Clin Infect Dis, 1998 Jun, 26(6), 1448 - 58 Molecular, serological, and clinical features of 16 consecutive cases of invasive streptococcal disease . Southeastern Minnesota Streptococcal Working Group; Cockerill FR 3rd et al.; We performed a comprehensive analysis of the molecular, serological, and clinical features of 16 consecutive cases of invasive streptococcal disease (ISD) . The majority of cases were linked to two group A streptococcus (GAS) clones closely related by pulsed-field gel electrophoresis (PFGE) and designated as PFGE-1 and PFGE-1.1 . These clones, serotyped as M-3, T-3/B3264, carried an allelic variant of the gene that encodes pyrogenic exotoxin A (speA3) and the gene that encodes streptococcal superantigen (SSA) but different emm alleles that encode M-protein . The characteristics and clinical features of patients were similar to those described in previous reports, regardless of the responsible GAS clone . However, worse clinical outcomes (shock and death) were more frequent when patients infected with PFGE1/1.1 clones were considered as a group and compared with all other patients as a group . One striking feature in some patients with deep tissue infection was a lack of inflammatory cells despite the presence of numerous streptococci . An evaluation of PFGE profiles of GAS isolated elsewhere demonstrated that the PFGE-1 clone has caused invasive disease in other locations in the United States and in Japan. Clin Infect Dis, 1998 Jun, 26(6), 1341 - 5 Why have group A streptococci remained susceptible to penicillin? Report on a symposium; Horn DL et al.; In spite of 50 years of extensive use of penicillin, group A streptococci remain exquisitely susceptible to this antibiotic . This observation that continuing susceptibility has occurred despite the development of resistance to other antimicrobial agents prompted a day-long meeting at Rockefeller University (New York) in October 1996 . Among the most likely explanations for this remarkable state of continued susceptibility to penicillin are that beta-lactamase may not be expressed or may be toxic to the organism and/or that low-affinity penicillin-binding proteins either are not expressed or render organisms nonviable . Other potential explanations are that circumstances favorable for the development of resistance have not yet occurred and/or that there are inefficient mechanisms for or barriers to genetic transfer . Recommended future actions include (1) additional laboratory investigations of gene transfer, penicillin-binding proteins, virulence factors, and homeologous recombination and mismatch repair; (2) increased surveillance for the development of penicillin resistance; (3) application of bioinformatics to analyze streptococcal genome sequences; and (4) development of vaccines and novel antimicrobial agents . Thus far the susceptibility of group A streptococci to penicillin has not been a major clinical or epidemiological problem . A similar observation, however, could have been made decades ago about Streptococcus pneumoniae . It is therefore vital for the scientific community to closely examine why penicillin has remained uniformly highly active against group A streptococci in order to maintain this desirable state. Am Fam Physician, 1998 Jun, 57(11), 2713 - 20, 2725 Prevention of neonatal group B streptococcal infection; Keenan C; Neonatal group B streptococcal infection is the primary cause of neonatal morbidity related to infection . It can often be prevented by identifying and treating pregnant women who carry group B streptococci or who are at highest risk of transmitting the bacteria to newborns . Increasing evidence and expert opinion support intrapartum treatment of women at relatively high risk of delivering an infant with group B streptococcal infection . Such women can be identified through the use of an anogenital culture for group B streptococci obtained at 35 to 37 weeks of gestation and by the presence of at least one of many risk factors associated with neonatal infection . These risk factors include preterm labor or rupture of the membranes at less than 37 weeks of gestation, previous delivery of an infant with invasive group B streptococcal disease, group B streptococcal bacteriuria during the present pregnancy, maternal intrapartum fever of 38 degrees C (100.4 degrees F) or higher and rupture of the fetal membranes for 18 hours or more . The recommended agent for intrapartum chemoprophylaxis is intravenous penicillin G; clindamycin is used in penicillin-allergic women . The use of risk markers alone to guide the administration of intrapartum antibiotics is much more cost-effective than other preventive strategies, but it exposes more women and infants to antibiotic-associated risks . Management of the infants of treated mothers is empiric and is currently guided by expert opinion. Diagn Microbiol Infect Dis, 1998 Jul, 31(3), 467 - 72 Empiric therapy of bacterial infections in patients with severe neutropenia; Glauser M; The urgent need to treat presumptive infections in neutropenic patients has meant that initial therapy is empiric based on the pathogens most likely to be responsible for the patient's rise in temperature or other symptoms of infection . The spectrum of causative pathogens has changed over time and reflects the availability and use of antimicrobial agents . Gram-positive organisms predominated in the 1940s and onward until the widespread use of early penicillins and cephalosporins effectively addressed this problem . The upsurge in infections in the 1970s and 1980s caused by Gram-negative organisms, particularly Pseudomonas aeruginosa, Escherichia coli and Klebsiella spp., has been supplanted by a new wave of infections caused by Gram-positive organisms, this time predominantly Staphylococcus aureus, Staphylococcus epidermidis, and the viridans streptococci . The fourth-generation cephalosporins (cefpirome) among other broad-spectrum beta-lactams, by virtue of their enhanced antimicrobial activity against Gram-positive pathogens and greater beta-lactamase stability, are promising candidates for use in the empiric management of febrile episodes in neutropenic patients . Early clinical trial results are promising and should lead the way for further use of these compounds in this indication. Diagn Microbiol Infect Dis, 1998 Jul, 31(3), 453 - 9 Epidemiology, laboratory detection, and therapy of penicillin-resistant streptococcal infections; Jones RN et al.; Streptococci cause a wide range of infections in humans including respiratory tract infections, endocarditis, meningitis, bacteremias, and skin and soft tissue lesions . Mutations in the penicillin binding proteins target sites in these organisms have recently caused resistance to penicillins and cephalosporins . The passage of resistant genetic material from one streptococcal species to another has been recognized as one of the mechanisms by which this resistance has occurred and spread . Such resistance has been a particular problem in Streptococcus pneumoniae and viridans group streptococci with penicillin resistance levels in excess of 25%, now common in both groups of organisms worldwide . Fourth-generation cephalosporins, with their enhanced antibacterial activity against Gram-positive organisms (cefpirome > cefepime) and their increased stability to the beta-lactamases produced by many bacterial species, offer a new option for the treatment of potentially life-threatening infections such as pneumococcal pneumonia and meningitis with or without bacteremia . Clinical trials are currently in place to evaluate the role of these agents in these, and other, indications of Gram-positive infections . Prior studies of cefpirome therapy for infections caused by Streptococcus spp . were successful, and recent expanded in vitro investigations profess a future for expanded use of cefpirome to treat infections produced by several Gram-positive species. Microb Pathog, 1998 Jun, 24(6), 333 - 9 Genetic inactivation of the extracellular cysteine protease enhances in vitro internalization of group A streptococci by human epithelial and endothelial cells; Burns EH Jr et al.; Group A Streptococcus (GAS) produces an extracellular cysteine protease (streptococcal pyrogenic exotoxin B) that participates in virulence . We examined two pairs of isogenic GAS strains (serotype M2 and M3) for ability to be internalized by human umbilical vein endothelial cells and A549 human lung fibroblasts . For both host cell types, the level of internalization by the cysteine protease-negative mutant strains was significantly greater than the wild type parent organisms . The data suggest that expression of the cysteine protease contributes to extracellular survival, an observation consistent with recent results from mouse infection studies (Lukomski et al., Infect immun 1998; 66: 771-6) . Clin Microbiol Rev, 1998 Apr, 11(2), 318 - 40 Use of enzyme tests in characterization and identification of aerobic and facultatively anaerobic gram-positive cocci; Bascomb S et al.; The contribution of enzyme tests to the accurate and rapid routine identification of gram-positive cocci is introduced . The current taxonomy of the genera of aerobic and facultatively anaerobic cocci based on genotypic and phenotypic characterization is reviewed . The clinical and economic importance of members of these taxa is briefly summarized . Tables summarizing test schemes and kits available for the identification of staphylococci, enterococci, and streptococci on the basis of general requirements, number of tests, number of taxa, test classes, and completion times are discussed . Enzyme tests included in each scheme are compared on the basis of their synthetic moiety . The current understanding of the activity of enzymes important for classification and identification of the major groups, methods of testing, and relevance to the ease and speed of identification are reviewed . Publications describing the use of different identification kits are listed, and overall identification successes and problems are discussed . The relationships between the results of conventional biochemical and rapid enzyme tests are described and considered . The use of synthetic substrates for the detection of glycosidases and peptidases is reviewed, and the advantages of fluorogenic synthetic moieties are discussed . The relevance of enzyme tests to accurate and meaningful rapid routine identification is discussed. Med Klin (Munich), 1998 May 15, 93(5), 307 - 10 {Mycotic aneurysm in endocarditis lenta as the etiology of intraparenchymatous cerebral hemorrhage}; Wurker M et al.; CASE REPORT: A 49-year-old male was admitted for left-side headache and mild speech defect . Clinical examination showed a pansystolic murmur of mitral regurgitation and mild Wernicke aphasia . In laboratory studies ESR and CRP were increased . Computed tomography of brain revealed a left temporoparietal hematoma . Echocardiographic examination demonstrated vegetations and mitral valve perforation . In blood cultures grew alpha-streptococci . Cerebral angiography was performed and a fusiform aneurysm on a distal branch of the left middle cerebral artery was identified . Follow-up angiography showed a total resolution of the aneurysm after 6 weeks of intravenous antibiotics . CONCLUSION: This case demonstrate that patients with intracerebral hematomas associated with infectious endocarditis should be investigated for mycotic intracranial aneurysm. J Rheumatol, 1998 Jun, 25(6), 1126 - 30 Reactive arthritis associated with group C and group G beta-hemolytic streptococci; Jansen TL et al.; OBJECTIVE: Group A beta-hemolytic streptococci (GAS) are known to be capable of evoking sterile arthritis . Reactive arthritis (ReA) has been reported sporadically following primary infection with group C and group G beta-hemolytic streptococci (GCS, GGS) . We prospectively studied 4 cases of ReA secondary to throat infection with GCS and GGS . METHODS: Four patients with arthritis secondary to throat infection were seen . Three patients were Dutch, one was Indonesian; female/male ratio was 1/3; mean age was 30 years (range 18-46) . Diagnostic evaluation included culture of throat swab and serological screening . RESULTS: All patients presented with a nonmigratory asymmetrical arthritis: monoarthritis in one patient, oligoarthritis in 3 . Culture of throat swab was positive in all . Antistreptolysin-O (ASO) titer rose significantly in 2 patients, and anti-DNase-B rose in 2 patients . ASO was maximal (mean 1000 U/ml; range 890-1110) and anti-DNase-B was 395 U/ml (range 290-500) . Treatment consisted of feneticillin for 5 days; nonsteroidal antiinflammatory drugs were prescribed on demand . All patients recovered fully in 3 to 12 weeks . CONCLUSION: These cases provide evidence of a benign non-group A streptococcal ReA, i.e., secondary to GCS or GGS . The presence of the organism in the throat along with the elevation of antibody to streptococcal products is important for the diagnosis of GCS/GGS associated ReA . A positive throat culture is needed for differentiation from GAS associated poststreptococcal ReA, because prophylactic measures are effective only in GAS associated sequelae, but not in GCS/GGS associated ReA. Br J Gen Pract, 1998 Feb, 48(427), 989 - 90 Streptococcal infection observed in the autumn of 1995; Sanders S; Near patient testing demonstrated an unusual infection pattern