Streptococci

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 prophylaxis has been shown to prevent these infections and also to improve survival . This article describes a child with sickle cell anemia who, while on penicillin prophylaxis, developed a group A streptococcal bacteremia, a pathogen not commonly associated with bacteremia in sickle cell disease.

Enferm Infecc Microbiol Clin, 1995 May, 13(5), 288 - 91
{Evaluation of specificity of pneumococcal antigen detection in clinical samples by using the polymerase chain reaction as reference method}; Nogues A et al.; BACKGROUND: Sensitivity and specificity of latex agglutination test on samples obtained by transthoracic needle aspiration was evaluated for diagnosis of pneumococcal pneumonia by using the polymerase chain reaction as reference method . METHODS: Samples from 29 patients with community acquired pneumonia were processed for culture, antigen detection and polymerase chain reaction . The latex agglutination test was performed with a reagents kit (Slidex meningite kit, BioMerieux, France) using the procedure recommended by the manufacturer . The polymerase chain reaction was carried out by using two primers: Pn2x up and Pn2x down that amplify the PBP2x gene of Streptococcus pneumoniae . RESULTS: Culture was positive in 5 patients, antigen detection in 15 and polymerase chain reaction in 14 patients . The specificity of latex agglutination test was 93% compared with polymerase chain reaction as reference method . CONCLUSION: The pneumococcal antigen detection by latex agglutination test is as sensitive as the polymerase chain reaction, it seems to be highly specific, and it is rapid and easy to perform.

Ophthalmology, 1995 May, 102(5), 705 - 12
Endophthalmitis after pars plana vitrectomy . The Postvitrectomy Endophthalmitis Study Group; Cohen SM et al.; PURPOSE: To describe the clinical course and incidence of culture-proven postvitrectomy endophthalmitis in 18 patients from five academic centers and three private practices . METHODS: Patients undergoing pars plana vitrectomy for recent trauma or endophthalmitis were excluded . The average age was 58 years (range, 21-85 year) . Sixty-one percent of the patients (11/18) had diabetes mellitus . The indication for initial vitrectomy was vitreous hemorrhage (n = 10), macular epiretinal membrane (n = 3), recurrent retinal detachment with proliferative vitreoretinopathy (n = 2), retinal detachment with retinoschisis (n = 1), proliferative diabetic retinopathy with tractional retinal detachment (n = 1), and dislocated intraocular lens (n = 1) . None of these eyes received prophylactic intraocular antibiotics during the vitrectomy . RESULTS: All eyes were treated with intraocular antibiotics after the diagnosis of postvitrectomy endophthalmitis was made . Final visual acuity ranged from 20/20 to no light perception and included five eyes with 20/50 or better visual acuity and 11 eyes with less than 5/200 visual acuity . Nine eyes had a final visual acuity of no light perception . Of the 16 eyes infected with a single organism, 71% (5/7) of eyes infected with coagulase-negative staphylococci retained 20/50 or better final visual acuity compared with no eyes (0/9) infected with other organisms (P = 0.005) . Two eyes infected with both coagulase-negative Staphylococcus and Streptococcus had a final visual acuity of 20/400 . Three eyes with a total hypopyon later had enucleation or evisceration . Based on the data from four medical centers, the incidence of endophthalmitis after pars plana vitrectomy performed over the last 10 years was 9/12,216 (0.07%) . CONCLUSION: Endophthalmitis after vitrectomy is rare . Postvitrectomy bacterial endophthalmitis caused by organisms other than coagulase-negative staphylococci has a poor visual prognosis.

J Cardiol, 1995 May, 25(5), 243 - 6
{Mitral valve repair for infectious endocarditis}; Okada Y et al.; Fourteen patients with mitral regurgitation resulting from infectious endocarditis underwent mitral valve repair between December 1988 and July 1994 . There were nine males and five females aged from 14 to 70 years (mean 40.2 +/- 19.7 years) . Three patients had active endocarditis . Time between the onset of endocarditis symptoms and surgery ranged from 1 to 24 months (mean 8.3 months) . Bacterial findings were Streptococcus in eight patients, Staphylococcus in one, and unknown in five . All macroscopically infected tissue was excised in patients with active endocarditis . Carpentier's reconstructive techniques were mainly used . There were no hospital deaths . Mean follow-up was 29 months and complete . Thirteen patients were in New York Heart Association functional class I and one in class II . There were no late deaths, reoperations, recurrent endocarditis, thromboembolic events, or other valve-related morbidity . We conclude that mitral valve repair is an attractive procedure in patients with mitral regurgitation resulting from infectious endocarditis.

J Am Vet Med Assoc, 1995 May 1, 206(9), 1366 - 8
Streptococcal fibrinous pericarditis and peritonitis in a Vietnamese pot-bellied pig; Rubin JL et al.; An 8-month-old female Vietnamese pot-bellied pig was examined because of a 48-hour history of anorexia and signs of depression . Hypothermia, dehydration, pronounced respiratory effort, and muffled heart sounds were detected . Abdominal ultrasonography revealed ascites and hepatic congestion . Echocardiography revealed pericardial effusion and fibrinous pericarditis . Ultrasound-guided pericardiocentesis was diagnostic and therapeutic . Cytologic examination of pericardial and peritoneal fluid revealed degenerated neutrophils and intra-and extracellular gram-positive cocci . On microbial culture of pericardial and peritoneal fluid specimens, moderate growth of a beta-hemolytic Streptococcus sp of group G was observed . After initial treatment corrected hypothermia and dehydration, the pig was treated with sulfadiazine/sulfamerazine/sulfamethazine and oxytetracycline for 30 days . Echocardiographic examination 3 months after the initial examination revealed resolution of the pericardial effusion and fibrinous pericarditis.

Lett Appl Microbiol, 1995 May, 20(5), 263 - 7
Effects of different acidulants on growth of 'Streptococcus milleri group' strains isolated from various sites of the human body; Osawa R et al.; Growth of human clinical isolates of Streptococcus constellatus, Strep . intermedius and Strep . anginosus in HCl-, acetate and lactate acidified media was investigated . Under aerobic conditions, Strep . constellatus and Strep . anginosus were significantly more tolerant to all the acidulants than was Strep . intermedius . Under anaerobic conditions, Strep . anginosus and Strep . intermedius were significantly more tolerant to acetic acid (pH < 4.5) than Strep . constellatus.

Postgrad Med, 1995 May, 97(5), 61 - 2, 65-9
Pharyngitis . When is aggressive treatment warranted?
Bonilla JA, Bluestone CD.
Pharyngitis is one of the most common disorders seen by primary care physicians . Fortunately, most cases resulting from viral or bacterial infection respond well to symptomatic medications or antibiotics . However, aggressive treatment of pharyngitis due to group A beta-hemolytic streptococcus is crucial to avoid complications, such as rheumatic fever and acute poststreptococcal glomerulonephritis.

Med Clin North Am, 1995 May, 79(3), 523 - 35
The growing threat of antibiotic-resistant Streptococcus pneumoniae; Lonks JR et al.; Resistance to penicillin has spread worldwide during the past 25 years . Strains resistant to alternative antibiotics have also emerged . Strains resistant to multiple antibiotics increasingly are isolated worldwide . Recently, isolates of penicillin-resistant S . pneumoniae resistant to cefotaxime and ceftriaxone have caused meningitis . As a result, recommendations for the empiric therapy of pneumococcal infections, especially meningitis, are changing.

J Infect Dis, 1995 May, 171(5), 1363 - 8
Toxicity of Streptococcus pneumoniae in neurons, astrocytes, and microglia in vitro; Kim YS et al.; The toxicity of pneumococci and endotoxin in primary cultures of rat neurons, astrocytes, and microglia and in a human astrocyte and two human glial cell lines was determined . Heat-inactivated, rough pneumococci (up to 10(8) cfu/mL) or their cell wall (up to 50 micrograms/mL) produced dose-dependent toxicity after 48 h in microglial cells and to a lesser extent in astrocytes but not in neurons . Toxicity was similar for equivalent doses of heat-inactivated organisms and pneumococcal cell wall, but time-course experiments showed significant differences between the two stimuli . Endotoxin at concentrations of up to 5 micrograms/mL did not induce significant toxicity in any of the cells . Thus, pneumococci can induce toxicity in two brain cell types, microglia and astrocytes, and the pneumococcal cell wall appears to mediate toxicity . Direct toxic effects of bacteria on brain cells may in part be responsible for brain injury during meningitis.

J Bacteriol, 1995 May, 177(10), 2751 - 9
Regulation of ATP-dependent P-(Ser)-HPr formation in Streptococcus mutans and Streptococcus salivarius; Thevenot T et al.; Sugar transport via the phosphoenolpyruvate (PEP) phosphotransferase system involves PEP-dependent phosphorylation of the general phosphotransferase system protein, HPr, at histidine 15 . However, gram-positive bacteria can also carry out ATP-dependent phosphorylation of HPr at serine 46 by means of (Ser)HPr kinase . In this study, we demonstrate that (Ser)HPr kinase in crude preparations of Streptococcus mutans Ingbritt and Streptococcus salivarius ATCC 25975 is membrane associated, with pH optima of 7.0 and 7.5, respectively . The latter organism possessed 7- to 27-fold-higher activity than S . mutans NCTC 10449, GS-5, and Ingbritt strains . The enzyme in S . salivarius was activated by fructose-1,6-bisphosphate (FBP) twofold with 0.05 mM ATP, but this intermediate was slightly inhibitory with 1.0 mM ATP at FBP concentrations up to 10 mM . Similar inhibition was observed with the enzyme from S . mutans Ingbritt . A variety of other glycolytic intermediates had no effect on kinase activity under these conditions . The activity and regulation of (Ser)HPr kinase were assessed in vivo by monitoring P-(Ser)-HPr formation in steady-state cells of S . mutans Ingbritt grown in continuous culture with limiting glucose (10 and 50 mM) and with excess glucose (100 and 200 mM) . All four forms of HPr {free HPr, P approximately (His)-HPr, P-(Ser)-HPr, and P approximately (His)-P-(Ser)-HPr} could be detected in the cells; however, significant differences in the intracellular levels of the forms were apparent during growth at different glucose concentrations . The total HPr pool increased with increasing concentrations of glucose in the medium, with significant increases in the P-(Ser)-HPr and P approximately HHis)-P-(Ser)-HPr concentrations . For example, while total PEP-dependent phosphorylation {P approximately(His)-HPr plus P approximately (His)-P-(Ser)-HPr} varied only from 21.5 to 52.5 microgram mg of cell protein (-1) in cells grown at the four glucose concentrations, the total ATP-dependent phosphorylation {P-(Ser)-HPr plus P approximately (His)-P-(Ser)-HPr} increased 12-fold from the 10 mM glucose-grown cells (9.1 microgram mg of cell protein (-1) to 106 and 105 microgram mg(-1) in the 100 and 200 mM glucose-grown cultures, respectively . (Ser)HPr kinase activity in membrane preparations of the cells varied little between the 10, 50, and 100 mM glucose-grown cells but increased threefold in the 200 mM glucose-grown cells . The intracellular levels of ATP, glucose-6-phosphate, and FBP increased with external glucose concentration, with the level of FBP being 3.8-fold higher for cells grown with 200 mM glucose than for those grown with 10 mM glucose . However, the variation in the intracellular levels of FBP, particularly between cells grown with 100 and 200 mM glucose, did not correlate with the extent of P-(Ser)-HPr formation, suggesting that the activity of (Ser)HPr kinase is not critically dependent on the availability of intracellular FBP.

J Bacteriol, 1995 May, 177(10), 2622 - 7
Sequence, expression, and function of the gene for the nonphosphorylating, NADP-dependent glyceraldehyde-3-phosphate dehydrogenase of Streptococcus mutans; Boyd DA et al.; We report the sequencing of a 2,019-bp region of the Streptococcus mutans NG5 genome which contains a 1,428-bp open reading frame (ORF) whose putative translation product had 50% identity to the amino acid sequences of the nonphosphorylating, NADP-dependent glyceraldehyde-3-phosphate dehydrogenases (GAPN) from maize and pea . This ORF is located approximately 200 bp downstream of the ptsI gene coding for enzyme I of the phosphoenolpyruvate:sugar phosphotransferase transport system . Mutant BCH150, in which the putative gapN gene had been inactivated, lacked GAPN activity that was present in the wild-type strain, thus positively identifying the ORF as the S . mutans gapN gene . Another strain of S . mutans, DC10, which contains an insertionally inactivated ptsI gene, still possessed GAPN activity, as did S . salivarius ATCC 25975, which contains an insertion element between the ptsI and gapN genes . Since the wild-type S . mutans NG5 lacks both glucose-6-phosphate dehydrogenase and NADH:NADP oxidoreductase activities, the NADP-dependent glyceraldehyde-3-phosphate dehydrogenase is important as a means of generating NADPH for biosynthetic reactions.

Ann Surg, 1995 May, 221(5), 558 - 63; discussion 563-5
Determinants of mortality for necrotizing soft-tissue infections; McHenry CR et al.; OBJECTIVE: The authors determined the risk factors of mortality in patients with necrotizing soft-tissue infections (NSTIs) and examined the incidence and mortality from NSTI secondary to Streptococcus pyogenes . METHODS: All patients with NSTIs who were treated between January 1989 and June 1994 were analyzed for presentation, etiology, factors important in pathogenesis and treatment, and mortality . RESULTS: Sixty-five patients were identified with NSTIs secondary to postoperative wound complications (18), trauma (15), cutaneous disease (15), idiopathic causes (10), perirectal abscesses (3), strangulated hernias (2), and subcutaneous injections (2) . Necrotizing soft-tissue infections were polymicrobial in 45 patients (69%) . S . pyogenes was isolated in only 17% of the NSTIs, but accounted for 53% of monomicrobial infections . Eight of ten idiopathic infections were caused by a single bacterium (p = 0.0005), whereas 82% of postoperative infections were polymicrobial . An average of 3.3 operative debridements per patient and amputation in 12 patients were necessary to control infection . The overall mortality was 29%; mortality from S . pyogenes infection was only 18% . The average time from admission to operation was 90 hours in nonsurvivors versus 25 hours in survivors (p = 0.0002) . Other risk factors previously associated with the development of NSTIs did not affect mortality . CONCLUSIONS: Early debridement of NSTI was associated with a significant decrease in mortality . S . pyogenes infection was the most common cause of monomicrobial NSTI, but was not associated with an increased mortality.

Angiology, 1995 May, 46(5), 441 - 4
Bivalvular endocarditis complicating pregnancy . A case report and literature review; Felice PV et al.; A twenty-nine-year old woman with a history of rheumatic fever and both mitral and tricuspid valve prolapse (without cardiac effects on the echocardiogram) presented with Streptococcus viridans infective endocarditis of both the tricuspid and mitral valves at seventeen weeks' gestation . Twelve weeks before admission she underwent a dental curettage and received presumably adequate antibiotic prophylaxis . The present case was successfully managed by means of aggressive antibiotic therapy appropriate for endocarditis, with adequate and appropriate monitoring of minimal inhibitory concentration and peak and trough levels . This case exhibits the appropriate management in the three phases of therapy for valvular disease, ie prevention, treatment, and subsequent prevention of sequelae, prior to vaginal delivery in a patient with endocarditis . The pregnancy resulted in a term vaginal delivery, without maternal or fetal morbidity.

J Bacteriol, 1995 May, 177(9), 2251 - 8
Glucose transport by a mutant of Streptococcus mutans unable to accumulate sugars via the phosphoenolpyruvate phosphotransferase system; Cvitkovitch DG et al.; Streptococcus mutans transports glucose via the phosphoenolpyruvate (PEP)-dependent sugar phosphotransferase system (PTS) . Earlier studies indicated that an alternate glucose transport system functions in this organism under conditions of high growth rates, low pH, or excess glucose . To identify this system, S . mutans BM71 was transformed with integration vector pDC-5 to generate a mutant, DC10, defective in the general PTS protein enzyme I (EI) . This mutant expressed a defective EI that had been truncated by approximately 150 amino acids at the carboxyl terminus as revealed by Western blot (immunoblot) analysis with anti-EI antibody and Southern hybridizations with a fragment of the wild-type EI gene as a probe . Phosphotransfer assays utilizing 32P-PEP indicated that DC10 was incapable of phosphorylating HPr and EIIAMan, indicating a nonfunctional PTS . This was confirmed by the fact that DC10 was able to ferment glucose but not a variety of other PTS substrates and phosphorylated glucose with ATP and not PEP . Kinetic assays indicated that the non-PTS system exhibited an apparent Ks of 125 microM for glucose and a Vmax of 0.87 nmol mg (dry weight) of cells-1 min-1 . Sugar competition experiments with DC10 indicated that the non-PTS transport system had high specificity for glucose since glucose transport was not significantly by a 100-fold molar excess of several competing sugar substrates, including 2-deoxyglucose and alpha-methylglucoside . These results demonstrate that S . mutans possesses a glucose transport system that can function independently of the PEP PTS.

Infect Immun, 1995 May, 63(5), 1975 - 9
Discrimination of virulent and avirulent Streptococcus suis capsular type 2 isolates from different geographical origins; Quessy S et al.; In an effort to relate the protein profile to virulence, proteins from the cellular fractions and from culture supernatants of Streptococcus suis capsular type 2 strains from different geographical origins were compared by using Western blots (immunoblots) . The protein profiles of the cellular fractions were similar for the majority of virulent and avirulent isolates studied, with the exception of three virulent Canadian strains for which a 135-kDa protein was not detected . Examination of the culture supernatants revealed the presence of a 135-kDa protein in all strains except the same three virulent Canadian isolates . In addition, a 110-kDa protein was present in 14 of 16 virulent strains and not in avirulent isolates . When injected into mice, the 110-kDa protein induced an immunoglobulin G response and protected against infection with homologous and heterologous virulent strains . Four strains (1330, 0891, TD10, and R75/S2) that were avirulent in the mouse model of infection and four other strains (1591, 999, JL590, and AAH4) that were virulent in the mouse model were injected into pigs . All virulent strains reproduced the disease, and all avirulent strains failed to reproduce the disease (with the exception of transient lameness in one case and fever in another case) . The 110-kDa protein therefore appears to be a reliable virulence marker and a good candidate for a subunit vaccine.

Infect Immun, 1995 May, 63(5), 1969 - 74
Effect of defined point mutations in the pneumolysin gene on the virulence of Streptococcus pneumoniae; Berry AM et al.; The thiol-activated toxin pneumolysin is a known pneumococcal virulence factor, with both cytotoxic (hemolytic) and complement activation properties . Copies of the pneumolysin gene carrying defined point mutations affecting either or both of these properties were introduced into the chromosome of Streptococcus pneumoniae D39 by insertion-duplication mutagenesis . The virulences of these otherwise isogenic strains were then compared . There was no significant difference in either the median survival time or overall survival rate between mice challenged with D39 derivatives producing the wild-type toxin and those expressing a pneumolysin gene with an Asp-385-->Asn mutation, which abolishes the complement activation property . However, mice challenged with strains carrying either His-367-->Arg or Trp-433-->Phe plus Cys-428-->Gly mutations, which reduce hemolytic activity to approximately 0.02 and 0.0001% of the wild-type level, respectively, had significantly greater median survival times and overall survival rates than mice challenged with D39 derivatives expressing a wild-type pneumolysin gene . No additional reduction in virulence was observed when mice were challenged with a D39 derivative carrying Trp-433-->Phe, Cys-428-->Gly, and Asp-385-->Asn, rather than Trp-433-->Phe and Cys-428-->Gly, mutations in the pneumolysin gene . Thus, it appears that in the intraperitoneal challenge model, the contribution of pneumolysin to virulence is largely attributable to its hemolytic (cytotoxic) properties rather than to its capacity to activate complement . Interestingly, however, the amount of pneumolysin required for full virulence may be very small, as D39 derivatives carrying the Trp-433-->Phe mutation (which reduces hemolytic activity to 0.1% of the wild-type level) had intermediate virulence.

Infect Immun, 1995 May, 63(5), 1940 - 6
Active release of bound antibody by Streptococcus mutans; Lee SF; Previous studies have shown that Streptococcus mutants is capable of releasing many surface protein antigens, particularly antigen P1 . Antigen P1 is immunodominant and has been implicated in adherence of S . mutants to the acquired pellicles . The purpose of this study is to investigate the significance of release of this antigen by the cells . S . mutants NG8 (serotype c) was incubated with an anti-P1 rabbit immunoglobulin G (IgG) or a human colostral IgA which contains natural anti-P1 activity . Results indicated that the bound antibodies were released by the cells in a pH- and time-dependent manner . The optimal pH for release was between 6 and 8, and the release rate reached a plateau in 1 h at 37 degrees C . The release of bound antibodies was considered an active process, since heat-killed cells remained capable of antibody binding but failed to release the antibodies . The release was also dependent on the age of the culture, with early-exponential-phase cells releasing the maximum amount of bound IgG . The released IgG was isolated by polyethylene glycol precipitation and protein A-Sepharose column chromatography and found to be associated with antigen P1, indicating that the antibodies were released together with the antigen in the form of immune complexes . The binding of S . mutans by secretory IgA (SIgA) inhibited the adherence of the cells to salivary agglutinin-coated hydroxylapatite . However, when the SIgA-coated S . mutans was allowed to release the bound antibodies, the inhibitory effect of SIgA on adherence was abrogated . These results suggest that S . mutans is capable of shedding surface-bound antibodies in the form of antibody-antigen immune complexes . Such an action may be a strategy employed by the cells to counter the neutralizing effect of naturally occurring antibodies in the oral cavity.

Infect Immun, 1995 May, 63(5), 1698 - 702
Effect of polyclonal and monoclonal antibodies on surface properties of Streptococcus sobrinus; van Raamsdonk M et al.; In this study, the effect of antibody adsorption on physicochemical properties of Streptococcus sobrinus was studied . Bacteria were preincubated with polyclonal antibodies or with OMVU10, a monoclonal antibody (MAb) reactive with S . sobrinus . The zeta potentials and the hydrophobicity as determined by microbial adhesion to hydrocarbons were measured in potassium phosphate buffer with a pH ranging from 2 to 9 . S . sobrinus preincubated with polyclonal antibodies was positively charged at pH 2, 3, and 4 and had an isoelectric point at pH 4.8 . Untreated S . sobrinus cells or cells preincubated with MAbs were negatively charged over the whole pH range . X-ray photoelectron spectroscopy showed a decrease in O/C and P/C ratios for bacteria preincubated with polyclonal antibodies . A combination of the pH-dependent zeta potential and the X-ray photoelectron spectroscopy data of the overall chemical composition of the cell surface suggests that polyclonal antibody adsorption occurs through blocking of surface phosphate . The measurement of hydrophobicity by microbial adhesion to hydrocarbons revealed that S . sobrinus preincubated with polyclonal antibodies was hydrophobic (90% of the bacteria bound to hexadecane), whereas the controls were relatively hydrophilic . S . sobrinus preincubated with OMVU10 was found to be more hydrophobic than the controls at pH 5 and 7 . Hydrophobicity as measured by water contact angles showed an increase in hydrophobicity when S . sobrinus was preincubated with polyclonal antibodies . The epitopes to which the antibodies are directed were visualized by immunogold labeling and electron microscopy . The results suggested that OMVU10 is reactive with only a few epitopes of the cell surface, whereas polyclonal antibodies were found to be reactive with many epitopes . In conclusion, adsorption of polyclonal antibodies was found to influence the overall physicochemical surface properties of the organism, probably by forming a coating over the whole cell surface . Adsorption of MAbs was more localized, which could explain their lesser influence on these surface properties.

Aust N Z J Obstet Gynaecol, 1995 May, 35(2), 178 - 81
A prospective study of the microbiological environment of the genitourinary tract in Hong Kong Chinese women during pregnancy; Yim SF et al.; Microbiological colonization of the genitourinary tract in pregnancy is associated with an increased risk of preterm labour and delivery . In our population, the risk of preterm labour is relatively low, and the purpose of this study was to examine the microbiological environment of the genitourinary tract to determine whether it differed from that reported in populations where the rate of preterm delivery is higher . A prospective study was made in 367 unselected women between 16 and 24 weeks' gestation . Although the rate of colonization with Candida species was higher than in most other studies (30.2%), colonization with Gardnerella, Group B Streptococcus, Trichomonas and Chlamydia was uncommon (1.9%, 0.8%, 0.6% and 3.5% respectively) . Significant bacteriuria was also uncommon, occurring in only 4.9% of cases . The results of this study confirmed a relatively low incidence of colonization of the genitourinary tract in this population of women with a low incidence of preterm delivery . These findings suggest that low levels of colonization may be related to a low incidence of preterm delivery in our patients.

J Infect, 1995 May, 30(3), 245 - 51
Capsular serotypes and antibiotic sensitivity of Streptococcus pneumoniae isolated from primary-school children; Ridgway EJ et al.; A total of 1049 primary-school children in 18 schools were screened for carriage of Streptococcus pneumoniae . Data on family size, antibiotic use, travel and hospital admissions were collected . Pneumococcal serotyping and sensitivity tests were performed . One third of children were found to be pneumococcal carriers . Ten of 344 isolates were penicillin-resistant (2.9%) . Apart from resistance to trimethoprim and ciprofloxacin, resistance rates in penicillin-sensitive strains were low . Among penicillin-resistant strains (PRP), co-resistance to trimethoprim, chloramphenicol and tetracycline was common . Cefotaxime-resistance was seen in 90% of PRP . Although 24 serotypes were represented, groups 6, 19 and 23 accounted for 55% of strains . Serogroup 23 strains were significantly more likely to be penicillin-resistant than other groups/types . Clustering of strains by serotype and antibiotic resistance was seen in several schools . No association with foreign travel, family size or age of siblings was seen and penicillin resistance was not associated with prior antibiotic use . However, hospital admission was significantly associated with carriage of PRP . The implications of detecting PRP in the community are discussed.

