Streptococci

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 levels of mutans streptococci in saliva and interdental plaque; Twetman S et al.; The aim of the present study was to evaluate and compare the effects of three different chlorhexidine (CHX)-containing preparations on mutans streptococci (MS) levels in interdental plaque and whole saliva . Ninety-three healthy school-children (8-10 years old) with high scores of salivary MS were selected by a screening procedure and randomised into three equally sized groups . MS were enumerated at all mesial interdental sites of the first permanent molars with aid of a modified chairside technique . The patients were then treated three times within 2 weeks with either a 1% CHX/thymol-containing varnish (group A) or a 1% CHX gel (group B), or they were subjected to daily supervised toothbrushing with a 0.4% CHX dentifrice for 1 month (group C) . Follow-up samples of saliva and plaque from the interdental sites were collected 1 and 3 months after termination of treatment . A statistically significant reduction of MS levels in saliva and interdental plaque was found in all groups after 1 month . The CHX-containing dentifrice (group C) was the most effective method in reducing MS levels in saliva, and a significantly stronger (p < 0.05) suppression was found after 1 and 3 months when compared with the gel and the varnish forms . The gel (group B) tended to be slightly more effective than the varnish (group A) . In the interdental plaque, the reduction of MS was less marked than in the saliva, and the three groups exhibited MS reductions of similar magnitude (20%) and duration, persisting up to 3 months . However, a high proportion (approximately 50%) of all interdental sites were relatively unaffected by the treatments . In conclusion, our results suggest that the interdental MS colonisation was difficult to combat, irrespective of CHX preparation and method, while the salivary levels were more easily affected . Daily tooth-brushing with a CHX-containing dentifrice was more effective in reducing MS in saliva compared with the gel or varnish applications.

Immunopharmacol Immunotoxicol, 1998 Feb, 20(1), 159 - 71
Effect of streptolysin-O-on rat hepatic acetyl coenzyme-A: arylamine N-acetyltransferase and cytochrome P-450 2B 1/2 activities ex vivo; Drobitch RK et al.; Numerous immunostimulants have been found to increase N-acetylation in vivo but are not associated with a similar increase in vitro . Streptolysin-O (SLO), a thiol-activated (oxygen-labile) hemolytic and immune-stimulating exotoxin produced by group A streptococci, has been reported to increase the metabolic rate constant for sulfamethazine in vivo and arylamine N-acetyltransferase (NAT) activity toward procainamide (PA) ex vivo . The effect of SLO pretreatment of rats on cytochrome P-450-catalyzed tolbutamide hydroxylation and NAT activities toward PA (a substrate for NAT1), and p-aminobenzoic acid (a substrate for NAT2) was examined ex vivo . Subacute SLO (SIGMA Chemical Company, St . Louis, MO) pretreatment (100 Hemolytic Units/kg/day, intraperitoneal, for 4 days) did not alter body weight, liver weight or cytosolic protein content as compared with controls . SLO-pretreatment did not alter NAT activities measured ex vivo, nor was an alteration in tolbutamide hydroxylation observed . Pretreatment with an alternative SLO preparation (DIFCO Laboratories, Detroit, MI) also failed to alter the parameters of body weight, liver weight or cytosolic protein content as compared with controls . While treated animals had significantly reduced microsomal protein content, SLO pretreatment failed to alter the enzyme activities measured . We conclude that SLO does not serve as a useful model immunostimulant for mechanistic studies as it produces no consistent effect on drug metabolizing enzymes.

Arch Pediatr, 1997 Dec, 4(12), 1192 - 6
{Bacteriological study of purulent nasopharyngitis in children in Senegal}; Cisse MF et al.; BACKGROUND: S pneumoniae, H influenzae and M catarrhalis are the main bacteria isolated from rhinopharynx in Europe . The purpose of this work was to study the frequency of potential pathogenic bacteria isolated from acute purulent rhinopharyngitis among children in Senegal . POPULATION AND METHODS: Ninety-three children from one month to 7-years old suffering from purulent rhinopharyngitis were recruited from April 1 to July 1996 . The withdrawal samples were taken from the cavum with a swab which was immediately immersed in an agar shipping medium . Bacteria's grouping and serotyping were made by immunoagglutination . A standard antibiogram was made for all isolates and furthermore the minimal inhibitory concentration (MIC) were determined for S pneumoniae . RESULTS: Two hundred bacterial strains were isolated: S pneumoniae 28% (60% of the children), C group streptococci: 19% (41% of the children), H influenzae: 15.5% (33% of the children), S pyogenes: 9.5% (20% of the children), S aureus: 8% (17% of the children) and M catarrhalis: 6% (13% of the children) . The other isolates were: B and D groups streptococci, P aeruginosa and Klebsiella spp . S pnuemoniae strains belonged to serogroups 6, 19 and 23 . Only three strains of H influenzae were capsulated (serotype b) . Infants aged from 6 to 18 months were the most affected . No resistance to penicillin was observed for S pneumoniae and S pyogenes . Ampicillin (81%) and chloramphenicol (96%) both inhibited the majority of H influenzae strains . CONCLUSIONS: This descriptive bacterial epidemiology study of children's rhinopharynx's flora in Senegal allowed us to identify three major pathogenic germs: S pneumoniae, H influenzae and S pyogenes contributing to a better knowledge of these microorganisms' serotypes, biotypes and antibiotypes.

Eur J Pediatr, 1998 Mar, 157(3), 221 - 4
Antibodies to group B streptococci in neonates and infants; Berg S et al.; Invasive group B streptococcal (GBS) infections are common in neonates but are rare after the 1st month of life . It is not known why GBS infections have this age distribution which differs from that of invasive infections caused by other encapsulated bacteria . The aim of this study was to test the possibility that serum antibodies against the GBS capsular polysaccharides (CPS) are acquired during the first months of life thereby preventing infections after the neonatal period . Cord sera were collected from 321 healthy term newborns . A second blood sample was collected at 2, 4, 8, 13 or 26 weeks of age . IgG CPS antibodies (measured by ELISA) against serotypes Ia, II and III were present in 98%-100% of all cord sera and decreased continuously during the first 6 months of life . No IgM antibodies against serotype III CPS were present in cord sera . Only 16%-17% of the children acquired IgM antibodies against serotype III CPS at 3 and 6 months of age . CONCLUSION: Early acquisition of IgG or IgM antibodies against CPS of the most common GBS serotypes was not demonstrated and cannot explain the rare occurrence of invasive GBS infections in children after the 1st month of life.

Scand J Immunol, 1980, 11(1), 37 - 46
Binding of murine myeloma proteins of different Ig classes and subclasses to Fc-reactive surface structures in gram-positive cocci; Myhre EB et al.; Twelve different murine myeloma proteins were tested for binding to seventy Gram-positive strains belonging to group A, C and G streptococci and to Staphylococcus aureus . Group A streptococci, known to bind human IgG, were incapable of binding any of eight murine IgG immunoglobulins tested except for one strain that bound an IgG2b myeloma protein . In contrast, group C and G streptococci interacted with murine immunoglobulins of subclasses IgG2a, IgG2b and IgG3, and G strains also to a lesser extent with IgG1 . Bovine and equine-group C streptococci did not differ from human group C streptococci in their IgG reactivity . Staphylococcal strains showed a high reactivity with murine myeloma components of IgG subclasses 2a, 2b and 3 and a low but definite binding of an IgG1 myeloma protein . IgA myeloma protein S-122 interacted with nine of fifteen group A streptococci . This binding could not be inhibited by human IgG and the reactivity is thus different from Fc-mediated binding of immunoglobulins . One of three IgA myeloma proteins tested, TEPC 15, bound to staphylococci . The Fc specificity of this interaction was confirmed by chromatography on protein A-Sepharose and by inhibition studies using polyclonal human IgG . The protein A reactivity of this monoclonal protein was detected in IgA aggregates and absent in the monomeric form of IgA.

Arch Dis Child Fetal Neonatal Ed, 1998 Jan, 78(1), F46 - 50
Impaired phagocytosis and opsonisation towards group B streptococci in preterm neonates; Kallman J et al.; AIMS: To study the chemiluminescence response in polymorphonuclear leucocytes (PMNL) at different stages of maturity and the opsonic capacity of sera with defined titres of anti-capsular type III antibodies, after exposure to serotype III group B streptococci (GBS) . The influence of GBS type III capsule expression on PMNL chemiluminescence response was also investigated . METHODS: Two clinical isolates of serotype III GBS and two serotype III reference strains which form isogenic variants with high and low amounts of capsule substance, respectively, were used . PMNL and sera were obtained from adult healthy blood donors, full term neonates, and preterm neonates . RESULTS: PMNL from premature infants showed a significantly lower chemiluminescence response (p < 0.0001) than the PMNL from adults and neonates, while the chemiluminescence response with adult, neonatal, and preterm sera gradually diminished . In the presence of a serum pool with a standardised complement value, raised (> 10 mg/l), rather than low (< 1.0 mg/l) anti-III antibody titres induced a higher chemiluminescence response to the capsule expressing variant . When GBS were cultured at pH 5.0, the bacteria had a higher buoyant density, reflecting decreased expression of capsule substance compared with bacteria grown at pH 7.4 . Concomitantly, there was a substantial increase in chemiluminescence response for all isolates cultured at the lower pH, except for the capsule deficient mutant . CONCLUSIONS: PMNL function and opsonic capacity are significantly impaired in neonates and correlate with maturation of the newborn child . The combined defect in cellular and humoral defences in preterm neonates may contribute to their increased susceptibility to GBS infection . Growth conditions for GBS, simulating different in vivo environments, greatly affect capsule expression and resistance to phagocytosis.

Immunology, 1998 Jan, 93(1), 86 - 95
Group B streptococci persist inside macrophages; Cornacchione P et al.; Group B streptococci (GBS) are an important cause of neonatal sepsis, pneumonia and meningitis . In the early phase of infection, macrophages and polymorphonuclear cells (PMN) are the first immune cells that interact with GBS . In this in vitro study, to gain insight into GBS-macrophage interaction in the absence of type-specific antibodies, we examined the features of GBS survival in thioglycollate-elicited murine peritoneal macrophages and the effect of GBS on the protein kinase C (PKC)-dependent transduction pathway . Our results demonstrate that type Ia GBS, strain 090 (GBS-Ia) and type III GBS strain COH 31r/s (GBS-III), after in vitro phagocytosis survive and persist intracellularly in macrophages for up to 24 and 48 hr, respectively . However, macrophage activation by interferon-gamma (IFN-gamma) and lipopolysaccharide from Escherichia coli (LPS) caused a significant reduction in the time of intracellular persistence . Macrophage activation by IFN-gamma and LPS seems to be a multifactorial event involving multiple intracellular signal pathways also including PKC . Since PKC is one of the components in the signal network leading to macrophage activation and an important target for several intracellular micro-organisms, we wondered whether PKC could have a role in intracellular GBS survival . Both PKC depletion by treatment with phorbol 12-myristate 13-acetate (PMA) for 18 hr and PKC inhibition by Calphostin C rendered macrophages more permissive for the intracellular GBS survival . Furthermore, GBS-infected macrophages were unable to respond to PMA and LPS, activators of PKC, by inducing antimicrobial activity . The ability of GBS to impair PKC-dependent cell signalling was also demonstrated by the reduced c-fos gene expression in GBS-infected macrophages with respect to control macrophages, after LPS stimulation . In conclusion, our results indicate that GBS survive in macrophages and impairment of PKC signal transduction contributes to their intracellular survival.

J Infect Dis, 1998 Apr, 177(4), 1116 - 9
Identification of a highly encapsulated, genetically related group of invasive type III group B streptococci; Takahashi S et al.; Type III group B streptococci (GBS) isolated from Tokyo and Salt Lake City were classified according to the similarity of HindIII and Sse83871 restriction digest patterns (RDPs) of bacterial DNA . The bacteria were clustered into three RDP types, with excellent correlation between subtyping based on the two enzymes . The majority (91%) of invasive isolates obtained from neonates were RDP type III-3 . The mean sialic acid content of the III-3 strains was higher than that of other type III strains . Closely related isolates were concordant for expression of the bacterial enzyme C5a-ase, but invasive strains were no more likely to be C5a-ase positive than were strains isolated from the genitourinary tract of pregnant women . These data indicate that a group of genetically related organisms with increased capsule production causes the majority of invasive type III GBS disease.

J Infect Dis, 1998 Apr, 177(4), 967 - 76
Identification of a novel insertion element, IS1548, in group B streptococci, predominantly in strains causing endocarditis; Granlund M et al.; Hyaluronidase has been postulated to be a virulence factor in group B streptococci (GBS) . No hyaluronidase activity was found in 15 of 50 GBS isolates from adults studied . Most of these hyaluronidase-negative strains belonged to serotype III . In strains lacking hyaluronidase activity, an insertion of 1317 nucleotides was found in the hyaluronidase gene . The fragment was cloned and sequenced and found to have characteristics of a novel insertion sequence, designated IS1548 . As well as in GBS serotype III, this sequence was found in 3 of 6 serotype II isolates and in all 10 group A streptococcal strains (GAS) tested . Homologies were found with repeated sequences in Streptococcus pneumoniae and with H repeats in Escherichia coli . All GBS strains harboring IS1548 and some GAS strains had one copy of IS1548 located downstream of the C5a peptidase gene . IS1548 was present in 9 of 13 GBS isolates from blood in endocarditis patients and in 3 of 22 vaginally colonizing strains.

Microbiology, 1998 Mar, 144 ( Pt 3), 629 - 37
Extensive genetic diversity among clinical isolates of Streptococcus pyogenes serotype M5; Desai M et al.; The genetic diversity of clinical isolates of Streptococcus pyogenes serotype M5 has been characterized . Strain genotypes were defined by macrorestriction profile, 16S ribotype, emm gene subtype, insertion element IS1239 profile, and exotoxin gene determinant . By these criteria, clinical isolates of M5 constituted a multiplicity of strain clusters rather than a homogeneous population as found for certain serotypes . Distance matrices and an unrooted tree were constructed from macrorestriction data with three rarely cutting endonucleases, determined by PFGE . A single IS1239 profile was common to 85% of isolates but there was great diversity of both ribotype and macrorestriction profile, and 18 different emm gene subtypes were detected by PCR-RFLP . DNA sequence analysis of the antigen-coding 5' (hypervariable) region of emm gene amplicons (about 240 bp) showed that 14/18 exhibited up to 6% divergence . Four amplicons had highly divergent sequences--corresponding to those previously determined for emm6, emm11, emm18 and emm77 . Further serological and hybridization studies were used to analyse the discrepancy between the Lancefield serotype of these strains (M5) and their emm genotype . Overall, this study shows a high degree of genetic diversity in serotype M5, with implications for the Lancefield scheme itself, for the epidemiology of group A streptococci, and for recombinant DNA strategies for M protein-based vaccine development.

J Biol Chem, 1998 Mar 13, 273(11), 6424 - 30
Molecular co-operation between protein PAM and streptokinase for plasmin acquisition by Streptococcus pyogenes; Ringdahl U et al.; Bacterial surface-associated plasmin formation is believed to contribute to invasion, although the underlying molecular mechanisms are poorly understood . To define the components necessary for plasmin generation on group A streptococci we used strain AP53 which exposes an M-like protein ("PAM") that contains a plasminogen-binding sequence with two 13-amino acid residues long tandem repeats (a1 and a2) . Utilizing an Escherichia coli-streptococcal shuttle vector, we replaced a 29-residue long sequence segment of Arp4, an M-like protein that does not bind plasminogen, with a single (a1) or the combined a1a2 repeats of PAM . When expressed in E . coli, the purified chimeric Arp/PAM proteins both bound plasminogen, as well as plasmin, and when used to transform group A streptococcal strains lacking the plasminogen-binding ability, transformants with the Arp/PAM constructs efficiently bound plasminogen . Moreover, when grown in the presence of plasminogen, both Arp/PAM- and PAM-expressing streptococci acquired surface-bound plasmin . In contrast, plasminogen activation failed to occur on PAM- and Arp/PAM-expressing streptococci carrying an inactivated streptokinase gene: this block was overcome by exogenous streptokinase . Together, these results provide evidence for an unusual co-operation between a surface-bound protein, PAM, and a secreted protein, streptokinase, resulting in bacterial acquisition of a host protease that is likely to spur parasite invasion of host tissues.

Microb Drug Resist, 1998 Spring, 4(1), 45 - 9
Streptococcus mitis with unusually high level resistance to beta-lactam antibiotics; Konig A et al.; Penicillin-resistant oral streptococci constitute the genetic reservoir for beta-lactam resistance in S . pneumoniae . Here we report the isolation of clinical strains of S . mitis with unusually high MIC values for beta-lactam antibiotics; resistance to benzylpenicillin was 64 microg/ml and to cefotaxime 128 microg/ml . Among the beta-lactam compounds tested, only the carbapenems imipenem and meropenem showed MICs below 32 microg/ml . Both S . mitis strains were resistant to tetracycline and were highly resistant to aminoglycosides . Pulse field mapping of chromosomal DNA revealed identical patterns in both strains, indicating clonal identity of the two isolates . Using chromosomal S . mitis DNA, the laboratory strain S . pneumoniae R6 could be transformed in four successive steps to cefotaxime and benzylpenicillin resistance of 64 microg/ml . The results exemplify the importance of commensal streptococci for the development of cefotaxime resistance in S . pneumoniae.

J Dairy Sci, 1998 Feb, 81(2), 570 - 8
Minimum inhibitory concentrations for selected antimicrobial agents against organisms isolated from the mammary glands of dairy heifers in New Zealand and Denmark; Salmon SA et al.; Minimum inhibitory concentrations were determined for selected antimicrobial agents against 872 bacteria isolated from intramammary infections in heifers in New Zealand (n = 401) and Denmark (n = 471) . These values were reported in micrograms per milliliters . Antimicrobial agents tested against isolates from New Zealand were penicillin, cloxacillin, cephapirin, ceftiofur, novobiocin, enrofloxacin, erythromycin, and pirlimycin . The minimum inhibitory concentrations that inhibit 90% of the strains tested for these antimicrobial agents with Staphylococcus aureus were 4.0, 0.5, 0.5, 2.0, 1.0, 0.25, 0.5, and 1.0, respectively . The minimum inhibitory concentration values that inhibit 90% of the strains tested against the Staphylococcus spp . ranged from 0.5 to 1.0 for all antimicrobics . The minimum inhibitory concentrations against streptococci were < or = 0.06, 0.5, 0.13, 0.13, 4.0, 1.0, 0.13, and < or = 0.06, respectively . Antimicrobial agents tested against isolates from Denmark included penicillin, ampicillin, oxacillin, cephalothin, ceftiofur, penicillin plus novobiocin, erythromycin, and pirlimycin . Against S . aureus, the minimum inhibitory concentrations were 0.13, 0.5, 0.5, 0.5, 1.0, 0.25, 0.5, and 0.5, respectively . The minimum inhibitory concentrations against Staphylococcus spp . were 0.25, 0.25, 0.5, 0.5, 1.0, < or = 0.06, 0.13, 1.0, and 0.5, respectively . The minimum inhibitory concentrations against the streptococci were < or = 0.06, 0.13, 0.5, 0.5, 1.0, < or = 0.06, 0.13, 0.5, and 0.5, respectively . Minimum inhibitory concentration values for staphylococci from New Zealand and Denmark were similar to values reported for US isolates . Streptococci from New Zealand and Denmark had lower minimum inhibitory concentration values than did US isolates . Only ceftiofur and enrofloxacin were active against the Gram-negative bacilli.

Zentralbl Bakteriol, 1998 Jan, 287(1-2), 33 - 9
In-vitro susceptibility of group A beta-haemolytic streptococci (GABHS) to penicillin, erythromycin, clarithromycin and azithromycin in Styria, Austria; Kriebernegg I et al.; 248 Strains of group A beta-haemolytic streptococci (GABHS) were tested against penicillin and the macrolide antibiotics, erythromycin, clarithromycin and azithromycin . 213 (85.9%) GABHS isolates were taken from throat swabs from patients with pharyngotonsillitis, 35 isolates (14.1%) were from other body sites or from invasive infections . The age of the patients ranged from 9 months to 89 years, 155 of the patients (62.5%) were below 10 years of age . The results of the E-test method and a disk diffusion assay were compared; to classify the phenotype of the erythromycin-resistant strains, a disk induction test was carried out . None of the 248 GABHS strains showed resistance to penicillin, whereas 53 GABHS isolates (21.4%) were resistant to the macrolide antibiotics included in the test . There were only minor discrepancies between the two testing methods . The MIC data obtained with the E-test method suggested that among the macrolides, erythromycin and clarithromycin had slightly higher antistreptococcal activity than azithromycin in vitro . 50 (94.3%) of the erythromycin-resistant GABHS showed the pattern of novel resistance (M phenotype), 2 (3.8%) strains showed inducible resistance (IR) and 1 (1.9%) strain exhibited consecutive resistance (CR).

APMIS, 1998 Feb, 106(2), 277 - 87
Triggering of renal tissue damage in the rabbit by IgG Fc-receptor-positive group A streptococci; Burova LA et al.; Our previous studies have shown that streptococcal IgG Fc receptors (FcR) act to elicit circulating anti-IgG as well as renal glomerular deposition of IgG in rabbits immunized with group A streptococci (GAS) . In order to study if other FcR-positive bacteria might have similar effects, rabbits were immunized with either group G streptococci (GGS; strain G148) or Staphylococcus aureus (strain Cowan I) for two periods of 8 and 6 weeks, respectively . At the end of immunization, circulating anti-IgG was found in 6 of 20 (30%) and 4 of 19 (21%) animals receiving G148 and Cowan I, respectively, compared to all 28 receiving FcR-positive GAS strains of types M1, M4, M15 or M22 (p < 0.05 for both comparisons); furthermore, anti-IgG appeared earlier and at higher levels in the GAS groups . Weak glomerular IgG deposits occurred in 5 out of 10 (50%) and 2 out of 8 (25%) animals immunized with G148 and Cowan I, respectively . In contrast, all 11 rabbits examined, given GAS of types M1 or M15, displayed heavy deposits . None of four control animals immunized with either of two FcR-negative strains, GAS type T27 or group B streptococci (GBS) type Ia, exhibited any renal IgG deposits or circulating anti-IgG . Renal tissue materials from rabbits immunized with any of the four FcR-positive GAS strains showed strong inflammatory and degenerative glomerular changes, compatible with the picture seen in acute poststreptococcal glomerulonephritis (APSGN) . Only transient renal changes were found in those rabbits immunized with G148 or Cowan I, or the controls injected with the FcR-negative strains, GAS type T27 or GBS . Thus, only the FcR-positive GAS strains showed capacity to induce high levels of anti-IgG, pronounced tissue deposition of IgG as well as irreversible glomerular changes . Our experimental data suggest that streptococcal IgG FcR activity might play an important role in triggering APSGN.

J Immunol, 1998 Apr 1, 160(7), 3349 - 54
Identification of a domain in human factor H and factor H-like protein-1 required for the interaction with streptococcal M proteins; Kotarsky H et al.; The plasma protein factor H (FH) inhibits the alternative pathway of complement activation . Previous work has shown that FH binds to group A streptococci and that the interaction does not interfere with the complement-inhibitory capacity of FH . In this work, we report a molecular analysis of this interaction . In absorption experiments with human plasma, M protein-expressing group A streptococci bound both FH and FH-like protein-1 (FHL-1), an active 42-kDa splice product of the FH-gene transcript comprising the first 7 of its 20 short consensus repeat (SCR) domains . rFHL-1 also bound to M protein-expressing streptococci, but rFH fragments containing SCR 1-5 or SCR 1-6 did not . rFHL-1 bound to purified M5 protein with an affinity that was higher than the value calculated for the interaction between FH and M5 protein . The binding of radiolabeled rFHL-1 to immobilized M5 was blocked completely by unlabeled rFHL-1, but was inhibited only partially by SCR 1-6, emphasizing the importance of SCR 7 for the interaction . In experiments with the FH-related proteins FHR-3 and FHR-4, only the former bound to M protein-expressing streptococci, again pointing to an involvement of SCR 7, since FHR-3, but not FHR-4, contains a domain that is similar to SCR 7 . Finally, the interaction between rFHL-1 and purified M5 protein was inhibited by heparin, which binds FH via SCR 7 . Together, these data indicate that the interaction between streptococcal M proteins and FH or FHL-1 requires SCR 7.

Infect Immun, 1998 Apr, 66(4), 1460 - 6
Effect of group A streptococcal cysteine protease on invasion of epithelial cells; Tsai PJ et al.; Cysteine protease of group A streptococci (GAS) is considered an important virulence factor . However, its role in invasiveness of GAS has not been investigated . We demonstrated in this study that two strains of protease-producing GAS had the ability to invade A-549 human respiratory epithelial cells . Isogenic protease mutants were constructed by using integrational plasmids to disrupt the speB gene and confirmed by Southern hybridization and Western immunoblot analyses . No extracellular protease activity was produced by the mutants . The mutants had growth rates similar to those of the wild-type strains and produced normal levels of other extracellular proteins . When invading A-549 cells, the mutants had a two- to threefold decrease in activity compared to that of the wild-type strains . The invasion activity increased when the A-549 cells were incubated with purified cysteine protease and the mutant . However, blockage of the cysteine protease with a specific cysteine protease inhibitor, E-64, decreased the invasion activity of GAS . Intracellular growth of GAS was not found in A-549 cells . The presence or absence of protease activity did not affect the adhesive ability of GAS . These results suggested that streptococcal cysteine protease can enhance the invasion ability of GAS in human respiratory epithelial cells.

Antimicrob Agents Chemother, 1998 Feb, 42(2), 257 - 62
A novel erythromycin resistance methylase gene (ermTR) in Streptococcus pyogenes; Seppala H et al.; Erythromycin resistance among streptococci is commonly due to target site modification by an rRNA-methylating enzyme, which results in coresistance to macrolide, lincosamide, and streptogramin B antibiotics (MLSB resistance) . Genes belonging to the ermAM (ermB) gene class are the only erythromycin resistance methylase (erm) genes in Streptococcus pyogenes with MLSB resistance that have been sequenced so far . We identified a novel erm gene, designated ermTR, from an erythromycin-resistant clinical strain of S . pyogenes (strain A200) with an inducible type of MLSB resistance . The nucleotide sequence of ermTR is 82.5% identical to ermA, previously found, for example, in Staphylococcus aureus and coagulase-negative staphylococci . Our finding provides the first sequence of an erm gene other than ermAM that mediates MLSB resistance in S . pyogenes.

Clin Infect Dis, 1998 Mar, 26(3), 689 - 94
Infective endocarditis in solid organ transplant recipients; Paterson DL et al.; Infective endocarditis, defined as pathologically or clinically definite by the Duke criteria, was observed in 14 transplant recipients at our institutions . In addition, we reviewed 32 previously reported cases in solid organ transplant recipients . The spectrum of organisms causing infective endocarditis was clearly different in transplant recipients than in the general population; 50% of the infections were due to Aspergillus fumigatus or Staphylococcus aureus, but only 4% were due to viridans streptococci . Fungal infections predominated early (accounting for six of 10 cases of endocarditis within 30 days of transplantation), while bacterial infections caused most cases (80%) after this time . In 80% (37) of the 46 cases in transplant recipients, there was no underlying valvular disease . Seventy-four percent (34) of the 46 cases were associated with previous hospital-acquired infection, notably venous access device and wound infections . Three patients with S . aureus endocarditis had had an episode of S . aureus bacteremia > 3 weeks prior to the diagnosis of endocarditis and had received treatment for the initial bacteremia of < 14 days' duration . The overall mortality rate was 57% (26 of 46 patients died), with 58% (15) of the 26 fatal cases not being suspected during life . Endocarditis is an underappreciated sequela of hospital-acquired infection in transplant recipients.

Rev Med Chir Soc Med Nat Iasi, 1995 Jan-Jun, 99(1-2), 134 - 8
{The frequency of Streptococcus anginosus in the pharyngeal exudate from children and its differentiation from other beta-hemolytic streptococci}; Coman G et al.; S . anginosus is a commensal of the oro-pharyngeal mucous membrane without any signification for the local pathology . Ignoring the existence of beta-haemolytic colonies of this species, the risk to report the presence of some beta-haemolytic streptococci that actually belong to the normal flora exists . The antigenic identifications of beta-haemolytic streptococci maintain the confusion either, S . anginosus being able to react with specific sera anti group G, C or A . In our study, two identification criteria out of those available demonstrated a high value: the small or very small colonies' size, especially in secondary cultures and the production of acetoin (Voges-Proskauer test) . S . anginosus was isolated with a quite great frequency in pharyngeal exudate from children: 41 strains out of 90 strains of beta-haemolytic non-group A streptococci were S . anginosus . Antigenically they belonged, in numerical order to groups C, G, F or they were ungroupable . IN CONCLUSION: The microbiologist has to identify, but not to report the presence of S . anginosus in pharyngeal exudate, it being a normal component of the oro-pharyngeal flora . Doing so, a better evaluation of the clinical signification of the other beta haemolytic streptococci's non group A will be possible.

