcus was a common cause of hospital infection prior to the introduction of penicillin . The potential now exists for nosocomial pneumococcal infection again to become a feared and ominous occurrence. J Antimicrob Chemother, 1995 Jun, 35(6), 785 - 91 Prevalence of penicillin resistant bacteria in acute suppurative oral infection; Lewis MA et al.; Pus aspirated from acute suppurative oral infections in 78 patients (age range 13-76 years) yielded a total of 331 bacterial strains consisting of 143 facultative anaerobes (predominantly Streptococcus spp.) and 188 strict anaerobes (predominantly Prevotella spp.) . Seventy-five isolates (23%) were resistant to penicillin (MIC > 1 mg/L), 37 (11%) were resistant to ampicillin (MIC > 2 mg/L) and 16 (5%) isolates were resistant to amoxycillin/clavulanic acid (MIC > 2 mg/L) . Samples from 43 (55%) of the patients yielded at least one penicillin resistant isolate and within this group 30 samples (73%) contained at least one strain which produced beta-lactamase . A history of antibiotic therapy during the 6 months before enrollment in the study did not influence the isolation of penicillin resistant bacteria . It is concluded that penicillin resistant bacteria are often present in the microflora of acute dental infection. Nippon Yakurigaku Zasshi, 1995 Jun, 105(6), 469 - 78 {Pharmacological study on the dry distillation tar of delipidated soybean (Glyteer) (5): Antimicrobial activity}; Ito K et al.; Glyteer (GL) possessed a broad antimicrobial spectra against bacteria and fungi . The antimicrobial activity of GL was bactericidal action, but not bacteriostatic action . GL was more effective against fungi than bacteria . GL ointment also showed antimicrobial activity equal to that of GL . Furthermore, GL had an effect on methicillin-resistant Staphylococcus aureus (MRSA) . Resistance to GL was not induced in broth cultures of Escherichia coli, Staphylococcus aureus, Streptococcus pyogenes, Candida albicans, and Trichophyton mentagrophytes . These results suggest that GL applied externally exerts a potent effect as an anti-microbial drug for dermopathy with various microbialpathogens. Clin Otolaryngol, 1995 Jun, 20(3), 201 - 3 Antimicrobial activity of glycerine-ichthammol in otitis externa; Ahmed K et al.; The clinical efficacy of glycerine-ichthammol in otitis externa may be due to an anti-inflammatory action of ichthammol or a dehydrating effect of glycerine on the oedematous ear canal . Its antimicrobial activity, if any, against the common organisms in otitis externa is not well known . A study of the antibacterial property of glycerine-ichthammol as measured by a growth inhibition test and a modified cidal assay, showed inhibition of selected gram positive organisms (Streptococcus pyogenes and Staphylococcus aureus) by ichthammol and glycerine-ichthammol combination, but only negligible antibacterial activity against Pseudomonas aeruginosa and Escherichia coli . Candida albicans was also weakly inhibited . As the activity against gram negative organisms is minimal, incorporation of an anti-gram negative antibiotic such as gentamicin in the glycerine-ichthammol compound to enhance its antibacterial spectrum is suggested. Clin Infect Dis, 1995 Jun, 20 Suppl 2, S279 - 82 Bacteriology of skin and soft-tissue infections: comparison of infections in intravenous drug users and individuals with no history of intravenous drug use; Summanen PH et al.; The bacteriology of cutaneous or subcutaneous abscesses (86 specimens) among intravenous drug users (IVDUs) was compared with the bacteriology of abscesses (74 specimens) in patients with no history of intravenous drug use (non-IVDUs) . The IVDU abscesses yielded 173 aerobes and 131 anaerobes . Staphylococcus aureus was the most common aerobe isolated (50% of specimens yielded this isolate), followed by "Streptococcus milleri" (46%) . The commonly encountered anaerobes were Fusobacterium nucleatum (17%), pigmented Prevotella species (22%), Peptostreptococcus micros (17%), Actinomyces odontolyticus (15%), and Veillonella species (13%) . The non-IVDU isolates included 116 aerobes and 106 anaerobes . S . aureus was isolated from 53% of these specimens, followed by coagulase-negative staphylococci (19%), "S . milleri" (19%), and Streptococcus pyogenes (16%) . The main groups of anaerobes were Peptostreptococcus species (35%), Bacteroides