Vaccine, 1997 Aug, 15(11), 1244 - 51 Nasal immunization with group B streptococci can induce high levels of specific IgA antibodies in cervicovaginal secretions of mice; Hordnes K et al.; We have studied the cervicovaginal antibody responses in mice, by ELISA, following mucosal immunizations with group B streptococci (GBS) serotype III/R4 . Immunizations were carried out either: (1) rectally with GBS alone; (2) rectally with GBS plus cholera toxin (CT); (3) nasally with GBS alone; (4) nasally with GBS+CT; or (5) nasally under general anesthesia with GBS+CT . Nasal immunizations with GBS alone led to at least tenfold higher levels of specific IgA-antibodies to GBS in cervicovaginal secretions than with any other immunization . These mucosal antibody levels were higher than after rectal immunizations, and 2-17 times higher than the corresponding IgA antibody levels in sera . Markedly lower cervicovaginal antibody levels were found in mice which had received GBS together with CT as a mucosal adjuvant than in mice immunized by the same routes with GBS alone . Our observations indicate that a nasal vaccine consisting of GBS might induce sufficient antibody levels to protect against genital colonization of these bacteria. Zentralbl Veterinarmed B, 1997 Aug, 44(6), 365 - 70 Treatment of bovine mastitis with houttuynin sodium bisulphate; Hu SH et al.; Houttuynin sodium bisulphate (HSB), alpha hydroxyl-capryl-ethyl-sodium-sulphonate, is a product formed by reacting sodium bisulphate with houttuynin, which is obtained from a medicinal herb Houttuynia cordata Thunb . From HBS an aqueous intramammary solution was made for the treatment of bovine clinical mastitis . A total of 104 acute and subacute mastitis cases were randomly assigned into two groups with 52 cases in each group: 1 . an HSB group in which 80 mg HSB was infused into an affected gland; and 2 . a PS group in which intramammary administration of 800,000 i.u . penicillin G in combination with 1 g of streptomycin (PS) was conducted . The treatments were administered twice daily until the inflammatory signs were eliminated and mammary secretion became normal . In acute mastitis, 88.2% (15 of 17) were clinically cured and 52.9% (nine of 17) microbiologically cured by HSB; in the PS group, 90.0% (18 of 20) were clinically cured and 55.0% (11 of 20) microbiologically cured . In subacute cases, the clinical and microbiological cure rates were 94.3% (33 of 35) and 45.7% (16 of 35) respectively, in the HSB group; and in the PS group the clinical and microbiological cure rates were 93.7% (30 of 32) and 43.8% (14 of 32), respectively . No statistically significant difference was found between HSB and PS groups in the treatment of acute as well as subacute mastitis . In addition, an inhibitory effect was found on the growth of lactic streptococcus in the milk collected within 48 h of intramammary treatment with penicillin G in combination with streptomycin . However, for HSB, a mild inhibitory effect on lactic streptococci was detected in the milk within 12 h of treatment. J Dairy Sci, 1997 Aug, 80(8), 1600 - 5 Bacteria counts in sawdust bedding; Hogan JS et al.; Bacteria counts in untreated sawdust bedding were compared with those in sawdust bedding after the addition of lime and after daily replacement of bedding in the back one-third of the stalls . Addition of 1 kg of lime to 10 kg of sawdust reduced Gram-negative bacteria, coliforms, Klebsiella spp., and streptococci prior to use as bedding . Sawdust treated with lime also showed decreased bacteria counts compared with bacteria counts for sawdust that was replaced daily and compared with bacteria counts for control bedding after 1 d in the stall . The decrease in bacterial populations was related to an increase in bedding pH . Mean pH in the sawdust treated with lime was greater prior to use and after 1 d in the stall than the pH of other treatments . After 2 and 6 d in stalls, however, bacteria counts and pH were similar among treatments . Dry matter content of bedding did not differ among bedding treatments . Bacteria counts in bedding were positively correlated with teat skin swabs . Gram-negative bacteria and Klebsiella spp . counts on teat swabs were lower for cows housed on bedding treated with lime on d 2 compared with those for cows housed on control bedding and bedding that was replaced daily . Addition of lime to sawdust in the back one-third of tie stalls caused a decrease in exposure of teats to environmental mastitis pathogens in bedding for 1 d . Daily replacement of bedding had a minimal effect on bacteria counts in bedding and on teat skin. Pediatr Infect Dis J, 1997 Aug, 16(8), 748 - 53 Polymerase chain reaction for Streptococcus pyogenes used to evaluate an optical immunoassay for the detection of group A streptococci in children with pharyngitis; Kaltwasser G et al.; BACKGROUND: In evaluations of sensitive rapid tests for group A streptococci such as the optical immunoassay (OIA), some samples are positive by the antigen test but negative by culture . A method is needed for resolving these discrepant results . OBJECTIVE: To develop a PCR-based assay to detect group A streptococci and to use it to establish a reference standard for evaluating an OIA for group A streptococcal antigen . METHODS: A PCR assay that detects a segment of the MF gene of Streptococcus pyogenes was developed for the detection of group A streptococci in throat swabs . Paired swabs were obtained from 200 children with symptomatic pharyngitis and used to perform OIA, agar culture, broth-enhanced culture and PCR . As a reference standard any patient with group A streptococci detected by either culture or PCR was considered to be truly positive . RESULTS: In comparison to agar and broth-enhanced culture procedures, OIA had sensitivities of 82 and 80% and specificities of 87 and 89%, respectively . Eight (44%) of 18 samples that were positive by OIA but negative by culture were positive for group A streptococci by PCR . Compared with the reference standard, sensitivities were OIA 76%, agar culture 79%, broth-enhanced culture 86% and PCR 96% . The specificity of OIA was 92% . CONCLUSIONS: PCR can be used to establish a reference standard for evaluating rapid tests for group A streptococci . With this reference standard OIA was nearly as sensitive as but less specific than agar culture for detection of group A streptococci . Maximum detection requires use of both tests. Acta Anaesthesiol Scand, 1997 Aug, 41(7), 837 - 42 Effects of open heart surgery on oral mucous host defence systems; Lahteenmaki M et al.; BACKGROUND: The immune response is affected by anaesthesia and surgery . This study was carried out on the effects of open heart surgery on the oral mucous host defence system, which is part of the common mucosal immune system . METHODS: Amylase, nonimmunological (lysozyme, myeloperoxidase, hypothiocyanite and thiocyanate) and immunological (IgA, IgG, and IgM) mucous host defence factors as well as oral bacterial flora were determined in the saliva of 18 patients undergoing open heart surgery preoperatively and on the 2nd, 3rd, and 7th postoperative days . To assess the specificity of the changes, the salivary flow rate and total protein content were also determined . RESULTS: Stimulated salivary flow decreased from 1.8 (1.3-2.2) ml/min (median; 25th and 75th quartiles) to 0.4 (0.3-0.5) ml/min by the 2nd postoperative day and to 0.4 (0.2-1.0) ml/min by the 3rd postoperative day (P < 0.001) . Amylase, lysozyme, myeloperoxidase, total salivary peroxidase and thiocyanate levels increased, whereas hypothiocyanite levels decreased postoperatively (p < 0.01-0.001) . Their total secretion rate, however, was reduced (P < 0.05-0.001) owing to the lowered salivary flow rate . IgG and IgM concentrations were raised on the 2nd, 3rd and 7th postoperative days (P < 0.05-0.001), and IgA concentrations on the 2nd postoperative day (P < 0.05) . The total secretion of IgG and IgM as well as their salivary concentrations in relation to total protein concentrations also increased . The number of salivary anaerobically growing bacteria decreased postoperatively (P < 0.01), but the number of salivary streptococci remained unaffected . CONCLUSIONS: Open heart surgery decreases the salivary secretion of nonimmunological host defence factors and increases the salivary secretion of IgA, IgG and IgM. Arch Pediatr Adolesc Med, 1997 Aug, 151(8), 824 - 9 Strategies for managing group A streptococcal pharyngitis . A survey of board-certified pediatricians; Hofer C et al.; OBJECTIVE: To assess the management strategies and knowledge of board-certified pediatricians regarding group A beta-hemolytic streptococcal (GABHS) pharyngitis . DESIGN: Survey of 1000 US pediatricians in 1991, chosen randomly from the membership of the American Academy of Pediatrics . The survey included questions related to 2 clinical scenarios, respondent demographics, and knowledge of streptococcal pharyngitis . SUBJECTS: Pediatricians who treated patients with pharyngitis . Of the 690 surveys that were returned, 510 pediatricians treated patients with pharyngitis and were included in the data analysis . DATA ANALYSIS: Data were analyzed using Chi 2 statistics for categorical data and the Student t test for continuous variables . RESULTS: Antigen detection tests (ADTs) were used by 64% of the pediatricians; 85% used throat cultures . Strategies for diagnosing streptococcal pharyngitis were throat culture alone (38%), consider positive ADTs definitive and use throat culture when ADTs are negative (42%), ADT alone (13%), ADT and throat culture for all patients with pharyngitis (5%), and no tests for GABHS performed (2%) . Thirty-one percent usually or always treated with antibiotics before test results were available . Only 29% of these "early treaters" always discontinued antibiotics when tests did not confirm the presence of group A streptococci . The drug of choice for treatment was penicillin (73%); another 26% preferred a derivative of penicillin, particularly amoxicillin . Many pediatricians altered their management when a patient had recurrent streptococcal pharyngitis . Nearly half of the respondents would use a different antibiotic than they used for routine acute streptococcal pharyngitis . They most often changed to erythromycin (25%), cefadroxil (23%), or amoxicillin-clavulanate (20%) . Follow-up throat culture was obtained by 51% of pediatricians after treatment of recurrent streptococcal pharyngitis . A patient with chronic carriage of GABHS and symptoms of pharyngitis would be treated with an antibiotic by 84%; most (62%) would use a penicillin . Other choices were cephalosporins (19%), erythromycin (12%), clindamycin (3%), or rifampin plus penicillin (3%) . Tonsillectomy was recommended for symptomatic carriers by 31% of respondents . Carriers without symptoms were less likely to be treated with antibiotics (23%) or referred for tonsillectomy (21%) . CONCLUSIONS: Most surveyed board-certified pediatricians managed acute GABHS pharyngitis appropriately, but 15% to 20% used diagnostic or treatment strategies that are not recommended . There was lack of a consensus about the management of recurrent GABHS pharyngitis and chronic carriage of GABHS. Antimicrob Agents Chemother, 1997 Aug, 41(8), 1682 - 5 Combination of flucloxacillin and gentamicin inhibits toxic shock syndrome toxin 1 production by Staphylococcus aureus in both logarithmic and stationary phases of growth; van Langevelde P et al.; Production of exotoxins by staphylococci and streptococci may lead to the development of toxic shock syndrome (TSS) . Because clindamycin inhibits exotoxin production, its use has been advocated for the treatment of TSS . However, the bacteriostatic action of clindamycin might be a disadvantage for the treatment of overwhelming infections . We investigated the effects of flucloxacillin and gentamicin on exotoxin production, because incubation with these antibiotics combines bactericidal action with protein synthesis inhibition . Staphylococcus aureus during the logarithmic and stationary phases of growth was incubated with either clindamycin, flucloxacillin, or a combination of flucloxacillin and gentamicin at concentrations of 2 or 10 times the MIC . In logarithmic-phase cultures clindamycin had a static effect on bacterial growth . After incubation with flucloxacillin, either alone or in combination with gentamicin, a rapid and large reduction in the number of viable bacteria was demonstrated . In stationary-phase cultures none of the antibiotics significantly changed the number of viable bacteria . TSS toxin 1 (TSST-1) production during logarithmic-phase growth was inhibited by > or =95% by all antibiotics . In stationary-phase cultures, clindamycin, flucloxacillin, and the combination of flucloxacillin and gentamicin inhibited TSST-1 production by 95, 30, and 75%, respectively, compared with the level of exotoxin production in the controls . The present results indicate that clindamycin inhibits TSST-1 production and exerts bacteriostatic activity in both bacterial growth phases . Because the combination of flucloxacillin and gentamicin combines the inhibition of exotoxin production with high bactericidal activity at least in logarithmic-phase cultures, it should be considered an alternative to clindamycin for the treatment of exotoxin-mediated diseases, especially in patients with overwhelming infections. J