Cardiology, 1998, 89(2), 79 - 86
Bacterial endocarditis at a tertiary hospital--how do we improve diagnosis and delay of treatment? A retrospective study of 140 patients; Kjerulf A et al.; During a period of 3.5 years, endocarditis was suspected in 151 patients admitted to Rigshospitalet . 140 were available for this study . In 59 of the 140 patients, the diagnosis was confirmed, and 36 had positive blood cultures . Echocardiographic findings compatible with the diagnosis were present in 92% of the 59 cases . The most common causes of endocarditis were Staphylococcus aureus and viridans streptococci . Patients with endocarditis caused by S . aureus had significantly (p = 0.002) more embolic episodes compared to patients having endocarditis caused by the viridans streptococci . The diagnosis was established at a mean of 3-4 weeks after the onset of symptoms and 2 weeks after admission to hospital . In order to minimize diagnostic delay, the following aspects may be important: (1) earlier detection of endocarditis among physicians examining patients at risk; (2) educating patients with cardiac disease and cardiac valve prosthesis; (3) earlier antibiotic therapy, and (4) developing further diagnostics for endocarditis.

Clin Ther, 1998 Jan-Feb, 20(1), 72 - 9
Clinical comparison of cefaclor twice daily versus amoxicillin-clavulanate or erythromycin three times daily in the treatment of patients with streptococcal pharyngitis; Esposito S et al.; The present study was undertaken to compare the efficacy and safety of a new regimen of cefaclor (25 mg/kg BID) with amoxicillin-clavulanate and erythromycin TID at standard doses for the treatment of pediatric patients with acute pharyngotonsillitis (APT) . A total of 673 children (age range, 2 to 12 years) with signs and symptoms of APT were enrolled; 245 of these children who had a positive throat culture for group A beta-hemolytic streptococci (GABHS) entered the study and were randomly assigned to receive cefaclor 25 mg/kg BID, amoxicillin-clavulanate 15 mg/kg TID, or erythromycin 15 mg/kg TID . A 10-day antibiotic course was prescribed for each patient . Clinical and bacteriologic responses were assessed at the end of treatment (day 10) and at the follow-up visit (day 30) . All GABHS strains isolated from throat cultures were tested for in vitro sensitivity to the antibiotics used in the study . Side effects (mainly nausea) were rare and mild in each group and did not require discontinuation of therapy . No GABHS strain was resistant to cefaclor or to amoxicillin-clavulanate; 37.9% of the strains were resistant to erythromycin . The results indicated that cefaclor given BID seems to be as effective as amoxicillin-clavulanate given TID (cure rate, 91.9% and 90.5%, respectively) and more effective than erythromycin given TID (cure rate, 76.8%) for the treatment of patients with APT . Erythromycin resistance among GABHS is an emerging problem in many geographic areas.

J Biol Chem, 1998 Feb 27, 273(9), 5331 - 6
Physical proximity and functional interplay of the glycoprotein Ib-IX-V complex and the Fc receptor FcgammaRIIA on the platelet plasma membrane; Sullam PM et al.; Although the glycoprotein (GP) Ib-IX-V complex and FcgammaRIIA are distinct platelet membrane receptors, previous studies have suggested that these structures may be co-localized . To determine more directly the proximity of GP Ib-IX-V and FcgammaRIIA, we assessed the effects of anti-GP Ibalpha monoclonal antibodies on FcgammaRIIA-mediated platelet aggregation and on the direct binding of polymeric IgG to human platelets . In addition, we directly examined the proximity of FcgammaRII and GP Ib-IX-V using flow cytometric fluorescence energy transfer and immunoprecipitation studies . Preincubation of platelets with either of two monoclonal antibodies (AN51 or SZ2) directed against GP Ibalpha completely blocked platelet aggregation by polymeric IgG . Similarly, these antibodies totally inhibited platelet aggregation by two strains of viridans group streptococci known to induce aggregation via FcgammaRIIA . In addition, AN51 and SZ2 significantly reduced the binding of polymeric IgG to washed fixed platelets . When assessed by flow cytometry, significant levels of bidirectional energy transfer were detected between FcgammaRIIA and GP Ibalpha, indicating a physical proximity of less than 10 nm between these receptors . This energy transfer was not due to high receptor density, because no homoassociative energy transfer was seen . Moreover, immunoprecipitation of FcgammaRIIA from platelet lysates also co-precipitated GP Ibalpha . These results indicate that GP Ibalpha and FcgammaRIIA are co-localized on the platelet membrane and that this association is not random.

FEMS Immunol Med Microbiol, 1998 Jan, 20(1), 11 - 20
Binding of complement subcomponent C1q to Streptococcus pyogenes: evidence for interactions with the M5 and FcRA76 proteins; Koroleva IV et al.; Binding of C1q, the first component of the complement system, to some human pathogens has been earlier reported . In the present study, direct binding of C1q to group A streptococci (GAS) of various serotypes as well as some other Gram-positive and Gram-negative species was demonstrated . The interaction between C1q and GAS was investigated more in detail . In hot neutral extracts of a number of GAS strains two components of 64 and 52 kDa, respectively, bound C1q; alkaline and SDS extracts yielded the 52 kDa component as the main C1q-binding substance . Trypsin treatment of the SDS extracts of two GAS strains suggested the C1q-binding component(s) to be of protein nature . C1q-binding material purified from the SDS extract of an avirulent strain, type T27, was separated in 12% SDS-PAGE and probed in Western blot with human C1q and fibrinogen, conjugated to horse radish peroxidase (HRP) as well as rabbit IgG antibodies complexed to HRP (PAP system) . The 52 kDa component was non-reactive with fibrinogen or rabbit IgG . However, C1q-binding components purified from the alkaline extracts of two M-positive strains revealed strong binding of either fibrinogen (type M5) or both fibrinogen and rabbit IgG (type M76); the molecular mass of these components . 55 kDa and 43-40 kDa, respectively, was in agreement with the reported molecular mass of the M5 and FcRA76 proteins . Our findings suggest that C1q may interact with GAS through certain M-family proteins as well as by a so far unidentified surface factor of protein nature occurring in most GAS strains . The involvement of M-family proteins, regarded as virulence factors of these organisms, may suggest the interaction of GAS with C1q as biologically important.

Community Dent Oral Epidemiol, 1998 Feb, 26(1), 12 - 20
The relationship between bottle usage/content, age, and number of teeth with mutans streptococci colonization in 6-24-month-old children; Mohan A et al.; OBJECTIVES: Mutans streptococci (MS) are the primary pathogens involved in the development of early childhood caries . However, factors that may affect their acquisition in the mouths of young children are not well understood, and the period of initial colonization remains controversial . This study investigated the relationship of age, number of teeth, and bottle usage/content with regard to the isolation of MS in 6-24-month-old children . METHODS: A total of 122 children from low-income families attending a nutritional supplement program, and their mothers, participated in this study . Children were examined for dental caries and number of erupted teeth and were sampled for MS . Mothers were administered a questionnaire to obtain details of baby bottle use, including what food items were put in the bottle during the last week . RESULTS: MS was detected in more than one-third of the 6-24-month-olds . Unlike some studies that suggest a later period of infectivity, approximately 20% of children under 14 months of age, including 4 of 22 infants aged 6-9 months, were colonized with MS . When examined separately, age, number of teeth, and bottle usage/content were each found to be related to the presence of MS . Mutans streptococci colonization was more likely with increasing age and number of teeth, and children whose bottles contained sweetened beverages were more likely to be colonized than children whose bottles contained milk . Logistic regression models that controlled for both age and number of teeth indicated that children who consumed sweetened beverages in their baby bottle had a statistically significant, four-fold increase in the odds of colonization by MS relative to children who consumed milk . CONCLUSIONS: The finding that approximately 20% of the children under 14 months of age were infected with MS indicates that colonization in this sample of low-income preschool children may begin earlier than suggested by some investigations . Additionally, the risk of MS colonization appears lower among infants who consume milk rather than sweetened beverages in the bottle.

Gene, 1998 Jan 30, 207(2), 119 - 26
Application of the resident plasmid integration technique to construct a strain of Streptococcus godronii able to express the Bacillus circulans cycloisomaltooligosaccharide glucanotransferase gene, and secrete its active gene product; Shiroza T et al.; A novel transformation technique, resident plasmid integration, for the cloning of foreign DNA in oral streptococci was described recently (T . Shiroza and H.K . Kuramitsu, Plasmid 34 (1995) 85-95 . This technique is based on the integration of linearized foreign genes by recombination-proficient bacteria onto a resident plasmid, if an appropriate selection marker is flanked by the same anchor sites present in the resident plasmid . Since the transforming vehicles for this system included a pUC-derived replication origin, the high level expression in Escherichia coli cells hindered the cloning of certain genes . In the present study, new plasmids were constructed, two resident plasmids, four integration plasmids, and four cloning plasmids, all of which possess the medium-copy number replication origin, p15A ori, isolated from pACYC177 . The resident plasmids consisted of the following three components: the p15A ori (0.65-kb Bg/II fragment), the pVA380-1 basic replicon functional in mutans streptococci (2.5-kb BamHI fragment), and either an erythromycin resistance or a spectinomycin resistance gene (0.9- or 1.1-kb BamHI fragment, respectively) . Most of the basic replicon of pVA380-1, except for the 3'-portion of the 0.2-kb region, in the resident plasmid was replaced with a kanamycin resistance gene to construct the four integration plasmids . Therefore, the upstream and downstream anchor sites for the double cross-over event in this new system were 0.65-kb p15A ori and the 0.2-kb portion of the 3'-end of pVA380-1 replicon, respectively . This system was used to clone the gene coding for cycloisomaltooligosaccharide glucanotransferase which produces cycloisomaltooligosaccharide, a potent inhibitor of oral streptococcal glucosyltransferase, isolated from Bacillus circulans chromosome, into Streptococcus gordonii, and its gene product was successfully secreted into the culture media . Plasmids described here should be useful tools for introducing heterologous DNA into resident plasmids following integration in oral streptococci.

J Antimicrob Chemother, 1997 May, 39 Suppl A, 139 - 43
Activity of quinupristin/dalfopristin against gram-positive bacteria: clinical applications and therapeutic potential; Rubinstein E et al.; In recent years there has been a dramatic worldwide increase in the prevalence of multiple drug-resistant strains of common Gram-positive bacteria . This highlights the need for a new class of antibiotic with activity against these organisms . Quinupristin/dalfopristin, the first injectable streptogramin antibiotic, has a unique spectrum of activity, encompassing most Gram-positive cocci (including multi-drug-resistant strains), respiratory pathogens and anaerobes, Gram-positive, and a prolonged post-antibiotic effect . Quinupristin/ dalfopristin is active in vitro against multi-drug-resistant isolates of Staphylococcus aureus, coagulase-negative staphylococci, penicillin-resistant pneumococci and vancomycin-resistant Enterococcus faecium . Clinical case reports have shown that the combination is active against intra-abdominal, aortic graft, bacteraemia and hydrocephalus shunt infections caused by multi-drug-resistant enterococci, particularly E . faecium . In almost all of these clinical situations the enterococcal infection had displayed resistance to all other antimicrobial therapies . Preliminary clinical data have demonstrated the activity of quinupristin/ dalfopristin against S . aureus bacteraemia, and quinupristin/dalfopristin may also prove useful in the treatment of pneumococcal infections . Thus, possible future applications of the combination include the treatment of multi-drug-resistant strains of staphylococci, streptococci and enterococci . Quinupristin/dalfopristin may prove useful in the treatment of staphylococcal infections in children, invasive systemic pneumococcal infections, and nosocomial and community-acquired Gram-positive infections in patients unable to tolerate beta-lactam antimicrobial agents or glycopeptide antibiotics.

J Antimicrob Chemother, 1997 May, 39 Suppl A, 75 - 80
In-vitro activity of quinupristin/dalfopristin compared with other widely used antibiotics against strains isolated from patients with endocarditis; Mouton JW et al.; The activity of quinupristin/dalfopristin was compared with that of other widely used antibiotics against 355 strains isolated from patients with endocarditis . MICs were determined by a standard agar dilution method . Quinupristin/dalfopristin was inhibitory at 1 mg/L for all coagulase-negative staphylococci (n = 36) and for the majority of Staphylococcus aureus strains (n = 87) . The activity of quinupristin/dalfopristin against 186 viridans streptococci was somewhat dependent on the species, with MIC50s ranging from 0.5 to 2 mg/L, being least active against Streptococcus bovis and most active against Streptococcus gordonii and Streptococcus mitis . For the staphylococci, quinupristin/dalfopristin was as active against erythromycin-susceptible as erythromycin-resistant strains . Viridans streptococci showed a slight but significant correlation between sensitivity to erythromycin and quinupristin/dalfopristin . It is concluded that quinupristin/dalfopristin has the potential to treat serious infections such as endocarditis caused by Gram-positive cocci.

Yonsei Med J, 1997 Dec, 38(6), 444 - 54
Streptococcal infection in the pathogenesis of Behçet's disease and clinical effects of minocycline on the disease symptoms; Kaneko F et al.; Although the precise pathoetiology of Behcet's disease (BD) remains obscure, patients with BD have a high incidence of chronic infectious foci, indicating an enhanced susceptibility to chronic tonsillitis, and dental caries . Sometimes, clinical symptoms appear after treatment of these foci in BD patients . It is believed that BD might be related to an allergic reaction to a bacterial infection in view of the many clinical symptoms, especially the presence of aphthous and genital ulcerations . An attempt to obtain cutaneous responses to bacterial antigens has been carried out using various vaccines developed from bacteria isolated from the ulcerative lesions and oral cavities of BD patients . BD patients often show intense hypersensitivity to various strains of streptococci, not only by their cutaneous reactions but also by in vitro testing . In this report, we describe our previous studies on the correlation between streptococcal antigens and the pathogenesis of BD and also discuss the recent reports of other authors . The intense hypersensitivity to streptococcal antigens acquired after streptococcal infection is thought to play an important role in the appearance of symptoms in BD patients since the production of pro-inflammatory cytokines by peripheral blood mononuclear cells (PBMC) was enhanced when stimulated with streptococcal antigen in a culture system . Minocycline, an antibiotic to which certain strains of streptococci are sensitive, reduced the frequency of clinical symptoms in BD patients as well as the production of pro-inflammatory cytokines by BD-PBMC stimulated with streptococcal antigen.

J Dent Assoc S Afr, 1994 Jul, 49(7), 339 - 41
Antibacterial action of honey on oral streptococci; Basson NJ et al.; The antibacterial properties of honey against medically important bacteria have been well documented but this information is not available for the oral bacteria and specifically for the oral streptococci . We determined the minimal inhibitory concentration (MIC) of honey for oral streptococci . Honey had a MIC of 25 per cent (vol/vol) for the bacteria tested with the exception of Streptococcus anginosus and Streptococcus oralis which were inhibited by 17 per cent (vol/vol) and 12 per cent (vol/vol) honey respectively . The hypertonic sugar control had a MIC of 25 per cent (vol/vol) for all the bacteria tested . Although the results of this study indicate that there could be other antibacterial agents present in the honey, it may be assumed that the hypertonic sugar concentration played an important role in this activity.

Eur Heart J, 1998 Jan, 19(1), 166 - 73
Infective endocarditis in the grown-up congenital heart (GUCH) population; Li W et al.; AIMS: Infective endocarditis accounts for 4% of admissions to a specialized unit for grown-up congenital heart patients . This study defines lesions susceptible to infection, antecedent events, organisms, outcome and surgical treatment in a group of such patients . METHODS AND RESULTS: The grown-up congenital heart disease database was searched for all patients aged 13 years and above with adequate documentation of infective endocarditis retrospectively between 1983-1993 and thereafter between 1993-1996 . There were 185 patients (214 episodes) divided into Group I: 128 patients unoperated or palliated and Group II: 57 patients after definitive repair and/or valve repair/replacement . In Group I, the commonest affected sites were ventricular septal defect in 31 (24%), left ventricular outflow tract in 22 (17%) and mitral valve in 17 (13%) and in Group II, left ventricular outflow tract in 20 (35%), repaired Fallot in 11 (19%), and atrioventricular defects in eight (14%) . Infective endocarditis was not seen in secundum atrial septal defects before or after closure; in closed ventricular septal defects and ducts without left-sided valve abnormality; in isolated pulmonary stenosis; in unrepaired Ebstein: or after Fontan-type or Mustard operations . Surgery was performed in 39 patients: as an emergency in 17, and for failed medical therapy in 22 . Only 87 (41%) of patients had a predisposing event: dental procedure or sepsis were the commonest events in Group I (33%) and cardiac surgery in Group II (50%) . Streptococci species were found in 54% of Group I patients and in 45% of Group II . Staphylococci aureus was commoner in Group II (25%) compared to Group I (14%) . Mean time from the onset of symptoms to diagnosis was 60 and 29 days in Groups I and II, respectively . Eight (4%) patients died as a result of septicaemia related to emergency or repeated surgery and Staphylococcus aureus infection . Recurrent attacks occurred in 21 (11%) patients . CONCLUSION: Reparative surgery does not prevent endocarditis except for closure of a ventricular septal defect and duct . Delay in diagnosis is serious since it contributes to mortality, although the overall mortality % is not high . Specific lesions are not affected so prophylaxis is probably unnecessary in those anomalies.

J Infect Dis, 1998 Mar, 177(3), 790 - 2
Capsular polysaccharide types of group B streptococcal isolates from neonates with early-onset systemic infection; Lin FY et al.; The distribution of serotypes of group B streptococci (GBS) isolated from 67 infants with early-onset sepsis are described . Case-infants were assembled from 13 hospitals across the United States from 15 July 1995 to 5 February 1997 through prospective active surveillance . The distribution of GBS serotypes was Ia, 40%; Ib, 9%; II, 6%; III, 27%; V, 15%; and nontypeable, 3% . Type V occurred more frequently in the northeast region (New York and New Jersey) than in other regions (29% vs . 9%, P = .06) . Conversely, type III occurred significantly less frequently in the northeast region than other regions (10% vs . 35%, P = .04) . GBS types Ia, III, and V accounted for 82% of the isolates . This report supports previous observations about the emergence of GBS type V, but our data caution that conclusions about serotype distributions based on one geographic location or on a small number of patients may not be generally applicable . Continued monitoring seems necessary for the design of a GBS vaccine.

Scand J Immunol, 1998 Feb, 47(2), 179 - 88
Cervical secretions in pregnant women colonized rectally with group B streptococci have high levels of antibodies to serotype III polysaccharide capsular antigen and protein R; Hordnes K et al.; Group B streptococci (GBS) colonizing the female genital tract will often infect newborn infants during delivery . In 200 pregnant women studied, 14% were colonized with GBS in the cervix, 12% in the rectum, and 9% in both cervix and rectum . We have previously reported that antibody levels to GBS serotypes Ia, II, and III in sera and cervical secretions were increased in women colonized in the rectum and/or cervix, when analyzed by a whole-cell ELISA . Here, we report the levels of antibodies to GBS serotype III capsular polysaccharide antigen (CPS III) and to protein antigen R4, which are present in most GBS III strains . Compared to culture-negative women, the group of women colonized rectally had markedly elevated levels of immunoglobulin (Ig)A and IgG antibodies in cervical secretions to both CPS III and protein R4 (P < 0.01 and P < 0.001, respectively) . In sera, the corresponding differences between culture-negative and culture-positive women were less pronounced, or not present . In contrast to antibody levels to whole-cell GBS, antibody levels to CPS III and protein R4 in cervical secretions were not significantly increased in women colonized only in the cervix, except that IgA antibodies to protein R4 were slightly elevated (P < 0.05) . These findings suggest that capsular type-specific polysaccharides and protein R4 in a mucosal vaccine might induce protective antibodies against GBS colonization of the uterine cervix.

Indian J Dent Res, 1997 Jul-Sep, 8(3), 72 - 6
Cariogenic {correction of Carcinogenic} potential of a typical cassava flour from the Amazonian region of Brazil; Rosalen PL et al.; The purpose of this study was to compare the cariogenic potential of a typical cassava flour (CF) with sucrose and starch, using a severe cariogenic challenge model in rats . Thirty Wistar female pups with their dams (mutans streptococci free) were infected by Streptococcus sobrinus 6715, desalivated when aged 25 days, and placed in a Konig-Hofer programmed feeder at age 26 days . They received 17 meals daily at hourly intervals for 21 days as follows: group (1) powdered plain sucrose and sterile distilled water ad libitum (sdwal); (2) Lf and Sdwal (3) powdered starch and sdwal . Essential nutrition was administered by gavage . Data were analyzed by ANOVA . The percentage of S . Sobrinus related to the total flora and the number of this microorganism were higher in the sucrose and CF groups than starch group . Smooth-surface and {sulcal} caries scores for the groups were: (1) 105.5 {48.0}; (2) 34.1 {39.2}; (3) 10.2 {18.1} . All the groups were statistically significantly different from each other (p < 0.01), although the result for sulcal score for CF was very close to the sucrose group . It is concluded that cassava flour, the main source of carbohydrate for the Amazonian population of Brazil, has moderate cariogenic potential.

Lakartidningen, 1998 Feb 11, 95(7), 628, 631 - 2, 635
{Meningitis is a rare complication of spinal anesthesia . Good hygiene and face masks are simple preventive measures}; Moen V; Although bacterial meningitis is a rare sequela of spinal anaesthesia, occasional case reports continue to appear in anaesthesiological literature . The article presents nine cases of iatrogenic meningitis reported to the treatment injury claims authority . Eight of these patients had undergone spinal anaesthesia, and one myelography . Alpha-haemolytic streptococci were isolated in cerebrospinal fluid culture in seven cases, the remaining two cases being culture-negative . Although alpha-haemolytic streptococci are normal commensals of the upper respiratory tract and mouth and rarely cause spontaneous meningitis, they have been implicated in several reported cases of iatrogenic meningitis . The risk of such infection raises the issue of the widespread habit of omitting face masks when performing dural puncture . As these bacteria are not known to cause infection in general surgery, the necessity of using face masks in the operating theatre has been questioned . However, the use of face masks has been shown to reduce the risk of bacterial contamination from the upper airway; and as available documentation on iatrogenic meningitis suggests oral commensals to be responsible, the use of face masks should be mandatory whenever any kind of lumbar puncture is performed.

FEMS Microbiol Lett, 1998 Mar 1, 160(1), 69 - 73
Detection of new and persistent Streptococcus uberis and Streptococcus dysgalactiae intramammary infections by polymerase chain reaction-based DNA fingerprinting; Oliver SP et al.; Polymerase chain reaction-based DNA fingerprinting was used as a tool to differentiate new and persistent Streptococcus uberis and Streptococcus dysgalactiae intramammary infections (IMI) in dairy cows . The same subtype of S . uberis or S . dysgalactiae was detected from some infected mammary glands from one lactation to the next documenting the persistence of these infections . Conversely, some streptococci isolated from mammary glands during a lactation or from one lactation to the next were different subtypes suggesting that a new IMI occurred . These new streptococcal IMI would never have been detected using phenotypic methods of streptococcal identification . Results of this study indicate that PCR-based DNA fingerprinting can be used as an effective procedure to differentiate new and persistent S . uberis and S . dysgalactiae IMI in dairy cows . This technique will be useful in epidemiological investigations, and drug and vaccine efficacy studies when attempting to delineate new and persistent IMI.

Ann Acad Med Singapore, 1997 Sep, 26(5), 691 - 3
Infections due to group A streptococcus: new concepts and potential treatment strategies; Norrby SR et al.; Important new information has been gained on the pathogenesis and treatment of life-threatening invasive infections caused by group A streptococci (GAS), i.e . the streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF) . Both STSS and NF lead to superantigen reactions with activation of up to 10% of the CD4+ lymphocytes and release of large amounts of cytokines; mainly tumour necrosing factor beta, interferon gamma, interleukin 1 and interleukin 6 . Streptococcal products known to trigger the superantigen reactions are the pyrogenic exotoxins, spe A, spe B and spe C and the M-proteins . Therapeutically clindamycin has been shown to reduce mortality in animal experiments in comparison to penicillin treatment . A possible mechanism is the effect of clindamycin on protein synthesis which might decrease the production of superantigens . In man, the use of intravenous immunoglobulin has been shown to significantly reduce mortality in STSS and NF . The most probable mechanism is neutralisation of superantigens by antibodies in the immunoglobulin preparations used.

J Vet Med Sci, 1998 Jan, 60(1), 129 - 31
Biochemical and serological examination of beta-hemolytic streptococci isolated from slaughtered pigs; Katsumi M et al.; A total of 170 beta-hemolytic streptococci isolated from lesions in slaughtered pigs during 1988 to 1995 were identified by biochemical and serological examinations . Of these, 132 strains (77.6%) were Streptococcus (S.) dysgalactiae and 38 strains (22.4%) were S . porcinus . The largest serological group of streptococci was group C (78 strains, 45.9%), followed by group L (43 strains, 25.3%), group U (14 strains, 8.2%), group G (11 strains, 6.5%), group E (5 strains, 2.9%), and group P (5 strains, 2.9%) . Most of isolates from endocarditis (61 strains) and arthritis (25 strains) were group C S . dysgalactiae, but about 33.3% of the isolates from lymphadenitis were group L S . dysgalactiae (28 strains), followed by group C (14 strains, 16.7%), group U S . porcinus (14 strains, 14.3%), and group G (10 strains, 11.9%).

Arch Pediatr, 1997 Nov, 4(11), 1074 - 8
{Role of group B streptococcus serotype V in materno-fetal infections}; Le Thomas I et al.; BACKGROUND: The classification of serogroup B streptococci in serotype is based on the structural differences of capsular polysaccharides and on presence or absence of a protein c antigen . They are classified as Ia, Ia/c, Ib/c, II, II/c, III, IV and V . The serotype V, unknown in 1970, seems emerging, and is placed in third position of frequency in some American studies . We have therefore decided to evaluate its frequency in Paris . POPULATION AND METHODS: In a population of 137 pregnant women and 60 neonates carrying streptococcus of serogroup B, the serotype was systematically determined using the test "Group B streptococcus serotyping test" (Dako, Danemark) . RESULTS: In the pregnant women population, 12% of the isolated strains were of serotype V, 26% of serotype III, 15% of serotype II, 14% of serotype Ia, and 21% could not be typed . In neonates, it represented 15% of the isolates and took place after the serotype Ia (20%), the serotype III (18%) and the serotype II (15%) . None of the neonates had early- or late-onset disease . They were only colonized . Only one mother exhibited, during the per-partum, a positive blood culture with a streptococcus group B of serotype V . CONCLUSION: These results confirm, in Paris, the importance of this serotype previously observed in foreign studies . It represents 11 to 15% of the isolated streptococcus group B in the neonates and can cause early or late-onset disease . However, larger studies are needed to evaluate the exact risk of pathology for the serotype V and its significance in neonatal infectious disease.

J Biol Chem, 1998 Feb 6, 273(6), 3291 - 5
Different endosomal proteolysis requirements for antigen processing of two T-cell epitopes of the M5 protein from viable Streptococcus pyogenes; Delvig AA et al.; We studied endosomal proteolysis of the surface fibrillar M5 protein from viable Streptococcus pyogenes as an essential step involved in major histocompatibility complex class II-restricted antigen processing of two immunodominant CD4(+) T-cell epitopes (17-31/Ed and 308-319/Ad) . Intracellular proteolysis of viable streptococci for presentation of 17-31, bound by serine proteinase cleavage sites, was mediated by serine proteinases, whereas processing of soluble recombinant M5 protein required in addition cysteine proteinases . Furthermore, processing of 17-31 was resistant to ammonium chloride and thus was not dependent on endosome acidification . Cysteine and serine proteinase cleavage sites were located adjacent to 308-319, and its processing was dependent on serine, cysteine, and aspartic proteinases, as well as on endosomal acidification . The data suggest that antigen processing of two major T-cell epitopes on streptococcal M5 protein occurred in different endosomal compartments by different classes of intracellular proteinases.

Infect Immun, 1998 Mar, 66(3), 974 - 9
Immunoglobulins to group A streptococcal surface molecules decrease adherence to and invasion of human pharyngeal cells; Fluckiger U et al.; The M protein is one of the most important virulence factors of group A streptococci (Streptococcus pyogenes) and may play an important role in the first steps of streptococcal infection . Since acute pharyngitis is a frequently occurring infectious disease caused by these bacteria, we wished to know whether antibodies to the M protein or other surface components inhibit adherence and internalization of streptococci to pharyngeal cells . We investigated the role of whole human secretory immunoglobulin A (sIgA), M6 protein-specific sIgA, and M6 protein-specific serum IgG in the inhibition of streptococcal adherence and internalization to cultured human pharyngeal cells . S . pyogenes D471, which produces a type 6 M protein (M+), and its isogenic M-negative (M-) derivative JRS75 were tested . Purified whole sIgA, M protein-specific sIgA, and sIgA preabsorbed with M protein were able to decrease significantly the adherence of streptococci to pharyngeal cells . Purified IgG against the M6 protein did not diminish the attachment of streptococci to the pharyngeal cells but did reduce internalization . Thus, our data suggest that secretory IgA may play a key role in preventing streptococcal infection at mucosal surfaces by blocking adherence while affinity-purified anti-M protein-specific IgG blocks epitopes responsible for invasion.