Eur J Clin Nutr, 1995 May, 49(5), 346 - 52
Hypocholesterolaemic effect of a new fermented milk product in healthy middle-aged men; Agerbaek M et al.; OBJECTIVE: There are still controversies as to the potential beneficial effects of milk and fermented milk products on the level of lipoproteins . The objective of the present investigation was to test the effect of a moderate daily intake of a new fermented milk product, which was based on a bacterial culture obtained from the intestinal flora of inhabitants of Abkhasia, on the lipoprotein levels of a homogeneous group of middle-aged Danish men . DESIGN: The study was randomised, double-blind, and placebo-controlled, and the intervention was performed for a period of 6 weeks . SUBJECTS: Fifty-eight healthy, non-obese, normocholesterolaemic, male volunteers born in 1949 of Danish descent participated (i.e . all were 44 years old) . INTERVENTIONS: During the intervention period the subjects' habitual diets were supplemented with 200 ml/day of either the new fermented milk product or a placebo product (chemically fermented) . The biologically fermented milk product contained Enterococcus faecium and two strains of Streptococcus termophilus . Fasting blood samples were drawn initially and after 3 and 6 weeks and analysed for plasma values of total cholesterol, high-density lipoprotein (HDL)-cholesterol and triglyceride . In addition, LDL-cholesterol was estimated . RESULTS: After these 6 weeks total cholesterol was reduced significantly in the group given biologically fermented milk (-0.37 mmol/l, confidence interval: -0.51 to -0.23) while no changes were observed in the placebo group (-0.02 mmol/l) (P < 0.01) . This reduction in total cholesterol could be completely ascribed to a fall in LDL-cholesterol by 10% (i.e . -0.42 mmol/l) since HDL-cholesterol and triglyceride were unchanged in both groups . CONCLUSIONS: Thus, this short-term study (6 weeks) demonstrated an LDL-cholesterol-lowering effect (10% reduction) of a new fermented milk product in middle-aged Danish men.

No To Hattatsu, 1995 May, 27(3), 226 - 30
{A case of acute disseminated encephalomyelitis with lesions in the cerebral gray matter on MRI in the acute phase}; Kubota K et al.; We reported a case of acute disseminated encephalomyelitis (ADEM) after Streptococcus infection . Brain MRI (T2-weighted image) showed high intensity lesion in the gray matter in the acute phase . The high intensity pattern of the lesion was different from those in previously reported cases . The boy, aged 14, had fever late in August 1993 . He had lumbago and back pain since September 3 and also leg weakness developed since September 7 . He became unable to urinate on September 10 and was admitted on September 12 . His consciousness became indistinct . We considered ADEM on the basis of high CSF level of myelin basic protein, clinical course, symptoms and MRI findings and began to administer steroid hormone on the second day after admission . He rapidly recovered . We reported here an atypical case of ADEM as to the antecedent infection and MRI lesion.

Aust Vet J, 1995 May, 72(5), 161 - 4
Retropharyngeal lymph node infection in horses: 46 cases (1977-1992); Golland LC et al.; A retrospective study of 46 horses with retropharyngeal lymph node (RPLN) infection presented to the Rural Veterinary Centre between 1977 and 1992 was undertaken . Horses aged less than one year were most commonly represented (46%) . Thirty-nine percent of cases had been exposed to horses with confirmed or suspected strangles (Streptococcus equi subsp equi infection) within the previous 8 weeks . Most frequent signs were unilateral or bilateral swelling of the throat region (65%), respiratory stertor/dyspnoea (35%), purulent nasal discharge (20%), inappetence and signs of depression (15%), and dysphagia (9%) . All horses had a soft tissue density in the retropharyngeal region on radiographs . Rhinopharyngoscopy, ultrasonography, haematology as well as cytological and microbial analysis of material aspirated from the soft tissue swelling facilitated diagnosis in some horses . Fifteen horses (33%) were treated with procaine penicillin intramuscularly for 4 to 7 days followed by oral trimethoprim-sulphadimidine for 7 to 14 days . Non-steroidal anti-inflammatory drugs were administered to 6 horses . Four required tracheostomy for severe respiratory distress . The 15 horses treated medically responded to treatment and were discharged from hospital . Three horses (6%) with mild signs received no treatment and recovered uneventfully . Twenty-eight horses (61%) underwent general anaesthesia and surgical drainage of a RPLN abscess . Nineteen received procaine penicillin G for 4 to 7 days . Four of the nine horses that did not receive antibiotic treatment after surgery required further surgical drainage 10 days to 7 weeks after the initial surgery . Limited follow-up information was available for 37 horses.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemotherapy, 1995 May-Jun, 41(3), 159 - 64
Interaction of beta-lactam antibiotics with the penicillin-binding proteins of penicillin-resistant Streptococcus pneumoniae; Ikeda F et al.; The binding of five structurally diverse beta-lactam antibiotics to penicillin-binding proteins (PBPs) of two clinical isolates of Streptococcus pneumoniae resistant to penicillin G was compared with that of a susceptible strain . A common feature of the PBP patterns of the resistant strains was the absence of PBP 1a detected in the susceptible strain . For each beta-lactam antibiotic tested, there appeared to be significant decreases in the affinity for BPB 1b, 2a and 2b of the resistant strains . We attempted to evaluate a quantitative correlation between the antibacterial activity of the drugs for three strains and their affinity for the various PBPs . A close correlation was found between the minimum inhibitory concentrations and the affinity for PBP 2a, but not for any of the other PBPs.

Acta Otolaryngol, 1995 May, 115(3), 433 - 7
Comparison of natural ostiotomy and antibiotic therapy in the treatment of acute maxillary sinusitis in rabbits; Min YG et al.; The goal of this study was to compare natural ostiotomy and the administration of a systemic antibiotic in the treatment of acute maxillary sinusitis . Maxillary sinusitis was induced in 28 rabbits by blocking the natural ostium with a bone chip and by introducing 0.2 ml of a suspension of Streptococcus pneumoniae (2 x 10(9) cells/ml) . The animals were divided into natural ostiotomy and antibiotic therapy groups: the natural ostiotomy group comprised 14 rabbits, in which the bone chip that blocked the natural ostium was removed; and the antibiotic therapy group comprised 14 rabbits treated with systemic antibiotic without reopening the ostium . The sinus mucosa of each group was examined histopathologically 2 weeks and 4 weeks after treatment . There were no significant differences in light microscopic findings between the natural ostiotomy and antibiotic therapy groups . Natural ostiotomy was as effective against acute maxillary sinusitis as the systemic administration of antibiotics . The results of this study suggest that natural ostiotomy and antibiotic therapy may be equally effective in the treatment of acute maxillary sinusitis in rabbits.

Nippon Koshu Eisei Zasshi, 1995 May, 42(5), 338 - 45
{Acute encephalitis and bacterial meningitis in children in Aichi Prefecture (1984-1993)}; Kuriki M et al.; A survey was performed of acute encephalitis and bacterial meningitis in infancy and childhood from 1984 to 1993 using a questionnaire directed to departments of pediatrics in large hospitals in Aichi prefecture . The case records for 391 patients with acute encephalitis including related diseases and 328 patients with bacterial meningitis were obtained from 63 hospitals . Of 391 patients with acute encephalitis, 224 were male and 167 were female . Of 328 patients with bacterial meningitis, 200 were male and 128 were female . Sex ratio were 1.3, 1.6 respectively . Of the patients, 52.4% of encephalitis and 84.8% of meningitis were under 4 years of age and 0 year olds made up 53.7% of the latter . The causes of these diseases were confirmed in 38.7% and 82.9% of the encephalitis and meningitis patients, respectively, etiologically . In encephalitis, rubella virus was the most frequent with 29 cases, followed by measles virus (27 cases), herpes simplex virus (24) and varicella-zostervirus (19) . In meningitis H . influenzae (95 cases), S . pneumoniae (56), Group B streptococcus (41) and E . coli (27) were frequently diagnosed . These diseases showed respective patterns of age distribution and clinical course, and moreover, the increases in their onset were clearly related to the prevalence of causal infections . Therefore, the results of this study should be utilized in the development of administrative measures for prevention of these diseases.

Appl Environ Microbiol, 1995 May, 61(5), 2040 - 2
Role of C-terminal direct repeating units of the Streptococcus mutans glucosyltransferase-S in glucan binding; Lis M et al.; The C-terminal glucan-binding domain of the glucosyltransferase-S of Streptococcus mutans GS-5 contains five 65-amino-acid direct repeating units . A series of deletion derivatives of both the glucosyltransferase-S and its glucan-binding domain were constructed and analyzed . The results demonstrated that the four C-terminal direct repeating units constituted part of the minimum domain required for glucan binding.

Arch Pediatr, 1995 May, 2(5), 442 - 6
{Hemophagocytic syndrome in children infected by HIV . Apropos of 3 cases}; Dalle JH et al.; BACKGROUND--The hemophagocytic syndrome has previously been reported in different infectious diseases (EBV, CMV, tuberculosis...) but rarely in adults with AIDS and never in children suffering from AIDS . CASE REPORTS--A hemophagocytic syndrome was recognized during the follow-up of 3 children with AIDS . The first, a 9-year-old girl developed an acute EBV coinfection and was treated with shots of corticosteroids and vepesid but died shortly afterwards . The second patient, a 3-year-old girl was infected with Aspergillus fumigatus for which she was given amphotericin B with a rapid improvement . The third patient, an 8-year-old boy had multi-resistant Streptococcus pneumoniae otitis and pneumonitis; his condition improved rapidly with adapted antibiotherapy . DISCUSSION--The HIV-hemophagocytic syndrome is not exceptional in HIV infection because of the association of immunodeficiency and resulting superinfections . Its diagnosis and treatment should be etiologic . Severe cases without etiology could benefit from chemotherapy . CONCLUSION--Management and outcome of this potentially lethal syndrome might depend on the identification of a curable infectious cause.

Pediatr Infect Dis J, 1995 May, 14(5), 424 - 8
Emergence of resistant Streptococcus pneumoniae: a problem in pediatrics; McCracken GH Jr; Penicillin resistance among strains of Streptococcus pneumoniae has emerged as an important worldwide problem . Beta-lactam-resistant pneumococci also can be resistant to erythromycin, trimethoprim/sulfamethoxazole and tetracycline and are uniformly susceptible to vancomycin and imipenem . Crowded conditions (e.g . daycare centers, hospitals, military barracks and prisons) and prior beta-lactam antibiotic therapy are the principal predisposing factors to colonization and disease . To date the two conditions caused by penicillin- and cephalosporin-resistant pneumococci that have been especially difficult to treat are acute otitis media and meningitis . Concentrations of beta-lactams in cerebrospinal fluid and middle ear fluid are usually inadequate to achieve prompt eradication of some intermediately resistant and most highly resistant pneumococcal strains . Use of unconventional therapeutic agents such as ceftriaxone or clindamycin for acute otitis media and vancomycin or rifampin for meningitis may be necessary . Control of this global problem will require innovative methods to reduce the selective pressure that results from widespread antibiotic use and to develop effective pneumococcal vaccines that are immunogenic in young infants.

J Immunoassay, 1995 May, 16(2), 199 - 212
Non-instrumental immunoassay based on coloured polyacrolein latex: application to group-specific polysaccharide of Streptococcus pyogenes; Pavlova IS et al.; Non-instrumental immunoassay methods based on immunofiltration and microtiter particle agglutination (MPA) techniques have been developed using coloured polyacrolein latex . These methods have been applied to the quantification of the group-specific polysaccharide, A-PS, of S.pyogenes (group A Streptococcus) and compared to the standard ELISA tests . The assay with the ability to detect the lowest concentration of antigen was MPA; as little as 0.05 ng A-PS/ml or 10(4) cells/ml could be detected in 1.5 h . In comparison to ELISA test the sensitivity of MPA was 10 times higher and the procedure of the assay was much more simple . The sensitivity of the immunofiltration assay using both enzyme and latex markers was shown to be the same (50 ng A-PS/ml) and the duration of the assay 3-5 min . No cross-reactions of latex conjugates with non A Streptococcus cell lysates have been observed . The developed methods are easy to perform and require neither sophisticated equipment nor specially trained personal.

Antimicrob Agents Chemother, 1995 May, 39(5), 1196 - 8
Trends in antimicrobial resistance of Streptococcus pneumoniae in Japan; Yoshida R et al.; A total of 184 isolates of Streptococcus pneumoniae were recovered from the sputa of patients over a 5-year period in the Nagasaki area and were examined . A total of 30 strains were resistant to penicillin (MIC, > or = 0.10 micrograms/ml), 13 of which belonged to serotype 19B . These strains showed decreased susceptibility to other antimicrobial agents . Vancomycin, cefpirome, and imipenem were the most active agents tested.

Antimicrob Agents Chemother, 1995 May, 39(5), 1166 - 8
Antimicrobial activities of beta-lactam antibiotics and gentamicin against penicillin-susceptible and penicillin-resistant pneumococci; Gross ME et al.; The MICs of penicillin and cefotaxime for a range of penicillin-susceptible and penicillin-resistant isolates of Streptococcus pneumoniae were unchanged by the addition of gentamicin . In time-kill studies the rate of killing was greater for 18 of 20 isolates in the presence of gentamicin . However, mean differences in killing after 6 h of incubation were modest, not exceeding 1 log10 unit.

Clin Infect Dis, 1995 May, 20(5), 1393 - 5
Group A streptococcus bacteremia at the Hadassah Medical Center in Jerusalem; Moses AE et al.; Streptococcus pyogenes bacteremia occurred in 104 patients over a 6-year period, during which time the annual incidence remained constant . The clinical and epidemiologic characteristics are described for 90 of these patients . Of the 90 patients, 90% had community-acquired infection, and 77% had an underlying illness predisposing them to infection . Skin infection was the cause of bacteremia in 61% of the cases . Septic shock developed in 13 patients . The overall mortality rate was 15% . An increased likelihood of death was associated with septic shock and diabetes mellitus.

Clin Infect Dis, 1995 May, 20(5), 1339 - 45
Capsular types and antibiotic susceptibility of pneumococci isolated from patients in Belgium with serious infections, 1980-1993; Verhaegen J et al.; During the 13-year period from 1 November 1980 to 31 January 1993, we received and serotyped a total of 5,619 clinically significant strains of Streptococcus pneumoniae isolated in more than 75 laboratories in Belgium (4,079 {72.6%} were from blood or pleural fluid, 462 {8.2%} were from cerebrospinal fluid, 691 {12.3%} were from middle ear aspirates, and 387 {6.8%} were from various other body fluids) . The isolates belonged to 64 of the 84 currently recognized serotypes . Among the 4,722 isolates tested for susceptibility since 1983, 22% were resistant to at least one antimicrobial agent . Resistance to penicillin has slowly increased since 1985 but remained stable at a level of 2%-4% between 1986 and 1993 . Of the 119 isolates with reduced penicillin susceptibility, only 23 were fully resistant (MIC, > or = 2 micrograms/mL) and none of these proved to be resistant to cephalosporins . Resistance to erythromycin increased significantly from 5.2% in 1986 to 21.5% in 1993 . Resistance to penicillin and erythromycin was also more frequently recognized in a smaller number of capsular types of S . pneumoniae.

Clin Infect Dis, 1995 May, 20(5), 1333 - 8
Group A streptococcal necrotizing fasciitis following varicella in children: case reports and review; Wilson GJ et al.; We report four cases of necrotizing fasciitis that occurred following varicella in children ranging in age from 2 to 8 years . The only organism isolated from each of these patients was Streptococcus pyogenes or group A beta-hemolytic Streptococcus (GABHS) . Each child recovered; however, three required repeated surgical debridements in addition to therapy with antibiotics . An interesting finding in these patients was the development of hyponatremia and/or hypocalcemia . M-typing and T-typing of the isolates demonstrated that the GABHS strain in two children who attended the same school was M5; M1 and M3 strains were identified in the other two children . In addition to the children described in this series, eleven other cases of children with necrotizing fasciitis following varicella have been reported in the English-language literature since 1970 . We believe that these cases provide further evidence that varicella is an important risk factor for necrotizing fasciitis that is caused by more-virulent strains of GABHS.

Clin Infect Dis, 1995 May, 20(5), 1275 - 80
Antimicrobial resistance of Streptococcus pneumoniae in Finland, 1987-1990; Nissinen A et al.; A nationwide survey of the prevalence of antimicrobial resistance among Streptococcus pneumoniae isolates from the middle ear fluid of children with acute otitis media (639 strains) and from throat-swab samples of healthy children (149 strains) was conducted in Finland during 1987-1990 . The MICs of penicillin, cephalothin, cefaclor, erythromycin, trimethoprim, and co-trimoxazole were determined by the agar dilution method . Low-level resistance to penicillin (MIC, 0.1-1 microgram/mL) was found in 1.7% of the otitis-related and 1.3% of the healthy-carrier strains . No highly penicillin-resistant strains (MIC, > or = 2 micrograms/mL) were found . Six multiresistant strains were detected, three of them possibly belonging to a previously identified clone present in Finland since 1985 . Eighty-five percent of the resistant otitis-related strains, including 9 of the 11 moderately penicillin-resistant strains (4 of which were multiresistant), belonged to the three most common serogroups (6, 19, and 23).

Clin Infect Dis, 1995 May, 20(5), 1195 - 200
Infections caused by erythromycin-resistant Streptococcus pneumoniae: incidence, risk factors, and response to therapy in a prospective study; Moreno S et al.; To evaluate the incidence and the significance of resistance to erythromycin among clinical isolates of Streptococcus pneumoniae, we identified and prospectively followed all hospitalized patients in a 27-month period who had the organism isolated from any clinical sample . Patients who had an infection caused by pneumococci resistant to erythromycin (minimum inhibitory concentration, > 1 microgram/mL) were compared to those with infections caused by erythromycin-susceptible organisms . The incidence of erythromycin resistance among pneumococci doubled over the study period (from 7.6% in 1988 to 15.2% in 1992) . Most strains (94%) showed resistance to multiple antibiotics, including other macrolides . By multivariate analysis, an age of < 5 years and nosocomial acquisition of the infection were independent risk factors for erythromycin resistance . Among patients with pneumococcal pneumonia caused by erythromycin-resistant organisms, 9 patients treated with third-generation cephalosporins were cured, while therapy with erythromycin failed for 2 of the 6 patients to whom it was administered . The rapid and significant increase of erythromycin resistance among clinical isolates of S . pneumoniae points to the need for routine surveillance of pneumococcal resistance.

Appl Microbiol Biotechnol, 1995 May-Jun, 43(2), 282 - 4
Isolation of SagI, a new HaeIII isoschizomer from Streptococcus agalactiae; Poch MT et al.; A new HaeIII isoschizomer from Streptococcus agalactiae was isolated by a single-step purification method . The highly active restriction endonuclease, SagI, was free of nonspecific nuclease activity and was suitable for use in molecular biology procedures . The rapid isolation procedure may be applicable for the recovery of other restriction endonucleases from bacteria.

Kansenshogaku Zasshi, 1995 May, 69(5), 568 - 71
{Distribution of the genes of streptococcal pyrogenic exotoxin among clinical isolates of Streptococcus pyogenes from the pharynx}; Kishishita M et al.; The distribution of the genes of streptococcal pyrogenic exotoxin (speA, B and C) among the 400 clinical isolates of Streptococcus pyogenes from Japanese pharnyx was detected by the PCR method (Nihonrinsho 50: 326, 1992) . Sixty, 399 and 303 isolates were positive for the speA, B and C genes, respectively . However, only one isolate had none of these genes . Several isolates possessed two or three genes, i.e., both speB & C, speA & B or speA, B & C were found in 258, 30 and 30 isolates, respectively . No isolate possessing both speA & C without speB was found in this study . We concluded that the PCR method is much more useful for the epidemiological study on streptococcal pyrogenic exotoxins (SPE) of S . pyogenes isolates because of specificity, rapidity and sensitivity of this method compared with the conventional SPE identification method.

Cornea, 1995 May, 14(3), 321 - 3
Infectious crystalline keratopathy following trabeculectomy and low-dose topical steroids; Apel A et al.; A case of infectious crystalline keratopathy in a patient who had undergone trabeculectomy without 5-fluorouracil is described . Chronic low-dose topical steroids were employed . Crystalline keratopathy occurring in this setting has not been previously described . A 73-year-old diabetic women presented with feathery crystal-like corneal infiltrates . These were cultured and treated with antibiotics based on the sensitivities . The cultures showed a nutritional variant of Streptococcus that was difficult to grow on routine culture plates . It was sensitive to vancomycin . Resolution of the infection occurred with topical treatment . Infectious crystalline keratopathy is a rare but classical corneal infection . The microbiological characteristics that give rise to its clinical appearance and laboratory characteristics are discussed . A rationale for diagnosis and treatment is suggested.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995 May, 79(5), 661 - 3
Prosthetic hip infection related to a dental procedure despite antibiotic prophylaxis; Skiest DJ et al.; A 39-year-old man with systemic lupus erythematosus who was taking corticosteroids had a prosthetic hip infection with Streptococcus oralis after a dental procedure despite prophylaxis with erythromycin . The causative organism was resistant to erythromycin . For patients with prosthetic joints the literature does not support dental prophylaxis, which even if given appropriately, may fail to prevent infection . Some experts advocate giving antibiotic prophylaxis to patients at high risk, although data supporting this practice are limited . However, considering that most orthopedic surgeons and many dental clinicians provide antibiotic prophylaxis, alternatives to erythromycin such as a first-generation cephalosporin should be considered.

Diagn Microbiol Infect Dis, 1995 May-Jun, 22(1-2), 35 - 42
In vitro killing of penicillin-susceptible, -intermediate, and -resistant strains of Streptococcus pneumoniae by cefotaxime, ceftriaxone, and ceftizoxime: a comparison of bactericidal and inhibitory activity with achievable CSF levels; Stratton CW et al.; This study assessed total microbial killing of 30 penicillin-susceptible, -intermediate, and -resistant strains of Streptococcus pneumoniae by cefotaxime, ceftriaxone, and ceftizoxime and compared these values with MICs for each strain against each agent as determined by three different methods/media . The results confirm the appropriateness of recent NCCLS recommendations for MIC interpretive criteria for third generation cephalosporins in which < or = 0.25 microgram/ml = susceptible and > or = 2.0 micrograms/ml = resistant when these agents are used to treat pneumococcal meningitis and data from total microbial killing studies suggests that most isolates with MICs of 0.5 and 1.0 mcg/ml would respond to high dose therapy with all three agents . The study also confirmed the recently described two- to four-fold decrease in activity of ceftizoxime against S . pneumoniae as compared with either cefotaxime or ceftriaxone; but noted that current NCCLS MIC interpretive criteria for the therapy of meningitis remain valid for all three agents . Finally, the study found that MICs determined by the E test or by microdilution broth methods using supplemented Todd Hewitt broth predict susceptibility as well as the NCCLS reference method . The actual selection among these agents for the therapy of pneumococcal meningitis should also consider other parameters including protein binding, age groups of clinical use, maximum potency against all clinically relevant pathogens, and cost.

Diagn Microbiol Infect Dis, 1995 May-Jun, 22(1-2), 19 - 33
Cefotaxime and desacetylcefotaxime antimicrobial interactions . The clinical relevance of enhanced activity: a review; Jones RN; This presentation reviews 15 years of in vitro, pharmacokinetic, and clinical data concerning the active metabolite of cefotaxime sodium, desacetylcefotaxime . This principle metabolite maintains an antimicrobial activity and spectrum superior to so-called "second-generation" cephalosporins, plus it has an extended serum elimination half-life . Furthermore, it penetrates well into various important body compartments . The metabolite enhances cefotaxime potency by additive or synergistic antimicrobial interactions that can significantly reduce cefotaxime minimum inhibitory concentrations (MICs) among oxacillin-susceptible staphylococci, Streptococcus species including pneumococci resistant to penicillin, anaerobes, enteric bacilli, Pseudomonas aeruginosa, and when tested in human serum, some enterococci . The high activity of cefotaxime alone and the contributions of desacetylcefotaxime to the drug's total antimicrobial value must be considered in reestablishing correct dosing of this "third-generation" cephalosporin . Physicians should use cefotaxime susceptibility tests to direct appropriate, cost-effective dosing and the selection of co-drugs when needed . Moreover, empiric cefotaxime regimen doses should also be reduced for some infections at sites where expected pathogen MICs remain low (< or = 2 micrograms/ml).

Diagn Microbiol Infect Dis, 1995 May-Jun, 22(1-2), 119 - 23
Bactericidal activity of cefotaxime, desacetylcefotaxime, rifampin, and various combinations tested at cerebrospinal fluid levels against penicillin-resistant Streptococcus pneumoniae; Cormican MG et al.; Penicillin resistance is increasingly prevalent amongst clinical isolates of Streptococcus pneumoniae . Recently, isolates resistant to the extended-spectrum cephalosporins have also begun to emerge, and combination therapy may be necessary for infection with such organisms . We have studied the activity of cefotaxime, ceftriaxone, ceftazidime, rifampin, chloramphenicol, and vancomycin against 10 S . pneumoniae strains with penicillin minimum inhibitory concentrations (MICs) ranging from 0.03-8 micrograms/ml . The bactericidal activity of cefotaxime, desacetylcefotaxime, rifampin, and combinations of these agents (cerebrospinal fluid levels) against these isolates was determined . Elevated MICs to penicillin were associated with generally twofold lower cefotaxime MICs . All strains remained susceptible to vancomycin and rifampin . The bactericidal activity of cefotaxime with or without desacetylcefotaxime was reduced by the addition of rifampin . Pneumococcal isolates with penicillin MICs of < or = 1 microgram/ml were slowly killed by cefotaxime alone or with desacetycefotaxime . At present, there is little evidence to support the addition of rifampin to cefotaxime for therapy of meningitis.