Dent Res, 1997 Aug, 76(8), 1477 - 84 Pathway for uptake and degradation of X-prolyl tripeptides in Streptococcus mutans VA-29R and Streptococcus sanguis ATCC 10556; Cowman RA et al.; The growth of Streptococcus mutans and Streptococcus sanguis in the oral environment requires that these micro-organisms be able to degrade salivary proteins and to assimilate the resulting peptides as an amino nitrogen source . Our research is aimed at the definition of the proteolytic enzyme systems in these oral streptococci which allow them to utilize such substrates . In the present work, the nature of the hydrolytic activity expressed by S . mutans VA-29R and S . sanguis ATCC 10556 against X-Pro4-nitroanilide and X-Pro-Y tripeptide substrates was investigated . This activity was predominantly associated with a cytoplasmic dipeptidyl peptidase which preferentially catalyzes the release of an N-terminal dipeptide from substrates in which proline is the penultimate residue . These streptococci also possess a second cytoplasmic peptidase, pepD, which catalyzes the hydrolysis of X-Pro dipeptides . We found that Gly-Pro-Ala or Ala-Pro-Gly were transported into the bacterial cells only when an energy source such as glucose was present . Peptide uptake was time-dependent, and selective exodus of peptide-derived amino acids from the bacterial cells occurred during peptide uptake . Results from these studies provide evidence that S . mutans VA-29R and S . sanguis ATCC 10556 possess a pathway for the complete degradation of X-Pro tripeptides . Transport of the peptides into cells prior to hydrolysis provides an efficient way by which all amino acids of a peptide may be obtained at an energy expense equivalent to that associated with the transport of just one amino acid . In light of the abundance of proline in salivary polypeptides, this degradative pathway could be an important component in the proteolytic pathway for salivary polypeptide utilization in these oral streptococci. Kansenshogaku Zasshi, 1997 Jul, 71(7), 659 - 63 {Effects of globulin preparations on phagocytic killing of oral streptococci}; Kaneko A et al.; The phagocytic bacterial activity on Streptococcus intermedius and Streptococcus oralis, clinical isolates from patients suffering from severe oral surgical infections, was evaluated by using sera and neutrophils of patients who had been treated with polyethylene glycal treated human normal immunoglobulin (Venoglobulin-IH) . The phagocytic function of the neutrophils against the two strains, approximately 10 cells/neutrophil, was unrelated to the administration of Venoglobulin-IH . The bactericidal function of the serum and neutrophils on the third day following Venoglobulin-IH administration, on the other hand, rose to 10 times that of the sera and neutrophils of patients with mild infections . The agglutinin titer of Venoglobulin-IH against S . intermedius and S . oralis were 32 and 16 times, respectively, indicating an evident rise in these titers against the clinical isolates in comparison with the reference strains of the same organisms . These findings indicated that the oral streptococci that are isolated from patients with grave infections are associated with an antigenicity that is different from the normal bacterial flora; and these organisms are more labile to phagocytosis by neutrophils that were obtained from patients who have been treated with Venoglobulin-IH. J Neurol, 1997 Jul, 244(7), 435 - 8 Meningitis due to viridans streptococci in adults; Enting RH et al.; Seven patients are reported with meningitis due to viridans streptococci . These patients represented 5% of culture-proven cases of bacterial meningitis in adults participating in a prospective multicentre clinical trial evaluating the use of dexamethasone . Meningitis was iatrogenic in three patients: one patient had been treated with endoscopic sclerotherapy for oesophageal varices, and two patients had undergone thermocoagulation of the gasserian ganglion for trigeminal neuralgia in the previous days. Microbiol Res, 1997 Jul, 152(2), 121 - 8 Shot-gun phage display mapping of two streptococcal cell-surface proteins; Jacobsson K et al.; We have used a phage display shot-gun cloning technique to map the binding domains in two cell surface proteins from animal group C streptococci . The proteins, MAG and ZAG, have affinity for alpha (2)-macroglobulin (alpha (2)M), serum albumin and IgG . In this work, parts of cloned i mag and zag genes were randomly cloned into a phagemid vector, and recombinant phages expressing alpha (2)-M- or albumin-binding activity were isolated through panning against immobilized alpha (2)M or albumin . Analysis of the clones revealed two distinct alpha (2)M-binding sites in protein MAG and two slightly overlapping binding sites in protein ZAG . The minimal albumin-binding domain in protein ZAG, as deduced from the affinity selected clones, consisted of 42 amino acids . These results show that the phage display shot-gun cloning is a rapid and convenient way to characterize the binding site(s) in receptor proteins without any prior knowledge of their number, size, and localization. Microbiol Res, 1997 Jul, 152(2), 113 - 9 Characterization of serotype II polysaccharide antigen of group E streptococci using a monoclonal antibody; Tomotake H et al.; A Monoclonal antibody (MAb II-T) specific for serotypes II and V Group E streptococci (GES) was prepared by fusing myeloma cells with spleen cells of mice immunized with whole cells of a serotype II strain . MAb II-T reacted in an enzyme immunoassay (EIA) with whole cells of both serotypes and reacted in gel diffusion test with autoclaved-saline extraction of serotypes II and V . The extract was purified by DEAE-Sephadex A-25, followed by treatment with proteinase K, and further by chromatography with a Sephadex G-200 column . The purified polysaccharide (PS) antigen contained 98.6% carbohydrate and 1.4% protein, but no detectable phosphorus . In hapten inhibition tests using various sugars, D-mannosamine markedly inhibited the precipitin reaction . These results indicated that the antigenic determinant might have a structure similar to D-mannosamine. Eur J Cardiothorac Surg, 1997 Jul, 12(1), 47 - 55 Aortic root replacement with human tissue valves in aortic valve endocarditis; Dossche K et al.; OBJECTIVE: Aortic allograft and pulmonary autograft aortic root replacement in native and prosthetic aortic valve endocarditis are evaluated and risk factors for hospital death are assessed by univariate risk factor analysis . METHODS: From April 1989 to May 1996, 59 patients with aortic valve endocarditis (27 native; 32 prosthetic) underwent aortic root replacement with a human tissue valve . Mean age was 53.4 +/- 12.3 years; 46 patients (78%) were male . The mean preoperative NYHA functional class was 3.4 . The predominant infective organisms were streptococci (30%) in the native valve group and staphylococci (30%) in the prosthetic valve group . In native valve endocarditis, valve destruction (32%) was the predominant finding . Abscesses, either annular (29%) or subannular (36%) and valve dehiscence (36%) were the most common findings in patients with prosthetic valve endocarditis . Partial or total ventriculo-aortic discontinuity (20%) and aortico-mitral discontinuity (27%) were other important operative observations . A cryopreserved allograft was used in 53 patients (89.5%), the pulmonary autograft (Ross procedure) in 5 patients (8.5%), and a fresh antibiotic sterilized allograft root in one patient (2%) . Mean aortic cross-clamp time was 131 +/- 32 min . In active native and prosthetic valve endocarditis, intravenous antibiotics were continued for at least 6 weeks, monitored by serial CRP measurements . RESULTS: Hospital mortality was 8.5% (n = 5; 70% CL: 4.9-12.1%) . Univariate risk factors for hospital mortality were age (P = 0.001), preoperative New York Heart Association functional class (P = 0.001), pre- (P = 0.001) and postoperative (P = 0.001) renal insufficiency . Major complications were allograft failure (n = 1; 2%), technical failure (n = 1; 2%) and false aneurysm formation at the proximal suture line (n = 1; 2%) . Follow-up was complete, mean 33.1 +/- 20.1 months . Two late deaths occurred . Actuarial five year survival was 88.8% (70% CL: 80.0-97.5%); actuarial five year freedom from recurrent endocarditis was 98.1% (70% CL: 94.5-100%) . CONCLUSION: Allograft aortic root replacement is a valuable technique in the life threatening situations both of native and prosthetic aortic valve endocarditis with involvement of the annular and peri-annular region. J Antimicrob Chemother, 1997 Jul, 40(1), 85 - 90 Ketolides lack inducibility properties of MLS(B) resistance phenotype; Bonnefoy A et al.; Ketolides belong to a new class of semi-synthetic 14-membered-ring macrolides, which differ from erythromycin A by having a 3-keto group instead of the neutral sugar L-cladinose . The ability of these molecules and their L-cladinose counterparts to induce MLS(B) resistance in staphylococci (one strain) and streptococci (two strains) was investigated using a disc agar susceptibility method as well as measuring induction kinetics . All 14- and 15-membered ring macrolides tested showed inducing activity . In contrast, ketolides were clearly unable to induce MLS(B) resistance, a result consistent with the high in-vitro activity of this new class of antibiotics against erythromycin A-inducible resistant bacteria. Pediatr Infect Dis J, 1997 Jul, 16(7), 651 - 6 Erythromycin resistance of group A streptococci from throat samples is related to age; Seppala H et al.; BACKGROUND: Factors associated to increased antimicrobial resistance among bacterial pathogens have been widely discussed and need to be evaluated . In Finland resistance to erythromycin in group A streptococci has become an important problem among outpatients . The aim of this study was to investigate whether occurrence of erythromycin resistance among group A streptococci isolated from noninvasive infections correlates with the patients' age and sex . METHODS: Group A streptococci isolated from 10 162 patients were tested for erythromycin resistance in 21 regional microbiologic laboratories located throughout Finland . The age of every patient and the sex of 8121 (80%) patients were known . The statistical significance of the association between the patients' age or sex and the occurrence of erythromycin resistance in group A streptococci, isolated from throat swab samples (8568 isolates) or pus samples (1594 isolates), was measured by logistic regression analysis . RESULTS: When erythromycin resistance of the isolates was regressed with the patients' age and sex, the age of the patient was a clearly significant predictor for the throat isolates (beta coefficient = -0.0114, SD 0.0029, observed value of t test statistic = -3.89, P = 0.0001) but not for the pus isolates . The odds ratio for age was 0.99 with a 95% confidence interval of 0.98 to 0.99 . Thus the expected risk of erythromycin resistance on a group A streptococcal throat isolate decreased with increasing age by 1% per year . No significant association between the patients' sex and the occurrence of erythromycin resistance was found . CONCLUSIONS: Significant differences may exist between different age groups in the frequency of antibiotic-resistant isolates among outpatients, perhaps caused by differences in antibiotic prescribing . Thus overall resistance levels do not necessarily represent all age groups, especially children. Am J Med, 1997 Jul, 103(1), 18 - 24 Population-based surveillance for group A streptococcal necrotizing fasciitis: Clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases . Ontario Group A Streptococcal Study; Kaul R et al.; PURPOSE: To determine the incidence of group A streptococcal necrotizing fasciitis in Ontario, Canada, and to describe the clinical features, outcome, and microbiologic characteristics of this infection . PATIENTS AND METHODS: Prospective, population-based surveillance for invasive group A streptococcal infections was conducted in Ontario from November 1991 to May 1995 . All 77 patients meeting clinical and/or histopathologic criteria for streptococcal necrotizing fasciitis were included . Demographic and clinical information was obtained by patient interviews and chart review . Group A streptococci were characterized by M-protein and T-agglutination typing, and polymerase chain reaction (PCR) detection of streptococcal pyrogenic exotoxin genes A and C (speA; speC) . RESULTS: The incidence of group A streptococcal necrotizing fasciitis increased during the study from 0.085 per 100,000 population in the first year to 0.40 per 100,000 population in the last year (P < 0.001) . The median age of cases was 57.5 years and the rate of disease increased with increasing age . Seventy-nine percent of cases were community-acquired, 11% were nosocomial, and 10% were acquired in a nursing home . Forty-seven percent of cases were associated with the presence of streptococcal toxic shock syndrome (Strep TSS) and 46% were bacteremic . Thirty-four percent of cases died and mortality was correlated with increasing age (P = 0.006), presence of hypotension (P = 0.01), and bacteremia (P = 0.03) . The most common streptococcal serotypes were M1 (35%) and M3 (25%) . Forty-one percent of strains possessed the speA gene and 30% the speC gene . Outcome was not correlated