Am Surg, 1998 Feb, 64(2), 122 - 6
Aspergillus: a rare primary organism in soft-tissue infections; Johnson MA et al.; Nonclostridial necrotizing soft-tissue infections are usually polymicrobial, with greater than 90 per cent involving beta-hemolytic streptococci or coagulase-positive staphylococci . The remaining 10 per cent are usually due to Gram-negative enteric pathogens . We describe the case of a 46-year-old woman with bilateral lower extremity fungal soft tissue infections . She underwent multiple surgical debridements of extensive gangrenous necrosis of the skin and subcutaneous fat associated with severe acute arteritis . Histopathological examination revealed Aspergillus niger as the sole initial pathogen . Despite aggressive surgical debridement, allografts, and intravenous amphotericin B, her condition clinically deteriorated and she ultimately died of overwhelming infection . Treatment for soft-tissue infections include surgical debridement and intravenous antibiotics . More specifically, Aspergillus can be treated with intravenous amphotericin B, 5-fluorocytosine, and rifampin . Despite these treatment modalities, necrotizing fascitis is associated with a 60 per cent mortality rate . Primary fungal pathogens should be included in the differential diagnosis of soft-tissue infections.

Mol Microbiol, 1998 Jan, 27(2), 337 - 46
Streptolysin O and adherence synergistically modulate proinflammatory responses of keratinocytes to group A streptococci; Ruiz N et al.; In contrast to a mutant adhesin-deficient Streptococcus pyogenes (group A streptococcus), its isogenic parental strain binds to human keratinocytes and promotes a vigorous proinflammatory response, characterized by enhanced expression of several cytokines, a more rapid release of prostaglandin E2 (PGE2) and damage to keratinocyte membranes . However, adherence alone is not sufficient to induce these responses . In this study, we have begun to examine the contribution of other streptococcal products in interactions with keratinocytes by the construction and evaluation of mutants deficient in expression of the secreted pore-forming haemolysin, streptolysin O (SLO) . Inactivation of SLO did not prevent the streptococci from adhering to cultured HaCaT keratinocytes or from expressing an unrelated second streptococcal haemolysin, streptolysin S, during infection of keratinocytes . As measured by a quantitative reverse transcriptase polymerase chain reaction (PCR) assay, inactivation of SLO also did not have a marked effect on the expression of interleukin 1alpha (IL-1alpha) during infection . However, the lack of the ability to produce SLO was associated with a considerable reduction in expression of IL-1beta, IL-6 and IL-8 by infected keratinocytes . Measurement of the release of PGE2 by an enzyme-linked immunosorbent assay demonstrated that the SLO-deficient mutants were also not capable of promoting the rapid high level of PGE2 release characteristic of the adherent SLO-producing parental strain . Finally, analyses using the fluorescent probe ethidium homodimer-1 and measurements of release of keratinocyte lactate dehydrogenase indicated that the failure of the SLO-deficient mutants to induce responses was associated with the failure of these mutants to damage the integrity of the keratinocyte membrane . These data implicate SLO as a factor that acts synergistically with an adhesin to modulate the signalling responses of keratinocytes during infection.

Kokubyo Gakkai Zasshi, 1997 Dec, 64(4), 512 - 7
{Distribution of Candida species and mutans streptococci related to oral conditions in elderly persons}; Shinada K et al.; The purpose of this investigation was to find the relationship between the occurrence of Candida species and mutans streptococci at 7 sites (saliva, tongue, mucosa, teeth, clasp, external, and mucosal denture surfaces) in the mouth of 97 elderly persons (males: 43, age: 76.4 +/- 6.7 years; females: 54, age: 75.0 +/- 6.6 years) . Among the subjects, there were complete denture wearers (n = 20), partial denture wearers (n = 45), and non-denture wearers (n = 32) . Candida species were more significantly (p < 0.001) predominant in complete and partial denture wearers (80% each) than in non-denture (18.8%) wearers . The presence of Candida was highest on the mucosal denture surfaces followed by clasp, tongue, and remaining teeth in that order . Positive correlation were significantly found between the CFU numbers of Candida species and mutans streptococci present on the external surfaces (p < 0.001), natural teeth (p < 0.001), clasp (p < 0.01), and saliva (p < 0.05) . A negative correlation (r = -0.503; p < 0.001) was found between the number of teeth and the CFU numbers of Candida species . Moreover, the CFU numbers of both groups of microorganisms also increased in 80-year-old and over persons . Candida species were most predominantly found in persons with poor oral and denture cleanliness.

Kansenshogaku Zasshi, 1997 Dec, 71(12), 1187 - 92
{Properties of extracellular products produced by group A streptococci isolated from patients with streptococcal toxic shock syndrome}; Suzuki J et al.; Extracellular products of group A streptococci isolated from patients with streptococcal toxic shock syndrome (STSS) were examined . The outline of the discussion of the 3 products are as follows; streptolysin O (SLO), proteinase and erythrogenic toxin . SLO and proteinase showed a relatively large amount of products more than erythrogenic toxin . SLO produced by group A streptococci isolated from the patient with STSS had an isoelectric point (pI) of 6.0 and a molecular weight of 64,000 and showed hemolytic activity in the presence of 2-mercaptoethanol (2-ME) . Furthermore, the hemolytic activities of all components were inhibited by gamma-globulin and cholesterol . Proteinase had pIs of 8.7 and 8.9, and a molecular weight of 21,000 . These data suggest that STSS clinical criteria probably reflects a characteristic of a large amount of products of individual S . pyogenes isolates.

Gesundheitswesen, 1997 Dec, 59(12), 710 - 5
{Caries decline in Germany--causes and consequences}; Kunzel W; The reunification of the two German states has resulted in social transformations in Eastern Germany after 1990, in the wake of which disadvantageous effects on oral health were to be expected . Contrary to the predicted caries increase, a caries decline in the juvenile population could be proven by epidemiological comparative studies (n = 50612) (decrease between 1983-1989 and 1993-1995 by 34.2%) . The caries decline is probably caused by a broader availability of fluorides, a high level of individual dental curative and preventive care (fissure sealings) and by changed oral health behaviour and nutritional habits . Reference is made to a possible tangent between a high level of antibiotics consumption and the virulence of oral pathogenic streptococci.

J Dent, 1998 Jan, 26(1), 31 - 7
The effect of saliva or serum on Streptococcus mutans and Candida albicans colonization of hydroxylapatite beads; Nikawa H et al.; OBJECTIVE: Several recent reports imply the possibility of cariogenicity of denture plaque containing Candida albicans . Hence the purpose of this study was to investigate the effects of salivary and serum pellicles on C . albicans and Streptococcus mutans colonization on hydroxylapatite beads . METHODS: The colonization of three isolates of C . albicans and two isolates of S . mutans was examined by the use of a bioluminescent adenosine triphosphate (ATP) assay based on the firefly luciferase-luciferin system . RESULTS: In the preliminary study, a good correlation was observed between the cell number and ATP amount of each isolate tested, and the results yielded a level of significance (P < 0.001; Student's t-test), confirming the validity of this method . When the relative ATP content of the 48 h colonization of both isolates of S . mutans were compared, a saliva pellicle was significantly more effective in promoting bacterial colonization than either uncoated or serum pellicle (ANOVA; P < 0.01) . In contrast, in the case of colonization of C . albicans isolates, a serum pellicle was significantly more effective in promoting the colonization of C . albicans GDH 18 and GDH 19, than both uncoated specimens and saliva pellicle (ANOVA; P < 0.01) . Similar trends were observed with C . albicans GDH 16, though significant differences were not observed (ANOVA; P > 0.05) . CONCLUSION: The results suggest that the mechanism involved in fungal colonization on hydroxylapatite (HAP) should be different from that of mutans streptococci.

J Dent, 1998 Jan, 26(1), 25 - 30
The effect of monitored chlorhexidine gel treatment on mutans streptococci in margins of restorations; Wallman C et al.; OBJECTIVES: The objective of this study was to compare the effect of a monitored chlorhexidine (CHX) gel treatment with a conventional two-day CHX treatment in subjects with well-restored dentitions and high numbers of salivary mutans streptococci (MS) . METHODS: In the test group (n = 8), the effect of the CHX gel applications was monitored in margins of restorations and in saliva during a period of 12 weeks . Strip Mutans was used for monitoring and whenever a sample revealed growth of MS, the subject received a 3 x 5 min 1% CHX gel treatment at the clinic . Nine subjects (control group) were only given the baseline (conventional) treatment with CHX gel 3 x 5 min on two consecutive days . RESULTS: The monitored treatment in the test group resulted in a more pronounced reduction of MS both in margins of restorations and in saliva than the conventional treatment . The difference between the level of MS in the margins in the two groups was, however, only significant at the 20-week examination . There was a large individual variation in the effect of the CHX treatment, and three to nine extra CHX gel applications were needed in the test group to keep MS below a detectable level during the 12 weeks . CONCLUSIONS: Our findings illustrate the difficulties to obtain a long-lasting reduction of MS in subjects with a large number of restorations and a high number of MS by antimicrobial treatment only . The results indicate the necessity to combine antimicrobial treatment with, for example, sucrose restriction, in order to keep MS at a low level for a longer period of time.

Br Dent J, 1998 Jan 10, 184(1), 29 - 32
Sugar substitutes, chewing gum and dental caries--a review; Edgar WM; The prevalent use of chewing gum has prompted interest in its dental effects . Important defining aspects are the ability to use sugar substitutes in gum manufacture and the prolonged stimulation of a protective flow of saliva . The main sugar substitutes used are sorbitol and xylitol . Because it is not fermented by oral bacteria, xylitol is considered to be non-cariogenic, and while sorbitol in solution can be fermented slowly by mutants streptococci, chewing sorbitol-sweetened gum does not cause a fall in plaque pH . Effects of chewing sugar-free gum on the ability of plaque to form acid from sucrose are equivocal, although the tendency is for the plaque acidogenicity to be reduced with the use of xylitol gum for 2-3 weeks, due to its inhibitory effects on mutants streptococci . Gum-chewing also stimulates a protective salivary flow when used after an acidogenic stimulus, and may enhance salivary function, especially in subjects with low flow rates . Sorbitol and xylitol gums have similar beneficial effects in promoting enamel remineralisation in short-term in-situ experiments . Clinical trials indicate that xylitol gum has a useful anticaries role, superior to the effects of sorbitol gum . In conclusion, both sorbitol and xylitol chewing gums are non-cariogenic in contrast to sugared gum, and exhibit beneficial anticaries properties through salivary stimulation . In addition, xylitol's antibacterial properties seem likely to lead to caries reductions superior to the more modest reductions with sorbitol gum.

Stomatologiia (Mosk), 1997, 76(6), 19 - 22
{The choice of antibacterial preparations for the combined treatment of periodontitis in the exacerbation stage}; Tsarev VN et al.; Antibiotic sensitivities of peptostreptococci, streptococci, Actinomyces, bacteroid, and fusobacterial strains pathogenic for the periodontium are analyzed . The sensitivities of these bacteria to broad-spectrum penicillins, cephalosporines, lincomycin, and macrolides, and to metronidasole and nitasole are assessed . New macrolide drugs macropen and rulide and gramicidine C, levomycetine, and rifampicin are highly active towards the above microflora . Microbiological indications for oral and local use of these antibiotics are validated . Some narrow-spectrum antibiotics, such as augmentine, cephalexin, and vancomicin are highly active, too; the latter drug is specifically active towards Actinomyces.

Epidemiol Mikrobiol Imunol, 1997 Dec, 46(4), 140 - 4
{Determination of antibodies to streptolysin O}; Bicova R; A new procedure for the assessment of the antibody against streptolysin O by a micromethod was tested by comparison with the photometric reference method . Agreement between the two methods was very good . The differences in titres did not exceed the titration error of the method . Based on the tested micromethod, a diagnostic set was produced in the Czech Republic which is to be used for common titration of antistreptolysin O in serum . The ITEST ASO was tested in relation to the photometric reference method and standardized neutralization micromethod of the National reference laboratory for streptococci and enterococci in Prague . From a group of 135 selected sera with different titres there was agreement between all tested methods . Selected kits used abroad for the titration of antistreptolysin O were tested in the National reference laboratory by using the authors own standardized materials and methods.

J Am Vet Med Assoc, 1998 Feb 1, 212(3), 407 - 12
Efficacy of parenteral administration of three antimicrobial agents in treatment of clinical mastitis in lactating cows: 487 cases (1989-1995); Pyorala SH et al.; OBJECTIVE: To evaluate the efficacy of parenteral administration of procaine penicillin G, spiramycin, or enrofloxacin in the treatment of clinical mastitis in lactating cows . DESIGN: Noncontrolled, clinical retrospective study . ANIMALS: 487 cows with mastitis involving 543 quarters . PROCEDURE: Clinical signs, histories, and results of bacteriologic examination, somatic cell count, and N-acetyl-beta-D-glucosaminidase activity of milk samples taken before and 3 to 4 weeks after treatment were retrieved from hospital records . Cows treated parenterally with procaine penicillin G, spiramycin, or enrofloxacin for 3 to 5 days were included . Supportive treatment alone was given to 35 cows infected with Escherichia coli . Factors possibly affecting outcome were analyzed, using ANOVA, correlation analyses, and the Mann-Whitney test . chi 2 Test was used to compare bacteriologic cure rates . RESULTS: Bacteriologic cure rates for mastitis caused by Staphylococcus aureus, coagulase-negative staphylococci, and streptococci were 34, 76, and 65%, respectively . Cure rates in cows in their first lactation and infected with S aureus and coagulase-negative staphylococci were significantly higher than those for older cows . In cows with mastitis caused by E coli, the cure rate was 74% for those treated with penicillin G and 71% for those not treated with antimicrobials . High N-acetyl-beta-D-glucosaminidase activity in milk samples obtained at initial examination indicated a poor outcome in S aureus and streptococcal mastitis . Cows infected in the early lactation period had more severe inflammatory responses and clinical signs if infected with coagulase-negative staphylococci and coliforms . CLINICAL IMPLICATIONS: 3 to 5 days of treatment with parenterally administered penicillin G for clinical mastitis caused by penicillin-susceptible S aureus strains is efficacious in young cows . Parenteral administration of spiramycin or enrofloxacin does not give satisfactory results in mastitis caused by penicillin-resistant S aureus . Use of antimicrobials in the treatment of mastitis caused by coliform bacteria is questionable.

Pediatr Infect Dis J, 1998 Jan, 17(1), 39 - 43
Comparison between cefprozil and penicillin to eradicate pharyngeal colonization of group A beta-hemolytic streptococci; Standaert BB et al.; BACKGROUND: Our objective was to perform a prospective, randomized, double blinded study of cefprozil and penicillin therapy to eradicate group A beta-hemolytic streptococci (GABHS) in children who were bacteriologic failures after receiving a standard 10-day course of penicillin treatment for GABHS pharyngitis . METHODS: Children and adolescents 2 to 18 years of age were eligible for the study . From 3 to 7 days after completing oral penicillin therapy for pharyngitis caused by GABHS, the study was explained, informed consent was obtained, a history and physical examination were completed and a throat culture was performed . Children with throat cultures positive for GABHS were randomized to receive either cefprozil or penicillin for 10 days . Children who were bacteriologic failures after administration of the first study drug were crossed over to receive the alternate drug . RESULTS: Of 180 enrolled children 66 (37%) had throat cultures positive for GABHS . Seventeen were excluded from the study, leaving 49 who completed the protocol . Of the 49 participants 26 received cefprozil initially whereas 23 received penicillin . GABHS were eradicated from the pharynx of 73% of children who received cefprozil as the first antibiotic compared with 39% of penicillin recipients (chi square, 5.748, 0.01 < P < 0.025) . After crossover of failures, the final efficacy rate for cefprozil was 65% compared with 36.7% for penicillin (chi square, 5.523, 0.01 < P < 0.025) . CONCLUSIONS: Cefprozil was more effective than penicillin in treating children who were bacteriologic failures after a standard 10-day course of oral penicillin.

Oral Microbiol Immunol, 1997 Aug, 12(4), 227 - 30
Ribosomal RNA (rrn) operons in Streptococcus mutans and nucleotide sequence of tRNA(Pro) gene associated with rrnB; Novak J et al.; Using a cloned 0.5-kb probe containing an internal fragment of 23S ribosomal RNA from the rrnB operon of Streptococcus mutans, we analyzed various endonuclease digests of the chromosomal DNA isolated from human-derived strains of mutans streptococci . Thus far, the examined S . mutans strains exhibited five ribosomal operons . Here, we describe a ribotyping technique for S . mutans based on restriction and Southern blot analyses with the biotin-labeled homologous probe and chemiluminescence detection . We cloned and sequenced a unique gene encoding tRNA(Pro) downstream from 23S rRNA gene at the 3' end of the operon . Primers designed to the 3' end of the rrnB operon PCR-amplified a 2.3-kb DNA fragment in all tested strains . Restriction fragment length polymorphism analysis of the amplicon revealed a diversity of the single locus among S . mutans isolates, thus establishing a potential use of the technique for the molecular epidemiology of mutans streptococci.

Oral Microbiol Immunol, 1997 Aug, 12(4), 212 - 8
Immunoglobulin A reaction to oral streptococci in saliva of subjects with different combinations of caries and levels of mutans streptococci; Bratthall D et al.; The aim of this study, performed in Bangkok, was to study whether a particular salivary immunoglobulin A (IgA) antibody profile against mutans streptococci could be related to the absence or presence of caries . A group of 12-year-old individuals representing various combinations of mutans streptococci levels and caries experience was selected . Whole saliva stimulated by paraffin-chewing was collected, and the children were investigated for decayed, missing and filled surfaces (DMFS) and teeth (DMFT), following WHO criteria and methods, at baseline and after 2 years . The total amount of salivary IgA was determined by an immunobead enzyme-linked immunosorbent assay, and SDS-PAGE and Western blot analysis was performed using sonicated antigens of Streptococcus mutans and Streptococcus sobrinus strains and, as a control, a Streptococcus parasanguis strain . The results showed that Thai children with low caries prevalence had more distinct immunoblot bands to antigens from mutans streptococci than did the high-caries children . A similar picture was not seen for S . parasanguis . On the whole, the Thai children also showed fewer bands than usual Swedish saliva samples from comparable age groups . The complexity of the relationship between dental caries and IgA in saliva is highlighted.

Oral Microbiol Immunol, 1997 Oct, 12(5), 274 - 80
The role of the Streptococcus mutans glucosyltransferases in the sucrose-dependent attachment to smooth surfaces: essential role of the GtfC enzyme; Tsumori H et al.; Previous results have indicated that the glucosyltransferase activities of mutans streptococci are required for sucrose-dependent colonization of tooth surfaces . We have constructed mutants of Streptococcus mutans GS5 that are altered in varying combinations of the three gtf genes present in this organism . A quantitative in vitro sucrose-dependent attachment system was used to demonstrate that the inactivation of the gtfC gene drastically reduced adherence to smooth surfaces . By contrast, inactivation of the gtfB gene resulted in a smaller, but significant, reduction in attachment while the gtfD mutant was only marginally affected . Furthermore, production of only the glucosyltransferase C enzyme allowed for attachment although at reduced levels compared to the wild-type organism . The results from reintroduction of single copies of each of the gtf genes into a mutant of strain GS5 lacking glucosyltransferase activity also demonstrated the crucial role of the glucosyltransferase C enzyme in colonization . These results suggest a unique role for the glucosyltransferase C enzyme in the sucrose-dependent colonization of tooth surfaces by S . mutans strains.

Oral Microbiol Immunol, 1996 Dec, 11(6), 412 - 9
Differential toxic effects of lactate and acetate on the metabolism of Streptococcus mutans and Streptococcus sanguis; Carlsson J et al.; Experiments were conducted with Streptococcus mutans NCTC 10449 and Streptococcus sanguis ATCC 10556 to determine whether the acid end-products, lactate and acetate, were involved in the regulation of cellular growth and metabolism . The growth rate and culture biomass of both organisms was inhibited by the addition of lactate and acetate at concentrations as high as 200 mM to the cultures, although the final pH values of the lactate and acetate cultures were similar . In addition, the metabolic conversion of glucose to lactate was decreased by external lactate but stimulated by acetate . In spite of this, calculation of the yield of cell biomass per mole of ATP (YATP) showed that the yield of both organisms actually increased in the presence of added lactate, but decreased with acetate . This indicates that the two acids interacted with the cells of the organisms by different mechanisms . For both organisms, the final external undissociated lactic acid was relatively constant at concentrations between 0 and 200 mM added lactate, 24.9-32.5 mM for S . mutans and 8.0-11.5 mM for S . sanguis . On the other hand, the final concentration of undissociated acetic acid in the S . mutans cultures increased from 2.9 to 83.7 mM as the medium acetate concentration increased, and from 1.0 to 36.0 mM with the S . sanguis cultures . Counterflow experiments provided evidence for a lactate carrier in both S . mutans and S . sanguis, but an acetate carrier in these organisms could not be demonstrated . {14C}-lactate and {14C}-acetate were taken up into de-energized, chemostatgrown cells of S . mutans and S . sanguis in response to an artificially generated pH gradient but not by an imposed electrical gradient . Thus, under these conditions lactate uptake occurred via a symport process with only one proton . Growth of both organisms in the presence of increasing concentrations of acetate resulted in a small reduction (27%) in the transmembrane pH gradient (delta pH) as measured by the permeant acid, {14C}-salicylate . However, the uptake of {14C}-acetate for the estimation of delta pH revealed significant inhibition of the acetate concentration gradient in the presence external acetate, indicating that the cells expelled the acetate anion . The results indicate that, unlike acetate uptake, lactate transport by S . mutans and S . sanguis was strictly regulated via the lactate carrier in order to prevent excessive dissipation of the pH gradient . Clearly, the formation of acetate by oral streptococci is more problematic for cellular homeostasis than the formation of lactate.

APMIS, 1997 Dec, 105(12), 972 - 4
Viridans streptococci in blood cultures . Can we see any patterns of species related to patient category? Review of 229 cases of positive cultures with viridans streptococci; Dwyer R et al.; We present a review of 229 blood cultures with viridans streptococci collected during a period of eight and a half years from 1986 to 1994 at a teaching hospital in Sweden . The clinical significance of the growth of viridans streptococci is always uncertain, since these bacteria can be contaminants from the skin flora . Growth in more than one culture bottle strengthens the clinical value of the finding . The question was whether species identification might also help in the assessment of the clinical relevance of the finding . The results show that Streptococcus mitis occurs significantly more frequently in blood cultures from the departments dealing with cancer patients . Even with polymicrobial growth in blood cultures, S . mitis should be considered a pathogen of clinical relevance, not a contaminant.

J Clin Pathol, 1997 Oct, 50(10), 847 - 51
An outbreak of penicillin resistant Streptococcus pneumoniae investigated by a polymerase chain reaction based genotyping method; Gillespie SH et al.; AIMS: To characterise the genotypes of penicillin resistant Streptococcus pneumoniae infecting patients in a care of the elderly ward and to study its transmission in a hospital environment . METHODS: Isolates of S pneumoniae were cultured from specimens obtained from patients who had been admitted to a care of the elderly ward where an outbreak had occurred . Penicillin resistant S pneumoniae were also obtained from a series of surveillance throat swabs taken from patients in the same ward . In addition, all penicillin resistant S pneumoniae isolated from specimens submitted for culture at the time of the outbreak were included . Four sensitive strains isolated from a routine microbiology laboratory were included as controls . A simple polymerase chain reaction (PCR) based genotyping method for the penicillin binding protein (PBP) genes 1a, 2x, and 2b was used to characterise the genotypes . RESULTS: Nine patients were infected with serotype 9 S pneumoniae . Four of these patients died; two deaths were directly attributable to the infection . Tested against a battery of haemolytic streptococci and other organisms found in the respiratory tract, only two false positive reactions for PBP 2x were found among S mitis . The method demonstrated that the outbreak strain had altered PBP 1a, 2b, and 2x genes, a pattern clearly distinguishable from other penicillin resistant strains isolated at the same time . CONCLUSIONS: This method is simple to perform and would enable many laboratories to characterise the genotype of penicillin resistant S pneumoniae and investigate transmission in their hospitals.

Diagn Microbiol Infect Dis, 1997 Dec, 29(4), 277 - 80
Antimicrobial susceptibility of viridans group streptococci; Tuohy M et al.; A total of 68 viridans group streptococci, including 31 Streptococcus sanguis, 12 S . mitis, 3 S . salivarius, and 8 S . milleri from blood, and an additional 14 S . milleri from abscesses and normally sterile sites, were tested against penicillin, amoxicillin, cefazolin, ceftriaxone, meropenem, clindamycin, quinupristin/dalfopristin, rifampin, levofloxacin, ofloxacin, vancomycin, and gentamicin with the microdilution method . The susceptibility rates for S . sanguis were: penicillin, 74%; amoxicillin, 84%; ceftriaxone, 94%; clindamycin, 87%, and vancomycin, 100% . The susceptibility rates for S . mitis were: penicillin, 42%; amoxicillin, 67%; ceftriaxone, 58%; clindamycin, 100%; and vancomycin, 100% . The susceptibility rates for S . milleri were: penicillin, 100%, amoxicillin . 100%; ceftriaxone, 100%, clindamycin, 100%; and vancomycin, 100% . Two of the three isolates of S . salivarius were susceptible to penicillin, amoxicillin, and ceftriaxone; all were susceptible to clindamycin and vancomycin . Levofloxacin, quinupristin/dalfopristin, and rifampin were highly active against all isolates.

Diagn Microbiol Infect Dis, 1997 Dec, 29(4), 273 - 6
In vitro activity of cefepime and ceftazidime against 197 nosocomial blood stream isolates of streptococci: a multicenter sample; Pfaller MA et al.; The increasing prevalence of streptococci as causes of potentially fatal nosocomial bacteremia requires that antimicrobial agents used for empiric therapy in hospitalized patients include both pneumococci and viridans group streptococci as well as beta-hemolytic streptococci in their activity profile . In this study, the in vitro activity of cefepime, a new fourth-generation cephalosporin, was compared with other cephalosporins versus 197 nosocomial blood stream isolates of streptococci (20 Streptococcus pneumoniae, 104 viridans group, and 73 beta-hemolytic) isolated from patients at more than 30 medial centers from 1995 to 1997 . Additional agents tested included penicillin, erythromycin, and vancomycin . Overall, cefepime inhibited 83% of the isolates at concentrations < or = 0.5 microgram/mL and 100% at < or = 8 micrograms/mL . By comparison, ceftazidime inhibited 35 and 88% of isolates at the same concentrations . Cefepime was approximately eightfold more potent than ceftazidime against S . pneumoniae, viridans group streptococci, and beta-hemolytic streptococci . Among the 42 isolates with penicillin MICs > 0.12 microgram/mL, 100% were inhibited by cefepime and only 48% by ceftazidime at < or = 8 micrograms/mL . The rank order of activity for all six agents against the 197 isolates was vancomycin > ceftriaxone > cefepime > penicillin > erythromycin > ceftazidime . Based on the results of the present study, cefepime and ceftriaxone were the superior cephalosporins in potency and spectrum for empiric coverage of patients at risk for streptococcal blood stream infections.

Diagn Microbiol Infect Dis, 1997 Dec, 29(4), 259 - 63
Nosocomial streptococcal blood stream infections in the SCOPE Program: species occurrence and antimicrobial resistance . The SCOPE Hospital Study Group; Pfaller MA et al.; Nosocomial blood stream infections due to streptococci represent an increasingly important problem, particularly among neutropenic cancer patients . This problem is compounded by the emerging resistance to antimicrobial agents commonly used for empiric or prophylactic treatment of hospitalized patients . In this study, we examined the species distribution and antimicrobial susceptibility profile of 295 streptococcal nosocomial blood stream isolates from more than 30 U.S . medical centers (SCOPE National Surveillance Program) . Streptococci accounted for 5.9% of all nosocomial blood stream isolates reported . The viridans group streptococci (VGS) were the most frequently isolated streptococci (50.8%), followed by the beta-haemolytic streptococci (31.9%) and pneumococci (13.2%) . The beta-haemolytic streptococci were dominated by serogroup B strains (63%), followed by serogroups A and G . Of these organisms, 193 strains were referred for subsequent monitor susceptibility testing . Approximately 14% of S . pneumoniae, 9.2% of VGS, and 0% of beta-haemolytic streptococci were resistant to penicillin . Ceftriaxone was highly active against virtually all isolates (93-100% susceptible) except the VGS (77% susceptible) . The rank order for activity of the four agents tested against the 193 isolates was vancomycin > ceftriaxone > penicillin > erythromycin . Importantly, 69% of the penicillin intermediate and resistant strains of VGS were also resistant to at least one additional antimicrobial (31% resistant to ceftriaxone, 51% resistant to erythromycin, 15% resistant to both ceftriaxone and erythromycin) . The relatively poor activity of erythromycin against virtually all streptococci and the frequent association of macrolide resistance with penicillin resistance among the VGS suggests that both macrolides and beta-lactam agents might have limited value as prophylactic agents for dental procedures and in empiric or prophylactic use in neutropenic patients.