Pediatr Pulmonol, 1995 May, 19(5), 291 - 8
Dose-response to inhaled nitric oxide in acute hypoxemic respiratory failure of newborn infants: a preliminary report; Buhrer C et al.; In acute hypoxemic respiratory failure of term and near-term neonates, extra- and intrapulmonary right-to-left shunting contribute to refractory hypoxemia . Inhaled nitric oxide (NO) decreases pulmonary arterial pressure and improves ventilation-perfusion mismatch in a variety of animal models and selected human patients . We report on 10 consecutive term and near-term newborns with severe acute hypoxemic respiratory failure due to diaphragmatic hernia, meconium aspiration syndrome, group B streptococcus sepsis, pneumonia or acute respiratory distress syndrome, who received increasing doses of inhaled NO (up to 80 ppm) to improve the arterial partial pressure of oxygen (PaO2) . The response to NO and the optimum NO concentration which improved PaO2 varied considerably between patients . Improvement of PaO2 was absent or poor (less than 10 mm Hg) in the 4 newborns with meconium aspiration syndrome and in 1 patient with congenital diaphragmatic hernia, while in the other 5 patients inhaled NO increased the mean (+/- SE) PaO2 from 41 +/- 6 to 57 +/- 9 mm Hg (P < 0.05) . Optimum NO concentrations determined by dose-response measurements performed during the first 8 hr of NO inhalation were 8-16 ppm except for 2 newborns with congenital diaphragmatic hernia who required 32 ppm to effectively increase PaO2 . Four of the 5 patients in whom the PaO2 rose by more than 10 mm Hg received inhaled NO for extended periods of time (5 to 23 days) with no signs of tachyphylaxis . The optimum NO concentration dropped to less than 3 ppm after prolonged mechanical ventilation or when intravenous prostacyclin was given concomitantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Mol Microbiol, 1995 May, 16(3), 509 - 19
Molecular population genetic analysis of the streptokinase gene of Streptococcus pyogenes: mosaic alleles generated by recombination; Kapur V et al.; To understand the mechanisms governing molecular evolution of the streptokinase gene (skn), a 384 bp DNA fragment encoding two variable regions of the molecule was characterized in 47 isolates of Streptococcus pyogenes . The results reveal that alleles of the streptokinase gene have a mosaic structure, and provide strong evidence for intragenic recombination . Moreover, organisms that are well differentiated in overall chromosomal character have identical skn alleles, which suggests that horizontal gene transfer and recombination have participated in the evolution of this locus . No simple relationship between skn allele and serum opacity factor production or specific disease was identified . The predicted amino acid sequences of highly divergent skn alleles are strikingly similar in hydrophilicity and hydrophobicity profiles, distribution of amphipathic and flexible regions, surface probability plots, and antigenic indices, indicating that despite extensive nucleotide polymorphism in the two skn variable regions, selective pressure has constrained overall structural divergence . These results add to an important emerging theme that intragenic recombination plays a critical role in diversifying genes coding for streptococcal virulence factors.

ASDC J Dent Child, 1995 May-Jun, 62(3), 187 - 91
The effect of caries scoring systems on the association between dental caries and Streptococcus mutans; Koroluk LD et al.; The purpose of this study was to examine the effect of caries scoring systems on the association between caries indices and salivary counts of S . mutans in a group of ninety-eight three to five-year-old preschool children in Saskatoon, Canada . Caries was recorded using the WHO (1987) criteria and a modified scoring system(MC) in which questionable lesions (no soft walls or floor) were included as carious . Whole stimulated saliva was collected from each subject and S . mutans counts were determined (CFU/ml of saliva) . Both dft(MC) = 1.03 and dfs(MC) = 1.53 were significantly different (p < .0001) from dft(WHO) = 0.69 and dfs(WHO) = 1.17, respectively . The S . mutans count was found to be significantly (p < .001) correlated with dft(MC), dfs(MC), dft(WHO) and dfs(WHO) . When questionable carious lesions are included in caries indices, they appear to remain well associated with salivary S . mutans counts.

J Refract Surg, 1995 May-Jun, 11(3), 207 - 9
Survival of streptococcus in optisol-GS medium; Varner AC et al.; BACKGROUND: Donor cornea contamination as a cause of endophthalmitis is one of the most serious complications of penetrating keratoplasty . Optisol-GS corneal storage medium with the combination of gentamicin and streptomycin was designed to provide wider antibiotic coverage, most notably against streptococcal species . However, many enterococci are resistant to streptomycin and genta micin . METHODS/RESULTS: We report a case in which Enterococcus faecium was isolated from cultures of the donor limbus prior to corneal excision and again from preoperative cultures of the donor corneal rim despite 5 days of preservation in Optisol-GS . The isolate was found to be resistant to both gentamicin and streptomycin . CONCLUSIONS: This case illustrates the need to raise awareness that streptococcus can remain a viable contaminant of donor corneas despite storage in Optisol-GS medium.

Alcohol Alcohol, 1995 May, 30(3), 311 - 8
The effect of ethanol ingestion on killing of Streptococcus pneumoniae, Staphylococcus aureus and Staphylococcus epidermidis by rat neutrophils; Jareo PW et al.; The precise effects of chronic ethanol ingestion on the role of neutrophil function in pneumococcal pneumonia have not been fully delineated . In this study, the bactericidal capacity of polymorphonuclear leucocytes (PMNL) from rats pair-fed an ethanol-containing liquid diet or a liquid control diet was compared both in vitro and in vivo . The PMNL were allowed to phagocytose several bacterial species in vitro, and intracellular killing after 1h was determined by plate counts . There was no significant difference in killing of Streptococcus pneumoniae types 6B or 37, Staphylococcus aureus or Staphylococcus epidermidis by PMNL from ethanol-fed and pair-fed rats (E-PMNL and P-PMNL, respectively) . However, E-PMNL killed significantly less of Streptococcus pneumoniae types 10A, 14 and 19F . To corroborate these results in vivo, rats were infected transtracheally, and quantitative lung counts were performed 1 week post infection . Streptococcus pneumoniae types 6B and 37, as well as Staphylococcus aureus, were effectively cleared from the lungs of both groups of rats . Streptococcus pneumoniae types 10A, 14 and 19F, however, were cleared well from the lungs of pair-fed but not ethanol-fed animals . These data suggest that chronic ethanol ingestion induces a strain-specific deficit in neutrophil bactericidal activity against certain S . pneumoniae which does not extend to commonly encountered staphylococci.

Br J Pharmacol, 1995 May, 115(2), 261 - 6
Group B Streptococcus and E . coli LPS-induced NO-dependent hyporesponsiveness to noradrenaline in isolated intrapulmonary arteries of neonatal piglets; Villamor E et al.; 1 . The effects of endotoxin (E . coli lipopolysaccharide, LPS) and heat inactivated group B Streptococcus (GBS) were studied on the contractile responses to noradrenaline (NA) in isolated pulmonary arteries and on the activity of the constitutive and inducible nitric oxide synthase (NOS) in lung fragments of neonatal piglets . 2 . Short-term (< or = 5 h) incubation with LPS (1 micrograms ml-1) or GBS (3 x 10(7) colonies forming units ml-1) did not modify the vascular responsiveness to NA (10(-8) M-10(-4) M) in isolated intrapulmonary arteries . However, long-term incubation (20 h) with LPS or GBS produced a significant reduction in the maximal contractile responses and shifted the concentration-response curve for NA downwards . 3 . Endothelium removal or the cyclo-oxygenase inhibitor meclofenamate (10(-5) M) did not affect the GBS- and LPS-induced hyporesponsiveness to NA . 4 . The presence of the nitric oxide (NO) precursor, L-arginine (10(-5) M), 30 min prior to the contractility challenge increased the LPS- and GBS-induced pulmonary vascular hyporesponsiveness to NA . In contrast, the addition, prior to the challenge with NA, of the NOS inhibitor NG-nitro-L-arginine methyl ester (L-NAME, 10(-4) M) or coincubation with dexamethasone (3 x 10(-6) M), a potent inhibitor of the induction of NOS, or with the protein synthesis inhibitor cycloheximide (10(-5) M) completely restored the reactivity to NA in LPS- and GBS-treated pulmonary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Acta Otolaryngol, 1995 May, 115(3), 386 - 91
NG-methyl-L-arginine protects the guinea pig cochlea from the cytotoxic effects of pneumolysin; Amaee FR et al.; Sensorineural hearing loss is a major sequela of the bacterial meningitis associated in particular with Streptococcus pneumoniae . Recent studies have shown pneumolysin, a toxin elaborated by S . pneumoniae, to be cytotoxic to the guinea pig cochlea . The mechanisms of this cytotoxicity are, however, not fully understood . In the present study this deleterious action of pneumolysin has been shown to be blocked by pretreating the cochlea with NG-methyl-L-arginine, a known inhibitor of nitric oxide synthesis . Furthermore, pretreatment of the cochlea with MK-801, an NMDA receptor antagonist, was also found to confer marked protection from the action of pneumolysin . This latter finding is consistent with previous reports that excess stimulation of NMDA receptors within the cochlea, an event known to lead to excess nitric oxide release, have similar effects on the cochlea as pneumolysin perfusion . It would therefore appear that nitric oxide may represent a significant link in the chain of events leading to the deafness of bacterial meningitis.

J Biol Chem, 1995 Apr 28, 270(17), 9862 - 7
Streptococcal cysteine proteinase releases biologically active fragments of streptococcal surface proteins; Berge A et al.; Streptococcus pyogenes are important pathogenic bacteria which produce an extracellular cysteine proteinase contributing to their virulence and pathogenicity . S . pyogenes also express surface molecules, M proteins, that are major virulence determinants due to their antiphagocytic property . In the present work live S . pyogenes bacteria of the M1 serotype were incubated with purified cysteine proteinase . Several peptides were solubilized, and analysis of their protein-binding properties and amino acid sequences revealed two internal fibrinogen-binding fragments of M1 protein (17 and 21 kDa, respectively), and a 36-kDa IgG-binding NH2-terminal fragment of protein H, an IgGFc-binding surface molecule . M protein also plays a role in streptococcal adherence, and removal of this and other surface proteins could promote bacterial dissemination, whereas the generation of soluble complexes between immunoglobulins and immunoglobulin-binding streptococcal surface proteins could be an etiological factor in the development of glomerulonephritis and rheumatic fever . Thus, in these serious complications to S . pyogenes infections immune complexes are found in affected organs . The cysteine proteinase also solubilized a 116-kDa internal fragment of C5a peptidase, another streptococcal surface protein . Activation of the complement system generates C5a, a peptide stimulating leukocyte chemotaxis . C5a-mediated granulocyte migration was blocked by the 116-kDa fragment . This mechanism, by which phagocytes could be prevented from reaching the site of infection, may also contribute to the pathogenicity and virulence of S . pyogenes.

EMBO J, 1995 Apr 18, 14(8), 1674 - 9
Protein H--a bacterial surface protein with affinity for both immunoglobulin and fibronectin type III domains; Frick IM et al.; Several bacterial species express surface proteins with affinity for the constant region (Fc) of immunoglobulin (Ig) G . The biological consequences of the interaction with IgG are poorly understood but it has been demonstrated that genes encoding different IgG Fc-binding proteins have undergone convergent evolution, suggesting that these surface molecules are connected with essential microbial functions . One of the molecules, protein H, is present in some strains of Streptococcus pyogenes, the most significant streptococcal species in clinical medicine . In contrast to other Ig-binding bacterial proteins tested, protein H was found to interact also with the neural cell adhesion molecule (N-CAM), a eukaryotic cell surface glycoprotein mediating homo- and heterophilic cell-cell interactions . The affinity for the interaction between protein H and N-CAM was 1.6 x 10(8)/M and the binding site on protein H was mapped to the NH2-terminal 80 amino acid residues . N-CAM and IgG are both members of the Ig superfamily and analogous to N-CAM, IgG binds to the NH2-terminal part of protein H . However, the binding sites for the two proteins were found to be separate, an unexpected result which was explained by the observation that the fibronectin type III (FNIII) domains and not the Ig-like domains of N-CAM are responsible for the interaction with protein H . Thus, the binding of N-CAM to protein H was blocked with fibronectin but not with IgG . Moreover, apart from fibronectin itself and N-CAM, fragments of fibronectin and the matrix protein cytotactin/tenascin containing FNIII domains also showed affinity for protein H.(ABSTRACT TRUNCATED AT 250 WORDS)

Med J Aust, 1995 Apr 17, 162(8), 413 - 7
Early-onset neonatal group B streptococcal sepsis: economics of various prevention strategies; Garland SM et al.; OBJECTIVES: To evaluate three strategies for preventing group B streptococcal neonatal sepsis in large teaching hospitals and to examine their cost effectiveness and cost benefit . METHODS: A decision tree was constructed to determine the outcome of three prevention strategies: (1) Screen all pregnant women for group B streptococcus (GBS) at 28 weeks' gestation and give intrapartum chemoprophylaxis to all GBS carriers; (2) Screen all pregnant women, but give chemoprophylaxis selectively to those carriers with obstetric risk factors (i.e., premature labour, prolonged rupture of membranes and maternal sepsis); and (3) Do not screen but give intrapartum chemoprophylaxis for all women with obstetric risk factors . Australian data were used if available, and the cost benefit and cost effectiveness of each strategy compared with no screening at all were estimated . RESULTS: All three strategies had a net cost benefit compared with no intervention at all . Strategy 1 could prevent 46%, Strategy 2 38% and Strategy 3 60%-80% of all early-onset GBS sepsis . CONCLUSION: A substantial proportion of early-onset GBS sepsis is preventable . Strategy 1, which is practical in some large teaching hospitals, prevents more sepsis at a lower cost per case prevented than Strategy 2 . Strategy 3 theoretically could prevent more cases at a substantially lower cost than Strategies 1 or 2, but has not been evaluated clinically.

Presse Med, 1995 Apr 15-22, 24(15), 715 - 8
{Pneumopathies caused by Streptococcus pneumoniae in 27 HIV infected patients}; Duval X et al.; OBJECTIVES: Determine the clinical features and outcome of acute pneumonia due to Streptococcus pneumoniae in HIV infected patients compared with non-HIV infected patients . METHODS: From January 1986 to February 1992, we observed 33 episodes of pneumococcal pneumonia in 27 HIV-infected patients . Most of the patients were drug addicts (16/27), and/or originated from Central Africa or Haiti (10/27) . In 9/27 (33%) patients, HIV infection was previously unknown . Eleven of the 27 patients were at the CDC stages II-III and CD4 cell count was greater than 200/mm3 and CD8 cell count was greater than 1000/mm3 in 12/23 patients and 10/20 patients respectively . RESULTS: In 10/33 episodes, respiratory symptoms were severe: bilateral pneumonia (n = 2) and/or hypoxaemia (n = 9) . In 22/33 episodes, hospitalization occurred less than 24 h after the onset of symptoms and in 9/33 episodes, the initial chest X-ray was normal . Streptococcus pneumoniae was isolated in 16/33 episodes, from blood (n = 10), bronchoalveolar lavage (n = 3) or sputum (n = 3) . Penicillin G or amoxicillin was used and allowed a favorable and quick response in all episodes . Recurrence occurred in 5/18 (27%) followed patients . These recurrences were not favoured by a low CD4 cell count since it was more than 200/mm3 in these five patients . However, the mean count of CD8 cells was higher in patients with recurrence than in patients without recurrence, 1990/mm3 versus 995/mm3 (p = 0.03) . CONCLUSION: CD8 hyperlymphocytosis could increase the risk of recurrence and would help identify a subgroup with higher risk of pneumococcal pneumonia among HIV infected persons.

FEMS Microbiol Lett, 1995 Apr 15, 128(1), 45 - 51
Insertional inactivation of virR in Streptococcus pyogenes M49 demonstrates that VirR functions as a positive regulator of ScpA, FcRA, OF, and M protein; McLandsborough LA et al.; Several reports have shown that Streptococcus pyogenes strains which produce opacity factor (OF+) have diverged significantly from OF- serotypes . This study questions whether several surface proteins of an OF+ culture are regulated by the positive regulatory protein VirR, in a manner similar to OF- strains . Interruption of the virR region of an OF+ S . pyogenes (strain CS101, M type 49) was performed using a temperature-sensitive plasmid containing a fragment of virR . Interruption of the virR region produced cultures with undetectable amounts of M49 and ScpA proteins, and reduced the yield of FcRA protein . In addition, mutants had a significant reduction in detectable opacity factor . These results suggest that virR functions as a positive regulator of a variety of surface proteins in OF+ strains.

Gene, 1995 Apr 14, 156(1), 93 - 6
Cloning and sequencing of the gene coding for dextranase from Streptococcus salivarius; Ohnishi Y et al.; We cloned and sequenced the dextranase (Dex) (1,6-alpha-glucanhydrolase; EC 3.2.1.11)-encoding gene from Streptococcus salivarius (Ss) strain M-33 . Recombinant clones from an Ss genomic library specifying Dex activity were identified as colonies surrounded by transparent halos on blue dextran plates . One of the clones had a 4.3-kb KpnI fragment containing the gene coding for an 826-amino-acid polypeptide with a molecular mass of 87.9 kDa, which corresponds well to that of native Dex from the Ss culture supernatant . There was no sequence homology between the gene encoding Ss Dex and the gene encoding dextran glucosidase of S . mutans, or between their protein products.

Gene, 1995 Apr 14, 156(1), 89 - 91
Molecular cloning of the gene encoding RecF, a DNA repair enzyme, from Streptococcus pyogenes; DeAngelis PL et al.; RecF is a component of one of the bacterial DNA repair systems . The start codon of the recF gene of Streptococcus pyogenes resides about 4.4 kb downstream from the end of hasA, the hyaluronan synthase-encoding gene, which is transcribed in the opposite orientation . The deduced 368-amino-acid RecF protein is 43.5% identical to its homolog from Bacillus subtilis . When cloned on a plasmid, recF could complement a S . pyogenes deletion mutant that was sensitive to ultraviolet irradiation and chemical mutagens . This is the first report of a recF sequence from a Gram+ pathogen.

J Biol Chem, 1995 Apr 14, 270(15), 8805 - 14
Cloning and expression of the beta-N-acetylglucosaminidase gene from Streptococcus pneumoniae . Generation of truncated enzymes with modified aglycon specificity; Clarke VA et al.; The gene encoding a beta-N-acetylglucosaminidase from Streptococcus pneumoniae has been obtained by screening an expression library for beta-N-acetylglucosaminidase activity . Clones of different nucleotide sizes each having arylglycoside activity were obtained, and DNA sequencing revealed a gene of 3933 base pairs possessing typical bacterial transcription initiation and termination sequences and terminating in an ochre stop codon . Computer analysis of the translated protein of 1311 amino acids (144,210 Da) identified a tandem repeat within which lies a sequence homologous with six other hexosaminidase gene products from a wide variety of species ranging from bacteria to humans . Also found were an amino-terminal putative secretion signal peptide and a carboxyl-terminal cell sorting/anchorage motif typically found in over 20 other Gram-positive surface proteins . The expression of an almost complete DNA clone in Escherichia coli produced a functional and authentic beta-N-acetylglucosaminidase with aglycon specificity identical to the wild-type enzyme . However, enzymes produced from truncated DNA clones show more restricted aglycon specificity and are unable to hydrolyze terminal beta 1-2GlcNAc residues from N-glycans containing a bisecting N-acetylglucosamine . The availability of these clones allows structural analyses to be made of catalytic and oligosaccharide recognition protein domains that enhance functional activity.

Toxicology, 1995 Apr 12, 98(1-3), 111 - 23
Immunotoxicologic studies with CI-959, a novel benzothiophene cell activation inhibitor; Bleavins MR et al.; CI-959 is an orally effective inhibitor of cellular activation in both in vitro and animal models . To assess the effects of CI-959 on immune function, male Fischer 344 rats were evaluated for splenic T- and B-lymphocyte populations, antibody-forming cell response to sheep red blood cells (sRBC), concanavalin A and pokeweed mitogen-induced lymphocyte proliferation, Natural Killer cell activity, and reticuloendothelial system clearance of sRBC . Host resistance was measured in female B6C3F1 mice using Listeria monocytogenes, Streptococcus pneumonia, and B16F10 melanoma models . CI-959 was administered to both species of rodents at 25, 50, and 75 mg/kg/day for 14 days . A vehicle control and two positive controls (cyclophosphamide and dexamethasone) were run concurrently . CI-959 generally did not suppress immunological responses in rats at doses lower than those which also altered body weight gain and reduced spleen and thymus weights . Natural Killer cell activity was significantly reduced at 50 and 75 mg/kg CI-959 . At 75 mg/kg rats also exhibited a reduction in ability to make anti-sRBC antibody . The number of T- and B-lymphocytes, proliferative response to mitogens, and macrophage activity of the reticuloendothelial system were not affected by CI-959 . CI-959 also did not alter resistance of mice to Listeria monocytogenes, Streptococcus pneumoniae, or B16F10 melanoma cells . Based on these ex vivo and in vivo assays, the rodent immune system does not appear to be a sensitive or toxicologically important target for CI-959.

Med Clin (Barc), 1995 Apr 8, 104(13), 493 - 9
{Infectious endocarditis of the native valve: its epidemiological profile and an analysis of its mortality between the years 1984 and 1993}; Carton JA et al.; BACKGROUND: The description of the epidemiologic profile and analysis of the mortality of infectious endocarditis (IE) observed from 1984-1993 . METHODS: One hundred thirty episodes of IE in a native valve (30 in drug addicts {IVDA} and 20 cases of nosocomial acquisition) were analyzed with right/left/bilateral localization (42/84/4, respectively), infection of the mitral/aortic/tricuspid valve (52/47/34, respectively) and the etiology was determined as Staphylococcus aureus in 52 cases, 41 Streptococcus, 13 negative coagulase Staphylococcus, and 11 Enterococcus . High risk IE were identified by uni and multivariate analysis (MVA) . RESULTS: The incidence of IE ranged from 0.36 and 0.70 cases x 1.000 admitted adults/year (mean: 0.50) . Transthoracic echocardiography detected bacterial vegetations in 67% of the cases with the validity to predict the development of embolisms being 55% . MVA showed the embolic episodes (present in 45% of the IE) to be associated with the IVDA patients and prolonged fever . The latter complication, being defined as > or = 10 days of fever under appropriate treatment, was observed in 32% of the cases and was due to mild (n = 15) and severe causes (n = 27) . Postembolic septic complications were associated to fever with MVA . Twenty three patients died (18%), 2 IVDA and 5 nosocomial IE, mainly due to heart failure (n = 13) . The independent risk factor predictors for death (p < 0.05) were: age > or = 60 years (mortality 34%), cerebral embolisms (55%), severe heart failure (37%), and the exclusion of the patient as a candidate for surgery (73%) . To the contrary, right IE (mortality 0%) and cardiac surgery (5%) favoured survival . CONCLUSIONS: To improve the prognosis of infectious endocarditis in high risk patients more opportune cardiac surgery accepting greater risks should be performed.

Harefuah, 1995 Apr 2, 128(7), 409 - 11, 464
{Penicillin resistance of pneumococci from invasive pediatric infections}; Goldbart A et al.; Susceptibility to antibiotics of 199 isolates of Streptococcus pneumoniae from blood and cerebrospinal fluid of children hospitalized during 1987-1993 was tested . Of 119 isolates, 18% were resistant to penicillin . The prevalence in 1992-93 was double that in 1987-89 . The increase in minimal inhibitory concentrations (MIC) of penicillin was associated with an increase in MIC of other beta-lactams . There was also resistance to other antibiotics: trimethoprim-sulfamethoxazole, erythromycin and chloramphenicol . Most of the resistant isolates belonged to serogroups 6, 14, 19 and 23 . When planning vaccine policies, resistant types should be taken into consideration.

Microb Drug Resist, 1995 Spring, 1(1), 85 - 94
In vitro development of resistance of Streptococcus pneumoniae to beta-lactam antibiotics; Carsenti-Etesse H et al.; In recent years, increasing numbers of Streptococcus pneumoniae strains displaying relative resistance to penicillin have been reported . Epidemiological studies have shown a correlation between aminopenicillin administration and resistance . We investigated the development of resistance in six strains (four sensitive and two intermediate-resistant to penicillin) by serial daily passages in subinhibitory concentrations of amoxicillin (AMX), amoxicillin + clavulanic acid (AMC), imipenem (IMP), cefixime (CFM), cefatrizine (CTZ), cefadroxil (CDX), and cefuroxime (CXM) . MICs were determined by the macrodilution method in brain-heart broth for each daily passage . The number of daily passages needed to increase the MIC by a factor of 8 was achieved with AMX, AMC, and CFM for most of the strains after a mean of 24, 20, and 11 passages, respectively, and for one-third of the strains, with CDX, IMP, and CTZ after 11, 11, and 21 passages, respectively . Decreased susceptibility to breakpoints for intermediate-resistant S . pneumoniae populations was noted for all strains with CFM, AMX, and AMC after a mean of 10, 18, and 21 serial passages, respectively, and for four of five strains with IMP and CTZ after 12 and 13 passages . CTZ-, CDX-, and CXM-passaged variants had increased MIC values only for cephalosporins, while AMX-, AMC-, IMP-, and CFM-passaged variants exhibited increased MICs to all antibiotics tested . These in vitro data appear to be in agreement with epidemiological studies and warrant further exploration with respect to possible clinical implications.