species (19%), and gram-positive bacilli (31%) . Overall, 67% of the IVDU isolates were of oral origin, compared with 25% of the non-IVDU isolates . Of the specimens from IVDUs and non-IVDUs, 48% and 67%, respectively, yielded only aerobes, and 2% and 4%, respectively, yielded only anaerobes . Sixty-four percent of the patients had one or more beta-lactamase-producing organisms. Clin Infect Dis, 1995 Jun, 20 Suppl 2, S214 - 9 Bacteriology of chronic otitis media, chronic sinusitis, and paranasal mucopyocele in Japan; Ito K et al.; A bacteriologic study of cases of chronic otitis media, chronic sinusitis, and paranasal mucopyocele diagnosed at Gifu University Hospital was performed between 1989 and 1992 . Bacteria were isolated from all of 13 samples of discharge from the ears of patients with chronic otitis media, all of 14 mucosal biopsy specimens from patients with chronic sinusitis, 8 of 10 aspirate samples from patients with chronic sinusitis, and 9 of 15 aspirates samples from patients with mucopyocele . Cultures often yielded polymicrobial growth, with an average of 3.1, 3.8, and 4.2 species per positive specimen from chronic otitis media, chronic sinusitis, and mucopyocele, respectively . The most commonly encountered anaerobes were Peptostreptococcus, Propionibacterium, and Prevotella species; the most common aerobes were Staphylococcus and Streptococcus species . One strain of Prevotella melaninogenica highly resistant to ampicillin and two strains of Peptostreptococcus resistant to cefaclor were found. Microbiology, 1995 Jun, 141 ( Pt 6), 1461 - 7 Heterogeneity among 16S-23S rRNA intergenic spacers of species within the 'Streptococcus milleri group'; Whiley RA et al.; The 16S-23S rRNA intergenic spacer has been suggested as a suitable region of the bacterial genome from which to derive useful taxonomic information, particularly with regard to identification at the species level . To investigate this approach as an aid to the identification of the three species comprising the 'Streptococcus milleri group' (SMG), the spacers of isolates of Streptococcus intermedius, Streptococcus anginosus and Streptococcus constellatus were amplified by PCR and length polymorphisms determined by agarose gel electrophoresis . Phenotypically atypical isolates which had been identified presumptively as belonging to these three species were also included . Spacers from two representatives of each spacer length found within the three SMG species were sequenced . 16S-23S rRNA intergenic spacer length polymorphisms allowed discrimination between S . anginosus (350 bp or 450 bp amplification product) and S . constellatus (380 bp amplification product), species that are difficult to differentiate phenotypically . S . intermedius (330 bp or 450 bp amplification product) and S . anginosus (350 bp or 450 bp amplification product) were not reliably distinguished by this method but are phenotypically distinct . Sequencing data demonstrated that the spacers had a central region of highly variable length flanked by conserved regions which included a single tRNA(Ala) gene . Polymorphism in the length of the 16S-23S spacer determined by PCR provides a rapid and useful adjunct to strain identification for S . anginosus and S . constellatus, which are not readily differentiated phenotypically. Microbiology, 1995 Jun, 141 ( Pt 6), 1451 - 60 Four glucosyltransferases, GtfJ, GtfK, GtfL and GtfM, from Streptococcus salivarius ATCC 25975; Simpson CL et al.; The four recombinant glucosyltransferases (GTFs), GtfJ, GtfK, GtfL and GtfM, that had previously been cloned from Streptococcus salivarius ATCC 25975, were individually expressed in Escherichia coli and their glucan products and kinetic properties were analysed . GtfJ was a primer-dependent GTF which synthesized an insoluble glucan composed mainly of alpha-(1-->3)-linked glucosyl residues in the presence of dextran T-10 . GtfK was primer-stimulated, and produced a linear soluble dextran without any detectable branch points both in the absence and in the presence of dextran T-10 . GtfL was primer-independent and produced a mixed-linkage insoluble glucan composed of approximately equal proportions of alpha-(1-->3)- and alpha-(1-->6)-linked glucosyl residues . GtfL was inhibited by dextran T-10 . GtfM was primer-independent and produced a soluble dextran with approximately 5% alpha-(1-->3)-linked