J Clin Microbiol, 1998 Jan, 36(1), 100 - 4
Abiotrophia elegans sp . nov., a possible pathogen in patients with culture-negative endocarditis; Roggenkamp A et al.; We isolated a hitherto undescribed microorganism from a patient with endocarditis . The microscopic appearance, a negative catalase reaction, and growth as satellite colonies next to Staphylococcus epidermidis suggested that this microorganism is a member of the genus Abiotrophia, formerly known as nutritionally variant streptococci . However, the clinical isolate described herein differed markedly from the known Abiotrophia spp., A . adiacens and A . defectiva, in terms of its (i) biochemical properties, (ii) restricted growth temperature range, (iii) whole-cell lysate polypeptide profile, and (iv) unique nutritional requirements . In contrast to the type strains of A . adiacens and A . defectiva, which used L-cysteine and pyridoxal hydrochloride as growth factors, the growth of the clinical isolate was only supported by L-cysteine hydrochloride and not by pyridoxal hydrochloride when the organism was tested in Todd-Hewitt or casein-soy peptone broth . Comparative 16S rRNA gene sequence analysis revealed that the microorganism was a member of the genus Abiotrophia and was most closely related to A . adiacens (96.9% homology) . Phenotypic and phylogenetic data are consistent with the assumption of a new species within the genus Abiotrophia, for which we propose the name Abiotrophia elegans sp . nov . The unique nutritional requirements of this strain are of importance for diagnostic laboratories . The media of blood culture systems supplemented only with pyridoxal hydrochloride as a growth factor may fail to promote the growth of A . elegans sp . nov., and thus, these systems might not detect this microorganism as a possible cause of endocarditis.

Rev Med Chil, 1997 Feb, 125(2), 165 - 73
{Infectious endocarditis: prognostic factors of mortality in 131 cases}; Oyonarte M et al.; BACKGROUND: Global hospital mortality for infective endocarditis ranges from 13 to 40% . AIM: To compare clinical, microbiological, echocardiographic factors and complications between patients that died during an episode of infective endocarditis and those who survived . PATIENTS AND METHODS: We followed during their hospital stay, 129 patients, aged 14 to 74 years old, who had 131 episodes of infective endocarditis . Clinical assessment, echocardiography and microbiological study was done to all patients . Surgical indications were those derived from complications . RESULTS: Thirty three patients died during hospital stay (25.2%) . There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs . Skin and mucosal septic manifestations occurred with higher frequency in deceased patients (57.1 and 24.3% respectively) . Blood cultures were positive in 55% in survivors and 48% in those who died . The most frequent infecting organisms were staphilococci and streptococci . Vegetations were found with greater frequency in aortic position in both groups of patients . Deceased patients had a higher frequency of cardiac failure (84 and 65% respectively) and embolic episodes (77 and 46% respectively) than survivors . Antimicrobial treatment was successful in 94% of survivors and 15% of those who died . Forty percent of survivors and 54% of deceased patients were subjected to surgical procedures . CONCLUSIONS: The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure.

Dtsch Med Wochenschr, 1997 Oct 10, 122(41), 1244 - 7
{Meningitis caused by Streptococcus suis type 2 in an adult}; Grebe T et al.; HISTORY AND ADMISSION FINDINGS: A 54-year-old huntsman who 3 days previously had shot a wild pig, developed severe headache, nausea and vomiting over the last 10 hours . Physical examination was unremarkable except for an 8 x 4 cm large reddening of the skin over the right tibia and fever (38.2 degrees C) . INVESTIGATIONS: Cranial computed tomography was normal . Cerebrospinal fluid showed pleocytosis (5.200 cells/mm3) . Gram-stained (CSF) smear showed gram-positive cocci and an increased white cell count (14,000/microliters) was found in blood . DIAGNOSIS, TREATMENT AND COURSE: After the diagnosis of bacterial meningitis had been made antibiotics were given intravenously (penicillin G 10 mill . IU, three times daily on days 1 to 16: at first with cefotaxim, three times daily 2 g on days 1 to 3, then with gentamicin twice 80 mg on days 3 to 13) . The acute neurological signs quickly regressed, the pretibial reddening (presumably at the port of entry) disappeared, as did the fever on the 4th day of the illness . The streptococci isolated from CSF and blood were identified as 5 . suis type 2 (Lancefield group R) . But despite the early and effective antibiotic treatment cochleovestibular symptoms (hearing impairment, vertigo and unsteady gait) set in after initial improvement, a frequent complication of S . suis meningitis . CONCLUSION: S . suis should be considered as the causative organism of generalized septicaemia and meningitis in adults, if the history reveals contact with domestic or wild pigs and there are early cochleovestibular signs.

Rev Alerg Mex, 1997 May-Jun, 44(3), 77 - 82
{Superantigens in human disease}; Rojas Ramos E et al.; Superantigens include viral and bacterial products, mainly of streptococci, staphylococci that stimulate T cells to proliferate nonspecifically through interaction with class II major histocompatibility complex products on antigen-presenting cells and then with variable regions on the beta chain of T cell receptor complex . Superantigens cause symptoms via release of immune cytokines . These proteins should be considered potential cause of illnesses such as rheumatic fever, arthritis . Kawasaki syndrome, atopic dermatitis, and guttate psoriasis because of their potent immune system-altering capacity.

Enferm Infecc Microbiol Clin, 1997 Jun-Jul, 15(6), 315 - 8
{Beta-hemolytic streptococci in tonsil hypertrophy and recurrent tonsillitis}; Ramirez A et al.; BACKGROUND: The recurrence of streptococci acute tonsillitis is a complication that often motivates the tonsillectomy . We studied the colonisation of tonsils and adenoids by S . pyogenes and other beta haemolytic streptococci in both surgical indications, recurrent tonsillitis and tonsillar hypertrophy . METHODS: We made for aerobic culture the following specimens, throat swabs, tonsils and adenoids tissue corresponding to 47 children referred for tonsillectomy . RESULTS: S . pyogenes was isolated in 11 cases (23.4%) of tonsils and other beta haemolytic non A streptococci was isolated in 11 cases, of them, group C streptococci was the most frequent with six cases . However in the recurrent tonsillitis group, S . pyogenes was isolated more significantly (47%) that other beta haemolytic streptococci (5.8%) . Otherwise in the tonsilar hypertrophy group, S . pyogenes was isolated in the 10% while that other streptococci was isolated in the 33.3% . The culture of 38 adenoids yielded S . pyogenes and beta haemolytic group C streptococci in 6 cases each one (15.7%) . CONCLUSIONS: S . pyogenes was isolated more frequently in recurrent tonsillitis that other micro-organisms while that in the tonsilar hypertrophy group predominated streptococci beta haemolytic non A, S . aureus and H . influenzae . Is of interest that the adenoids in our study showed an important reservoir of beta haemolytic streptococci . The throats swabs yielded less of the half of all beta haemolytic streptococci isolated in tonsilar tissue cultured.

Mol Cell Probes, 1997 Oct, 11(5), 349 - 54
Strain differentiation of isolates of streptococci from bovine mastitis by pulsed-field gel electrophoresis; Baseggio N et al.; Pulsed-field gel electrophoresis (PFGE) was examined as a tool to differentiate strains of streptococci isolated from clinical and sub-clinical cases of bovine mastitis . Analysis of SmaI chromosomal digests of Streptococcus agalactiae, S . dysgalactiae subsp . dysgalactiae and S . uberis isolates revealed intraherd and interherd strain relationships within each species . Comparison of S . agalactiae isolates from the same herd revealed little variability in their SmaI restriction patterns indicating a single strain originating from a common source of infection . However, comparison of S . agalactiae isolates between herds showed that each herd was infected with a distinct strain . The restriction profiles from S . dysgalactiae subsp . dysgalactiae and S . uberis were more diverse and often multiple strains of both species were present within an individual herd, with some herds containing more than one representative of a particular strain . Interestingly, it was only observed with S . dysgalactiae subsp . dysgalactiae that some strains were present in more than one herd . PFGE was found to be a useful and reproducible method for the discrimination of different strains of the three most important species of streptococci responsible for bovine mastitis and to offer a means to identify environmental sources of infection.

Clin Infect Dis, 1998 Jan, 26(1), 66 - 71
Infective endocarditis caused by beta-hemolytic streptococci . The Infectious Diseases Society of America's Emerging Infections Network; Baddour LM; Infective endocarditis caused by beta-hemolytic streptococci is infrequently seen . Members of the Infectious Diseases Society of America's Emerging Infections Network (EIN) were polled for cases of beta-hemolytic streptococcal endocarditis that were seen between 1 January 1994 and 31 December 1996 . Thirty-one cases were submitted by 22 members . The patients' ages ranged from 4 months to 79 years, and 18 (58.1%) were males . Prosthetic valve infection occurred in six cases and intravenous drug abuse was noted in only one case . Diabetes mellitus was noted in 10 patients (32.3%) . Group B beta-hemolytic streptococci accounted for over two-thirds of isolates (21 {67.7%} of 31) . Twenty-five patients (80.7%) developed complications of infective endocarditis, and 15 (48.4%) underwent surgical intervention with valvular revision or excision . Sixty-one percent (19 of 31) received aqueous crystalline penicillin G either as monotherapy or in combination with gentamicin sulfate . In contrast to previously published data, the mortality rate (12.9%) among patients in this survey was remarkably low . There was no infection relapse documented in 16 of the remaining 27 patients for whom posttreatment follow-up information was available.

Rev Med Chir Soc Med Nat Iasi, 1995 Jul-Dec, 99(3-4), 203 - 10
{Infections in the oral and maxillofacial areas: their prevalence (1983-1992) and the evolution of the antibiotic sensitivity of the microbes involved}; Barna M et al.; A retrospective clinical study (1983-1992) was done in order to establish the frequency of etiological agents in determining peri-maxillary infections and also for evaluate the evolution of antibiotics resistance of isolated bacteria . The study group consisted of 5227 patients with different infections in maxillo-facial territory . Year distribution of cases was equilibrate . Study group particularities were synthetic analysed . Our results revealed the predominance of anaerobic streptococci (33.6%) and Staphylococcus aureus (32.5%) and also mixed infections (23.04) . Etiological diagnosis of peri-maxillary infections was proved as an essential step for a correct treatment.

Arch Dermatol Res, 1997 Nov, 289(12), 671 - 6
Induction of cutaneous lymphocyte-associated antigen expression by group A streptococcal antigens in psoriasis; Baker BS et al.; The cutaneous lymphocyte-associated antigen (CLA) has been proposed as a homing receptor for the selective migration of memory T cells into the skin . To investigate the effect of group A streptococci (GAS) on the migration of T cells in psoriasis, CLA expression was assessed by double-staining for CD3 and the HECA-452 epitope on peripheral blood T cells from 13 patients with psoriasis, 10 patients with other inflammatory skin diseases and 12 normal controls before and after 7 days culture with a GAS sonicate, Candida albicans (control antigen) or medium . In addition, CLA+, and CLA-, CD3+ CD45RO+ subsets were isolated from individuals in each group and V beta 2 expression and proliferation to GAS studied . Mean CLA expression by freshly isolated T cells was almost identical in the three groups . After culture with GAS, T cells from the psoriatic patients and control showed a significant increase in mean percentage CLA+ expression compared to medium (P < 0.002, P < 0.05, respectively) . This induction was inhibited by the addition of anti-IL-12 antibody . However, in psoriatic patients, but not in controls, the GAS-induced increase was significantly greater than that of C . albicans (P < 0.002) and was accompanied by a decrease in T cells positive for the peripheral lymph node homing receptor, L-selectin (P < 0.05) . The percentage of V beta 2+ T cells was markedly higher in the CLA+ than in the CLA- T-cell subset in psoriatic patients (P < 0.01) and controls; both subsets proliferated to GAS, in each group . These findings suggest a differential modulation of specific tissue homing receptors on T cells by GAS in psoriasis.

World J Surg, 1998 Feb, 22(2), 135 - 45
Burn wound infections: current status; Pruitt BA Jr et al.; The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin . Patient factors such as age, extent of injury, and depth of burn in combination with microbial factors such as type and number of organisms, enzyme and toxin production, and motility determine the likelihood of invasive burn wound infection . Burn wound infections can be classified on the basis of the causative organism, the depth of invasion, and the tissue response . Diagnostic procedures and therapy must be based on an understanding of the pathophysiology of the burn wound and the pathogenesis of the various forms of burn wound infection . The time-related changes in the predominant flora of the burn wound from gram-positive to gram-negative recapitulate the history of burn wound infection . Proper clinical and culture surveillance of the burn wound permits early diagnosis of gram-positive cellulitis, and the stable susceptibility of beta-hemolytic streptococci to penicillin has eliminated the threat of this once common burn wound pathogen . Selection and dissemination of intrinsic and acquired resistance mechanisms increase the probability of burn wound colonization by resistant species such as Pseudomonas aeruginosa . Even so, effective topical antimicrobial chemotherapy and early burn wound excision have significantly reduced the overall occurrence of invasive burn wound infections . Individual patients, usually those with extensive burns in whom wound closure is difficult to achieve, may still develop a variety of bacterial and nonbacterial burn wound infections . Consequently, the entirety of the burn wound must be examined on a daily basis by the attending surgeon . Any change in wound appearance, with or without associated clinical changes, should be evaluated by biopsy . Quantitative cultures of the biopsy sample may identify predominant organisms but are not useful for making the diagnosis of invasive burn wound infection . Histologic examination of the biopsy specimen, which permits staging the invasive process, is the only reliable means of differentiating wound colonization from invasive infection . Identification of the histologic changes characteristic of bacterial, fungal, and viral infections facilitates the selection of appropriate therapy . A diagnosis of invasive burn wound infection necessitates change of both local and systemic therapy and, in the case of bacterial and fungal infections, prompt surgical removal of the infected tissue . Even after the wounds of extensively burned patients have healed or been grafted, burn wound impetigo, commonly caused by Staphylococcus aureus, may occur in the form of multifocal, small superficial abscesses that require surgical debridement . Current techniques of burn wound care have significantly reduced the incidence of invasive burn wound infection, altered the organisms causing the infections that do occur, increased the interval between injury and the onset of infection, reduced the mortality associated with infection, decreased the overall incidence of infection in burn patients, and increased burn patient survival.

J Med Microbiol, 1998 Jan, 47(1), 29 - 37
Lectin-oral streptococci interactions; Lee W et al.; Lectins of various specificities were examined for interaction with strains of oral streptococci of various species . The lectins were capable of binding galactose, N-acetylgalactosamine, glucose, N-acetylglucosamine, mannose, fucose and sialic acid . Lectin reactivities were strain-dependent in that some members of a species, but not others, could be aggregated by certain lectins . Proteolysis and extraction with hot water, guanidine hydrochloride and sodium dodecyl sulphate tended to increase the reactivity of the streptococci with lectins but did not change the recognition patterns of the bacteria . Sonication, in contrast, tended to reduce the ability of streptococci to be agglutinated by lectins . Furthermore, lectin reactivities were dependent on the growth conditions, as evidenced by changes in lectin titres following streptococcal growth in sub-inhibitory concentrations of citrate, fluoride or antibiotics . It is likely that lectins could be useful tools for epidemiological studies and to probe strain-dependent and growth-dependent surface characteristics of viridans streptococci.

J R Coll Surg Edinb, 1997 Dec, 42(6), 410 - 3
Life-threatening cervical necrotizing fasciitis; Helmy AS et al.; Eight cases of cervical necrotizing fasciitis are presented . Three were odontogenic, two were pharyngeal in origin and three were primary or idiopathic . Soft tissue gas was recognized in four patients . The bacteriology showed streptococci on the top of the list (50%), while for the idiopathic cases, it was monomicrobial and caused by staphylococci . Third generation cephalosporin and metronidazole represent good initial empirical antibacterial coverage . Histopathologically, all cases showed extensive necrosis of the debrided fascia and vascular thrombosis of the dermal vessels . The mortality rate was 3/8 (37.5%) . Early diagnosis of cervical necrotizing fasciitis and initiation of definitive therapy in an intensive care environment is essential to minimize mortality . It is also important to recognize that this devastating infection may occur spontaneously, and it should be suspected in patients with unexplained soft tissue pain and tenderness.

Eur J Clin Microbiol Infect Dis, 1997 Nov, 16(11), 843 - 5
Brucellar prosthetic arthritis in a total knee replacement; Orti A et al.; The infecting pathogens most commonly implicated in prosthetic joint infections are staphylococci, streptococci, and gram-negative rods . Prosthetic infections caused by Brucella spp . are rarely described in the literature . Treatment of prosthetic infections remains complex and controversial, the most accepted course being antibiotic treatment with removal or retention of prosthetic components . The case of a 60-year-old man who developed Brucella septic arthritis of the right knee in a total knee replacement is reported . Conservative treatment using a three-drug therapy was employed, with excellent results.

Orthopade, 1997 Oct, 26(10), 838 - 47
{Coxitis in the newborn infant and infant . Diagnosis and therapy}; Parsch K et al.; From 198 o 1996 (12 years) we saw 24 neonates and small infants with septic arthritis of the hip joint . A minority of these infants was simultaneously affected by osteomyelitis of the femoral neck or the acetabulum . Clinical signs are a painful leg, pseudoparalysis, uneasiness and refusal to drink . Quantitative measurements of C-reactive protein (CRP) are more reliable then leucocyte count and sedimentation rate . Ultrasound images yield early information about capsular swelling and septic effusion; in late cases US can visualize femoral neck necrosis . Emergency arthrotomy to relieve the joint from septic effusion, bacteriological specimens and capsular biopsy are mandatory . Intravenous application of a second-generation cephalosporin as antibiotic has proven effective . We have been using cefuroxim for the past 10 years, changed if necessary according to the antibiogram . Parenteral antibiotic treatment is continued for an average of 3 weeks, followed by oral treatment for another 3 weeks . CRP normalisation monitors the cure from the disease . Our 24 cases included 7 with group B streptococci 2 with Staphylococcus aureus, 2 with Staphylococcus epidermidis and 2 with Escherichia coli . In 8 cases no germs could be cultured; 6 of them had outside antibiotic treatment before being transferred . If treatment was initiated within 3 days, healing without residuals was the rule . In 18 cases with early and sufficient treatment no sequelae were observed . With delay of treatment for several days, moderate osteomyelitic changes of the neck and the acetabulum were observed . In a case with delay of surgical treatment for 5 weeks, complete destruction of the hip joint occurred, causing a poor final result.

Klin Padiatr, 1997 Nov-Dec, 209(6), 364 - 72
{Infection caused by viridans streptococci in children with malignant hematologic diseases}; Rieske K et al.; This is a review of the symptoms and signs of children with malignant diseases and septicemia due to viridans streptococci, treated during a 6-year-period (1990-1995) in the Departments of Pediatrics or Pediatric Surgery, University of Leipzig . All 11 children suffered from leukemia . Streptococcus mitis was the most frequently isolated streptococcal species . All patients had fever and malaise, in most cases we could find inflammatory signs of the respiratory tract . In two children we saw a severe course of the disease, one child had symptoms and signs of ARDS, the other died on septicemic shock . All 11 patients had neutropenia and a central venous line, 10 of them were treated by cytarabine before the streptococcal infection was diagnosed . Like others we could note during the last years an increase of systemic infections due to viridans streptococci in neutropenic patients with malignant diseases . Possibly there is an association between streptococcal infection and cytarabine therapy . The empiric antibiotic therapy in neutropenic patients with malignant diseases should cover also streptococcal infections.

Microb Drug Resist, 1997 Winter, 3(4), 379 - 84
Antibiotic susceptibility of group A streptococci in 2 Italian cities: Milano and Catania; Cocuzza C et al.; Resistance to macrolides has increasingly been reported for Group A streptococci . In this study, the in vitro antibiotic susceptibility pattern of 305 clinical isolates of S . pyogenes was determined . Strains were isolated during 1996 from pharyngeal swabs of children with uncomplicated pharyngitis living in 2 Italian cities: Milano and Catania, situated in the North and South of Italy, respectively . All isolates were found to be fully susceptible to penicillin and other beta-lactam agents tested . Susceptibility to macrolides differed markedly between the two centers with relatively high resistance rates to erythromycin being observed in Milano (30%) as compared to Catania (3%) . Resistance to erythromycin was always crossed with that of the other 14- and 15-membered macrolides tested . However, resistance to josamycin and clindamycin was generally found in approximately 25% of the erythromycin-resistant (ER) strains . The erythromycin-resistant isolates from Milano and Catania (58 strains) were further subdivided into the three previously described resistance phenotypes: constitutive, inducible, and novel resistance phenotypes . The novel resistance phenotype accounted for 58% of all resistant strains, while 17% and 26% were found to be of the inducible and constitutive resistance phenotypes . Strains of the novel resistance phenotype were characterized by lower MIC values (MIC90 = 16 mg/L) to 14 and 15 carbon atom macrolides as compared to the other two phenotypes (MIC90 > 128 mg/L), and retained susceptibility to clindamycin and to josamycin, a 16 carbon atom macrolide . Resistance to tetracyclines was found in 25% to 36% of the ER isolates as compared to 2% to 10% of the susceptible strains . In particular, resistance to this agent was more commonly associated to isolates belonging to the novel and constitutive resistance phenotypes . MIC values for chloramphenicol in all isolates were within the susceptible or intermediate range; decreased susceptibility to this agent did not appear to be associated with erythromycin resistance.

Microb Drug Resist, 1997 Winter, 3(4), 371 - 8
High incidence of erythromycin-resistant Streptococcus pyogenes in Monza (North Italy) in untreated children with symptoms of acute pharyngo-tonsillitis: an epidemiological and molecular study; Cocuzza CE et al.; A retrospective analysis of susceptibility data available for Group A streptococcal isolates collected between January 1990 and January 1996 at the Hospital Microbiology Laboratory of Monza (North Italy), showed a sharp rise in the erythromycin resistance rates during the last 3 years . Streptococcus pyogenes resistant to erythromycin accounted for approximately 1% of strains isolated between 1990 and 1992; the percentage then rose from 5% in 1993 to almost 39% in 1995 . In January 1996, the resistance rates peaked to 81% . A prospective controlled study performed between March and May of 1996 to determine the percentage of erythromycin-resistant Group A streptococci isolated in Monza from untreated children with acute pharyngo-tonsillitis, gave further confirmation of a high rate of erythromycin resistance (47%) in this area . Molecular characterization by T-serotyping and pulse-field gel electrophoresis analysis of 25 erythromycin-resistant Group A streptococcal isolates, showed a relatively high degree of heterogeneity among these strains, demonstrating that the increased resistance is not caused by the spread of a single clone.

Zentralbl Bakteriol, 1997 Nov, 286(4), 487 - 93
Isolation, in vitro antimicrobial susceptibility and penicillin tolerance of Arcanobacterium haemolyticum in a Turkish university hospital; Arikan S et al.; Arcanobacterium haemolyticum (Ah) was isolated from 5 (0.3%) out of 1531 throat cultures of patients with presumed pharyngotonsillitis . The age of the patients who had a positive culture for Ah varied between 6 and 22 . The isolation rate of beta-haemolytic streptococci (BHS) was 7.4%, 72.6% of which belonged to Group A, followed by groups G, C and B . None of the throat samples yielded simultaneous growth of Ah and BHS . Antimicrobial susceptibility of Ah isolates to phenoxymethylpenicillin, cephalexin, cefotaxime, vancomycin, erythromycin, azithromycin, doxycycline, ciprofloxacin, and trimethoprim-sulfamethoxazole was tested by the agar dilution method . The isolates were found to be susceptible to all antimicrobials tested except trimethoprim-sulfamethoxazole . Penicillin tolerance could be detected in none of the Ah strains, including the reference strain Ah ATCC 9345 . We conclude that Ah should be kept in mind as a potential pathogen causing pharyngitis in adolescents and young adults.

Tidsskr Nor Laegeforen, 1997 Nov 20, 117(28), 4109 - 13
{What is the purpose of mucosal antibodies? Relevance to colonization with group B streptococci}; Hordnes K et al.; The surface area of the mucosae is extremely large and its contact with the external environment is of vital importance . Most infectious agents use the mucosae as their portal of entry . Some microorganisms, however, colonize the mucosal surfaces without causing disease, and may even be beneficial by contributing to the digestion of food or by excluding pathogens . An important part of the immune system operates in the mucosae, the principal mediator substance of this local immune system being secretory IgA . Other antibody isotypes are usually found in small amounts in exocrine fluids, but IgG predominates in secretions of the uterine cervix . These mucosal antibodies may eliminate microbes, or they may coexist with persistent colonization . In a recent study, we found increased levels of IgA and IgG antibodies to group B streptococci in the cervical secretions of women colonized with these bacteria . Group B streptococci are often transmitted to the infant during delivery, and are a major cause of severe infection in newborns . We have used this study as a background for discussing the role of mucosal antibodies . Presumably, group B streptococci may be eradicated by reenforcing the local antibody response, and a mucosal vaccine will be evaluated in the near future.

J Bacteriol, 1998 Jan, 180(2), 290 - 5
The adhesion-associated sca operon in Streptococcus gordonii encodes an inducible high-affinity ABC transporter for Mn2+ uptake; Kolenbrander PE et al.; ScaA lipoprotein in Streptococcus gordonii is a member of the LraI family of homologous polypeptides found among streptococci, pneumococci, and enterococci . It is the product of the third gene within the scaCBA operon encoding the components of an ATP-binding cassette (ABC) transporter system . Inactivation of scaC (ATP-binding protein) or scaA (substrate-binding protein) genes resulted in both impaired growth of cells and > 70% inhibition of 54Mn2+ uptake in media containing < 0.5 microM Mn2+ . In wild-type and scaC mutant cells, production of ScaA was induced at low concentrations of extracellular Mn2+ (< 0.5 microM) and by the addition of > or = 20 microM Zn2+ . Sca permease-mediated uptake of 54Mn2+ was inhibited by Zn2+ but not by Ca2+, Mg2+, Fe2+, or Cu2+ . Reduced uptake of 54Mn2+ by sca mutants and by wild-type cells in the presence of Zn2+ was abrogated by the uncoupler carbonylcyanide m-chlorophenylhydrazone, suggesting that Mn2+ uptake under these conditions was proton motive force dependent . The frequency of DNA-mediated transformation was reduced > 20-fold in sca mutants . The addition of 0.1 mM Mn2+ to the transformation medium restored only partly the transformability of mutant cells, implying an alternate role for Sca proteins in the transformation process . Cells of sca mutants were unaffected in other binding properties tested and were unaffected in sensitivity to oxidants . The results show that Sca permease is a high-affinity mechanism for the acquisition of Mn2+ and is essential for growth of streptococci under Mn2+-limiting conditions.

J Dent Res, 1998 Jan, 77(1), 81 - 90
Agglutinin and acidic proline-rich protein receptor patterns may modulate bacterial adherence and colonization on tooth surfaces; Carlen A et al.; Bacterial binding to salivary proteins may in part account for individual differences in the colonization of tooth surfaces . High-molecular-weight glycoproteins, agglutinins, mediate S . mutans adherence, whereas acidic proline-rich proteins mediate adherence of other early-colonizing streptococci and Actinomyces . The aim of the present study was to examine the composition of adherence-related salivary proteins and dental plaque micro-organisms in three individuals with a low, moderate, and high capacity to mediate S . mutans adherence . The S . mutans (strain Ingbritt) binding activity resided with a 300-kDa agglutinin which was six-fold more prevalent in the high S . mutans binding saliva compared with the low one . Binding to all three salivas was completely blocked by a monoclonal anti-agglutinin antibody . The moderate S . mutans binding saliva was found to contain adherence-inhibiting components . Furthermore, the low and moderate S . mutans binding salivas mediated binding of A . naeslundii strain LY7 to a greater extent than the saliva with high S . mutans binding . The A . naeslundii binding activity resided with the acidic proline-rich proteins (APRPs) and paralleled the relative content of 106- and 150-residue APRPs . Low A . naeslundii binding coincided with an almost two-fold higher ratio of 106/150 APRPs compared with the high A . naeslundii binding saliva . During conventional gel filtration, a degradation of the acidic, basic, and glycosylated proline-rich proteins was evident in the saliva with high S . mutans and low A . naeslundii binding . This saliva donor had a comparably high rate of dental plaque formation, high counts of S . mutans, and low counts of other streptococci and Actinomyces.

Scand J Infect Dis, 1997, 29(5), 469 - 71
Group A streptococci in household pets' eyes--a source of infection in humans?
Falck G.
Household pets were examined when we carried out an investigation to study intrafamilial spread of group A streptococcal infection . Cultures were taken from 114 index cases, and 61 pets . Group A streptococci were demonstrated in eye secretions from 2 pets . Transmission of group A streptococci from humans to pets and vice versa can probably occur, but is uncommon.