Microb Drug Resist, 1995 Spring, 1(1), 79 - 84
Clinical isolates and nasopharyngeal carriage of antibiotic-resistant Streptococcus pneumoniae in Hospital for Infectious Diseases, Sofia, Bulgaria, 1991-1993; Setchanova L; The antimicrobial resistance of Streptococcus pneumoniae was surveyed in 1991-1993 at the Hospital for Infectious Diseases in Sofia, Bulgaria . Pneumococcal isolates were collected from routine clinical specimens and from nasopharyngeal secretions of inpatient carriers . The incidence of penicillin-resistant S . pneumoniae (PRSP) was 24.3% among clinical samples and nasopharyngeal carriage of PRSP was as high as 40% among children . Penicillin-resistant strains were more frequently resistant to non-beta-lactam antibiotics than were penicillin-sensitive strains . More than half of the PRSP strains were multiply resistant . On the basis of MIC values of ampicillin, it was established that ampicillin was not superior to penicillin . The MICs of five cephalosporins were found to increase in parallel with the MICs of penicillin G . Some of the pneumococcal strains that were highly penicillin-resistant were also resistant to cefotaxime/ceftriaxone (MIC = 1-4 micrograms/ml), but the number of strains was small . On the basis of MIC values of cefotaxime and ceftriaxone for strains from cerebrospinal fluid, both antibiotics may be suitable alternatives for treating meningitis due to strains with resistance to penicillin.

Microb Drug Resist, 1995 Spring, 1(1), 71 - 8
Novel penicillin-resistant clones of Streptococcus pneumoniae in the Czech Republic and in Slovakia; Figueiredo AM et al.; Seventy-two penicillin-resistant Streptococcus pneumoniae isolates collected from clinical specimens in the Czech and Slovakian Republics between 1990 and 1992 were analyzed by a variety of molecular techniques . Most of the highly resistant isolates (40/72) (penicillin MIC between 1 up to 16 micrograms/ml) were represented by two distinct pneumococcal clones, and most of these isolates (35/40) were also resistant to at least two other antibiotics (tetracycline plus chloramphenicol or erythromycin) . All 17 isolates belonging to the first clone were of serotype 14, had very high penicillin MICs (8-12 micrograms/ml), shared a common, abnormal penicillin-binding protein (PBP) pattern and one of two related pulsed-field gel electrophoretic (PFGE) patterns . The 15 isolates belonging to the second clone were all of serotype 19A, had penicillin MICs between 1 and 4 micrograms/ml, shared a unique, abnormal PBP pattern, and could be divided into two subgroups on the basis of PFGE patterns, one of which was indistinguishable from the PFGE pattern of a multiresistant capsular type 19A clone of S . pneumoniae already identified earlier in Hungary . Thirty-two of the 72 pneumococcal isolates had lower penicillin MICs (0.1-0.5 microgram/ml), and these isolates differed from the more highly resistant ones in several respects: They belonged to seven different serotypes, showed large variation in PFGE patterns (20 patterns in 32 isolates) and most of them (21/32) were resistant to penicillin only . Tentative explanations for these findings, in terms of epidemiological and molecular mechanisms, are considered.

Microb Drug Resist, 1995 Spring, 1(1), 59 - 69
Antibiotic susceptibility of Streptococcus pneumoniae isolates in Portugal . A multicenter study between 1989 and 1993; Pato MV et al.; A total of 1,104 strains of Streptococcus pneumoniae were isolated from hospitalized patients (75.5%) and from colonization sites at the Public Health Institute (24.5%) during the last 4 years (1989-1993) . Penicillin resistance (defined as MIC > or = 0.1 microgram/liter) was found to increase in time: 4.6% in 1989, 4.9% in 1990, 6.4% in 1991, 11.3% in 1992, and 17% in 1993 . In 1992, 0.8% of the strains had penicillin MIC = 2 mg/liter . Increase in penicillin resistance was also evident among invasive strains {blood, cerebrospinal fluid (CSF), pleura}: 2/92 isolates from 1989-1992 (2.3%) were penicillin resistant as compared to 7/101 isolates from 1992 (6.9%) . Multiresistance (resistance to three or more antibiotics) was 4.4% with penicillin, tetracycline, chloramphenicol being the predominant resistant phenotype at the end of 1992 . In 1993, strains with resistance to penicillin plus chloramphenicol plus tetracycline increased further . Erythromycin resistance was usually associated with clindamycin resistance, but the majority of such strains remained susceptible to penicillin . Drift in the direction of increasing MIC values was also noted during this 3-year period among "susceptible" isolates: bacteria with MIC of 6-10 ng/ml representing the majority of isolates in 1990-1991 decreased and were replaced by cells with MIC of 20 ng/ml . The most frequent pneumococcal serotypes were 23, 19, 3, 6, 14, 9, and 8, with the frequency of type 9 increasing from 2.9% (in 1989) through 3.2% (1990) to 6.4% (1992) . Among all antibiotic resistant strains, the prevalent serotypes were 23, 9, 14, and 6 . The chromosomal backgrounds of resistant isolates tested by pulsed-field gel electrophoresis showed close resemblance to the background of the serotype 23F multiresistant clone first identified in Spain . The data suggest that the recent large increase in the frequency of penicillin-resistant pneumococci represents the import of this clone into Portugal during the early 1990s . The increased frequency of drug-resistant pneumococci highlights the importance of continued surveillance of these dangerous pathogens.

Microb Drug Resist, 1995 Spring, 1(1), 35 - 42
Relatedness among penicillin-binding protein 2b genes of Streptococcus mitis, Streptococcus oralis, and Streptococcus pneumoniae; Potgieter E et al.; Penicillin-binding protein (PBP) 2b similarities among Streptococcus mitis, S . oralis, and S . pneumoniae using DNA fingerprinting and sequencing were investigated . The polymerase chain reaction (PCR) was performed on 41 penicillin-susceptible and -resistant clinical isolates of S . mitis and S . oralis using the susceptible S . pneumoniae R6 PBP 2b primers . PCR products were then analyzed using Hinf I and Sty I restriction enzymes . Of 41 S . mitis/S . oralis isolates studied 15 strains produced a PCR product of a similar size to that of S . pneumoniae R6 . On fingerprinting these 15 strains, 11 different patterns were seen using Sty I restriction enzyme and 12 different patterns with Hinf I . The PBP 2b genes of the S . mitis and S . oralis isolates studied were found to be very heterogenous . The PBP 2b genes of two S . mitis isolates, MICs 0.5 and 2 micrograms/ml, were sequenced . These PBP 2b genes were found to possess a mosaic structure when compared to those of other S . pneumoniae and viridans streptococcal species . Analysis of these mosaic blocks indicates that both S . mitis strains contain areas that originated from S . pneumoniae as well as regions of unknown origin . PBP 2b sequence comparisons of a susceptible S . oralis with reported sequences of S . pneumoniae R6 and S . mitis NCTC 10712 revealed what appears at this stage to be nucleotide regions unique to S . oralis . A penicillin-resistant S . oralis strain contained a pneumococcal region of 272 bp that was flanked by S . oralis sequences . These specific S . oralis regions have been located in PBP 2b genes of penicillin-resistant S . oralis and S . pneumoniae isolates described from Europe and South Africa.

Exp Mol Pathol, 1995 Apr, 62(2), 99 - 108
Antibody protection in aging: influence of idiotypic repertoire and antibody binding activity to a bacterial antigen; Nicoletti C; Previous studies demonstrated that the anti-phosphorylcholine (PC) antibodies produced by aged BALB/c (18-22 months old) mice are structurally different and less protective against infection with Streptococcus pneumoniae than those produced by young (3-4 months old) syngeneic mice . However, PC antibody from aged animals had a different idiotypic repertoire and, at the same time, showed a diminished antibody binding activity to pneumococci compared to "young" antibody . To determine the cause of the reduced protective activity of the "aged" antibody, experiments of passive protection were performed using anti-PC monoclonal antibody (mAb) from either young and aged BALB/c or young syngeneic mice that were neonatally injected with an equimolar mixture of two monoclonal antibodies specific for two distinct idiotopes of the T15 idiotype (Id) family . At young/adult age, the mice neonatally injected with anti-Id antibody were still able to respond to PC, but the idiotypic repertoire was characterized by the absence of the dominant T15 idiotype . The two groups of mAb generated had a similar affinity to PC and binding activity to pneumococci but were totally diverse in regard to both their idiotypic repertoire and VH/VL gene utilization . Experiments of passive protection allowed us to determine the influence of the idiotypic repertoire and antibody binding activity to pneumococci on the reduced antibody protective efficiency in aging . Young recipients (BALB/c) were injected ip with a dose of anti-PC mAb from young, either T15Id+ or T15Id-, and aged donors (20 micrograms/recipient) and 2 hr later the groups of mice were challenged with 10(3) CFU of S . pneumoniae WU-2 . Both groups of "young" antibody afforded a similar degree of protection, regardless of the idiotypic repertoire, always higher than that of PC antibody from aged mice . These experiments suggested that the decline of binding activity, and not the switch in the idiotypic repertoire, may be responsible for the reduced anti-pneumococcal activity of the anti-PC antibody on aging.

J Immunol, 1995 Apr 1, 154(7), 3373 - 82
A novel phosphocholine antigen protects both normal and X-linked immune deficient mice against Streptococcus pneumoniae . Comparison of the 6-O-phosphocholine hydroxyhexanoate-conjugate with other phosphocholine-containing vaccines; Fischer RT et al.; A novel form of phosphocholine (PC), p-nitrophenyl-6-(O-phosphocholine)hydroxyhexanoate (EPC) coupled to keyhole limpet hemocyanin (KLH) has been compared with unencapsulated, avirulent Streptococcus pneumoniae (R36a) and with the traditional thymus-dependent form of PC, diazophenylphosphocholine (DPPC)-conjugated KLH for its vaccine potential against virulent S . pneumoniae . Immunization with any of these three PC-containing Ags protects normal mice against a lethal challenge with 10(4) S . pneumoniae, whereas only EPC-KLH provides total protection to Xid mice . DPPC-KLH and unencapsulated S . pneumoniae confer less than 40% protection in Xid mice . Passive transfer of a PC-specific hybridoma Ab made from EPC-KLH-immunized Xid mice also provided protection against lethal challenge with S . pneumoniae . Protective anti-PC Ab were capable of binding to the surface of virulent bacteria, whereas anti-PC Ab incapable of binding to the bacterial surface failed to protect . Furthermore, serum Ab from EPC-KLH immunized and protected mice bound to S . pneumoniae, whereas secondary Abs from DPPC-KLH- or R36a-immunized mice failed to bind to the bacteria . EPC-KLH is potentially a vaccine candidate for pneumococcal prophylaxis in settings of immune compromise.

Infect Immun, 1995 Apr, 63(4), 1305 - 10
Breakdown of the round window membrane permeability barrier evoked by streptolysin O: possible etiologic role in development of sensorineural hearing loss in acute otitis media; Engel F et al.; Sensorineural hearing loss is a common sequela of acute and chronic otitis media, and the round window membrane (RWM) is currently being considered as a major route for noxious agents to pass from the middle ear cavity to the cochlea . Streptococcus pneumoniae, a major causative agent of otitis media, and Streptococcus pyogenes A produce molecularly related toxins, pneumolysin and streptolysin O (SLO), that form large pores in target membranes . In this study, we analyzed the effects of SLO on the permeability of the RWM . Resected RWMs from a total of 104 guinea pigs were embedded between two chambers of an in vitro system . One chamber was designated as the tympanal (cis) compartment, and the other was designated as the inner ear (trans) compartment . The permeability of normal and SLO-damaged RWMs towards Na+, {14C}mannitol, and proteins was investigated . SLO evoked permeability defects dose dependently in the RWM with fluxes of both Na+ and {14C}mannitol being demonstrable over a time span of up to 8 h . Serum proteins and radioiodinated SLO were also shown to pass through the damage RWM . Scanning electron microscopy revealed the morphological correlates to these results . We propose that damage to the RWM by potent pore-forming cytolysins leads to leakage of ions from the perilymph . Ionic disequilibrium and passage of noxious macromolecules to the cochlea could contribute to disturbances of the inner ear function.

Infect Immun, 1995 Apr, 63(4), 1153 - 7
Effect of experimental influenza A virus infection on isolation of Streptococcus pneumoniae and other aerobic bacteria from the oropharynges of allergic and nonallergic adult subjects; Wadowsky RM et al.; Intranasal challenge with both influenza A virus and Streptococcus pneumoniae promotes otitis media with S . pneumoniae in chinchillas . We investigated whether influenza A virus infection promotes oropharyngeal colonization with S . pneumoniae and other middle ear pathogens by selectively inhibiting commensal bacteria . On study day 0, 12 allergic and 15 nonallergic adult subjects were intranasally inoculated with influenza A/Kawasaki (H1N1) virus . Every subject was infected with the virus as demonstrated by nasal shedding or seroconversion . Average upper respiratory symptom scores and nasal secretion weights from the entire subject group were elevated between days 2 and 6 (acute phase) and were not significantly different between allergic and nonallergic subjects . S . pneumoniae was not isolated from any subject prior to the virus challenge but was isolated in heavy density from 4 (15%) subjects on day 6 (P = 0.055) . Staphylococcus aureus was isolated more frequently from the nonallergic subjects than from the allergic subjects on days 2 (80 versus 25%, respectively) 4, (67 versus 17%, respectively), and 6 (73 versus 25%, respectively) (P < 0.05) . The isolation rates of other middle ear pathogens were not significantly different before virus challenge and during the acute and resolution phases (days 27 to 30) of the experimental infection for the entire subject group or either the allergic or nonallergic subgroup . Densities and isolation rates of commensal bacteria from the entire subject group were similar throughout the observational period . These results suggest that the virus infection promoted S . pneumoniae colonization of the oropharynx and that nonallergic persons may be more vulnerable to colonization with S . aureus than allergic persons . The altered colonization rates were not attributed to inhibition of commensal bacteria.

Clin Infect Dis, 1995 Apr, 20(4), 826 - 35
High incidence of resistance to multiple antimicrobials in clinical isolates of Streptococcus pneumoniae from a university hospital in Korea; Lee HJ et al.; One hundred thirty-one strains of Streptococcus pneumoniae isolated from clinical specimens between January 1991 and April 1993 were serotyped and tested for susceptibility to 10 antimicrobials by the agar dilution method . Five serotypes (6A, 6B, 14, 19F, and 23F) accounted for 67% of all isolates . Seventy percent of isolates were not susceptible to penicillin, exhibiting either intermediate resistance (37%) or high-level resistance (33%); 82% of isolates from children and 59% of those from normally sterile body fluids were resistant to penicillin . A significantly increased rate of penicillin resistance (P < .01, Fisher's exact or chi 2 test) was associated with hospitalization, an age of < or = 15 years, ongoing antimicrobial therapy at the time of isolation of the organism, nosocomial acquisition, and several specific serotypes (6, 14, 19F, and 23F) . No penicillin-resistant strain showed beta-lactamase activity . Various proportions of the penicillin-resistant strains also displayed resistance to cefaclor (89%), cefotaxime (82%), chloramphenicol (65%), erythromycin (52%), and ciprofloxacin (15%), but none was resistant to teicoplanin or vancomycin . The prevalence of pneumococcal resistance documented in Korea in this study is among the highest figures published to date.

Clin Infect Dis, 1995 Apr, 20(4), 797 - 800
Fatal sepsis due to a beta-lactamase-producing strain of Fusobacterium nucleatum subspecies polymorphum; Goldstein EJ et al.; A patient with Waldenstrom's macroglobulinemia was treated empirically with imipenem for sepsis related to oropharyngeal infection and responded within 24 hours . When blood cultures yielded Streptococcus agalactiae, the regimen was changed to ampicillin and gentamicin . The patient's condition rapidly deteriorated, and she died 3 days later . After her death, a strain of Fusobacterium nucleatum subspecies polymorphum producing beta-lactamase (PEN-Y; group 2a) was isolated from blood cultures . A literature review revealed increasingly frequent isolation of beta-lactamase-producing strains of F . nucleatum . Thus strains of F . nucleatum isolated from blood and other specimens from patients with serious infections should be tested for beta-lactamase production.

Clin Infect Dis, 1995 Apr, 20(4), 1058 - 60; discussion 1061-2
Varicella gangrenosa with toxic shock-like syndrome due to group A streptococcus infection in an adult: case report; Gonzalez-Ruiz A et al.; Varicella gangrenosa is a rare and serious complication of chickenpox that has been described in children only . We describe a case of an adult with varicella gangrenosa that presented as necrotizing fasciitis of a limb . This infection is caused by group A streptococcal superinfection of the skin lesions due to chickenpox . It can be misdiagnosed, with fatal consequences . Because of prompt recognition and aggressive surgical and medical treatment, the patient survived without loss of the affected limb.

J Clin Microbiol, 1995 Apr, 33(4), 1031 - 3
Methods for predicting susceptibility of Streptococcus pneumoniae to cefixime; Barry AL et al.; Among 698 Streptococcus pneumoniae isolates, 475 were penicillin susceptible and > 99% of those were susceptible to 0.5 microgram of cefixime per ml; other pneumococci were tentatively assumed to be resistant to cefixime . A 1-microgram oxacillin disk was more reliable than a 5-micrograms cefixime disk for predicting susceptibility to cefixime.

Antimicrob Agents Chemother, 1995 Apr, 39(4), 985 - 6
Pneumococcal resistance in southwest Virginia; Evans TG et al.; Resistance patterns of Streptococcus pneumoniae in southwest Virginia were determined for 100 consecutive, hospital-based isolates, mostly from adults . Oxacillin disk screening identified all resistant isolates . Sixteen percent of the isolates were penicillin resistant (10% were highly resistant) . E-strip testing revealed the following MICs (in micrograms per milliliter, with percentages of isolates in parentheses): cefotaxime, < or = 0.5 (92%); ceftriaxone, < or = 0.5 (95%); ceftizoxime, < or = 0.5 (85%); erythromycin, < or = 1 (87%); ofloxacin, < or = 2 (80%); vancomycin, < or = 1 (98%).

Antimicrob Agents Chemother, 1995 Apr, 39(4), 964 - 70
In vitro evaluation of ABT-719, a novel DNA gyrase inhibitor; Flamm RK et al.; ABT-719 (A-86719.1) is the first compound of a new class of novel DNA gyrase inhibitors, the 2-pyridones, with potent antibacterial activity against gram-positive, gram-negative, and anaerobic organisms . ABT-719 was more active than ciprofloxacin, sparfloxacin, and clinafloxacin against gram-positive bacteria . ABT-719 was particularly active against Staphylococcus aureus (MIC at which 90% of the isolates were inhibited {MIC90} = 0.015 micrograms/ml) and Streptococcus pneumoniae (MIC90 = 0.03 micrograms/ml) . ABT-719 was also the most active of the compounds tested against ciprofloxacin-resistant S . aureus isolates, with an MIC90 of 0.25 micrograms/ml, compared with 64 micrograms/ml for ciprofloxacin . Against gram-negative organisms, ABT-719 was as active as or slightly more active than ciprofloxacin and was the most active compound against ciprofloxacin-resistant Pseudomonas aeruginosa (MIC90 = 2.0 micrograms/ml) . ABT-719 was also the most active compound against both gram-positive and gram-negative anaerobes, with MIC90s ranging from 0.12 to 0.25 micrograms/ml.

Antimicrob Agents Chemother, 1995 Apr, 39(4), 859 - 67
Alterations in penicillin-binding protein 2B from penicillin-resistant wild-type strains of Streptococcus pneumoniae; Smith AM et al.; The 1.5-kb transpeptidase-encoding region (TER) of penicillin-binding protein (PBP) 2B was amplified and sequenced from 18 penicillin-resistant isolates of Streptococcus pneumoniae, with each isolate representing a different DNA fingerprint profile of the TER . PBP 2B TERs from penicillin-resistant isolates revealed extensive sequence divergence from the penicillin-susceptible R6 strain, differing by up to 170 nucleotide substitutions and resulting in up to 38 alterations in the amino acid sequence of the protein . All penicillin-resistant isolates showed sequence divergence within a +/- 300-bp area at the center of the PBP 2B TER . Although a number of amino acid substitutions were found within this central area of PBP 2B, only two substitutions were common to all resistant isolates, namely, Thr-252 replacement by Ala and Glu-282 replacement by Gly . These two substitutions appear to be essentially associated with a decreased affinity of PBP 2B for penicillin . A second block of divergent nucleotide sequence was prominent amongst isolates with high levels of resistance . This was a +/- 100-bp area of the TER around nucleotide 1300 and included the substitution of Gly for Asp-431, which was the only amino acid substitution within this area that was common to all isolates . These data may assist in the definition of the structural changes in the penicillin-binding site of PBP 2B associated with penicillin resistance in S . pneumoniae.

Am J Vet Res, 1995 Apr, 56(4), 468 - 72
Comparative treatment of mares susceptible to chronic uterine infection; Troedsson MH et al.; Four intrauterine treatment strategies were evaluated for effectiveness in mares that were confirmed to be susceptible to chronic uterine infection . Pretreatment samples were obtained at detection of estrus, and a genital strain of Streptococcus zooepidemicus was infused into the uterus when a preovulatory (> 35 mm) follicle was detected . At 12 hours after inoculation, mares were assigned to 1 of 4 selected treatment groups: autologous plasma, 100 ml (n = 5); potassium penicillin, 5 million U in 100 ml of phosphate-buffered saline solution (PBSS; n = 5); 10 mg of prostaglandin F2 alpha in 100 ml of PBSS (n = 5)' and large-volume lavage with normal saline solution (1,000 ml increments) . A fifth group, treated with vehicle alone (100 ml of PBSS), served as a negative control (n = 7) . All treatments were administered into the uterus . To assess the effectiveness of the treatment, samples for culture and cytologic examination were collected at 96 hours after bacterial inoculation . An effect of treatment was observed on the number of uterine neutrophils (P = 0.02) and growth of S zooepidemicus (P < 0.01) . Intrauterine treatment with potassium penicillin, prostaglandin F2 alpha, and large-volume uterine lavage significantly reduced the growth of S zooepidemicus (P < 0.01) as well as the number of neutrophils (P < 0.02) . Autologous plasma reduced the number of neutrophils (P < 0.05), but not growth of S zooepidemicus . There was significant correlation between the number of uterine neutrophils and growth of S zooepidemicus for each treatment group (r = 0.57; P < 0.05).

Thorax, 1995 Apr, 50(4), 360 - 5
Bronchial inflammation in chronic bronchitis assessed by measurement of cell products in bronchial lavage fluid; Riise GC et al.; BACKGROUND--Bronchial inflammation in chronic bronchitis has not been characterised as well as in asthma . The present study was undertaken to assess whether a characteristic pattern of bronchial inflammatory markers could be found in patients with chronic bronchitis . METHODS--Bronchoscopy with bronchial lavage was performed in 42 patients with chronic bronchitis and in 13 healthy controls . Twenty three of the patients had non-obstructive chronic bronchitis and 19 had chronic bronchitis and chronic obstructive pulmonary disease (COPD) . Eighteen of the patients with bronchitis had recurrent infective exacerbations and 24 did not . Intrabronchial bacterial cultures were taken with a protected specimen brush . RESULTS--Increased activity of neutrophils, fibroblasts, and eosinophils was found in the patients with chronic bronchitis as assessed by the levels of myeloperoxidase (MPO) and interleukin-8 (IL-8), hyaluronan, and eosinophil cationic protein (ECP), respectively . The levels of tryptase did not differ from the controls . High correlations were found between the levels of MPO and IL-8, as well as ECP and IL-8 . No differences were found between the patients with COPD and those with non-obstructive chronic bronchitis . CONCLUSIONS--Recruitment and activation of both neutrophils and eosinophils seem to be a characteristic of chronic bronchitis . This activation is associated with IL-8 . The patients with intrabronchial cultures of Streptococcus pneumoniae had the highest individual levels of MPO, ECP, and IL-8 of all subjects in the study, indicating that colonisation with S pneumoniae could promote bronchial inflammation.

Jpn J Antibiot, 1995 Apr, 48(4), 571 - 94
{Antimicrobial activities of piperacillin against fresh clinically isolated strains}; Deguchi K et al.; In order to evaluate the antimicrobial activity of piperacillin (PIPC), along with control agents, minimum inhibitory concentrations (MIC's) were determined against fresh clinically isolated strains from January to June, 1994 . 1 . The MIC70's of PIPC against major strains were approximately equal to those reported in the mid 1980s . 2 . Strains for the study were supplied in approximately equal numbers from community-acquired hospitals and general hospitals . The ratios of bacteria resistant to beta-lactams including PIPC were low in the former group and high in the latter . 3 . "New types of beta-lactam-resistant strains" which did not exist in mid 1980s but found at this time included benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae, PCG-resistant S . pneumoniae, cephems-resistant Escherichia coli and beta-lactamase producing Prevotella spp . These bacteria were also found among strains obtained from community-acquired hospitals.

