Sao Paulo Med J, 1994 Oct-Dec, 112(4), 635 - 8 E test: a novel technique for antimicrobial susceptibility testing; Sader HS et al.; We describe the applicability of the E test (AB Biodisk Solna, Sweden), a new method for determining minimum inhibitory concentrations of antimicrobial agents against bacteria . This report is based on the literature review and on our own experience using the E test for susceptibility testing of the Xanthomonas maltophilia, Streptococcus pneumoniae and Streptococcus viridans group against eight different drugs. Tidsskr Nor Laegeforen, 1994 Sep 30, 114(23), 2732 - 3 {All persons without spleen should be given pneumococcal vaccine}; Aaberge IS et al.; Splenectomized individuals run increased risk of developing overwhelming septicemia from encapsulated bacteria, especially Streptococcus pneumoniae . Polyvalent pneumococcal polysaccharide vaccine should be given to all splenectomized individuals above two years of age . Antipneumococcal antibody levels should be measured three to five years after the first vaccination, and persons with low antibody levels should be revaccinated . Splenectomized persons may be given a supply of penicillin V to enable them to start therapy while avaiting medical attention. Tidsskr Nor Laegeforen, 1994 Sep 30, 114(23), 2709 - 10 {Splenectomy and pneumococcal vaccine . How to follow-up?}; Knudsrod OG et al.; The authors describe the case of an otherwise healthy man who died from pneumococcal septicemia 18 years after having undergone splenectomy . It is widely accepted that splenectomized patients run increased risk of serious bacterial infections . Meningitis and septicemia caused by encapsulated organisms, especially Streptococcus pneumoniae, are most important in this respect, with a reported mortality of 30-60% . Since 1977, splenectomized patients have been offered pneumococcal vaccine as a routine, but persons who was splenectomized before 1977 are not identified, and run an unknown risk of serious infectious disease . Possible approaches to this problem of identification are discussed. J Chromatogr A, 1994 Sep 30, 680(1), 201 - 8 Application of capillary ion electrophoresis and ion chromatography for the determination of O-acetate groups in bacterial polysaccharides; Hepler RW et al.; Many bacterial polysaccharides possess O-linked acetate groups as constituents of their repeating units which often can serve as immunological determinants . It is therefore important to develop analytical methods for process monitoring as well as product characterization when such O-acetylated polysaccharides are used as components of vaccines . This is the case in a polysaccharide conjugate vaccine under development for treatment of diseases caused by Streptococcus pneumoniae . An ion chromatographic (IC) method utilizing suppressed conductivity detection (SCD) was developed to quantitatively measure O-acetate groups in the capsular polysaccharides from S . pneumoniae types 18C and 9V following hydrolytic release of O-acetate from the polysaccharide backbones using 2 mM sodium hydroxide . IC was carried out using an OmniPac PAX-500 column and 0.98 mM NaOH in 2% methanol as the mobile phase . Capillary ion electrophoresis (CIE) with indirect photometric detection was evaluated as an alternative method . The CIE method utilized a 72 cm x 75 microns I.D . fused-silica capillary and an electrolyte composed of 5 mM potassium hydrogenphthalate, 0.5 mM tetradecyltrimethylammonium bromide, and 2 mM sodium tetraborate, pH 5.88 . A comparison of CIE and IC-SCD in terms of reproducibility, accuracy, linearity, and sensitivity will be presented. N Engl J Med, 1994 Sep 8, 331(10), 643 - 8 An epidemic of pneumococcal disease in an overcrowded, inadequately ventilated jail; Hoge CW et al.; BACKGROUND . In the United States many correctional facilities now operate at far over capacity, with the potential for living conditions that permit outbreaks of respiratory infections . We investigated an outbreak that was identified in an overcrowded Houston jail after two inmates died of pneumococcal sepsis on the same day . Outbreaks of pneumococcal disease have been rare in the era of antibiotics . METHODS . We assessed risk factors for pneumococcal disease in both a case-control and a cohort study . Ventilation was evaluated by measuring carbon dioxide levels and air flow to the living areas of the jail . The extent of asymptomatic infection was determined by culturing pharyngeal specimens from a random sample of inmates . Type-specific immunity was determined with an enzyme immunoassay . RESULTS . Over a four-week period, 46 inmates had either acute pneumonia or invasive pneumococcal disease due to Streptococcus pneumoniae serotype 12F . The jail's capacity had been set at 3500 inmates, but it housed 6700 at the time of the outbreak; the inmates had a median living area of only 34 ft2 (3.2 m2) (interquartile range, 28 to 56 ft2 {2.6 to 5.2 m2}) per person . There were significantly fewer cases of disease among inmates with 80 ft2 (7.4 m2) per person or more (P = 0.030) . Carbon dioxide levels ranged from 1100 to 2500 ppm (acceptable, < 1000), and the ventilation system delivered a median of only 6.1 ft3 of outside air per minute per person (interquartile range, 4.4 to 8.5 ft3; recommended, > or = 20 ft3) . The attack rate was highest among inmates in cells with the highest carbon dioxide levels and the lowest volume of outside air delivered by the ventilation system (relative risk, 1.94; 95 percent confidence interval, 1.08 to 3.48) . Of underlying medical conditions, intravenous drug use was most strongly associated with disease (odds ratio, 4.50) . The epidemic strain (serotype 12F) was cultured from 7 percent of the asymptomatic inmates . Of 11 case patients tested with the enzyme immunoassay, 9 (82 percent) lacked preexisting immunity to this strain . CONCLUSIONS . Severe overcrowding, inadequate ventilation, and altered host susceptibility all contributed to this outbreak of pneumococcal disease in a large urban jail. Clin Diagn Lab Immunol, 1994 Sep, 1(5), 585 - 9 Soluble human complement receptor type 1 inhibits complement-mediated host defense; Swift AJ et al.; Soluble complement receptor type 1 (sCR1) is a powerful inhibitor of complement activation . Because of this ability, sCR1 may prove to be an important therapeutic agent that can be used to block the immunopathologic effects of uncontrolled complement activation in a variety of clinically significant disorders . Although several previous studies have examined the ability of sCR1 to inhibit complemented-mediated immunopathologic damage, there is no information on its ability to interfere with the host's defense against infection . In the current experiments sCR1 exerted a concentration-dependent inhibitory effect on the phagocytosis of Streptococcus pneumoniae by human polymorphonuclear leukocytes in vitro . Not only di sCR1 inhibit complement-dependent opsonization of the pneumococcus but at higher concentrations it also inhibited the ingestion of bacteria which had been previously opsonized . Furthermore, when rats were injected with sCR1, it inhibited both their serum hemolytic activity and serum opsonic activity in a dose-dependent fashion . Finally, for rats treated with sCR1, the 50% lethal dose was S . pneumoniae and Pseudomonas aeruginosa . These data demonstrate that sCR1 significantly inhibits complement-mediated host against bacterial infection. Ann Otol Rhinol Laryngol, 1994 Sep, 103(9), 713 - 8 Acute otorrhea: bacteriology of a common complication of tympanostomy tubes; Mandel EM et al.; We prospectively followed 246 children with tympanostomy tubes and observed acute otorrhea through a functioning tube at least once in 50% of subjects . Pathogens typical of acute otitis media (Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes) were found in 42% of all episodes; Pseudomonas aeruginosa or Staphylococcus aureus was found in 44% of all episodes . Pathogens of acute otitis media were found in 50.0% of subjects under 6 years old versus 4.4% of subjects 6 years or over at the first episode (p < .001) . Pseudomonas aeruginosa was found more often in children 6 years or older (43.5% versus 20.5% at the first episode, p = .052) . Pathogens typical of acute otitis media were less prevalent in the summer months (14.7% versus 52.2% for the first episode, p = .001), while P aeruginosa was more prevalent in summer (44.1% versus 16.4% for the first episode, p = .006) . This suggests that while many younger children with acute otorrhea may respond to treatment with oral antimicrobials alone, outpatient therapy of older children may involve use of topical antipseudomonal agents that may be complicated by the question of the safety of such medications. J Clin Invest, 1994 Sep, 94(3), 965 - 77 M protein and protein F act as important determinants of cell-specific tropism of Streptococcus pyogenes in skin tissue; Okada N et al.; The pathogenic gram-positive bacterium Streptococcus pyogenes (group A streptococcus) causes numerous diseases of cutaneous tissue, each of which is initiated after the interaction of the bacterium with the cells of the epidermis . In this study, we show that different surface proteins of S . pyogenes play important roles in determining the cell-specific tropism of the bacterium in skin . Using streptococcal strains with defined mutations in the genes which encode surface proteins in combination with primary cultures of human skin and an in situ adherence assay which uses histological sections of human skin, we show that the M protein of S . pyogenes mediates the binding of the bacterium to keratinocytes, while a second streptococcal surface protein, protein F, directs the adherence of the organism to Langerhans' cells . Characterization of binding revealed that adherence was inhibited by purified streptococcal proteins and pretreatment of both host cells with the protease trypsin . Adherence was only slightly affected by the state of keratinocyte differentiation in vitro, but was considerably modulated in response to environmental conditions known to regulate expression of M protein and protein F, suggesting that the interaction between these bacterial cell-surface structures/adhesins and keratinocytes and Langerhans' cells may play an important role in streptococcal skin disease. Med Clin North Am, 1994 Sep, 78(5), 987 - 95 New aspects of old pathogens of pneumonia; Marrie TJ; Changes in the microorganism or in the host have resulted in exciting new aspects of several old pathogens of pneumonia . Penicillin-resistant Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, and "toxic strep" are examples of changes in the microorganisms . Host changes have resulted in Mycoplasma pneumoniae now emerging as a cause of pneumonia in the elderly. J Infect Dis, 1994 Sep, 170(3), 609 - 14 Persistent acylation of high-molecular-weight penicillin-binding proteins by penicillin induces the postantibiotic effect in Streptococcus pyogenes; Yan S et al.; Penicillin at 10X MIC induced a postantibiotic effect (PAE) of 2.1 h in Streptococcus pyogenes . Progressive increases in the densities of penicillin-binding proteins (PBPs) 1-3 of the bacterium were detected at 30, 60, and 90 min during the postantibiotic phase . The increase in colony-forming units during this phase paralleled the kinetics of incorporation of lysine into proteins, suggesting that growth was triggered by de novo synthesis of PBPs . The question was raised as to whether the progressive increases in densities of PBPs were due to the restoration of preexisting PBPs or to synthesis of new PBPs . With 10X MIC of clindamycin to inhibit PBP synthesis during the postantibiotic phase, the temporal increase in densities of PBPs 1-3 were totally inhibited . These results suggest that the PAE of penicillin in S . pyogenes is caused by irreversible binding of penicillin to PBPs 1-3 and represents the time necessary for synthesis of new PBPs required for normal growth. J Infect Dis, 1994 Sep, 170(3), 600 - 8 Degradation of C3 by Streptococcus pneumoniae; Angel CS et al.; After growth to exponential phase in Todd-Hewitt broth, clinical and laboratory isolates of Streptococcus pneumoniae serotypes 3, 4, and 14 readily degraded first the beta and then the alpha chains of purified human C3 in the absence of serum or other complement proteins, as assessed by SDS-PAGE . With exponentially growing pneumococci, degradation of native C3 was detectable within 30 min; methylamine-treated C3 and preformed C3b were degraded with equal avidity . Pneumococcal C3-degrading activity was cell associated, abolished by heat killing, and independent of the presence of the polysaccharide capsule . After degradation, 44% of C3 molecules contained a disrupted thiolester bond . Pneumococci treated with 100 micrograms of mutanolysin released 94% of C3-degrading activity from the pneumococcal surface into the supernatant . These studies demonstrate that clinical and laboratory isolates of virulent pneumococci degrade and inactivate soluble C3. J Infect Dis, 1994 Sep, 170(3), 592 - 9 Opsonization and antibodies to capsular and cell wall polysaccharides of Streptococcus pneumoniae; Vitharsson G et al.; Opsonin-dependent phagocytosis is believed to be the major defense mechanism against Streptococcus pneumoniae . In addition to type-specific antibodies to pneumococcal capsular polysaccharides (PPS), most persons also produce antibodies to cell wall polysaccharide (CWPS), which may be detected in antibody assays due to contamination of PPS antigens . Antibodies to CWPS and PPS from common serotypes were analyzed in relation to opsonic activity before and after vaccination of healthy adults . A highly significant relationship was generally found between opsonization and pneumococcal antibody levels, and this correlation increased markedly by neutralization of CWPS antibodies . This applied in particular for IgG2, which showed no correlation without neutralization . Adsorption of PPS antibodies almost abolished the opsonic activity, whereas removal of CWPS antibodies had no effect . These findings indicate that opsonization of pneumococci is almost exclusively mediated by PPS antibodies and emphasize the importance of neutralizing CWPS antibodies when immunity to this organism is evaluated. Arch Otolaryngol Head Neck Surg, 1994 Sep, 120(9), 925 - 30 Otogenic meningoencephalitis induced by Streptococcus pneumoniae in gerbils; Muffat-Joly M et al.; OBJECTIVE: Study and development of a gerbil model of pneumococcal meningoencephalitis secondary to acute middle ear (ME) otitis . Preliminary data raised the hypothesis of a direct bacterial dissemination from the ME focus to the central nervous system . This infection pattern was examined . DESIGN: Animals were inoculated bilaterally by transbulla challenge with a serotype 3 strain of Streptococcus pneumoniae at various inoculum sizes . The incidence and course of meningeal complications were studied in relation to the course of ME otitis . RESULTS: After inoculation of 40 bacteria per ear, lethal meningeal complications occurred in 14 (29%) of 48 cases . A 76% rate (25 of 33 animals) of early meningeal involvement was observed after inoculation of 10(4) bacteria per ear . Actual involvement of brain was confirmed histologically for both infection schemes . Bacterial counts 20 to 22 hours after infection with the higher inoculum showed various phases of the extension of the ME infection to brain tissue, cerebrospinal fluid, and bloodstream . Bacterial counts in ME and brain tissue were strongly correlated (P < .001) . Nine of the 25 animals with infection of the central nervous system had positive brain tissue cultures without bacteremia . CONCLUSION: Gradations in inflammatory aspects of the meninges and cerebral parenchyma, together with bacteriologic findings, indicate a primary invasion of meningeal spaces that can result in lethal encephalitis and septicemia . This model might be useful for preclinical therapeutic assays on pneumococcal meningeal complications, including infections due to strains with abnormal susceptibility to antibiotics. J Bacteriol, 1994 Sep, 176(17), 5574 - 7 Penicillin-binding protein 2b of Streptococcus pneumoniae in piperacillin-resistant laboratory mutants; Hakenbeck R et al.; In Streptococcus pneumoniae, alterations in penicillin-binding protein 2b (PBP 2b) that reduce the affinity for penicillin binding are observed during development of beta-lactam resistance . The development of resistance was now studied in three independently obtained piperacillin-resistant laboratory mutants isolated after several selection steps on increasing concentrations of the antibiotic . The mutants differed from the clinical isolates in major aspects: first-level resistance could not be correlated with alterations in the known PBP genes, and the first PBP altered was PBP 2b . The point mutations occurring in the PBP 2b genes were characterized . Each mutant contained one single point mutation in the PBP 2b gene . In one mutant, this resulted in a mutation of Gly-617 to Ala within one of the homology boxes common to all PBPs, and in the other two cases, the same Gly-to-Asp substitution at the end of the penicillin-binding domain had occurred . The sites affected were homologous to those determined previously in the S . pneumoniae PBP 2x of mutants resistant to cefotaxime, indicating that, in both PBPs, similar sites are important for interaction with the respective beta-lactams. J Med Microbiol, 1994 Sep, 41(3), 184 - 90 Production of specific glycosidase activities by Streptococcus intermedius strain UNS35 grown in the presence of mucin; Homer KA et al.; An isolate of Streptococcus intermedius from a brain abscess showed neuraminidase (sialidase), beta-D-galactosidase, N-acetyl-beta-D-glucosaminidase and N-acetyl-beta-D-galactosaminidase activities . The optimal pH values of these enzymes were 5.5-6.0, 5.5-6.0, 5.0-5.5 and 5.0-5.5, respectively . The km of the enzymes varied according to whether the type of substrate was chromogenic or fluorogenic; sialidase was most active at the lowest substrate concentrations, with a km of 0.01 mM . In semi-defined medium, with porcine gastric mucin--a model glycoprotein--as the sole source of fermentable carbohydrate, levels of the glycosidases were significantly increased . Addition of glucose to the mucin-containing medium, or growth of cells in media supplemented with glucose alone, repressed glycosidic activities and the majority of these were cell-associated . S . intermedius cells from cultures grown with mucin were able, simultaneously, to transport via sugar:phosphoenolpyruvate phosphotransferase (PTS) systems, monosaccharides which are constituents of carbohydrate side chains of glycoproteins . These cells also possessed significant levels of neuraminate-pyruvate lyase, involved in the intracellular catabolism of neuraminic acid; this was absent from cells grown with glucose . These mechanisms, collectively, may facilitate the persistence and growth of S . intermedius in vivo. Infect Immun, 1994 Sep, 62(9), 3829 - 36 Pneumolysin activates phospholipase A in pulmonary artery endothelial cells; Rubins JB et al.; Pneumolysin has been identified as a virulence factor in Streptococcus pneumoniae disease . In addition to producing tissue injury through its cytolytic effect, pneumolysin might injure tissues indirectly by eliciting an inflammatory response . We demonstrate for the first time that pneumolysin is a rapid and potent activator of cellular phospholipase A in bovine pulmonary artery endothelial cells . In contrast to other toxin-activated phospholipases, pneumolysin-stimulated phospholipase A showed no substrate specificity among major cellular membrane phospholipids . Phospholipase A activation required the formation of functional transmembrane pores by pneumolysin rather than membrane lipid perturbation . Pneumolysin stimulation of phospholipase A was calcium dependent; however, pneumolysin did not appear to function simply as a calcium ionophore . Pneumolysin was capable of stimulating purified bee and snake venom phospholipase A2s against a phospholipid substrate isolated from endothelial cells . Thus, pneumolysin stimulates cellular phospholipase A and the resulting products might further injure tissues by direct cytolytic effect or by evoking inflammatory responses. Infect Immun, 1994 Sep, 62(9), 3688 - 95 A neuraminidase from Streptococcus pneumoniae has the features of a surface protein; Camara M et al.; A gene from Streptococcus pneumoniae (nanA), with features entirely consistent with a neuraminidase gene, has been sequenced . High levels of neuraminidase activity were obtained after cloning of this gene, without flanking sequences, into a high-expression vector . RNA hybridization studies have shown that the gene is transcribed by a virulent pneumococcus strain . The predicted molecular weight of the protein and certain amino acid sequences are typical of other neuraminidases . NanA contains the four copies of the sequence SXDXGXTW that is present in all the bacterial neuraminidases previously described . Kyte and Doolittle analysis showed that NanA is a hydrophilic protein with hydrophobic domains at the N terminus and the C terminus . A putative signal peptide was found in the N terminus of this protein, indicating that the protein is exported from the pneumococcus . The C terminus has the features of the anchor motif found in other surface proteins from gram-positive bacteria . Electron microscopy studies showed the presence of neuraminidase associated with the cell surface of the pneumococcus. Infect Immun, 1994 Sep, 62(9), 3599 - 603 Local vaccination with killed Streptococcus uberis protects the bovine mammary gland against experimental intramammary challenge with the homologous strain; Finch JM et al.; The ability of killed streptococcus uberis to induce protection against mastitis when administered either into the cistern of the dry mammary gland (intramammary vaccination) without adjuvant or subcutaneously with adjuvant was investigated . Bacteria were never reisolated from vaccinated quarters following challenge with the same strain during the subsequent lactation, and no inflammatory response was detected . In contrast, following subcutaneous vaccination, milk from challenged quarters contained very small numbers of bacteria, but these quarters did exhibit clinical disease, whereas quarters on nonvaccinated control animals produced discolored, clotted secretion with large numbers of bacteria and somatic cells and required antibiotic therapy by 60 h postchallenge . There was a significant increase in the levels of S . uberis-specific immunoglobulin G1 (IgG1), IgG2, and IgM in milk following intramammary vaccination and in the levels of specific IgG1 and IgG2 in milk following subcutaneous vaccination . Levels of specific antibody in serum were also elevated following vaccination by either route . However, despite this, there was no increase in the opsonic activity of serum or milk . Both peripheral blood lymphocytes and dry-period mammary gland lymphocytes showed strong proliferative responses to S . uberis in vitro following subcutaneous vaccination, but only mammary gland lymphocytes responded following intramammary vaccination . It was concluded that the protection seen in vaccinated quarters did not appear to be related to levels of specific antibody or neutrophil function and was possibly brought about by the inhibition of bacterial growth. Eur Respir J, 1994 Sep, 7(9), 1635 - 9 A hospital outbreak of penicillin-resistant pneumococci in The Netherlands; Mandigers CM et al.; Respiratory infections with penicillin resistant pneumococci constitute an increasing health care problem . This paper describes the nosocomial spread of penicillin resistant pneumococci (PRP) on a pulmonary ward . During an eight-month period, minimal inhibitory concentrations (MICs) for penicillin and several other antibiotics were performed on all Streptococcus pneumoniae isolates that were shown to be penicillin resistant by a screening assay . The personal data and case history of all patients with penicillin resistant pneumococci were evaluated . Penicillin Resistant Pneumococci were cultured from 18 patients, 16 men (mean age 74 +/- 8 yrs) and 2 women (aged 54 and 60 yrs) . Chronic obstructive pulmonary disease was diagnosed in 16 patients, 10 of which had an additional underlying disease (2 diabetes mellitus, 2 heart failure, 2 malignancy) . Prior to culture of Penicillin Resistant Pneumococci, 11 out of 18 patients were treated with antibiotics, a beta-lactam in most instances . Ten out of 18 patients died during or shortly after hospitalization . The death of one patient seems to be directly related to infection with Penicillin Resistant Pneumococci . The five Penicillin Resistant Pneumococci isolates available for serotyping were all type 9 . The minimal inhibitory concentrations for penicillin varied from 0.5 to 2.0 mg.l-1 . High minimal inhibitory concentrations were also noted for cefixime (all over 4.0 mg.l-1) and ceftriaxone (0.5-1.0 mg.l-1) . It is concluded that penicillin resistant pneumococci can spread rapidly among old and debilitated patients . Thus, patients with this infection should be barrier nursed. Jpn J Antibiot, 1994 Sep, 47(9), 1160 - 85 {Antimicrobial activities of ciprofloxacin against recently obtained clinical isolates}; Deguchi K et al.; In order to evaluate antimicrobial activity of ciprofloxacin (CPFX), minimum inhibitory concentrations (MICs) of CPFX and other drugs were determined against clinical isolates that were obtained in our laboratory from January to December of 1991, and of 1993 . The results are summarized as follows: 1 . CPFX-resistant strains were on the increase in various strains, compared to those in the early 1980s . However, many of CPFX-resistant strains were multi-drug resistant including beta-lactams . In addition, they showed cross resistance to other fluoroquinolone agents . 2 . MIC distribution of other drugs suggested that there were increased frequencies of benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae (PISP) and CEPs-resistant Escherichia coli . However, MIC distribution of CPFX to these resistant strains were in a relatively low range . 