with M-type or the presence of spe genes . CONCLUSIONS: The incidence of necrotizing fasciitis caused by group A streptococcus increased in Ontario between 1992 and 1995 . Elderly individuals were more likely to acquire the disease and to die from it . Mortality because of streptococcal necrotizing fasciitis was also associated with the presence of hypotension, Strep TSS, or bacteremia, but not with M-type or the presence of pyrogenic exotoxin genes. Ann Otol Rhinol Laryngol, 1997 Jul, 106(7 Pt 1), 571 - 4 Interaction between oral alpha-streptococci and group A streptococci in patients with tonsillitis; Fujimori I et al.; The incidence of oral alpha-streptococci with inhibitory activity against group A streptococci, as a defense mechanism against bacterial infection in the oral cavity, was investigated in 141 patients with streptococcal tonsillitis . The study population included both children (n = 79) and adults (n = 62) . Infection by group A streptococci appeared to be more common in children than in adults, as the detection rates of inhibitory alpha-streptococci in healthy children (29.7%), as well as pediatric patients with tonsillitis (14.9%), were lower than those in adults (63.0%; p < .01) . It is possible to consider oral alpha-streptococci with inhibitory activity to be among the indications for tonsillectomy in patients with streptococcal tonsillitis, since the detection rate of inhibitory alpha-streptococci in surgical cases (10.9%) was significantly lower than that in nonsurgical cases (31.1%; p < .01) . The high detection rate of these strains during the postoperative state supported the observation that the incidence of group A streptococcal infection was decreased postoperatively . Accordingly, it is useful to investigate bacterial interference between oral alpha-streptococci and group A streptococci in patients scheduled for tonsillectomy. Am Fam Physician, 1997 Jul, 56(1), 145 - 9 Necrotizing fasciitis: a diagnostic challenge; Meltzer DL et al.; Group A streptococci are responsible for much of the morbidity associated with skin infections . Necrotizing fasciitis, the most extreme form of these infections, may be life-threatening . Consequently, physicians need to know how to diagnose and effectively treat this deep infection of the subcutaneous tissues . The diagnosis of necrotizing fasciitis is based on the history (i.e., predisposing factors to infection), gram staining and culture, radiography and, ultimately, surgical exploration . The infection is treated with antibiotics, hyperbaric oxygenation and surgical debridement. Antimicrob Agents Chemother, 1997 Jul, 41(7), 1598 - 600 Antibiotic resistance among enterococci isolated from clinical specimens between 1953 and 1954; Atkinson BA et al.; Two hundred twenty group D streptococci isolated from 1953 to 1954 from patients in the Washington, D.C., area were characterized . All were susceptible to ampicillin, vancomycin, and gentamicin; none produced beta-lactamase activity . High-level resistance to streptomycin was expressed by 117 strains, and 2 strains were resistant to >8 microg of chloramphenicol per ml . Three isolates were resistant to both erythromycin and lincomycin, and DNA from these hybridized to an ermAM probe . Of 118 strains resistant to tetracycline and minocycline, genomic DNA from 63 was examined for homology to tet(M), tet(O), and tet(S) . DNA from 20 strains hybridized to tet(M), DNA from 37 strains hybridized to tet(S), and DNA from none of the strains hybridized to tet(O). Chemotherapy, 1997 Jul-Aug, 43(4), 254 - 63 In vitro antimicrobial activity of the thiazolyl peptide antibiotic MDL 62,879 (GE2270 A); Kenny MT et al.; Compound MDL 62,879 (GE2270 A) is a thiazolyl peptide antibiotic that appears to inhibit aminoacyl-tRNA binding to elongation factor Tu . In the present study, it was shown that MDL 62,879 broth microdilution MIC values were generally 2-4 doubling dilutions lower in the presence of 0.02% bovine serum albumin . Using US clinical isolates and BSA-supplemented media, MDL 62,879 was more active than teicoplanin and vancomycin against the staphylococci and glycopeptide-resistant and glycopeptide-susceptible enterococci and equally active against the streptococci . Broth microdilutions MIC values were not appreciably affected by inoculum concentrations of 5 x 10(4) to 5 x 10(8) cfu/ml or in the presence of 3.5% human serum albumin. J Infect Dis, 1997 Jul, 176(1), 177 - 82 A genetic-based evaluation of the principal tissue reservoir for group A streptococci isolated from normally sterile sites; Fiorentino TR et al.; The primary sites of infection and principal reservoirs for transmission of group A streptococci are the nasopharyngeal mucosa and the impetigo lesion . However, pharyngitis and impetigo are rarely observed prior to invasive disease, and, thus, the origin of invasive strains is largely unknown . As part of an active surveillance program, group A streptococci were obtained from normally sterile tissue sites of Connecticut residents during a 6-month period . Organisms were analyzed for genetic markers that distinguish between strains that use the nasopharynx versus an impetiginous lesion as their primary site for infection . The nasopharyngeal marker was observed for most sterile-site isolates, suggesting that the upper respiratory tract is the principal reservoir from which organisms causing invasive disease are disseminated . Genotypic analyses of sterile-site isolates support the view that additional factors, aside from a recent emergence of a few virulent clones, are important contributors to invasive group A streptococcal disease. J Clin Microbiol, 1997 Jul, 35(7), 1885 - 6 Cross-reactions of reagents from streptococcal grouping kits with Streptococcus porcinus; Thompson T et al.; Streptococcus porcinus is usually associated with swine . Because we have received several isolates from human sources that had cross-reacted with commercial group B streptococcal reagents, we examined several commercial kits to determine the extent of this cross-reaction . Fifteen reference and 15 clinical strains of S . porcinus were tested for cross-reactions with group B streptococcal reagents from 12 different commercial kits . Cross-reactions were detected with all group B reagents, but the number of cross-reactions varied with each kit . We recommend that manufacturers of reagents designed to identify group B streptococci by serologic methods test their reagents for cross-reactions with selected S . porcinus cultures or antigens. Ugeskr Laeger, 1997 Jun 23, 159(26), 4117 - 22 {Puerperal fever . A survey of an epidemic using a case-controlled study}; Strobaek S et al.; Puerperal fever caused by group A streptococci (GAS) is a most serious infection deriving from the birth canal after childbirth or caesarian section and is manifest by fever and/or local signs of infections . Secundary infections in the umbilicus or skin can occur in the newborn child . As approximately 5% of the Danish population are carriers of GAS in nose, throat, rectum and/or vagina the risk of infection is present especially in childbirth . GAS epidemics in the community result in increased risk of hospital-acquired GAS infections . In the literature it is recommended to take action and implement preventive strategies when two simultaneous cases occur in one department . We describe the course of seven GAS infections in six patients (two children) in the same obstetric ward over a seven-week period, the elucidation by case-control analysis and the implementation of preventive measures . The importance of good hygienic practices is highlighted. Arch Oral Biol, 1997 Jun, 42(6), 417 - 22 Production of glucosyltransferases by clinical mutans streptococcal isolates as determined by semiquantitative cross-dot assay; Alaluusua S et al.; Forty-four clinical isolates of mutans streptococci were examined by a semiquantitative cross-dot assay for in vitro production of glucosyltransferases GTF-I, GTF-SI and GTF-S of Streptococcus mutans, and GTF-I of Strep . sobrinus, using monospecific antibodies . The isolates were obtained from 12 1.5- to 3-year old children, six caries-active and six caries-free, and from their mothers . The isolates were selected originally from 243 isolates and they represented 35 genetically distinct types as analysed by serotyping and ribotyping . 27 isolates were of serotype c, nine of serotype e and eight of serotype g . Mother child pairs shared nine ribotypes, suggesting vertical transmission . The results showed that, when cultured in Todd-Hewitt broth supplemented with 1% glucose, all Strep . mutans isolates produced GTF-I and GTF-S and all except two produced GTF-SI of Strep . mutans . All Strep . sobrinus isolates produced GTF-I of Strep . sobrinus . The Strep . mutans GTF-I, GTF-SI and GTF-S production of isolates exhibiting a different ribotype showed variability . The variability of GTF-SI and GTF-S production was less pronounced for serotype e isolates . The GTF-I production by Strep . sobrinus isolates did not vary . Transmitted strains produced the same levels of GTFs as strains that were distinct (not transmitted) . Strep . mutans isolates of caries-active children produced the same levels of GTF-I and GTF-S, but tended to produce lower levels of GTF-SI than isolates of caries-free children . In conclusion, the results suggested that Strep . mutans isolates exhibiting a different ribotype often had differences in production of GTFs . However, no clear superiority of the high-producer over the low-producer strains was found in regard to their colonization or caries promotion in young children. Indian J Med Res, 1997 Jun, 105, 249 - 53 An outbreak of post-streptococcal reactive arthritis; Madhuri V et al.; We describe an outbreak of an illness with fever, mono-, pauci- or polyarticular arthritis, and high antideoxyribonuclease B (ADNB) titres in 11 patients . Two patients had concomitant non-purulent conjunctivitis and one had endogenous endophthalmitis . There was no clinical or echocardiographic (6 patients) evidence of carditis . Blood culture grew Group A beta haemolytic streptococci in one patient . A simultaneous synovial fluid culture in this patient and similar cultures in four more patients yielded no microorganism . Most patients recovered completely, but one developed rheumatoid factor negative spondyloarthropathy . Monoarticular arthritis in several patients, the absence of carditis, and the presence of high ADNB titres without high anti-streptolysin O titres indicate that this was not acute rheumatic fever but post-streptococcal reactive arthritis (PSRA). J Clin Gastroenterol, 1997 Jun, 24(4), 280 - 5 Gastrointestinal autonomic nerve tumor with giant abscess . A case report and literature review; Honda K et al.; We report a gastrointestinal autonomic nerve tumor of the stomach with a giant abscess . The patient had fever and pain and was found to have anemia and an abdominal mass . X-ray and endoscopic examination showed a gastric submucosal tumor with a fistula to the gastric lumen . Partial gastrectomy was performed and no metastasis was found . On gross examination, the excised tumor was seen to be a submucosal solid tumor with a giant abscess . Alpha streptococci and anaerobic gram-negative rods were cultured from the pus of the abscess . The tumor resembled a gastric myogenic tumor composed of spindle cells, partly showing storiform and epithelioids . Tumor cells showed positive staining for vimentin and neuron-specific enolase but were negative for desmin, alpha-smooth muscle actin, and S-100 protein . Ultrastructural examination showed remarkable interdigitation of cytoplasmic processes with neurosecretory granules between the tumor cells . This lesion was similar to previously described gastrointestinal autonomic nerve tumors . Gastrointestinal autonomic nerve tumors are a rare, distinct subtype of gastrointestinal stromal tumors; although several cases of focally necrotic tumors have been reported, there has been only one report of the tumor with an abscess, as in our case. Mol Gen Genet, 1997 Jun, 255(1), 125 - 30 Lack of polymorphism within the rRNA operons of group A streptococci; Sriprakash KS et al.; Polymerase chain reaction (PCR) ribotyping of many bacterial species has shown that polymorphism of the ribosomal RNA (rRNA) operons, within and between strains, is common . Restriction fragment length polymorphism (RFLP) analysis of the rRNA operons of thirty-two genetically and geographically distinct strains of group A streptococci (GAS) revealed that there are only two major HaeIII PCR-ribotypes . This variation is due to a single nucleotide change within the 16S-23S intergenic spacer regions of these operons . As in many other bacterial species, this spacer region in streptococci also contains the gene for tRNA(ala) . Within each GAS isolate, hybridization results are consistent with the presence of six rRNA operons . Interestingly, for a given strain, irrespective of its origin, all six rRNA operons have the same RFLP pattern . This contrasts with the findings in many other bacteria species, where heterogeneity of the rRNA operons within a genome is a common feature . This lack of heterogeneity of rRNA operons in an organism that is known to acquire genetic sequences through horizontal transfer is intriguing. J Antimicrob Chemother, 1997 Jun, 39 Suppl B, 15 - 22 In-vitro activity of trovafloxacin