Jpn J Antibiot, 1995 Apr, 48(4), 522 - 8
{Clinical evaluation of cefpodoxime proxetil, a new oral cephem, in the treatment of respiratory tract infections with the special reference to community-acquired Streptococcus Pneumoniae infections}; Akiyama O et al.; The clinical usefulness of cefpodoxime proxetil (CPDX-PR) was investigated in the treatment of pneumonia and chronic airway infections occurring in patients first visiting our outpatient clinic or those being treated at the outpatient clinic . CPDX-PR was orally administered twice a day after meals at a dose of 100-200 mg for acute respiratory tract infections and at a dose of 200 mg for chronic respiratory tract infections . Excellent, good, fair, and poor responses were observed in 20, 33, 10, and 3 of 66 patients (4 with acute bronchitis, 27 with pneumonia, and 35 with acute exacerbation of chronic airway infection), respectively, demonstrating an 80.3% efficacy rate (53/66) . Causative organisms, including Streptococcus pneumoniae, were all eradicated from the patients whose causative organisms were examined over time, although 2 of the patients were superinfected with Pseudomonas aeruginosa . There were no serious adverse reactions or abnormal changes in laboratory test results . It was concluded that CPDX-PR could be used as a first-choice drug for the treatment of respiratory tract infections at an outpatient clinic, and that this drug should acquire greater importance in particular consideration of recent increases in infections with S . pneumoniae.

J Dent Res, 1995 Apr, 74(4), 1040 - 7
Monoclonal antibodies against a high-molecular-weight agglutinin block adherence to experimental pellicles on hydroxyapatite and aggregation of Streptococcus mutans; Carlen A et al.; High-molecular-weight (HMW) glycoproteins, agglutinins, in parotid saliva induce the aggregation of S . mutans and mediate binding of the bacteria to saliva-coated hydroxyapatite (SHA) . Two types of monoclonal antibodies (mAb) directed against, respectively, protein and carbohydrate epitopes on the agglutinin have been reported to inhibit the aggregation of S . mutans . In this study, the mAbs were tested for their ability to block aggregation and adherence to SHA of S . mutans serotype c mediated by parotid, submaxillary, and whole saliva from three subjects . Both types of antibody inhibited the adherence and aggregation in a dose-dependent manner . However, individual variations were noted for the effects of the antibodies . Sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE) and subsequent immunoblotting with the antibodies revealed a > 300 kDa agglutinin component in all types of saliva and in the proteins desorbed from SHA . The degree of staining of this component in immunoblots of the salivas and the desorbates seemed to be paralleled by the rates of aggregation and adherence, respectively . Thus, our results indicate that the adherence to SHA as well as the aggregation of S . mutans serotype c is primarily mediated by structurally related, HMW glycoproteins in parotid, submaxillary, and whole saliva.

Enferm Infecc Microbiol Clin, 1995 Apr, 13(4), 203 - 8
{Puerperal endometritis: study of 52 clinically and microbiologically diagnosed cases}; Bosch J et al.; BACKGROUND: To know the epidemiologic features, clinical manifestations and etiology of puerperal endometritis in our environment in addition to the use of endometrial cultures in the microbiologic diagnosis of this infection . METHODS: A retrospective study of 52 cases of puerperal endometritis, clinically and microbiologically diagnosed over a 4-year period . RESULTS: Fifty percent of patients had undergone a cesarean, 36.5% presented puerperal anemia and 23% presented upper amniorrhexis at 12 hours . All the patients presented puerperal fever greater than 38 degrees C, 46% uterine subinvolution and 24% fetid lochia . The most frequently isolated microorganisms in the endometrial aspirate were Escherichia coli, Streptococcus agalactiae and Bacteroides spp . The association of ampicillin plus cefoxitine and clindamycin plus tobramycin presented in vitro efficacy in more than 85% of the isolates . CONCLUSIONS: The practice of endometrial aspirate and blood cultures in patients suspected of having puerperal endometritis effectively contributes to the diagnosis and treatment of this infection.

J Trop Pediatr, 1995 Apr, 41(2), 81 - 5
A 4-year study of neonatal meningitis: clinical and microbiological findings; Adhikari M et al.; The clinical and microbiological data of 60 neonates, 23 from the Neonatal Unit (Group I) and 37 (Group II) from the General Paediatric Wards with meningitis are presented . The overall prevalence/1000 was significantly lower in Group I (0.36) than in Group II (1.11; P < 0.0001) . This low incidence follows the introduction of amikacin for the treatment of the ill neonate in 1986 . Streptococcus agalactiae 21 (35 per cent), Klebsiella pneumoniae 17 (28 per cent) and E . coli 10 (17 per cent) were the commonest pathogens accounting for 80 per cent of the cases . Streptococcus agalactiae isolates were uniformly susceptible to penicillin and chloramphenicol . Gram negative isolates showed resistance to ampicillin, chloramphenicol and sulphamethoxazole-trimethoprim . In addition K . pneumoniae isolates showed resistance to gentamycin and amikacin . All isolates were fully susceptible to cefotaxime . Recently, four of six cases of K . pneumoniae in the Neonatal Unit were resistant to amikacin . Low birth weight, additional clinical problems, and ultrasound changes on cranial scanning carried a poor prognosis . Emphasis should be placed on close collaboration between clinicians and microbiologists in the choice of antimicrobial agents and aseptic techniques for the care of neonates.

J Trop Pediatr, 1995 Apr, 41(2), 109 - 11
Neonatal meningitis: a 3-year retrospective study at the Mount Hope Women's Hospital, Trinidad, West Indies; Ali Z; The objective of this 3-year (1988-1990) retrospective study was to report the experience with neonatal meningitis at the Neonatal Intensive Care Unit, Mount Hope Women's Hospital, Trinidad, West Indies . Neonates were included in the study if organisms were cultured from the cerebrospinal fluid (CSF) and/or if there was a pleocytosis (> or = 100/mm3) in the CSF . There were 49 neonates with meningitis out of a total of 17,048 live born (LB) infants during the 3-year period to give an overall incidence of 2.87/1000 LB . This was five times higher than the incidence reported in the literature . There were an additional five who were outborns to give a total of 54 cases . There were 34 males (63 per cent) with a mean birth weight of 2389 g . Antenatal risk factors included preterm delivery (50 per cent), prolonged rupture of the amniotic membranes (37 per cent) . Associated maternal conditions included hypertension and antepartum haemorrhage (9 per cent) . In contrast to other reported studies, there was early onset of the condition (mean age at presentation was 4 days) and the commonest organism found was Group B streptococcus while the least common were the Gram-negative organisms . Also different in the present study was the high percentage (56 per cent) of meningitis associated with Group B septicaemia, the low mortality rate (13) and the low rate of neurological sequelae (40 per cent).

J Radiol, 1995 Apr, 76(4), 205 - 8
{Mycotic aneurysm of the posterior tibial artery and pseudo-phlebitis: contribution of color Doppler ultrasonography}; Menanteau B et al.; Mycotic aneurysm of the posterior tibial artery and pseudophlebitis: role of color Doppler sonography A case of a 78-year-old male patient presenting with endocarditis caused by Streptococcus bovis and pseudophlebitis of the left lower limb is described . Color Doppler sonography ruled out thrombophlebitis and showed a large pulsatile mass of the posterior compartment of the leg due to a mycotic aneurysm of the posterior tibial artery . This aneurysm was confirmed by angiography and treated by surgery . The important role of color Doppler sonography for the diagnosis of this particular case is emphasized.

Genitourin Med, 1995 Apr, 71(2), 71 - 2
Pneumococcal vaccine and HIV infection: report of a vaccine failure and reappraisal of its value in clinical practice; Willocks LJ et al.; A clinical failure of pneumococcal vaccine is reported . A 22 year old African woman was given 23-valent pneumococcal vaccine at her initial presentation with HIV infection . She was asymptomatic and had a CD4+ lymphocyte count above 500 cells/mm3 . Eighteen months later she died of meningitis and septicaemia due to Streptococcus pneumoniae type 9 (an antigen included in the 23-valent vaccine) . Pneumococcal antibody levels performed on stored blood demonstrated no serological response to the vaccine . This is the first reported case of clinical failure of pneumococcal vaccine in an HIV infected patient who received vaccine whilst at the asymptomatic stage of HIV infection and with relatively intact immune function . The literature pertaining to pneumococcal vaccination in the context of HIV infection was reviewed . Pneumococcal vaccination is recommended for HIV positive patients in the UK by the Departments of Health . It is likely that many physicians are not aware of these recommendations or are concerned about the poor efficacy of the vaccine, and it may consequently be underused in clinical practice . But the potential gain to the HIV positive patient is such that the vaccine should be offered to all HIV positive patients as soon as they present for medical care, irrespective of the stage of HIV disease . Physicians and patients should be aware that the vaccine is not fully protective and that episodes of sepsis, pneumonia and meningitis could still be pneumococcal in origin and should be treated appropriately . Awareness of the substantial risks of pneumococcal disease in HIV infected patients with prompt diagnosis and effective treatment is the most important strategy to decrease morbidity and mortality.

Am J Trop Med Hyg, 1995 Apr, 52(4), 349 - 53
Serologic evidence of respiratory and rickettsial infections among Somali refugees; Gray GC et al.; Somali refugees living in a camp located in Djibouti were studied in October 1991 and May 1992 . The refugees had been living at the camp for about two years . The median age of volunteers was 25 years, of whom 69% were female . Paired sera obtained seven months apart were evaluated by complement fixation, microimmunofluorescence, indirect fluorescent antibody, streptococcal antibody, and enzyme-linked immunosorbent assay techniques for evidence of pathogen infection . Fifty-two percent, 31.3%, 8.0%, 5.9%, and 25.4% of the volunteers had serologic evidence for pre-enrollment infection with Chlamydia pneumoniae, Mycoplasma pneumoniae, Rickettsia typhi, R . conorii, and Coxiella burnetti, respectively . Similarly, 43.5%, 5.2%, 6.1%, 10.7%, 15.8%, and 11.9% of the volunteers studied had serologic evidence for new infection with Streptococcus pyogenes, C . pneumoniae, M . pneumoniae, R . typhi, R . conorii, and Cox . burnetii, respectively . These data suggest that the studied pathogens may be endemic in displaced populations living in the Horn of Africa.

J Bacteriol, 1995 Apr, 177(8), 2194 - 6
Cross-species complementation of the indispensable Escherichia coli era gene highlights amino acid regions essential for activity; Pillutla RC et al.; Era is an essential GTP binding protein in Escherichia coli . Two homologs of this protein, Sgp from Streptococcus mutans and Era from Coxiella burnetii, can substitute for the essential function of Era in E . coli . Site-specific and randomly generated Era mutants which may indicate regions of the protein that are of functional importance are described.

J Infect Dis, 1995 Apr, 171(4), 890 - 6
Transmission of multidrug-resistant serotype 23F Streptococcus pneumoniae in group day care: evidence suggesting capsular transformation of the resistant strain in vivo; Barnes DM et al.; Surveillance for nasopharyngeal colonization with Streptococcus pneumoniae was maintained in a research day care center between 1985 and 1992 . An outbreak of nasal carriage of a multi-drug-resistant (MDR) serotype 23F organism occurred between May 1990 and December 1991 involving 14 of 52 children . Electrophoresis of penicillin-binding proteins (PBP) and pulsed-field gel electrophoresis (PFGE) of chromosomal DNA indicated that the MDR serotype 23F organism was closely related to a serotype 23F MDR clone that has been prevalent in Spain since the early 1980s . In June 1991, an MDR serotype 14 organism was isolated from a child who had previously carried the MDR serotype 23F strain . PFGE and PBP typing revealed that the MDR serotype 14 organism was very similar to the circulating MDR serotype 23F strain, suggesting serotype transformation . Dissemination of MDR pneumococcal strains and possibly spread of the MDR phenotype to additional serotypes may be facilitated in group day care.

J Infect Dis, 1995 Apr, 171(4), 885 - 9
Serotype distribution of Streptococcus pneumoniae infections among preschool children in the United States, 1978-1994: implications for development of a conjugate vaccine; Butler JC et al.; Conjugation of pneumococcal polysaccharide antigens to a protein carrier may improve protective immunity after vaccination of young children, an age group with high incidence of Streptococcus pneumoniae infection and poor immune responses to polysaccharide vaccines . To identify serotypes most commonly associated with infection in young children, pneumococcal isolates were serotyped from 3884 children < 6 years old (including 3007 < 2 years old) with pneumococcal bacteremia (n = 3169), meningitis (n = 401), or otitis media (n = 314) . The isolates were submitted as part of a national surveillance during 1978-1994 . Seven serotypes (14, 6B, 19F, 18C, 23F, 4, and 9V) accounted for 3045 isolates (78%) . A conjugate pneumococcal vaccine protecting against these seven serotypes and serologically cross-reactive serotypes could potentially prevent 86% of bacteremia and 83% of meningitis but only 65% of otitis media cases . The proportion of isolates covered by such a vaccine increased from 78% to 87% during 1978-1994 . Surveillance for pneumococcal serotypes causing infection is needed to detect shifts in serotype distribution over time.

Invest Ophthalmol Vis Sci, 1995 Apr, 36(5), 965 - 8
Corneal pharmacokinetics of topical clarithromycin; Gross RH et al.; PURPOSE . To evaluate the pharmacokinetics of topically applied clarithromycin, a new macrolide antibiotic, at various concentrations in a rabbit model . METHODS . Clarithromycin in dosages of 10, 20, and 40 mg/ml was administered topically every 2 hours for 48 hours to three groups of 16 New Zealand albino rabbits . Both corneas were treated . Right corneas were deepithelialized with n-heptanol . At 6, 12, 24, and 48 hours, tissue concentrations were determined in four animals from each group . RESULTS . Tissue drug concentrations increased with drug dosage and duration of therapy . Drug concentrations were significantly higher at 48 hours than at 6 hours, 12 hours, and 24 hours for both epithelialized and deepithelialized eyes in the 20 mg/ml and 40 mg/ml treatment groups (all P < or = 0.0015) . A steady state concentration was not achieved in any group . Tissue drug concentrations were higher in deepithelialized corneas for each dose after 6 hours, although differences were not significant (all P > 0.059) . Highest mean drug concentration at 48 hours was 241 micrograms/g in animals receiving 40 mg/ml of clarithromycin . After 6 hours, tissue concentrations in some groups were above MIC90 for many Chlamydia sp., Streptococcus sp., and Staphylococcus sp., and by 12 hours, concentrations were greater than MIC90 in all groups for many nontuberculous mycobacteria . CONCLUSIONS . Topical clarithromycin achieves therapeutic levels in corneal tissue in a rabbit model . Clarithromycin might be a useful broad-spectrum antibiotic for topical use in humans.

Arch Otolaryngol Head Neck Surg, 1995 Apr, 121(4), 392 - 6
Antibiotic resistance; Bartlett JG et al.; Antibiotics are commonly viewed as the most important advance in the history of medicine . During the six decades that followed the introduction of sulfonamides there has been a continuous supply of new agents responsive to evolving resistance of prior pathogens and emerging new pathogens . It now appears that the microbes confronting clinicians in the 1990s pose challenges that are unprecedented in the recent past . There are examples in virtually every category: malaria, multidrug-resistant Mycobacterium tuberculosis, multiply resistant gram-negative bacilli, azole-resistant Candida species, and metronidazole-resistant Trichomonas . The two pathogens that are arguably the most important to otolaryngologists are vancomycin-resistant Enterococcus faecium and penicillin-resistant Streptococcus pneumoniae . The former is a nosocomially acquired pathogen that is especially prevalent in intensive care units and usually cannot be treated with antibiotics that have established merit . Penicillin-resistant S pneumoniae is suddenly becoming a major problem in much of the world and its frequency in the United States is escalating at an alarming rate, especially in some geographic areas . This organism will require entirely new strategies for the empiric treatment of serious infections in which S pneumoniae is a documented or suspected pathogen . It is premature to say that traditional approaches to sinusitis and otitis need to be changed, but many suspect this will happen . One important lesson from this experience is that extensive antibiotic use and abuse has had some devastating consequences and many now believe that these are inevitable given current usage rates . The second lesson is that, although resistance seems predictable, specific patterns are not.(ABSTRACT TRUNCATED AT 250 WORDS)

J Pediatr, 1995 Apr, 126(4), 581 - 2
Life-threatening infection in two children with hemoglobin S-beta-thalassemia; Lynch A et al.; Life-threatening infections with Streptococcus pneumoniae and parvovirus occurred in two patients with hemoglobin S-beta-thalassemia . We recommend that acute febrile illnesses in the presence of any hemoglobinopathy be considered potentially life threatening, and managed accordingly.

Eur Heart J, 1995 Apr, 16 Suppl B, 103 - 6
Extension of native aortic valve endocarditis: surgical considerations; Amrani M et al.; Among 101 consecutive patients operated on for native infective aortic valve endocarditis (53 males, 48 females, mean age 39 years), 69 presented various forms of infectious extension to the surrounding areas . Twenty-six lesions were noted in the aortic roots: 18 annular abscesses, one abscess of the Valsalva sinus and seven aortic wall destructions . Among the subaortic valve pathology, 27 cases of septal lesions were noted and in one case the mitral fibrous trigone was involved . The mitral apparatus was infected in 26 cases, the tricuspid valvule in one case . Both tricuspid and mitral valvular replacements had to be performed in five cases . Among the 16 postoperative atrioventricular blocks, 14 needed a pacemaker . The most frequent causative microorganisms were Staphylococcus aureus and Streptococcus . Surgical management of the lesions consisted of extensive debridement followed by either simple repair of defects or complex reconstructions involving pericardial or synthetic patches or other more complex operations . Early and late mortality rates were 8.5% and 16%; early and late reoperation rates were 6% and 9.5%, respectively . The mean follow-up time was 148 months (12-265 months) with a survival rate of 74% (SE: +/- 0.08) at 10 years . We conclude that, although surgical correction of infective endocarditis may need a complex approach, it provides good results with an acceptable surgical risk.

Antibiot Khimioter, 1995 Apr, 40(4), 3 - 7
{Data on the cultural and morphologic features of dissociation forms of nisin-producing Streptococcus}; Baranova IP et al.; Colonies and cells of S and G variants of Streptococcus lactis, strain MSU were studied comparatively . It was shown that in the G form the growth rate and other biosynthetic peculiarities and in particular the capacity for the nisin synthesis were lower . Morphological properties of the colonies and cells of the S and G variants of the nisin-producing streptococcus were investigated.

Eur J Clin Microbiol Infect Dis, 1995 Apr, 14(4), 341 - 2
Failure of pristinamycin treatment in a case of pneumococcal pneumonia; Burucoa C et al.; A case of pneumonia caused by Streptococcus pneumoniae occurring in a patient receiving pristinamycin is reported . Despite empirical treatment with pristinamycin, 2 g/day for five days, the patient's condition worsened . Protected brush specimen and blood cultures permitted isolation of Streptococcus pneumoniae . MIC testing indicated that the strain was susceptible to pristinamycin and resistant to erythromycin and penicillin . Streptococcus pneumoniae was eradicated by cefotaxime, and pneumonia resolved . This case underlines the fact that pristinamycin may not be suitable for the treatment of multiresistant pneumococcal infections.

Acta Med Okayama, 1995 Apr, 49(2), 75 - 9
Effect of Picibanil (OK-432) on the scavenging effect of free radicals produced during liver regeneration in the rat; Okamoto K et al.; We administered a biological response modifier Picibanil (OK-432), attenuated Streptococcus pyogenes, via the dorsal vein of the penis after 70% hepatectomy in rats, and clarified the scavenging effect of Picibanil on free radicals generated in the regenerating liver . A group of 5 rats was intravenously administered with 25 KE/kg of OK-432 after hepatectomy, while the control group was given saline after hepatectomy . Serum levels of aspartate aminotransferase and alanine aminotransferase and the value of thiobarbituric acid-reactive substances in serum and hepatic tissue after hepatectomy were serially measured, and these values were significantly lower in Picibanil treated animals than in control animals . Free radical production in the regenerating liver was also measured by electron spin resonance spectrometry, and OK-432 injection significantly reduced free radical production . These results suggested that OK-432 reduced hepatocellular damage in regenerating liver by inhibiting lipid peroxidation.

Br J Surg, 1995 Apr, 82(4), 505 - 9
Wound management in burn centres in the United Kingdom; Papini RP et al.; Despite advances in the use of topical and parenteral antimicrobial therapy, and the practice of early tangential excision, infection of the burn wound remains a leading cause of morbidity and mortality . The aim of this study was to survey and compare wound management and antibiotic usage in burn surgery in all UK burn centres . A postal questionnaire was used, followed up by telephone . Answers were obtained from all 39 units treating burns in the UK . A written policy on antibiotic usage was used by 13 centres . Excisions were covered routinely by prophylactic antibiotic therapy in 18 units, and three of these used antibiotic cover during all procedures in which the wound was manipulated . No routine antibiotic cover was given in 21 units . All units obtained surface swab cultures, but only two performed punch biopsy of the wounds . Quantitative bacteriology (counting colony forming units) was employed by three centres . Most units cleaned the burn with saline (17 of 39) or chlorhexidine (eight of 39) but combinations of these and other agents were also used . Nearly half (17 of 37) of those who replied had not seen any cases of proven or suspected toxic shock syndrome in the past 2 years . Four units gave prophylaxis against Staphylococcus aureus, and four gave antibiotics against Streptococcus pyogenes, despite recommendations in the literature . Twenty-nine units gave no prophylaxis . This study has revealed that there is no consensus on antibiotic usage amongst centres treating burns in the UK and that most units rely on surface swab cultures to monitor infection.

Trends Microbiol, 1995 Apr, 3(4), 155 - 9
Mucosal immune responses to pneumococcal polysaccharides: implications for vaccination; van den Dobbelsteen GP et al.; Systemic vaccination does not effectively induce a protective immune response to Streptococcus pneumoniae infections in infants, elderly people and immunosuppressed patients, who are highly susceptible to this pathogen . As mucosal immune responses develop early in life and still function well in the elderly, mucosal vaccination (that is, by oral, intratracheal or intranasal routes) may be an alternative approach to current strategies.

Curr Eye Res, 1995 Apr, 14(4), 281 - 4
Growth and virulence of a complement-activation-negative mutant of Streptococcus pneumoniae in the rabbit cornea; Johnson MK et al.; Our previous work has demonstrated the importance of pneumolysin in the virulence of S . pneumoniae in a rabbit intracorneal model . This was accomplished by showing that deletion of the gene encoding pneumolysin resulted in reduced virulence, whereas restoration of the wild-type gene resulted in restoration of the virulent phenotype . To assess the importance of a particular domain in the pneumolysin molecule, we have now constructed a strain which produces a pneumolysin molecule which is hemolytic but which bears a site-specific mutation in the domain known to be associated with the complement-activating properties of this molecule . Comparison of the virulence of this strain with that of a strain bearing the wild-type gene showed statistically significantly lower total slit lamp examination (SLE) scores at 12, 18, 24, and 36 h (particularly with respect to fibrin formation), but no difference at 48 h . Determination of colony forming units (CFU) in eyes infected with the two strains showed approximately 10(6) bacteria per cornea until 36 h . Between 36 and 48 h, the bacteria were almost completely cleared with very few bacteria recoverable at the later time point . The loss of virulence observed with this mutation in the complement-activation domain of pneumolysin, though less than that observed with the gene deletion mutant, suggests that complement activation by pneumolysin has a significant role in the pathology observed in this model of corneal infection.

Pediatr Infect Dis J, 1995 Apr, 14(4), 295 - 300
Comparative efficacy and safety of four-day cefuroxime axetil and ten-day penicillin treatment of group A beta-hemolytic streptococcal pharyngitis in children; Aujard Y et al.; In a prospective randomized multicenter study, 308 children, ages 2 to 15 years, were randomized to receive either cefuroxime axetil suspension (N = 152; 20 mg/kg/day twice daily) for 4 days, penicillin suspension (N = 156; 45 mg/kg/day divided three times daily) for 10 days, of whom 97 and 103, respectively, had culture-proved group A beta-hemolytic Streptococcus infection . Two to 4 days after completion of the treatment, group A beta-hemolytic Streptococcus were eradicated from 85 of 97 (87.6%) children taking cefuroxime and from 90 of 103 (87.4%) taking penicillin; respective clinical cure rates were 94.8% and 96.1% . Clinical signs and symptoms resolved significantly more rapidly with cefuroxime (P < 0.05) . At 28 to 32 days posttreatment the eradication of the primary isolate was confirmed in 94.4 and 91.9% of cefuroxime axetil and penicillin-treated patients, respectively . Drug-related adverse events (mainly gastrointestinal and cutaneous reactions) were reported in 2.1 and 2.7% of the cefuroxime- and penicillin-treated patients, respectively . Results indicated that a 4-day treatment with cefuroxime axetil was as effective and well-tolerated as the conventional 10-day treatment with penicillin in children with acute group A beta-hemolytic Streptococcus pharyngitis.

Pediatr Infect Dis J, 1995 Apr, 14(4), 278 - 81
Invasive group B streptococcal disease in children beyond early infancy; Hussain SM et al.; There is little information available on invasive group B Streptococcus (GBS) infection in pediatric patients older than 3 months of age . Review of infection control records at LeBonheur Children's Medical Center from January 1, 1986, to June 30, 1993, identified 143 patients with a positive GBS culture from normally sterile body fluid . Medical records of 18 (13%) patients > 3 months old with their first GBS infection were reviewed . Age range was 15 weeks to 18 years (median age, 13 months) . Ten were black and 11 were girls . Five infants had a history of premature birth and 2 infants were infected with human immunodeficiency virus . The serotype distribution of 12 available GBS isolates was 4 type III, 2 each type V and Ia and 1 each type Ia/c, Ib/c, II and II/c . Bacteremia without a focus (9 patients) was the most common clinical manifestation . All 4 type III isolates were associated with bacteremia . One infant with human immunodeficiency virus infection had sepsis and bullous desquamation; a toxin-producing type V strain was isolated from her blood . Two adolescents with ventriculoperitoneal shunts had meningitis, including one whose cerebrospinal fluid also grew a type V strain . Other clinical manifestations were septic arthritis, endocarditis (Ia, II/c), central venous catheter (Ia/c) and ventriculostomy infections.