3 . When isolates of 1991 were compared to those of 1993, we confirmed that CPFX-resistant strains decreased among certain bacteria such as Staphylococcus aureus . Also we confirmed that fewer CPFX-resistant strains were found among bacteria that may be highly related to infections encountered in daily medical care. Nippon Kyobu Geka Gakkai Zasshi, 1994 Sep, 42(9), 1350 - 4 {A case of aortic and mitral regurgitation with two aneurysms in the mitral valve}; Ichikawa Y et al.; A 59-year-old male was found to have two aneurysms in the mitral valve, mitral regurgitation, and aortic regurgitation by the echocardiographic examination . The patient had a previous history of infectious endocarditis by streptococcus at the age of 24 . Under the diagnosis of mitral aneurysms developed after infectious endocarditis, surgery was undertaken . A 5 x 8 mm sized perforation in the right coronary cusp and two aneurysms in the anterior mitral leaflet, 22 mm and 17 mm in size, were found intraoperatively . Both the mitral and aortic valves were replaced . Patients with a history of infectious endocarditis have to be followed up for a long period of time . Transesophageal echocardiogram is useful in those patients . Considering high prevalence of aortic valvular diseases in those with a mitral aneurysm after infectious endocarditis, aortic valves should be carefully evaluated. J Am Vet Med Assoc, 1994 Sep 1, 205(5), 739 - 41 Streptococcus dysgalactiae polyarthritis in dairy goats; Blanchard PC et al.; Two Saanen does on the same farm developed signs of polyarthritis . Streptococcus dysgalactiae was isolated on microbial culture of samples from multiple joints of both goats . Antibiotic susceptibility testing of the S dysgalactiae revealed resistance to tetracycline, a commonly used antibiotic to treat arthritis in goats . The isolate was susceptible to penicillin . Polyarthritis was clinically diagnosed in 25 Saanen goats on this farm over a 2-year period . Streptococcus dysgalactiae has been reported as a cause of polyarthritis in calves and lambs and should be considered as a cause of polyarthritis in adult goats . Joint fluid samples for Mycoplasma, aerobic bacterial, and Chlamydia culture and serum samples for caprine arthritis-encephalitis virus serologic testing should be obtained from live goats during clinical evaluation of herd outbreaks of polyarthritis. Ear Nose Throat J, 1994 Sep, 73(9), 648 - 54 Acute mastoiditis--revisited; Luntz M et al.; The clinical course and causative organisms were studied in 18 patients with acute mastoiditis, 13 of whom (72%) had no previous history of middle ear disease . Their age ranged from 5 months to 21 years, and duration of middle ear symptoms immediately prior to admission ranged from 1 to 45 days (average 9.7 days) . None had undergone a myringotomy prior to admission, while 13 (72%) had been receiving antibiotic treatment for acute otitis media . Three were admitted with intracranial complications . Bacteria were isolated in 10 of the 16 patients in whom samples were available for bacterial culture, and included Streptococcus pneumonia (2), Streptococcus pyogenes (2), Staphylococcus aureus (2), Staphlococcus coagulase negative (2), Klebsiella pneumonia (1), and Pseudomonas aeruginosa (1) . Of the 17 patients treated by us, 11 received surgery . Acute otitis media, secretory otitis media, acute mastoiditis, subacute mastoiditis and masked mastoiditis create a continuum . Antibiotic treatment for acute otitis media cannot be considered as an absolute safeguard against acute mastoiditis . When antibiotics are prescribed for acute mastoiditis before culture result is available, an anti-staphylococcal agent should be included . At least some patients with acute mastoiditis develop a primary infection of the bony framework of the middle ear cleft . The prevalence of the intracranial complications in acute mastoiditis is still high and may appear soon after or concomitant with the first sign of acute mastioditis. Microbiol Rev, 1994 Sep, 58(3), 563 - 602 Bacterial gene transfer by natural genetic transformation in the environment; Lorenz MG et al.; Natural genetic transformation is the active uptake of free DNA by bacterial cells and the heritable incorporation of its genetic information . Since the famous discovery of transformation in Streptococcus pneumoniae by Griffith in 1928 and the demonstration of DNA as the transforming principle by Avery and coworkers in 1944, cellular processes involved in transformation have been studied extensively by in vitro experimentation with a few transformable species . Only more recently has it been considered that transformation may be a powerful mechanism of horizontal gene transfer in natural bacterial populations . In this review the current understanding of the biology of transformation is summarized to provide the platform on which aspects of bacterial transformation in water, soil, and sediments and the habitat of pathogens are discussed . Direct and indirect evidence for gene transfer routes by transformation within species and between different species will be presented, along with data suggesting that plasmids as well as chromosomal DNA are subject to genetic exchange via transformation . Experiments exploring the prerequisites for transformation in the environment, including the production and persistence of free DNA and factors important for the uptake of DNA by cells, will be compiled, as well as possible natural barriers to transformation . The efficiency of gene transfer by transformation in bacterial habitats is possibly genetically adjusted to submaximal levels . The fact that natural transformation has been detected among bacteria from all trophic and taxonomic groups including archaebacteria suggests that transformability evolved early in phylogeny . Probable functions of DNA uptake other than gene acquisition will be discussed . The body of information presently available suggests that transformation has a great impact on bacterial population dynamics as well as on bacterial evolution and speciation. J Laryngol Otol, 1994 Sep, 108(9), 779 - 82 Two cases of lateral sinus thrombosis presenting with extracranial head and neck abscesses; Pearson CR et al.; Two cases of lateral sinus thrombosis in fit adults with no previous otological history are presented . One case occurred in association with Bezold's abscess and followed mastoiditis which was masked by previous antibiotic treatment . The other case occurred in association with an occipitoparietal scalp abscess and there was no obvious preceding middle ear infection . The causative bacteria were Streptococcus milleri and a variant Streptococcus intermedius . Lateral sinus thrombosis is discussed. Kansenshogaku Zasshi, 1994 Sep, 68(9), 1113 - 6 {A case report of toxic shock-like syndrome associated with prevalence of streptococcal pharingitis in the family}; Shimizu Y et al.; A case of streptococcal toxic shock-like syndrome in a previously healthy, 57 year old Japanese female has been reported . Initially, she had a sore throat and low grade fever for 5 days . Because of sudden severe pain on the extremities and erythema on bilateral forearms, she was hospitalized . On admission, her conciousness was clear . Although profound hypotension, anuria and prolonged blood coagulation were observed . Antibiotics, fluid therapy and dopamine were given . Four hours after admission, she died in spite of resuscitation efforts, by sudden cardiac arrest . Streptococcus pyogenes was isolated in her blood . At the same time as when she died, three of the five people of the patient's family living with her, had pharingitis or pneumonia . From the pharynxs of the three people with pharingitis, Streptococcus pyogenes was also isolated . The serotype of all organisms was T11, and they produced exotoxintype B in vitro . This case suggests that infection of Streptococcus pyogenes is not essential for the development of toxic shock-like syndrome. Microbiology, 1994 Sep, 140 ( Pt 9), 2433 - 8 Transport of mannose by an inducible phosphoenolpyruvate:fructose phosphotransferase system in Streptococcus salivarius; Pelletier G et al.; Streptococcus salivarius transports mannose by a phosphoenolpyruvate:sugar phosphotransferase system (PTS) which consists of a membrane Enzyme II and two forms of Enzyme III (IIIMan) with molecular masses of 38.9 kDa (IIIManH) and 35.2 kDa (IIIManL) respectively . Using a pseudorevertant (strain 57P) isolated from a IIIManL-deficient spontaneous mutant unable to grow on mannose, we demonstrated that S . salivarius could also transport mannose by an inducible fructose PTS . This PTS phosphorylated fructose at the C-1 position with a high affinity (10 microM) and mannose at the C-6 position with a low affinity (200 microM) . Derepression of this system in some IIIManL-deficient mutants would explain their ability to grow on mannose. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1994 Sep-Oct, 35(5), 449 - 54 Brachial plexus neuropathy secondary to septic arthritis and osteomyelitis: report of two cases; Wang YC et al.; Two infants, delivered uneventfully, later developed right brachial plexus palsy secondary to pyogenic osteomyelitis and arthritis of the right shoulder joint . Weakness of right arms occurred at the sixth and tenth days of age respectively . Both had right arm tenderness on palpation and passive movement . Roentgenograms of their right shoulder joints showed irregular radiolucency of the proximal margin of right humerus head . In both cases, electromyography revealed various degrees of significant denervation pattern for the C5-C7 innervated muscles . Pus culture from right shoulder joints grew Streptococcus viridans and Staphylococcus aureus, respectively . After antibiotic therapy and arthrotomy with drainage, weakness improved gradually following continuous rehabilitation . Follow-up at six months of age showed almost complete recovery of right upper extremity function in one patient, but mild residual weakness in the other . Follow-up electromyography studies showed continued improvement . The possible mechanism of this rare occurrence is discussed. J Dent Res, 1994 Sep, 73(9), 1503 - 8 Change of salivary IgA secretion and caries development in irradiated rats; Takei T et al.; Xerostomia is a serious side-effect of radiotherapy for head and neck cancer and often enhances caries activity . However, the relationship between caries induction and the IgA level in saliva in rats subjected to irradiation of the salivary glands is unclear . The effect of salivary gland irradiation on salivary function was examined in specific pathogen-free Sprague-Dawley rats infected with or without Streptococcus mutans MT8148R (serotype c) . The flow rate of saliva and the protein concentration in saliva were significantly reduced in irradiated rats, regardless of infection of S . mutans . The caries activity was enhanced in these rats, and and irradiation level of 50 Gy significantly increased the caries score . However, longitudinal study indicated that the salivary concentration of IgA reactive with S . mutans whole cells maintained similar or significantly higher levels in irradiated rats, when compared with those of nonirradiated rats . In addition, there was no negative correlation between the caries score and the salivary concentration of IgA reactive with S . mutans . These findings suggest that the secreted IgA against S . mutans may not play a significant role in the caries induction of hyposalivated rats. Zh Mikrobiol Epidemiol Immunobiol, 1994 Sep-Oct, (5), 10 - 3 {The heterogeneity of Streptococcus pyogenes strains isolated from clinically healthy and sick children in an organized collective}; Bitko SA et al.; Experiments on typed strains used as an example revealed that kinetic curves obtained in the lysis by endo-N-aretylmuramidase of virulent strains greatly differed from those obtained from nonvirulent ones: the lysis rate of M+ variants was less than that of M- variants; M- strains gave rather steep kinetic curves of lysis, while those of M+ strains were more declivous . In this study group A S . pyogenes cultures isolated from healthy and sick children in a summer camp were used . The study revealed that cultures, newly isolated from healthy and sick children, were heterogeneous with respect to the M+ and M- state of group A S . pyogenes strains, the amino acid composition of pepsin fragments of M-proteins in the cultures of streptococcus M 1 under study being also heterogeneous. Diagn Microbiol Infect Dis, 1994 Sep, 20(1), 7 - 11 Postantibiotic effect of roxithromycin on streptolysin O production, hydrophobicity, and bactericidal activity of PMNL by Streptococcus pyogenes; Shibl AM et al.; Exposure of Streptococcus pyogenes to 5 x minimum inhibitory concentration of roxithromycin for 1 h produced a significant postantibiotic effect . More than 2.5 h was necessary for roxithromycin-treated bacteria to increase by 1 log10 in colony-forming units after drug removal, compared with the unexposed cells . After exposure to and removal of the drug, treated cells failed to exhibit normal hemolytic activity for at least 4 h . The inhibitory effect persisted for 20 h after drug removal, although the extent of growth for treated and untreated cells was almost the same . Hydrophobicity of treated cells, studied throughout the logarithmic growth phase with a water-hexadecan two-phase system, was markedly decreased by 40%, compared with untreated cells 4 h after drug removal . Cells that had been treated with roxithromycin became more susceptible to the bactericidal activity of human PMNL than untreated bacteria . The data indicate that some of the metabolic activity that contributes to the virulence of S . pyogenes is affected by postexposure to roxithromycin, and its minimum inhibitory concentration and serum level might not be the best indicators of efficacy in this class of drugs. J Chemother, 1994 Sep, 6 Suppl 4, 17 - 22; discussion 23-4 Treatment failure in otitis media: an analysis; Cohen R et al.; An epidemiological study was conducted in order to monitor the involvement of penicillin-resistant pneumococci (PRP) in treatment failure in acute otitis media (AOM), in an area of France where resistance to antibiotics is high . A total of 293 children presenting to 12 ear, nose and throat (ENT) specialists were included in the study . The mean age of the patients was 15.3 months and most of the children (58.7%) were attending day care centres . Bacteriological sampling demonstrated that in 146 cases (49.8%), no pathogen was present at the time of treatment failure . In the remaining patients Streptococcus pneumoniae was the most frequently recovered pathogen, being isolated from 81/147 (55.1%) of bacteriologically documented cases . Serotype 23F was the predominant strain, representing 53% of all S . pneumoniae isolates recovered . Resistance or reduced susceptibility to the prescribed antibiotic was seen in 70/81 (86.4%) of the S . pneumoniae isolates . In 32 out of 49 children administered a beta-lactam antibiotic, treatment failure involved PRP . Amoxycillin seemed to be the most active oral beta-lactam against these pathogens . The multiresistance of S . pneumoniae poses a serious therapeutic problem and should make myringotomy and bacteriological sampling obligatory in cases of antibiotic treatment failure. Mol Microbiol, 1994 Sep, 13(6), 1101 - 9 Positive selection for resistance to 2-deoxyglucose gives rise, in Streptococcus salivarius, to seven classes of pleiotropic mutants, including ptsH and ptsI missense mutants; Gauthier L et al.; We have used the toxic non-metabolizable glucose/mannose analogue 2-deoxyglucose to isolate a comprehensive collection of mutants of the phosphoenolpyruvate:sugar phosphotransferase system from Streptococcus salivarius . To increase the range of possible mutations, we isolated spontaneous mutants on different media containing 2-deoxyglucose and various metabolizable sugars, either lactose, melibiose, galactose or fructose . We found that the frequency at which 2-deoxyglucose-resistant mutants were isolated varied according to the growth substrate . The highest frequency was obtained with the combination galactose and 2-deoxyglucose and was 15-fold higher than the rate observed with the mixture melibiose and 2-deoxyglucose, the combination that gave the lowest frequency . By combining results from: (i) Western blot analysis of IIIMan, a specific component of the phosphoenolpyruvate:mannose phosphotransferase system in S . salivarius; (ii) rocket immunoelectrophoresis of HPr and EI, the two general energy-coupling proteins of the phosphotransferase system; and (iii) from gene sequencing, mutants could be assigned to seven classes.