with a high incidence of Lancefield group D beta-haemolytic streptococci in patients with pharyngitis and tonsillitis in a London general practice . This raises questions regarding the epidemiology of this streptococcus strain, which is not usually associated with upper respiratory infections. Int J Antimicrob Agents, 1998 Apr, 10(1), 23 - 30 In vitro activity of BAY 12-8039, a new fluoroquinolone, against species representative of respiratory tract pathogens; Souli M et al.; The in vitro antibacterial activity of BAY 12-8039, a novel 8-methoxy-quinolone, was compared with those of other quinolones, amoxicillin/clavulanate, cefuroxime and erythromycin against species commonly implicated in respiratory tract infections as well as viridans group streptococci . The new compound was highly active against methicillin-susceptible staphylococci (MIC90 0.125 microgram/ml), penicillin-susceptible and penicillin-resistant pneumococci (MIC90 0.5 and MIC50 0.25 microgram/ml, respectively), penicillin-susceptible and penicillin-resistant viridans group streptococci (MIC90 0.5 and 0.25 microgram/ml, respectively), group A streptococci (MIC90 0.25 microgram/ml), M . catarrhalis (MIC90 0.125 microgram/ml) and H . influenzae (MIC90 0.063 microgram/ml), irrespective of beta-lactamase production . It was, however, less active against methicillin-resistant staphylococci (MIC50 and MIC90, 2 and 4 micrograms/ml, respectively) . The new compound demonstrated bactericidal activity at concentrations 2, 4, 8 times the MIC against representative isolates of the above collection . At a concentration of eight times the MIC, the frequency of spontaneous resistance ranged from 2.5 x 10(-7) to < 4 x 10(-8) . These results suggested that BAY 12-8039 would be a promising agent for the eradication of respiratory tract pathogens and that clinical trials assessing its efficacy for the management of infections caused by these organisms are warranted. Antimicrob Agents Chemother, 1998 Jun, 42(6), 1517 - 9 Antimicrobial susceptibilities of group B streptococci isolated between 1992 and 1996 from patients with bacteremia or meningitis; Fernandez M et al.; In vitro testing of 229 group B streptococcal isolates from a variety of patients with invasive infections indicated uniform penicillin G susceptibility . However, 17 (7.4%) isolates were resistant to erythromycin and 8 (3.4%) were resistant to clindamycin . These results support the continued use of penicillin G as the drug of choice for the treatment and prevention of group B streptococcal disease. Antimicrob Agents Chemother, 1998 Jun, 42(6), 1493 - 4 Different erythromycin resistance mechanisms in group C and group G streptococci; Kataja J et al.; Different mechanisms of erythromycin resistance predominate in group C and G streptococcus (GCS and GGS, respectively) isolates collected from 1992 to 1995 in Finland . Of the 21 erythromycin-resistant GCS and 32 erythromycin-resistant GGS isolates, 95% had the mefA or mefE drug efflux gene and 94% had the ermTR methylase gene, respectively. Antimicrob Agents Chemother, 1998 Jun, 42(6), 1402 - 5 Oral antimicrobial prophylaxis in bone marrow transplant recipients: randomized trial of ciprofloxacin versus ciprofloxacin-vancomycin; Ford CD et al.; The optimal oral antimicrobial prophylactic regimen for bone marrow transplant recipients remains to be elucidated . We randomized 84 patients to receive either oral ciprofloxacin or ciprofloxacin plus vancomycin at hospital admission . Patients were monitored for bacteremias and clinical parameters, and stool and throat swab surveillance cultures were performed . The addition of vancomycin resulted in a significant decrease in the frequency of patients with surveillance cultures positive for coagulase-negative staphylococci (stool cultures, 44 versus 23%; throat swab cultures, 37 versus 19%) and alpha-hemolytic streptococci (throat swab cultures, 90 versus 60%) . The frequencies of positivity for Candida spp . and gram-negative organisms on surveillance cultures were comparable . Despite these results, no differences in the incidences of bacteremias (12 of 41 versus 12 of 43 patients) or clinical parameters such as number of days to first fever, total number of febrile days, length of stay, and number of transfusions could be demonstrated . Because of a lack of efficacy of vancomycin and emerging problems with vancomycin-resistant isolates, vancomycin should not be used in oral antimicrobial prophylaxis regimens. Fortschr Med, 1998 Apr 30, 116(12), 36 - 40 {Erysipelas and lymphedema}; Herpertz U; The most common complication of lymphedema is erysipelas (Saint Anthony's fire) . The protein-rich lymph is such an excellent medium for the growth of bacteria that the risk of erysipelas developing is as high in the most severe forms of lymphedema as 50% compared with only 1/1000 in the general population . Treatment requires the use of antibiotics . Of importance for prophylaxis is the rigorous disinfection of minor injuries that provide a portal for bacteria, usually streptococci, and the physical edema therapy described by Asdonk comprising manual lymph drainage and compression. Kansenshogaku Zasshi, 1998 Apr, 72(4), 414 - 7 {A patient with Streptococcus intermedius brain abscess treated with high dose penicillin G--susceptibility of the isolate to penicillin G and the concentration of penicillin G in cerebrospinal fluid}; Saijo M et al.; We report here a 2-year-old boy with a Streptococcus intermedius brain abscess and bilateral ventriculitis successfully treated with a high dose penicillin G (200,000 U/kg/dose, 6 times a day, 1 hour continuous infusion) . Although hydrocephalus residuced, the high dose penicillin G therapy cured his brain abscess and bilateral ventriculitis . The minimal inhibitory concentration of penicillin G to the isolate was 0.008 microgram/ml . The penicillin G concentration in the cerebrospinal fluid after 2 hours from the infusion was about 5 micrograms/ml . S . intermedius must be considered as one of the causative agents for brain abscess . High dose penicillin G therapy is one choice of treatment for brain abscess due to penicillin-susceptible streptococci. J Biol Chem, 1998 Jun 5, 273(23), 14503 - 15 alpha-enolase, a novel strong plasmin(ogen) binding protein on the surface of pathogenic streptococci; Pancholi V et al.; The plasmin(ogen) binding property of group A streptococci is incriminated in tissue invasion processes . We have characterized a novel 45-kDa protein displaying strong plasmin(ogen) binding activity from the streptococcal surface . Based on its biochemical properties, we confirmed the identity of this protein as alpha-enolase, a key glycolytic enzyme . Dose-dependent alpha-enolase activity, immune electron microscopy of whole streptococci using specific antibodies, and the opsonic nature of polyclonal and monoclonal antibodies concluded the presence of this protein on the streptococcal surface . We, henceforth, termed the 45-kDa protein, SEN (streptococcal surface enolase) . SEN is found ubiquitously on the surface of most streptococcal groups and serotypes and showed significantly greater plasmin(ogen) binding affinity compared with previously reported streptococcal plasminogen binding proteins . Both the C-terminal lysine residue of SEN and a region N-terminal to it play a critical role in plasminogen binding . Results from competitive plasminogen binding inhibition assays and cross-linking studies with intact streptococci indicate that SEN contributes significantly to the overall streptococcal ability to bind plasmin(ogen) . Our findings, showing both the protected protease activity of SEN-bound plasmin and SEN-specific immune responses, provide evidence for an important role of SEN in the disease process and post-streptococcal autoimmune diseases. Cytokine, 1998 May, 10(5), 370 - 6 Cytokine release and mitogenic activity in the viridans streptococcal shock syndrome; Soto A et al.; Viridans streptococci are a heterogeneous group of Gram-positive bacteria that are normal inhabitants of the mouth, upper gastrointestinal tract and oropharynx . These organisms are typically thought of as of low virulence, classically as the cause of infective endocarditis, although recently they have been implicated in serious infections in other settings . In particular, viridans group streptococci have been described as responsible for the alpha-streptococcal shock syndrome in neutropenic patients . The mechanism by which viridans streptococci cause bacteraemia associated with adult respiratory distress syndrome (ARDS) in these patients has not been elucidated . Using enzyme-linked immunosorbent assays, we compared the ability of cell-free bacterial supernatants derived from commensal and clinical strains of viridans streptococci to induce the pro-inflammatory cytokines tumour necrosis factor alpha (TNF-alpha), tumour necrosis factor beta (TNF-beta) and interleukin 8 (IL-8) from human peripheral blood mononuclear cells (PBMC) in vitro . Supernatants of clinical isolates induced significantly more TNF-beta (P < 0.002) and IL-8 (P < 0.001) than did supernatants from commensal strains . The increased production of IL-8 by the clinical strains may be of importance in view of the role of IL-8 in the pathogenesis of the acute respiratory distress syndrome (ARDS), one of the principal clinical features of the alpha-streptococcal shock syndrome. Ann N Y Acad Sci, 1997 Dec 29, 830, 19 - 31 The microbial ecology and immunology of the adenoid: implications for otitis media; Bernstein JM et al.; The nasopharyngeal tonsil, or adenoid, is a major inductive site for the synthesis of J-chain-positive B cells that may migrate to other areas of the upper respiratory tract, such as the nasal mucosa, the parotid gland, the lacrimal gland, and the middle ear during inflammation . The production of secretory IgA by both the nasopharyngeal tonsil and the nasal mucosa plays a major role in local immune protection against bacteria and viruses . The release of cytokines from Th1 and Th2 lymphocytes must be appropriate for B cells to produce IgA . The factors or mechanisms responsible for this are not, at present, known, but it appears that there is a difference in the profiles of cytokine secretion by Th1 and Th2 lymphocytes in the adenoids in both otitis-prone, as well as nonotitis-prone children . We have suggested that if this specific immune system does not protect the host from invasion by potential pathogens, there are other modalities of therapy to protect the nasopharynx from colonization with pathogenic bacteria or viruses . These include the production of specific antibodies against bacterial surface proteins that have been identified as mucin-binding proteins . Alteration of the microbial flora with commensal organisms such as viridans streptococci can be utilized . These alpha-hemolytic streptococci probably function by producing an acid environment that prevents colonization of organisms such as nontypeable H . influenzae . Finally, the induction of specific SIgA by conserved outer membrane protein antigens of potential pathogens may be another strategy in the prevention of colonization of potential bacterial pathogens in the nasopharynx. Pediatr Infect Dis J, 1998 May, 17(5), 377 - 81 Studies of the continuing susceptibility of group A streptococcal strains to penicillin during eight decades; Macris MH et al.; BACKGROUND: In view of the widespread use of penicillin for >50 years for the treatment of group A streptococcal infections, we examined the question of whether there has been a change in susceptibility to penicillin in group A streptococcal strains collected during a span of 80 years (1917 to 1997) . METHODS: One hundred thirty-three group A streptococcal strains collected during 80 years were tested for changes in penicillin susceptibility . Three tests were used: (1) the microtiter broth minimal inhibitory concentration (MIC); (2) the minimal bactericidal concentration (MBC); and (3) the penicillin E strip MIC . RESULTS: The results indicate there has been no change in the susceptibility to penicillin in these group A streptococci during the past 80 years . The microtiter broth MIC90 for the oldest strains (0.032 microg/ml) was not significantly different from those collected most recently (0.032 microg/ml); there is no statistical difference between the raw MIC data for the four collection periods (P=0.468, analysis of variance on ranks) . CONCLUSIONS: There has been no change in the susceptibility of group A streptococci during this time in spite of well-documented cases of penicillin resistance in other Gram-positive organisms and despite recognized resistance of group A streptococci to other antibiotics. Aust Dent J, 1998 Apr, 43(2), 87 - 98 Molecular biological techniques and their use to study streptococci in dental caries; Jacques N; This review explains some of the basic techniques of molecular biology and their application to the study of oral streptococci . Examples of how these techniques have furthered the understanding of streptococcal colonization in health and disease are discussed along with approaches to controlling dental caries that have been made plausible by the knowledge gained using these techniques. Scand J Prim Health Care, 1998 Mar, 16(1), 8 - 12 Recurrence rate of streptococcal pharyngitis related to hygienic measures; Falck G et al.; OBJECTIVE: To test the hypothesis that