Pathology, 1995 Apr, 27(2), 165 - 7
Meningitis caused by Streptococcus pneumoniae showing high level resistance to penicillin; Wise KA et al.; A case of meningitis caused by a strain of Streptococcus pneumoniae (SPn) showing high level resistance to penicillin is described . The patient responded to a combination of high dose penicillin and ceftriaxone . After reviewing the Australian situation and the world literature, we propose that empiric treatment of SPn meningitis in Australia should consist of high dose penicillin plus a third generation cephalosporin, with appropriate modification once the identification of the organism and its susceptibilities are confirmed.

Pathol Biol (Paris), 1995 Apr, 43(4), 241 - 4
{Evolution of the susceptibility to penicillin G of Streptococcus pneumoniae at the Limoge University Hospital Center}; Ploy MC et al.; A systematic detection of Streptococcus pneumoniae strains with reduced susceptibility to penicillin has been realized at Limoges Hospital during two years half . Of 302 strains isolated, 27 had reduced susceptibility to penicillin (8,9%), and, for 15 strains (5%), the MIC of penicillin G reached at least 2 mg/l . The frequency of strains with reduced susceptibility to penicillin increased from 1992 to 1994: 8,2% in 1992, 8,7% in 1993 and 12,2% in 1994 . The resistance level exhibited by pneumococcus strains increased since 1992: the percentage of resistant strains (MIC mg/l > 1) was 2,7% in 1992, 6,9% in 1993 and 7,3% in 1994 . Most of the strains with reduced susceptibility to penicillin belonged to serotype 23 (52%) and were isolated from blood cultures, cerebral-spinal or pleural fluids (41%).

Mol Microbiol, 1995 Apr, 16(2), 215 - 27
The genetic basis of colony opacity in Streptococcus pneumoniae: evidence for the effect of box elements on the frequency of phenotypic variation; Saluja SK et al.; Streptococcus pneumoniae undergoes spontaneous phase variation in colony morphology . Differences in colony opacity have previously been shown to correlate with differences in the ability of organisms to colonize the mucosal surface of the nasopharynx in an animal model . The genetic basis of opacity variation was identified in transformation experiments . A DNA library, from a strain that varies at high frequency, was screened to identify a single clone capable of transforming a transparent recipient strain which varies at low frequency to an opaque phenotype . Analysis of this opacity locus revealed two genes, glpD and glpF, with similarity to genes required for glycerol metabolism in other bacteria . Following the pneumococcal glpF, repetitive intergenic elements, boxes A and C, were identified . These stem-loop-forming elements were not present in the same locus of the recipient strain . Although not required for phase variation in colony opacity, the box element was necessary for expression of phase variation at high frequency . Introduction of the box elements during transformation affected colony morphology, possibly by altering expression of a putative regulatory gene downstream from the box element . Mutagenesis within this region confirmed the contribution of the putative regulatory gene to the expression of colony opacity . Growth characteristics of strains generated in this study provide additional evidence for an association of differences in cell wall autolysis and variation in colony opacity.

Thorac Cardiovasc Surg, 1995 Apr, 43(2), 83 - 9
Early and late prognosis following valve replacement for bacterial endocarditis of the native valve; Dehler S et al.; Between 1983 and 1922 70 patients of the author's institution underwent valve replacement for bacterial endocarditis of native valves . In 22 cases the source of infection could be identified . Among them the most frequent source of infection was dental manipulation (7 patients) . The predominating causative microorganism was Streptococcus viridans followed by Staphylococcus aureus . Preoperative complications, the intraoperative finding of extensive destructions, and the histological finding of acute changes influenced significantly the occurrence of perioperative complications . 20 patients died (28.6% overall mortality), there were 9 perioperative deaths (perioperative survival 87.1%) . The one-year survival was 73.8% the five-year survival 61.5% . Significant risk factors for the prognosis were preoperative complications, positive bacteriological result of the analyzed resected valves, perioperative complications, duration of the postoperative antibiotic treatment, and the postoperative NYHA functional class . Therefore one should intervene surgically before preoperative complications appear . Perioperative complications must by treated immediately, and an adequate postoperative antibiotic therapy must be guaranteed.

Glycoconj J, 1995 Apr, 12(2), 109 - 12
Streptococcal glucan-binding lectins do not recognize methylated alpha-1,6 glucans; Wang J et al.; The glucan-binding lectin (GBL) of Streptococcus sobrinus is cell associated, enabling the bacteria to be aggregated by alpha-1,6 glucans . Glucans, such as amylose, pullulan, laminarin and nigeran, have no affinity for the lectin . High molecular weight alpha-1,6 glucans (dextrans) readily aggregate the bacteria, whereas low molecular weight glucans inhibit the aggregation brought about by the high molecular weight species . Methylated glucan T-2000 (an alpha-1,6 glucan with an average molecular weight of 2 x 10(6) Da) aggregated the bacteria very poorly when the extent of methylation (DS, or degree of substitution) was high, and less poorly when the DS was low . Similarly, methylated low molecular weight alpha-1,6 glucan was a poor inhibitor of aggregation induced by the high molecular weight glucan T-2000 . Because the methylation occurred primarily on the hydroxyl of C-2, it is suggested that the hydroxyl is needed for formation of the lectin-glucan complex . It appears that the GBL is not only stereospecific in interaction with glucans, but also regio-specific, interacting only with the underivatized alpha-1,6-glucan.

J Clin Microbiol, 1995 Apr, 33(4), 968 - 72
Detection of genomic heterogeneity in Streptococcus suis isolates by DNA restriction fragment length polymorphisms of rRNA genes (ribotyping); Okwumabua O et al.; Whole-cell chromosomal digests of 54 isolates of Streptococcus suis encompassing all known serotypes from a geographically varied collection were examined by PstI restriction fragment length polymorphisms and then hybridized with a digoxigenin-11-dUTP-labeled cDNA probe transcribed from a mixture of 16S and 23S rRNAs from Escherichia coli MRE600 . The hybridization patterns showed genetic heterogeneity within and between S . suis serotypes . Most isolates (87%) representing 28 serotypes contained a common band at approximately 1.8 kb . However, 13% of the isolates representing seven serotypes lacked the 1.8-kb band, indicating that the species as currently defined is diverse . Nonetheless, the 1.8-kb band may be a useful genotypic marker for identification of most S . suis isolates . We tested the ability of this technique to discriminate between virulent and avirulent S . suis type 2 isolates . A virulent strain of S . suis type 2 could be distinguished from avirulent strains by the presence of specific bands . No correlation was obvious between band pattern and hemolysin production.

Cancer Immunol Immunother, 1995 Apr, 40(4), 219 - 27
Biological response modifiers (BRM) as antigens . III . T cell lines specific for BRM kill tumor cells in a BRM-specific manner; Ozaki S et al.; In order to investigate tumoricidal effector cells in therapy by biological response modifiers (BRM) such as Propionibacterium acnes, bacillus Calmette-Guerin (BCG), Streptococcus pyogenes and a protein-bound polysaccharide (PSK), we established T cell lines specific for each BRM from BALB/c mice immunized with the corresponding BRM . These T cell lines proliferated and produced interleukin-2 (IL-2) and/or IL-4, but only in the presence of the relevant BRM and BALB/c spleen cells as the antigen and antigen-presenting cells respectively . Cross-functional experiments indicated that each BRM acts as a nominal antigen, but not as a non-specific immunostimulator . In addition, the T cell lines killed Ia-positive syngeneic B lymphoma cells, but only in the presence of the relevant BRM . These experiments excluded the possibility of cytotoxic effects by each BRM . The T cell lines and clones also killed Ia-negative bystander target cells, but only in the presence of both a relevant antigen and antigen-presenting cells . The T cell clones specific for S . pyogenes or P . acnes tested were Thy1+, L3T4+ and Lyt2- . These results indicate that some BRM exert tumoricidal activity by inducing T cells that recognize them as an antigen and kill tumor cells in an antigen-specific manner . The T cells killed tumor targets in either a tumor-necrosis-factor(TNF)-dependent or a TNF-independent manner . The mediator of the latter pathway remains to be elucidated.

Int J Syst Bacteriol, 1995 Apr, 45(2), 235 - 9
"Streptococcus milleri" strains displaying a gliding type of motility; Bergman S et al.; Isolates belonging to the "Streptococcus milleri" species group that appear to exhibit a gliding type of motility, which is expressed as spreading growth on certain types of agar media, are described . These strains resembled a biotype of "S . milleri" that is usually isolated from genitourinary sources and is notable for its ability to ferment a wide array of carbohydrates . This biotype, which is currently included in the species Streptococcus anginosus, has been implicated in cases of neonatal infection . The "S . milleri" isolates which we studied lacked any observable organelles of motility and gave negative results when they were tested in conventional motility test medium stab cultures . Colonies growing on certain agar media, however, spread over the surfaces of plates and increased in area with increasing time of incubation . Chocolate agar supported maximum spreading, while this characteristic was barely discernible on blood agar . Electron microscopy studies revealed that there was more production of extracellular glycocalyx by motile strains than by a nonmotile isolate having a similar biotype . The results of an analysis of 16S rRNA gene sequences suggested that the motile strains are closely related to S . anginosus and represent a distinct rRNA population within the "S . milleri" species complex.

J Clin Invest, 1995 Apr, 95(4), 1782 - 8
P-selectin/ICAM-1 double mutant mice: acute emigration of neutrophils into the peritoneum is completely absent but is normal into pulmonary alveoli; Bullard DC et al.; Neutrophil emigration during an inflammatory response is mediated through interactions between adhesion molecules on endothelial cells and neutrophils . P-Selectin mediates rolling or slowing of neutrophils, while intercellular adhesion molecule-1 (ICAM-1) contributes to the firm adhesion and emigration of neutrophils . Removing the function of either molecule partially prevents neutrophil emigration . To analyze further the role of P-selectin and ICAM-1, we have generated a line of mice with mutations in both of these molecules . While mice with either mutation alone show a 60-70% reduction in acute neutrophil emigration into the peritoneum during Streptococcus pneumoniae-induced peritonitis, double mutant mice show a complete loss of neutrophil emigration . In contrast, neutrophil emigration into the alveolar spaces during acute S . pneumoniae-induced pneumonia is normal in double mutant mice . These data demonstrate organ-specific differences, since emigration into the peritoneum requires both adhesion molecules while emigration into the lung requires neither . In the peritoneum, P-selectin-independent and ICAM-1-independent adhesive mechanisms permit reduced emigration when one of these molecules is deficient, but P-selectin-independent mechanisms cannot lead to ICAM-1-independent firm adhesion and emigration.

Thromb Haemost, 1995 Apr, 73(4), 680 - 2
Therapeutic advantage of recombinant human plasminogen activator in endocarditis: evidence from experiments in rabbits; Meyer MW et al.; In infective endocarditis vegetations are stabilized by fibrin . To learn if fibrin digestion would be therapeutic, experimental endocarditis was induced in rabbits by inoculation with a platelet-aggregating strain (Agg+) of Streptococcus sanguis and treated with recombinant tissue plasminogen activator (rt-PA), rt-PA with penicillin, or penicillin alone . Control rabbits were inoculated with saline . All treatments of Agg+ endocarditis reduced the mass of valvular vegetations and clinical signs of endocarditis, including the frequency of left axis deviation and heart ischemia . rt-PA with penicillin was more effective than penicillin or rt-PA alone, reducing the mass of vegetations and clinical signs to that of saline controls . Within 50 min, rt-PA cleared 5-fold more 111Indium-labelled platelets from the heart than untreated rabbits and 1.4-fold more after 3 days . Combined with penicillin, thrombolytic therapy for human endocarditis should be reconsidered.

Zentralbl Veterinarmed B, 1995 Apr, 42(2), 78 - 83
Distribution of serotype, virulence markers and further characteristics of Streptococcus suis isolates from pigs; Salasia SI et al.; This study was designed to comparatively investigate 28 S . suis cultures isolated from various pathological processes of pigs . All cultures could be identified biochemically and most of the cultures could be serogrouped with specific antiserum against Lancefield's serogroup D . Serotyping of the S . suis isolates mainly revealed capsular types 2, 1, and 22 . In addition, part of the cultures, mostly those of serotype 2, reacted with monoclonal antibodies to the virulence protein muraminidase-released protein, and, in parallel with monoclonal antibodies against the virulence protein extracellular factor . Independently of serotype and the occurrence of both virulence proteins, four cultures haemagglutinated erythrocytes from pigs, humans and rabbits . The haemagglutination reaction appeared to be related to the surface hydrophobicity of the isolates . However, part of the cultures with hydrophobic surfaces did not haemagglutinate the available erythrocyte preparations . The surface characteristics of the S . suis isolates shown in this investigation could be used to characterize individual isolates of S . suis that might be of importance for epidemiological studies.

Commun Dis Rep CDR Rev, 1995 Mar 31, 5(4), R45 - 50
Pneumococcal bacteraemia and meningitis in England and Wales 1982 to 1992; Aszkenasy OM et al.; In the 11 years from 1982 to 1992, microbiology laboratories in England and Wales reported 22,567 episodes of serious illness in which Streptococcus pneumoniae was isolated from blood and 3500 in which it was isolated from cerebrospinal fluid . Half of the reported cases of bacteraemia occurred in people of over 65 years (11,299 cases) . A predisposing cause was seldom reported . Annual totals of reports of pneumococcal bacteraemia and meningitis have risen in parallel with other serious infections . The rates of pneumococcal infections reported in very young and elderly people have risen much more rapidly and, although this observation may be artefactual, it may be associated with an observed increase in reports of antibiotic resistance . The proportion of pneumococcal isolates resistant to penicillin rose from 0.3% in 1989 to 1.9% in 1992 (p < 0.05) . We suggest that the role of pneumococcal vaccination should be re-evaluated.

Proc Natl Acad Sci U S A, 1995 Mar 28, 92(7), 2489 - 93
Membrane cofactor protein (CD46) is a keratinocyte receptor for the M protein of the group A streptococcus; Okada N et al.; The pathogenic Gram-positive bacterium Streptococcus pyogenes (group A streptococcus) is the causative agent of numerous suppurative diseases of human skin . The M protein of S . pyogenes mediates the adherence of the bacterium to keratinocytes, the most numerous cell type in the epidermis . In this study, we have constructed and analyzed a series of mutant M proteins and have shown that the C repeat domain of the M molecule is responsible for cell recognition . The binding of factor H, a serum regulator of complement activation, to the C repeat region of M protein blocked bacterial adherence . Factor H is a member of a large family of complement regulatory proteins that share a homologous structural motif termed the short consensus repeat . Membrane cofactor protein (MCP), or CD46, is a short consensus repeat-containing protein found on the surface of keratinocytes, and purified MCP could competitively inhibit the adherence of S . pyogenes to these cells . Furthermore, the M protein was found to bind directly to MCP, whereas mutant M proteins that lacked the C repeat domain did not bind MCP, suggesting that recognition of MCP plays an important role in the ability of the streptococcus to adhere to keratinocytes.

MMWR Morb Mortal Wkly Rep, 1995 Mar 24, 44(11), 207 - 9, 215
Emergence of penicillin-resistant Streptococcus pneumoniae--southern Ontario, Canada, 1993-1994; Bactericidal properties of hydrogen peroxide and copper or iron-containing complex ions in relation to leukocyte function; Department of Chemistry, Biochemistry, and Molecular Biology, Oregon Graduate Institute of Science & Technology, Portland, USAVarious combinations of hydrogen peroxide, reductant (ascorbic acid and superoxide ion), and copper or iron salts and their coordination complexes were examined to determine their cytotoxicity toward several bacteria with diverse metabolic capabilities and cell envelope structures . Four sets of bactericidal conditions were identified, comprising: (1) high concentration levels (5-100 mM) of H2O2 in the absence of exogenous metal ions and reductant; (2) ferrous or ferric coordination complexes plus enzymatically generated O2.- and H2O2 at relatively low steady-state concentration levels; (3) cupric ion plus low concentration levels of H2O2 (1 microM-1 mM) and ascorbate (10 microM-4 mM); (4) cuprous ion (or cupric ion plus ascorbate) in the absence of O2 and H2O2 . Rates of losses in viabilities increased proportionately with increases in the concentration of H2O2 in metal-free environments and with each of the components in the Cu2+/ascorbate/H2O2 bactericidal assay system . Oxidant levels required for equivalent killing increased with increasing cell densities of the bacterial suspensions over the range investigated (2 x 10(7)-2 x 10(9) cfu/ml) . Other experimental conditions or other combinations of reagents, most notably Fe3+/ascorbate/H2O2 systems, did not generate bactericidal environments . The patterns of response of the three organisms tested, Streptococcus lactis, Escherichia coli, and Pseudomonas aeruginosa, were similar, suggesting common bactericidal mechanisms . However, preliminary evidence suggests that the lethal lesions caused by the various bactericidal conditions are distinct: As discussed, each of the four bactericidal conditions could conceivably be attained within the phagosomes of leukocytes, although none has as yet been identified.

Am J Orthod Dentofacial Orthop, 1995 Mar, 107(3), 293 - 7
Clinical effectiveness of fluoride-releasing elastomers . I: Salivary Streptococcus mutans numbers; Wilson TG et al.; The purpose of this study was to examine the effect of fluoride-releasing elastomers on salivary Streptococcus mutans numbers . Twenty-four patients with fixed orthodontic appliances were randomly divided into experimental and control groups consisting of 12 patients each . Conventional elastomers were in place while two baseline whole saliva samples were collected from each subject in both groups at their regular appointments . After the second baseline sample was taken, conventional elastomers were replaced with fluoride-releasing elastomers in the experimental group, whereas conventional elastomers were continued in the control group . Three saliva samples were then collected from all subjects at 1-week intervals . Conventional elastomers were placed in all subjects while two postexperimental saliva samples were collected at regular appointments . Results showed that the control group demonstrated no significant changes (p > 0.05) in the percentage of S . mutans over the 13-week study period . However, after the fluoride-releasing elastomers were placed, the percent of salivary S . mutans decreased significantly (p < 0.01) in the experimental group . There was no significant effect after the fluoride-releasing elastomers were in place for 2 or more weeks.

Laryngoscope, 1995 Mar, 105(3 Pt 1), 300 - 4
Streptococcus pneumoniae resistant to penicillin: incidence and potential therapeutic options; Rodriguez WJ et al.; Streptococcus pneumoniae was recovered from 12 (50%) samples of middle ear fluid of 24 consecutive patients with AOME and in mixed culture of middle ear pathogens from one (4%) additional specimen . Two (15.3%) isolates had intermediate resistance to penicillin (minimal inhibitory concentration (MIC) 0.125 and 1.0 micrograms/mL) . The antimicrobial susceptibility to various antimicrobials of 30 S pneumoniae strains recovered from patients seen in the last 12 months was also determined . One of the patients with AOME developed bacteremia that resolved uneventfully, whereas the other developed meningitis . MIC90 was determined from penicillin (2 micrograms/mL), erythromycin (> 32 micrograms/mL), cefaclor (32 micrograms/mL), loracarbef (> or = 64 micrograms/mL), cefixime (16 micrograms/mL), ceftibuten (> 64 micrograms/mL), chloramphenicol (16 micrograms/mL), cefpodoxime (4 micrograms/mL), ciprofloxacin (2 micrograms/mL), cephalexin (> or = micrograms/mL), augmentin (2 micrograms/mL), cefprozil (8 micrograms/mL), clindamycin (64 micrograms/mL), TMP-SXT (> 64 micrograms/mL), clarithromycin (32 micrograms/mL), rifampin (0.06 micrograms/mL), cefuroxime (2 micrograms/mL), cefotaxime (0.25 micrograms/mL), vancomycin (0.25 micrograms/mL), and imipenem (0.5 micrograms/mL) . Cefprozil, vancomycin, and rifampin inhibited all strains, whereas cefpodoxime, cefuroxime, clindamycin, and clarithromycin exhibited very good activity.

J Exp Med, 1995 Mar 1, 181(3), 973 - 83
Characterization of the cassette containing genes for type 3 capsular polysaccharide biosynthesis in Streptococcus pneumoniae; Dillard JP et al.; The capsular polysaccharide is the major virulence factor of Streptococcus pneumoniae . Previously, we identified and cloned a region from the S . pneumoniae chromosome specific for the production of type 3 capsular polysaccharide . Now, by sequencing the region and characterizing mutations genetically and in an in vitro capsule synthesis assay, we have assigned putative functions to the products of the type-specific genes . Using DNA from the right end of the region in mapping studies, we have obtained further evidence indicating that the capsule genes of each serotype are contained in a gene cassette located adjacent to this region . We have cloned the region flanking the left end of the cassette from the type 3 chromosome and have found that it is repeated in the S . pneumoniae chromosome . The DNA sequence and hybridization data suggest a model for recombination of the capsule gene cassettes that not only describes the replacement of capsule genes, but also suggests an explanation for binary capsule type formation, and the creation of novel capsule types.

J Immunol, 1995 Mar 1, 154(5), 2403 - 12
In vivo regulation of rat neutrophil apoptosis occurring spontaneously or induced with TNF-alpha or cycloheximide; Tsuchida H et al.; We previously demonstrated that human TNF-alpha induces rapid apoptosis of human neutrophils . To understand better the in vivo significance of neutrophil apoptosis, we examined spontaneous, recombinant human and mouse TNF-alpha- or cycloheximide-induced apoptosis of normal peripheral blood neutrophils (PBN), PBN from rats injected i.p . with proteose peptone or a streptococcus preparation, OK-432 (inflammatory PBN), peritoneally exudated neutrophils (PEN) obtained after a proteose peptone injection, and normal bone marrow neutrophils . The following observations were made . 1) Normal PBN responded to TNF-alpha, but PEN, normal bone marrow neutrophils, and inflammatory PBN at 12 h after stimulation did not . 2) The sensitivity to TNF-alpha of the inflammatory PBN started to decrease at 3 h, was lowest at 12 h, and was almost restored at 52 h after stimulation . 3) Spontaneous apoptosis of normal and inflammatory PBN reached 25% at 12 h after in vitro incubation, but that of PEN and normal bone marrow neutrophils was very low over this period . 4) The sensitivity to cycloheximide (6 h incubation) was high for normal PBN and bone marrow neutrophils, but low for PEN and inflammatory PBN after 12 h . 5) 125I-rhTNF-alpha binding of bone marrow neutrophils was significantly lower than that of normal and inflammatory PBN and PEN . 6) TNF-alpha-induced apoptosis of normal or inflammatory PBN and bone marrow neutrophils was enhanced by treatment with low doses of cycloheximide that alone were barely able to induce neutrophil apoptosis; however, apoptosis of PEN was not . The mechanisms and in vivo significance of these phenomena are discussed.

Infect Immun, 1995 Mar, 63(3), 994 - 1003
Genetic diversity and relationships among Streptococcus pyogenes strains expressing serotype M1 protein: recent intercontinental spread of a subclone causing episodes of invasive disease; Musser JM et al.; Chromosomal diversity and relationships among 126 Streptococcus pyogenes strains expressing M1 protein from 13 countries on five continents were analyzed by multilocus enzyme electrophoresis and restriction fragment profiling by pulsed-field gel electrophoresis . All isolates were studied for the presence of the gene encoding streptococcal pyrogenic exotoxin A by PCR . Strain subsets were also examined by automated DNA sequencing for allelic polymorphism in genes encoding M protein (emm), streptococcal pyrogenic exotoxin A (speA), streptokinase (ska), pyrogenic exotoxin B (interleukin-1 beta convertase) (speB), and C5a peptidase (scp) . Seven distinct emm1 alleles that encode M proteins differing at one or more amino acids in the N-terminal variable region were identified . Although substantial levels of genetic diversity exist among M1-expressing organisms, most invasive disease episodes are caused by two subclones marked by distinctive multilocus enzyme electrophoretic profiles and pulsed-field gel electrophoresis restriction fragment length polymorphism (RFLP) types . One of these subclones (ET 1/RFLP pattern 1a) has the speA gene and was recovered worldwide . Identity of speA, emm1, speB, and ska alleles in virtually all isolates of ET 1/RFLP type 1a means that these organisms share a common ancestor and that global dispersion of this M1-expressing subclone has occurred very recently . The occurrence of the same emm and ska alleles in strains that are well differentiated in overall chromosomal character demonstrates that horizontal transfer and recombination play a fundamental role in diversifying natural populations of S . pyogenes.