against clinical bacterial isolates from patients with cancer; Rolston KV et al.; The antibacterial activity of trovafloxacin was compared with that of ciprofloxacin, levofloxacin, ofloxacin, sparfloxacin and norfloxacin against bacterial isolates from patients with cancer . In general, the activity of trovafloxacin was comparable to that of ciprofloxacin, levofloxacin and sparfloxacin against most Gram-negative isolates tested (minor differences in the activity of each agent against individual species were seen) and it was the most active agent tested against Stenotrophomonas maltophilia, inhibiting 80% of these isolates at <2.0 mg/L . Trovafloxacin was also the most active agent tested against Gram-positive organisms, including ciprofloxacin-susceptible strains and most ciprofloxacin- and methicillin-resistant staphylococci and enterococci . It was much more active than ciprofloxacin against streptococci, including Streptococcus pneumoniae and the viridans streptococci, and was also active against Bacillus cereus and Listeria monocytogenes, inhibiting all isolates at a concentration of <0.5 mg/L. Epidemiol Infect, 1997 Jun, 118(3), 215 - 20 Isolation and characterization of group B streptococci from human and bovine sources within and around Nairobi; Mosabi JM et al.; Group B streptococci (GBS) were isolated from bovine milk and from vaginas and throats of antenatal and postnatal women using TKT and rapid GBS media . Sixty-three of 529 (12%) bovine bulk milk samples, 9 of 48 (19%) vaginal and 3 of 48 (6%) throat samples were positive . Both bovine and human beta haemolytic isolates were characterized biochemically and serologically . Pigment production was a characteristic of both human and bovine beta haemolytic isolates . The majority (88%) of human isolates fermented salicin and not lactose and most bovine isolates were either lactose positive/salicin positive (41%) or lactose positive/salicin negative (38%) . Human and bovine isolates were 100% and 85% typable respectively . Serotype distribution was similar in the bovine and human populations with serotype la, lc and lll being most common in both . Fermentation of sugars showed major differences between bovine and human isolates but similarity in serotype distribution suggests some genetic relationship. Ann Thorac Surg, 1997 Jun, 63(6), 1737 - 41 Active native valve endocarditis: determinants of operative death and late mortality; Jault F et al.; BACKGROUND: In this report, we reviewed 247 patients who underwent operation by our team for active native valve endocarditis between January 1979 and December 1993 . METHODS: There were 201 male and 46 female patients (mean age, 45.4 +/- 6 years) . The aortic valve was involved in 163 cases, the mitral valve in 36 cases, both mitral and aortic valves in 44 cases, and the tricuspid valve alone in 4 cases . The most common microorganisms were streptococci . Univariate Pearson (chi2 test) and multivariate (stepwise logistic regression {BMDPLR}) analyses were used to identify significant predictors of operative mortality, reoperation, and recurrent endocarditis . Cox proportional hazards regression model was used to study late survival . RESULTS: Operative mortality was 7.6% (n = 19) . Increased age, cardiogenic shock at the time of operation, insidious illness, and greater thoracic ratio (>0.5) were the predominant risk factors; the length of antibiotic therapy appeared to have no influence . Two hundred thirteen patients were followed up . Median follow-up time was 6 years (range, 2 to 19 years) . Overall survival rate (operative mortality excluded) was 71.3% +/- 3.8% at 9 years . Increased age, preoperative neurologic complications, cardiogenic shock at the time of operation, shorter duration of the illness, insidious illness before the operation, and mitral valve endocarditis were the predominant risk factors for late mortality . The probability of freedom from reoperation (operative mortality included) was 73.3% +/- 4.2% at 8 years; risk factors were younger age and aortic valve endocarditis . The rate of prosthetic valve endocarditis was 7% . No significant risk factor was found . CONCLUSIONS: Increased age, insidious illness, and hemodynamic failure are the main risk factors for operative mortality . Long-term survival is good except for patients with preoperative neurologic complications and mitral valve endocarditis. FEMS Microbiol Lett, 1997 Jun 1, 151(1), 65 - 70 M protein mediated adhesion of M type 24 Streptococcus pyogenes stimulates release of interleukin-6 by HEp-2 tissue culture cells; Courtney HS et al.; We investigated the contributions of lipoteichoic acid and M protein to reversible and irreversible adhesion of group A streptococci and the effects of such adhesion on release of interleukin-6 . Streptococci in which lipoteichoic acid was masked by the hyaluronate capsule were readily washed from HEp-2 cells, indicating no attachment . Unencapsulated, M-negative streptococci in which lipoteichoic acid was exposed were removed more slowly, indicating loose attachment . Only unencapsulated streptococci that expressed both lipoteichoic acid and M protein remained stably adherent to HEp-2 cells throughout multiple washes . Streptococci expressing both M protein and lipoteichoic acid induced release of interleukin-6 from HEp-2 cells, whereas an isogenic, M-negative mutant failed to induce release of interleukin-6 . These data suggest that lipoteichoic acid mediates reversible adhesion and that M protein is required for irreversible adhesion and for inducing release of interleukin-6 from HEp-2 cells. J R Soc Health, 1997 Jun, 117(3), 160 - 3 Non-group A streptococci: are they pathogens in the throat? Chowdhury MN, Kambal AM, al-Eissa YA, Khaliq MR, al-Ayed IH, al-Sanie AM. A total of 3,184 paediatric patients with sporadic pharyngitis was studied at King Khalid University Hospital in Riyadh, Saudi Arabia . In addition, 478 children without pharyngitis who were matched for age and sex were included as controls . Group A beta-haemolytic streptococci (beta HS) were detected significantly more often among the children with pharyngitis than among the controls (8.4% vs 2.3%; p < 0.0001) . In contrast, total non-group A and group C beta HS were isolated at lower frequency from the sick than control children (0.9% vs 2.5% and 0.2% vs 1.2% respectively; p < 0.01) while other non-group A beta HS such as groups B, G and F were each isolated in similar frequency from both the sick and control children . We conclude that non-group A beta HS appear not to be as important as aetiological agents of sporadic pharyngitis in these children. Clin Chem, 1997 Jun, 43(6 Pt 1), 930 - 5 Use of polymerase chain reaction to identify pneumococcal infection associated with hemorrhage and shock in two previously healthy young children; Messmer TO et al.; A PCR assay was developed for detection of Streptococcus pneumoniae in clinical specimens including blood and paraffinized tissues . We were able to detect one organism of purified DNA or 4.5 colony-forming units in blood . The primers did not cross-react with other upper respiratory tract streptococci or with pathogens commonly found in clinical specimens . This assay was used in an investigation of an outbreak of severe illness characterized by septic shock and hemorrhage in previously healthy children . PCR detected S . pneumoniae in cerebrospinal fluid and autopsy tissues of the two infants who died . The findings from this assay indicated that PCR offers increased specificity and sensitivity over latex agglutination and counterimmunoelectrophoresis and should prove useful in the identification of additional cases of severe illness caused by S . pneumoniae. J Bacteriol, 1997 Jun, 179(11), 3391 - 6 Identification of essential amino acids in the Streptococcus mutans glucosyltransferases; Tsumori H et al.; A comparison of the amino acid sequences of the glucosyltransferases (GTFs) of mutans streptococci with those from the alpha-amylase family of enzymes revealed a number of conserved amino acid positions which have been implicated as essential in catalysis . Utilizing a site-directed mutagenesis approach with the GTF-I enzyme of Streptococcus mutans GS-5, we identified three of these conserved amino acid positions, Asp413, Trp491, and His561, as being important in enzymatic activity . Mutagenesis of Asp413 to Thr resulted in a GTF which expressed only about 12% of the wild-type activity . In contrast, mutagenesis of Asp411 did not inhibit enzyme activity . In addition, the D413T mutant was less stable than was the parental enzyme when expressed in Escherichia coli . Moreover, conversion of Trp491 or His561 to either Gly or Ala resulted in enzymes devoid of GTF activity, indicating the essential nature of these two amino acids for activity . Furthermore, mutagenesis of the four Tyr residues present at positions 169 to 172 which are part of a subdomain with homology to the direct repeating sequences present in the glucan-binding domain of the GTFs had little overall effect on enzymatic activity, although the glucan products appeared to be less adhesive . These results are discussed relative to the mechanisms of catalysis proposed for the GTFs and related enzymes. Infect Immun, 1997 Jun, 65(6), 2472 - 4 Conversion of M serotype 24 of Streptococcus pyogenes to M serotypes 5 and 18: effect on resistance to phagocytosis and adhesion to host cells; Courtney HS et al.; In this study, we utilized recombinant strains expressing the M5 and M18 proteins and M- mutants of group A streptococci to compare the abilities of these M proteins to confer resistance to phagocytosis and to mediate adhesion to host cells . The data indicate that the M5 and M18 proteins can confer resistance to phagocytosis, that fibrinogen is required for this resistance, and that these M proteins can mediate adhesion to HEp-2 cells. Infect Immun, 1997 Jun, 65(6), 2197 - 205 Preferential recognition of human myocardial antigens by T lymphocytes from rheumatic heart disease patients; El-Demellawy M et al.; Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune sequelae of upper respiratory infections with group A streptococci (GAS) . To gain a better understanding of the pathogenesis of these diseases, we examined the in vitro proliferative responses of peripheral blood mononuclear cells (PBMC) from RHD patients to human myocardial proteins in a T-cell Western assay . A number of myocardial proteins fractionated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis were recognized by PBMC from both patients and controls . However, PBMC from a significant percentage of RHD patients (40%) responded to a discrete band of myocardial proteins migrating with an apparent molecular mass of 50 to 54 kDa while none of the control subject PBMC responded to this protein band (P < or = 0.0001) . To further investigate the link between infections with GAS and autoimmune carditis, we studied the proliferative responses of PBMC from patients and controls to myocardial proteins before and after in vitro stimulation of the cells with opsonized GAS isolated from ARF patients . Priming of PBMC with rheumatogenic GAS caused the percentage of RHD patients responding to the 50- to 54-kDa myocardial proteins to increase from 43 to 90% (P < or = 0.0284) . By contrast, PBMC from control subjects failed to recognize the 50- to 54-kDa myocardial proteins even after stimulation with the opsonized streptococci (P < or = 0.0001) . The assay sensitivity was increased from 40 to 90% after priming of a patient's cells with opsonized GAS, but the positive predictive value was 100% in both unprimed and primed cultures . Antibodies generated to partially purified 50- to 54-kDa myocardial proteins did not cross-react with either streptococcal homogenates, purified M protein, myosin, laminin, or vimentin, suggesting a lack of cross-reactivity at the humoral level . This study suggests that the 50- to 54-kDa myocardial proteins contain a putative antigen that is preferentially recognized by T cells from RHD patients and demonstrates that exposure to streptococcal antigens enhances the ability of patients to recognize these proteins. Infect Immun, 1997 Jun, 65(6), 2119 - 26 Keratinocyte proinflammatory responses to adherent and nonadherent group A streptococci; Wang B et al.; The gram-positive bacterium Streptococcus pyogenes (group A streptococcus) is the causative agent of a wide variety of suppurative infections of cutaneous tissues . Previous analyses have demonstrated that the M protein of S . pyogenes is an adhesin that directs the attachment of the streptococcus to keratinocytes in the skin . In this study, we have examined keratinocyte function in response to S . pyogenes and found that adherent versus nonadherent streptococci promote distinct patterns of expression of several proinflammatory molecules and keratinocyte cell fate . When analyzed by a quantitative reverse transcriptase PCR method, infection of cultured HaCaT keratinocytes with adherent, but not nonadherent, streptococci resulted in increased expression of mRNA for the cytokines interleukin-1alpha (IL-1alpha), IL-1beta, and IL-8 but neither infection induced expression of tumor necrosis factor alpha . In contrast, both adherent and nonadherent S . pyogenes induced expression of IL-6 and each promoted synthesis and release of prostaglandin E2 (PGE2) . However, considerably greater levels of IL-6 expression were