treatment failures of streptococcal pharyngotonsillitis may be caused by reinfection by the patients' own streptococci remaining on a toothbrush or in the bedclothes . DESIGN: To elucidate the role of streptococcal contamination of the environment, hygienic measures regarding change of toothbrush and bed linen and washing of toys were given to half of the patients/families . Throat specimens were taken from all the patients before treatment with phenoxymethylpenicillin for 5 days, and the patients were followed-up for 1 month . At a home visit after 6-10 days, throat specimens were taken from the patients and all permanent residents of the home . Environmental samples were taken from pillowcases, floors, toothbrushes, dummies, and toys . SETTING: Six health care centres . SUBJECTS: 114 patients of all ages suffering from group A streptococcal pharyngotonsillitis, and 289 family members . MEASUREMENTS AND MAIN RESULTS: 54 patients/families received hygiene instructions . The total number of recurrences was 40 (35%) . There was no difference in treatment failure rate between patients/families that had taken or not taken hygienic measures . CONCLUSIONS: Hygienic measures have no decisive influence on the risk of recurrence of streptococcal pharyngotonsillitis. Microbiology, 1998 May, 144 ( Pt 5), 1223 - 33 Identification and analysis of a gene (abpA) encoding a major amylase-binding protein in Streptococcus gordonii; Rogers JD et al.; Oral streptococci such as Streptococcus gordonii bind the abundant salivary enzyme alpha-amylase . This interaction may be important in dental plaque formation and metabolism, thus contributing to the initiation and progression of dental caries and periodontal disease, the two most common plaque-mediated diseases . The conjugative transposon Tn916 was used to insertionally inactivate gene(s) essential to the expression of amylase-binding components of S . gordonii Challis, and a mutant deficient in amylase-binding (Challis Tn1) was identified . While wild-type strains of S . gordonii released both 20 kDa and 82 kDa amylase-binding proteins into culture supernatants, Challis Tn1 expressed the 82 kDa but not the 20 kDa protein . The 20 kDa amylase-binding protein was isolated from culture supernatants of S . gordonii Challis by hydroxyapatite chromatography . A partially purified, functionally active 20 kDa protein was sequenced from blots, and the N-terminal sequence obtained was found to be DEP(A)TDAAT(R)NND . A novel strategy, based on the single-specific-primer polymerase chain reaction technique, enabled the gene inactivated by Tn916 to be cloned . Analysis of the resultant nucleotide sequence revealed an open reading frame of 585 bp, designated amylase-binding protein A (abpA), encoding a protein of 20 kDa (AbpA), immediately downstream from the insertion site of Tn916 . This protein possessed a potential signal peptide followed by a region having identity with the N-terminal sequence of the 20 kDa amylase-binding protein . These results demonstrate the role of the 20 kDa protein in the binding of amylase to S . gordonii . Knowledge of the nature of amylase-binding proteins may provide a better understanding of the role of these proteins in the colonization of S . gordonii in the oral cavity. Cancer, 1998 Jun 1, 82(11), 2275 - 81 The impact of mucositis on alpha-hemolytic streptococcal infection in patients undergoing autologous bone marrow transplantation for hematologic malignancies; Ruescher TJ et al.; BACKGROUND: Antibacterial prophylaxis with quinolone antibiotics has resulted in an increase in streptococcal infections among bone marrow transplantation (BMT) recipients with myelosuppression . Oral ulceration (mucositis), which frequently occurs as a consequence of chemotherapy, has been implicated as a significant portal of entry for streptococci . The objectives of this study were to confirm the correlation between mucositis and streptococcal bacteremia, determine the risk associated with this correlation, and evaluate the impact of mucositis and streptococcal bacteremia on hospital course and costs associated with autologous BMT . METHODS . This was a retrospective, case-control study in which the charts of autologous BMT recipients treated for hematologic malignancies between 1990 and 1996 were reviewed . Twenty-four patients were identified who met the criteria of autologous BMT; their blood cultures confirmed (x2) alpha-hemolytic streptococcal sepsis . A control group of 45 without positive cultures was matched by gender, age, diagnosis, and treatment to the study group . RESULTS . The results confirm that ulcerative mucositis is a significant risk factor for alpha-hemolytic streptococcal bacteremia among autologous BMT patients . Of the 24 patients with bacteremia, 15 of 24 (62%) had ulcerative mucositis, compared with 16 of 45 (36%) of patients in the control population (P < 0.05) . Patients with ulcerative mucositis were found to be three times as likely to develop alpha-hemolytic streptococcal bacteremia as those without ulcerative mucositis (odds ratio=3.02) . Both independently and as a cofactor associated with bacteremia, mucositis adversely affected the length of hospital stay (LOS) . Of all the patients studied, those with oral ulcerations had a LOS of 34 days, compared with 29 days for patients without oral ulcerations (P < 0.05) . Of patients in the study group, those with oral ulcerations stayed in the hospital 6 days longer than patients without oral ulcerations (40 days vs . 34 days, P < 0.05) . CONCLUSIONS: Oral ulcerative mucositis is a significant, common, and important risk factor for alpha-hemolytic streptococcal bacteremia in BMT recipients with myelosuppression; it results in longer hospital stay and increased costs. J Infect Dis, 1998 Jun, 177(6), 1600 - 7 Invasion and survival of Streptococcus pyogenes in eukaryotic cells correlates with the source of the clinical isolates; Molinari G et al.; The invasiveness of 96 group A streptococci (GAS) isolates (56 from throat or skin and 40 from blood) were analyzed . GAS invasion strongly correlated with the source of the isolates, whereas no correlation was observed with the Vir type . Isolates from throat or skin exhibited the highest invasion efficiency (57% were between 0.1% and 10%) . In contrast, 77.5% of the blood isolates were noninvasive (efficiency <0.01%) and only 7.5% exhibited rates comparable to those of throat or skin isolates (>0.1%) . Immunofluorescence studies of 34 selected isolates showed that attachment and invasion are strain-related . Although isolates with high invasiveness usually exhibit high attachment, isolates that showed high attachment and no invasion or poor attachment and efficient internalization were identified . The ability of GAS to invade and survive within eukaryotic cells may provide bacteria a sure niche, in which they are protected against host defense mechanisms or antimicrobial agents favoring their local persistence. Antibiot Khimioter, 1998, 43(4), 40 - 2 {Susceptibility of community-acquired pneumonia pathogens to azithromycin}; Mitrokhin SD et al.; Two hundred and sixty eight microbial strains were tested for their antibiotic susceptibility . Azithromycin (sumamed) was shown to have an efficient inhibitory action on pneumococci, streptococci and hemophilic bacilli . Doxycycline and gentamicin were not sufficiently active against gram-positive cocci, the same as trimethoprime/sulfamethoxazole which was equally not sufficiently active against hemophilic bacilli . Adequate therapy of bronchopulmonary diseases requires the pathogen antibioticograms. J Immunol, 1998 Jun 1, 160(11), 5267 - 72 Two T cell epitopes from the M5 protein of viable Streptococcus pyogenes engage different pathways of bacterial antigen processing in mouse macrophages; Delvig AA et al.; We studied the mechanisms of MHC class II-restricted bacterial Ag processing of the surface fibrillar M5 protein from viable Streptococcus pyogenes in murine macrophages . Two previously defined T cell epitopes were studied using T cell hybridomas specific for 308-319/Ad, associated with the cell wall on the surface of streptococci, and 17-31/Ed, located at the protruding amino terminus of M5 . Studies with metabolic inhibitors showed that slow (1 h) processing of M5 308-319 occurred in late endosomes and was dependent on newly synthesized MHC class II molecules and microtubules and on communications between early and late endosomes, consistent with engagement of the classical MHC class II processing pathway . In contrast, fast (15 min) bacterial Ag processing of 17-31 occurred in early endosomes independently of newly synthesized MHC class II molecules and microtubules and of trafficking between early and late endosomes, consistent with the recycling MHC class II processing pathway . Finally, bacterial Ag processing of the epitopes exhibited differential sensitivity to blocking with anti-MHC class II Abs . Thus, two T cell epitopes of a single protective Ag from the surface of whole bacteria are routed to distinct MHC class II processing pathways. Bone Marrow Transplant, 1998 Mar, 21(6), 591 - 5 Streptococcus viridans bacteremia following autologous peripheral blood stem cell transplantation; Bilgrami S et al.; A retrospective evaluation of 200 consecutive recipients of autologous peripheral blood stem cell transplantation was conducted to ascertain the incidence and outcome of Streptococcus viridans bacteremia as well as to determine the role of prophylactic ampicillin therapy in the peri-transplant setting . Viridans streptococci were isolated from the blood of 35 individuals at a median of 6 days (range 2-8 days) following stem cell infusion . The most common isolates were S . sanguis and S . mitis . All patients received ciprofloxacin orally during the peri-transplant period . Additionally, 79 patients received oral ampicillin prophylactically against gram-positive cocci . Although none of the patients suffered a fatal outcome, three individuals developed respiratory compromise requiring mechanical ventilation . Female sex proved to be the only independent risk factor for viridans streptococcal bacteremia (P=0.04) . The shorter duration of neutropenia observed after stem cell transplantation did not impact on the incidence of S . viridans infections . Moreover, the prophylactic use of ampicillin failed to decrease the incidence of viridans sepsis and selected out organisms that were resistant to beta-lactam antibiotics. Br J Dermatol, 1998 Feb, 138(2), 229 - 35 Peripheral blood lymphocytes from psoriatic patients are hyporesponsive to beta-streptococcal superantigens; Horiuchi N et al.; The strong association of acute guttate psoriasis and streptococcal throat infection, together with the preferential use of T cells expressing a particular T-cell receptor, has suggested a role for bacterial superantigens in the pathogenesis of psoriasis . We examined the proliferative responses of peripheral blood lymphocytes (PBLs), obtained from patients with psoriasis and from healthy controls, to streptococcal superantigens, cytoplasmic membrane-associated protein (CAP) and secretion-type CAP (SCAP), isolated from group A, beta-haemolytic streptococci . PBLs from patients with psoriasis showed significantly less response to SCAP and CAP than those from healthy controls . Because there was no difference between psoriatic patients and controls in the proliferative response of PBLs to staphylococcal enterotoxin A or E (SEA, SEE) or the mitogen phytohaemagglutinin (PHA), these findings strongly suggest that the reduced reactivity to the streptococcal superantigens seems to reflect anergy of a population of PBLs to the superantigens . As the CAP used in the present study stimulates V beta 8 T cells selectively, we further examined the proliferation of V beta 8 T cells after such stimulation using flow cytometry . V beta 8 T cells obtained from three of four psoriatic patients failed to proliferate in the presence of CAP, whereas they proliferated vigorously in the presence of SEE, which activates V beta 8 T cells, confirming the specific hyporesponsiveness of PBLs from psoriatic patients to streptococcal superantigens . We then determined the effects of serum factors on the suppressed response of PBLs to the streptococcal superantigens with SCAP or CAP . It was partially restored when PBLs were cultured with sera obtained from healthy subjects, although the responses were still significantly lower than those of the healthy controls . In contrast, psoriatic sera markedly suppressed the proliferative response of PBLs from healthy controls to CAP or SCAP, but showed no suppression of the proliferative response of PBLs to SEA . Because these findings suggest the presence of specific inhibitory factors in psoriatic sera, we examined whether the inhibitory effect was caused by antisuperantigen antibody . However, no significant increase was detected in antibody titre to CAP in psoriatic sera, as has been noted in sera from patients with poststreptococcal glomerulonephritis . The present results show for the first time the hyporesponsiveness of PBLs to streptococcal superantigens and the presence of serum inhibitors that specifically inhibit T-cell response to the superantigens in psoriatic patients . These findings suggest a pathological role for streptococcal infections in the pathogenesis of psoriasis. Infect Immun, 1998 Jun, 66(6), 2666 - 