Pediatrics, 1998 Jan, 101(1 Pt 1), 86 - 8
Antistreptolysin O and anti-deoxyribonuclease B titers: normal values for children ages 2 to 12 in the United States; Kaplan EL et al.; BACKGROUND . Measurement of antibodies to the extracellular antigens produced by group A streptococci, antistreptolysin O (ASO) and anti-deoxyribonuclease B (anti-DNase B), is often necessary to confirm a clinical diagnosis of a previous group A streptococcal infection, especially in patients suspected of having a nonsuppurative sequel to this infection . Age is among several factors that may influence antibody levels in children . Thus, in contrast to adults, what is considered a normal titer for one age group (infants) is not appropriate for another (older children) . Age-related "normal" values for ASO and anti-DNase B are provided in the package inserts of commercially available kits; however, there are no recent comprehensive data to validate such values . OBJECTIVE . Using sera from 1131 children (from 23 states) ages 2 to 12 years, we determined age-specific geometric mean titers (GMT) and upper limits of normal (ULN) of ASO and anti-DNase B . METHODS . ASO and anti-DNase B titers were measured by conventional laboratory methods . RESULTS . Children 7 years of age comprised the largest proportion (14%) of the study population . Approximately two-thirds of the sera were collected during winter and early spring months . For both ASO and anti-DNase B, both GMT values and ULN increased with age . The GMTs for ASO and anti-DNase B for the entire group of subjects were 89 and 112, respectively . The ULN for the entire group for ASO and anti-DNase B were 240 and 640, respectively . CONCLUSION . The age-specific values for GMT and ULN for this group of children from 23 states were slightly higher than previously reported . These values are likely representative of the pediatric population in the United States and should be of clinical value to physicians, epidemiologists, and clinical laboratory personnel.

Drug Saf, 1997 Dec, 17(6), 369 - 73
Nonsteroidal anti-inflammatory drugs and necrotising fasciitis . An update; Holder EP et al.; Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and others are the treatment of choice for mild to moderate pain . Because of the relative safety and efficacy of NSAIDs, many of the agents are now available in the US and in other parts of the world without a physician prescription . While these drugs are relatively well tolerated, adverse effects resulting from their use can occur . One such adverse effect recently linked to NSAID use is necrotising fasciitis . Reports of necrotising fasciitis possibly associated with NSAID use have been published in both the medical and lay literature . Several hypotheses regarding a possible association between NSAIDs and the development of necrotising fasciitis have appeared in the literature . One hypothesis is a simple masking of the signs and symptoms of an existing infection, leading to a delay in diagnosis . Some authors have speculated that in certain skin and soft-tissue infections, particularly those caused by group A beta-haemolytic streptococci, this delay in diagnosis may have allowed a simple infection to progress to necrotising fasciitis . Other postulated mechanisms of NSAID involvement in the development of necrotising fasciitis include an impairment of natural host defense mechanisms . A review of the medical literature for reports of possible NSAID-associated necrotising fasciitis revealed that the events were rare, but clinically significant . From the available evidence, a causal relationship between NSAIDs and necrotising fasciitis cannot be established.

Pediatr Infect Dis J, 1997 Dec, 16(12), 1140 - 4
Increased prevalence of penicillin-resistant viridans group streptococci in Japanese children with upper respiratory infection treated by beta-lactam agents and in those with oncohematologic diseases; Mogi A et al.; BACKGROUND: Viridans group streptococci, especially penicillin-resistant strains, have been emerging as pathogens of bacteremia in neutropenic patients with hematologic malignancies . OBJECTIVES: To survey the penicillin susceptibilities of viridans group streptococci in Japanese children with and without oncohematologic diseases and to evaluate the effect of the short term administration of beta-lactam agents on the antibiotic susceptibility . METHODS: We tested 113 isolates of viridans group streptococci by the microdilution method for the minimal inhibitory concentrations (MICs) to 10 antibiotics . We isolated 40 isolates from the throats of children with an upper respiratory infection (URI) before beta-lactam antibiotic treatment, 32 isolates after the treatment, 33 isolates in hospitalized children with oncohematologic diseases and 8 isolates from blood . RESULTS: Twenty-five isolates (62.5%) from the children with URI before treatment were penicillin-intermediate or -high level resistant (MIC > or = 0.25 microg/ml) . The prevalence of those isolates after antibiotic treatment (87.5%) was significantly increased compared with that before treatment (P = 0.03) . The prevalences of the penicillin-high level resistant isolates (MIC > or = 4 microg/ml) in the children with oncohematologic diseases (39.4%) and in the isolates from blood (62.5%) were significantly higher than that in the children with URI before treatment (12.5%) (P < 0.01) . Decreased susceptibilities to other beta-lactam agents were observed in the penicillin-high level resistant strains . CONCLUSIONS: The high prevalence of penicillin-intermediate or -high level resistant viridans group streptococci in healthy Japanese children was documented . The administration of beta-lactam agents decreased the prevalence of penicillin-susceptible isolates in the children with URI . High prevalences of penicillin-high level resistant isolates were observed in the oncohematologic patients and in the isolates from blood.

Infect Immun, 1998 Jan, 66(1), 259 - 65
Streptococcal histone-like protein: primary structure of hlpA and protein binding to lipoteichoic acid and epithelial cells; Stinson MW et al.; In addition to its role in the nucleoid, the histone-like protein (HlpA) of Streptococcus pyogenes is believed to act as a fortuitous virulence factor in delayed sequelae by binding to heparan sulfate-proteoglycans in the extracellular matrix of target organs and acting as a nidus for in situ immune complex formation . To further characterize this protein, the hlpA genes were cloned from S . pyogenes, S . gordonii, S . mutans, and S . sobrinus, using PCR amplification, and sequenced . The encoded HlpA protein of S . pyogenes has 91 amino acids, a predicted molecular mass of 9,647 Da, an isoelectric point of 9.81, and 90% to 95% sequence identity with HlpA of several oral streptococci . The consensus sequence of streptococcal HlpA has 69% identity with the consensus sequence of the histone-like HB protein of Bacillus species . Oral viridans group streptococci, growing in chemically defined medium at pH 6.8, released HlpA into the milieu during stationary phase as a result of limited cell lysis . HlpA was not released by these bacteria when grown at pH 6.0 or below . S . pyogenes did not release HlpA during growth in vitro; however, analyses of sera from 155 pharyngitis patients revealed a strong correlation (P < 0.0017) between the production of antibodies to HlpA and antibodies to streptolysin O, indicating that the histone-like protein is released by group A streptococci growing in vivo . Extracellular HlpA formed soluble complexes with lipoteichoic acid in vitro and bound readily to heparan sulfate on HEp-2 cell surfaces . These results support a potential role for HlpA in the pathogenesis of streptococcus-induced tissue inflammation.

Shock, 1997 Dec, 8(6), 450 - 3
Streptococcal pyrogenic exotoxins A (SpeA) and C (SpeC) stimulate the production of inducible nitric oxide synthase (iNOS) protein in RAW 264.7 macrophages; Christ EA et al.; Streptococcal pyrogenic exotoxins A (SpeA) and C (SpeC) are members of a family of superantigens produced by group A streptococci that appear to play a key role in the pathogenesis of streptococcal toxic shock syndrome . Since it is known that nitric oxide (NO) and tumor necrosis factor (TNF) are largely responsible for the shock and multiple organ dysfunction of Gram-negative sepsis, we hypothesized that SpeA and/or SpeC could trigger the production of inducible nitric oxide synthase (iNOS) and/or TNF by murine macrophages . We exposed RAW 264.7 macrophages to increasing concentrations of SpeA or SpeC alone and in combination with recombinant murine interferon-gamma (rIFN gamma) for 16-24 h . We found that both SpeA and SpeC triggered iNOS production in the presence of low concentrations of rIFN gamma, while neither provoked iNOS accumulation in the absence of rIFN gamma . Neither SpeA nor SpeC (with or without rIFN gamma) reproducibly induced TNF production by these murine macrophages . These data indicate that two streptococcal exotoxins up-regulate iNOS production by murine macrophages and suggest that nitric oxide production may play an important role in the pathogenesis of streptococcal toxic shock syndrome.

J Antimicrob Chemother, 1997 Nov, 40(5), 725 - 8
Effect of penicillin or cefprozil therapy on tonsillar flora; Brook I et al.; The effect on the tonsillar bacterial flora of antimicrobial therapy with penicillin or a second-generation cephalosporin (cefprozil) was studied . Sixty children scheduled for elective tonsillectomy because of recurrent group A beta-haemolytic streptococcal tonsillitis participated in a prospective randomized study that divided them into three groups . One group received no therapy, and the others were given either penicillin or cefprozil for 10 days prior to surgery . The core of the patients' tonsils was cultured for aerobic bacteria . Group A beta-haemolytic streptococci (GABHS) were isolated from 15/20 (75%) of untreated, 11/20 (55%) of penicillin, and 2/20 (10%) of the cefprozil group (P < 0.001) . Thirty-two beta-lactamase-producing bacteria were recovered from 19/20 (95%) of untreated, 33 from 17/20 (85%) treated with penicillin and six from 4/20 (20%) treated with cefprozil (P < 0.01) . Alpha-haemolytic streptococci (AHS) inhibiting GABHS were less often isolated from patients treated with penicillin . These data illustrate the ability of a second-generation cephalosporin to eradicate GABHs, as well as beta-lactamase-producing bacteria, while preserving AHS.

Scand J Immunol, 1997 Dec, 46(6), 597 - 600
Difference in binding of killed and live Streptococcus pneumoniae serotypes by C-reactive protein; de Beaufort AJ et al.; The binding and opsonic properties of C-reactive protein (CRP) for various species of bacteria were investigated . CRP bound more avidly to killed than to live Streptococcus pneumoniae, the binding varying among various serotypes; CRP hardly bound to a number of other bacterial species studied . CRP enhanced complement-dependent phagocytosis of live S . pneumoniae by granulocytes but did not enhance the phagocytosis of live Staphylococcus aureus or group B streptococci . We suppose that CRP may serve as an opsonin for killed bacteria and bacterial debris but is probably not an important opsonin for live bacteria other than S . pneumoniae.

Zhonghua Yi Xue Za Zhi (Taipei), 1997 Sep, 60(3), 161 - 3
Pyogenic myositis: caused by viridans streptococci in an adult with tetralogy of Fallot; Lin TH et al.; A 34-year-old man came to this Emergency Room because of fever, swelling and pain in the right thigh . Tetralogy of Fallot with bicuspid pulmonary valve was diagnosed after serial examination, and computed tomography of the right thigh revealed pyogenic myositis . Surgical drainage of the right thigh abscess and a further pus culture yielded viridans streptococci . There has been no record in the medical literature of a pyogenic myositis caused by viridans streptococci in an adult tetralogy of Fallot . This is thus the first case reported.

Protein Sci, 1997 Dec, 6(12), 2489 - 93
Knowledge-based model of a glucosyltransferase from the oral bacterial group of mutans streptococci; Devulapalle KS et al.; Mutans streptococci glucosyltransferases catalyze glucosyl transfer from sucrose to a glucan chain . We previously identified an aspartyl residue that participates in stabilizing the glucosyl transition state . The sequence surrounding the aspartate was found to have substantial sequence similarity with members of alpha-amylase family . Because little is known of the protein structure beyond the amino acid sequence, we used a knowledge-based interactive algorithm, MACAW, which provided significant level of homology with alpha-amylases and glucosyltransferase from Streptococcus downei gtfI (GTF) . The significance of GTF similarity is underlined by GTF/alpha-amylase residues conserved in all but one alpha-amylase invariant residues . Site-directed mutagenesis of the three GTF catalytic residues are homologous with the alpha-amylase catalytic triad . The glucosyltransferases are members of the 4/7-superfamily that have a (beta/alpha)8-barrel structure and belong to family 13 of the glycohydralases.

Rev Clin Esp, 1997 Jul, 197(7), 494 - 9
{Pyogenic hepatic abscess . Review of 59 cases and experience with imipenem}; Asensi Alvarez V et al.; OBJECTIVES: To study the different etiopathogenic, microbiological, clinical, evolutive, and therapeutic aspects in patients with pyogenic liver abscesses, with a special emphasis in the usefulness of imipenem-cilastatin therapy . MATERIALS AND METHODS: The clinical records of 59 patients with liver abscesses (45 single abscess and 14 multiple abscesses) diagnosed at our institution in the last eleven years were studied . RESULTS: The most common predisposing conditions included biliary (35.6%) and colon (15.3%) diseases, and abdominal trauma (15.3%) . The microorganisms responsible for these abscesses included E . coli, Bacteroides spp., and different streptococci . CT and/or abdominal echography were the diagnostic techniques most commonly used . Twenty-three patients were treated with percutaneous drainage and antibiotics, 22 with surgical drainage and antibiotics, 6 with both types of drainage and antibiotics, and 8 exclusively with antibiotics . Twenty-three patients received imipenem (1 g/IV/8 h) and 29 other antibiotics . Twelve patients died and 9 required admission at the ICU . With regard to patients treated with imipenem, 17 (73.9%) cured, 3 of them (one single abscess and two multiple abscesses) without drainage . Two patients treated with imipenem (8.7%) and 4 treated with other antibiotics (13.8%) relapsed . CONCLUSIONS: Imipenem can be a useful antibiotic in association with percutaneous or surgical drainage for the treatment of pyogenic liver abscesses.

Ophthalmology, 1997 Nov, 104(11), 1857 - 62
Periocular necrotizing fasciitis: a review of five cases; Marshall DH et al.; OBJECTIVE: The purpose of the study is to display a spectrum of clinical presentations of periocular necrotizing fasciitis caused by group A streptococci and to discuss recent trends and treatment of this disease . DESIGN AND INTERVENTION: A case series of five patients (four female and one male) was seen between July 1990 and January 1995 in four university centers . All had clinical evidence of periocular necrotizing fasciitis and grew group A streptococci on wound cultures or had serologic evidence of streptococcal infection . Details of patient presentation, treatment, and outcome are examined . RESULTS: The five patients showed a spectrum of clinical severity from a necrotizing infection confined to the eyelid to a potentially fatal, severe shock-like syndrome characterized by sepsis and multiorgan system failure . A history of trauma often was absent . Patients were treated successfully by a combination of appropriate antibiotics and surgical debridement . CONCLUSIONS: Group A streptococci can cause severe necrotizing infections of the eyelids . Early recognition and prompt treatment can be essential to these patients' survival.

Am J Respir Crit Care Med, 1997 Nov, 156(5), 1508 - 14
Empyema thoracis and lung abscess caused by viridans streptococci; Jerng JS et al.; We retrospectively studied the bacteriology and clinical features of empyema thoracis and lung abscess caused by viridans streptococci in 72 patients seen from January 1984 to September 1996 . A total of 76 strains of viridans streptococci were isolated, of which the most common isolates were Streptococcus constellatus (21 strains), S . intermedius (17), and S . sanguis (10) . Species belonging to the S . milleri group accounted for the majority (68%) of isolates . In 38 (53%) patients these organisms were recognized as the sole pathogens . Of the 72 patients, 53 had empyema, 14 had lung abscesses, and five had both empyema and lung abscess . Forty-six (64%) patients had underlying diseases . Of these, malignancies were the most common (17 patients), followed by diabetes mellitus (12 patients) and central nervous system diseases (10 patients) . Of the 48 patients who underwent chest-tube drainage, 27 (56%) received further treatments, including intrapleural streptokinase (18 cases), surgery (9), and both intrapleural streptokinase and surgery (3) . Two (14%) of the patients with lung abscess alone underwent surgical treatment . Although all viridans streptococcal isolates were susceptible to penicillin, the patients in the study had a high mortality (21%) . Univariate and multivariate analysis of data for patients with empyema alone (n = 53) showed a significantly increased risk of death in those with underlying malignancy (OR = 16.0, p = 0.023) and those with non-S . milleri-group isolates (OR = 3.72, p = 0.030) . These data imply a strong clinical significance of viridans streptococci in the pathogenesis of empyema and lung abscess, as well as the need for species identification of viridans streptococci in patients with pleuropulmonary diseases.

J Exp Med, 1997 Nov 17, 186(10), 1633 - 43
Regulation of the phosphorylation of human pharyngeal cell proteins by group A streptococcal surface dehydrogenase: signal transduction between streptococci and pharyngeal cells; Pancholi V et al.; Whether cell-to-cell communication results when group A streptococci interact with their target cells is unknown . Here, we report that upon contact with cultured human pharyngeal cells, both whole streptococci and purified streptococcal surface dehydrogenase (SDH) activate pharyngeal cell protein tyrosine kinase as well as protein kinase C, thus regulating the phosphorylation of cellular proteins . SDH, a major surface protein of group A streptococci, has both glyceraldehyde-3-phosphate dehydrogenase and ADP-ribosylating enzyme activities that may relate to early stages of streptococcal infection . Intact streptococci and purified SDH induce a similar protein phosphorylation pattern with the de novo tyrosine phosphorylation of a 17-kD protein found in the membrane/particulate fraction of the pharyngeal cells . However, this phosphorylation required the presence of cytosolic components . NH2-terminal amino acid sequence analysis identified the 17-kD protein as nuclear core histone H3 . Both phosphotyrosine and phosphoserine-specific monoclonal antibodies reacted with the 17-kD protein by Western blot, suggesting that the binding of SDH to these pharyngeal cells elicits a novel signaling pathway that ultimately leads to activation of histone H3-specific kinases . Genistein-inhibitable phosphorylation of histone H3 indicates that tyrosine kinase plays a key role in this event . Treatment of pharyngeal cells with protein kinase inhibitors such as genistein and staurosporine significantly inhibited streptococcal invasion of pharyngeal cells . Therefore, these data indicated that streptococci/SDH-mediated phosphorylation plays a critical role in bacterial entry into the host cell . To identify the membrane receptor that elicits these signaling events, we found that SDH bound specifically to 30- and 32-kD membrane proteins in a direct ligand-binding assay . These findings clearly suggest that SDH plays an important role in cellular communication between streptococci and pharyngeal cells that may be important in host cell gene transcription, and hence in the pathogenesis of streptococcal infection.

J Dairy Sci, 1997 Nov, 80(11), 2820 - 5
Accuracy of methods using somatic cell count and N-acetyl-beta-D-glucosaminidase activity in milk to assess the bacteriological cure of bovine clinical mastitis; Pyorala S et al.; This study examined the capability of milk somatic cell count (SCC) and NAGase activity to discriminate between quarters that had been cured versus those that had not been cured at 4 wk after antimicrobial therapy for clinical mastitis . The distribution of microorganisms that were isolated before therapy from 630 quarters with mastitis was as follows: 225 strains of Staphylococcus aureus, 96 strains of coagulase-negative staphylococci, 152 strains of streptococci (Streptococcus dysgalactiae and Streptococcus uberis), and 157 strains of coliform bacteria . Bacteriological cure rates were 35% for mastitis caused by Staph . aureus, 75% for mastitis caused by coagulase-negative staphylococci, 66% for mastitis caused by streptococci, and 72% for mastitis caused by coliforms . Diagnostic accuracy of milk SCC and NAGase and their interquarter ratios for predicting bacteriological status of the control samples was assessed by calculating sensitivity, specificity, and accuracy and by means of receiver operating characteristic analysis . The efficiency of milk SCC and NAGase for predicting bacteriological cure was greatest for cows that had been infected with Staph . aureus . The main problem in detecting coagulase-negative staphylococci was low sensitivity, and the main problem in detecting streptococci and coliforms was low specificity . Receiver operating characteristic analysis is not completely suitable for the detection of mastitis because reference method bacteriology and indirect tests can never fully agree . To assess the recovery of cows from mastitis caused by Staph . aureus, bacteriology should be supplemented with an examination of milk SCC or NAGase activity at threshold values such as those presented here.

Eur J Clin Microbiol Infect Dis, 1997 Oct, 16(10), 753 - 6
Colonization rates and serotypes of group B streptococci isolated from pregnant women in a Korean tertiary hospital; Uh Y et al.; In a study designed to provide data on the rates of maternal carriage of group B streptococci (GBS) in Korean women, vaginal, anorectal, and urethral swab specimens from 459 pregnant women and ear canal and umbilicus swabs from their 288 neonates were cultured with new Granada medium and selective Todd-Hewitt broth . Additionally, the serotypes of 64 isolates of GBS and the minimal inhibitory concentrations of seven antimicrobial agents for these isolates were determined . The rate of colonization by GBS in pregnant women and in their babies was 5.9% (27/459) and 0.7% (2/288), respectively . The rates of resistance of GBS isolated from pregnant women were 13.3% to clindamycin, 5% to erythromycin, and 98.3% to tetracycline . The majority of GBS isolates from pregnant women belonged to serotypes Ib (48.3%), Ia (24.1%), and III (20.7%).

South Med J, 1997 Dec, 90(12), 1248 - 9
Acute pansinusitis with bacteremia due to a beta-hemolytic group C streptococcus: Streptococcus milleri; El-Guizaoui AE et al.; A 41-year-old truck driver had acute onset of weakness, severe headache and pain over the left side of the face, forehead, and orbital area . He was found to have acute pansinusitis . Blood cultures and culture of the sinus drainage yielded beta-hemolytic group C streptococcus: Streptococcus milleri . He recovered completely after treatment with cefazolin, surgical drainage and debridement, and outpatient cephalexin therapy . Beta-hemolytic streptococci are uncommon causes, and bacteremia is rare in acute sinusitis . Speciation of the streptococcus is important in determining the epidemiology and clinical spectrum of streptococcal infections.

J Med Microbiol, 1997 Dec, 46(12), 999 - 1005
Streptococcus agalactiae beta gene and gene product variations; Maeland JA et al.; Streptococcus agalactiae (group B streptococci; GBS) are serotyped on the basis of the capsular polysaccharide antigens and subtyped on the basis of the strain-variable and surface-localised c proteins c alpha, c beta, and R proteins . This study compared c beta protein detection and the polymerase chain reaction (PCR) for beta gene detection, by examining 50 clinical GBS strains . The c beta protein was detected by antibody-based immunofluorescence in a GBS whole-cell assay and Western blotting by probing with the anti-c beta antibody or human IgA . Absorption experiments were performed to test for surface-anchoring of c beta; and bacterial supernates were examined to test for c beta production . Primers for the PCR target regions resulted in a 620-bp product that included beta gene-encoding IgA-binding domains . The results demonstrated four categories of GBS with respect to the beta gene and the c beta protein: (1) strains (16 of 50) that harboured the beta gene and regularly expressed normal surface-localised c beta with a M(r) of 120 kDa; (2) strains (5 of 50) that harboured the gene but did not express the protein; (3) strains (2 of 50) that harboured the gene but expressed a c beta that was not surface-localised and had reduced M(r); (4) strains (27 of 50) without beta gene and c beta expression . One strain amongst the third group generated a PCR product of 1330 bp . These results demonstrate considerable strain variability of the beta gene of GBS and of its product the c beta protein.

Diagn Microbiol Infect Dis, 1997 Nov, 29(3), 199 - 201
Comparative antistreptococcal activity of two newer fluoroquinolones, levofloxacin and sparfloxacin; Pfaller MA et al.; The objective of this study was to evaluate the in vitro activity of sparfloxacin, levofloxacin, ofloxacin, and ciprofloxacin against contemporary strains of streptococci . Susceptibility testing of a panel of 300 recent clinical isolates of streptococci (100 each of beta-hemolytic, viridans group, and Streptococcus pneumoniae) using reference broth microdilution methods was performed, and the results were compared . Sparfloxacin was the most active of the four tested fluoroquinolones, inhibiting 99-100% of all isolates at concentrations of < or = 1 microgram/ml, and was two- to eightfold more potent than the three comparative agents . Levofloxacin was also quite active, inhibiting 98-100% of the isolates at concentrations < or = 2 micrograms/ml . Both sparfloxacin and levofloxacin possess an improved spectrum and potency against contemporary strains of streptococci compared to currently available fluoroquinolones.

Pediatr Res, 1997 Dec, 42(6), 799 - 804
Penetration of group B streptococci through polarized Madin-Darby canine kidney cells; Kallman J et al.; Group B streptococci (GBS) are one of the major causes of invasive neonatal infection . The pathogenesis of early onset disease is a multistep process . Adhesion of GBS to eucaryotic cells is considered to be an important step for the establishment of infection . Subsequent to adhesion, GBS invade cells and give rise to septicemia and meningitis . To investigate passage of GBS across epithelial cell linings we examined the interaction between bacteria and Madin-Darby canine kidney (MDCK) cells . When grown on permeable support, these cells form a polarized epithelial monolayer with an apical-to-basolateral orientation, which more reflects the in vivo situation compared with conventionally cultured cells . Our results show that GBS are translocated in vacuoles from the apical to the basolateral surface of MDCK cells in a temperature-dependent process . The passage of GBS through the cells is selective with only small numbers of bacteria penetrating in the basolateral-to-apical direction . Transcytosis of GBS starts before decrease in transepithelial resistance of the monolayer . These data suggest a mechanism for traversal of GBS over intact chorioamniotic membranes and from alveoli into the circulation of the fetus.

Eur J Oral Sci, 1997 Oct, 105(5 Pt 2), 485 - 94
On the rôle of human salivary micelle-like globules in bacterial agglutination; Young A et al.; The hypothesis to be tested in this in vitro study was that the salivary micelle-like globules (SMGs) have a role in the agglutination of some oral bacteria . An attempt to determine the mechanisms for the interactions involved was also carried out . 4 laboratory and 4 native streptococci strains were tested . Human whole (HWS) and parotid (HPS) saliva was collected from 4 subjects, and SMGs were isolated from both salivas, and agglutination was recorded in the various bacterial suspensions over time . HPS, HWS and SMGs isolated from HPS and HWS caused typical agglutination patterns for the mutans strains . Salivary supernatants (without SMGs) caused a much delayed or no agglutination . Electron microscopy showed SMG-like structures on the surface of the agglutinated bacteria . Addition of pyrophosphate to HPS prevented agglutination, whereas guanidine HCl prevented normal agglutination of a sanguis strain, and urea had no obvious effect . Together, these results indicate that the SMGs are important in the agglutination of streptococci, and that both calcium-dependent, electrostatic and hydrophobic interactions may be involved.

Infect Immun, 1997 Dec, 65(12), 5216 - 21
Immunogenicity and protective efficacy of the alpha C protein of group B streptococci are inversely related to the number of repeats; Gravekamp C et al.; Infection by group B streptococci (GBS) is an important cause of bacterial disease in neonates . Alpha C protein is a protective cell surface-associated protein of GBS . This protein contains a repeat region flanked by N and C termini . Variable expression of tandem repeating units of alpha C proteins had been found among clinical isolates of GBS . We examined the effect of the number of repeats on the immunogenicity of the alpha C protein and its ability to elicit protection from GBS infection in a neonatal mouse model . Mice were immunized with purified alpha C proteins of constructs containing various numbers of repeats (n = 1, 2, 9, and 16) and the N- and C-terminal regions . Both the N-terminal and the repeat regions contain protective and opsonic epitopes . Antibody responses to the alpha C protein constructs with various numbers of repeats were tested with enzyme-linked immunosorbent assay plates coated with either native, nine-repeat alpha C protein or "repeatless" N-terminal antigen . An inverse relationship was found between the number of repeats and the immunogenicity of the alpha C protein; this effect was most pronounced on titers of antibody to the N-terminal region . An inverse relationship was also observed between the number of repeats and protective efficacy, i.e., mouse dams immunized with 5 microg of one- or nine-repeat alpha C protein transferred protective immunity to 65 or 11% of their pups, respectively (P < 0.0001) . Thus, the presence of multiple repeats appears to lessen the antibody response to the complete alpha C protein, and especially the antibody response to its N-terminal region, and suggests a mechanism whereby repeat elements contribute to the evasion of host immunity.

Infect Immun, 1997 Dec, 65(12), 5157 - 64
Invasion of dentinal tubules by oral streptococci is associated with collagen recognition mediated by the antigen I/II family of polypeptides; Love RM et al.; Cell surface proteins SspA and SspB in Streptococcus gordonii and SpaP in Streptococcus mutans are members of the antigen I/II family of polypeptides produced by oral streptococci . These proteins are adhesins and mediate species-specific binding of cells to a variety of host and bacterial receptors . Here we show that antigen I/II polypeptides are involved in the attachment of oral streptococci to collagen and that they also determine the ability of these bacteria to invade human root dentinal tubules . Wild-type S . gordonii DL1 (Challis) cells showed heavy invasion of tubules to a depth of approximately 200 microm, whereas the abilities of cells of isogenic mutant strains OB220 (sspA) and OB219 (sspA sspB) to invade were 50 and >90% reduced, respectively . Likewise, wild-type S . mutans NG8 cells invaded dentinal tubules, whereas cells of isogenic mutant strain 834 (spaP) did not . The invasive abilities of strains OB220 and OB219 were restored by heterologous expression of S . mutans SpaP polypeptide in these strains . The extents of tubule invasion by various wild-type and mutant strains correlated with their levels of adhesion to type I collagen, a major component of dentin . Furthermore, S . gordonii DL1 cells exhibited a growth response to collagen by forming long chains . This was not shown by ssp mutants but was restored by the expression of SpaP in these cells . The production of SspA polypeptide by S . gordonii DL1, but not production of SspB polypeptide by strain OB220 (sspA), was enhanced in the presence of collagen . These results are the first to demonstrate that antigen I/II family polypeptides bind collagen and mediate a morphological growth response of streptococci to collagen . These antigen I/II polypeptide activities are critical for intratubular growth of streptococci and thus for establishment of endodontic infections.