glucosyl residues . GtfM was essentially unaffected by the presence of dextran T-10 . The results confirmed that each enzyme represented one of the four possible combinations of primer-dependency and product solubility and that each possessed unique biosynthetic properties . The soluble dextrans formed by GtfK and GtfM, as well as the mixed-linkage insoluble glucan formed by GtfL, were also capable of acting as primers for the primer-dependent GtfJ and the primer-stimulated GtfK . Unexpectedly, the linear dextran produced by GtfK was by far the least effective either at priming itself or at activating and priming the primer-dependent GtfJ. Vaccine, 1995 Jun, 13(9), 867 - 70 Vaccination with whole-cell vaccine and bacterial protein extract protects tilapia against Streptococcus difficile meningoencephalitis; Eldar A et al.; Formalin-killed Streptococcus difficile strains used as vaccines delivered intraperitoneally were able to protect tilapia against a challenge of 100 LD50 . The protection obtained was not strain specific . A vaccine based on an S . difficile extract containing 50% protein conjugated to alum also protected tilapia challenged with a virulent S . difficile strain . Protection in tilapia was correlated with the development of specific agglutinins . Western blot analysis supported the hypothesis that only a few proteins act as protective antigens in both the whole-cell vaccine and the streptococcal extract . The high efficacy of these vaccines make them good candidates for the control of streptococcal fish meningoencephalitis. Mol Cell Probes, 1995 Jun, 9(3), 157 - 60 Identification of a patient with Streptococcus pneumoniae bacteremia and meningitis by the polymerase chain reaction (PCR); Isaacman DJ et al.; A polymerase chain reaction (PCR) assay based on the penicillin-binding protein gene PBP2B identified the presence of DNA specific for Streptococcus pneumoniae in the serum and CSF of a patient with culture-proven bacteremia and meningitis . Positive signals were seen to dilutions of 1:125 and 1:390,625 for the blood and CSF specimens, respectively . Potential advantages of PCR over conventional culture include exquisite sensitivity, faster results and the ability to identify the organisms by the presence of species-specific DNA even in patients pretreated with antibiotics. Ann N Y Acad Sci, 1995 May 31, 754, 214 - 21 Progress on development of the live BCG recombinant vaccine vehicle for combined vaccine delivery; Hanson MS et al.; BCG, the current vaccine for tuberculosis, has been administered to approximately three billion people . This live vaccine has a low incidence of serious side effects and can be given at birth . Within the past six years, systems for the manipulation and expression of foreign genes in mycobacteria have been developed, allowing the evaluation of rBCG as a vaccine delivery vehicle for heterologous antigens . Recent studies from our group have shown that rBCG expressing outer surface protein A of Borrelia burgdorferi can completely protect mice from an intradermal challenge with this organism . Immune responses protective against Streptococcus pneumoniae challenge have also been achieved by immunization of mice with rBCG expressing PspA . The simplest means of administering multiple vaccine antigens in a rBCG vehicle would be to coexpress these simultaneously in the same BCG recombinant . Currently two general classes of vectors exist for the expression of foreign proteins in BCG: shuttle plasmid vectors, which replicate extrachromosomally in mycobacteria, and shuttle "phasmid" vectors, which integrate as a single copy into the mycobacterial chromosome by means of vector-encoded integration functions of the lysogenic mycobacteriophage L5 . The genetic capacity of the multicopy plasmid vectors may be 20 kb or more, while the potential exists for stable integration of much larger amounts of DNA into the mycobacterial genome (L5 itself is 52 kb) . Additionally, these two expression systems can have the compatibility to coexist in a single BCG cell . Otitis media is caused by infections of the middle ear chiefly with either S . pneumoniae or H . influenzae . Thus, an effective vaccine would necessarily include antigens from both these pathogens . Our initial attempt at construction of a BCG multivaccine vehicle was to express proteins from each of these pathogens