73 A fibrinogen-binding protein of Staphylococcus epidermidis; Nilsson M et al.; The present study reports on fibrinogen (Fg) binding of Staphylococcus epidermidis . Adhesion of different S . epidermidis strains to immobilized Fg was found to vary significantly between different strains, and the component responsible was found to be proteinaceous in nature . To further characterize the Fg-binding activity, a shotgun phage display library covering the S . epidermidis chromosome was constructed . By affinity selection (panning) against immobilized Fg, a phagemid clone, pSEFG1, was isolated, which harbors an insert with an open reading frame of approximately 1.7 kilobases . Results from binding and inhibition experiments demonstrated that the insert of pSEFG1 encodes a specific Fg-binding protein . Furthermore, affinity-purified protein encoded by pSEFG1 completely inhibited adhesion of S . epidermidis to immobilized Fg . By additional cloning and DNA sequence analyses, the complete gene, termed fbe, was found to consist of an open reading frame of 3,276 nucleotides encoding a protein, called Fbe, with a deduced molecular mass of approximately 119 kDa . With a second phage display library made from another clinical isolate of S . epidermidis, it was possible to localize the Fg-binding region to a 331-amino-acid-long fragment . PCR analysis showed that the fbe gene was found in 40 of 43 clinical isolates of S . epidermidis . The overall organization of Fbe resembles those of other extracellular surface proteins of staphylococci and streptococci . Sequence comparisons with earlier known proteins revealed that this protein is related to an Fg-binding protein of Staphylococcus aureus called clumping factor. Infect Immun, 1998 Jun, 66(6), 2595 - 600 Mutacin production by Streptococcus mutans may promote transmission of bacteria from mother to child; Gronroos L et al.; The production of bacteriocin-like inhibitory substances, mutacins, by mutans streptococci varies among isolates . To find if the degree of mutacin activity of an isolate was related to its transmission between mother and her child, 19 mothers and their 18-month- to 3-year-old children were sampled for their oral mutans streptococci . In addition, the stability of mutacin activity was studied with isolates from the mothers and with isolates from five unrelated 5-year-old children in 5- to 7-year follow-up studies . A total of 145 oral mutans streptococcal isolates were serotyped by immunodiffusion, ribotyped, and mutacin typed by the stab culture technique . Mutacin was produced by 88% of the strains against more than 1 of the 14 indicator strains, representing mutans streptococci, Streptococcus sanguis, Streptococcus salivarius, Streptococcus oralis, Streptococcus gordonii, and Streptococcus pyogenes . Streptococcus mutans isolates showed more inhibitory activity than did Streptococcus sobrinus isolates . Identical ribotypes had similar mutacin activity profiles within a subject, initially and in the follow-up studies, in all but two cases . The mothers harbored a total of 37 different mutans streptococcal ribotypes . Six children were negative for mutans streptococci . Transmission was probable in 9 of 20 mother-child pairs on the basis of the presence of identical strains, as determined by ribotyping and bacteriocin (mutacin) typing . S . mutans strains shared between a mother and her child showed a broader spectrum of inhibitory activity than did nontransmitted strains . In conclusion, the mutacin activity of clinical isolates is reasonably stable, and this virulence factor seems to be of clinical importance in early colonization by S . mutans. Med Arh, 1996, 50(3-4), 93 - 4 {Comparison of the major cardio-rheumatologic diseases at the Pediatric Clinic before and during the war}; Mesihovic H et al.; This article presented the analysis of structure of morbidity of cardiorheumatological diseases at Pediatric's Clinic Sarajevo, before and during the war . The results showed that number of acquired heart diseases has not decreased, with permanent presence of streptococci. Cleve Clin J Med, 1998 May, 65(5), 241 - 9 Group A streptococcal necrotizing fasciitis . Diagnosing and treating the "flesh-eating bacteria syndrome"; File TM Jr et al.; Over the past decade the incidence of necrotizing fasciitis due to group A streptococci has increased . Appropriate management of this life-threatening infection requires rapid recognition, immediate antibiotic therapy, and expeditious surgical debridement or excision. Scand J Immunol, 1998 Apr, 47(4), 314 - 23 Cytokine response to group B streptococcus infection in mice; Rosati E et al.; This study was undertaken to better understand the complex relationship between specific and non-specific host defence mechanisms and group B streptococci (GBS) . A comprehensive kinetics analysis of cytokine mRNA expression was performed, by Northern blot assay, in peritoneal exudate cells (PEC) and spleen cells (SC) recovered from CD-1 mice at various times during the course of an intraperitoneal infection with a lethal dose (5 x 10(3) microorganisms/mouse) of type Ia GBS, reference strain 090 (GBS-Ia) . Analysis of cytokines involved in the development of a specific TH response shows that GBS-Ia in PEC induce only a weak increase of IL-2 mRNA expression and in SC a cytokine pattern characterized by IL-2, IFN-gamma and IL-12 in the absence of IL-4, IL-5 and IL-10 . This selected cytokine pattern could provide appropriate conditions for the development of a TH1 response . Analysis of inflammatory cytokines, which are usually induced early during an in vivo infection, shows that there is a significant expression of mRNA specific for IL-1beta, TNFalpha and IL-6, both in PEC and SC only at 24 h which persists at a high level until 36 h . This delayed cytokine induction, accompanied by the contemporary activation of splenic phagocytic cells, occurs only when the number of GBS-Ia is extremely high . In fact, at 24 h GBS-Ia have heavily colonized all organs . In vitro infection of thioglycollate-elicited peritoneal macrophages confirms that the ability of GBS-Ia to induce a strong inflammatory cytokine response depends strictly on the number of infecting microorganisms . Indeed, macrophages respond to GBS-Ia with a very rapid induction of IL-1beta and TNFalpha mRNA when infected at a ratio of 1:10, but not at 100:1 . Two major observations emerged from this study: (1) GBS-Ia, by inducing a cytokine pattern which seems to favour development of a TH1 response, could evade antibody production essential for resistance to GBS; and (2) inflammatory cytokine response is induced when a heavy microbial invasion of the host has already occurred . These novel features of GBS-Ia could contribute to the development and progression of lethal infection in mice. Blood, 1998 May 1, 91(9), 3439 - 46 Reduced ex vivo interleukin-8 production by neutrophils in septic and nonseptic systemic inflammatory response syndrome; Marie C et al.; Ex vivo cytokine production by circulating lymphocytes and monocytes is reduced in patients with infectious or noninfectious systemic inflammatory response syndrome . Very few studies have addressed the reactivity of polymorphonuclear cells (PMN) . To analyze further the relative contribution of systemic inflammatory response syndrome alone or in combination with infection we studied the interleukin-8 (IL-8) production by PMN isolated from patients who had undergone cardiac surgery with cardiopulmonary bypass (CPB) and patients with sepsis . Cells were activated with either lipopolysaccharide (LPS) or heat-killed streptococci . Compared with healthy controls, the release of IL-8 by PMN in both groups of patients was significantly reduced whether activated by LPS, independently of its concentration and origin, or by heat-killed streptococci . These observations suggest that stressful conditions related to inflammation, independently of infection, rapidly dampened the reactivity of circulating PMN . We investigated whether the observed diminished reactivity of PMN might reflect an endotoxin tolerance phenomenon . Our in vitro experiments with PMN from healthy controls indicated that PMN could not be rendered tolerant stricto sensu . However, our data suggested that LPS-induced mediators such as IL-10 may be responsible for the observed anergy in patients. J Clin Microbiol, 1998 Apr, 36(4), 1135 - 6 Bile-esculin test for presumptive identification of enterococci and streptococci: effects of bile concentration, inoculation technique, and incubation time; Chuard C et al.; The bile-esculin test is used to differentiate enterococci and group D streptococci from non-group D viridans group streptococci . The effects on test performance of the concentration of bile salts, inoculum, and duration of incubation were examined with 110 strains of enterococci, 30 strains of Streptococcus bovis, and 110 strains of non-group D viridans group streptococci . Optimal sensitivity (> 99%) and specificity (97%) of the bile-esculin test can be obtained with a bile concentration of 40%, a standardized inoculum of 10(6) CFU, and incubation for 24 h. J Dent, 1998 Mar, 26(3), 233 - 8 Effect of 6-monthly applications of chlorhexidine varnish on incidence of occlusal caries in permanent molars: a 3-year study; Fennis-le YL et al.; OBJECTIVES: The aim of this study was to assess the effect of a chlorhexidine varnish on occlusal caries incidence when applied 6-monthly into the fissures of erupting and freshly erupted permanent molars . METHODS: In a double-blind clinical trial, 332 children aged 5/6 and 11/12 years attending a Child Dental Health Centre were randomly assigned to a control and an experimental group . Criteria for inclusion in the study were that all first permanent molars in 5-6-year-olds and all second permanent molars in 11-12-year-olds either had recently erupted, or were in a stage of eruption, or would erupt within half a year . At baseline, counts of dmfs/DMFS and mutans streptococci in saliva were recorded . During a maximum of 3 years, every 6 months the occlusal surfaces of molars in the experimental group received a 40% chlorhexidine varnish application, whereas those in the control group received a placebo varnish application . RESULTS: Data of 316 children were analysed and ANOVA showed no significant occlusal caries reduction in this sample of Dutch 5/6- and 11/12-year-old children . After stratification into low and high caries risk groups, a statistically significant caries-reducing effect on occlusal caries in permanent molars was found in the group of children with > or = 10(6) mutans streptococci per ml saliva (P < 0.05) . CONCLUSION: Six-monthly application of chlorhexidine varnish has no caries-reducing effect on occlusal caries in recently erupted permanent molars in a population with low caries prevalence. Mol Microbiol, 1998 Apr, 28(1), 157 - 67 High-frequency intracellular infection and erythrogenic toxin A expression undergo phase variation in M1 group A streptococci; Cleary PP et al.; A clonal variant of serotype M1 group A streptococcus, strain 90-131, disseminated to several continents, where it was associated with severe systemic infections and toxic shock . Although this strain harbours the speA gene and is efficiently internalized by human epithelial cells, clinical isolates often fail to express the erythrogenic toxin under laboratory growth conditions . Cultures of strain 90-131 were observed to phase vary between small, dry, compact and larger, more mucoid colonies . The former were shown to be poorly internalized by epithelial cells . Analysis of RNA by Northern hybridization demonstrated that the emml, hasA and speA genes were weakly transcribed in cultures derived from the small colonies and highly transcribed in those derived from the large colonies . An insertion mutation in mga (the multigene activator) downregulated the invasion of epithelial cells and the transcription of emm1 and hasA, but had little impact on the transcription of speA . These are the first data to suggest the existence of a common regulatory circuit linking intracellular invasion, M protein, hyaluronic acid capsule and erythrogenic toxin expression by group A streptococcus . Moreover, the genetic instability of toxin expression exhibited by this serotype may impact on laboratory studies that attempt to associate toxin production with toxic shock. Antimicrob Agents Chemother, 1998 May, 42(5), 1073 - 5 Five-day cefdinir treatment for streptococcal pharyngitis . Cefdinir Pharyngitis Study Group; Tack KJ et al.; A multicenter, randomized, controlled, investigator-blind study was performed to evaluate the safety and efficacy of oral cefdinir versus oral penicillin V for the treatment of pharyngitis due to group A beta-hemolytic streptococci (GABHS) . Patients 13 years of age and older were randomized to receive either oral cefdinir (300 mg twice a day) for 5 days followed by placebo for 5 days or oral penicillin V (250 mg four times a day) for 10 days . Throat cultures were obtained, and signs and symptoms of pharyngitis were recorded at study admission and follow-up visits on study days 11 to 15, 16 to 20, and 25 to 31 . Patients kept a diary to record medication intake and their assessment of throat pain at admission and at each day of study treatment . Five hundred fifty-eight patients were enrolled, of whom 432 (77.4%) were clinically and microbiologically