stimulated by adherent streptococci relative to nonadherent streptococci and the kinetics of PGE2 release in response to nonadherent streptococci was delayed compared to the response to adherent streptococci . Staining with the fluorescent probe ethidium homodimer-1 revealed that keratinocyte membranes were rapidly damaged upon infection with adherent streptococci but were not damaged by nonadherent streptococci . Finally, treatments which inhibited streptococcal metabolism completely blocked the ability of adherent streptococci to elicit responses . These data suggest that expression of an adhesin is a strategy used by S . pyogenes to modulate keratinocyte responses during infection of the skin and implicate additional streptococcal products in these signaling interactions. Infect Immun, 1997 Jun, 65(6), 2080 - 7 Intranasal immunization with C5a peptidase prevents nasopharyngeal colonization of mice by the group A Streptococcus; Ji Y et al.; Early inflammatory events are initiated by phased production of C5a and interleukin-8 in tissue . Most serotypes of group A streptococci express a surface-bound peptidase (SCPA) which specifically cleaves mouse and human C5a chemotaxins . This study investigates the impact of SCPA on colonization of the nasopharyngeal mucosa of mice and evaluates its potential to induce protective immunity . Two strains, serotypes M6 and M49, which contain insertion and deletion mutations in the SCPA gene (scpA) and represent the two major subdivisions of group A streptococci, were characterized and compared in a mouse intranasal infection model . In this model, SCPA mutants were more rapidly cleared from the nasopharynges of inoculated mice compared with wild-type strains . A 2,908-bp fragment of scpA49 gene, obtained by PCR, was ligated to the expression vector pGEX-4T-1 and expressed in Escherichia coli . The affinity-purified deltaSCPA49 protein proved to be highly immunogenic in mice and rabbits . Although the purified deltaSCPA49 immunogen lacked enzymatic activity, it induced high titers of rabbit antibodies which were able to neutralize peptidase activity associated with M1, M6, M12, and M49 streptococci in vitro . This result confirmed that antipeptidase antibodies lack serotype specificity . Intranasal immunization of mice with the deleted form of the SCPA49 protein stimulated significant levels of specific salivary secretory immunoglobulin A (IgA) and serum IgG antibodies and reduced the potential of wild-type M1, M2, M6, M11, and M49 streptococci to colonize . These experiments suggest a new approach to vaccine development for prevention of streptococcal pharyngitis. Biochem Biophys Res Commun, 1997 May 19, 234(2), 445 - 9 The hemopexin-type repeats of human vitronectin are recognized by Streptococcus pyogenes; Liang OD et al.; The specific binding of vitronectin to Streptococcus pyogenes is believed to play an important role in the infection process by mediating adherence of the bacteria to host cells . The domain of vitronectin involved in the interaction with S . pyogenes is unknown . In the present study, we constructed a vitronectin random epitope phage display library, which was used to pan against intact cells of S . pyogenes . Several phage-displayed vitronectin peptides containing a hydrophobic pentapeptide motif within the hemopexin-type repeats were found to bind to streptococci . These data were supported by competition experiments, in which a representative 23-amino acid synthetic vitronectin peptide comprising part of a hemopexin-type repeat inhibited binding of the bacteria to vitronectin, while a control peptide with identical amino acid composition but a scrambled sequence had no effect . Moreover, cells of S . pyogenes were shown to bind to the synthetic peptide as well as to immobilized hemopexin, whose structural homology to the hemopexin-type repeats in the vitronectin molecule has long been underlined . Soluble vitronectin could inhibit streptococcal binding to immobilized hemopexin . These results provide first evidence for a biological role of hemopexin itself and respective repeats in vitronectin in bacterial binding, suggesting that during an infection process these or other hemopexin-type repeat-containing proteins could be potential targets for bacterial attachment and subsequent colonization. ASDC J Dent Child, 1997 May-Jun, 64(3), 201 - 4, 228 Mutans streptococcal serotypes in children with gastroesophageal reflux disease; Holtta P et al.; It has been suggested that vomiting acid gastric contents in bulimia might favor oral growth of Streptococcus sobrinus . We studied the colonization of Streptococcus sobrinus (serotypes g and d) and Streptococcus mutans (serotypes c, e and f) in sixteen children, ages five to fifteen years, who had suffered for four to eleven years from gastroesophageal reflux, another condition with recurrent acid regurgitation . Our aim was to find out if the prevalence of Streptococcus sobrinus would be higher also in this patient group . Mutants streptococci were detected in twelve out of sixteen (75 percent) study patients of the saliva samples cultured on MSB agar . For the Mutans streptococci positive children healthy controls were matched by salivary levels of mutans streptococci and age as closely as possible . From each child three to six isolates representing both Streptococcus mutans and Streptococcus sobrinus (n = 103) were serotyped by immunodiffusion method . The distribution of serotypes in the study/control group was: c: 7/10; e: 4/2; f: 0/1; g:3/2; d:0/0 . One strain in the study group remained untypable . All patients infected with Streptococcus sobrinus were also infected with Streptococcus mutans . Our results indicate the great similarity in the distribution of ms serotypes in the gastroesophageal reflux children and their healthy controls . The data do not suggest that the acid regurgitation would have an influence on the prevalence of Streptococcus sobrinus. Kansenshogaku Zasshi, 1997 May, 71(5), 397 - 404 {Study of bacterial flora in the oral cavity and stomach of elderly patients receiving nasogastric tube feeding}; Matsuura T et al.; To investigate the significance of oropharyngeal flora and gastric flora in elderly patients receiving nasogastric tube feeding, throat secretions and gastric aspirates were cultured and the pH of the latter was measured . Of 116 bacterial isolates from throat secretions of 27 elderly patients, 30 were beta-streptococci and 28 were Pseudomonas aeruginosa . Bacteria isolated from gastric aspirates numbered 86 and 24 (27.9%) of them were the same species as those found in the throat secretions . Patients with gastric pH were below 3.5 had significantly lower concentrations of gram-negative bacili in gastric aspirates . We also studied oropharyngeal flora in 33 elderly patients who were admitted to Nagoyashi Koseiin Geriatric Hospital . The major bacterial isolates from throat swabs of bedridden patients were gram-negative bacilli and beta-streptococci, especially group B streptococci (GBS) . We measured the level of antibody to GBS in these patients . Those from whom GBS were isolated had high titers . These results suggest that in elderly patients receiving enteral nasogastric) tube feeding, large numbers of bacteria colonize the oral cavity and stomach . The measurement of type-specific antibody to GBS may be useful in managing such patients. Zentralbl Veterinarmed A, 1997 May, 44(3), 143 - 58 Clinical assessment of udder health status of sows at time of weaning with special reference to bacteriology and cytology in milk; Persson A; The main objective of this study was to obtain data about the frequencies of teat injuries, udder skin lesions and abnormal palpatory findings of the mammary glands at the day of weaning and 7 days after weaning . Milk samples were collected from mammary glands and teats without clinical changes and from glands and teats showing abnormal clinical appearance . Bacteriological examination was performed and evaluated . The total cell content (TCC) and the polymorphonuclear leucocytes (PMNLs) were counted and used as indicators of inflammatory response . Sixty per cent of the lactations showed teat injuries and (or) udder skin lesions irrespective of lactation number . The prevalence of palpable changes increased gradually from the first to the second and subsequent lactations (15%, 30% and 60%), the increase from the first to the second and from the first to the third and subsequent lactations being significant or highly significant (P < 0.05 and P < 0.001) . The average number of teats injured per 'lactation with teat injuries' showed a numerical but not significant decrease (3.0, 3.2 and 2.4, respectively) . The average number of palpable changes per 'lactation with palpable changes' varied from 1.7 to 2.5 . The teat injuries were numerically more frequent within the two thoracic and first three abdominal teat pairs, varying from 11% to 16% . The clinical appearance of the teat injuries and palpatory changes subsided rapidly, 76% and 49% being scored as clinically normal when the re-examination was performed 7 days after weaning . Irrespective of clinical group, the milk collected at the day of weaning yielded non- as well as alpha- and beta-haemolytic streptococci . The beta-haemolytic streptococci turned out to be more frequently isolated from milk collected from clinically abnormal glands and teats . The limited number of secretion samples obtained and cultured 7 days after weaning yielded staphylococci and Actinomyces pyogenes, which indicated a bacterial flora known to cause infectious mastitis . A cytological comparison between milk from clinically normal and abnormal mammary glands and teats revealed almost significantly or significantly increased levels of TCC and PMNLs (12.17 vs . 17.76 x 10(6) cells/ml and 1.40 vs . 2.77 x 10(6) cells/ml) . A comparison between levels of TCC and PMNLs in milk collected from the two clinical groups of sows, but where the bacteriological growth turned out to be negative, also revealed significant increases in the levels of the two cell parameters emanating from clinically abnormal glands and teats . The individual sow, but not herd or lactation, showed a significant influence on the variation of TCC. J Accid Emerg Med, 1997 May, 14(3), 165 - 6 Tap water as a wound cleansing agent in accident and emergency; Riyat MS et al.; OBJECTIVE: To investigate the bacterial cleanliness of tap water in a large accident and emergency (A&E) department for its possible use in the cleansing and irrigation of open traumatic wounds . METHODS: Tap water samples were collected from different areas within the department and analysed on two separate occasions for coliforms, S aureus, clostridia, pseudomonas, and beta haemolytic streptococci . RESULTS: Pathogenic bacteria were not isolated from the tap water samples within the A&E department . CONCLUSIONS: Tap water of drinking quality can be used to irrigate open traumatic wounds. Acta Derm Venereol, 1997 May, 77(3), 175 - 80 Detection of streptococcal class I M protein in psoriasis by confocal immunofluorescent microscopy; Talanin NY et al.; Epidemiological evidence implicates Streptococcus pyogenes (group A) infection as a common triggering stimulus for psoriasis . Unequivocal demonstration of streptococcal antigens in psoriatic skin has been difficult due to cross-reactive antigens in both normal human tissue and group A streptococci, which complicate immunohistological analysis . In this study cryostat sections of involved psoriatic skin were stained with monoclonal antibody 111-15504 to group A streptococci . The epitope recognized by this antibody was found to be specific for group A streptococci and is associated with class I M protein . Streptococcal antigens were found in the dermal papillae and epidermis of psoriatic skin lesions of 20 out 38 patients . These findings indicate that specific S . pyogenes antigen, associated with class I M protein, is often present in psoriatic lesions . Such an antigen, originating from focal infection elsewhere could be responsible for T-lymphocyte inflammatory responses triggering the development of psoriatic lesions. Indian J Med Res, 1997 May, 105, 200 - 5 Comparative evaluation of two indigenously developed tests for rapid detection of group-A streptococci directly from throat swabs; Gupta R et al.; The efficacy of two indigenously developed rapid tests, latex agglutination and antibody capture assay (a colour immunochromatographic assay) to detect group A Streptococcus pyogenes (GAS) was evaluated in comparison with the traditional culture method ('Gold Standard') in both asymptomatic children (1500) and symptomatic patients (233) . Throat swabs were taken in duplicate and rapid tests performed on one swab and culture on the other . Both latex agglutination and antibody capture assays showed a sensitivity of 100 per cent and specificity of > 98 per cent as compared to culture and isolation in symptomatic patients . However, among asymptomatic carriers sensitivity of 100 per cent and 87.5 per cent and specificity > 95 per cent were observed for latex agglutination and antibody capture assays respectively . Latex agglutination showed no false negative results and sensitivity was not affected by low beta-haemolytic counts in asymptomatic children . The rapid tests described here will help in the detection and thereby the management of GAS infection. J