from the same multicopy plasmid . We have recently succeeded in coexpressing the S . pneumoniae PspA and H . influenzae PAL proteins in BCG . Future work will address how the biochemical characterization of and immune responses to the recombinant antigens of the "bivalent" rBCG:PspA/PAL vaccine compare to those of the respective "monovalent" rBCG vaccines. Gene, 1995 May 19, 157(1-2), 209 - 12 Possible regulation of DNA methyltransferase expression by RNA processing in Streptococcus pneumoniae; Lacks SA et al.; Atypical ribosome-binding sites lacking Shine-Dalgarno sequences appear to be used for translation of the DpnM and DpnA DNA methyltransferases of the DpnII restriction system . Preliminary results indicate that the 5'-endpoints of DpnII system mRNAs result from degradation of the original transcript . These tentative findings serve as the basis for a possible regulatory model that would accommodate the DpnII cassette either as a single copy in the chromosome or on a multicopy plasmid. FEMS Microbiol Lett, 1995 May 15, 128(3), 327 - 32 Sucrose-derived exopolymers have site-dependent roles in Streptococcus mutans-promoted dental decay; Munro CL et al.; We have constructed a panel of mutants of S . mutans V403 which are defective in one or more of the glucosyltransferase genes (gtfB, C or D) or the fructosyltransferase gene (ftf) . These strains have been tested for virulence in a gnotobiotic rat caries model with reference to both buccal (smooth surface) and sulcal (pit and fissure) carious lesions . Our data suggest differing roles for degradable and non-degradable polymers at buccal and sulcal sites . Non-degradable polymers (made by products of the gtfB and C genes) contributed significantly to the severity of smooth surface lesions . However, our studies suggested their role in pit and fissure lesions was not as important as the role of degradable polymers . Specifically, a mutant deficient in the major insoluble glucan synthesizing activity (product of the gtfB gene) was 25% more cariogenic on sulcal surfaces than was the wild-type V403 strain . We propose that extracellular glucosyltransferases and fructosyltransferase compete for sucrose and that this competition influences pathogenicity at differing tooth sites. Spine, 1995 May 15, 20(10), 1199 - 204 Intramedullary spinal cord abscess . A case report; Bartels RH et al.; STUDY DESIGN . A case of an intramedullary spinal cord abscess is presented . The literature on this subject is carefully reviewed . OBJECTIVES . To give an overview of clinical presentation, radiographic examination, pathogenesis, treatment, and outcome of intramedullary spinal cord abscesses . Cases presented in the literature are arranged and the findings summarized . SUMMARY OF BACKGROUND DATA . Intramedullary spinal cord abscesses are rare . Most frequently, single cases were reported, followed by a short discussion . All previously reported cases were reviewed . METHODS . After an extensive literature search, all cases of an intramedullary spinal cord abscess (totaling 93 patients), including ours, were reviewed . Incidence, clinical presentation, neuroradiologic investigations, treatment, and pathogenesis are discussed . RESULTS . Intramedullary spinal cord abscesses are rare . The presentation can be very confusing, mimicking thoracic or abdominal diseases . Magnetic resonance imaging is the best diagnostic technique, although the findings are not pathognomonic . Appropriate antibiotic therapy after surgical drainage is warranted . If left untreated, the outcome is bleak . Whereas most cultures remain sterile (38.7%), Staphylococcus or Streptococcus species are involved frequently (23.7% and 17.2%) . CONCLUSIONS . Although intramedullary spinal cord abscess is a rare disease, every spine surgeon should have knowledge of its existence because misjudgment and deferring adequate treatment may lead to an unfavorable outcome. Schweiz Med Wochenschr, 1995 May 13, 125(19), 952 - 8 {Pneumococcal bacteremia: what is new?