(ABSTRACT TRUNCATED AT 250 WORDS) Anticancer Res, 1994 Sep-Oct, 14(5A), 1833 - 7 Evidence for the involvement of sulfhydryl groups in the expression of antitumor activity of streptococcal acid glycoprotein (SAGP) purified from crude extract of Streptococcus pyogenes; Yoshida J et al.; An acidic glycoprotein (SAGP), purified from crude extract (CE) of Streptococcus pyogenes, inhibits the growth of murine fibrosarcoma (Meth A) cells in vitro and prolongs the life span of mice inoculated with the same cells . This study revealed that the growth inhibitory activity of SAGP on Meth A cells in vitro was lowered in the presence of sulfhydryl-oxidizing agents such as cystamine and 5, 5'-dithiobis (2-nitrobenzoic acid) in a dose dependent manner . The activity of SAGP was also diminished by pretreatment of SAGP with cystamine . Inactivation of SAGP by cystamine was reversed by dithiothreitol . Furthermore, the effect of CE on prolonging the life span of Meth A-bearing mice was reduced by the administration of cystamine . These findings suggest that SH-groups are involved in the expression of anti-tumor activity of SAGP or CE in vitro and in vivo. Prev Med, 1994 Sep, 23(5), 627 - 31 The prevention of low birthweight and its sequelae; Goldenberg RL; BACKGROUND . Low birthweight and its components preterm birth and fetal growth retardation account for the vast majority of perinatal mortality and more than 50% of the long term neurologic morbidity . METHODS . Historical trends and the effectiveness of various interventions designed to improve pregnancy outcomes associated with low birthweight were evaluated in an attempt to define which future research efforts might be useful . RESULTS . Practices aimed at achieving a reduction in the low birthweight rate (the use of tocolytics, enhanced prenatal care, nutritional interventions) have not generally been successful or have not been widely utilized (smoking cessation programs) . Practices aimed at improving low birthweight survival and reducing morbidity (group B streptococcus prophylaxis, maternal corticosteroids, surfactant use, newborn ventilation) have been responsible for most of the improvements in outcome . CONCLUSION . Continued effort into discovering effective practices for reducing low birthweight, for understanding the most appropriate methods of implementing practices known to be effective in reducing low birthweight, and refinement of practices known to reduce mortality and long term handicap in low birthweight babies should be major foci of prevention research. Biol Chem Hoppe Seyler, 1994 Sep, 375(9), 609 - 15 Identity of human extra parotid glycoprotein (EP-GP) with secretory actin binding protein (SABP) and its biological properties; Schenkels LC et al.; In this paper the identity of the salivary protein EP-GP (extra-parotid glycoprotein) is reported, also apparent in other human secretions . Immunochemical and biochemical analysis demonstrated that EP-GP is similar to the secretory actin-binding protein (SABP), also known as gross cystic disease fluid protein-15 (GCDFP-15) and prolactin-inducible protein (PIP) . The molecular mass and charge microheterogeneity of EP-GP, also observed for SABP, was shown to be predominantly caused by the carbohydrate moiety . In addition, evidence was given that EP-GP is not related to the lipocalin Von Ebner's gland protein (human; VEGh) . The biological significance of EP-GP and its homologues is not clear . EP-GP bound to actin and fibrinogen as described for SABP and GCDFP-15 . However, the affinity for these proteins does not appear to have any direct physiological role in the mucosal secretions . On the other hand, EP-GP binds to several bacteria . By electron microscopy the ultrastructural localization is demonstrated of EP-GP to the cell wall of both Streptococcus salivarius HB and its cell appendage-lacking mutant Streptococcus salivarius HB-C12 . Concerning this finding we hypothesize on the possible functional aspects of this enigmatic protein EP-GP. Res Vet Sci, 1994 Sep, 57(2), 259 - 61 Serotypes and putative virulence markers of Streptococcus suis isolates from cats and dogs; Salasia SI et al.; Thirteen isolates of Streptococcus suis from cats and dogs were characterised . Formamide extracts of 10 of the 13 cultures reacted with group D specific antiserum, and serotyping of the cultures with specific antisera against capsular types 1 to 28 revealed the serotypes 9, 20, 1/2, 22, 26 and 4; the remaining cultures were untypable . In addition one of the cultures reacted with monoclonal antibodies against muramidase-released protein and in parallel with monoclonal antibodies against the extracellular factor (EF) of S suis . The latter reacted with proteins with a molecular weight of more than 150,000 indicating that the strain exhibited EF-related proteins . One of the 13 cultures haemagglutinated erythrocytes from human beings and various animal species and adhered in large numbers to HeLa cells. J Dairy Sci, 1994 Sep, 77(9), 2526 - 36 Effect of naturally occurring coagulase-negative staphylococcal infections on experimental challenge with major mastitis pathogens; Nickerson SC et al.; The influence of pre-existing Staphylococcus sp . IMI on development of new IMI after experimental challenge with Staphylococcus aureus and Streptococcus agalactiae was studied . The IMI data were analyzed from five trials in which quarters were challenged with major pathogens incident to studies of teat dip efficacy . Prior to each trial, quarter IMI status was determined, and new IMI were enumerated during challenge . Percentage of new Staph . aureus IMI in uninfected quarters was 3-fold that of quarters already infected with Staphylococcus sp . Of quarters that were initially uninfected, 13.23% acquired new Staph . aureus IMI, and 4.49% of quarters infected with Staphylococcus sp . became infected . Conversely, the percentage of new Strep . agalactiae IMI in quarters infected with Staphylococcus sp . was 1.5-fold that of uninfected quarters (8.38 vs . 5.52%) . The percentage of clinical Staph . aureus IMI in uninfected quarters was higher than for quarters infected with Staphylococcus sp., but percentages of clinical Strep . agalactiae IMI were similar among IMI statuses . Geometric mean SCC prior to challenge were 87 x 10(3) for uninfected quarters and 260 x 10(3)/ml for quarters infected with Staphylococcus sp . Quarters infected with Staphylococcus sp . were less susceptible to Staph . aureus IMI, but more susceptible to Strep . agalactiae IMI. FEMS Immunol Med Microbiol, 1994 Sep, 9(3), 245 - 51 The effects of growth in human serum on an acapsular group B Streptococcus mutant; Platt MW et al.; A Group B Streptococcus Type III (GBS) mutant which, when grown in Todd Hewitt broth (THB), does not produce any detectable capsule, produced a clearly visible polysaccharide capsule when grown in human serum . We isolated cytoplasmic membranes from GBS and separated the component membrane proteins by polyacrylamide gel electrophoresis . A significant change in membrane composition was found during growth in human serum . Several unique proteins were produced on serum growth and there was both up- and down-regulation of other proteins . We measured the intracellular levels of sialic acid for a variety of GBS serotype III isolates . Interestingly, while there was little difference between the intracellular sialic levels of most isolates, the sialic acid level of COH31-15 grown in THB was over 100% higher than that of any other isolate . When grown in serum this pool was reduced to a level similar to that in other strains . The concentration of bacterial cell sialic acid was directly correlated with the sialic acid content of the serum . Exogenous sialic acid content, in concert with other serum factors, plays a role in determining the capsular size in GBS. Antimicrob Agents Chemother, 1994 Sep, 38(9), 1953 - 8 In vivo efficacy of a broad-spectrum cephalosporin, ceftriaxone, against penicillin-susceptible and -resistant strains of Streptococcus pneumoniae in a mouse pneumonia model; Moine P et al.; The increasing emergence of penicillin-resistant (Pr) strains of Streptococcus pneumoniae could pose a therapeutic problem in the next few years . Ceftriaxone (CRO), a broad-spectrum cephalosporin, exhibits a smaller increase in MICs against Pr S . pneumoniae strains than amoxicillin (AMO) (usually referred as to the "gold standard" therapy for pneumococcal infections) . Therefore, we compared their respective efficacies in a leukopenic Swiss mouse model of pneumococcal pneumonia . Infection was induced with two serotype 19 strains: a penicillin-susceptible (Ps) strain (MICs of < 0.01 for penicillin, 0.03 for AMO, and 0.03 for CRO) and a Pr strain (MICs of 4 for penicillin, 2 for AMO, and 0.5 for CRO) . Untreated mice died within 2 or 3 days . Against the Ps strain, the minimal protective dose (two subcutaneous injections at 12-h intervals for 3 days) for both CRO and AMO was 5 mg/kg of body weight (87% survivors) . Ten-fold-increased doses of CRO (50 mg/kg) gave similar protection (75% survivors) against the Pr strain, whereas 20- and 40-fold-increased doses of AMO protected 0 and 34% of the animals, respectively, against the Ps strain . CRO had a marked and prolonged antibacterial effect in the lungs (2.7-log-unit reduction of CFU in 24 h after a single 50-mg/kg injection) against the Pr strain in comparison with AMO . A standard dosage of 50 mg of CRO per kg in mice resulted in peak levels in serum and protein binding comparable to those observed with 1 g given intravenously in humans . This dosage remained effective against a highly Pr S . pneumoniae strain in this model . The microbiological activity and pharmacodynamic and pharmacokinetic properties of CRO (time during which concentrations exceed the MIC for the test pathogen {delta t MIC}, > or less than 8 h; and peak/MIC ratio, >90 for free active drug) accounted for its efficacy relative to AMO (50 mg/kg: delta t MIC, <2; peak/MIC ratio, <25) against the highly Pr S . pneumoniae strain used in this study. J Infect, 1994 Sep, 29(2), 171 - 82 A review of the clinical presentation, laboratory features, antimicrobial therapy and outcome of 77 episodes of pneumococcal meningitis occurring in children and adults; Kirkpatrick B et al.; Seventy-seven episodes of pneumococcal meningitis in 69 patients were reviewed . Twelve (15.6%) episodes occurred in those over 60 years old, 14 (18.2%) in patients between 10 and 60 years, 22 (28.6%) in patients between 2 and 10 years and 29 (37.7%) in those under 2 years . Overall mortality was 13.0% (10/77) and age of > 60 years was significantly associated with mortality (P < 0.05) . Twelve episodes resulted in disabilities, eight of which were in those under 2 years, and took the form of hearing impairment in nine . Many patients had predisposing conditions with aural pathology, malignancy and diabetes mellitus being commonest in those over 10 years of age and aural pathology, preceding viral infection, renal disease, sinusitis or recent lower respiratory tract infection commonest in those aged between 2 and 10 years . Three of five patients with recurrent meningitis had CSF leaks . The most common features at presentation were fits, irritability, diarrhoea, and bulging fontanelles in those under 6 months; vomiting, drowsiness and poor feeding in those between 6 months and 2 years; neck stiffness, vomiting and drowsiness in those between 2 and 10 years while neck stiffness, focal neurology, headache and vomiting were commonest in those over 10 years old . Fever was common in all age groups as were foci of infection outside the CSF, with chest infections being significantly associated with mortality (P < 0.05) . Of the laboratory parameters measured, low platelets (< 100 x 10(9)/l and high blood urea (> 7 mmol/l) were associated with mortality (P < 0.05) . Blood cultures grew Streptococcus pneumoniae in 79.7% patients . Seventy-four (96%) patients had CSF taken of which 81% had gram films which were positive and interpreted correctly as showing pneumococci . Pneumococci were grown in 87.8% CSF cultures and all were sensitive to penicillin but a single isolate was chloramphenicol resistant . Many different antimicrobial drugs were used but penicillin plus chloramphenicol was the most commonly employed after the results of CSF microscopy were known and penicillin alone after culture results were available . Penicillin mono-therapy was associated with a low mortality. J Hosp Infect, 1994 