Oral Rehabil, 1997 May, 24(5), 325 - 31 Release of cariostatic agents from a new buffering fluoride- and xylitol-containing lozenge to human whole saliva in vivo; Tenovuo J et al.; A new buffering lozenge (sucking tablet) was developed for patients susceptible to dental caries and erosion, in particular for those with reduced salivary secretion . As active ingredients this lozenge comprises of a combination of xylitol, fluoride, calcium, phosphate, zinc and buffering compounds . To test the lozenge's activity in vivo, the release of ingredients was monitored in 19 healthy subjects for 22 min after sucking the lozenge was completed . In subjects with a normal salivary secretion rate the lozenge caused only a slight stimulation of saliva flow, but a significant elevation both in salivary pH and buffer effect was observed . Furthermore, fluoride, calcium and phosphate were effectively released into whole saliva with peak values 2-4 min after use . The same salivary parameters were also quantitated after 1 month's regular use (3 lozenges/day) but no consistent long-term changes were found . Salivary mutans streptococci and total anaerobic microflora did not change significantly during the long-term use . The results show that the buffering fluoride- and xylitol-containing lozenge, which also releases calcium and phosphate, is active in vivo but its serviceability as a remineralizing agent, in particular for elderly patients with reduced salivary flow rate, has to be analysed separately. Am J Obstet Gynecol, 1997 May, 176(5), 981 - 4 In vitro cytokine and prostaglandin production by amnion cells in the presence of bacteria; Reisenberger K et al.; OBJECTIVE: Our goal was to evaluate the effect of group B streptococci on cytokine and prostaglandin production by amnion cells in vitro . STUDY DESIGN: Amnion cells from placentas obtained immediately after primary cesarean section were incubated for 48 hours with heat-inactivated group B streptococci at increasing concentrations . Samples for quantification of interleukin-1 beta, interleukin-6, interleukin-8, tumor necrosis factor-alpha, and prostaglandin E2 were collected at 6, 12, 24, and 48 hours . RESULTS: Basal cytokine production was not demonstrable for any of the cytokines investigated . Incubation of amnion cells with bacterial antigen led to a significant increase in interleukin-6 and interleukin-8 production, whereas secretion of interleukin-1 beta and tumor necrosis factor-alpha was not enhanced . In contrast to cytokines, basal prostaglandin E2 production was measurable but failed to increase after addition of antigen . CONCLUSION: Amnion cells can be stimulated to secrete interleukin-6 and interleukin-8 in response to streptococcal antigen . However, this rise in cytokines does not induce an increase in prostaglandin E2 . This may be explained by the lack of interleukin-1 and tumor necrosis factor-alpha production, two cytokines that have been shown to activate prostaglandin E2 secretion by amnion cells. FEMS Microbiol Lett, 1997 May 1, 150(1), 107 - 12 Differentiation of human and animal strains of Streptococcus dysgalactiae by pulsed-field gel electrophoresis; Bert F et al.; The genetic diversity among 54 human isolates and 33 animal isolates belonging to the species Streptococcus dysgalactiae (20 alpha-haemolytic Streptococcus dysgalactiae, 23 Streptococcus equisimilis, 43 group G streptococci and one group L streptococcus) was evaluated by macrorestriction analysis of chromosomal DNA with SmaI and resolution by pulsed-field gel electrophoresis . This technique revealed a high degree of intraspecies polymorphism, leading to the differentiation of 80 distinct banding patterns, and identified the presence of two major clusters, one containing isolates of human origin and the other isolates of animal origin . These results suggest than human and animal isolates of S.dysgalactiae are genetically distinct, and support the recent proposal of the subspecies S . dysgalactiae subsp . equisimilis for human isolates . The heterogeneity revealed within isolates from the same host type indicates that pulsed-field gel electrophoresis is a powerful epidemiological tool for studying S . dysgalactiae infections. Antimicrob Agents Chemother, 1997 May, 41(5), 1196 - 202 In vitro activity of RU 64004, a new ketolide antibiotic, against gram-positive bacteria; Schulin T et al.; The comparative in vitro activity of RU 64004 (also known as HMR 3004), a new ketolide antibiotic, was tested by agar dilution against approximately 500 gram-positive organisms, including multiply resistant enterococci, streptococci, and staphylococci . All streptococci were inhibited by < or = 1 microg of RU 64004 per ml . The ketolide was more potent than other macrolides against erythromycin A-susceptible staphylococci and was generally more potent than clindamycin against erythromycin A-resistant strains susceptible to this agent . Clindamycin-resistant staphylococci (MIC, > 128 microg/ml) proved resistant to the ketolide, but some erythromycin A- and clindamycin-resistant enterococci remained susceptible to RU 64004. Antimicrob Agents Chemother, 1997 May, 41(5), 1190 - 2 In vitro activity of premafloxacin, a new extended-spectrum fluoroquinolone, against pathogens of veterinary importance; Watts JL et al.; The in vitro activity of premafloxacin against 673 veterinary pathogens was evaluated . Premafloxacin was equivalent to ciprofloxacin, enrofloxacin, and danofloxacin in activity against the gram-negative bacilli but was much more active (MIC for 90% of the strains tested {MIC90}, 0.015 to 0.25 microg/ml) than the comparison antimicrobial agents (MIC90, 0.13 to 16.0 microg/ml) against the staphylococci, streptococci, and anaerobes tested. Antimicrob Agents Chemother, 1997 May, 41(5), 1146 - 9 Comparative in vitro activities of trovafloxacin (CP-99,219) against 445 gram-positive isolates from patients with endocarditis and those with other bloodstream infections; Endtz HP et al.; The in vitro activity of trovafloxacin (CP-99,219), a new fluoroquinolone, was compared with the in vitro activities of other commonly used quinolones and other antimicrobial agents against 445 gram-positive microorganisms isolated between 1986 and 1995 from patients with endocarditis and those with other bloodstream infections . The MICs at which 90% of the isolates are inhibited (MIC90) of trovafloxacin for methicillin-susceptible staphylococci, viridans group streptococci, and enterococci were 0.06, 0.25, and 0.5 mg/liter, respectively . The MIC90 of trovafloxacin for vancomycin-resistant enterococci as well as for methicillin-resistant Staphylococcus aureus and methicillin-susceptible and ciprofloxacin-resistant S . aureus, isolated from sources other than blood, was 1 mg/liter . For the quinolones the rank order of activity was trovafloxacin > sparfloxacin > ciprofloxacin = ofloxacin > pefloxacin . Depending on the species tested, trovafloxacin was 4- to 64-fold more active than ciprofloxacin . Further experimental and in vivo studies are warranted to evaluate the efficacy of trovafloxacin in the treatment of bacterial endocarditis and other infections caused by gram-positive organisms. Antimicrob Agents Chemother, 1997 May, 41(5), 999 - 1003 Galactose oxidase-glucan binding domain fusion proteins as targeting inhibitors of dental plaque bacteria; Lis M et al.; In order to inhibit the growth of bacteria present in the human oral cavity, a novel system which targets antimicrobial agents to dental plaque has been developed . This system involves a hybrid protein consisting of a peptide expressing the bactericidal properties of galactose oxidase (GAO) fused to the glucan binding domain (GBD) of the Streptococcus mutans glucosyltransferase-S enzyme . A gene encoding GAO from the fungus Fusarium sp . has been inserted into an Escherichia coli expression vector and fused to sequences encoding the GBD, which binds to the glucans synthesized by oral streptococci . Bacterial extracts expressing the hybrid protein were tested for their ability to target the GAO activity to an in vitro plaque model consisting of streptococcal cells bound to microtiter plate wells . The binding of the hybrid protein to the streptococcal cells through its GBD and the dependence of binding on the production of glucans by bacteria were demonstrated . Furthermore, killing of three different species of oral streptococci by bound hybrid protein in conjunction with the galactose-lactoperoxidase-iodide cytotoxic system has been demonstrated . These results suggest a novel strategy for controlling dental plaque formation as well as dental caries in humans. Appl Environ Microbiol, 1997 May, 63(5), 1667 - 73 Deletions in the carboxyl-terminal region of Streptococcus gordonii glucosyltransferase affect cell-associated enzyme activity and sucrose-associated accumulation of growing cells; Vickerman MM et al.; The single glucosyltransferase (GTF) of Streptococcus gordonii Challis CH1 makes alpha 1,3- and alpha 1,6-linked glucans from sucrose . The GTF carboxyl-terminal region has six direct repeats thought to be involved in glucan binding . Strains with defined mutations in this region have been described recently (M . M . Vickerman, M . C . Sulavik, P . E . Minick, and D . B . Clewell, Infect . Immun . 64:5117-5128, 1996) . Strain CH107 GTF has three internal direct repeats deleted; the 59 carboxyl-terminal amino acids are identical to those of the parental strain . This deletion resulted in decreased enzyme activity but did not affect the amount of cell-associated GTF protein . The GTFs of strains CH2RPE and CH4RPE have six and eight direct repeats, respectively, but are both missing the 14 carboxyl-terminal amino acids . Strain CH2RPE had significantly decreased levels of cell-associated GTF; this decrease was not obviated by the increased number of direct repeats in strain CH4RPE . Thus, the carboxyl-terminal amino acids appeared to influence the amount of cell-associated GTF more than the direct repeats . The qualitative and quantitative differences in the GTFs did not affect the abilities of these strains to accumulate on hydroxyapatite beads in the absence of sucrose . However, when sucrose was added as a substrate for GTF, the mutant strains were unable to accumulate on these surfaces to the same extent as the parent . These differences in sucrose-associated accumulation may be due to changes in the nature of the glucans produced by the different enzymes and/or cohesive interactions between these glucans and the GTF on the surfaces of the growing streptococci. J Infect Dis, 1997 May, 175(5), 1115 - 20 Identification of key gene products required for acquisition of plasmin-like enzymatic activity by group A streptococci; Christner R et al.; Group A streptococci incubated in human plasma can acquire a plasmin-like enzymatic activity . This process involves at least two bacterial proteins and two human protein cofactors . In this study, the key bacterial proteins were identified by using a series of isogenic mutants of group A isolate, CS101 . These studies confirm a key role for the secreted plasminogen activator, streptokinase, and identify the major surface fibrinogen-binding protein as the product of the mrp gene . The requirement for human fibrinogen and plasminogen as key cofactors was also confirmed. J Clin Microbiol, 1997 May, 35(5), 1166 - 71 Comparison of the BacT/Alert FAN aerobic and the Difco ESP 80A aerobic bottles for pediatric blood cultures; Welby-Sellenriek PL et al.; We compared the BacT/Alert system using the aerobic FAN bottle with the ESP system using the 80A aerobic bottle for the detection of pediatric bloodstream pathogens at a children's hospital . From 6,636 blood culture sets complying with the inclusion criteria, 308 pathogens were detected, including 177 that were detected by both systems, 69 that were detected by BacT/Alert FAN only, and 62 that were detected by ESP 80A only (P = 0.6; not significant) . BacT/Alert FAN detected more isolates of Staphylococcus aureus (47 versus 34; P = 0.02), while ESP 80A detected more episodes of streptococcal and enterococcal infection . BacT/Alert FAN detected more pathogens from patients receiving antibiotic therapy (107 versus 93; P = 0.04) . Of 248 separate episodes of bacteremia or fungemia, 146 were detected by both systems, 56 were detected by ESP 80A only, and 46 were detected by BacT/Alert FAN only (P = 0.37; not significant) . The median times to detection were 13.6 h for ESP 80A and 15.7 h for BacT/Alert FAN (P < 0.001) . Both systems were considered easy to operate and were free from significant mechanical difficulties . False-positive or false-negative signals were rare or nonexistent with both systems . We conclude that both systems rapidly detect a broad range of pediatric bloodstream pathogens . BacT/Alert FAN provides better detection of Staphylococcus aureus, especially from patients receiving antibiotics . ESP 80A provides better detection of streptococci and enterococci. Biochemistry, 1997 Apr 22, 36(16), 4987 - 94 Coiled-coil structure of group A streptococcal M proteins . Different temperature stability of class A and C proteins by hydrophobic-nonhydrophobic amino acid substitutions at heptad positions a and d; Cedervall T et al.; M proteins and M-like proteins, expressed on the surface of group A streptococci and binding to human plasma proteins, can be divided into two classes, A and