Infect Immun, 1997 Dec, 65(12), 5074 - 81
Invasion of brain microvascular endothelial cells by group B streptococci; Nizet V et al.; Group B streptococci (GBS) are the leading cause of meningitis in newborns . Although meningitis develops following bacteremia, the precise mechanism or mechanisms whereby GBS leave the bloodstream and gain access to the central nervous system (CNS) are not known . We hypothesized that GBS produce meningitis because of a unique capacity to invade human brain microvascular endothelial cells (BMEC), the single-cell layer which constitutes the blood-brain barrier . In order to test this hypothesis, we developed an in vitro model with BMEC isolated from a human, immortalized by simian virus 40 transformation, and propagated in tissue culture monolayers . GBS invasion of BMEC monolayers was demonstrated by electron microscopy . Intracellular GBS were found within membrane-bound vacuoles, suggesting the organism induced its own endocytic uptake . GBS invasion of BMEC was quantified with a gentamicin protection assay . Serotype III strains, which account for the majority of CNS isolates, invaded BMEC more efficiently than strains from other common GBS serotypes . GBS survived within BMEC for up to 20 h without significant intracellular replication . GBS invasion of BMEC required active bacterial DNA, RNA, and protein synthesis, as well as microfilament and microtubule elements of the eukaryotic cytoskeleton . The polysaccharide capsule of GBS attenuated the invasive ability of the organism . At high bacterial densities, GBS invasion of BMEC was accompanied by evidence of cellular injury; this cytotoxicity was correlated to beta-hemolysin production by the bacterium . Finally, GBS demonstrated transcytosis across intact, polar BMEC monolayers grown on Transwell membranes . GBS invasion of BMEC may be a primary step in the pathogenesis of meningitis, allowing bacteria access to the CNS by transcytosis or by injury and disruption of the endothelial blood-brain barrier.

Infect Immun, 1997 Dec, 65(12), 5035 - 41
Structural and antigenic types of cell wall polysaccharides from viridans group streptococci with receptors for oral actinomyces and streptococcal lectins; Cisar JO et al.; Lectin-mediated interactions between oral viridans group streptococci and actinomyces may play an important role in microbial colonization of the tooth surface . The presence of two host-like motifs, either GalNAc beta1-->3Gal (Gn) or Gal beta1-->3GalNAc (G), in the cell wall polysaccharides of five streptococcal strains accounts for the lactose-sensitive coaggregations of these bacteria with Actinomyces naeslundii . Three streptococcal strains which have Gn-containing polysaccharides also participate in GalNAc-sensitive coaggregations with strains of Streptococcus gordonii and S . sanguis . Each Gn- or G-containing polysaccharide is composed of a distinct phosphodiester-linked hexa- or heptasaccharide repeating unit . The occurrence of these polysaccharides on 19 additional viridans group streptococcal strains that participate in lactose-sensitive coaggregations with actinomyces was examined . Negatively charged polysaccharides that reacted with Bauhinia purpurea agglutinin, a Gal and GalNAc binding plant lectin, were isolated from 17 strains by anion exchange column chromatography of mutanolysin-cell wall digests . Results from nuclear magnetic resonance and immunodiffusion identified each of 16 polysaccharides as a known Gn- or G-containing structural type and one polysaccharide as a new but closely related Gn-containing type . Unlike the reactions of lectins, the cross-reactions of most rabbit antisera with these polysaccharides were correlated with structural features other than the host-like motifs . Gn-containing polysaccharides occurred primarily on the strains of S . sanguis and S . oralis while G-containing polysaccharides were more common among the strains of S . gordonii and S . mitis examined . The findings strongly support the hypothesis that lectin-mediated recognition of these streptococci by other oral bacteria depends on a family of antigenically diverse Gn- and G-containing cell wall polysaccharides, the occurrence of which may differ between streptococcal species.

Infect Immun, 1997 Dec, 65(12), 4926 - 30
Murine model of recurrent group G streptococcal cellulitis: no evidence of protective immunity; Bisno AL et al.; Despite the well-known tendency of cellulitis due to beta-hemolytic streptococci to recur, little is known regarding the mechanisms of human immunity to this infection . We established cellulitis in mice by using a strain of group G streptococcus (1750) originally isolated from the bloodstream of a patient with acute cellulitis . This strain, which has been studied extensively in our laboratory, expresses M protein structurally and functionally analogous to that of group A streptococci, and we have cloned and sequenced the gene encoding this protein (emmMG1) . Mice injected with 5 x 10(7) CFU of strain 1750 developed nonlethal necrotic skin and soft tissue infections that healed spontaneously after 14 to 16 days . After healing, the mice were repetitively reinoculated three times with the same challenge dose of 1750 . Lesion size did not decrease in severity, size, or time to healing after repetitive challenge . The maximum lesion size and tissue concentration of microorganisms increased between the first and fourth challenges . Pretreatment of 1750 cells with opsonic antisera to MG1 diminished neither the maximum lesion size nor the time course of evolution of the lesions . Thus, in the mouse model used here, there was no evidence of acquired protective immunity to experimentally induced cellulitis.

J Lab Clin Med, 1997 Nov, 130(5), 515 - 9
Viridans streptococcal isolates from patients with septic shock induce tumor necrosis factor-alpha production by murine macrophages; Orlicek SL et al.; Viridans streptococci are an important cause of bacteremia and septic shock in neutropenic patients, especially patients receiving chemotherapeutic agents that induce severe mucositis . The mechanisms by which viridans streptococci cause septic shock are unclear . We hypothesized that septic shock due to viridans streptococci is attributable to host cytokine production . Three clinical isolates of viridans streptococci were evaluated for their ability to induce production of tumor necrosis factor-alpha (TNF-alpha) by RAW 264.7 murine macrophages . These three strains of viridans streptococci induced TNF-alpha in a dose-dependent fashion, and the kinetics of TNF-alpha induction were similar to those observed with a clinical isolate of Escherichia coli.

Zhonghua Kou Qiang Yi Xue Za Zhi, 1996 Mar, 31(2), 104 - 6
{A bacteriological study of frontal deciduous dental caries in children}; Liu Y et al.; Bacteriological factors of caries in anterior deciduous teeth were studied by analysing the flora in 25 children, aged 3 to 4 years . Samples were collected from the caries of labial surfaces of maxillary anterior deciduous teeth, including caries lesions, white spot margins of these lesions and caries-free smooth enamel surfaces . Plaques were obtained from the cervical third areas of the maxillary labial anterior deciduous tooth surfaces in caries-free children and served as controls . The results show the detectable rate of S . mutans and their amount against total streptococci in the 3 sampling sites are both significantly higher than that of caries-free children . This suggests S . mutans may be the major pathogenic bacteria of caries of anterior deciduous teeth.

Otolaryngol Head Neck Surg, 1997 Nov, 117(5), 433 - 7
Effect of radiotherapy on the levels of secretory immunoglobulin A against indigenous and virulent streptococci; Himi T et al.; It is well known that the frequency of upper respiratory infection is clinically increased after radiotherapy of the head and neck region . This study found higher antibacterial secretory immunoglobulin A (S-IgA) activity against three indigenous streptococci (Streptococcus mitis, S . salivarius, and S . sanguis I) and S . pneumoniae in patients who had undergone radiation therapy of the head and neck region than in control subjects . This showed no relation to the extent of the radiation field . Compared with before radiotherapy, the S-IgA titer against S . pneumoniae and its ratio to the activities against the indigenous streptococci were significantly higher in patients with fully irradiated major salivary glands . These results indicated that the radiotherapy promoted the antigen-specific S-IgA production of virulent streptococci in most patients with head and neck cancer, even more than 6 months after radiotherapy . The resulting altered balance in the S-IgA system of normal indigenous streptococci may also impair the ability to maintain the stable bacterial interference between normal indigenous and virulent streptococci in the oropharyngeal cavity.

Acta Odontol Scand, 1997 Oct, 55(5), 296 - 8
HLA-DR4 and number of mutans streptococci in saliva among dental students and staff; Wallengren ML et al.; Our aim was to corroborate previous findings that HLA-DR4 carriers are characterized by higher levels of mutans streptococci in saliva than are individuals expressing other HLA-DR types . Of 68 subjects (dental students, staff, and faculty) who were sampled for salivary counts of mutants streptococci, 13 subjects with the lowest counts of mutans streptococci and 15 subjects with the highest counts were selected for HLA-typing . Of the 13 who expressed HLA-DR4, 8 were heavily colonized by mutants streptococci . Although a trend towards a relationship was found between HLA-DR4 carriage and high levels of mutans streptococci, it was not statistically significant . In this selected population, knowledge of how to minimize the risk of caries and mutans streptococci level may have influenced the results.

Am J Obstet Gynecol, 1997 Oct, 177(4), 780 - 5
Maternal colonization with group B Streptococcus and prelabor rupture of membranes at term: the role of induction of labor . TermPROM Study Group; Hannah ME et al.; OBJECTIVES: Our purpose was to determine the effect of induction of labor on neonatal infection if mothers are group B streptococci positive and have prelabor rupture of membranes at term . STUDY DESIGN: In the TermPROM study 5041 women were randomized to induction with intravenous oxytocin, induction with vaginal prostaglandin E2 gel, or expectant management with induction, if needed . Of these, 4834 women had vaginal or introital swabs for group B streptococci taken at entry . We used logistic regression to test for effects of treatment within group B streptococci subgroups . RESULTS: Group B streptococci were predictive of neonatal infection for the induction with vaginal prostaglandin E2 gel and expectant groups but not for the induction with oxytocin group . For women positive for group B streptococci the rates of neonatal infection were 2.5% for the induction with oxytocin group and > 8% for all other groups . CONCLUSIONS: Induction of labor with intravenous oxytocin may be preferable for group B streptococci-positive women with prelabor rupture of membranes at term.

J Am Dent Assoc, 1997 Nov, 128(11), 1525 - 30
Nd:YAG laser irradiation of infected root canals in combination with microbiological examinations; Moritz A et al.; In this in vivo study, 30 subjects with infected root canals were treated with the neodymium: yttrium-aluminum-garnet, or Nd:YAG, laser using standard laser settings and procedures . In microbiological examinations conducted before irradiation, the authors found streptococci in 30 cases and staphylococci in 15 cases . After the first irradiation, the authors found that 19 root canals showed minimal streptococcal growth and 10 root canals showed minimal staphylococcal growth.

Vaccine, 1997 Nov, 15(16), 1805 - 12
Human antibodies to the conserved region of the M protein: opsonization of heterologous strains of group A streptococci; Brandt ER et al.; A 20-mer peptide (p145) in the carboxyl-terminal region of the M protein of group A streptococci (GAS) has previously been defined as the target of bactericidal antibodies . Sequence analysis of seven field isolates from indigenous Australians living in an area highly endemic for GAS and five laboratory reference strains (encompassing nine unique serotypes plus three nontypeables) demonstrates that this region is highly conserved (sequence identity ranging from 65 to 95%) with six of the 12 sequences being identical to p145 . Most of the sequence dissimilarity is contained within the last seven amino acids of p145 . Competitive ELISA demonstrates that human antibodies specific for p145 cannot discriminate between p145 and synthetic peptides representing four from four of the variant sequences tested . Ig purified from endemic sera was able to opsonize each of the GAS isolates and free p145 as well as a peptide expressing a minimal conformational epitope within p145 (requiring amino acids between positions 2 and 13 of p145), but not an irrelevant peptide, were able to partially or completely inhibit opsonization of all isolates and reference strains . Thus adult endemic sera contain antibodies which are bactericidal for multiple GAS serotypes and which are specific for a sequence of 12 amino acids contained within the p145 region of the M protein.

Int Arch Allergy Immunol, 1997 Nov, 114(3), 224 - 8
Streptococcal erythrogenic toxins induce tryptophan degradation in human peripheral blood mononuclear cells; Murr C et al.; BACKGROUND: In various cells including monocytes the cytokine interferon-gamma as well as lipopolysaccharide induce indoleamine 2,3-dioxygenase which degrades tryptophan to form L-kynurenine . We addressed the question of whether the exposure of human peripheral mononuclear cells to superantigens derived from streptococci is associated with tryptophan degradation in vitro . METHODS: Peripheral blood mononuclear cells were exposed to streptococcal erythrogenic toxins A and B and a streptococcal-derived mitogen named BX . In addition, the myelomonocytic cell line THP-1 was treated with these toxin preparations . RESULTS: In peripheral blood mononuclear cells all three toxins induced tryptophan degradation . In parallel, production of interferon-gamma was found, and the tryptophan degradation could be blocked by antihuman interferon-gamma antibodies . Tryptophan degradation was not induced when the human myelocytoma cell line THP-1 was stimulated with these toxins, but there was a costimulatoty effect to interferon-gamma . CONCLUSIONS: In peripheral blood mononuclear cell culture streptococcal erythrogenic toxins are able to stimulate tryptophan degradation in humans via the induction of interferon-gamma production . There seems to be no direct effect on myelomonocytic THP-1 cells . Because some of the degradation products of tryptophan, such as quinolinic acid and kynurenic acid, are toxic, superantigen-driven degradation oftryptophan may play a role for example in the development of the toxic-shock-like syndrome associated with severe group A streptococcal infections.

Drugs, 1997 Nov, 54(5), 730 - 44
Recognition, management and prophylaxis of endocarditis; Stamboulian D et al.; Infective endocarditis (IE) remains a disease with high morbidity and mortality . In recent years, a higher frequency of IE has been observed in the elderly, in intravenous drug users and in patients with prosthetic valves . The diverse manifestations of this disease demand a high degree of suspicion from the practitioner, in order to make an early diagnosis . Advances in and increasing use of echocardiography (especially transoesophageal) allow us to identify valvular changes earlier and more precisely . The use of the new Duke's diagnostic criteria, based on clinical manifestations and microbiological and echocardiographic findings, facilitates the diagnosis and categorisation of IE . An increase in staphylococci and other problem pathogens, such as penicillin-resistant streptococci, enterococci resistant to beta-lactams, aminoglycosides and methicillin-resistant staphylococci has been observed . Important changes have also taken place in the management of IE . There is a clear trend towards the use of shorter treatment courses, oral and once-daily regimens and outpatient programmes, all of which aim to reduce costs and provide patients with improved quality of life . Antibiotic prophylaxis for the prevention of IE is still controversial . In the past few years more rational regimens have been used, and indications are now more precise . In spite of all this, however, few cases are prevented and patient compliance to the prophylaxis regimens remains low.

J Infect, 1997 Sep, 35(2), 135 - 41
Changes in the oral streptococcal flora of children undergoing allogeneic bone marrow transplantation; Lucas VS et al.; The changes in the oral streptococcal flora of twenty children undergoing allogeneic bone marrow transplant are described . Saliva was collected from each child on four separate occasions: (i) before the conditioning regimen; (ii) 7 days post-transplantation; (iii) when the neutrophil count had risen above 0.5 x 10(9)/l; (iv) 119 days post-transplantation . Indices for dental caries, plaque, gingivitis, herpetic stomatitis and mucositis were also recorded . There was a significant decrease in the total aerobic (P<0.001) and anaerobic counts (P<0.0002) between baseline and 7 days post-transplantation . The proportion of the 'Streptococcus oralis group' (Streptococcus mitis and S . oralis) increased significantly from baseline 12.1% to 48.4% at 7 days post-transplantation (P<0.003) . The plaque and gingivitis indices increased significantly from baseline to 7 days post-transplantation (P<0.001) . Twenty percent of the children had either positive blood cultures or Hickman line cultures for the 'S . oralis group', and it is possible that the inflamed gingival tissues are a further site of entry for these streptococci . There were no differences in the total anaerobic counts or the proportion of the 'S . oralis group' between baseline and the end of the study in the transplant children, or between the transplant and control children.

Infect Immun, 1997 Nov, 65(11), 4558 - 63
Tonsillar application of killed Streptococcus mutans induces specific antibodies in rabbit saliva and blood plasma without inducing a cross-reacting antibody to human cardiac muscle; Fukuizumi T et al.; When Streptococcus mutans cells are injected into the skeletal muscle of rabbits, an antibody against human cardiac muscle, as well as an anti-S . mutans antibody, is induced in blood plasma . Our previous study showed that when sheep erythrocytes are applied to palatine tonsils, an antibody against the applied cells is induced both in blood plasma and saliva . This antibody has no activity against cardiac muscle . It is not clear, however, if S . mutans application to the tonsils evokes an antibody response against cardiac muscle . In this study, we immunized rabbits against S . mutans or Streptococcus sobrinus by tonsillar application or by intramuscular injection every 3 days for 6 weeks . Tonsillar applications of formalin-killed cells of S . mutans induced saliva immunoglobulin A (IgA) and blood plasma IgG to the applied cells . In contrast, intramuscular injection of such cells induced only blood plasma IgG . When the route of immunization was intramuscular injection, antibodies in blood plasma cross-reacted with cardiac muscle . By enzyme-immunohistochemistry and Ouchterlony immunodiffusion tests, no cross-reaction to cardiac muscle was observed with the antibody in saliva or in blood plasma after the tonsillar applications . Western blotting of the S . mutans antigen showed that blood plasma from rabbits injected with S . mutans reacted with antigens of 46, 52, 62, and 85 kDa, while that from rabbits subjected to tonsillar application of S . mutans did not react with these bands . Similar results were obtained for S . sobrinus applications . Thus, tonsillar applications of mutants group streptococci induce antibodies differing in antigen specificity and do not induce any cross-reacting antibody to cardiac muscle.

Infect Immun, 1997 Nov, 65(11), 4424 - 30
Immunogenicity and protective immunity induced by synthetic peptides associated with a catalytic subdomain of mutans group streptococcal glucosyltransferase; Smith DJ et al.; We examined the immunogenicity and induction of protective immunity of two 19-mer sequences (GGY and AND) which overlapped a highly conserved region which has recently been implicated in the enzymatic activity of glucosyltransferases (GTFs) of the mutans group streptococci . These peptides were synthesized as eight-branched constructs on a lysine core . Serum immunoglobulin G (IgG) antibody, induced by subcutaneous (s.c . {salivary gland vicinity}) injection with these peptide constructs, reacted with the inciting antigen, with mutans streptococcal GTFs, and with a 21-mer peptide (CAT) containing an aspartate previously shown to covalently bind sucrose . Several of these antisera also inhibited the ability of Streptococcus sobrinus GTF to synthesize insoluble glucan . Significant levels of salivary IgA antibody were also induced by GGY and AND peptide constructs after s.c . injection . The effect of immunization with the GGY and AND peptide constructs on the cariogenicity of Streptococcus mutans was studied in three experiments by immunization of weanling Sprague-Dawley rats, twice at 7- to 14-day intervals with peptides, S . sobrinus GTF, or phosphate-buffered saline . All rats were then orally infected with S . mutans SJ . After 63-day infection periods, the GGY and AND-injected groups had significant dental caries reductions compared with sham-injected groups in most experiments . These studies support the existence of an additional catalytic subdomain within the sequence defined by the GGY and AND peptides . Furthermore, the epitopes defined in these sequences have significant immunogenicity, can induce immune responses which interfere with GTF-mediated glucan synthesis in vitro, and can protect rats from experimental dental caries.

J Bacteriol, 1997 Nov, 179(21), 6589 - 94
Natural competence in the genus Streptococcus: evidence that streptococci can change pherotype by interspecies recombinational exchanges; Havarstein LS et al.; To map the incidence of natural competence in the genus Streptococcus, we used PCR to screen a number of streptococcal strains for the presence of the recently identified competence regulation operon, containing the comC, -D, and -E genes . This approach established that the operon is present in strains belonging to the S . mitis and S . anginosus groups, but it was not detected in the other strains examined . Competence is induced in S . pneumoniae and S . gordonii by strain-specific peptide pheromones, competence-stimulating peptides (CSPs) . With its unique primary structure, each CSP represents a separate pheromone type (pherotype), which is recognized by the signalling domain of the downstream histidine kinase, ComD . Thus, all bacteria induced to competence by a particular CSP belong to the same pherotype . In this study, we identified a number of new pherotypes by sequencing the genes encoding the CSP and its receptor from different streptococcal species . We found that in several cases, these genes have a mosaic structure which must have arisen as the result of recombination between two distinct allelic variants . The observed mosaic blocks encompass the region encoding the CSP and the CSP-binding domain of the histidine kinase . Consequently, the recombination events have led to switches in pherotype for the strains involved . This suggests a novel mechanism for the adaptation of naturally competent streptococci to new environmental conditions.

J Clin Microbiol, 1997 Nov, 35(11), 2923 - 6
Decreased capacity for type-specific-antigen synthesis accounts for high prevalence of nontypeable strains of group B streptococci in Mexico; Palacios GC et al.; The low incidence of group B streptococcal (GBS) invasive neonatal disease in Mexico has been attributed to the low prevalence of serotype III strains, a major serotype in developed countries . In addition, nontypeable strains account for 12% of the isolates in Mexico and < 1% of the isolates in the United States . In this study, 57 GBS isolates (28 nontypeable by the Lancefield procedure) from carrier and infected neonates and women from Mexico were also examined for the presence of type-specific antigen by an enzymatic procedure using N-acetylmuramidase digestion of the cell wall to release soluble type-specific antigen . Of the 28 nontypeable strains from Mexico, 23 were typeable by the enzyme extraction procedure, with serotype III being the predominant serotype in invasive disease . These results suggest that nontypeable isolates of GBS should be further examined by the enzymatic extraction procedure to determine the presence of type-specific antigen . Furthermore, these limited results suggest that serotype III is likely a major serotype in invasive disease also in Mexico.

Diagn Microbiol Infect Dis, 1997 Sep, 29(1), 29 - 32
Argentinian collaborative study on prevalence of erythromycin and penicillin susceptibility in Streptococcus pyogenes . The Argentinian Streptococcus Study Group; Lopardo HA et al.; Two monthly studies on the prevalence of penicillin and erythromycin susceptibility of Streptococcus pyogenes were performed in May and October of 1994 in Argentina . A total of 58 centers from 27 cities participated in these studies . A total of 1072 isolates were tested by a diffusion method, although 595 isolates were tested both by the diffusion and an agar dilution method (n = 1767 isolates) . No penicillin-resistant streptococci were found in our study (MIC100 = 0.03 microgram/ml) . Only four isolates were confirmed as erythromycin resistant S . pyogenes (prevalence 0.14 and 0.28% in May and October 1994, respectively) . Resistance in three isolates was due to an inducible mechanism, although in one strain a different phenotype was observed.

Acta Otolaryngol, 1997 Sep, 117(5), 744 - 9
Selective attachment of beta-haemolytic streptococci group A to oropharyngeal epithelium in health and disease; Lilja M et al.; Localization and semiquantification of beta-haemolytic streptococci, Group A (GABHS), GABHS attachment and general bacterial attachment to epithelial cells (bacterial number and morphology) were studied during GABHS-positive acute tonsillitis and pharyngitis infections and among healthy GABHS carriers . Samples were collected from various areas of the oropharynx (palatine tonsils, posterior oropharyngeal wall, palatoglossal arch and buccal mucosa) . During acute tonsillitis and pharyngitis, GABHS grew in samples obtained from the palatine tonsils and posterior oropharyngeal wall . The ratio of GABHS colonies to other aerobic colonies increased, and GABHS became attached to epithelial cells of both palatine tonsils and posterior oropharyngeal wall . In GABHS carriers, GABHS were found mainly on the palatine tonsils, but these microorganisms were not attached to the epithelium . Overall bacterial attachment to tonsillar and oropharyngeal epithelial cells increased during active tonsillitis and pharyngitis.

J Chir (Paris), 1997 Jul, 134(2), 69 - 72
{Combination of colorectal tumor and Streptococcus bovis endocarditis . Apropos of 3 cases}; Cailliez-Tomasi JP et al.; The authors report about 3 cases of bovis endocarditis revealing a colic carcinoma . This morbidity confirms the need for routine digestive investigations in endocarditis due to group D streptococci and eventually a liver disease.

Arch Oral Biol, 1997 Aug, 42(8), 539 - 45
Adherence of oral streptococci to an immobilized antimicrobial agent; Saito T et al.; An antimicrobial agent, 3-(trimethoxysilyl)-propyldimethyloctadecyl ammonium chloride, was immobilized on silica . Interaction between the material (termed) OAIS) and various oral bacterial species were then studied . Seven species of Streptococcus and two Actinomyces were investigated for their ability to adhere to this biomaterial . Cell-surface hydrophobicity and zeta-potential were examined as well . Analysis of extracted hydrophobic proteins which adhered to OAIS revealed that the adherence of these micro-organisms was closely related to the hydrophobicity of their cell surfaces . The results of zeta-potential assays indicated that negative charge on the cell surface inhibited adherence to OAIS . Gel electrophoresis revealed that OAIS could absorb cell-surface hydrophobic proteins from all bacterial species tested . Preadsorption of hydrophobic components on the cell surface inhibited adherence of the Strep . mutans strain to OAIS in a dose-dependent manner . The results indicate that OAIS adsorption of these oral bacteria was dependent on the degree of hydrophobicity of their surfaces . A major component of this adherence was hydrophobic cell-surface proteins.

Scand J Prim Health Care, 1997 Sep, 15(3), 149 - 55
The prevalence of beta-haemolytic streptococci in throat specimens from healthy children and adults . Implications for the clinical value of throat cultures; Gunnarsson RK et al.; OBJECTIVE: To examine the influence of age and season of the year on the carrier rate of beta-haemolytic streptococci (BHS) in healthy individuals and patients with throat pain . DESIGN: The prevalence of BHS in throat specimens from healthy individuals was compared with that from patients with throat pain of the same age in a defined geographical area, collected during the same mid-winter and late summer periods . RESULTS: The prevalence of BHS in healthy individuals was low before the age of 3 years (1.9-7.1%) and in adults > or = 16 years (2.4-3.7%) and highest in the age group 3-15 years (5.0-21.2%) . The difference in prevalence of BHS between healthy individuals and patients with throat pain was small during the late summer season and large during the mid-winter season . CONCLUSION: Prevalence of BHS varies with age and season in healthy individuals and patients with throat pain . During the summer, it is much more difficult to interpret the result of a throat culture in individuals aged < 16 years.

Bull World Health Organ, 1997, 75(4), 355 - 9
Serotypes of group A streptococci isolated from healthy schoolchildren in the United Arab Emirates; Ameen AS et al.; Group A streptococci (GAS) are the most frequent cause of pharyngitis in children and are a common cause of emergency room or paediatric clinic visits worldwide . This study determined the representative M and T types of GAS, and their distribution, among schoolchildren in the United Arab Emirates . Throat swabs were taken and cultured for GAS isolates during the winter of 1994-95 from 1000 children aged 5-7 years attending nine schools . Of the isolates obtained, 100 were serotyped using standard techniques . Nearly all these isolates (91%) were T typable, falling into 15 T types; the commonest being type 1 (n = 17), type 6 (n = 15), type 11 (n = 10), type 2 (n = 8), type 12 (n = 8), and type 28 (n = 8) . A total of 76% of the isolates were typable for M protein, falling into 14 M types, with type 1 (n = 17), type 6 (n = 15), type 2 (n = 8), type 22 (n = 5), type 28 (n = 7), and type 75 (n = 5) predominating . Serotype clusters were found in certain classes or schools, although the number of isolates examined was too small to allow definitive epidemiological conclusions to be drawn . The ease of serotyping these isolates suggests that GAS strains in the United Arab Emirates are similar, but not necessarily related, to those commonly found in the USA and Europe, and that these may be the most prevalent strains worldwide . The relative prevalence of M type 1 is significant, as this GAS serotype is associated with serious diseases such as rheumatic heart disease, a recognized problem in the United Arab Emirates, and toxic shock syndrome, which has not yet been reported from this area . Knowledge of the prevalence of GAS serotypes, and further research on the epidemiology of streptococcal disease, will be useful should streptococcal vaccines become available.

Zh Mikrobiol Epidemiol Immunobiol, 1997 Jul-Aug, (4), 51 - 4
{The dynamics of the species composition, antilysozyme activity and antibiotic resistance of the causative agents of soft-tissue surgical infection}; Bukharin OV et al.; The dynamics of the microflora in the foci of surgical infection in 54 patients was studied . Staphylococci and streptococci prevailed among the primarily isolated causative agents . In complicated forms of surgical infection of soft tissues the change of causative agents, mainly to gram-negative opportunistic microflora with a higher level of resistance to antibiotics and high antilysozyme activity, was observed more often than in noncomplicated forms of such infection.