evaluable . The GABHS eradication rates 5 to 10 days after completion of therapy were 193 of 218 (88.5%) in the cefdinir group and 176 of 214 (82.2%) in the penicillin group (P = 0.053) . Clinical cure rates were 89.0 and 84.6%, respectively (P = 0.80) . By the time of the long-term follow-up visit, 2 to 3 weeks after completion of treatment, 156 of 191 (81.7%) of the assessable cefdinir patients and 152 of 195 (77.9%) of the penicillin patients remained free of GABHS . Both treatments were well tolerated, with adverse reaction rates of 18.3% in the cefdinir study arm and 15.0% in the penicillin study arm (P = 0.278) . Five-day treatment with cefdinir is safe and effective therapy for GABHS pharyngitis . Based on its twice-a-day dosage and shorter course of therapy, leading to potentially greater patient compliance, cefdinir may be considered for use in the treatment of pharyngitis caused by GABHS. J Infect Dis, 1998 May, 177(5), 1418 - 21 The effect of lactic acid on mononuclear cell secretion of proinflammatory cytokines in response to group B streptococci; Steele PM et al.; This study found that lactate alone had a stimulatory effect (207.1 +/- 16.3%; P = .001) on tumor necrosis factor (TNF)-alpha production by human mononuclear cells with the most profound secretion being at pathologic concentrations of 4-8 mM lactate . Furthermore, exposure of these mononuclear cells to group B streptococci (GBS, 10(5) cfu) resulted in TNF-alpha production of up to 621.1 +/- 42% of control; the combination of lactic acid and GBS increased TNF-alpha production up to 1019.3 +/- 16.1% (P = .001) . The combination of GBS and lactate also enhanced the secretion of interleukin (IL)-1beta and IL-6 . Lactate in pathologic concentrations, therefore, likely enhances the secretion of these inflammatory mediators and contributes to septic shock and meningitis caused by GBS. Acta Vet Scand, 1998, 39(1), 119 - 26 Bovine mastitis in Finland in 1988 and 1995--changes in prevalence and antimicrobial resistance; Myllys V et al.; Two surveys were carried out (during 1988 and 1995) to estimate the prevalence of bovine mastitis in Finland . In 1988, 17,111 quarter milk samples were obtained from 4495 cows, and in 1995 the corresponding figures were 10,410 and 2648 . Antimicrobial susceptibility of mastitis pathogens was studied . Prevalence of mastitis on cow basis decreased from 47.8% in 1988 to 37.8% in 1995 . Staphylococci was the largest group of pathogens isolated . The proportion of Staphylococcus aureus decreased and that of coagulase-negative staphylococci (CNS) increased . The proportion of strains resistant to at least one antibacterial drug increased with regard to S . aureus from 36.9% in 1988, to 63.6% in 1995 and with CNS from 26.6% to 49.7% . Most of the increase in antibacterial resistance was due to a higher number of beta-lactamase producing strains . Multiresistance also increased, but it was proportional to the overall increase in resistance . All the predominant mastitis streptococci were susceptible to beta-lactams tested. Zhonghua Kou Qiang Yi Xue Za Zhi, 1996 Nov, 31(6), 323 - 5 {Location of the surface protein antigen I/II on Mutans Streptococci with immunogold electron microscope}; Fang M et al.; Mutans Streptococci possess a number of surface protein antigens . The surface protein antigen I/II with a molecular mass of 190,000 is considered to play an important role in the initial attachment to tooth surface . The antigen is highly immunogenic and has been successfully used as a vaccine against dental caries . The object of this study is to locate the surface protein antigen I/II of Mutans Streptococci with immunogold electron microscope . The results suggest that (1) antigen I/II locate on the cell wall surface of serotype c, e, f; (2) antigen I/II locate on the "fuzz coat" of the cell wall of serotype d, g; (3) some antigen I/II locate at the surface of cell wall of serotype a; (4) antigen I/II are absent on the cell wall surface of serotype b strain. Afr Dent J, 1994, 8, 11 - 5 Distribution of mutans streptococci among Nigerian school children; el-Nadeef MA et al.; A group of 504 Nigerian school children with an average age of 13 years were included in this study . The children attended 4 schools in the Jos area, Plateau State, and Toro Local Government area of Bauchi State . Salivary levels of mutans streptococci in these children were estimated with the "Strip mutans" test . Mutans streptococci were found in 73% of the urban children and 65% of the rural ones . Compared to most known populations, the prevalence of mutans streptococci was relatively low (69%) . On the other hand 45% of the children had high salivary levels of mutans streptococci (score 3, approximately > 10(6) per ml saliva). Electrophoresis, 1998 Apr, 19(4), 597 - 601 Mosaic genes and their role in penicillin-resistant Streptococcus pneumoniae; Hakenbeck R; Penicillin resistance in clinical isolates of Streptococcus pneumoniae is mediated by mosaic genes encoding altered penicillin binding proteins . Mosaic sequence blocks are the result of a genetic exchange between related streptococcal species . It is likely that resistance has emerged in commensal streptococci before being transferred into the pneumococcus . Closely related mosaic genes are found in different pneumococcal clones and in different streptococcal species isolated worldwide since the first reports on such strains in the late 70s, demonstrating the importance of commensal streptococci for the spread of selectable markers in naturally transforming pathogens. Egypt Dent J, 1993 Oct, 39(4), 527 - 32 The incidence of Streptococcus pyogenes in throat and plaque cultures in cases with acute throat infections; Aboul Dahab OM et al.; This study was performed on 50 children with clinically suspected streptococcal upper respiratory tract infection at Abu-El-Rich hospital . DMF and plaque indices were recorded for all cases . Plaque and throat swabs were taken from all patients and directly inoculated on sheep blood agar plates . Haemolytic streptococci were further identified presumptively using bacitracin . 34% of cases had Beta-haemolytic streptococci type A (streptococcus pyogenes) in throat and 8% of cases had the same bacteria in plaque as well . This emphasizes the importance of proper plaque control in children together with the prophylactic ten days of antibiotic treatment in cases with acute throat infection to avoid the development of rheumatic heart disease in children. Pediatr Emerg Care, 1998 Apr, 14(2), 109 - 11 A streptococcal score card revisited; Wald ER et al.; OBJECTIVE: To evaluate the utility of a simple scoring system as a predictor of obtaining a positive throat culture for group A streptococci (GAS) . DESIGN: Prospective descriptive study . Scores were assigned prior to the availability of the results of throat cultures . SETTING: Emergency department and walk-in clinic of the Children's Hospital of Pittsburgh . PATIENTS: Patients were 365 children between the ages of two and 16 years with acute onset of sore throat and a history of or documentation of fever within the preceding 24 hours . INTERVENTIONS: A streptococcal score was assigned on the basis of a 6-point schema in which the features were 1) age; 2) season; 3) temperature of at least 38.3 degrees C; 4) adenopathy; 5) pharyngeal erythema, edema, or exudate; and 6) no symptoms of a viral upper respiratory infection (conjunctivitis, rhinorrhea, or cough) . A throat culture was performed for the isolation of GAS . MAIN OUTCOME MEASURE: Positive predictive value of the streptococcal score in identifying children with a positive throat culture for GAS . RESULTS: A score of 5 or 6 predicted a positive culture for GAS in 59 and 75% of children, respectively . In patients with evidence of acute pharyngitis, the combination of age between five and 15 years, fever and absence of upper respiratory symptoms predicted a positive culture for GAS in 72% of patients . CONCLUSIONS: The score can be used to predict the likelihood that a throat culture will be positive for GAS. W V Med J, 1998 Mar-Apr, 94(2), 90 - 2 Bacteremia due to streptococcus zooepidemicus associated with an abdominal aortic aneurysm; Albarracin C et al.; Group C streptococci are a common cause of infection in animals but a rare cause of infection in man . To our knowledge, the English literature contains only three cases of arteriosclerotic aneurysms of the abdominal aorta (AAA) secondarily infected with group C Beta-hemolytic Streptococci . Two cases did not survive in spite of adequate antibiotic therapy . One patient responded to aortic repair with a bifurcated woven dacron graft followed by four weeks of high-dose intravenous penicillin . This article describes our clinical experience with a patient who survived an atherosclerotic aneurysm of the abdominal aorta and S . zooepidemicus infection. Am J Gastroenterol, 1998 Apr, 93(4), 652 - 3 Immunoblastic lymphadenopathy presenting as an acute abdomen and mixed bacteremia with Eikenella corrodens and group C streptococci; Monkemuller KE et al.; Eikenella corrodens and group C streptococci have been noted to occur with increased frequency in patients with underlying malignancies and immunosuppressive states . We report a case where these organisms were isolated from a patient with immunoblastic lymphadenopathy and discuss the possible association between these two conditions. J Immunol, 1998 May 1, 160(9), 4535 - 42 Involvement of CD14 and complement receptors CR3 and CR4 in nuclear factor-kappaB activation and TNF production induced by lipopolysaccharide and group B streptococcal cell walls; Medvedev AE et al.; This study was undertaken to evaluate the role of CD14 and complement receptors type 3 (CR3) and 4 (CR4) in mediating TNF release and NF-kappaB activation induced by LPS and cell wall preparations from group B streptococci type III (GBS) . LPS and GBS caused TNF secretion from human monocytes in a CD14-dependent manner, and soluble CD14, LPS binding protein, or their combination potentiated both LPS- and GBS-induced activities . Blocking of either CD14 or CD18, the common beta-subunit of CR3 and CR4, decreased GBS-induced TNF release, while LPS-mediated TNF production was inhibited by anti-CD14 mAb only . Chinese hamster ovary cell transfectants (CHO) that express human CD14 (CHO/CD14) responded to both LPS and GBS with NF-kappaB translocation, which was inhibited by anti-CD14 mAb and enhanced by LPS binding protein . While LPS showed fast kinetics of NF-kappaB activation in CHO/CD14 cells, a slower NF-kappaB response was induced by GBS . LPS also activated NF-kappaB in CHO cells transfected with either human CR3 or CR4 cDNA, although responses were delayed and weaker than those of CHO/CD14 cells . In contrast to LPS, GBS failed to induce NF-kappaB in CHO/CR3 or CHO/CR4 cells . Both C3H/OuJ (Lps{n}) and C3H/HeJ (Lps{d}) mouse peritoneal macrophages responded to GBS with TNF production and NF-kappaB translocation, whereas LPS was active only in C3H/OuJ macrophages . Thus, LPS and GBS differentially involve CD14 and CR3 or CR4 for signaling NF-kappaB activation in CHO cells and TNF release in human monocytes, and engage a different set of receptors and/or intracellular signaling pathways in mouse macrophages. Langenbecks Arch Chir Suppl Kongressbd, 1997, 114, 508 - 12 {Necrotizing fasciitis}; Billing A et al.; Necrotizing fasciitis has changed considerably over time . The disease used to be due to group A streptococci and affected otherwise quite healthy or traumatized subjects . Today we see multibacterial infections in polymorbid or immunocompromised patients . Rapid and resolute surgery is of critical prognostic value . Early clinical recognition may be difficult . Sometimes frozen-section biopsy proves helpful . Septic immune response and organ failure develop rapidly in these patients . After vigorous staged necrosectomy, extensive plastic reconstruction is mostly required. Oral Microbiol Immunol, 1998 Feb, 13(1), 17 - 22 Arbitrarily primed polymerase chain reaction fingerprinting for the genotypic identification of mutans streptococci from humans; Li Y et al.; Determining whether two strains of bacteria are unique, identical or clonally related depends upon comparisons of phenotypic and/or genotypic traits . Individual isolates can then be grouped according to differences or similarities among those traits . One method of genotyping strains of bacteria is commonly referred to as chromosomal DNA fingerprinting . Previously, we generated chromosomal DNA fingerprints of mutans streptococci to study the transmission of this organism within families . Here, we developed and evaluated an arbitrarily primed polymerase chain reaction (AP-PCR) method for the genotypic characterization of mutans streptococci . Results were compared to those derived from the more conventional chromosomal DNA fingerprinting method . First, we showed that randomly selected clinical isolates displayed a unique banding profile by both methods; the mean similarity indices between DNA fragment patterns were 0.69 for chromosomal DNA fingerprinting and 0.74 for AP-PCR . This indicated that AP-PCR demonstrated less diversity than chromosomal DNA fingerprinting . Subsequently, we tested the agreement between chromosomal DNA fingerprinting and AP-PCR in determining genotypic similarities among 21 mutans streptococci strains obtained from 10 