C, depending on the structure of the central repeated regions . The class C proteins have been shown to be dimers with a coiled-coil structure . In this work, we have compared the structure and binding of a class A protein, Mrp4, and a class C protein, Arp4, expressed by the same bacterial strain . Circular dichroism spectra, gel filtration, and binding assays showed that both proteins had a coiled-coil dimer configuration and a high-affinity binding at 20 degrees C . However, striking differences were seen at 37 degrees C . The class A protein, Mrp4, was still a coiled-coil dimer with high affinity binding activity, whereas the class C protein, Arp4, had lost both the coiled-coil structure and binding activity . Raising the temperature even higher, Mrp4 retained the coiled-coil structure up to 70-90 degrees C . Furthermore, a recombinant protein, Mrp(C), in which the A-repeats of Mrp4 were replaced by the C-repeats of Arp4, lost its coiled-coil structure and fibrinogen-binding around 40-45 degrees C . These results suggest a high thermal stability of class A proteins and a low stability of class C proteins and that the structural basis for this can be found partly in the A- and C-repeats . Analysis of the amino acid sequences of the A- and C-repeats, revealed a large difference, 87% and 45%, respectively, in the content of hydrophobic amino acid residues in the positions regarded as important for the formation of the coiled-coil structure . In particular, several alanine residues in the A-repeats were replaced by serine residues in the C-repeats . Our results suggest that important structural and functional changes within the M protein family have evolved by specific hydrophobic-nonhydrophobic amino acid replacements. Ugeskr Laeger, 1997 Apr 14, 159(16), 2396 - 7 {Toxic shock-like syndrome caused by streptococci--treated with clindamycin}; Norgaard M; The number of invasive group A streptococcal infections have been increasing in the last years . Toxic Shock-like Syndrome due to infections with streptococci (TSLS) is a serious condition still associated with a mortality rate of 30% despite proper treatment . Early diagnosis is difficult and early treatment is important . A typical case of TSLS in a previously healthy 33 year-old woman treated with clindamycin is reported . Penicillin is still the drug of choice for most Group A streptococcal infections, but in fulminant infections failure has been described . Clindamycin is a good choice in complicated infections. Oral Microbiol Immunol, 1997 Apr, 12(2), 98 - 105 Bacteriocin production and sensitivity among coaggregating and noncoaggregating oral streptococci; Tompkins GR et al.; Twenty-one oral Streptococcus isolates of known interbacterial coaggregation groups were tested against one another (as both producers and indicators) to detect bacteriocin-like inhibitory activity . In agar-based antagonism tests, seven strains produced small inhibitory zones (< or = 3 mm diameter) but in liquid medium, only strain Streptococcus gordonii DL1 (Challis) produced a detectable antibacterial action (bacteriocin STH1) . Five strains were sensitive to bacteriocin STH1, but neither the production of nor the sensitivity to any of the antagonistic agents correlated with coaggregation groupings . Four strains (C219, 903, 118 and Wicky) developed stable resistance in response to the bacteriocin, whereas one isolate (strain 34) remained sensitive following repeated bacteriocin exposure . With one exception (strain 903), bacteriocin STH1-sensitive strains were competent for genetic transformation, but not all competent strains were bacteriocin-sensitive . Bacteriocin-resistant derivatives of transformable strains exhibited decreased competence (80-90% reduction) compared with their parent strains. Oral Microbiol Immunol, 1997 Apr, 12(2), 72 - 6 Effects of acidification on growth and glycolysis of Streptococcus sanguis and Streptococcus mutans; Takahashi N et al.; After carbohydrate intake, pH in dental plaque decreases rapidly and reaches about 4 within a few minutes . The acidification not only promotes demineralization of tooth surface but can also cause damage to bacteria in dental plaque . We, therefore, investigated the effect of acidification on the dental plaque bacteria Streptococcus sanguis and Streptococcus mutans . At pH 4.0 and 4.2, both growth and glycolytic activities in these streptococci were repressed . Prolonged acidification (for 60 min at pH 4.0) not only repressed both growth and glycolytic activities but also impaired them in S . sanguis cells with concomitant inactivation of the glycolytic enzymes, hexokinase, phosphofructokinase, glyceraldehydephosphate dehydrogenase and enolase . The impaired abilities of glycolysis and growth recovered following incubation at pH 7.0 for 80-90 min, and this was accompanied by reactivation of the glycolytic enzymes . On the other hand, these impairments were not observed in S . mutans cells exposed to prolonged acidification . These results indicate that the low pH frequently occurring in dental plaque may transiently impair streptococcal glycolysis and growth and that S . mutans is more durable to the acidification than S . sanguis. Zhonghua Yi Xue Za Zhi (Taipei), 1997 Apr, 59(4), 259 - 64 Presumptive identification of streptococci by pyrrolidonyl-beta-naphthylamide (PYR) test; Chen CH et al.; BACKGROUND: Group A streptococci and enterococci can be differentiated from other streptococci on the basis of their ability to cleave L-pyrrolidonyl-beta-naphthylamide . METHODS: In the present study, the L-pyrrolidonyl-beta-naphthylamide (PYR) test, pigment medium and bile esculin medium have been used to presumptively identify the streptococci . In total, 114 strains of group A streptococci, 350 strains of non-group A streptococci, 202 strains of enterococci and 197 strains of non-enterococci have been tested . RESULTS: The results of the present investigation show that sensitivities of different test methods are: PYR broth, 99.08%; Murex PYR, 98.48%; bacitracin, 95%; bacitracin and sulfamethoxazole/trimethoprim (SXT), 95%; pigment medium, 99.23%; bile esculin medium, 99.26% . Additionally, specificities of various tests are: PYR broth and Murex PYR, 99.82%; bacitracin, 90.90%; bacitracin and SXT, 98.87%; pigment medium and bile esculin medium, 100%, respectively . CONCLUSIONS: PYR test has been observed to be very easy to use and may hence be considered as a rapid, reliable and cost-effective method for presumptive identification of group A streptococci and enterococci in the clinical laboratory. J Clin Pathol, 1997 Apr, 50(4), 332 - 5 Lancefield grouping and smell of caramel for presumptive identification and assessment of pathogenicity in the Streptococcus milleri group; Brogan O et al.; AIM: To evaluate Lancefield grouping and caramel smell for presumptive identification of the Streptococcus milleri group, and to find whether Lancefield group, species, or protein profile correlated with virulence or infection site . METHODS: Prospective studies were made of 100 consecutive streptococcal isolates in blood cultures or pus from 100 patients in whom the severity of infection was categorised as serious, moderate, or not significant . The usefulness of Lancefield group and the caramel smell for presumptive identification was examined, and the relation of the S milleri species, Lancefield group, and SDS-PAGE protein analysis to severity of infection and infection site was investigated . Lower respiratory tract and genital tract specimens, strict anaerobes, group D streptococci, and strains identified as Streptococcus pneumoniae, Streptococcus pyogenes, or Streptococcus agalactiae were excluded . RESULTS: Most streptococci occurring in pure or significant growth density were S milleri group (87/100; 87%, 95% confidence interval 0.81-0.93) . Of these, 89.7% (78/87; 0.84-0.96) were associated with infection . Lancefield group F antigen predominated (41/87; 47.1%, 0.38-0.56) . Lancefield group F alone or accompanied by the caramel smell had a specificity of 100%, but a sensitivity of only 47.3% for group F alone, and 19.5% for group F accompanied by the caramel smell . There was no significant association between species, Lancefield group, and severity of infection, site of infection, or pathogenicity . SDS-PAGE analysis failed to discriminate between strains . CONCLUSIONS: Neither species nor Lancefield antigen was related to the site of infection . The presence of Lancefield group F antigen alone or accompanied by a caramel smell was a useful indicator for the S milleri group when present, but was too insensitive to use as a screening test . Most streptococci occurring in pure culture or in significant growth density were of clinical importance . Such organisms should be identified to species level to detect the S milleri group. Curr Opin Pediatr, 1997 Apr, 9(2), 133 - 40 Neonatal infections; Bhutta ZA; Neonatal infections range from early-onset vertically acquired infections to nosocomial bacterial sepsis, and they account for significant morbidity and mortality globally . The recent emergence of perinatally acquired HIV-1 infection has also placed an enormous burden on existing meager health resources in developing countries . The risk of early-onset group B streptococci sepsis may be related to heavy genital tract colonization at term . Perinatally acquired HIV-1 infection also occurs at birth, with higher rates of infection after vaginal delivery . Detection of circulation HIV-1 viral DNA by polymerase chain reaction offers an extremely sensitive screening method in the neonatal period . In contrast, rapid confirmation of bacterial sepsis in the newborn still poses considerable problems . A review of data on antimicrobial prophylaxis of preterm premature rupture of membranes does reveal improved neonatal outcome . However, the rapid and widespread emergence of multidrug resistance among bacterial pathogens dictates the need for judicious use of antibiotics, as well as close attention to preventive strategies. J Laryngol Otol, 1997 Apr, 111(4), 392 - 5 Direct microscopy of effusions obtained from peritonsillar abscesses as a complement to bacterial culturing; Lilja M et al.; Effusion material was aspirated from 51 consecutive peritonsillar abscesses (34 male, 17 female; age range eight to 46 years) and subjected to direct microscopy after staining with acridine orange . Bacteria were counted per ml effusion material and their morphology was analyzed . In addition, aerobic and anaerobic bacterial culturing was performed . Effusions containing beta-haemolytic streptococci Group A, which appeared as a single species contained fewer bacteria (8 x 10(6) per ml, median value) than effusions harbouring a mixed flora (7 x 10(8) bacteria per ml, median value) . Direct microscopy of effusions obtained from peritonsillar abscesses makes possible rapid identification of a single or mixed flora, which is of importance for the antibiotic treatment of the disease. APMIS, 1997 Apr, 105(4), 329 - 36 A case control study of chorioamniotic infection and histological chorioamnionitis in stillbirth; Folgosa E et al.; In order to elucidate the role and aetiology of chorioamnionitis in stillbirth a case referent study was carried out in 58 pregnant women with late foetal death (cases) and in 58 pregnant women at term with live foetus (referents) matched for age and parity in Maputo Mozambique . Samples from women, stillborns and liveborns, were collected for microbiological and histological assessment . Histological chorioamnionitis was diagnosed in 96% of the cases and in 67% of the referents (OR = 13.5; 95% CI: 2.9-123.9) . Escherichia coli was the species most frequently isolated in stillborns; in 14/16 (88%) cases it was isolated from intracardiac fluid . E . coli was associated with chorioamnionitis in 28% of the stillborns as compared to 5% of the referents (OR = 6.9; 95% CI: 1.4-65.4) . No group B streptococci were recovered from any placenta or newborn . Vasculitis was present in 12 (21%) cases and in 3 (5%) referents (OR = 4.8; 95%, CI: 1.2-27.7) . Histological chorioamnionitis was thus associated with stillbirth . E . coli was common in stillborns . The presence of vasculitis in one fifth of the stillborns indicated that the foetus was alive at the onset of infection. Diagn Microbiol Infect Dis, 1997 Apr, 27(4), 151 - 4 In vitro evaluation of contemporary beta-lactam drugs tested against viridans group and beta-haemolytic streptococci; Pfaller MA et al.; Streptococci continue to be prevalent causes of mild as well as of serious, life-threatening infections . Furthermore, some species harbor antimicrobial resistances (pneumococcus, viridans gr . streptococci) that compromise effective chemotherapy with beta-lactam drugs or other antimicrobial classes . In this study, the potency and spectrum of 12 beta-lactams was assessed versus 274 contemporary isolates of viridans group and beta-haemolytic streptococci using reference methods . Cefotaxime and ceftriaxone (MIC90s, 0.015 to 2 micrograms/ml, 84 to 100% susceptible) were consistently most potent among the agents tested . Ceftazidime (MIC90s, 0.25 to 8 micrograms/ml) and ticarcillin (MIC90s, 0.5 to > 32 micrograms/ml) were least active among the cephalosporins and penicillins, respectively . When 25% pooled serum was added to the reference test medium, ceftriaxone activity decreased fourfold, and cefotaxime remained