Zh Mikrobiol Epidemiol Immunobiol, 1997 Jul-Aug, (4), 108 - 11
{Microorganism persistence in hematopoietic tissue: means for detecting it and its significance}; Sanin AV et al.; Many microorganisms are capable of prolonged persistence in the marrow . In this study, carried out by the method of negative selection based on the treatment of mouse marrow cells with specific antimicrobial sera and complement, Mycoplasma arthritidis and L-forms of group B streptococci were found to be capable of persisting in the marrow in close association with the late category of clonogenic precursor cells, CFU-7, as well as, to a lesser extent, with late erythroid precursors, CFUe . Early colony-forming cells, CFUs-12 and PFUe, as well as granulocyto-macrophagal precursors, CFUgm, did not practically express antigens to the given infective agents on their surface.

Pediatr Cardiol, 1997 Nov-Dec, 18(6), 419 - 24
Trends of childhood infective endocarditis in Israel with emphasis on children under 2 years of Age; Ashkenazi S et al.; This study retrospectively analyzed the characteristics of infective endocarditis (IE) in children in light of recent advances in pediatric cardiology . We evaluated 25 consecutive patients with IE from 1980 to 1991 at a tertiary Children's Medical Center in Israel . The incidence of IE increased significantly over the second half of the study period, owing mainly to an increase in the number of patients less than 2 years old . Concomitantly, the causative microorganisms changed considerably, with a decrease in viridans streptococci, an increase in staphylococci and other uncommon causes of IE, and increased antibiotic resistance . Children under the age of 2 years, previously considered uncommon IE patients, accounted for 47% of the IE cases during the second half of the study period . The infection often (78%) appeared in children with complex congenital heart diseases, commonly after early palliative or definitive cardiac surgery . Infants who underwent systemic-to-pulmonary shunting, especially with implantation of foreign materials, were at highest risks . IE was more often hospital-acquired (56% versus 6%) and acute (56% versus 44%) in the younger children than in the older ones and often lacked the typical clinical presentation of the disease . In addition, uncommon causative organisms were noted more frequently (67% versus 13%; p = 0.009) in the younger group . The study shows a significant increase in IE in infants and young children with distinctive underlying conditions, clinical presentation, and microbiologic findings, all of which should be considered currently for the diagnosis and treatment of pediatric IE.

Pediatr Dermatol, 1997 Sep-Oct, 14(5), 351 - 4
An epidemiologic study of perianal dermatitis among children in Egypt; Mostafa WZ et al.; Perianal dermatitis is a common problem occurring among infants and children . Streptococci, particularly beta-hemolytic group A organisms, play a major role in its causation . An epidemiologic association between perianal dermatitis caused by group A beta-hemolytic streptococci in some patients and pharyngeal colonization with the same organisms seems to exist . A similar relation is also true for other organisms, including non-group A beta-hemolytic streptococci and Staphylococcus aureus . This was the main conclusion of a hospital-based study performed on 150 children with perianal dermatitis . All patients were subjected to a questionnaire, clinical examination, two perianal swabs, and two throat swabs . The bacteriologic examination of the perianal swabs revealed the presence of beta-hemolytic streptococci in 35.3% of the cases, half of which were of the group A beta-hemolytic strain (17.3%) and half of which were non-group A (18%) . Throat swabs revealed the presence of beta-hemolytic streptococci in 44% of cases, half of which were found to belong to group A (21.3%) and half to non-group A (22.7%) . Among patients with perianal dermatitis caused by group A beta-hemolytic streptococci, 53.8% had associated pharyngeal colonization by the same organism . S . aureus was isolated from the perianal skin in five patients (3.4%); in four of whom the same organism also grew in cultures from throat swabs . A relatively good association between pharyngeal colonization by beta-hemolytic streptococci and Staphylococci and the presence of perianal dermatitis caused by the same organisms was demonstrated using the Kappa test of agreement (K = 0.4).

J Leukoc Biol, 1997 Oct, 62(4), 415 - 29
Microorganisms and their interaction with the immune system; Kotwal GJ; Microorganisms interact with the immune system in multiple ways . In an interaction between a microorganism and its host, the defense of the host does not go unchallenged . Microorganisms have for decades been suspected of possessing the capabilities of hiding from and escaping the consequences of immune surveillance . Escape mechanisms like antigenic variation, latency, and genomic integration can best be described as passive mechanisms for avoiding interaction with the host immune system, to differentiate them from the more engaging and host-directed active mechanisms of interaction . Studies of the mechanism of direct entry of viruses (HIV, measles, and enteroviruses), bacteria (streptococci and staphylococci), and parasites (Leishmania and plasmodium) into immune cells like CD4+ T cells or macrophages, as reported very recently, indicate an even more aggressive mode of interaction . This aggressive mechanism of interaction with the components of the host immune system allows the microbe not only to block the normal function of immune components on the surface of immune cells from functioning, but also to obliterate a vital immune function, cellular immunity, causing immunosuppression, e.g . the depletion of CD4+ T cells due to the entry and replication of HIV . Collectively, microorganisms have evolved various mechanisms by which they can actively block almost any cellular, humoral, or systemic immune response . One general feature of the proteins that assist microorganism to immunomodulate and actively evade host defense is their structural and therefore functional similarity to the host proteins, which they effectively mimic . Understanding the different mechanisms by which microorganisms interact with the immune system can impact the design of live vaccines as well as the development of novel therapeutic immunomodulators that can provide medicine with powerful new tools to manage immune disorders, allograft rejection, remote multiple organ failure resulting from trauma, autoimmune diseases, etc.

J Infect Dis, 1997 Oct, 176(4), 1001 - 12
A global gene pool for high-level cephalosporin resistance in commensal Streptococcus species and Streptococcus pneumoniae; Reichmann P et al.; Highly penicillin- and cephalosporin-resistant Streptococcus mitis and Streptococcus oralis were isolated in Spain, Hungary, and Berlin . With chromosomal DNA of these strains, resistant transformants of Streptococcus pneumoniae were obtained that expressed low-affinity variants of penicillin-binding proteins (PBPs) 2x, 1a, 2a, and 2b in different combinations, depending on the selective conditions . The transformants had cefotaxime MICs of up to 6 microg/mL, and those with a low-affinity PBP 2b were highly deficient in penicillin-induced lysis . Sequence analysis of the pbp2x genes confirmed the presence of a global gene pool of penicillin resistance determinants shared by commensal and pathogenic streptococci.

Adv Exp Med Biol, 1997, 418, 917 - 9
Phagocytic, serological, and protective properties of streptococcal group A carbohydrate antibodies; Zabriskie JB et al.; Group A streptococcal antibodies promote phagocytosis of several different strains of GR A streptococci . These antibodies passively protect against an in vivo mouse challenge model.

Adv Exp Med Biol, 1997, 418, 909 - 11
Immunoglobulins inhibit adherence and internalization of Streptococcus pyogenes to human pharyngeal cells; Fluckiger U et al.; Purified human sIgA against group A streptococci inhibited streptococcal adherence to pharyngeal cells whereas rabbit serum raised against the whole M+ strain did not . Of note, inhibition of adherence by sIgA occurred despite a much lower immunreactivity against the M6 protein as compared to the hyperimmune serum against the whole M+ strain . The M protein does probably not mediate the adherence of group A streptococci to respiratory cells, as shown by previous studies . However, since the isogenic M- derivative was less invasive to human pharyngeal cells than the M+ strain, our invasion experiments suggest that the M protein may play a role in internalization of group A streptococci into eukaryotic cells . More importantly, internalization and not adherence could be blocked by rabbit serum immunized with recombinant M6 protein.

Adv Exp Med Biol, 1997, 418, 737 - 9
Identification and characterization of a new protein from Streptococcus pyogenes having homology with fibronectin and fibrinogen binding proteins; Rocha CL et al.; Fibronectin and fibrinogen-binding proteins have been described as possible adhesin in streptococci and staphylococci . Recent published data has demonstrated that Protein F, a fibronectin-binding protein from group A streptococci, is important in adherence to respiratory cells (8) . Other similar proteins already described (i.e . SOF, Sfb and SfbII) are able to competitively inhibit the binding of fibronectin to S . pyogenes (9,10,5) . Similarly, clumping factor from S . aureus, is known to promote adherence to fibrinogen-coated surfaces (7) . When the sequence from SFFBP-12 was compared against all the others fibronectin and fibrinogen-binding proteins described in streptococci and staphylococci (1-10), an identity at the amino acid level, ranging from 38 to 69% was found for the C region . For the repeated region (R), the identity ranged between 47 and 75% . Unlike all the other proteins already described in group A streptococci, the protein we describe here, SFFBP-12, shares a high degree homology (67-75%) with the fibronectin-binding protein B from S . dysgalactiae (6), as well as homology with the S . aureus clumping factor (7) and fibronectin-binding protein B (3), making it a new potential fibronectin-fibrinogen binding protein for group A streptococci . These characteristics would also imply that SFFBP-12 contains two different fibronectin-binding domains (regions B and C), thus enhancing its role as a possible major adhesin molecule . RNA transcription assays showed a transcript with the expected molecular size for the intact SFFBP-12 protein, confirming that the protein is actively expressed during bacterial growth . SFFBP-12 is the largest protein of its kind identified from group A streptococci and is comparable in size to the fibronectin binding protein B from S . dysgalactiae (6) . If it is shown that SFFBP-12 does in fact bind both fibronectin and fibrinogen, as the sequence data suggest, it would make this molecule a major virulence determinant for the group A streptococcus.

Adv Exp Med Biol, 1997, 418, 627 - 30
The role of group B streptococci beta-hemolysin expression in newborn lung injury; Nizet V et al.; There is a direct correlation between the level of GBS beta-hemolysin expression and the ability of GBS to injury lung epithelial cells . Electron microscopy suggest the hemolysin acts as a pore-forming cytolysin . beta-hemolysin-associated lung epithelial cell injury is inhibited by surfactant phospholipid, a substance in which high-risk premature infants are deficient . We have now shown that loss of GBS hemolysin activity is associated with decreased animal virulence following intrathoracic inoculation of the organism . Further, a knockout of a putative GBS beta-hemolysin gene from the literature suggests it is not the major GBS hemolysin determinant . Cloning and sequencing analysis of the Tn916 (or Tn916DE) insertions in three of our nonhemolytic GBS mutants show identical integration sites in a distinct chromosomal locus . Finally, a putative 11-kd hemolysin species is identified by comparative analysis of protein extracts from isogenic hemolysin mutants.

Adv Exp Med Biol, 1997, 418, 615 - 8
Cloning and expression in Escherichia coli of a protective surface protein from type V group B streptococci; Lachenauer CS et al.; This report describes a trypsin-resistant laddering protein purified from a type V strain, a serotype of important emerging clinical significance . This protein is present in a majority of type V clinical strains, elicits protective antibody in an animal model, and is cross-reactive with the alpha C protein and R1 . The gene encoding this protein has been cloned; preliminary nucleotide sequence analysis reveals significant homology, though not identity, with the alpha C protein gene . These data support the hypothesis that there exists a family of related but distinct GBS surface proteins which may play a role in immunity to GBS infection.

Adv Exp Med Biol, 1997, 418, 537 - 43
Molecular markers for throat and skin isolates of group A streptococci; Bessen DE et al.; In summary, the emm chromosomal patterns distinguish between the two principal tissue site reservoirs of group A streptococci--the nasopharyngeal mucosa and impetigo lesion . Strains derived from normally sterile tissue sites are probably transmitted to new hosts by respiratory droplets, at least in the Connecticut population . The speA gene provides an example of how genetic exchange between different strains of group A streptococci may be limited to a single tissue site or to a subset of emm chromosomal patterns.

Adv Exp Med Biol, 1997, 418, 511 - 5
Proteins M6 and F1 are required for efficient invasion of group A streptococci into cultured epithelial cells; Jadoun J et al.; Group A streptococci were recently shown to be capable of invading human epithelial cell monolayers . Cell invasion might be an important virulence trait of streptococci that enable the pathogen to gain entry into deeper tissues after initial binding to host cells . Nothing is known concerning the nature of streptococcal components that mediate invasion . Using isogenic mutants of strain JRS4 that are defective in the expression of either M6 protein or protein F1, or both proteins, it was demonstrated that both adhesins are required for efficient invasion . Further more, expression of protein F1 on the surface of a non-invasive strain rendered the latter invasive, suggesting that protein F1 is directly involved in the invasion process.

Gene, 1997 Sep 1, 196(1-2), 75 - 82
Two-domain motif for IgG-binding activity by group A streptococcal emm gene products; Bessen DE et al.; A biological role for the non-immune binding of human IgG by group A streptococci is evidenced by its strong association with a subpopulation of strains giving rise to tissue-specific infection . IgG-binding activity lies within many of the M and M-like surface proteins (encoded by emm genes), and several structurally distinct IgG-binding sites are known to exist . In this report, two adjacent IgG-binding domains, differing in their specificity for human IgG subclasses, are localized within the M-like protein, protein H . The putative coding regions for the two IgG-binding domains were mapped for 82 epidemiologically unrelated strains . Both coding regions are associated with phylogenetically distant emm genes, supporting a role for horizontal transfer and intergenomic recombination in the evolution of emm genes . In most instances, the two coding regions are tightly linked, suggesting that there exist strong selective pressures to maintain a two-domain binding motif . Both coding regions are found among all strains bearing emm gene markers associated with impetigo lesions as the principal tissue reservoir, but are absent from most strains that exhibit markers for a predominant nasopharyngeal reservoir . The data support the hypothesis that the pathogenic potential of an isolate is dictated, at least in part, by its unique array of multifunctional emm gene products.

Ann Hematol, 1997 Jul-Aug, 75(1-2), 9 - 16
Management of infections during intensive treatment of hematologic malignancies; Maschmeyer G et al.; In febrile neutropenic patients with high-grade hematologic malignancies, empirical antimicrobial intervention is mandatory . Large randomized clinical trials have elucidated the benefit of broad-spectrum beta lactam antibiotics used as single drugs or in combination with aminoglycosides in order to provide activity against gram-negative aerobes as well as against streptococci and Staphylococcus aureus . As a result, infection-related mortality was reduced to less than 10% also in patients undergoing intensified remission induction or consolidation therapy for acute leukemias . Distinct subgroups of patients have been identified who need an empirical modification of antimicrobial treatment i.e., patients with catheter-related infections, patients with pulmonary infiltrates, and patients with unexplained fever not responding to first-line antibiotics . In two consecutive, prospectively randomized trials conducted by the Paul Ehrlich Society it was demonstrated that empirical antifungal therapy is beneficial for second-line treatment in patients with persistent unexplained fever and should be part of the first-line approach in patients with lung infiltrates . The empirical addition of glycopeptides, however, should be restricted to patients with catheter-related infections due to coagulase-negative staphylococci.

Am J Obstet Gynecol, 1997 Sep, 177(3), 666 - 72
Regulation of decidual cell chemokine production by group B streptococci and purified bacterial cell wall components; Dudley DJ et al.; OBJECTIVE: Our purpose was to determine whether cultured human decidual cells produce chemokines in response to different strains of group B streptococci and purified bacterial cell wall components . STUDY DESIGN: Human decidual cells were cultured from term placentas by standard techniques . Different strains of group B streptococci were isolated from neonates with early-onset group B streptococci sepsis . Confluent cell monolayers were incubated with these different strains of group B streptococci and various concentrations of purified bacterial cell wall components (including lipoteichoic acid, sialic acid, lipopolysaccharide, and lipid A) for 16 hours at 37 degrees C . Culture supernatants were collected and assayed for macrophage inflammatory protein-1 alpha and interleukin-8 . Statistical analysis was by analysis of variance . RESULTS: We found that cultured human decidual cells produced significant amounts of the two chemokines macrophage inflammatory protein-1 alpha and interleukin-8 in a strain-specific fashion to the various different strains of group B streptococci tested, from 215% to 421% over baseline production (p < 0.05 by analysis of variance) . Also, we found that incubation of decidual cells with various concentrations of lipoteichoic acid, sialic acid, lipopolysaccharide, and lipid A resulted in significant concentration-dependent increases in decidual cell macrophage inflammatory protein-1 alpha and interleukin-8 production (p < 0.05.) CONCLUSIONS: Decidual cells produced significant amounts of the chemokines macrophage inflammatory protein-1 alpha and interleukin-8 in response to intact group B streptococci in a strain-specific fashion and in response to various concentrations of different bacterial cell wall components . Because chemokines are important mediators signaling migration of different immune effector cells into areas of inflammation, we suggest that decidual cell chemokine production in response to bacteria and bacterial cell wall components may be a key early event in the pathogenesis of infection-associated preterm labor.

Infect Immun, 1997 Oct, 65(10), 4017 - 21
Soluble antigens from group B streptococci induce cytokine production in human blood cultures; von Hunolstein C et al.; Group B streptococcal antigens stimulated tumor necrosis factor alpha (TNF-alpha), interleukin-1 (IL-1), and IL-6 production in human blood cultures in a concentration- and time-dependent fashion . The minimal concentrations of type-specific polysaccharides, lipoteichoic acid, and group-specific polysaccharide required to produce these effects were, respectively, 0.01, 1, and 10 microg/ml . Cell separation experiments indicated that monocytes were the cell type mainly responsible for cytokine production . Time course studies indicated that TNF-alpha was released before the other cytokines . TNF-alpha, however, did not appear to directly induce IL-1beta, as shown by blockade experiments with anti-TNF-alpha antibodies . IL-6 levels were moderately but significantly decreased by anti-TNF-alpha . These data indicate that several products from group B streptococci are able to directly stimulate human monocytes to release TNF-alpha, IL-1beta, and IL-6 . These findings may be clinically relevant, since proinflammatory cytokines can mediate pathophysiologic changes during sepsis.

J Clin Microbiol, 1997 Oct, 35(10), 2634 - 8
Advantage of combining resin with lytic BACTEC blood culture media; Rohner P et al.; The BACTEC 9240 (Becton Dickinson, Sparks, Md.) automated blood culture system is based on the continuous monitoring of CO2 production by means of a fluorescent sensor attached to the bottom of a culture vial . We compared two media for this system, resin-containing Plus aerobic/F and Lytic anaerobic/F . Sets of Plus aerobic/F and Lytic anaerobic/F vials inoculated with similar volumes (9 +/- 2.5 ml) were evaluated . In the laboratory, the vials were introduced into the system in accordance with the recommendations of the manufacturer and incubated at 35 degrees C for 5 days . A total of 10,914 sets consisting of two bottles each were obtained from 3,674 patients (2.97 cultures per patient) . Of these, 1,233 (11%) were culture positive, including 1,074 (10%) yielding at least one pathogen, and 178 (2%) were contaminated . A total of 1,135 isolates were considered clinically relevant in 624 septic episodes; we isolated 894 from Plus aerobic/F and 852 from Lytic anaerobic/F (P = 0.06 {not significant}) . More S . aureus isolates (P = 0.05), Pseudomonas spp . (P < 0.0001), other gram-negative bacteria (P = 0.004), and yeasts (P < 0.0001) were isolated from Plus aerobic/F medium, but more streptococci (P < 0.0001), E . coli (P = 0.02) strains and anaerobes (P < 0.0001) were detected with Lytic anaerobic/F medium . Lytic anaerobic/F vials were significantly (P < 0.0001) more often positive at least 6 h before Plus aerobic/F vials (n = 112 versus 52, respectively) . Significantly more (P < 0.0001) Plus aerobic/F vials (n = 210; 1.9%) than Lytic anaerobic/F vials (n = 42; 0.4%) were unconfirmed positives . Plus aerobic/F and Lytic anaerobic/F proved to be a valuable pair of blood culture media . Plus aerobic/F performs better for patients under antibiotic treatment, due to the antimicrobial-neutralizing effect of resins . For patients without antibiotic therapy, more microorganisms could be isolated from Lytic anaerobic/F due to cell lysis.

J Clin Microbiol, 1997 Oct, 35(10), 2458 - 63
Identification of Abiotrophia adiacens and Abiotrophia defectiva by 16S rRNA gene PCR and restriction fragment length polymorphism analysis; Ohara-Nemoto Y et al.; Abiotrophia adiacens and Abiotrophia defectiva, previously referred to as nutritionally variant streptococci, Streptococcus adjacens and Streptococcus defectivus, respectively, are causes of infective endocarditis . We describe a method of identifying these two species and also of distinguishing them from 15 other major etiological pathogens of infective endocarditis by means of 16S rRNA gene PCR amplification followed by restriction fragment length polymorphism analysis (PCR-RFLP) . The 16S rRNA genes were successfully amplified with a set of universal primers from all 17 species of bacteria examined, including viridans group streptococci . The RFLP patterns of A . adiacens and A . defectiva obtained by HaeIII or MspI digestion were readily distinguished from each other and from those of other bacteria . When PCR analysis was performed with the supernatant of a suspension of a boiled colony, the 16S rRNA genes of 80 of 82 isolates (97%) of A . adiacens and all isolates (11 of 11) of A . defectiva were amplified . The HaeIII RFLP patterns of the isolates were the same as those of the corresponding type strains, although 28% of A . adiacens isolates revealed intraspecies polymorphism . The detection limit of this method was 0.1 pg of genomic DNA, as assessed by using the digoxigenin-labeling DNA detection system . Thus, the PCR-RFLP analysis that we developed is applicable for the routine detection of Abiotrophia from clinical specimens.

Zhonghua Yi Xue Za Zhi (Taipei), 1997 Jul, 60(1), 62 - 5
Group A streptococcal septicemia with retropharyngeal abscess: a case report; Choong CS et al.; Group A streptococcal (GAS) septicemia is rare in occurrence but has a significant morbidity and mortality, whereas retropharyngeal abscess (RPA) is infrequent and it is most commonly found in children under the age of 6 years, with half of the cases occurring in children between 6 and 12 months old . This report concerns a case of GAS septicemia complicated with RPA . The patient, a five-year-old boy, was referred from a local medical department under the impression of meningitis . However, blood and throat cultures were both found to be positive for group A streptococci . Widening of the retropharyngeal space was noted in lateral neck roentgenography . RPA was confirmed by computed tomography (CT) of the neck . Ampicillin was prescribed for a period of four weeks . The patient was then discharged and oral form ampicillin was continued for four more weeks . No surgical incision and drainage was performed . Complete disappearance of the abscesses were noted via CT of the neck at an Outpatient Department follow-up.

Lancet, 1997 Sep 27, 350(9082), 918 - 21
Effectiveness of clinical guidelines for the presumptive treatment of streptococcal pharyngitis in Egyptian children; Steinhoff MC et al.; BACKGROUND: Primary prevention of acute rheumatic fever requires antibiotic treatment of acute streptococcal pharyngitis . In developing countries, clinicians must rely on clinical guidelines for presumptive treatment of streptococcal pharyngitis since bacterial culture and rapid diagnostic tests are not feasible . We evaluated the WHO Acute Respiratory Infection guideline in a large urban paediatric clinic in Egypt . METHODS: Children between 2 and 13 years of age who had a sore throat and pharyngeal erythema were enrolled in the study . Clinical, historical, and demographic information was recorded and a throat culture for group A beta-haemolytic streptococci was done . Sensitivity (% of true-positive throat cultures) and specificity (% of true-negative throat cultures) were calculated for each clinical feature . The effect of various guidelines on correct presumptive treatment for throat-culture status was calculated . FINDINGS: Of 451 children with pharyngitis, 107 (24%) had group A beta-haemolytic streptococci on throat culture . A purulent exudate was seen in 22% (99/450) of these children and this sign was 31% sensitive and 81% specific for a positive culture . The WHO Acute Respiratory Infections (ARI) guidelines, which suggest treatment for pharyngeal exudate plus enlarged and tender cervical node, were 12% sensitive and 94% specific; 13/107 children with a positive throat culture would correctly receive antibiotics and 323/344 with a negative throat culture would, correctly, not receive antibiotics . Based on our data we propose a modified guideline whereby exudate or large cervical nodes would indicate antibiotic treatment, and this guideline would be 84% sensitive and 40% specific; 90/107 children with a positive throat culture would correctly receive antibiotics and 138/344 with a negative throat culture would, correctly, not receive antibiotics . INTERPRETATION: The WHO ARI clinical guideline has a high specificity but low sensitivity that limits the unnecessary use of antibiotics, but does not treat 88% of children with a positive streptococcal throat culture who are at risk of acute rheumatic fever . A modified guideline may be more useful in this population . Prospective studies of treatment guidelines from many regions are needed to assess their use since the frequency of pharyngitis variesPIP: In developing country settings without access to bacterial culture and rapid diagnostic tests, the prevention of acute rheumatic fever depends on clinicians' presumptive treatment of streptococcal pharyngitis . This study evaluated the effectiveness of World Health Organization (WHO) acute respiratory infection guidelines in a large pediatric clinic (Abu Reesh Children's Hospital) in Cairo, Egypt . 451 children 2-13 years of age with sore throat and pharyngeal erythema were enrolled, 107 (24%) of whom had group A beta-hemolytic streptococci on throat culture . Purulent exudate, present in 99 (22%) of these children, was 31% sensitive and 81% specific for a positive culture . The WHO guidelines, which recommend treatment for pharyngeal exudate plus enlarged and tender cervical node, were 12% sensitive and 94% specific . Based on these guidelines, 13 of 107 children with a positive throat culture would correctly receive antibiotics and 323 of 344 with a negative culture would not receive antibiotics . A modified guideline in which exudate or large cervical nodes would indicate antibiotic treatment would be 84% sensitive and 40% specific . With this modification, 90 of 107 children with a positive throat culture would correctly receive antibiotics and 138 out of 344 with a negative culture would not receive treatment . However, additional prospective studies from other regions of Egypt are necessary before modified guidelines are implemented .

Clin Infect Dis, 1997 Sep, 25(3), 685 - 9
Role of benzathine penicillin G in prophylaxis for recurrent streptococcal cellulitis of the lower legs; Wang JH et al.; Cellulitis of the lower leg is an infection caused by streptococci or, less commonly, Staphylococcus aureus and other gram-negative rods . Recurrence of cellulitis is a common problem . In the present study, we evaluated the use of monthly intramuscular injections of benzathine penicillin G to prevent recurrences of cellulitis . A total of 115 patients with definite or presumptive cases of streptococcal cellulitis were enrolled in this study . Eighty-four of these patients who declined follow-up or received incomplete prophylaxis were considered controls . Recurrence occurred in four (12.9%) of 31 cases who received prophylaxis and 16 (19%) of the 84 cases who did not receive prophylaxis . The difference was not statistically significant . Predisposing factors for cellulitis were found in 57 (49.6%) of the 115 enrolled cases and were mostly related to the impairment of local circulation . Administration of prophylaxis successfully reduced the recurrence rate to zero among patients without predisposing factors but failed to prevent recurrence in those with predisposing factors (20%) . We conclude that monthly benzathine penicillin G prophylaxis benefits only patients without predisposing factors for cellulitis.

Clin Infect Dis, 1997 Sep, 25 Suppl 2, S127 - 31
Can we afford to do anaerobic cultures and identification? A positive point of view; Rosenblatt JE; Because anaerobic bacteria cause significant human infections that require specific therapy and because anaerobes are resistant to certain antimicrobials, the isolation, identification, and determination of antimicrobial susceptibilities are as important for these bacteria as they are for other pathogenic bacteria . Anaerobic culturing can be made cost-efficient by strict adherence to several principles, including the selective culturing of only appropriate general specimens that are uncontaminated by normal flora (this can be achieved by educating physicians and nurses in recognizing likely sources of anaerobic infection); rapid transport of specimens and use of appropriate transport system; use of a system of rejection and notification when inappropriate or when multiple specimens have been received; and use of a logical algorithm for determining the degree of isolation and identification to be performed, according to the numbers and types of organisms present . Testing of all significant gram-negative organisms for the production of beta-lactamases can provide an early indication of antimicrobial susceptibility, and actual testing limited to screening of three or four drugs can be performed on selected isolates by using a rapid and simple method such as the Etest (AB BIODISK, Solna, Sweden) . Although the number of anaerobic bacteremias has declined since the 1970s, this number has plateaued in recent years, and these infections are life-threatening . Routine culturing of blood for anaerobes is still indicated in many institutions because of the unpredictable clinical sources of some bacteremias and the improved yields of both anaerobes and some streptococci when anaerobic blood culture systems are used.

J Formos Med Assoc, 1997 Sep, 96(9), 749 - 53
Streptococcal toxic shock syndrome complicating varicella in children; Yang YJ et al.; The most common complication in children with varicella is cutaneous superimposed infection with pyogenic bacteria . Group A beta-hemolytic streptococci, which are known to cause life-threatening infections in both previously healthy children and those with underlying diseases, are the most frequently associated pathogens . A newly recognized disease, called streptococcal toxic shock syndrome, is associated with severe morbidity and mortality . We report a 3-year-old boy with a diagnosis of this syndrome who presented with increasing fever, vomiting, and lethargy 7 days after the development of a classic varicella skin lesion . In spite of aggressive fluid supply, administration of inotropic agents, and cardiopulmonary resuscitation, a rapidly deteriorating clinical course led to death 4 hours after hospitalization . This is the first report of this association in Taiwan . Pediatricians evaluating children with varicella must be mindful of the potential for Group A beta-hemolytic streptococcal infection.