mother-child pairs, and 5 mutans streptococci strains from 5 fathers . The Kappa value for agreement was 0.88 . We conclude that AP-PCR, which generates patterns of 8 to 12 amplicons, is capable of distinguishing strains of mutans streptococci among non-related individuals . Moreover, AP-PCR can discern both homogeneity and heterogeneity of mutans streptococci genotypes among mother and child pairs . Overall, we found that AP-PCR gave results comparable to those of chromosomal DNA fingerprinting. Oral Microbiol Immunol, 1998 Feb, 13(1), 11 - 6 Rapid isolation of chromosomal DNA from oral streptococci and polymerase chain reaction-oriented restriction fragment-length polymorphism analysis for genetic heterogeneity; Shiroza T et al.; We have extensively modified the published method for the lysis of gram-positive bacteria to isolate chromosomal DNA from only 1 ml of oral streptococcal overnight culture . Cells were incubated with lysozyme and R Nase A in the presence of polyethylene glycol . After centrifugation, cells were lysed with sodium dodecyl sulfate and proteinase K . Following ethanol precipitation, sodium dodecyl sulfate solution was added to the residue, and the pellet was completely dispersed by incubating at 65 degrees C . The chromosome was purified by extraction over phenol and chloroform . Two regions corresponding to the ribosomal RNA (rrn) operon and the glucosyltransferase gene were amplified using the chromosome from Streptococcus mutans and Streptococcus sobrinus by polymerase chain reaction (PCR) . Genetic heterogeneity was assessed by restriction fragment-length polymorphism (PCR-RFLP) . The PCR-RFLP analysis readily allowed us to subtype each strain, suggesting that the strategy presented here will provide a useful tool to verify epidemiological studies at the molecular level. Oral Microbiol Immunol, 1998 Apr, 13(2), 89 - 96 Structural integrity of infant salivary immunoglobulin A (IgA) in IgA1 protease-rich environments; Smith DJ et al.; IgA1 protease-secreting Streptococcus mitis often dominate the oral flora of the neonate and young infant at a time when salivary IgA concentrations are low and usually enriched in the secretory IgA1 subclass . To study the possible influence of these degradative enzymes on emerging host immunity, the presence of IgA1 protease-secreting streptococci was related to the structural integrity of salivary IgA in 24 infants who were between 3 and 18 weeks of age . At least one IgA1 protease-secreting strain could be isolated from the oral mucosa of 79% of the infants and comprised a mean of 38% of the total streptococcal flora of these infants . Chromatographic analyses of resting whole saliva from 16 infants revealed, however, that 95% of the secretory IgA (range 88-100%) remained intact, indicating that minimal immediate IgA proteolysis occurred in the bulk salivary phase . Proteolysis of infant salivary IgA, presumably by indigenous IgA1 protease, could be observed after extended (more than 7 h) in situ incubation of whole saliva at 37 degrees C . Salivary IgA antibody activities to S . mitis components were demonstrated by Western blot in infants colonized with an IgA1 protease-secreting flora . Preliminary evidence suggested that salivary antibody activity in some infants may be directed to IgA1 protease . Thus, the infant's antibody defenses not only appear very early in life but are substantively intact in the bulk salivary phase, even when the oral cavity is colonized with IgA1 protease-secreting streptococcal flora. Int J Antimicrob Agents, 1998 Feb, 9(4), 219 - 25 Retrospective study of teicoplanin as home continuation of hospital-initiated therapy; South R; Data were collected retrospectively on 69 cases of infection in 57 patients who had received teicoplanin on a non-inpatient basis for at least part of a course of therapy . A total of 52 records related to patients who were undergoing treatment for a hematological malignancy, most of whom had central venous catheter infection or catheter-related septicemia . Eleven cases were related to the treatment of bone and/or joint infection, two were concerned with the treatment of endocarditis and two were linked to soft tissue infections . In most cases in which bacteriological identification was made, coagulase-negative staphylococci were the causative organisms . Other pathogens included Staphylococcus aureus, streptococci, enterococci and diphtheroids . In most cases, the dose of teicoplanin used corresponded to the recommended dose for serious infections . All patients received teicoplanin intravenously and some patients administered the drug themselves . Clinical success (cure plus improvement) was achieved in 94% of evaluable cases and bacteriological success in 83% . Two adverse events were reported, but neither related to problems of antibiotic administration in a non-inpatient setting. Infect Immun, 1998 May, 66(5), 2362 - 4 Clot formation by group A streptococci; Donabedian H et al.; Group A streptococci of several different M serotypes can cause human plasma to clot in nutrient-poor media . Addition of glucose to the medium prevents clot formation . Once formed, clots are stable for several days and can be lysed on addition of exogenous streptokinase or urokinase . Clot lysis can also be achieved by addition of glucose to a clot containing wild-type group A streptococci but not clots containing an isogenic mutant in which the ska gene was inactivated. Infect Immun, 1998 May, 66(5), 2279 - 83 Opsonic antibodies to the surface M protein of group A streptococci in pooled normal immunoglobulins (IVIG): potential impact on the clinical efficacy of IVIG therapy for severe invasive group A streptococcal infections; Basma H et al.; The surface M protein of group A streptococci (GAS) is one of the major virulence factors for this pathogen . Antibodies to the M protein can facilitate opsonophagocytosis by phagocytic cells present in human blood . We investigated whether pooled normal immunoglobulin G (IVIG) contains antibodies that can opsonize and enhance the phagocytosis of type M1 strains of GAS and whether the levels of these antibodies vary for different IVIG preparations . We focused on the presence of anti-M1 antibodies because the M1T1 serotype accounts for the majority of recent invasive GAS clinical isolates in our surveillance studies . The level of anti-M1 antibodies in three commercial IVIG preparations was determined by enzyme-linked immunosorbent assay (ELISA), and the opsonic activity of these antibodies was determined by neutrophil-mediated opsonophagocytosis of a representative M1T1 isolate . High levels of opsonic anti-M1 antibodies were found in all IVIG preparations tested, and there was a good correlation between ELISA titers and opsonophagocytic activity . However, there was no significant difference in the levels of opsonic anti-M1 antibodies among the various IVIG preparations or lots tested . Adsorption of IVIG with M1T1 bacteria removed the anti-M1 opsonic activity, while the level of anti-M3 opsonophagocytosis was unchanged . Plasma was obtained from seven patients with streptococcal toxic shock syndrome who received IVIG therapy, and the level of anti-M1 antibodies was assessed before and after IVIG administration . A significant increase in the level of type M1-specific antibodies was found in the plasma of all patients who received IVIG therapy (P < 0.006) . The results reveal another potential mechanism by which IVIG can ameliorate severe invasive group A streptococcal infections. Infect Immun, 1998 May, 66(5), 2026 - 32 Immunologic memory induced by a glycoconjugate vaccine in a murine adoptive lymphocyte transfer model; Guttormsen HK et al.; We have developed an adoptive cell transfer model in mice to study the ability of a glycoprotein conjugate vaccine to induce immunologic memory for the polysaccharide moiety . We used type III capsular polysaccharide from the clinically relevant pathogen group B streptococci conjugated to tetanus toxoid (GBSIII-TT) as our model vaccine . GBS are a major cause of neonatal infections in humans, and type-specific antibodies to the capsular polysaccharide protect against invasive disease . Adoptive transfer of splenocytes from mice immunized with the GBSIII-TT conjugate vaccine conferred anti-polysaccharide immunologic memory to naive recipient mice . The transfer of memory occurred in a dose-dependent manner . The observed anamnestic immune response was characterized by (i) more rapid kinetics, (ii) isotype switching from immunoglobulin M (IgM) to IgG, and (iii) 10-fold-higher levels of type III-specific IgG antibody than for the primary response in animals with cells transferred from placebo-immunized mice . The adoptive cell transfer model described in this paper can be used for at least two purposes: (i) to evaluate conjugate vaccines with different physicochemical properties for their ability to induce immunologic memory and (ii) to study the cellular interactions required for an immune response to these molecules. Arch Intern Med, 1998 Apr 27, 158(8), 868 - 72 Bacteremic pneumonia in neutropenic patients with cancer: causes, empirical antibiotic therapy, and outcome; Carratala J et al.; BACKGROUND: Bacteremic pneumonia is a major cause of death among neutropenic patients with cancer . METHODS: We analyzed the causes, empirical antibiotic therapy, and outcome of 40 consecutive cases of bacteremic pneumonia identified among 408 episodes of bacteremia in adult neutropenic patients with cancer, prospectively documented from 1986 to 1995 . RESULTS: The most frequent causative organisms were Pseudomonas aeruginosa (17 cases), Streptococcus pneumoniae (12 cases), Escherichia coli (5 cases), and Streptococcus mitis (3 cases) . Overall, P . aeruginosa and S . pneumoniae caused 72.5% of all episodes of bacteremic pneumonia, compared with 11.4% of bacteremic episodes from other sources (P< .001) . Thirty patients received ceftazidime and 10 patients received imipenem as the beta-lactam component of the initial empirical treatment . All strains of P . aeruginosa were susceptible to both agents . Forty-seven percent of streptococcal strains were penicillin resistant and showed a decreased susceptibility to ceftazidime (minimum inhibitory concentration ranged from 1 to 64 microg/mL) . Five patients (12.5%) were considered to have received inappropriate empirical antibiotic therapy . Attributable mortality in patients with bacteremic pneumonia was higher than in patients with bacteremia from other sources; 22 (55%) of the 40 patients with bacteremic pneumonia died, whereas 39 (10.6%) of the 368 patients with bacteremia from other sources died (P<.001) . CONCLUSIONS: Our data suggest that bacteremic pneumonia in neutropenic cancer patients is associated with a poor outcome and that empirical antibiotic therapy for neutropenic patients with pneumonia should include agents active against both P . aeruginosa and cephalosporin-resistant streptococci. Arch Oral Biol, 1998 Jan, 43(1), 33 - 8 Stabilization of the glucan-binding lectin of Streptococcus sobrinus by specific ligand; Denson AM et al.; Cell suspensions of Streptococcus sobrinus can be aggregated by high molecular-weight alpha-1,6 glucans . The aggregation depends on the fidelity of a cell wall-bound, glucan-binding lectin (GBL) . It is thought that the lectin may play a part in the sucrose-dependent accretion of streptococci in dental plaques . Results showed that the anionic detergent, sodium dodecyl sulphate (SDS) was a potent inhibitor of the lectin . When cells were incubated in SDS and washed to remove the detergent, lectin activity was diminished . Following incubation of the cells with SDS in the presence of glucan T-10, a low molecular-weight alpha-1,6 glucan, the loss of activity was less pronounced, suggesting that the glucan afforded partial protection against denaturation . Urea and guanidine hydrochloride were good inhibitors of the lectin, but, unlike SDS, were not able to inhibit it irreversibly, except at very high concentrations . Cationic detergents, such as cetylpyridinium bromide (and chloride), also irreversibly denatured the streptococcal lectin, but were not as effective as SDS in abolishing its activity . The results suggest that alpha-1,6 glucan stabilizes the GBL of S . sobrinus, rendering it more resistant to the effect of chaotropes . This may be one reason why dental plaques tend to resist detergents in dentrifices. J Chromatogr A, 1998 Mar 6, 798(1-2), 65 - 72 Fast isolation of protein receptors from streptococci G by means of macroporous affinity discs; Kasper C et al.; A fast affinity method for the semi-preparative isolation of recombinant Protein G from E . coli cell lysate is proposed . Rigid, macroporous affinity discs based on a glycidyl methacrylate-co-ethylene dimethacrylate polymer were used as chromatographic supports . The specific ligands (here human immunoglobulin G, hIgG) were immobilized by the one-step reaction between native epoxy groups of the polymer surface and epsilon-amino groups of the IgG molecules . No intermediate spacer was necessary to reach full biological activity of the ligand . The globular affinity ligands are located directly on the pore wall surface and are thereby freely accessible to target molecules (here Protein G) migrating with the mobile phase through the pores . It is shown that the conditions chosen for the hIgG immobilization do