Sep, 28(1), 31 - 7 An outbreak of group C streptococcal infection in a maternity unit; Galloway A et al.; An outbreak of Group C streptococcal infection (Streptococcus equisimilis serotype T204) occurred in a Maternity Unit in Durham over a 2-week period . The outbreak strain possessed an M-protein antigen identical to that found in a previously reported Maternity Unit outbreak . Seven patients in total were affected, and in two patients infected perineal wounds took several weeks to heal . The source of the outbreak appeared to be a patient who developed a perineal wound infection and who subsequently returned to the ward for reassessment . Environmental contamination is likely to have been the reservoir of infection for the subsequent patients . The outbreak was controlled by applying strict infection control procedures and establishing a high standard of routine cleaning. Ann Pharmacother, 1994 Sep, 28(9), 1014 - 7 Stability and activity of intravenous immunoglobulin with neonatal dextrose and total parenteral nutrient solutions; Lindsay CA et al.; OBJECTIVE: To determine in vitro the compatibility of reconstituted intravenous immunoglobulin (IVIG) (Gammagard, Baxter-Hyland) with five different neonatal and pediatric intravenous solutions in Viaflex polyvinyl chloride bags . DESIGN: In vitro compatibility study . INTERVENTIONS: Samples were taken at time = 0, 10, 30, 60, 90, and 120 minutes and at 4, 8, 12, and 24 hours and assayed for total immunoglobulin G content and antibodies to hepatitis B surface antigen . Type III group B Streptococcus (GBS) and opsonic activity for type III GBS were analyzed at time = 0, 60, and 120 minutes and 12 and 24 hours . All results were compared with those from pure IVIG . RESULTS: Our results demonstrate that mixing IVIG with intravenous solutions commonly used in the care of premature infants (dextrose 5% in water {D5W}, D15W, D5W/NaCl 0.225%, and total parenteral nutrition {TPN}) does not significantly alter total immunoglobulin G concentrations or concentration of antibodies to hepatitis B surface antigen or type III GBS . As well, the in vitro functional activity for type III GBS of the IVIG, when mixed with these solutions for up to 24 hours, remained intact . An apparent decrease in bactericidal killing was seen with the IVIG/central TPN mixture . This apparent decrease was found to be an artifact of the high concentration of glucose (20 percent) in the solution . CONCLUSIONS: We propose that Gammagard may be mixed with these solutions through Y-site connections without loss of antibody content or functional activity of the IVIG. J Periodontal Res, 1994 Sep, 29(5), 318 - 23 Cytotoxicity in bacterial cultures: interaction and cell-specificity, possible factors in periodontal disease; Johansson A et al.; Cytotoxicity in culture media of various growing bacterial strains was estimated by Cr-51 release of labelled target-cells . Interaction studies were made by adding each of the different UV-killed bacteria to the medium with viable bacteria . The reference oral bacterial strains were: Actinobacillus actinomycetemcomitans Y4, Porphyromonas gingivalis, Fusobacterium nucleatum and Streptococcus mitis, which were compared with the reference bacteria Staphylococcus aureus 209 and Staphylococcus epidermidis . The target cells were: gingival fibroblasts (GF), periodontal membrane fibroblasts (PMF), pulpal fibroblasts (PF), HeLa-cells (HeLa), and lymphoid neoplasm cells (LN) . Synergistic, as well as antagonistic, effects on target cells were observed . The cytotoxicity of A . actinomycetemcomitans in presence of P . gingivalis is neutralized while in presence of S . aureus it was increased . Bacterial interactions with F . nucleatum and P . gingivalis cytotoxicity were observed . The cytotoxicity of F . nucleatum was increased when cultured together with A . actinomycetemcomitans . Each cell type reacted differently to the toxicity of the supernatant of growth medium in which the same bacterial strain had been cultivated, which indicates cell specificity of the toxins. Arq Bras Cardiol, 1994 Sep, 63(3), 211 - 3 {Beta-hemolytic streptococcus endocarditis in an adolescent with hypertrophic cardiomyopathy}; Aoun NB et al.; A 15 year-old male adolescent was hospitalized in a severe septic condition, due to infectious endocarditis which abided for 20 days . The admittance echocardiogram displayed a mitral valve vegetation in conjunction to a hypertrophic cardiomyopathy . In spite of applied antibiotics the patient expired . The authors emphasize the diagnostic difficulties of this compound entity and stress the need of antibiotic prophylaxis for patients who bear a hypertrophic cardiomyopathy, even in those with a non-obstructive disposition. Arq Bras Cardiol, 1994 Sep, 63(3), 173 - 7 {Infective endocarditis in children and adolescents}; Jorge Sdo C et al.; PURPOSE--To assess infective endocarditis (IE) predisposing factors, etiologic agents and hospital course in infants and adolescents . METHODS--We Studied 222 patients admitted under compatible IE diagnosis, from 1985 to 1990 . The population of this study is fifty patients (23%) under 16 years of age . RESULTS--Rheumatic valvular disease, as predisposing cardiopathy was proeminent within 9 to 16 years of age, markedly Statistical difference when compared to age range of 0 to 8 years (p < 0.05) . Among congenital cardiopathies, the most frequent were: interventricular septal defect (26.0%) and tetralogy of Fallot (21.7%) . Blood cultures, surgical material or emboli cultures were positive in 35 (70.0%) assessed patients . Streptococcus viridans (45.7%) and Staphylococcus aureus (42.8%) were the etiologic agents most often isolated . It was found that endocarditis by Staphylococcus aureus had mortality rate of 53.3% {(clinical (66.6%) and surgical (44.4%)}, (p < 0.05) when compared to those by Streptococcus viridans; with total mortality of 6.2% (no clinical death and 16.6% in the surgical group) . Total in-hospital mortality (clinical and surgical) was 26.0% (13 deaths) . CONCLUSION--IE in infants and adolescents in this studied population presented Streptococcus viridans responsible for 46.7% of patients with endocarditis and the Staphylococcus aureus for 42.8% were the etiologic agents most often found . Total, clinical and surgical mortality was greater in patients with endocarditis by Staphylococcus aureus when compared with those by Streptococcus viridans . Among the congenital cardiopathies, whether operated on or not, ventricular septal defect and of Fallot's tetralogy were the most involved ones; rheumatic cardiopathy Still remains a significant predisposing factor to infective IE in our country. J Dent Res, 1994 Sep, 73(9), 1493 - 502 Affinity and specificity of the interactions between Streptococcus mutans antigen I/II and salivary components; Hajishengallis G et al.; Adherence to salivary pellicle-coated tooth surfaces and aggregation by salivary components of Streptococcus mutans involves a major cell surface protein termed antigen (Ag) I/II . The objectives of this study were to evaluate the affinity and specificity of the interactions between AgI/II and human saliva in assays of 125I-AgI/II binding to saliva-coated hydroxyapatite (SHA) and of S . mutans aggregation by salivary agglutinin (SAG), monitored turbidimetrically . 125I-AgI/II binding to SHA followed saturation kinetics, and Scatchard plot analysis indicated two binding sites with dissociation constants of the order of 10(-10) mol/L and 10(-9) mol/L . The binding to SHA of the C-terminal one-third of AgI/II which corresponds to AgII was less than one-fifth that of the whole molecule and did not show evidence of saturation . The binding of 125I-AgI/II was inhibited by native or recombinant fragments that mapped in the N-terminal part of the molecule and that contained the alanine-rich repeat region, whereas fragments mapping at the central or C-terminal one-third had no effect . As with binding to SHA, the regions of AgI/II which inhibited aggregation mapped at the N-terminal part of the molecule, but, in addition, a recombinant segment mapping at the central part and containing the proline-rich repeat region was also inhibitory . The S . mutans-aggregating activity of SAG or whole saliva was inhibited by amino compounds, and most strongly by L-lysine and analogues possessing omega-primary amine groups . These data support the role of AgI/II as an adhesin with high-affinity binding for SHA receptors, mediated by the N-terminal part of the molecule . This region is also involved in SAG-induced S . mutans aggregation, which is sensitive to amino compounds. Infect Immun, 1994 Sep, 62(9), 4034 - 42 Identification of antigenic epitopes in a surface protein antigen of Streptococcus mutans in humans; Matsushita K et al.; The reactivities of antibodies in human serum and saliva to a cell surface protein antigen (PAc) of Streptococcus mutans and synthetic peptides covering the PAc molecule were examined . Both an enzyme-linked immunosorbent assay (ELISA) and Western blotting (immunoblotting) showed that all the serum samples from five adult subjects harboring serotype c S . mutans in their oral cavity reacted with recombinant PAc (rPAc) . On the other hand, the serum from a 4-month-old infant did not react with rPAc in ELISA . The immunoglobulin A (IgA) antibodies in saliva samples from the five adult subjects reacted with rPAc . However, in saliva samples from these subjects, the titers of IgA antibody to rPAc did not correlate with the titers of serum antibody to the antigen . To map continuous antigenic epitopes in the PAc molecule, we synthesized 153 decapeptides covering the entire mature PAc molecule, 121 overlapping decapeptides covering the alanine-rich repeating region (A-region) of the PAc molecule, and 21 overlapping decapeptides covering the middle region (residues 824 to 853) according to multiple pin-coupled peptide synthesis technology . Of 153 decapeptides covering the mature PAc, 27 decapeptides showed a strong reaction with the antibodies in serum from the adult subjects . The epitope-scanning patterns in the serum samples from these subjects were also very similar to each other . The antigenic epitope patterns in the saliva resembled those in the serum . However, the ELISA titers of salivary IgA antibodies to these decapeptides differed from the titers of the serum antibody . Of the 121 overlapping decapeptides covering the A-region, 27 decapeptides showed a positive reaction with the antibodies in serum from the adult subjects . All of these 27 decapeptides had either one or two of the five common sequences YQAXL, NADAKA, VQKAN, NNAKNA, and IKKRNA . Six decapeptides of the 21 overlapping decapeptides covering the middle region reacted strongly with the serum antibodies from a high PAc responder, and each of the six decapeptides had one of the two common sequences KVTKEKP and VKPTAPTK . These epitopes might therefore be relevant to the humoral responses against the PAc protein during natural infection with S . mutans in humans. BMJ, 1994 Aug 20-27, 309(6953), 506 - 8 Relation between mouth and haematogenous infection in total joint replacements; Bartzokas CA et al.; OBJECTIVE--To investigate the source of infections associated with orthopaedic prostheses . DESIGN--Analysis of four infections of prosthetic joints with case records; minimum inhibitory and minimum bactericidal concentrations and sodium dodecylsulphate polyacrylamide gel electrophoresis of the cell wall polypeptides of the Streptococcus sanguis isolates from the mouth and infected prostheses; examination of the patients' mouths for periodontal disease and caries . SUBJECTS--Four adults (three men) aged 58-83 . RESULTS--For each patient the strain of S sanguis isolated from the mouth was indistinguishable from that isolated from the prosthesis . All patients had severe periodontal disease and caries . CONCLUSIONS--The mouth was probably the source of bacterial infection in the prosthetic joints of these patients; the route of infection was possibly haematogenous . Incipient oral infection should be treated before joint replacement, and oral health should be maintained indefinitely. Biochem Biophys Res Commun, 1994 Aug 15, 202(3), 1407 - 12 Lipoteichoic acid from Streptococcus sanguis is a natural glucosyl acceptor for glucosyltransferases; Chiu TH et al.; The synthesis of methanol insoluble-{14C}labeled-polymers from {14C}sucrose by S . mutans glucosyltransferases was stimulated up to four-fold by the presence of highly purified, lipoteichoic acid (LTA) from S . sanguis . Gel filtration chromatography (Sepharose 4B) and ion exchange chromatography (DEAE-Bio-Gel A) of the {14C}labeled-polymers formed in the presence of {3H}glycerol-labeled-LTA showed that high molecular weight, negatively charged {14C}labeled-{3H}glycerol-labeled-LTA complexes were being formed . The {14C}component was identified as glucose by acid hydrolysis and paper chromatography . A similar high molecular weight, negatively charged {14C}glucosyl-{3H}glycerol-labeled-polymer was extracted from S . mutans cells grown in the presence of {3H}glycerol and {14C}sucrose, suggesting that LTA is a glucosyl-acceptor for glucosyltransferases in vivo as well as in vitro. Blood, 1994 Aug 15, 84(4), 1328 - 32 Increased risk of infection in marrow transplant patients receiving methylprednisolone for graft-versus-host disease prevention; Sayer HG et al.; One hundred forty-seven patients with hematologic diseases and treated by allogeneic marrow transplants received graft-versus-host disease (GVHD) prevention with methotrexate and cyclosporine . In addition, 73 of the 147 patients were randomized to receive methylprednisolone during the first 35 days after transplant to improve GVHD prevention, whereas 74 patients were randomized not to receive methylprednisolone . The randomized trial enabled us to examine whether