}; Carey I et al.; 85 patients who displayed Streptococcus pneumoniae (S . pneumoniae) bacteremia during hospitalization at the CHUV between January 1990 and December 1991 are reviewed retrospectively to reassess the importance of this pathology after the introduction in Switzerland of antipneumococcal vaccination . The data were compared with those obtained from a similar study at Lausanne between 1974 and 1978 . Epidemiology, underlying diseases (present in 82% of patients), clinical findings (78% pneumonia, 8% meningitis, 14% bacteremia without detected primary focus) and mortality (31%) were comparable in the two series . There were, however, points of difference . First, the incidence of pneumococcal bacteremia increased between 20 and 40 years, affecting HIV positive patients in particular, with high mortality . Second, nosocomial pneumococcal bacteremia was relatively frequent (7%) and particularly severe, with very high mortality . Third, 17% of strains proved resistant to one or more antibiotics . Finally, use of the antipneumococcal vaccine is not widespread since only one of the 85 patients had been vaccinated whereas 82% presented a recognized indication for the vaccine . In conclusion, pneumococcal bacteremia remains frequent, involves major mortality and is more often due to resistant strains . These are important arguments in favour of vaccinating patients at risk. Dtsch Med Wochenschr, 1995 May 12, 120(19), 681 - 4 {Systemic infection due to group A Streptococcus pyogenes}; Pohl TS et al.; A 47-year-old woman developed oedematous swelling of the skin over the left hip and leg, with joint pains and reddening over joints of the hands and left ankle . 2 months before her son had had scarlet fever, following which the patient had two episodes of fever . Shortly before hospitalization she was treated with a glucocorticoid because a rheumatic disease had been suspected . On admission the blood sedimentation rate was 58/90, the white cell count was 15.100/microliters with left shift in the differential count . The swellings in arms and legs became abscesses which were incised . An abscess over the left buttock, diagnosed by 67-gallium whole-body scintigraphy, was also treated surgically . On the day of admission penicillin (10 mill . IU three times daily intravenously) and, from the 4th day onwards, gentamicin (80 mg three times daily intravenously) were administered . Histological examination of fascia and muscle biopsies revealed nonspecific inflammation without signs of malignancy, white blood culture grew group A Streptococcus pyogenes . 20 days after the surgical intervention the patient was discharged in full health . Necrotizing fasciitis caused by Streptococcus pyogenes has become more frequent in the last few years and has often been accompanied by severe systemic complications. Med Microbiol Immunol (Berl), 1995 May, 184(1), 1 - 8 Superantigens and pseudosuperantigens of gram-positive cocci; Fleischer B et al.; Superantigens use an elaborate and unique mechanism of T lymphocyte stimulation . Prototype superantigen are the pyrogenic exotoxins produced by Staphylococcus aureus and Streptococcus pyogenes . Many candidate proteins of bacterial, viral and protozoal origin have recently been reported to be superantigens . In most cases the evidence that these proteins are in fact superantigens is highly indirect . In this review the evidence that gram-positive cocci produce superantigens other than the pyrogenic exotoxins is critically discussed . Evidence in described demonstrating that the epidermolytic toxins of Staphylococcus aureus and the pyrogenic exotoxin B and M-proteins of Streptococcus pyrogenes are not superantigens . Criteria are described for acceptance of a candidate as a superantigen. Arch Bronconeumol, 1995 May, 31(5), 252 - 4 {Fulminant pneumonia caused by Streptococcus milleri: rare or not diagnosed?}; Gallego Carrion B et al.; Streptococcus milleri is increasingly isolated in laboratory samples and is worthy of consideration as a differential diagnosis in pyogenic infections, particularly in adults with underlying infections . We describe a well-documented case of pleuropulmonary infection in a young man with no known risk factors . We analyze the diversity of microbiological features of these bacteria in culture, as well as their clinical importance as pathogens. J Natl Med Assoc, 1995 May, 87(5), 347 - 8 Group A beta-hemolytic streptococcal bacteremia in a patient with sickle cell anemia on penicillin prophylaxis; LeBlanc W et al.; Serious invasive bacterial infections, particularly those due to Streptococcus pneumoniae and Hemophilus influenzae, are a well-known complication in patients with sickle cell disease . Early penicillin p