not involve an active site of the protein and thus do not bias the formation of the affinity complex . Chromatographically determined constants of dissociation of hIgG-Protein G affinity complexes confirm the high selectivity of this separation method . Two different aspects of the affinity separation are discussed, which differ mostly in terms of scale . In disc chromatography, high volumetric flow velocities are possible because of the small backpressure . Since in addition the mass transfer is more efficient, it becomes possible to achieve very short analysis times . The discs proposed can be used in a single-step enrichment of Protein G from lysates of non-pathogenic E . coli . Gel electrophoresis data are used to demonstrate the high degree of purity achieved for the final product. Int J Syst Bacteriol, 1998 Jan, 48 Pt 1, 117 - 25 Whole-cell protein electrophoretic analysis of viridans streptococci: evidence for heterogeneity among Streptococcus mitis biovars; Vandamme P et al.; One hundred reference strains representing all species belonging to the different phylogenetic lineages of the viridans streptococci were examined by means of one-dimensional whole-organism protein electrophoresis . For most of the species examined, multiple strains characterized by DNA-DNA hybridization were included and, wherever described, representatives of different biochemical variants were analysed . Most species were clearly differentiated . The data support the viewpoint that members of the Streptococcus anginosus group constitute a single species and indicate that Streptococcus mitis biovar 2 is a heterogeneous taxon comprising strains from several streptococcal species. South Med J, 1998 Apr, 91(4), 333 - 7 Invasive disease due to group A beta-hemolytic streptococci: continued occurrence in children in North Carolina; Givner LB; BACKGROUND: We have previously reported a significant increase beginning in the late 1980s in the incidence of invasive disease due to group A beta-hemolytic streptococci (GABS) in children admitted to our hospital . To determine subsequent trends in epidemiology, we have continued to monitor cases . METHODS: We prospectively monitored cases of invasive disease due to GABS at Brenner Children's Hospital during the 5 1/2 years (July 1, 1990, to December 31, 1995) since our last report . RESULTS: Twenty-five patients had GABS isolated from normally sterile sites . Their presentations were varied . One patient had necrotizing fasciitis and one had toxic shock-like syndrome . The one death was that of a newborn infant with sepsis and meningitis . The proportion of GABS infections associated with varicella was significantly greater during this period (7/25, 28%) than during the period 1983 to 1990 (1/22, 5%) . Isolates were available tor study from 24 patients . Serotypes were M1 (4), M3 (4), M6 (2), M12 (3), M22 (3), M75 (1) and M-nontypeable (7) . The number of cases of invasive disease seen annually from 1983 through 1995 also is reviewed . CONCLUSIONS: The resurgence of invasive disease due to GABS in children noted in the late 1980s continues through the first half of the 1990s . The clinical manifestations are varied as are the causative M-types . As almost one third of cases in this series were associated with varicella infection, widespread use of the varicella vaccine may lead to a decrease in the incidence of invasive GABS disease. Ir Med J, 1998 Jan-Feb, 91(1), 21 - 2 Group B streptococcus (GBS) colonisation among expectant Irish mothers; Kieran E et al.; Group B streptococci (GBS) have been recognised for more than three decades as a serious cause of perinatal morbidity and neonatal mortality . The aim of this study was to accurately determine the prevalence of GBS carriage and the serotype distribution among pregnant Irish women . 504 women attending antenatal clinics had two swabs (one perianal and one low vaginal) taken in the last four weeks of their pregnancy . These were placed in Todd Hewitt broth and then subcultured onto solid media . Serotyping of the isolates was performed by the Central Public Health Laboratory, London . GBS colonised women were treated with prophylactic antibiotics in labour and their infants received prophylaxis for 48 hours . 129 women (25.6%) were found to be asymptomatically colonised with GBS . Dual site screening (low-vaginal and perianal) identified 5% more GBS carriers than one site would have done . Serotypes identified included types I (30%), II (17%), III (30%), IV (1%) and V (9%) . GBS colonisation is very common in Irish pregnant women and therefore a strategy for management in pregnancy ought to be developed in order to reduce the recognised occurrence of neonatal morbidity and mortality caused by this organism. Chemotherapy, 1998 Mar-Apr, 44(2), 85 - 93 In vitro antibacterial activity of trovafloxacin and five other fluoroquinolones; Montanari MP et al.; The in vitro inhibitory and bactericidal activities of the investigational fluoroquinolone trovafloxacin were studied and compared with those of five other fluoroquinolones (ciprofloxacin, ofloxacin, pefloxacin, rufloxacin and sparfloxacin) against a wide range of clinical isolates from Italian hospitals . Against gram-positive bacteria, trovafloxacin was overall more active than the other antibiotics tested, including sparfloxacin, another gram-positive-oriented fluoroquinolone, and was active against all ciprofloxacin-resistant streptococci, enterococci, and listeriae, all ciprofloxacin-resistant Staphylococcus aureus isolates and most ciprofloxacin-resistant coagulase-negative staphylococci . Its antistaphylococcal activity was not affected by oxacillin resistance or susceptibility of the isolates, nor was its antipneumococcal activity affected by whether isolates were susceptible or resistant to penicillin . Against gram-negative bacteria, trovafloxacin retained a high potency mostly comparable with that of ciprofloxacin . Rufloxacin and pefloxacin were less active than the other fluoroquinolones against most test strains of both gram-positive and gram-negative organisms . Trovafloxacin minimal bactericidal concentrations usually equalled or exceeded by 2-4 times the minimal inhibitory concentration values, indicating that the compound is overall highly bactericidal. East Afr Med J, 1997 Nov, 74(11), 729 - 31 Secondary bacterial infection in Ghanaian patients with scabies; Adjei O et al.; From 110 patients with secondarily infected scabies lesions, 105 bacteria consisting of 66 aerobes and 39 anaerobes were isolated . A mixture of aerobic and anaerobic bacteria was present in 15 (13.6%) . The predominant aerobic and anaerobic bacteria were staphylococcous aureus 39.1% and pepostreptococcus spp . 14.2% respectively . Organisms that resided in the mucus membranes close to or in contact with the lesions predominated in those infections . Most organisms were recovered from the finger and buttock lesions . These organisms were mainly staph . aureus, beta-haemolytic streptococci group . A and peptostreptococcus . More than 80% of staph . aureus isolated were resistant to penicillin . Less than 20% of the anaerobes were resistant to penicillin . The enteric Gram-negative, E . coli and Klebsiella spp . showed 100% sensitivity to Amoxycilin/clavulanic acid and gentamicin . Pseudomonas spp . were only susceptible to gentamicin, Amoxycillin/clavulanic acid proved to be the most active therapeutic agent in in vitro against the isolated microorganisms. Medicine (Baltimore), 1998 Mar, 77(2), 122 - 39 Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G . Analysis of 23 cases and a review of the literature; Schattner A et al.; The clinical features, essential laboratory findings, management, and outcome of all 23 cases of septic arthritis caused by different serogroups of beta-hemolytic streptococcus (BHS) seen at the Stanford Medical Center, Stanford, CA, from July 1, 1985, through October 31, 1996, were reviewed and compared to those found in the literature . Group A streptococci (GAS) accounted for 9 (40%) of our cases; group B (GBS), for 7 (30%); and Group G (GGS), for 7 (30%) . No cases were caused by Group C (GCS) or F (GFS) during this period . During the same period, GAS accounted for 66 (33%) of 200 cases of bacteremia due to BHS, GBS, for 98 (49%); GCS, for 12 (6%); GFS, for 4 (2%); and GGS, for 20 (10%) . A review of potential risk factors revealed that, with the exception of GGS, male and female patients were almost equally distributed among each of the serogroups . Patients aged 50 years and older comprised 56%-77% of each group . Associated conditions and risk factors were present among most patients (19/23, 83%); autoimmune diseases and a chronic skin wound or trauma were notably present among patients with GAS, while diabetes mellitus and malignancy were more common among patients with GBS . Infected prosthetic implants were present in 7 patients, including 4/7 patients with GGS . All patients had positive cultures of synovial fluid, and 11/23 (49%) had positive blood cultures (GAS, 5/9; GBS, 6/7; and GGS, 0/7) . The clinical presentation and hospital course of patients infected with the different serogroups varied . Patients infected with GAS had the most severe disease and those with GGS the least severe . Necrotizing fascitis, shock, DIC, and admission to the intensive care unit were found only among patients infected with GAS . Despite aggressive management with antimicrobial therapy and surgery, 4/23 patients died (3 patients with GAS; 1 with GBS) . The isolates from our patients were not available for study; investigations by others of the biology of BHS suggest that the production of 1 or more of the streptococcal pyrogenic exotoxins by isolates of GAS may account for the differences in the severity of disease among our patients with septic arthritis caused by different serogroups of BHS . Although septic arthritis due to BHS is uncommon, such patients provide a valuable model to study features of the host-parasite interaction that may contribute to the observed differences in severity of disease. Arch Dermatol, 1998 Apr, 134(4), 439 - 44 Clinical, pathologic, and immunologic features of human T-lymphotrophic virus type I-associated infective dermatitis in children; La Grenade L et al.; OBJECTIVES: To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotrophic virus type I (HTLV-I) . DESIGN: A case series of patients with ID were compared with patients with atopic dermatitis (AD), which is an important disease in the differential diagnosis of ID . SETTING: Patients were recruited from dermatology and pediatric clinics at the University Hospital of the West Indies and the Bustamante Children's Hospital, Kingston, Jamaica . MAIN OUTCOME MEASURES: Clinical and laboratory features of patients with AD were compared with those of patients with ID . PATIENTS: Consecutive patients older than 1 1/2 years diagnosed as having ID (n=50) and AD (n=35) were enrolled based on clinical findings . RESULTS: The mean ages of patients with ID and AD were 6.9 and 7.8 years, respectively . Histologically, both diseases were predominantly chronic dermatitis with propensity for skin colonization with Staphylococcus aureus and beta-hemolytic streptococci; however, the distribution of sites of skin involvement differed . Infection with HTLV-I was the most distinguishing feature among patients with ID, with seropositive results in 100%; only 5 (14%) of the 35 patients with AD had results seropositive for HTLV-I . Infective dermatitis was further characterized by dermatopathic lymphadenitis in 16 (67%) of 24 patients with palpable nodes . Anemia, lymphocytosis, and low albumin and elevated serum globulin levels were more prevalent among patients with ID . Significant elevations of IgA, IgD, and IgG levels were observed among patients with ID compared with those with AD . However, both patients with AD and those with ID had levels of IgD and IgE elevated above the normal range . T-cell subsets among patients with ID revealed T-cell activation with a high percentage of HLA-DR antigen positivity, elevated CD4 (2.4 x 10(9)/L) and CD8 (1.4 x 10(9)/L) cell counts, with an increased CD4/CD8 ratio of 1:73 . CONCLUSION: Infective dermatitis is a distinct clinical entity associated with HTLV-I, which plays a role in the pathogenesis and immune perturbations observed. J Altern Complement Med, 1998 Spring, 4(1), 39 - 45 Extraction, assay, and analysis of antimicrobials from plants with activity against dental pathogens (Streptococcus sp.) Tichy J, Novak J. Many dental and periodontal diseases are largely a question of bacterial etiology . Dental caries develop due to an increase of strongly acidogenic and aciduric gram-positive bacteria while common forms of periodontal disease are linked to anaerobic gram-negative bacteria in subgingival plaque . Many plants and plant-derived antimicrobial components are used in folklore therapeutics for the treatment of periodontal disorders and for the purposes of oral hygiene . Some have been evaluated for possible use in modern medicine, while thousands of other potentially useful/plants have not been tested . In this study, we evaluated the feasibility of screening for antibacterials isolated from plants with activity against three representatives of oral streptococci . We developed and tested the following methodologies: (1) Extraction of antibacterial components from plants; (2) Assays for