methylprednisolone increased the risk of infection after marrow grafting . Charts of study patients were analyzed retrospectively for infection events including bacteremia, septicemia, and fungemia . The randomization was stratified by diagnosis, patient age, genotypic HLA identity, and assignment to laminar airflow room isolation . All patients were given a short course of methotrexate (no longer than 11 days) and cyclosporine for no longer than 180 days after marrow transplantation . Methylprednisolone was begun on the day of marrow grafting at a dose of 1 mg/kg body weight intravenously in divided AM and PM doses through day 22 . Methylprednisolone was administered at a dose of 0.5 mg/kg in divided doses from days 22 through 35, and then discontinued . Infections were analyzed for the time interval ending on day 65 after transplantation, which included the period of methylprednisolone administration and 1 month thereafter . Seventy-one episodes of first infection events were observed in patients receiving methylprednisolone compared with 47 episodes in patients not receiving the drug . Predominant infections were bacteremias, followed in descending order by fungemias and septicemias . The most prevalent organisms cultured were gram-positive bacteria, especially coagulase-negative Staphylococcus and Streptococcus species . Pseudomonas species were the most common gram negative bacteria, and the most prevalent fungus was Candida albicans . Multivariable Cox regression analysis showed that patients receiving methylprednisolone had a 1.5 times higher risk of infection (P = .03), with acute GVHD being another independent risk factor for infections (P = .005) . Methylprednisolone, when added to GVHD prevention by methotrexate and cyclosporine, increases the risk of infection during the early posttransplantation period. FEMS Microbiol Lett, 1994 Aug 15, 121(2), 243 - 9 Differential localization of the Streptococcus mutans GS-5 fructan hydrolase enzyme, FruA; Burne RA et al.; Streptococcus mutans GS-5 synthesizes an exo-beta-D-fructosidase, FruA, capable of degrading levans, inulins, sucrose and raffinose, with the greatest activity on levans . A previous analysis of the deduced amino acid sequence of the FruA protein revealed the presence of a C-terminus with an LPXTGX membrane sorting sequence and membrane spanning domain, characteristic of many Gram-positive cocci surface proteins . Here it is demonstrated that FruA, which had been previously shown to exist almost exclusively as an extracellular enzyme, can be detected in significant proportions at the surface of S . mutans cells . Moreover, growth of S . mutans GS-5 at steady state in continuous culture at pH values of 7.0, 6.0, or 5.0 revealed that the amount of cell-associated enzyme increased with decreasing pH values, such that roughly 50% of the total fructanase activity of pH 5.0-grown organisms was cell-associated . This result was confirmed using anti-recombinant-FruA antisera in Western blotting of culture supernate and cell-associated enzyme preparations from chemostat-grown cells . Incubation of S . mutans at pH values of 5.0, 6.0 or 7.0 in buffered media yielded results similar to those observed in the chemostat experiments . The release of FruA from S . mutans was also shown to be inhibitable by copper, which is known to interfere with the release of the surface adhesin, P1, from intact cells and protoplasts of S . mutans . These data provide evidence for a unique post-translational mechanism for the regulation of the catabolism of polysaccharides by bacteria.(ABSTRACT TRUNCATED AT 250 WORDS) FEMS Microbiol Lett, 1994 Aug 15, 121(2), 237 - 41 Identification and characterisation of two extracellular proteases of Streptococcus mutans; Harrington DJ et al.; Streptococcus mutans was shown to produce two extracellular proteases capable of degrading both gelatin and collagen-like substrates . These enzymes have molecular masses of 52 and 50 kDa when analysed by SDS-PAGE . Both enzymes were inhibited by EDTA, but not by a range of other inhibitors with different specificities, indicating that they are metalloproteases . The activity of EDTA-inactivated enzymes could be restored by the addition of manganese and zinc . The identical inhibition and restoration profiles of the two enzymes suggest that one of the proteases may be a degradation product of the other. FEMS Microbiol Lett, 1994 Aug 15, 121(2), 217 - 21 A role in cell-binding for the C-terminus of pneumolysin, the thiol-activated toxin of Streptococcus pneumoniae; Owen RH et al.; Cell binding of pneumolysin to target cells is an important step in the lysis of cells by this toxin . We sought to locate the cell-binding region of pneumolysin . Deletion of the six C-terminal amino acids decreased cell-binding activity by 98% . Furthermore, mutagenesis of an amino acid near the C-terminus decreased the cell-binding activity of full-length pneumolysin by 90% . The C-terminus of pneumolysin has an important role in cell-binding activity. Vet Microbiol, 1994 Aug 15, 41(4), 321 - 32 Streptococcus bovis infections in pigeons: virulence of different serotypes; De Herdt P et al.; In a first experiment, the relative virulence for pigeons of 5 strains of S . bovis was assessed by experimental inoculations . Two S . bovis serotype 1 strains, one serotype 2 strain and two serotype 3 strains were examined . One of the serotype 1 strains and the serotype 2 strain were isolated from pigeons that died from septicaemia . The other strains were isolated from cloaca samples of healthy pigeons . For each strain, 10-20 pigeons were intravenously inoculated with 1 x 10(9) CFU . Morbidity after infection with the serotype 1 and 2 strains varied between 75% and 90% . Disease signs included inability to fly, lameness, emaciation, production of slimy, green droppings, polyuria and sudden death . In groups of pigeons inoculated with the serotype 3 strains, morbidity was 0% and 6%, respectively . Results demonstrate that serotype 3 strains are less virulent for pigeons than serotype 1 and 2 strains . In a second experiment, bacteriological and histological examinations were performed on organs of pigeons serially killed between 1 and 10 days after experimental inoculation with an S . bovis serotype 3 strain of low virulence . Results were compared with results of studies carried out with a highly virulent serotype 1 strain . Notwithstanding bacterial spread and replication in various organs of inoculated pigeons, clinical disease was not observed and histological lesions were scarce and of limited extent. N Engl J Med, 1994 Aug 11, 331(6), 377 - 82 Management of infections caused by antibiotic-resistant Streptococcus pneumoniae; Friedland IR et al.; The increasing resistance of S . pneumoniae to antimicrobial agents is a cause for concern . Although a number of therapeutic strategies are possible, local patterns of resistance must be considered . It is essential to determine the susceptibility of individual strains to penicillin and other antimicrobial agents that could be used for therapy . Communication between the clinician and the laboratory is vital to determine the best therapeutic options . The recent recognition of cephalosporin-resistant strains emphasizes the need to determine susceptibility to cephalosporins . Clinical laboratories should be aware of the recently proposed changes in the definition of cephalosporin resistance, and clinicians need to be aware of how these changes affect the choice of antibiotic therapy . Until pneumococcal disease can be effectively prevented, we can expect resistant pneumococcal infections to continue to pose therapeutic difficulties. J Mol Biol, 1994 Aug 5, 241(1), 44 - 58 Three highly homologous membrane-bound lipoproteins participate in oligopeptide transport by the Ami system of the gram-positive Streptococcus pneumoniae; Alloing G et al.; Oligopeptides are an important source of nutrients, but can serve also as signals for intercellular communication . Oligopeptide-binding proteins seem likely to play a role both in oligopeptide transport and in communication processes . One such protein, AmiA, has been identified in Streptococcus pneumoniae . amiA is the first gene of an operon, ami, which encodes a multicomponent oligopeptide transporter belonging to the family of ABC transporters (or traffic ATPases) . This transporter was the first system of this type described in Gram-positive bacteria . To investigate the role and the subcellular location of the putative oligopeptide-binding protein in a bacterium devoid of periplasm, AmiA null mutants were first constructed . None was affected for oligopeptide uptake by the Ami system . Since this apparent dispensability of AmiA could result from a functional redundancy, we looked for chromosomal genes encoding homologues of AmiA . Two homologous genes were identified by DNA-DNA hybridization at low stringency with an amiA probe . Both genes (aliA and aliB) were cloned and shown to encode putative lipoproteins highly homologous to AmiA (close to 60% amino acid identity) . Examination of all combinations of amiA, aliA and aliB mutations indicated that these proteins have overlapping specificities toward oligopeptides . The triple mutant is as deficient for oligopeptide transport as mutants in the amiCDE or F genes, which demonstrates that an oligopeptide-binding component is absolutely required for transport by the Ami system . Metabolic labelling with {3H}palmitic acid and cell fractionation were used to demonstrate that the three proteins are indeed membrane-bound lipoproteins in S . pneumoniae . This supports our previous hypothesis that substrate-binding lipoproteins are functionally equivalent to the periplasmic substrate-binding component of ABC transporters of Gram-negative bacteria . Finally, the observation that competence for genetic transformation was drastically reduced in a particular AliB mutant suggests that oligopeptide sensing is important for triggering competence. Scand J Dent Res, 1994 Aug, 102(4), 206 - 9 Efficacy of chlorhexidine solution with fluoride varnishing in preventing enamel softening by Streptococcus mutans in an artificial mouth; Sorvari R et al.; For study of the enamel-protective effect of chlorhexidine-fluoride applications, the labial surfaces of pieces of bovine incisors were treated with 0.2% chlorhexidine gluconate solution, with Duraphat fluoride varnish, or with both of the above agents, while one group was treated with distilled water and one was left as an untreated control . Furthermore, a placebo varnish was used in the chlorhexidine- and distilled-water-treated groups; all the varnishes were removed after 24 h . The enamel slabs were mounted pairwise in an artificial mouth to form approximal contacts . The teeth were continuously rinsed with a common pool of artificial saliva to which was added 3% sucrose, and which was infected on the first day with Streptococcus mutans, "Ingbritt" . The saliva was renewed daily and the incubation at 37 degrees C lasted for 10 days . The appreciable softening found in the distilled-water- and placebo-varnish-treated group tended to be prevented by the chlorhexidine and even more by the fluoride treatment, while the chlorhexidine-fluoride treatment prevented enamel softening completely . The saliva, infected only on the first day, and renewed daily, tended to become more acidified toward the end of the experimental period, obviously because the fermenting organisms had infected the surfaces of the model and formed plaque-like coatings on the enamel. Ann Hematol, 1994 Aug, 69(2), 69 - 71 Pre-emptive administration of corticosteroids prevents the development of ARDS associated with Streptococcus mitis bacteremia following chemotherapy with high-dose cytarabine; Dompeling EC et al.; Adult respiratory distress syndrome (ARDS) complicating Streptococcus mitis bacteremia is a major cause of mortality in patients undergoing therapy for leukemia . In order to try to prevent the development of ARDS in 11 patients with S . mitis bacteremia following chemotherapy including cytarabine, high doses of corticosteroids were administered pre-emptively . None of these patients developed ARDS . In a historical control group of 21 comparable patients who had not been given corticosteroids, the incidence of ARDS was high (38%), with a death rate of 14% . Preemptive administration of high-dose corticosteroids appeared to be highly effective in suppressing the mechanisms that induce ARDS in patients with S . mitis bacteremia after cytarabine treatment . The results suggest that ARDS complicating S . mitis bacteremia is not merely a microbiological problem but may, at least in part, represent an immunologically mediated phenomenon. J Fam Pract, 1994 Aug, 39(2), 171 - 7 Group B streptococcus: perinatal considerations; Agnoli FL; Group B streptococcal (GBS) infections are responsible for significant perinatal morbidity and mortality in the United States . It has been proposed that to prevent neonatal sepsis, all pregnant women be screened for GBS colonization, and that intrapartum antibiotics be used in certain high-risk situations . These recommendations are controversial, as is the current management of the asymptomatic newborn of a GBS-colonized mother. Am J Respir Crit Care Med, 1994 Aug, 150(2), 455 - 61 The role of cytoskeletal proteins in neutrophil emigration during pneumonia in rabbits; Mueller GA et al.; The cytoskeletal proteins, actin and tubulin, are critical in modulating many aspects of the structural, mechanical, and biochemical properties of cells . This study determined if rearrangements of microtubules or filamentous actin were necessary for neutrophil margination within the pulmonary microvasculature or emigration into the alveolar spaces in response to Streptococcus pneumoniae . Microtubule assembly was inhibited using colchicine, and F-actin depolymerization