highly active . As penicillin/beta-lactam-resistant streptococci with altered penicillin-binding protein target sites become more prevalent, only a few "third-generation" cephems seem to have sustained activity when used alone or possibly with a carefully selected co-drug . Routine testing of these species against beta-lactams and alternative drugs should be encouraged to detect emerging resistance patterns. Aust Dent J, 1997 Apr, 42(2), 77 - 80 Bacteraemia caused by periodontal probing; Daly C et al.; Bacteraemia of oral origin may result in infective endocarditis in susceptible individuals . The aim of this pilot study was to investigate the occurrence of bacteraemia due to periodontal probing . Thirty patients (15 male, 15 female; mean age 42.7 years) with untreated periodontitis were investigated . All were free of significant medical disorders and none had taken antibiotics in the previous month . Prior to and immediately following periodontal probing, 20 mL of venous blood were obtained from each patient and inoculated into aerobic and anaerobic blood culture bottles and incubated . Negative bottles were monitored continuously for three weeks before being discarded . Periodontal probing consisted of measuring pockets at six points around each tooth and recording the presence or absence of bleeding . A positive bacteraemia was recorded for three of the patients prior to probing . One patient exhibited Prevotella species whilst two exhibited skin commensals . Following probing, 13 patients (43 per cent) exhibited bacteraemia of oral origin . Viridans streptococci were the most common isolates (45 per cent) . No significant correlations were found between bacteraemia and the severity of periodontitis or extent of bleeding on probing . The results indicate that periodontal probing can cause bacteraemia in patients with periodontitis . It would be advisable for patients considered at risk of developing infective endocarditis to receive antibiotic prophylaxis for periodontal probing if they have radiographic evidence of periodontitis. Eur J Oral Sci, 1997 Apr, 105(2), 170 - 7 Effects of xylitol, xylitol-sorbitol, and placebo chewing gums on the plaque of habitual xylitol consumers; Soderling E et al.; Xylitol reduces plaque but the reduction mechanism is largely unknown . The main aim of the present study was to determine whether the xylitol-induced reduction in the amount of plaque and the number of mutans streptococci could be demonstrated in subjects with (presumably) high levels of xylitol-resistant (XR; not inhibited by xylitol) mutans streptococci acquired following previous xylitol consumptions . 37 healthy dental students participated in the double-blind study . All subjects had been uncontrolled, habitual consumers of xylitol-containing products for at least 1 yr before the study . A 1-month washout period was followed by a 2-week test period during which either xylitol, xylitol-sorbitol or unsweetened chewing gum base was chewed 3-5 x a day . Plaque and saliva samples were collected at baseline and at the 2-week point for determination of the amount of plaque, microbiological variables, and hydrolytic enzymes . Mixtures of xylitol and sorbitol seemed to perform equally well with respect to reduction in the amount of plaque but not the number of mutans streptococci . Thus, polyols were the active ingredients of chewing gums able to modulate the amount of plaque and its microbial composition . Xylitol reduced plaque with a mechanism which appeared not to be associated with the study-induced changes in the proportion (%) of mutans streptococci in plaque, the number of salivary mutans streptococci, the proportion of XR strains in plaque or saliva, or the hydrolytic enzyme activities of plaque. Clin Infect Dis, 1997 Apr, 24(4), 669 - 75 Infective endocarditis: 35 years of experience at a children's hospital; Martin JM et al.; We review the predisposing conditions, the presenting signs and symptoms, as well as the risk factors and bacterial etiologies in children with infective endocarditis, focusing on hospital course and outcome . We conducted a retrospective analysis of 76 cases of endocarditis in 73 patients occurring at Children's Hospital of Pittsburgh from January 1958 through December 1992 . The median age of the patients was 9 years (range, 1 month to 18 years) . Predisposing conditions included congenital heart disease (62 patients) and rheumatic heart disease (four patients) . Seventy-seven percent of the children with congenital heart disease had undergone cardiac surgery . After therapy with appropriate antibiotics was started, blood cultures for 67 patients (70 episodes of infective endocarditis) remained positive for a mean (+/-SD) of 0.7 +/- 1.41 days, and all patients who presented with fever (75 episodes in 72 patients) remained febrile for a mean (+/-SD) of 4.28 +/- 6.21 days . Secondary fever occurred in 39% of the children . Thirty (41%) of the 73 patients survived without any complications and 13 (18%) died . Fifteen children with complications required surgery . Children with endocarditis caused by Staphylococcus aureus were more likely than those with infection caused by viridans streptococci to have prolonged fever, secondary fever, and/or complications as well to require surgery. Eur J Obstet Gynecol Reprod Biol, 1997 Apr, 72(2), 137 - 40 Selective intrapartum anti-bioprophylaxy of group B streptococci infection of neonates: a prospective study in 2454 subsequent deliveries; Poulain P et al.; OBJECTIVE: To investigate the efficacy of a selective intrapartum prophylaxy of group B streptococci (GBS) infection of the neonates . STUDY DESIGN: A prospective protocol of universal antepartum screening of GBS and selective intrapartum treatment from the 1st February 1994 to the 31st December 1995, on 2454 subsequent deliveries was designed . Our policy included: (1) antepartum screening as soon as possible after 28 weeks by a single vaginal and perianal sample for culture; (2) intrapartum recognition of one condition of high risk of fetal contamination during labor (these conditions included: a temperature of 38 degrees C during labor, rupture of membranes for more than 12 h or prolonged labor for more than 12 h with rupture of membranes, prematurity, twins, maternal diabetes, previous pregnancy with GBS infection of the neonate); and (3) intrapartum anti-bioprophylaxy (amoxicillin) for women with positive screening during pregnancy and one condition of high risk of fetal contamination during labor . We studied the outcome of neonates during this period to look for immediate GBS severe infection of the neonates in the form of bacteraemia or meningitis and compared the results with the rate of neonatal infection before this protocol (4.5/1000 live births in 1993) . RESULTS: We noted that 11% of pregnant women were carriers, 25% of which led to antibiotic chemoprophylaxis during the labor . We noticed four cases of neonatal bacteraemia of GBS . One case arose from the group of carriers (but no condition of risk of fetal contamination during the labor and no chemoprophylaxy) . The three other cases were from women with a negative antepartum screening . There was no case of meningitis and all four babies were in good health at day 10 of life . Comparing with results prior to the study, we noticed that the rate of neonatal bacteraemia dropped from 4.5 to 1.6 per 1000 livebirths (P < 0.0001) . CONCLUSION: This protocol of intrapartum anti-bioprophylaxy significantly decreases the rate of GBS neonatal sepsis . We propose to improve the efficacy of this prevention program, especially with regard to the method of antepartum screening of pregnant women colonized with GBS. Epidemiol Infect, 1997 Apr, 118(2), 125 - 35 Characterization of the Lancefield group C streptococcus 16S-23S RNA gene intergenic spacer and its potential for identification and sub-specific typing; Chanter N et al.; The 16S-23S RNA gene intergenic spacers of isolates of Streptococcus equi (n = 5), S . zooepidemicus (n = 5), S . equisimilis (n = 3) and S . dysgalactiae (n = 2) were sequenced and compared . There were distinct regions within the spacer, arranged in the order 1-9 for all S . equi and one S . zooepidemicus isolate and 1,2 and 4-9 for the remaining isolates . Region 4 was identical to the tRNA(ala) gene found in the 16S-23S intergenic spacers of other streptococci . Regions 1, 5, 6 and 7 had distinct variations, each conserved in different isolates . However, amongst the intergenic spacers there were different combinations of variant regions, suggesting a role for DNA recombination in their evolution . The intergenic spacer of all isolates of S . equi and one S . zooepidemicus isolate were almost identical . Primers derived from the variant sequences of regions 1 and 5 to 6 were used to group all S . zooepidemicus (n = 17) and S . equi (n = 5) into 1 of 8 types by polymerase chain reaction; three S . zooepidemicus isolates typed the same as S . equi . S . equi and S . zooepidemicus were clearly distinguishable from S . equisimilis and S . dysgalactiae which had shorter regions 5 and 6 and no region 7 . Most homology for the group C sequences was found in previously published sequences for the 16S-23S intergenic spacers of S . anginosis, S . constellatus, S . intermedius, S . salivarius and S . agalactiae . A 75-90 nucleotide length shared with S . anginosus and S . intermedius in opposite orientations in the two main variants of region 6 supported the role for DNA recombination in the evolution of the spacer . The 16S-23S intergenic spacers indicate that S . zooepidemicus was the archetypal species for S . equi and that both are genetically more distant from S . equisimilis and S . dysgalactiae . The intergenic spacer can be used to identify specifically the group C streptococci and as an epidemiological marker for S . zooepidemicus. J Dent Res, 1997 Apr, 76(4), 852 - 7 Prophyromonas gingivalis fimbriae mediate coaggregation with Streptococcus oralis through specific domains; Amano A et al.; Fimbriae are major adhesive components on the cell surface of Prophyromonas gingivalis . In this study, we evaluated the role of fimbriae in coaggregation with Streptococcus oralis . Fimbriae purified from P . gingivalis competitively inhibited the coaggregation by 100% at a concentration of 50 micrograms/mL . On the other hand, the same amount of lipopolysaccharide isolated from P . gingivalis was inhibited by only 25% of the level of the fimbriae . A fimA-inactivated mutant of P . gingivalis failed to show distinct coaggregation activity . Fimbriae added to a solution of various strains of streptococci caused their self-aggregation at a concentration of 10 to 30 micrograms/mL . The self-aggregation induced by fimbriae was inhibited by lambda-arginine (20 to 40 mM/L) . Iodinated fimbriae reacted with S . oralis cells immobilized on the nitrocellulose membrane, and 100 degrees C heating of the cells diminished the binding abilities . Recombinant fimbrillin (r-Fim, corresponding to whole residues 1 to 337 of native fimbrillin) of P . gingivalis also showed 100% inhibition of the coaggregation . The r-Fim variant (residues 1 to 286) lacking the C-terminal 51 residues was as inhibitory as r-Fim . However, the variant (residues 1 to 265) without the C-terminal 72 residues lost 77% of the inhibitory activity . These findings suggested that residues 266 to 286 contain a domain involved in the coaggregation of P . gingivalis with S . oralis . Inhibition by three polypeptides corresponding to residues 266 to 286, 266 to 337, and 287 to 337 was studied . Peptides 266 to 286 and 266 to 337 inhibited by 96 and 100%, respectively, at a concentration of 1.5 nmol/mL . Peptide 287 to 337 also showed a significant inhibitory effect but to a slightly lesser extent than that of peptide 266 to 286 . P . gingivalis fimbriae appear to be involved in coaggregation with streptococci, probably through an adhesive protein molecule(s) of the latter, and the fimbriae possess several domains in the C-terminal residues 266 to 337 for interaction with S . oralis. Infect Immun, 1997 Apr, 65(4), 1357 - 63 The fibronectin-binding protein of Streptococcus pyogenes, SfbI, is involved in the internalization of group A streptococci by epithelial cells; Molinari G et al.; Streptococcus pyogenes organisms (group A streptococci) are considered to be highly adhesive extracellular pathogens . However, it has recently been reported that S . pyogenes has the capacity to efficiently invade eukaryotic cells . In this study, we demonstrate that the interaction of S . pyogenes fibronectin-binding protein (SfbI) with fibronectin on nonphagocytic HEp-2 cells triggers bacterial internalization . Blocking of the SfbI adhesin by either antibodies against the whole protein or antibodies against the fibronectin-binding domains of SfbI, as well as pretreatment of HEp-2 cells with purified SfbI protein, prevents both S . pyogenes attachment and internalization . Inert latex beads precoated with the purified SfbI protein are ingested by eukaryotic cells, demonstrating that SfbI is per se enough to trigger the internalization process . Experiments performed with a recombinant SfbI domain encompassing the two fibronectin-binding regions of the SfbI molecule demonstrated that these binding regions are essential and sufficient to activate uptake by HEp-2 cells . These results demonstrate that the fibronectin-bi