antibacterial activity; (3) Chromatographic methods for initial analysis of compounds of interest . The screening process for plant antimicrobials consisted of extraction of plant material and assay of antibacterial activity using a spotting test with the selected oral streptococci as indicator strains . In addition, we developed chromatographic procedures that allow characterization and optimization of initial isolation steps . Depending on the indicator microorganisms used, the screening assay can target additional pathogens including other streptococci (group A and B, and pneumococci) and periodontal pathogens such as Porphyromonas . Also, we noted that the activity of some extracts varied against different oral bacteria . Our conclusion, supported by extensive data, was that the screening for antimicrobials from plants is a feasible approach to the identification of natural compounds with antimicrobial properties against dental pathogens. Clin Oral Investig, 1997 Jun, 1(2), 77 - 80 A microbiological study of pre- and postoperative apicoectomy sites; Samaranayake LP et al.; There is little information on the microbiology of periapical lesions, and no data on the residual microbial flora in the periapex, if any, after apicoectomy procedures . Hence, 64 patients treated by apicoectomy procedures were prospectively studied to assess the bacterial flora in the periapex and to evaluate the residual bacteria in postoperative apicoectomy sites . Of the 64 lesions studied, 14 (22%) were sterile and 50 (78%) yielded bacteria preoperatively . Bacteria could be recovered from 28 (56%) of the latter lesions after apicoectomy and curettage . A total of 105 bacterial strains was isolated from 50 lesions, yielding a range of 1-4 (mean 2.1) species per sample . The isolates comprised 84 (80%) facultative anaerobes and 21 (20%) strict anaerobes . A polymicrobial growth was obtained from 39 lesions whilst 11 lesions yielded pure cultures . On detailed microbiological analyses of 29 lesions, 40% of the isolates were identified as alpha-haemolytic streptococci, half of which were Streptococcus sanguis; anaerobic streptococci were the predominant anaerobes . None of the organisms or group(s) of organisms emerged as recalcitrant colonisers which were difficult to dislodge after surgical debridement . These data indicate that the majority of periapical lesions harbour a variety of flora which cannot be eradicated despite thorough apicoectomy procedures. J Immunol, 1998 Jan 1, 160(1), 293 - 8 Peptides that mimic the group B streptococcal type III capsular polysaccharide antigen; Pincus SH et al.; Microbial polysaccharides are notably poor immunogens . We have developed an alternate route for the production of Abs to important carbohydrate epitopes . mAb S9, a protective mAb against the type III capsular polysaccharide of group B streptococci (GBS), was used to select epitope analogues from a peptide display phage library . Depending upon desorption conditions, two populations of phage were identified with displayed sequences of WENWMMGNA and FDTGAFDPDWPA . ELISA results demonstrated that these phage bound to S9 and no other Abs . Phage blocked the binding of S9 to type III GBS, but did not block binding by another anti-GBS mAb . Phage displaying the latter peptide sequence showed greater inhibition . Ab S9 and other monoclonal and polyclonal anti-GBS type III antisera bound the synthetic peptide FDTGAFDPDWPAC . The binding of S9 to GBS was inhibited by the free peptide with an IC50 of 30 microg/ml . The binding of polyclonal anti-GBS antibodies to peptide could be blocked by intact GBS as well as purified capsular polysaccharide . The peptide was conjugated to three different carriers and was used to immunize mice . All mice produced a significant antibody response to GBS and to the purified capsular polysaccharide following a single immunization . These data demonstrate that a peptide mimetic of the GBS capsular polysaccharide is both antigenic and immunogenic . The incorporation of such peptides into vaccine preparations may enhance the efficacy of vaccines in inducing Ab responses to important carbohydrate epitopes. J Hepatol, 1998 Mar, 28(3), 426 - 32 Bile duct bacterial isolates in primary sclerosing cholangitis: a study of explanted livers; Olsson R et al.; BACKGROUND/AIMS: The pathogenesis of the inflammatory lesion in primary sclerosing cholangitis is unknown . The clinical picture is characterized by i.a . episodes of fever, the cause of which also remains speculative . Previous studies of bacterial isolates in the liver or bile ducts in primary sclerosing cholangitis have had the shortcoming of possible contamination associated with the sampling . The aim of this study was to investigate whether bile and bile duct tissue, obtained under sterile conditions in connection with liver transplantation, contain bacteria . METHODS: We studied bile from bile duct walls and bile collected from the explanted livers of 36 patients with primary sclerosing cholangitis and 14 patients with primary biliary cirrhosis . RESULTS: Positive cultures were obtained from 21 of 36 primary sclerosing cholangitis patients, but from none of the primary biliary cirrhosis patients . The number of bacterial strains was inversely related to the time after the last endoscopic retrograde cholangiography . Treatment with antibiotics or intraductal stent, or the occurrence of fever before liver transplantation did not seem to influence the culture results, whereas antibiotic treatment in connection with endoscopic retrograde cholangiography may possibly have reduced the number of isolates in the cultures . Alpha-haemolytic Streptococci were retrieved as late as 4 years after the last endoscopic retrograde cholangiography . Retrospective analysis of liver laboratory tests after endoscopic retrograde cholangiography did not indicate a deleterious effect of the investigation . CONCLUSIONS: The data suggest that antibiotics should be given routinely in connection with endoscopic retrograde cholangiography . They also raise the question of a possible role of alpha-haemolytic Streptococci in the progression of primary sclerosing cholangitis. Endod Dent Traumatol, 1997 Apr, 13(2), 82 - 7 Coronal leakage in teeth root-filled with gutta-percha and two different sealers after long-term storage; Chailertvanitkul P et al.; This in vitro study investigated the effect of long-term storage on the coronal leakage of a microbial marker in teeth root-filled with lateral condensation of cold gutta-percha and one of two sealers . Sixty single-rooted teeth were prepared chemomechanically to a size 40 master apical file . The teeth were divided into two groups of 20 teeth each and obturated with gutta-percha using either Apexit or Tubliseal EWT sealer . The teeth were stored for 6 months in artificial saliva and tested for leakage using a marker consisting of Anaerobic streptococci and Prevotella intermedia . The teeth were checked for bacterial leakage daily for 90 days . All positive control teeth leaked within 48 hours, while the negative control teeth remained uncontaminated throughout the test period . Leakage in the experimental teeth started at times varying from 10 to 71 days; 30% and 75% of the specimens of the Apexit and Tubliseal EWT groups respectively showed leakage at 90 days . The Tubliseal EWT group showed significantly more leakage (p < 0.05) than the Apexit group. Dent Mater J, 1996 Dec, 15(2), 201 - 4 Adherence of oral streptococci to composite resin of varying surface roughness; Yamamoto K et al.; The adherence of oral bacteria to composite resins plays an important role in the development of secondary caries . The present study deals with the adherence to composite resin having various surface roughness of S.oralis, which is frequently isolated from composite resin squares attached to maxillary first molars . available commercial resin was used in this experiment . In vitro bacterial adhesion test was carried out under a sucrose independent conditions . The surface roughness values of each specimen ranged between 0.2 micron and 3.0 microns . No relationship was observed between the surface roughness values and bacterial adhesion because S . oralis adhered firmly to the filler particles of all composite resin surfaces. Int Endod J, 1997 Sep, 30(5), 318 - 22 An evaluation of microbial coronal leakage in the restored pulp chamber of root-canal treated multirooted teeth; Chailertvanitkul P et al.; This in vitro study investigated the effect of a resin-reinforced glass ionomer lining material on the coronal leakage of a mixed obligate microbial marker in maxillary molars obturated with lateral condensation of cold gutta-percha and Tubliseal sealer, after 2 years' storage . Forty maxillary first molars were prepared chemomechanically to a size 30-40 master apical file . The teeth were divided into an experimental group (30 teeth) and control group (10 teeth) . In the experimental group, the floor of pulp chamber and the root-canal opening of 15 teeth were covered with Vitrebond as a lining; the remaining 15 teeth received no lining . These teeth were tested for leakage using a microbiological marker consisting of anaerobic streptococci and Fusobacterium nucleatum . The teeth were checked daily for bacterial leakage for 60 days . All positive control teeth leaked within 48 h, while the negative control teeth remained uncontaminated throughout the test period . The teeth restored with Vitrebond liner showed no leakage whilst 60% of the specimens with no Vitrebond liner showed leakage after 60 days. APMIS, 1998 Mar, 106(3), 396 - 402 Pyogenic hepatic abscess . A 10-year population-based retrospective study; Hansen PS et al.; A 10-year retrospective survey was undertaken of patients with pyogenic hepatic abscesses (PHA) . Fifty-two patients fulfilled the criteria of PHA, equivalent to a mean annual incidence of 11/1,000,000 . The main symptom was fever . Laboratory tests were compatible with infection, slightly elevated alkaline phosphatase being the only test pointing towards the liver as the focus of infection . Forty-one patients (79%, 95% CL, 68-90%) had positive cultures from aspirated pus, with a total of 79 isolates . Enteric Gram-negative rods accounted for 45% and anaerobic bacteria for 31% of PHA isolates . Gram-positive cocci, predominantly non-haemolytic streptococci, were the third largest group (19%), but were rare among blood isolates . Positive blood cultures were found in 21 patients (40%, 95% CL, 27-54%), with a total of 28 isolates . Percutaneous drainage was performed in 26, percutaneous needle aspiration in 10, combinations thereof in 5, and abdominal surgery in 5 . Forty-nine patients received systemic antibiotic therapy, four of whom were treated with antibiotics only . Seven recurrences occurred and the overall case fatality rate was 6% (95%, CL 0-12%), which might reflect a low rate of underlying malignant diseases in our study material. Am J Dent, 1996 Dec, 9(6), 236 - 9 Antibacterial effect of propolis and honey on oral bacteria; Steinberg D et al.; PURPOSE: To investigate the antibacterial properties of propolis and honey against oral bacteria in vitro and in vivo . MATERIALS AND METHODS: In vitro study: The antibacterial effects of propolis and honey on oral streptococci were determined using the broth method . Clinical study: The short-term antibacterial effect of propolis solution and honey on salivary total bacteria and Streptococcus mutans was tested in 10 volunteers . RESULTS: Propolis demonstrated an antibacterial effect both in vitro on isolated oral streptococci and in the clinical study on salivary bacterial counts . Honey induced bacteria growth at low concentrations, while at high concentrations honey had an inhibitory effect on bacterial growth in vitro . Salivary counts of total bacteria and Streptococcus mutans were lower for 1 hour after application of honey . The antibacterial effect of the honey tested may be attributed to its osmolarity effect. Ned Tijdschr Geneeskd, 1997 Sep 27, 141(39), 1841 - 5 {Puerperal fever: an old enemy in aggressive form}; Schols WA et al.; Two previously healthy women, aged 30 and 35 years, suffered pain in the lower abdomen, one before and the other after spontaneous delivery at 40 and 33 4/7 weeks of amenorrhoea, respectively, while a third woman, aged 33, at 36 weeks of amenorrhoea developed pain in the lower abdomen, fever, vomiting, and diarrhoea . All three women were found to have a uterine infection caused by streptococci of Lancefield group A (group A Streptococcus, GAS) . In one woman, the diagnosis was made rapidly so that antibiotic treatment could be instituted in time; the other two developed sepsis and multiorgan failure, with a fatal issue in one of them . The three children also were septic, two recovered after treatment and one died . Since the eighties, serious GAS infection has been on the increase . The worst manifestation is the toxic shock syndrome caused by streptococci . Abdominal pains after delivery may be a first sign of this, and should not too readily be interpreted as just after pains . The condition may also develop before delivery . In view of the high mortality rate, early diagnosis and antibiotic treatment are of vital importance for mother and child. Caries Res, 1998, 32(2), 113 - 8 Comparison of the efficacy of three different chlorhexidine preparations in decreasing the lev