was inhabited using phalloidin . Anesthetized rabbits received an intrabronchial instillation of S . pneumoniae either after intravenous pretreatment with colchicine (1 mg/kg every 2 h) or combined with TRITC-phalloidin (2 microM in instillate) . Four hours later, the lungs were fixed and removed . The results show that the intravenous injection of colchicine caused a rapid decrease in circulating neutrophil counts, most likely caused by sequestration within the pulmonary microvasculature, that gradually recovered . In the pneumonic region, colchicine inhibited neutrophil emigration by 74 +/- 5%, but it did not prevent the stimulus-induced increase in margination . Phalloidin inhibited neutrophil emigration by 83 +/- 4% . These studies suggested that microtubule reassembly occurs during neutrophil transit through the normal pulmonary microvasculature and that it is required for migration but not sequestration during pneumonia . Rearrangement of actin filaments in lung cells but not neutrophils are required for neutrophil emigration induced by S . pneumoniae. Isr J Med Sci, 1994 Aug, 30(8), 619 - 22 Group A beta-hemolytic streptococcal pharyngitis in children younger than 5 years; Amir J et al.; We report on a prospective study of 152 children aged 3 months to 5 years, from a community pediatric clinic, who had signs of pharyngitis, temperature > or = 38 degrees C and were not treated by antibiotics during the preceeding week . Nose and throat cultures were taken from each child . Blood antistreptolysin (ASO) was examined . If the cultures were positive for group A beta hemolytic Streptococcus (GABHS), a second blood sample for ASO was obtained later . True streptococcal infection was defined in a case of a positive culture and an increase in the ASO titer of at least two tubes, while cases of positive cultures without significant changes in ASO titer were defined as carriers . Positive GABHS cultures were found in 23 cases . True group A Streptococcus infection was found only in patients > 2 years old . The carriers of GABHS increased gradually from 3% during the 1st year to 22% by the 5th year . This study demonstrated that in the population evaluated, the incidence of true GABHS infection in children < 2 years of age is low, as was observed in the past. Isr J Med Sci, 1994 Aug, 30(8), 617 - 9 Evaluation of a rapid test to detect Streptococcus group A; Amir J et al.; Rapid tests for the detection of group A beta-hemolytic streptococcus (GABHS) directly from a throat swab have become very popular . Previous studies have reported an antigen test sensitivity of 55-95% and a specificity of 88-100% . The present study evaluates the reliability of one rapid test in detecting GABHS (PathoDx) . A total of 164 throat swab specimens was taken . GABHS was isolated on the culture in 37 (22.5%), and the rapid test was positive in 60 (36.6%) . The sensitivity of the rapid test was 86.5% and the specificity 80% . Of the 60 positive rapid test results, 28 (47%) were false positive and the positive predicted value was 53% . We conclude that results obtained using rapid test kits should be compared to throat cultures in order to determine the reliability of such kits in specific clinical settings. Infect Immun, 1994 Aug, 62(8), 3559 - 63 Streptococcus pyogenes type M12 protein shows selective binding to some human immunoglobulin G3 myeloma proteins; Johansson PJ et al.; Purified, recombinant M12 protein from Streptococcus pyogenes CS24 has recently been demonstrated to bind human immunoglobulin G3 (IgG3) . The binding site for IgG has been localized to an internal peptide encoded by a PvuII fragment of the gene emm12 . We have investigated the ability of an isolated recombinant M12 protein consisting of the peptide encoded by the PvuII fragment to bind various monoclonal human IgG3 myeloma proteins representing a number of both Caucasian and Oriental IgG3 Gm(allotypic) phenotypes . Of nine Caucasian IgG3 myeloma proteins, only two bound strongly to the recombinant M12 protein in enzyme-linked immunosorbent assays . The allotypic phenotypes of the reactive proteins were IgG3m(b+)(g-) and IgG3m(b-)(g+) . No binding was seen for seven IgG3 myeloma proteins of Oriental origin with G3m(st+)(u-)(b+)(g-), G3m(st-)(u+)(b+)(g-), G3m(st-)(u+)(b-)(g+), and G3m(st-)(u-)(b-)(g+) phenotypes . The binding of human IgG3 to M12 protein seems to be related to features other than its Gm allotypic markers . Selective reactivity of IgG3 myeloma proteins with M12 protein may provide another way to subclassify human IgG3 molecules . The biological significance of the selective reactivity is not known. Infect Immun, 1994 Aug, 62(8), 3515 - 20 Inhibition of C3 deposition on Streptococcus equi subsp . equi by M protein: a mechanism for survival in equine blood; Boschwitz JS et al.; The effect of the M protein of Streptococcus equi subsp . equi on complement deposition, complement degradation, and bacterial survival in equine whole blood was examined in vitro . Preincubation of bacteria with rabbit M protein-specific immunoglobulin G (IgG) inhibited the survival of the M+ strain in whole blood by 20-fold (P < 0.01) . In addition, preincubation of bacteria with M protein-specific F(ab')2 fragments inhibited the survival of M+ cells in whole blood by 3.8-fold (P < 0.01) . In the absence of specific antibody, an M+ strain (CF32) of S . equi subsp . equi survived 100-fold better in whole blood than an M- isolate (strain 19) (P < 0.01) . Complement inactivation by cobra venom factor significantly enhanced the ability of the M- and M+ strains of S . equi subsp . equi to survive in whole blood, the latter in the presence or absence of M protein-specific IgG . The major opsonic forms of C3, C3b and iC3b, were present on both M- and M+ cells after opsonization in nonimmune plasma . However, colloidal gold staining indicated that the M- strain bound four times as much C3 as the M+ strain (P < 0.02) and that preincubation of the M+ strain with M protein-specific IgG or F(ab')2 fragments also enhanced the amount of C3 deposited by a factor of 4 (P < 0.02) . Therefore, at least part of the M protein's ability to enhance bacterial survival in equine whole blood may be related to its ability to interfere with the deposition of equine complement on the bacterial surface. J Infect Dis, 1994 Aug, 170(2), 461 - 4 Serotype distribution and antimicrobial resistance patterns of invasive isolates of Streptococcus pneumoniae: Alaska 1986-1990; Parkinson AJ et al.; From January 1986 through December 1990, 672 cases of invasive pneumococcal disease were identified . From these, 574 pneumococcal isolates were recovered from normally sterile sites (blood, cerebrospinal and pleural fluid); 92% were serotypes represented in the 23-valent pneumococcal polysaccharide vaccine . The most common serotypes from children < 2 years old were 4, 6B, 9V, 14, 18C, 19F, and 23F, recovered from 83% of Alaska Native and 75.1% of nonnative children with invasive disease . Moderate penicillin resistance (MIC, 0.1-1.0 micrograms/mL) was found in 3.8% of isolates . All were sensitive to chloramphenicol, vancomycin, rifampin, ceftriaxone, cefotaxime, cephalothin, and cefaclor . However, in the Yukon-Kuskokwim Delta region, 16.9% of isolates were moderately resistant to penicillin, and 10.8% were resistant to erythromycin and 6.2% to trimethoprim-sulfamethoxazole; the number resistant to two or more antibiotics increased significantly during surveillance . All multiply resistant isolates were serotype 6B, and all were from Alaska Native patients < 2 years old. Mycopathologia, 1994 Aug, 127(2), 77 - 81 Survey of mycotic and bacterial keratitis in Sri Lanka; Gonawardena SA et al.; Over a two-year period (1976-1977 and 1980-1981), 66 cases of bacterial and mycotic cases of keratitis were diagnosed in the Eye Clinic of the General Hospital in Kandy, Sri Lanka . The clinical and microbiologic aspects of these cases are described . Noteworthy was the first known human case caused by Paecilomyces farinosus, a geophilic species, commonly encountered as an insect parasite throughout the world . The bacterial and the other fungal etiologic agents isolated and identified were: Pseudomonas aeruginosa, Streptococcus pneumoniae, Aspergillus flavus, A . niger, Fusarium oxysporum, and Lasiodiplodia theobromae . In vitro the fungi showed sensitivity in decreasing order to flucytosine, nystatin, amphotericin B and econazole . Due to the out-patient status of the patients, their in-vivo response to treatment was not assessable. Acta Paediatr, 1994 Aug, 83(8), 862 - 5 Acute rheumatic fever in children in the Ankara area in 1990-1992 and comparison with a previous study in 1980-1989; Karademir S et al.; Two hundred and twenty-eight patients with acute rheumatic fever (ARF), who were admitted to Dr Sami Ulus Children's Hospital between January 1990 and November 1992, were evaluated . Compared with the 1980s, an increase in the frequency of the disease was observed . The majority of patients (56.5%) were between 9 and 12 years old and 36.8% were admitted in winter . One hundred patients had arthritis only, 59 carditis and 40 chorea; 5 had carditis and chorea and 24 had arthritis and carditis . Nineteen percent of patients had a history of a previous attack . Seven of 84 patients with carditis had congestive heart failure and 2 had pericarditis . Cardiomegaly was present in 36 patients . The mitral valve was affected in 77 patients, tricuspid valve in 1 patient and both miral and aortic valves in 6 patients . One patient died as a result of severe congestive cardiac failure . Twenty-one patients had a recurrent attack . We observed that ARF is still a significant cause of morbidity in our country . As the disease is preventable by the eradication of streptococcus, we conclude that more effort should be made in the early detection and treatment of streptococcal infections. Vaccine, 1994 Aug, 12(10), 875 - 8 Protection of infant mice from challenge with Streptococcus pneumoniae type 19F by immunization with a type 19F polysaccharide--pneumolysoid conjugate; Lee CJ et al.; The immunogenicity and protective efficacy of a conjugate of Streptococcus pneumoniae type 19F polysaccharide and a genetically toxoided derivative of the pneumococcal toxin pneumolysin was investigated in an infant mouse model . The conjugate was administered to Balb/c mice during pregnancy and/or lactation, and to their offspring during early infancy . The anti-polysaccharide and anti-pneumolysin titres of the immunized infant mice were significantly higher than those of non-immunized controls . When the infant mice were challenged with type 19F pneumococci, the bacteria were cleared more effectively from the blood of immunized mice than from that of control mice . The survival rate for the immunized mice was also significantly higher than that for the control group . These results indicate that highly protective anti-pneumococcal responses can be induced in infant mice by immunization with the conjugate during gestation or early infancy, and suggest a possible role for pneumolysoid-polysaccharide conjugates as human vaccine components. Vet Microbiol, 1994 Aug 1, 41(3), 235 - 47 A fibronectin-binding protein from Streptococcus equisimilis: characterization of the gene and identification of the binding domain; Lindgren PE et al.; We have cloned and characterized a gene, fnb, from S . equisimilis, encoding a fibronectin-binding protein, FnB . A genomic library containing chromosomal DNA from S . equisimilis strain Se165 in the pUC18 vector in E . coli TG1 was screened using a DNA fragment of the gene fnbB from S . dysgalactiae strain S2 as probe . The complete gene was sequenced . The molecular mass of the protein, calculated from the deduced amino acid sequence is 120 kDa, which coincides with that determined by gel electrophoresis and Western blotting of the gene product . The fibronectin-binding activity was localized to a region of three repeated units, each 36 amino acids long . The COOH-terminal part of FnB from S . equisimilis, including the repeated Fn-binding domain, is very similar to the corresponding part of FnBB from S . dysgalactiae, indicating a common origin of the regions encoding Fn-binding activity of the respective genes. Pediatr Infect Dis J, 1994 Aug, 13(8), 697 - 703 Streptococcus pneumoniae in human immunodeficiency virus type 1-infected children; Gesner M et al.; The purpose of this study was to characterize systemic Streptococcus pneumoniae disease in human immunodeficiency virus type 1 (HIV-1)-infected children . All cases of bacteremia and meningitis caused by S . pneumoniae among children less than 18 years old were collected by review of the Microbiology Laboratory records at the Bellevue Hospital Center during the period August 1, 1978, through July 31, 1993 . There were 31 bouts of systemic S . pneumoniae disease in 19 of 235 HIV-1-infected children cared for by the Pediatric Infectious Disease staff and 116 bouts in 113 children not known to be HIV-1-infected . Four of the 19 HIV-1-infected children had multiple episodes of S . pneumoniae bacteremia as compared with 3 of 113 in the general population (P = 0.008) . The frequency of serotypes and distribution of infections by season of the year did not differ between the 2 groups . The median ages at the time of the S . pneumoniae infection were 1.8 and 1.1 years for the HIV-1-infected children and the general population of children, respectively, when those children with multiple episodes were included for their initial episode only (P = 0.06) . In the HIV-1-infected patients, 10 episodes were associated with pneumonia, 5 with pneumonia and otitis media, 5 with otitis media only, 1 with pneumonia and meningitis, 1 with meningitis only and 1 with periorbital cellulitis; 5 had no apparent focus of infection . One episode of pneumonia was complicated by lung abscess and there were 2 deaths . Most HIV-1-infected patients recovered without significant sequelae, and the clinical course of their systemic infections did not appear to be markedly different than that of healthy children. J Clin Pathol, 1994 Aug, 47(8), 749 - 51 Diagnosis of Streptococcus pneumoniae pneumonia by quantitative enzyme linked immunosorbent assay of C-polysaccharide antigen; Gillespie SH et al.; AIMS--To evaluate the use of a quantitative enzyme linked immunosorbent assay (ELISA) detecting C-polysaccharide (PnC) antigen in sputum for the diagnosis of Streptococcus pneumoniae infection . METHODS--Specimens of sputum from 60 patients with acute community and hospital acquired pneumonia and infective exacerbations of obstructive airways disease were examined by semiquantitative culture and antigen ELISA . RESULTS--Using a cutoff value of 1 microgram/ml PnC antigen for a positive result, the sensitivity of this assay was 90.3%, specificity 93.1%, predictive value of a positive result was 93.5%, and the predictive value of a negative result 89.6% . CONCLUSIONS--Quantitation of C-polysaccharide antigen in sputum by ELISA distinguishes between carriage of oral bacteria which express PnC-like antigen and infection with S pneumoniae and compares favourably with other diagnostic methods. Clin Pharmacokinet, 1994 Aug, 27(2), 129 - 49 Pharmacokinetic considerations in the treatment of bacterial keratitis; Callegan MC et al.; The eye is relatively impermeable to micro-organisms and other environmental elements . However, if corneal integrity is breached by trauma, a sight-threatening bacterial infection can result . Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pneumoniae are the most common bacterial pathogens associated with infection of compromised corneas . Bacterial enzymes and toxins, as well as factors associated with the host immune response, can lead to tissue destruction during corneal infection . For successful therapy, an antibacterial agent must be active against the pathogen and must be able to overcome the permeability barrier of the cornea . Topical application of antibacterial agents adequately delivers drugs to the cornea and aqueous humour . However, drug concentrations at the site of infection are not always sufficient to rapidly kill infective organisms . Infections with antibiotic-resistant strains present an even greater therapeutic challenge . In addition, sterilisation of the cornea by antibacterial agents does not eliminate inflammation and corneal scarring that accompany infection . Steroidal and non-steroidal antiinflammatory agents limit corneal scarring during experimentally induced bacterial keratitis . However, although promising, concomitant use of these drugs with antibacterial agents remains controversial . Two ocular drug delivery systems that provide high and sustained concentrations of drug to ocular tissues are corneal collagen shields and transcorneal iontophoresis . The collagen shield, originally designed as a bandage lens, prolongs drug contact with the cornea . Chemotherapeutic studies of experimental bacterial keratitis demonstrate that shields hydrated with antibacterial agents reduce bacteria in the cornea as well as or better than frequent applications of fortified antibacterial drops . Transcorneal iontophoresis uses an electric current to drive charged drugs into the cornea . In experimentally induced bacterial keratitis, transcorneal iontophoresis of antibacterial agents is superior to topically administered ocular drops for reducing the numbers of bacteria in the cornea . Although both drug delivery systems appear to be well tolerated and nontoxic in animal models, clinical trials in patients are required to determine the usefulness of these drug delivery systems in clinical trials . Based on present experimental results, future therapy of bacterial keratitis will involve efficient drug delivery devices, the use of new antibacterial agents or combinations of presently available antibacterial agents, and careful use of adjuvant anti-inflammatory agents. Tuber Lung Dis, 1994 Aug, 75(4), 308 - 12 Community acquired pneumonia in adults in Addis Ababa: etiologic agents and the impact of HIV infection; Aderaye G; SETTING: Black Lion Hospital, a tertiary care referral hospital in Addis Ababa, Ethiopia . OBJECTIVE: To determine the prevalence of HIV infection in patients with Community Acquired Pneumonia (CAP) and compare the etiologic agents, clinical and radiographic presentation and outcome of the disease in HIV positive and negative patients . DESIGN: A hospital based prospective study on 110 adult patients consecutively coming to Black Lion Hospital between August 1987 and July 1989 . RESULTS: 8% of patients with pneumonia versus 2.4% for the general population (P < 0.05) were seropositive for HIV-I . Streptococcus pneumoniae was the most common offending pathogen . HIV positive patients were more likely to be male, young and of urban residence . They had fewer chills, increased bilateral and multilobar lung involvement, frequent association with pulmonary tuberculosis and recurrent chest infiltrate . CONCLUSION: The incidence of Community Acquired Pneumonia in patients with HIV infection is likely to increase with the rapid rise in HIV infection . Future studies should therefore look further into (a) the pattern of etiologic agents, (b) unusual clinical patterns which may help set criteria for screening for HIV infection, and (c) the use of pneumococcal vaccine in selected groups of patients. Kansenshogaku Zasshi, 1994 Aug, 68(8), 977 - 81 {Prevalence of penicillin-insensitive Streptococcus pneumoniae and its response to oral beta lactam antibiotics at a primary pediatric office}; Kakuta O et al.; Penicillin (PC) resistance of Streptococcus pneumoniae was tested by oxacillin disk method (Bauer-Kirby method) of the strains collected at the primary pediatric office . The rate of oxacillin resistance of S . pneumoniae was 36.4% in 1990, 41.4% in 1991, and 51.9% in 1992, respectively . The efficacy of oral antibiotics in the treatment of PC-insensitive S . pneumoniae infections was also studied retrospectively in 234 cases . Treatment failure rate was 17.7% in the amoxicillin group, 8.7% in the cefpodoxime proxetil group, while it was 42.9% in the cefixime group . These differences were statistically significant . From these data prevalence of PC-insensitive S . pneumoniae is very high in Japanese children, and amoxicillin and cefpodoxime proxetil can be used for the treatment of outpatients with PC-insensitive S . pneumoniae infections. Microbiology, 1994 Aug, 140 ( Pt 8), 1839 - 45 The Bacillus subtilis lipoprotein LplA causes cell lysis when expressed in Escherichia coli; Gomez A et al.; A gene called lplA (lipoprotein-like) has been isolated from a genomic library of Bacillus subtilis expressed in Escherichia coli . Clones carrying the lplA gene were selected by the ability of the colonies to give visible haloes of starch hydrolysis . The cloned fragment contains an open reading frame (ORF) of 1509 bp encoding a protein of 56 kDa . The protein contains a typical N-terminal signal sequence, a putative transmembrane anchor domain and a leucine zipper at the C-terminus . The expression of this protein in E . coli causes cell lysis, only the N-terminal domain of the LplA protein being responsible for this phenotype . The mechanism of cell lysis is similar to that previously suggested for the expression in E . coli of the lipoproteins encoded by the Streptococcus pneumoniae genes malX and amiA . The protein is modified with palmitic acid when secreted in E . coli, confirming that it is a typical lipoprotein. Microb Pathog, 1994 Aug, 17(2), 121 - 9 Characterization of the antiphagocytic activity of equine fibrinogen for Streptococcus equi subsp . equi; Boschwitz JS et al.; The antiphagocytic property of equine fibrinogen for Streptococcus equi subsp . equi strain CF32 was examined in vitro . The results of bactericidal assays demonstrated that the presence of fibrinogen enhanced the ability of overnight and early log-phase cultures of strain CF32 to resist killing by equine neutrophils by 12-fold and seven-fold, respectively (p > 0.01) . In addition, fibrinogen-coated bacteria treated with fibrinogen specific F(ab')2 fragments were 32% more susceptible to killing by equine neutrophils after opsonization in serum (p > 0.05), indicating that specific epitopes on fibrinogen may be important for its antiphagocytic effect . Since complement deposition is inhibited on subsp . equi (Boschwitz JS, Timoney JF, Infect Immun 1994; 42, 3515-20, we examined the effect of fibrinogen on complement deposition by using colloidal gold labeling of surface-bound C3 . No significant differences were detected in the quantity of C3 deposited on the cell surface after opsonization with serum, serum plus fibrinogen, or plasma . These results suggest that the antiphagocytic property of fibrinogen is not related to the inhibition of complement deposition on the bacterial surface . Pretreatment of CF32 with M protein specific antibody inhibited fibrinogen binding by 72%, and a strain of subsp . equi expressing low levels of M protein bound 64% less fibrinogen than CF32, suggesting that the some of the fibrinogen deposited on the surface of subsp . equi is bound to M protein. Zh Mikrobiol Epidemiol Immunobiol, 1994 Aug-Sep, Suppl 1, 51 - 5 {Streptococcal group A carriage: new data on the characteristics of the biology of the causative agent and of the immune response of the host}; Briko NI et al.; Carriership of group A streptococcus (A-STR) was registered with significantly greater frequency among children of preschool and early school age (29.8%) than among adults (4.0%) . Cultures of A-STR isolated from carriers were characterized by their low capacity for secreting erythrogenic toxin of type A (ET-A), lipoteichoic acid and by lower content of surface proteins than those isolated from tonsillitis and scarlet fever patients . Highly hydrophobic strains of A-STR prevailed in long-time carriers and patients . Elevated immunological characteristics for group-specific polysaccharide A and ET-A were more frequently detected in children than in adults, which correlated with frequency of A-STR carriership in these groups and the capacity of the infective agent to produce ET-A . Some specific features in the character of humoral immune response in carriers, manifested mainly by defects of local immunity (a low level of SIgA to polysaccharide A), were established. Zh Mikrobiol Epidemiol Immunobiol, 1994 Aug-Sep, Suppl 1, 36 - 40 {An immunological analysis of bacterial persistence in the bone marrow}; Sanin AV et al.; A method for the evaluation of bacterial persistence in the bone marrow in association with particular clonogenic target cells was developed . The method was based on the negative selection of cells expressing microbial antigens after treatment with hyperimmune antiserum specific to a given infective agent and the subsequent quantitation of target cells thus eliminated in appropriate assays . Using this approach, we demonstrated that Mycoplasma arthritidis and L-forms of Streptococcus strain L-406 were capable of persisting in murine bone marrow in close association with CFUs-7 (a subpopulation of hematopoietic stem cells) for at least several months after experimental infection . Francisella tularensis was also found to be capable to express on the CFUs-7 membranes . Persisting microorganisms enhanced both proliferation and migration of CFUs-7. Diagn Microbiol Infect Dis, 1994 Aug, 19(4), 245 - 7 Dual infections with Staphylococcus aureus and Streptococcus pyogenes causing toxic shock syndrome . Possible synergistic effects of toxic shock syndrome toxin 1 and streptococcal pyrogenic exotoxin C; Smith RJ et al.; We describe a 35-year-old woman with clinical, microbiologic, and serologic findings suggesting that the patient developed toxic shock syndrome as a result of dual infections caused by toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes . Certain aspects of the pathogenesis of this toxin-related syndrome are reviewed. J Antimicrob Chemother, 1994 Aug, 34 Suppl A, 61 - 73 Acute bacterial meningitis in the newborn; de Louvois J; Acute bacterial meningitis is more common during the neonatal period than at any other time of life and is accompanied by a high incidence of mortality and long term significant sequelae . The incidence of neonatal meningitis is variously calculated at between 0.25 and 0.32 per 1000 live births depending on the inclusion criteria . There is no evidence that the incidence has changed during the last 25 years although during this time there have been dramatic changes in the neonatal population . The pathogenesis of neonatal meningitis is complex and not fully understood . The range of bacteria involved is wider than in paediatric meningitis . Mortality rates are highest following infection with enteric Gram-negative bacilli, and still exceed 30%, lower with the Lancefield group B streptococcus and lower still with other Gram-positive bacteria . The predisposing factors to neonatal meningitis are few with the exception of maternal infection or pyrexia at the time of delivery . Any association between meningitis and other possible predisposing factors has not been reliably established . There is evidence to suggest that meningitis in premature low birth weight and sickly babies is caused by organisms, usually from the maternal genital tract, which do not have recognized pathogenicity factors . In contrast, late onset infection is associated with organisms with recognized virulence and pathogenicity factors, many of which have a predisposition to the central nervous system . The clinical presentation of neonatal meningitis is non-specific and meningitic babies cannot be easily distinguished from those with other septic foci or sick uninfect