Infect Immun, 1995 Mar, 63(3), 757 - 61
Relationship between colonial morphology and adherence of Streptococcus pneumoniae; Cundell DR et al.; Phase variants in colonial opacity of pneumococci differ in the ability to colonize the nasopharynx of infant rats . To explain this observation at a cellular level, we compared the ability of opacity variants to adhere to buccal epithelial cells, type II pneumocytes, or vascular endothelial cells and to the glycoconjugates that represent the cognate receptors at each of these sites . The transparent phenotype was associated with enhanced adherence to buccal cells (approximately 100%) and their receptor relative to that of the opaque variants . Only modest differences in adherence (< 45%) were demonstrated to resting lung and vascular cells . In contrast, adherence of transparent variants increased by 90% to lung cells stimulated with interleukin-1 and by 130% to endothelial cells stimulated with tumor necrosis factor . In contrast, cytokine stimulation did not influence the adherence of opaque pneumococci . This difference correlated with the unique ability of transparent variants to adhere to immobilized GlcNAc and to cells bearing transfected platelet-activating factor receptors . These results suggest that the mechanism of enhanced colonization of the nasopharynx in vivo by transparent as compared with opaque phase variants involves a greater ability to adhere to both GlcNAc beta 1-3Gal on buccal epithelial cells and GlcNAc and PAF receptors on cytokine-activated, as opposed to resting, lung and endovascular cells.

Infect Immun, 1995 Mar, 63(3), 1084 - 8
Altered expression of the platelet aggregation-associated protein from Streptococcus sanguis after growth in the presence of collagen; Erickson PR et al.; Certain strains of Streptococcus sanguis adhere selectively to human platelets (Adh+) and, in plasma, induce them to aggregate into in vitro thrombi (Agg+) . The induction of aggregation is mediated by the platelet aggregation-associated protein (PAAP) expressed on the cell surface of the streptococcus . In endocarditis, expression of PAAP may be regulated by association with host proteins on damaged heart valves . To begin to test this hypothesis, three strains of S . sanguis were each cultured in the presence or absence of collagens (types I to X), laminin, or PAAP-derived peptide preparations . After harvesting and washing, the platelet-interactive phenotype of strains 133-79 (Adh+ Agg+), L74 (Adh+ Agg-), and 10556 (Adh- Agg-) was unchanged . The cells from each culture were then digested mildly with trypsin to isolate PAAP . PAAP isolated from strain 133-79 (Adh+ Agg+) grown in the absence of added collagen, other proteins, or peptides inhibited platelet aggregation in response to untreated cells of S . sanguis . Platelet aggregation was induced immediately, however, by PAAP from strain 133-79 isolated after growth in the presence of 300 nM type I collagen, while lower concentrations yielded protein fragments that potentiated the response to intact cells . Aggregation-inducing PAAP could be removed by anti-PAAP (PGEQGPK) immunoaffinity chromatography, but only inhibitory activity could be recovered . The agonist effect of PAAP was not associated with collagen itself, since the PAAP preparations did not contain detectable amounts of hydroxyproline . PAAP antigens isolated from cells grown in the presence and absence of collagen had similar apparent molecular weights, as estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western immunoblotting . When electrophoresis was performed under nondenaturing conditions, however, PAAP isolated from cells grown in type I collagen migrated more slowly . Strain L74 grown with type I collagen yielded tryptic fragments of proteins that inhibited aggregation significantly better than control peptides (no collagen in the medium) . Strain 10556 was apparently unaffected by growth in type I collagen . The effect of type I collagen was somewhat unique . Growth in the presence of collagen types II to VI (300 nM) yielded protein fragments that potentiated without inducing platelet aggregation, while other collagens, laminin, and PAAP-derived peptides did not affect platelet aggregation . These results suggest that growth in the presence of type I collagen and, perhaps, collagens II to VI alters the expression and conformation of PAAP in certain strains of S . sanguis.

Obstet Gynecol, 1995 Mar, 85(3), 440 - 3
Universal screening for group B streptococcus: recommendations and obstetricians' practice decisions; Gigante J et al.; OBJECTIVE: To determine how obstetricians' opinions regarding universal screening of pregnant women for group B streptococcus (GBS) and their responses to positive culture results vary from American Academy of Pediatrics recommendations, and to determine the physician characteristics that predict divergent opinions . METHODS: One hundred ninety-four practicing obstetricians in the middle Tennessee region were queried by a mail survey . They were asked if they agreed with universal screening for GBS and to indicate whether they would prescribe antibiotics for women in labor, represented by six scenarios that differed with respect to presence or absence of preterm labor, premature rupture of membranes (ROM), prolonged ROM, and a positive GBS cervical culture . They were also asked to describe their practice and personality characteristics . RESULTS: Completed surveys were returned by 135 of 194 obstetricians (70%) . Although only 28% of the respondents agreed with routine prenatal screening for GBS, most (74%) said they would treat a patient on the basis of a positive culture alone . Other risk factors, when added to a positive culture, slightly increased the decision to treat (from 74 to 88%) . Multiple logistic regression, used to assess the relative effect of clinical and physician characteristics on treatment decisions, revealed that chemoprophylaxis for GBS was predicted most strongly by a positive culture at 28 weeks' gestation followed by prolonged ROM and preterm labor . Practicing in an urban location and seeing fewer than 20 patients per day also influenced the decision to treat . CONCLUSION: Although most obstetricians in the middle Tennessee region do not believe in universal screening, most will prescribe intrapartum antibiotics on the basis of a positive screening culture . However, other clinical risk factors and physician characteristics significantly and independently affect the decision to treat as well.

Obstet Gynecol, 1995 Mar, 85(3), 437 - 9
Enhanced antenatal detection of group B streptococcus colonization; Philipson EH et al.; OBJECTIVE: To improve culture methods for the detection of group B streptococcus colonization . METHODS: This study prospectively compared the standard culture medium, a blood agar plate, to a selective culture medium, Todd Hewitt broth with antibiotics, and compared vaginal culture with rectal culture at the first prenatal exam . RESULTS: Of the 383 vaginal swabs received for evaluation of the two culture media, 78 (20.4%) were positive for group B streptococcus . The detection rates of the blood agar plate method and the Todd Hewitt broth with antibiotics were 64.1 and 97.4%, respectively . Using the Todd Hewitt broth with antibiotics, an additional 94 patients were cultured vaginally and rectally . Twenty-nine (30.9%) had positive cultures . The rate of detection was 58.6% for the vaginal culture, 89.7% for the rectal culture, and 100% for both culture sites combined . CONCLUSION: These data indicate that culture detection of group B streptococcus can be improved by using both a selective broth medium and a dual vaginal and rectal culture.

Invest Radiol, 1995 Mar, 30(3), 135 - 43
Magnetization transfer and high-dose contrast in early brain infection on magnetic resonance; Runge VM et al.; RATIONALE AND OBJECTIVES . The authors studied the effect of contrast dose, use of magnetization transfer (MT), and temporal delay on the visualization of contrast enhancement with gadoteridol (Gd HP-DO3A) in a canine brain abscess model . METHODS . Alpha streptococcus brain abscesses were studied in five dogs at 1.5 tesla (T) 1 and 5 days after implantation . Scans were performed 1, 11, and 21 minutes after contrast was administered, using an initial dose of 0.1 mmol/kg . A supplemental contrast injection of 0.2 mmol/kg was given (for a cumulative dose of 0.3 mmol/kg), with scans repeated at 31, 41, and 51 minutes . RESULTS . Lesion conspicuity on day 1 was greater at high-contrast doses (0.3 mmol/kg) compared with standard doses (0.1 mmol/kg), regardless of whether imaging was performed without (0.89 +/- 0.02 compared with 0.26 +/- 0.08) or with (0.97 +/- 0.04 compared with 0.28 +/- 0.06) MT . High-dose, MT, and a delay after contrast was injected all produced a statistically significant improvement . On blinded review of films obtained 11 and 14 minutes after injection, enhancement of the lesion could not be identified with certainty in two of five dogs at a dose of 0.1 mmol/kg, regardless of whether MT was used . Enhancement was seen consistently in all lesions at 0.3 mmol/kg . On day 5, results were comparable, with greater absolute enhancement . CONCLUSIONS . In early brain infection, high-contrast doses (0.3 mmol/kg), MT, and a moderate delay after injection all improve visualization of lesion enhancement.

Eur Heart J, 1995 Mar, 16(3), 394 - 401
Characteristics of infective endocarditis in France in 1991 . A 1-year survey; Delahaye F et al.; OBJECTIVE: To update data on incidence and characteristics of infective endocarditis in France . BACKGROUND: Numerous studies have shown that the incidence and course of infective endocarditis remain stable in spite of advances in treatment and of prophylactic recommendations . METHODS: A survey of all consecutive cases of infective endocarditis was conducted over 12 months in all the institutions of three French regions . RESULTS: Data were collected from 415 cases of definite (32%), probable (53%), and possible (15%) infective endocarditis . The adjusted annual incidence was 24.3 cases per million inhabitants . Thirty-four percent of the patients had no previously known heart disease, 33% had native valve disease, 22% had a prosthetic valve, and 11% had miscellaneous underlying conditions . Infective endocarditis was located solely on the mitral valve in 39%, solely on the aortic valve in 36%, and on the tricuspid valve in 6% . Echocardiography showed a vegetation on the mitral valve in 39%, on the aortic valve in 29%, and on the tricuspid valve in 8% . The causal microorganism was identified in 92%; it was a Streptococcus in 58%, and a Staphylococcus in 23% . Twenty patients were intravenous drug users, and 45 had had a medical or a surgical procedure, which might be associated with the occurrence of infective endocarditis . During the first 2 months after admission, 24% of the patients underwent surgery, and 17% of all patients died . CONCLUSIONS: Despite medical and surgical advances, infective endocarditis remains frequent and severe in France.

J Rheumatol, 1995 Mar, 22(3), 529 - 32
Poststreptococcal reactive arthritis in children: a potential predecessor of rheumatic heart disease; Moon RY et al.; OBJECTIVE: To report several cases of arthritis seen in children after infection with Group A beta-hemolytic Streptococcus (GABHS) which were not associated with carditis or other major manifestations of the Jones Criteria for acute rheumatic fever (ARF); and to analyze the literature to determine these patients' potential risks for the subsequent development of rheumatic heart disease . METHODS . A retrospective chart review was performed of all patients seen in a pediatric rheumatology clinic from January, 1990 to December, 1992 . RESULTS . Four patients were identified with poststreptococcal reactive arthritis (PSReA) and no carditis . Their arthritis had an acute onset, tended to have a longer duration than the arthritis typically seen in ARF, and in most instances did not respond promptly to therapy with aspirin or nonsteroidal antiinflammatory agents . In some patients, there was no history of sore throat or fever . Diagnosis of PSReA was made by serologic testing . Cardiac evaluation in all 4 patients was negative . CONCLUSION . PSReA should be considered in the differential diagnosis for any pediatric patient with the acute onset of arthritis, whether the arthritis is the classic migratory polyarthritis typically seen in ARF or not . Throat culture and serologic testing for streptococcal infection should be performed on these patients . If recent GABHS infection is confirmed, cardiac evaluation, including echocardiogram, is warranted . Both ARF and PSReA occur after GABHS infection, but the precise relationship between these 2 entities is unclear . Longterm follow up of pediatric patients with PSReA in previous reports have shown that a certain percentage of them upon subsequent GABHS infection develop carditis . Until the specific risk factors (either host or bacterial characteristics) for developing subsequent carditis are better delineated, antibiotic prophylaxis similar to that used in ARF should be considered in patients with PSReA.

J Nihon Univ Sch Dent, 1995 Mar, 37(1), 41 - 6
Effects of salivary immune response to Streptococcus mutans on caries occurrence and caries development in mice with autoimmune disease; Maeda T et al.; MRL/l strain mice, which possess a lymphoproliferative gene inducing swelling of systemic lymph nodes, develop a SLE (systemic lupus erythematosus)-like syndrome at around 8 w of age . MRL/n mice, which carry 99.6% of the genes of MRL/l mice, lack the gene for lymphoproliferation and exhibit only a slight degree of lymph node swelling late in life . This study investigated whether the salivary immune response caused by Streptococcus mutans(S . mutans) infection prevented dental caries in MRL/l and MRL/n mice after 8 w of age . A total of 10 MRL/l mice and 10 MRL/n mice were fed a commercial pellet diet without sucrose until 74 d of age, and then fed Diet 2000 containing 56% sucrose ad libitum from 75 to 130 d of age . On d 75, both strains of mice were inoculated with S . mutans JC-2 for 7 d . At 130 d of age, saliva samples were collected and caries scores were assessed . The results obtained suggested that the salivary immune response was one of the most important factors regulating caries occurrence.

J Nihon Univ Sch Dent, 1995 Mar, 37(1), 1 - 7
Persistence of 99mTc-labelled microorganisms on surfaces of impression materials; Keyf F et al.; Impression materials or prostheses can be contaminated with oral microflora and provide a significant source for cross-contamination . A study of such contamination was carried out using an approach different from that of infection control, which has often been investigated in previous studies . The study focused on microorganisms known to cause local and systemic diseases and which are normally found in the oral flora . The persistence of Streptococcus mutans (S . mutans), Escherichia coli (E . coli), Staphylococcus aureus and Candida albicans (C . albicans) on zinc-oxide eugenol, silicone rubber, irreversible hydrocolloid and polyether-rubber was investigated using 99mTc-labelled microorganisms . Ten specimens from each of the four impression materials were prepared as discs of 3 mm in height and 10 mm in diameter . After the specimens had been placed into a suspension of 99mTc-labelled microorganisms, remaining radioactivity was counted in a gamma counter . According to own findings, S . mutans was the most, and E . coli the least persistent on the specimen surfaces . The number of microorganisms removed after washing was less than the amount remaining on the surfaces . C . albicans was removed most easily from all impression surfaces that bore persistent microorganisms after washing . Other microorganisms showed various degrees of persistence according to the impression material.

Int J Pediatr Otorhinolaryngol, 1995 Mar, 31(2-3), 129 - 35
Peritonsillar abscess in children . Is incision and drainage an effective management?
Apostolopoulos NJ, Nikolopoulos TP, Bairamis TN.
Debate continues concerning proper management of peritonsillar abscess (PA) . We studied 189 children (mean age, 9 years) admitted in our department during the last 7 years with the diagnosis of PA . Management consisted of incision and drainage (performed in 92.5% of the children without general anaesthesia) and antibiotic therapy intravenously . There was resolution without complications in the overwhelming majority of the cases . After the initial episode, we further followed up 101 children . The recurrence rate was 15.8% . Forty-seven percent of the recurrences occurred 1 month after the children had been discharged . Probably some of these second PA should be considered as persistent and not as recurrent . Therefore, we propose that after their discharge, the children must take oral antibiotics (resistant to beta-lactamase) for more than 10 days . Cultures were taken from 58 cases . The predominant bacterial isolates were Streptococcus spp . (55%), anaerobes spp . (12%) and Staphylococcus aureus (6%) . To our knowledge, this is the first survey that addresses exclusively a pediatric population and suggests that incision and drainage without general anaesthesia is an applicable and effective management in children with PA . Moreover, we believe that peritonsillar abscess is no longer a strong indication for tonsillectomy due to the relatively low rate of recurrence . We recommend close follow-up, mainly for the first months after the initial episode.

Am J Vet Res, 1995 Mar, 56(3), 321 - 8
Antiphagocytic properties of uterine isolates of Streptococcus zooepidemicus and mechanisms of killing in freshly obtained blood of horses; Causey RC et al.; A total of 22 clinical streptococcal isolates, predominantly Streptococcus zooepidemicus, associated with endometritis in horses were tested for their ability to withstand the natural bactericidal properties of freshly obtained blood . During a 3-hour incubation in blood from a single horse, 8 of these isolates survived and grew, the remainder were killed . To determine whether this ability to grow extended to blood of other horses, 5 of these growing isolates were tested for their ability to grow in the blood of 5 additional horses . The same 5 horses were used for each isolate . The isolates grew in blood of some of the horses, but were killed in blood of the others . However, the horse's blood that mediated killing was different for each isolate . Killing required leukocytes, but the specificity for killing appeared to reside in plasma, although plasma by itself was not bactericidal . Heat-stable and heat-labile components in plasma, interpreted as antibody and complement, respectively, appeared necessary for killing . Isolates that could grow in fresh blood lost this ability after 10 passages in artificial media . Results of these experiments of phagocytosis in fresh blood may provide helpful insights into the phagocytosis of S zooepidemicus in equine uterine fluid.

Infect Dis Clin North Am, 1995 Mar, 9(1), 65 - 96
Pulmonary complications of diabetes mellitus . Pneumonia; Koziel H et al.; Diabetes mellitus is often identified as an independent risk factor for developing lower respiratory tract infections . Pulmonary infections, such as those caused by Mycobacterum tuberculosis, mucor, Staphylococcus aureus, and gram-negative bacteria may occur with an increased frequency whereas infections due to Streptococcus pneumoniae, Legionella, and influenza may be associated with increased morbidity and mortality . The predisposition to lower respiratory tract infections may represent alterations in pulmonary host defenses at several levels . The purpose of this article is to review the spectrum of pulmonary infections encountered in the diabetic patient, focusing on predisposing defects in pulmonary host defense, highlighting characteristic clinical features, and discussing diagnostic approaches, therapeutic interventions, and prophylaxis in this patient population.

Semin Respir Infect, 1995 Mar, 10(1), 31 - 6
The emergence of resistant pneumococcus as a pathogen in childhood upper respiratory tract infections; Kaplan SL; Streptococcus pneumoniae continues to be the most common organism causing acute otitis media and sinusitis in infants and children and remains an important bacterial cause of pneumonia, septic arthritis, and bacterial meningitis in the pediatric age group . The definition, incidence, and mechanisms for penicillin resistance in pneumococcus are reviewed here . Physicians caring for children should know and understand these important concepts . At present, for most respiratory infections in children penicillin-resistant pneumococcus does not represent a clinical dilemma as far as regarding alteration of empiric antibiotic therapy . However, as this problem continues to grow, especially for patients with recurrent otitis media or sinusitis, physicians will be facing upper respiratory infections that are more commonly caused by these isolates and the antibiotic management of infections in the respiratory tract caused by penicillin and other antibiotic-resistant pneumococcal isolates will require modification.

Semin Respir Infect, 1995 Mar, 10(1), 14 - 20
Acute sinusitis; Diaz I et al.; Acute sinusitis is one of the most commonly observed entities in clinical practice . Despite the frequency of the disease, diagnosis and therapy often remain empiric . Most cases are secondary to sinus ostia obstruction associated with the common cold or allergies . Maxillary sinusitis is most common . Because of the proximity of vital anatomic structures and venous drainage systems, serious complications frequently arise from sphenoid, frontal, and ethmoid sinusitis . Clinical signs and symptoms most helpful in the diagnosis of maxillary sinusitis are the presence of a maxillary toothache, lack of improvement with decongestants, a purulent nasal discharge, cough, purulent secretions observed on nasal examination, abnormal transillumination, and sinus tenderness . Plain film radiographs are helpful, but do not adequately visualize the anterior ethmoid sinuses . Computed tomography provides superior visualization, but cost remains prohibitive for routine cases . Most maxillary sinusitis in adults is secondary to Streptococcus pneumoniae or Hemophilus influenzae . Moroxella catarrhalis is common in children . Staphylococcus aureus is observed more frequently in frontal or sphenoid disease . Most patients with acute sinusitis are treated without microbiological diagnosis and respond well to commonly used oral antimicrobials with activity against the usual pathogens . Complications of sinusitis include meningitis, periorbital infections, subdural empyema, epidural abscess, brains abscess, cavernous sinus thrombosis, and osteomyelitis.

Chemotherapy, 1995 Mar-Apr, 41(2), 100 - 12
In vitro and in vivo antibacterial activities of Q-35, a novel fluoroquinolone; Iwasaki H et al.; Q-35, a new fluoroquinolone, was evaluated for its in vitro and in vivo antibacterial activities . In vitro antibacterial activity against gram-positive bacteria was almost equal to that of sparfloxacin or tosufloxacin, but its activity against gram-negative bacteria was 2 times or more lower than that of other quinolones tested . In experimental septicemia, the in vivo activity of Q-35 reflected its in vitro antibacterial activity . In respiratory tract infections with Streptococcus pneumoniae TMS-3 in mice, Q-35 showed a therapeutic effect similar to sparfloxacin and tosufloxacin . Q-35 showed almost the same activity as that of ofloxacin in mice with pyelonephritic infection due to Escherichia coli TMS-3 . The peak levels of Q-35 in murine serum, lungs and kidneys after a single oral administration were intermediate compared to those of tested quinolones.

Clin Infect Dis, 1995 Mar, 20(3), 696 - 9
Folliculitis decalvans and human T cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis; Araujo AQ et al.; Human T-cell lymphotropic virus type I (HTLV-I) can be associated with either adult T-cell leukemia or HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a chronic progressive immune-mediated myelopathy . Skin manifestations such as xerosis and erythema may be associated with HAM/TSP . Infective dermatitis due to Staphylococcus aureus or beta-hemolytic Streptococcus has recently been described as a marker for HTLV-I infection and as a probable risk factor for the development of adult T-cell leukemia and lymphoma in Jamaican children . We report a case of folliculitis decalvans, a rare chronic follicular inflammatory process of bacterial origin that is extremely resistant to treatment, in a patient with HAM/TSP . This case suggests the possibility that the disturbance of the immune system that was observed in patients with HAM/TSP can play a role in the persistence of this severe skin lesion . In addition, the findings of our case cast doubt on the hypothesis that the cause of infective dermatitis in persons infected with HTLV-I is immunosuppression due to congenital or perinatal infection of the immature immune system.

Clin Infect Dis, 1995 Mar, 20(3), 671 - 6
Diminished activity of ceftizoxime in comparison to cefotaxime and ceftriaxone against Streptococcus pneumoniae; Haas DW et al.; Previous reports documenting the essentially identical spectra of activity of ceftizoxime, cefotaxime, and ceftriaxone prompted our hospital formulary committee to replace the latter two drugs with ceftizoxime on the basis of cost differences . However, we subsequently observed that every one of 60 isolates of Streptococcus pneumoniae tested was less susceptible to ceftizoxime than to either cefotaxime or ceftriaxone . The difference between minimal inhibitory concentrations (MICs) was greatest for strains moderately or fully resistant to penicillin, which at our institution represent approximately 32% of all isolates of S . pneumoniae . Ten isolates with cefotaxime and ceftriaxone MICs of 2.0-6.0 micrograms/mL had ceftizoxime MICs of > or = 256 micrograms/mL . Time-kill kinetic studies assessing bactericidal activity confirmed the diminished activity of ceftizoxime against penicillin-resistant isolates of S . pneumoniae . Ceftizoxime should not be used to treat proven or suspected pneumococcal infection in areas where resistance to penicillin is prevalent.

J Clin Microbiol, 1995 Mar, 33(3), 596 - 601
Detection of Streptococcus pneumoniae in whole blood by PCR; Zhang Y et al.; Streptococcus pneumoniae is a major cause of bacteremia in both children and adults . Currently, the diagnosis of pneumococcal bacteremia relies on the isolation and identification of the bacteria from blood cultures . We have developed a sensitive assay for the detection of S . pneumoniae in whole blood by the PCR . A specific primer-probe set (JM201 and JM202 primers with JM204 probe) designed from the penicillin-binding protein 2B gene was demonstrated to reproducibly detect between 10 and 100 fg of input purified S . pneumoniae DNA . This assay system was shown to be inclusive for all strains of S . pneumoniae evaluated, including 15 different serotypes and a battery of penicillin-resistant and -sensitive strains . The specificity of this PCR-based assay was demonstrated by its inability to support amplification from a series of human, bacterial, and yeast genomic DNAs . A general specimen preparation method which should be suitable for the purification of DNA from any pathogens in whole blood was developed . With this protocol it was possible to detect S . pneumoniae-specific DNA from whole blood specimens inoculated with as little as 4 CFU/ml . Copurified human blood DNA, ranging from 0 to 4.5 micrograms per PCR, did not affect the sensitivity of S . pneumoniae detection by PCR . A blinded clinical trial was used to compare the PCR-based assay with standard microbiological blood culture for the detection of S . pneumoniae bacteremia in 36 specimens obtained from pediatric patients seen in the emergency room of Children's Hospital of Pittsburgh . With culture as the "gold standard," the PCR-based assay had a sensitivity of 80% (4 of 5 culture-positive specimens were PCR positive) and a specificity of 84% (26 of 31 culture-negative specimens were PCR negative) . However, three patients whose specimens were PCR positive and culture negative had histories suggestive of bacteremia, including recent positive blood cultures, treatment with antibiotics, cellulitis, and multiple emergency room visits for fever within a 24-h period . These data suggest that PCR-based assays for S . pneumoniae may prove useful to augment current methods of detection for S . pneumoniae bacteremia.

Respir Med, 1995 Mar, 89(3), 187 - 92
The aetiology of severe community-acquired pneumonia and its impact on initial, empiric, antimicrobial chemotherapy; Feldman C et al.; Of 259 patients admitted to an intensive care unit with severe acute community-acquired pneumonia, 173 had primary infections and 86 had secondary infections . The commonest organism isolated in each group was Streptococcus pneumoniae (51.3 and 36.6% of known isolates in each group respectively) . Klebsiella pneumoniae was the next most common isolate (31.9 and 29.3% respectively) . A variety of other Gram-negative organisms and Staphylococcus aureus accounted for most of the remaining pathogens . Based on retrospective analysis of data, there appeared to be no difference in the alcohol consumption of patients with infection due to S . pneumoniae and K . pneumoniae . The overall mortality rate for the primary infections was 47.4%, with 68.4% of these infections due to K . pneumoniae and 33.9% due to the pneumococcus (P < 0.002) . Among the secondary infections, the overall mortality rate was 40.8% (not significantly different to that of primary infections) with 45.5% due to K . pneumoniae and 23.1% due to the pneumococcus (not significantly different on statistical analysis, probably due to low patient numbers) . Our investigation confirms that severe community-acquired pneumonia due to K . pneumoniae is extremely common, even in patients without obvious risk factors for Gram-negative colonization . This organism is contributing to the high mortality rate seen in our intensive care unit among patients with pneumonia, and our empiric therapy for such cases routinely includes a combination of agents active against this organism (e.g . a cephalosporin and an aminoglycoside).