Rev Clin Esp, 1997 Jun, 197(6), 393 - 7
{Bacteremias due to the Streptococcus milleri group . An analysis of 18 episodes}; Sanchez-Porto A et al.; OBJECTIVE: To study the epidemiological and clinical characteristics of bacteremia caused by Streptococcus milleri group streptococci (SMG) . METHODS: Prospective evaluation of all bacteremic episodes with clinical significance from 1990 to 1995 in two general hospitals . In this study all episodes caused by SMG were analyzed . RESULTS: A total of 905 bacteremic episodes with clinical significance were detected; 18 (1.98%) were caused by SMG (0.16/1,000 admissions) . The mean age of patients were 43 years and the male/female ratio 1.6 . Seventeen patients (94.4%) had some underlying disease; nine patients had diabetes, four were parenteral drug abusers, and two had neoplasms . The most common sources of bacteremia were intraabdominal in four episodes (two liver abscesses, one subphrenic abscess and one pancreatic pseudocyst), cutaneous and/or soft tissues in four, surgical wound in two and respiratory in two; no source was identified in five episodes . Four episodes had a polymicrobial origin . In 13 isolates the identification was at species level (Streptococcus anginosus eight, Streptococcus intermedius four and Streptococcus constellatus one) . All strains were susceptible to penicillin . Six patients (33.3%) required surgery . In ten episodes a favorable outcome was recorded, although four patients required surgery . The infection associated mortality rate was 31.2% . The mean age of deceased patients was higher than for cured patients (62.2 +/- 20.2 versus 35.3 +/- 20.3; p < 0.05) . CONCLUSIONS: SMB bacteremia is uncommon . It involved mainly diabetic patients or parenteral drug abusers, commonly with an intraabdominal suppurative source or in skin or soft tissues . The mortality rate was high despite surgery in one third of patients . Patients with advanced age had a poorer prognosis . All isolates investigated were susceptible to penicillin.

Minerva Ginecol, 1997 May, 49(5), 235 - 40
{Streptococcus group B and pregnancy: the therapeutic role of topical intravaginal clindamycin}; Danti L et al.; OBJECTIVE: To evaluate the clinical and therapeutic efficacy of 2% clindamycin vaginal cream in pregnant women heavily colonized with group B streptococci (GBS) . STUDY DESIGN: A prospective, clinical trial in which carriers of group B streptococci were randomized to receive topical intravaginal clindamycin or oral amoxicillin . PATIENTS: We randomized 105 pregnant women: 55 received 2% clindamycin vaginal cream (100 mg/day for 7 days) and 50 oral amoxicillin (2 g/day for 7 days) . INTERVENTIONS: Patients were treated during pregnancy, none of them received intrapartum chemoprophylaxis . On the other hand, all the neonates, within 24 hours from delivery, were studied from the microbiological point of view, carrying out auricolar, nasal, oropharyngeal and umbilical cultures . RELIEFS: The eradication of the microorganism was evaluated by performing a vaginal culture after 6 weeks from the beginning of antibiotic therapy . RESULTS: The eradication rate of the microorganism was significantly higher in women treated with topical clindamycin compared with the group receiving oral amoxicillin (71% versus 36%; p < 0.05) . The neonatal outcome was similar in the two groups in terms of gestational age at delivery and mean birthweight . None of the neonates was admitted to the neonatal intensive care unit and no cases of neonatal sepsis were recorded . CONCLUSIONS: From our experience we can conclude that, during pregnancy, a treatment with topical intravaginal clindamycin may be useful in the eradication of GBS.

Vaccine, 1997 Aug-Sep, 15(12-13), 1330 - 7
Commensal bacteria as vectors for mucosal vaccines against sexually transmitted diseases: vaginal colonization with recombinant streptococci induces local and systemic antibodies in mice; Medaglini D et al.; There is a need to develop vaccines to control the spread of sexually transmitted diseases (STDs) . Novel immunization strategies that elicit a mucosal immune response in the genital tract, may show improved protection by preventing or at least limiting entry of the pathogenic micro-organism . However, it has proven difficult to obtain a local immune response in the vaginal mucosa . Our approach is based on the use of recombinant bacteria capable of colonizing mucosal surfaces as live vaccine vectors . The human commensal Streptococcus gordonii, engineered to express the E7 protein of human papillomavirus type 16, was used for intravaginal immunization of mice . A single inoculum of recombinant bacteria was sufficient to establish colonization of the murine vagina and therefore induce papillomavirus-specific vaginal IgA and serum IgG . Evidence that mucosal colonization with recombinant commensal bacteria can induce a local immune response in the female genital tract represents a significant step toward the development of new vaccines against STDs.

Immunology, 1997 Jul, 91(3), 406 - 13
Superantigenicity of helper T-cell mitogen (SPM-2) isolated from culture supernatants of Streptococcus pyogenes; Rikiishi H et al.; A superantigen (Streptococcus pyogenes mitogen-2; SPM-2) that stimulates human helper T cells bearing unique types of variable domains of T-cell receptor beta-chain (TCR V beta) was isolated from the culture supernatant of S . pyogenes strain T12 . The active molecule isolated by diethylaminoethyl (DEAE)-cellulose chromatography and isoelectric focusing was a protein with a molecular weight (MW) of 29,000 and isoelectric point (pl) of 6.0 . This new superantigen was found to activate preferentially V beta 4+, 7+, and 8+ T cells, whereas recombinant streptococcal pyrogenic exotoxin A and C activated V beta 12+ and V beta 2+ T cells, respectively, as determined by flow cytometry and reverse transcriptase-polymerase chain reaction (RT-PCR) methods . This proliferative response was significantly inhibited by anti-HLA-DR monoclonal antibody, and required paraformaldehyde-fixed antigen-presenting cells (APC), indicating that this action is dependent on major histocompatibility complex (MHC) class II molecules without processing . Analysis of the amino-terminal amino acid sequence of the molecule failed to find any identical or significantly homologous proteins . We have previously reported that cytoplasmic membrane-associated protein (CAP), a streptococcal superantigen isolated from the cell membranes of S . pyogenes T12 strain, stimulated mainly V beta 8+ T cells . Both SPM-2 and CAP preferentially stimulated helper T cells, and rabbit antiserum against SPM-2 completely neutralized the T-cell-stimulating activities of CAP, suggesting that SPM-2 and CAP belong to a family of streptococcal mitogenic proteins . The SPM-2 activity with stimulation of V beta 8+ T cells was detected extensively in the culture fluids of group A streptococci, but not in those of other streptococcal species, including groups B and D streptococci, and most of the activities detected were completely inhibited by anti-SPM-2 serum . These results indicate that SPM-2 may be a newly discovered superantigen molecule, which can be commonly synthesized by group A streptococci.

Acta Odontol Scand, 1997 Aug, 55(4), 212 - 6
Effect of xylitol in an enzyme-containing dentifrice without sodium lauryl sulfate on mutans streptococci in vivo; Jannesson L et al.; The aim of this investigation was to compare the effect of an enzyme-containing dentifrice without sodium lauryl sulfate but with addition of xylitol (Zendium Dentine) on mutans streptococci (MS) in saliva and dental plaque with that of the same dentifrice without xylitol . The subjects were divided into a test group, using a dentifrice with 10% xylitol (part A) or 5% xylitol (part B), and a control group, using a dentifrice without xylitol, for 3 months . In part A the MS counts in saliva and plaque were significantly lower in the xylitol group (n = 50) than in the control group (n = 57) (P < 0.01 and P < 0.001, respectively) . In part B (n = 89 + 91), evaluating MS counts in saliva only, no significant difference was found . Thus, this study demonstrated I) that addition of 10% xylitol to an enzyme-containing dentifrice without sodium lauryl sulfate has an inhibitory effect on MS counts in saliva and dental plaque, and 2) that the inhibitory effect seems to be dose-dependent.

Rev Med Chil, 1996 Aug, 124(8), 999 - 1005
{Necrotizing fasciitis}; Iribarren O; Necrotizing soft tissue infection or necrotizing fasciitis is a rapidly progressive inflammation that leads to necrosis of subcutaneous tissues and fascia with secondary necrosis of skin . It is usually attributed to group AB hemolytic streptococci but may be caused by anaerobic bacteria . It occurs with higher frequency in elders, diabetics, alcoholics and patients with impaired immunity . Report mortality rates range from 14 to 80% . An early and timely surgical debridement with remotion of all necrotic tissue is mandatory . Wounds must be closed with splint skin grafts as soon as the local viability of tissues has been assured and the general conditions of the patients allow the procedure . Antibiotics nutritional and hemodynamic support are also necessary.

Am J Orthod Dentofacial Orthop, 1997 Sep, 112(3), 271 - 4
Mutans streptococci and incipient caries adjacent to glass ionomer cement or resin-based composite in orthodontics; Ortendahl T et al.; Levels of mutans streptococci in plaque adjacent to orthodontic brackets retained with a glass ionomer cement (GIC) (Ketac-Cem) and a resin-based composite (CR) (Concise) were investigated, using the split mouth technique in 11 patients who, before treatment, had more than 10(5) CFU of these microorganisms . After full-term orthodontic treatment (mean 9.5 months), the percentage of mutans streptococci of total CFU count in plaque was lower adjacent to GIC-retained brackets (mean 3.9) than adjacent to CR-retained brackets (6.7), but the difference was not statistically significant . Two subjects harbored S . sobrinus . These subjects were the only ones who developed incipient caries during the orthodontic treatment . Incipient lesion formation occurred only adjacent to CR-retained brackets . This suggests that in patients who have relatively high salivary levels of mutans streptococci before treatment and especially in those who harbor S . sobrinus, the use of GIC for bonding may prevent incipient caries formation during orthodontic treatment.

Australas J Dermatol, 1997 Aug, 38(3), 158 - 60
Toxic streptococcal syndrome; Stanford DG et al.; The reappearance of more virulent strains of exotoxin-producing streptococci over the past decade has led to the re-emergence of invasive Group A streptococcal infections and the recognition of a new syndrome resembling staphylococcal toxic shock syndrome . Toxic streptococcal syndrome is characterized by fever, shock, multiorgan system failure and a desquamating scarlatiniform rash . It usually occurs in otherwise healthy young adults, often in association with a severe soft tissue infection and has a 30% mortality rate . The case of a 37-year-old obese man, who rapidly developed features of this syndrome after an antecedent pharyngitis and cellulitis, is presented . There was serological evidence of a recent Group A streptococcal infection . Intensive organ supportive measures and intravenous antibiotic therapy led to his gradual recovery.

Appl Environ Microbiol, 1997 Sep, 63(9), 3539 - 47
New genetic techniques for group B streptococci: high-efficiency transformation, maintenance of temperature-sensitive pWV01 plasmids, and mutagenesis with Tn917; Framson PE et al.; Three techniques were developed to improve the genetic manipulation of group B streptococci (GBS) . We first optimized a protocol for transformation of GBS by electroporation, which provided transformation efficiencies of 10(5) CFU/microgram . Variables that influenced the transformation efficiency were the glycine content of the competent cell growth media, the electric field strength during electroporation, the electroporation buffer composition, the host origin of the transforming plasmid, and the concentration of selective antibiotic at the final plating . Our transformation protocol provides an efficiency sufficient for cloning from ligation reactions directly into GBS, obviating an intermediate host such as Escherichia coli . Second, temperature-sensitive plasmids of the pWV01 lineage were shown to transform GBS, and their temperature-sensitive replication was confirmed . Lastly, the temperature-sensitive pWV01 plasmid pTV1OK, which contains Tn917, was used as a transposon delivery vector for the construction of genomic Tn917 mutant libraries . We have shown, for the first time, that Tn917 transposes to the GBS chromosome and at a frequency of 10(-3)/CFU . Furthermore, representative clones from a Tn917 library contained single transposon insertions that were randomly located throughout the chromosome . These techniques should provide useful methods for cloning, mutagenesis, and characterization of genes from GBS.

Scand Cardiovasc J, 1997, 31(4), 233 - 5
Descending necrotizing mediastinitis secondary to pharyngitis . A case report; Nomori H et al.; The patient was a 38-year-old female with descending necrotizing mediastinitis (DNM) originating from pharyngitis . The pus from infection by Bacteroides and aerobic streptococci had collected in the anterior and posterior mediastinum and bilateral thoracic cavity . Systemic antibiotic treatment with clindamycin and gentamycin was administered promptly after admission under a diagnosis of DNM, without waiting for results of culture and sensitivity studies . Four puncture drainages were performed by echoguide to treat bilateral empyema and left upper mediastinal pus collections . Additional surgical drainage via the transcervical approach was performed to drain right upper mediastinal pus . the patient was discharged on hospital day 50, and has since been in good health . Proper drainage at all pus collection sites by echo at both aerobic and anaerobic organisms are essential in the treatment of DNM.

Lasers Surg Med, 1997, 21(3), 221 - 6
Irradiation of infected root canals with a diode laser in vivo: results of microbiological examinations; Moritz A et al.; BACKGROUND AND OBJECTIVE: It was shown in previous studies {1} that the Nd:YAG laser can be used as an excellent tool for killing bacteria in root canals . The present examinations were carried out with a high power diode laser in comparison with a conventionally treated control group . STUDY DESIGN/MATERIALS AND METHODS: In this in vivo study, 40 patients with infected root canals underwent diode laser treatment . To verify the findings, microbiological tests were performed and the results compared to those obtained with conventional antibacterial treatment . RESULTS: The microbiological examination revealed streptococci at relevant concentrations in 20 cases and staphylococci in 5 cases . Extensive bacterial reduction was achieved in all cases by repeating laser treatment only once . Following the first irradiation, minimal streptococcal growth was observed in 7 root canals and minimal staphylococcal growth in 2 root canals . The maximum log kill was 4.22 for streptococci and 3.33 for staphylococci . In the control group, a maximum reduction by only one log step could be achieved in 6 of 10 patients . CONCLUSIONS: Compared with the results achieved with the conventional bactericidal technique in the control group, the high power diode laser seems to be highly suitable for killing bacteria in infected root canals.

Surg Neurol, 1997 Sep, 48(3), 278 - 82; discussion 282-3
Diagnostic and staged stereotactic aspiration of multiple bihemispheric pyogenic brain abscesses; Chacko AG et al.; BACKGROUND: Empiric antibiotic therapy for multiple brain abscesses is not advised, as biopsy to rule out other causes and material for cultures can be obtained with minimal morbidity using computed tomography (CT)-guided stereotaxy . METHODS: We report a good outcome following treatment of this 60-year-old nonimmunocompromised patient with six pyogenic cerebral abscesses . CT-guided stereotactic aspiration of two abscesses were done on the first occasion and appropriate antibiotics were administered . Serial CT scans were done and the abscesses that recollected or enlarged were again aspirated . RESULTS: Group A beta hemolytic streptococci were grown from the pus . Two abscesses recollected and one enlarged during antibiotic therapy . These were aspirated on the second and third occasions, 1 week and 2 weeks after the first procedure . The abscess less than 3 cm resolved with antibiotics alone . Intravenous crystalline penicillin, chloroamphenicol, and metronidazole were given for 2 weeks followed by oral ampicillin and cotrimoxazole for 10 weeks . There was no morbidity related to the multiple procedures and the patient had a good outcome at the end of 16 weeks . CONCLUSIONS: CT-guided stereotactic aspiration of multiple brain abscesses is known to have a low morbidity and mortality . We highlight the additional option of multiple, staged aspirations for those abscesses not readily responding to antibiotic therapy.

Arch Intern Med, 1997 Sep 8, 157(16), 1891 - 4
Toxic shock-like syndrome caused by non-group A beta-hemolytic streptococci; Hirose Y et al.; Two patients with rapidly developing shock, multisystem organ failure, and destructive soft-tissue infection caused by groups G and C streptococci are described . Both patients died rapidly despite aggressive treatment . The clinical characteristics cannot be distinguished from those of toxic shock-like syndrome, but Streptococcus pyogenes was not recovered . These strains did not produce any previously identified type of streptococcal pyrogenic exotoxins . These findings suggest that toxic shock-like syndrome can be caused not only by group A but also groups G and C streptococci . The causative strains of toxic shock-like syndrome may have something in common with unknown virulent factors for this syndrome.

Infect Immun, 1997 Sep, 65(9), 3753 - 8
Identification of a Streptococcus gordonii SspB domain that mediates adhesion to Porphyromonas gingivalis; Brooks W et al.; Porphyromonas gingivalis, a primary pathogen in adult periodontitis, may establish itself in the oral cavity by adhering to early plaque bacteria such as Streptococcus gordonii . Our previous studies (R . J . Lamont et al., Microbiology 140:867-872, 1994) suggested that this interaction is mediated by the SspB polypeptide, a member of the antigen I/II family of streptococcal surface proteins . S . gordonii was recently shown to express a second Ssp polypeptide (SspA) that resembles SspB and the structurally homologous antigen I/II polypeptide (Pac) of Streptococcus mutans . To determine if all of these related antigen I/II proteins interacted with P . gingivalis, SspA, SspB, and Pac were tested for adhesion to P . gingivalis cells . Both of the S . gordonii Ssp proteins bound labeled target cells, whereas the S . mutans Pac polypeptide did not, suggesting that antigen I/II-mediated binding of P . gingivalis by streptococci may be species specific . To investigate the molecular basis for this functional difference, the P . gingivalis binding domain of SspB was mapped . The binding properties of a family of truncated SspB polypeptides lacking C-terminal sequences were determined . In addition, the lack of binding activity exhibited by the Pac protein was exploited to construct and analyze chimeric SspB-Pac polypeptides . Both approaches revealed that the region defined by residues 1167 to 1250 of SspB was essential for P . gingivalis binding . This region of SspA and SspB is entirely conserved, consistent with the binding properties determined for these proteins . However, the corresponding region of Pac differs in both the primary sequence and predicted secondary structure, suggesting that the overall structure of this domain may define its functional activity.

Infect Immun, 1997 Sep, 65(9), 3731 - 5
Role of interleukin 12 in experimental neonatal sepsis caused by group B streptococci; Mancuso G et al.; Cytokines are suspected to play an important role in systemic infections by group B streptococci (GBS), an important cause of neonatal sepsis . This work was undertaken to determine if interleukin 12 (IL-12) is produced in mouse pups infected with GBS and has a role in this sepsis model . IL-12 elevations were measured by both an enzyme-linked immunosorbent assay and a bioassay in plasma samples obtained from 12 to 72 h after GBS challenge . Pretreatment with neutralizing anti-IL-12 antibodies significantly increased lethality and blood CFU (P < 0.05) . Conversely, either prophylactically or therapeutically administered recombinant IL-12 (rIL-12) significantly improved survival time and decreased blood CFU . Since these beneficial effects were associated with increased spleen gamma interferon (IFN-gamma) production, we examined whether the latter cytokine mediated the observed rIL-12 effects . Pretreatment with neutralizing anti-IFN-gamma monoclonal antibodies significantly counteracted the beneficial effects of rIL-12 on lethality . Our data indicate that rIL-12 is a possible candidate for treatment of GBS sepsis and that its activities in this model are at least partially mediated by IFN-gamma.

J Clin Microbiol, 1997 Sep, 35(9), 2337 - 41
Identification of clinically relevant viridans group streptococci to the species level by PCR; Garnier F et al.; A PCR assay that allows identification of clinically relevant viridans group streptococci (Streptococcus gordonii, S . mitis, S . mutans, S . oralis, S . salivarius, and S . sanguis) to the species level and identification of milleri group streptococci (S . anginosus, S . constellatus, and S . intermedius) to the group level was developed . This assay was based on specific amplification of internal fragments of genes encoding D-alanine:D-alanine ligases which are species specific and ubiquitous in prokaryotes possessing peptidoglycan . The specificity of this assay was tested on 9 reference strains and 91 characterized clinical isolates . This assay offers a specific and rapid alternative to phenotypic or DNA-DNA hybridization methods for identification of clinically relevant viridans group streptococci.

J Am Vet Med Assoc, 1997 Aug 15, 211(4), 470 - 5
Use of physiologic variables to predict milk yield after clinical mastitis in dairy cattle; Sischo WM et al.; OBJECTIVE: To determine the association between intramammary infections caused by various bacteria and hepatic damage, as measured by serum sorbitol dehydrogenase (SDH) activity, WBC counts, and PCV and the association of clinical variables with milk production after a case of clinical mastitis . DESIGN: Prospective, cohort study . ANIMALS: 82 cows with clinical mastitis . PROCEDURE: Information on milk production, mastitis status, and selected physiologic variables was collected during a 1-year period . Milk samples for bacteriologic evaluation were collected on day 1 of an episode of clinical mastitis . Physical examination was performed and blood samples for laboratory evaluation were collected on days 1, 5, and 9 . Primary outcome was mature equivalent 305-day (ME305) milk production . Correlations were assessed using a multiple regression model . RESULTS: Higher WBC counts were associated with higher ME305 values . For cows with coliform mastitis, increases in SDH values were associated with higher ME305 values . For cows with coliform and streptococci/staphylococci mastitis, PCV was associated with ME305 values . Higher PCV values were associated with lower ME305 values for streptococci/ staphylococci and coliform infections . CLINICAL IMPLICATIONS: The association between milk production and WBC count indicated that cows mobilizing WBC were better able to neutralize mammary gland infections, which may result in better milk production . The association between milk production and PCV suggested that maintaining hydration in cows with clinical mastitis may be a critical aspect of treating all cows with mastitis.

J Biol Chem, 1997 Aug 15, 272(33), 20774 - 81
Streptococcal protein H forms soluble complement-activating complexes with IgG, but inhibits complement activation by IgG-coated targets; Berge A et al.; Protein H, a surface protein of Streptococcus pyogenes interacting with the constant Fc region of IgG, is known to be released from the streptococcal surface by a cysteine proteinase produced by the bacteria . Poststreptococcal glomerulonephritis and rheumatic fever are conditions in which immune complexes and autoimmune mechanisms have been suggested to play pathogenetic roles . The present study demonstrates that addition of protein H to human serum produces complement activation with dose-dependent cleavage of C3 . The activation was IgG-dependent and the result of complexes formed between IgG and protein H . These complexes were size heterogeneous with molecular masses of 400 kDa to 1.4 MDa . Using complement-depleted serum reconstituted with complement proteins, the activation by protein H was found to be dependent of the classical, but independent of the alternative pathway of complement . In contrast to results of experiments based on soluble protein H.IgG complexes, complement activation was inhibited by protein H when IgG was immobilized on a surface . The interaction between C1q and immunoglobulins represents the first step in the activation of the classical pathway, and protein H efficiently inhibited the binding of C1q to IgG immobilized on polyacrylamide beads . Protein H reduced C3 deposition on the IgG-coated beads and inhibited immune hemolysis of IgG-sensitized erythrocytes . Finally, significantly less C3 was deposited on the surface of protein H-expressing wild-type streptococci than on the surface of isogenic mutant bacteria devoid of protein H . The results demonstrate that protein H.IgG complexes released from the streptococcal surface can produce complement breakdown at the sites of infection, whereas complement activation on bacterial surfaces is inhibited . This should have important implications for host-parasite relationships . In addition, soluble protein H.IgG complexes might contribute to immunological complications of streptococcal infections.

N Engl J Med, 1997 Aug 14, 337(7), 441 - 6
The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland . Finnish Study Group for Antimicrobial Resistance; Seppala H et al.; BACKGROUND: In the early 1990s there was an increase in erythromycin resistance among group A streptococci in Finland . In response, policies regarding outpatient antibiotic therapy were changed, and nationwide recommendations were issued that called for reductions in the use of macrolide antibiotics for respiratory and skin infections in outpatients . We studied the effect of this policy on the pattern of erythromycin resistance throughout Finland . METHODS: From 1991 through 1996, a total of 39,247 group A streptococcal isolates from throat swabs (82 percent of the isolates) and pus samples (18 percent) and 290 isolates from blood cultures were studied in regional microbiology laboratories . The susceptibility of the isolates to erythromycin was tested by the disk-diffusion or the screening-plate method . RESULTS: Consumption of macrolide antibiotics decreased from 2.40 defined daily doses per 1000 inhabitants per day in 1991 to 1.38 in 1992 (P=0.007) and remained near the lower level during the study period . The change in consumption was followed by a steady decrease in the frequency of erythromycin resistance among group A streptococcal isolates from throat swabs and pus samples, from 16.5 percent in 1992 to 8.6 percent in 1996 (odds ratio for 1996 as compared with 1992, 0.5; 95 percent confidence interval, 0.4 to 0.5) . CONCLUSIONS: In Finland, after nationwide reductions in the use of macrolide antibiotics for outpatient therapy, there was a significant decline in the frequency of erythromycin resistance among group A streptococci isolated from throat swabs and pus samples.

Epidemiol Infect, 1997 Aug, 119(1), 41 - 8
Serotyping of Streptococcus pyogenes isolated from common and severe invasive infections in Japan, 1990-5: implication of the T3 serotype strain-expansion in TSLS . The Working Group for Group A Streptococci in Japan; Inagaki Y et al.; To clarify the relationship between the epidemics of severe invasive group A streptococcal infections (streptococcal Toxic Shock-Like Syndrome: TSLS) and common group A streptococcal infections in Japan, we examined the T serotypes of S . pyogenes strains (group A streptococci) isolated from clinical specimens of the streptococcal infections (17999 cases) in the period 1990-5, including the severe infections (TSLS) (29 cases) in the period 1992-5 . Characteristic points of the analyses were: (1) dominant serotypes of the infections in these periods were T12, T4, T1, T28 and TB3264, which were consistently isolated; (2) isolates of T3 rapidly increased through 1990 to 1994 while T6 decreased in the period 1990-3; (3) when Japanese area was divided into three parts, T3 serotype tended to spread out from the north-eastern to the south-western area; (4) strains of T3 and T1 serotypes were dominant in the TSLS . Dominant-serotype strains of streptococcal infections did not always induce severe infections and dominance of T3 serotype in the TSLS seemed to be correlated with the increase of T3 in streptococcal infections . These results may indicate that certain clones of S . pyogenes are involved in the pathogenesis of the TSLS.

Vaccine, 1997 Aug, 15(11), 1261 - 8
Generation of bovine immune colostrum against Streptococcus mutans and Streptococcus sobrinus and its effect on glucose uptake and extracellular polysaccharide formation by mutans streptococci; Loimaranta V et al.; Due to potential side-effects of active immunization by cariogenic mutans streptococci, oral administration of passively-derived antibodies could be a more acceptable way to reduce colonization and virulence of these microorganisms in human dentition . The aim of this study was to produce antistreptococcal immunoglobulins into bovine colostrum and explore the possible antibacterial mechanisms of these immunoglobulins against mutans streptococci . Specific serum IgG antibodies to whole cell antigens of both Streptococcus mutans and Streptococcus sobrinus increased rapidly in cows during immunization and were high also in the final whey-product . Low concentration (0.5% w/v) of bovine immune preparation inhibited significantly the incorporation of {14C}glucose by both S . mutans and S . sobrinus . Higher concentration (> 1%) was needed to inhibit the glucosyltransferase or fructosyltransferase activities of these bacteria . No such inhibitory effects were observed with the control preparation from the non-immunized cows . Our results indicate that bovine immune colostrum has a significant inhibitory potential against mutans streptococci, apparently dependent on the presence of specific IgG antibodies against S . mutans and S . sobrinus.

What Is Water Purification?, What Is Activated Sludge?, What Is Rhizobia?, What Is Protein?, What Is Antibiotic?, a, Microbiology, o, Bacteriology, e, Microorganism, c, Bacteria, n, Bacterium, r, Rhizobacterium, a, Escherichia coli, c, Escherichia coli, o, Escherichia coli, o, Enterococci, e, Botulism, i, Serratia, c, Thermophiles, s, Bacteriological, e, Leuconostoc, c, S. cerevisiae, c, Bactericidal, n, Escherichia coli, o, Escherichia coli, n, Cholera, e, Bacteria, c, Leuconostoc, i, Rhodococci, c, Cell cultures, i, Rhizobacter, r, Clostridia

Scientific Publications - Work Done by Microbiology Reader Bioscreen C
Agricultural Microbiology Anaerobic Microbiology Antimicrobial Susceptibility Artificial Atmosphere Bioassay of Antibiotics Biofilm Microbiology Bioreactor Technology Biotechnology Cell Biology Clinical Microbiology Environmental Microbiology Experiments with Yeast	Fermentation Food Microbiology Functional Genomics Gene Technology Growth Media Development Growth Rate and Lag Time Industrial Microbiology Medical/Pharmaceutical Field Microbiological Assay Microbiological Research Microbiology of Cosmetics go to a specific theme...	Military Microbiology Molecular Microbiology Mutagenicity and Genotoxicity Oral Microbiology Patents Postantibiotic Studies Soil Microbiology Spore Microbiology Veterinary Microbiology Waste/Wastewater Treatment Water Microbiology Wine Microbiology

� 2005 Transgalactic Ltd (manufacturer of Bioscreen C software) | Privacy Statement | P.O. Box 1393, 00101 Helsinki, Finland, phone: +358 9 85172920, fax: +358 9 8749481, e-mail: microbiology@bionewsonline.com

Last modified: May 25, 2005