Kansenshogaku Zasshi, 1995 Mar, 69(3), 308 - 15
Pathogenicity of the Streptococcus milleri group in pulmonary infections--effect on phagocytic killing by human polymorphonuclear neutrophils; Toyoda K et al.; The pathogenicity of Streptococcus constellatus in pulmonary infections was investigated in mice in correlation with the phagocytic killing of the microorganisms by human polymorphonuclear neutrophils (PMNs) . The histological inflammation score of the lungs in mice inoculated intratracheally with 10(8) cfu/mouse of the virulent strain S . constellatus RZYK001 obtained from bronchoalveolar fluid of a patient with pneumonia, was significantly higher than in mice inoculated with the avirulent strains S . constellatus RT4303 and RT6002 obtained from saliva of healthy adults (p < 0.001) . The bactericidal activity of human PMNs against Staphylococcus aureus ATCC 25923 was not inhibited at all by the culture filtrate of the virulent strain, but the killing index against RZYK001 was 36.4% after 90-min incubation whereas that against RT4303 and RT6002 was 94.7% and 99.4%, respectively (p < 0.001) . Therefore, these results suggest a possible pathogenic mechanism of S . constellatus apparently mediated by a structural component of the organisms so that a virulent strain is less likely to be killed than an avirulent one, predisposing it to survive in the infection sites.

FEMS Microbiol Lett, 1995 Mar 1, 126(3), 299 - 303
Genetics of high level penicillin resistance in clinical isolates of Streptococcus pneumoniae; Barcus VA et al.; Mosaic penicillin-binding proteins (PBP) 1A, 2X and 2B genes were cloned from four clinical isolates of Streptococcus pneumoniae with levels of susceptibility to penicillin ranging from 1.5 to 16 micrograms benzylpenicillin ml-1 . In each instance it was possible to transform either the penicillin-sensitive laboratory strain R6 or a sensitive clinical isolate 110K/70 to the full level of penicillin resistance with these three penicillin-binding proteins alone . Until now it has not been possible to clearly determine whether alterations to PBP1A, 2X and 2B alone were sufficient to attain high level penicillin resistance.

FEMS Microbiol Lett, 1995 Mar 1, 126(3), 291 - 8
Cold-sensitive conditional mutations in Era, an essential Escherichia coli GTPase, isolated by localized random polymerase chain reaction mutagenesis; Lerner CG et al.; Conditional cold-sensitive mutations in Era, an essential Escherichia coli GTPase, were isolated . Localized random polymerase chain reaction (PCR) mutagenesis employing Taq and T7 DNA polymerases under error prone amplification conditions was exploited to generate mutations in the era gene . A plasmid exchange technique was used to identify conditional cold-sensitive mutations in Era that give rise to defective cell growth below 30 degrees C . Three recessive missense mutations in Era, N26S, A156D, and E200K, were isolated . All three mutations are located at residues conserved in Era homologues from Streptococcus mutans and Coxiella burnetti.

FEMS Microbiol Lett, 1995 Mar 1, 126(3), 257 - 61
Acid adaptation in Streptococcus mutans UA159 alleviates sensitization to environmental stress due to RecA deficiency; Quivey RG Jr et al.; A RecA-deficient stain of Streptococcus mutans, isolated previously, was found to be more susceptible than the prototroph organism to acid killing and also showed reduced colony-forming ability on sucrose-containing medium . The deficient strain was able to grow in chemostat culture at a low pH value of 5 and did not show reduced capacity to produce acid in standard pH-drop experiments with excess glucose . Moreover, it was able to undergo an adaptive response when grown at a low pH to become more resistant to acid killing and also to killing by ultraviolet radiation or hydrogen peroxide . In fact, after adaptation, it was nearly as resistant as the prototroph strain . These findings were interpreted, in part, in terms of an acid-inducible DNA repair system which functions independently of RecA.

Microbiology, 1995 Mar, 141 ( Pt 3), 655 - 62
Lagging-strand origins of the promiscuous plasmid pMV158: physical and functional characterization; Kramer MG et al.; The streptococcal plasmid pMV158 replicates by a rolling circle mechanism, which involves the generation of single-stranded plasmid DNA intermediates . This plasmid has the unique feature of having two lagging-strand origins of replication . One of these origins, termed ssoU, is functional in Streptococcus pneumoniae and in Bacillus subtilis in an orientation-dependent manner . The other origin, ssoA, is only functional in the former host . RNA polymerase seems to be involved in the initiation of the conversion of single- to double-stranded plasmid DNA from both ssoA and ssoU . Mutational and deletion analyses have allowed us to define ssoA as being within a highly structured, non-coding 199 bp region . Within this region, two elements which are conserved in several rolling-circle replicating plasmids are located, the recombination site RSB and a 6 base consensus sequence . Both elements may play a role in the conversion of single- to double-stranded plasmid DNA.

Microbiology, 1995 Mar, 141 ( Pt 3), 623 - 7
Relatedness of penicillin-resistant Streptococcus pneumoniae serogroup 9 strains from France and Spain; Gasc AM et al.; Pulsed-field gel electrophoresis of the genomic DNA of penicillin-resistant strains of Streptococcus pneumoniae was carried out . Eleven clinical strains of serogroup 9 from different French towns and Paris hospitals were tested . The restriction enzymes Apal and Smal were used to digest intact chromosomes, and the fragments were resolved by field-inversion gel electrophoresis (FIGE) . Five strains were similar using Apal and Smal . Four others were closely related when using Apal, and five others were closely related when using Smal . These results suggest that 10 of these strains are genetically related and have a clonal origin . The profile of the eleventh strain was completely different . Thus, in a given serotype the spreading of penicillin resistance can result from both clonal and independent events . Five strains had similar FIGE profiles to strains first isolated in Spain, suggesting that a resistant strain had spread from Spain to France.

Zh Mikrobiol Epidemiol Immunobiol, 1995 Mar-Apr, (2), 34 - 9
{The production of erythrogenic toxin and the epidemic process in respiratory streptococcal infection}; Briko NI et al.; The capacity of Streptococcus pyogenes, isolated from clinically healthy children in a large organized group, for producing erythrogenic toxin A, B and C was studied . The dynamics of toxin production was compared with changes in the levels of morbidity and carrier state, as well as with some characteristics of the interaction between the populations of the infective agent and the host by such values as virulence and susceptibility . Similarity in the dynamics of the parameters under study was noted . The seasonal dynamics of characteristics which determined the capacity for toxin production significantly influenced the levels and one year morbidity dynamics with respiratory streptococcal infection . The study demonstrated the information value of the characteristics of toxin production for understanding both the interval mechanisms of the epidemic process and the influence of the external ones on subsequent epidemic situation.

Zh Mikrobiol Epidemiol Immunobiol, 1995 Mar-Apr, (2), 26 - 30
{The protein antigens of Streptococcus pneumoniae}; Padiukov LN et al.; Protein preparations of three S . pneumoniae strains belonging to different serological types according to the structure of their capsular polysaccharides have been analyzed . Immunoblotting with antiserum to a protein preparation isolated from one strain, pooled serum of patients with pneumococcal infection and individual sera of such patients have revealed that different S . pneumoniae strains have serologically active proteins with similar molecular weights . Analysis made with the use of rabbit antiserum to a protein preparation has demonstrated that most of such preparations (mol . wt . of 44, 49, 50 kD, etc.) belong to the group of proteins Pnp II, average in their molecular weight among the preparations under study (23-53 kD) . At the same time serological response in pneumococcal infection is linked with common S . pneumoniae proteins with mol . wt . of 50, 87 and 97 kD, but not always with pneumolysin.

J Biochem (Tokyo), 1995 Mar, 117(3), 629 - 34
Effects of alcohols on the hydrolysis of colominic acid catalyzed by Streptococcus neuraminidase; Inouye K et al.; Regulation of the activity of neuraminidase of Streptococcus sp . (group K) was evaluated by examining the effects of alcohols on the hydrolysis of colominic acids catalyzed by the neuraminidase . Two kinds of alcohol binding site, activation and inhibition sites, were proposed to exist . Competitive inhibition was observed with alcohols smaller than polyethylene glycol #300 (average molecular weight: 300), so the inhibition site is considered to be the substrate binding site, the size of which was estimated to be 10 A in diameter . On the contrary, polyethylene glycols larger than this size activated the enzyme by 1.5-1.8 times . The activity could be raised by binding of the polyethylene glycols to the activation site . This activation was shown to be due solely to the decrease in the Michaelis constant, Km . The smaller polyethylene glycols (#200 and #300) were also considered to bind to the activation site, although activation was not clearly observed due to compensation with inhibition . Strong substrate inhibition by colominic acid was also observed . The activity of Streptococcus neuraminidase was shown to be regulated intricately by the substrate colominic acid and alcohols contained in the reaction medium.

Mol Microbiol, 1995 Mar, 15(6), 1039 - 48
Molecular population genetic analysis of the enn subdivision of group A streptococcal emm-like genes: horizontal gene transfer and restricted variation among enn genes; Whatmore AM et al.; The group A streptococcal emm-like genes, which encode the cell-surface M and M-like proteins, are divided into distinct mrp, emm and enn subdivisions and are clustered together in a region of the chromosome called the vir regulon . In order to understand the mechanisms involved in the evolution of emm-like genes, a 180 bp fragment of the 5' variable region of the enn gene was characterized in 31 strains for which emm sequences and multilocus enzyme electrophoretic profiles have been previously determined . The results demonstrate that nucleotide polymorphisms at the enn locus are generated predominantly by point mutations and short deletions or insertions, and that variation among enn and emm genes has arisen by similar mechanisms . However, diversity at the enn locus is restricted in comparison to the emm locus . Moreover, there is strong evidence for intragenic recombination at the enn locus and the pattern of distribution of emm and enn alleles among strains suggests that these genes may be independently acquired by horizontal transfer and recombination from distinct donor strains, thereby generating a mosaic structure for the vir regulon . The results add to a growing body of evidence that horizontal gene transfer has played a major role in the evolution of Streptococcus pyogenes vir regulons.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995 Mar, 79(3), 311 - 20
Mineralization of Streptococcus mutans in vitro . An ultrastructural study; Souchay A et al.; Streptococcus mutans mineralization was studied in vitro, with the use of various metastable calcium phosphate solutions, fluoride-containing or otherwise . Degeneration of bacteria always occurred before their mineralization . After complete mineralization of the cytoplasmic area, growth of crystals was observed both in length and in thickness within the extracellular environment . Composition of the calcifying medium was an essential factor in the S . mutans mineralization process . The present study shows that, contrary to carbonate and magnesium ions that prevent intra- and extracellular deposits, fluoride ions promote crystal growth in the above mentioned mediums . Clinical implications of the role of fluoride, at the plaque level, are foreseen.

Eur J Clin Microbiol Infect Dis, 1995 Mar, 14(3), 229 - 34
Serotypes and resistance patterns of Streptococcus pneumoniae causing systemic disease in northern Norway; Magnus T et al.; During the period 1985-1990, Streptococcus pneumoniae was isolated form 97 patients with systemic pneumococcal disease in Northern Norway . Systemic disease occurred most frequently in the age groups 0-4 years and > 60 years . An increasing incidence was observed, especially among children less than five years old . Serotypes covered by the 23-valent pneumococcal polysaccharide vaccine were found in 86 of 97 (88.7%) isolates . The vaccine did not cover 16.7% of the systemic isolates from children less than five years old . Reduced sensitivity to penicillin was found in one isolate (1.0%) which was resistant to ampicillin, doxycycline and chloramphenicol . The E-test and the Rosco agar diffusion test differed in sensitivity to penicillin, chloramphenicol, ciprofloxacin and erythromycin . Three serotype 12F strains showed unusual cross-resistance to chloramphenicol and erythromycin.

Eur J Clin Microbiol Infect Dis, 1995 Mar, 14(3), 182 - 7
Efficacy and safety of azithromycin versus benzylpenicillin or erythromycin in community-acquired pneumonia; Bohte R et al.; Azithromycin, a recently introduced antibiotic, offers the potential advantages of short-course administration and lower toxicity compared to other macrolides . Approved for the treatment of mild pneumonia, this drug was investigated in a study of patients hospitalized for community-acquired pneumonia . In an open-labelled randomized study, oral azithromycin was compared with intravenous benzylpenicillin in patients suspected to have pneumococcal pneumonia . Azithromycin was also compared with erythromycin, both administered orally, in all other patients . Three hundred thirty-four patients with community-acquired pneumonia were hospitalized, 108 of whom were randomized; 104 could be evaluated . A need for intravenous therapy was the most common reason for exclusion . In the pneumococcal group, 35 patients received azithromycin and 29 benzylpenicillin . The clinical and radiological success rate achieved with azithromycin (83%) was considerably higher than that achieved with benzylpenicillin (66%), though the difference was not significant . In the non-pneumococcal group, 19 patients received azithromycin and 21 erythromycin; no differences in the success rate were found (79% and 76%, respectively) . Eight patients on azithromycin had a blood culture positive for Streptococcus pneumoniae; in three of these patients therapy was changed . None of the five patients with pneumococcal bacteraemia who received benzylpenicillin required a change in therapy . It is concluded that oral azithromycin, administered as short-course therapy, is an appropriate antibiotic for treating patients with community-acquired pneumonia . However, it is not yet certain that azithromycin is a good choice for patients with pneumococcal bacteraemia.

Vet Immunol Immunopathol, 1995 Mar, 45(1-2), 115 - 26
Purification of goat immunoglobulin G1 (IgG1) and IgG2 antibodies by use of Streptococcus dysgalactiae cells with Fc receptors; Rantamaki LK et al.; The application of stabilised streptococcal cells for the purification of both immunoglobulin 1 (IgG1) and IgG2 subclasses from goat sera was evaluated . Guanidinium chloride extracted, lyophilised cells of the Lancefield Group C Streptococcus dysgalactiae Sc1 strain showed strong binding to goat IgG, reaching a capacity of approximately 1.4 mg IgG per 100 mg cells (dry weight) . The IgG preparation obtained was of high quality . In immunoelectrophoretic analysis the preparation appeared to consist of pure IgG, whereas the high pressure liquid chromatography (HPLC) gel filtration and immunoblot analyses showed a very slight contamination (less than 1.3% of the total probe) with alpha 2-macroglobulin . The presence of both IgG subclasses in the preparation was verified by HPLC ion exchange chromatography . The adsorption procedure proved to be efficient and easy to perform without advanced technical equipment and the cells were reusable . As these streptococcal cells bind both IgG subclasses, this method presents an economical way for the small scale purification of goat IgG . Additionally the streptococcal cells may conveniently substitute Protein A bearing Staphylococcus aureus cells in various immunological assays.

Plasmid, 1995 Mar, 33(2), 153 - 7
A Tn4001 delivery system for Streptococcus gordonii (Challis); Lunsford RD; The Staphylococcus aureus transposon Tn4001 was found to transpose in Streptococcus gordonii . Transposition sites appeared to be randomly distributed, and the element was stable in the absence of antibiotic selection . An increase in transposition frequency was noted when the delivery plasmid was propagated in a Dam- Dcm- Escherichia coli host strain . The utility of Tn4001 was demonstrated by the generation of lactose-negative mutants . Small size, clonal stability, random transposition, and known nucleotide sequence make Tn4001 a useful addition to the repertoire of tools available to the streptococcal geneticist.

Plasmid, 1995 Mar, 33(2), 127 - 38
Characterization of IS1167, a new insertion sequence in Streptococcus pneumoniae; Zhou L et al.; A new insertion sequence in Streptococcus pneumoniae was identified as a 1435-bp segment of the genome containing 24-bp terminal inverted repeats and flanked by 8-bp direct repeats . A copy of the element, named IS1167, adjacent to the comAB genes was sequenced; seven additional copies were found in the genome of strain CP1200 and relatives descended from strain R36A . Among 22 independent pneumococcal isolates, 11 contained copies of elements hybridizing to IS1167 in nine distinct restriction fragment patterns, with 3-12 copies each . The bulk of the element was occupied by two overlapping open reading frames, encoding basic proteins which together exhibited strong similarity to the full length of the putative transposase of the staphylococcal transposable element, IS1181, as well as significant similarity to those of seven additional known or putative insertion sequences related to the mycobacterial element, IS1096.

Anesthesiology, 1995 Mar, 82(3), 765 - 71
Time-dependent efficacy of bacterial filters and infection risk in long-term epidural catheterization; De Cicco M et al.; BACKGROUND: Epidural infection represents a serious albeit infrequent complication of long-term epidural catheterization . The catheter hub is regarded as the main point of entry for microorganisms among the three possible routes (hematogenous, insertion site, hub) of microbial colonization of the inserted catheter . The current study was aimed at evaluating whether frequent changing of antimicrobial filters carries an increased risk of catheter hub contamination and the time-dependent efficacy of commonly used antimicrobial filters after prolonged use . METHODS: In the first part of the study, a microbiologic survey (skin, filter, hub, and catheter tip) was performed weekly in a group of 47 patients with cancer bearing subcutaneously tunneled catheters managed at home . Subsequently, the time-dependent efficacy of 96 micropore filters (32 Portex, 32 Sterifix-Braun, 32 Encapsulon TFX-Medical) differing in surface areas and/or composition of the filtering membrane was evaluated in a laboratory study . Filters were perfused, under the usual conditions of clinical use (flow resistance, injection pressure, temperature), every 8 h up to 60 days, with 5 ml of two different analgesic solutions, either sterile or containing 1.5 x 10(5)/ml of Streptococcus milleri I . Eight filters of each type subsequently were flushed with a S . milleri suspension (0.5 McFarland) after 7, 14, 28, and 60 days of continuous perfusion, and the resulting filtrates were cultured . RESULTS: In 16 of 19 positive hub cultures, the same microorganisms (species, biotype, antibiotype) were cultured from skin and filters . A statistically significant positive trend was found between the number of filter changes and the rate of positive hub cultures (chi 1(2) trend 5.11; P = 0.02) . A high correlation coefficient was found between number of positive skin cultures and number of positive filtrates (r = 0.88; P = 0.01) and between number of positive filtrates and number of positive hub cultures (r = 0.93; P = 0.003) . Cultures obtained from Portex and Sterifix-Braun filters yielded no bacterial growth (64/64) throughout the study period . Cultures from Encapsulon TFX-Medical filters showed bacterial growth 2/8 at seventh day, 7/8 at the 14th day, and 16/16 from the 28th day onward . CONCLUSIONS: Our data indicate significant correlation between the incidence of catheter hub colonization and the filter-change frequency, when the skin close to the filter-hub connection is contaminated . Our results also show that Portex and Sterifix-Braun bacterial filters, when perfused with reduced volumes at low injection pressures, maintain an unmodified antimicrobial function for at least 60 days . Based on these data, it appears clinically feasible to reduce the frequency of filter changes during long-term epidural catheterization, with a consequent possible decrease of epidural catheter colonization.

Infect Immun, 1995 Mar, 63(3), 961 - 8
Synthetic peptides representing T-cell epitopes act as carriers in pneumococcal polysaccharide conjugate vaccines; de Velasco EA et al.; Improvement of antibody responses to polysaccharides through their linkage to proteins is thought to be mediated by protein-specific T helper (Th) cells . To investigate whether the carrier protein of a conjugate could be substituted by a Th epitope, Streptococcus pneumoniae type 17F polysaccharide (PS) was bromoacetylated and coupled to different peptides via their carboxy-terminal cysteines . Two peptides, one from the mycobacterial 65-kDa heat shock protein (hsp65) and the other from influenza virus hemagglutinin, are well-known Th epitopes . Two other peptides were selected from the pneumolysin sequence by Th epitope prediction methods; one of them was synthesized with cysteine either at the carboxy or the amino terminus . Three conjugates consistently elicited in mice anti-PS immunoglobulin M (IgM) and IgG responses that were not observed upon immunization with derivatized PS without peptide . The same conjugates induced no anti-PS antibody responses in athymic (nu/nu) mice, whereas clear responses were elicited in euthymic (nu/+) controls, demonstrating the thymus-dependent character of these conjugates . Only the three conjugates inducing anti-PS responses were capable of eliciting antipeptide antibodies . One of the immunogenic conjugates was studied in more detail . It induced significant protection and an anti-PS IgG response comprising all subclasses . On the basis of these results and proliferation studies with peptide and conjugate-primed cells, it is concluded that linkage of Th epitopes to PS in the right orientation enhances its immunogenicity in a thymus-dependent manner . Future possibilities for using peptides as carriers for inducing antibody responses to poorly immunogenic saccharide antigens are discussed.

Curr Microbiol, 1995 Mar, 30(3), 143 - 8
Identification of intracellular amylase activity in Streptococcus bovis and Streptococcus salivarius; Whitehead TR et al.; The ruminal bacterium Streptococcus bovis has been demonstrated to produce an extracellular amylase activity . We previously reported on the cloning of a gene from S . bovis encoding for what was initially believed to be the extracellular amylase . DNA sequence analyses indicated that the amylase produced by the cloned gene did not match the N-terminus amino acid sequence of the purified extracellular amylase and contained no apparent leader sequence for secretion . Analyses of crude extracts demonstrated the presence of an intracellular amylase in S . bovis JB1 that differed in molecular weight (56,000) from that of the extracellular amylase (70,000) . The 56,000 molecular weight amylase was identical to the amylase produced by Escherichia coli containing the cloned amylase gene . Low levels of intracellular amylase activity were also detected in other strains of S . bovis and also Streptococcus salivarius . Introduction of the plasmid pVA838 containing the cloned amylase gene into S . bovis and S . sanguis resulted in enhanced intracellular amylase production by both organisms . The amylase gene has been sequenced, and analysis of the deduced amino acid sequence for the amylase indicates a high degree of similarity with secreted amylases from Bacillus species.

Afr J Med Med Sci, 1995 Mar, 24(1), 47 - 53
Respiratory syncytial virus--associated lower respiratory diseases in hospitalised pre-school children in Ibadan; Aderele WI et al.; An analysis of the features of lower respiratory diseases (LRD) associated with Respiratory Syncytial Virus (RSV) in 21 children aged 1-23 months, indicated that the clinical features did not differ appreciably from those described for LRD due to other infective agents . It was however, remarkable that none of the children was grossly malnourished, neither was there any death . The final respiratory diagnoses were bronchiolitis alone (6 cases), bronchopneumonia (6 cases), empyema/pleural effusion (3 cases, including one with bronchopneumonia), lobar pneumonia (3 cases, including one with associated bronchopneumonia) . Streptococcus pneumonia and Klebsiella pneumoniae respectively, were isolated from blood culture in the two cases with lobar pneumonia alone . One child had laryngotracheobronchitis (croup) alone and another, croup associated with bronchiolitis and bronchopneumonia . Radiologically, the single most common lesion was patchy consolidation (8 cases) followed by hyper-inflation (6 cases); in one case, there was no observable lesion on the chest radiograph . All the 6 children who had bronchiolitis alone were aged 12 months and below, and were well nourished; conversely, 8 of the 12 children with pneumonia alone or in addition to other lesions and both children with pleural effusion, were older than 12 months and underweight . Other viral agents were identified in 8 (38%) of the cases . Complications included heart failure in 4 cases and a combination of anaemia and heart failure in one child with empyema . In a child with symptom complex and radiological features suggestive of acute obstructive lower respiratory infection with immunofluorescence evidence of RSV infection, age and nutritional status are important factors in determining the need for antibiotic therapy pending the outcome of bacterial cultures.

N Engl J Med, 1995 Feb 16, 332(7), 424 - 8
Bartonella (Rochalimaea) quintana bacteremia in inner-city patients with chronic alcoholism; Spach DH et al.; BACKGROUND . Bartonella (Rochalimaea) quintana is a fastidious gram-negative bacterium known to cause trench fever, cutaneous bacillary angiomatosis, and endocarditis . Between January and June 1993 in Seattle, we isolated B . quintana from 34 blood cultures obtained from 10 patients not known to be infected with the human immunodeficiency virus (HIV) . METHODS . After identifying the isolates as B . quintana by direct immunofluorescence and DNA-hybridization studies, we determined strain hybridization with studies of restriction-fragment-length polymorphisms (RFLPs) of the intergenic spacer (noncoding) region of ribosomal DNA amplified by the polymerase chain reaction (PCR) . To characterize the epidemiologic and clinical features of bartonella infections in these patients, we performed a retrospective case-control study using as controls 20 patients with blood cultures obtained at approximately the same time as those obtained from the index patients . RESULTS . B . quintana isolates from the 10 patients were indistinguishable by PCR-RFLP typing . All 10 patients had chronic alcoholism, and 8 were homeless (P = 0.001 for both comparisons with controls) . The six patients who underwent HIV testing were seronegative . At the time of their initial presentation, seven patients had temperatures of at least 38.5 degrees C . Six patients had three or more blood cultures that were positive for B . quintana, and in four of these patients B . quintana was isolated from blood cultures obtained 10 or more days apart . Subacute endocarditis developed in two patients and required surgical removal of the infected aortic valve in one of them . Nine patients recovered; one died of sepsis from Streptococcus pneumoniae infection . CONCLUSIONS . B . quintana is a cause of fever, bacteremia, and endocarditis in HIV-seronegative, homeless, inner-city patients with chronic alcoholism.

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