Cardiol Clin, 1996 Aug, 14(3), 351 - 62 Clinical approach to infective endocarditis; Saccente M et al.; The epidemiology of IE has evolved over the past 50 years . Mitral valve prolapse and degenerative valvular disease have replaced rheumatic heart disease as the most common predisposing conditions . The average age of patients with IE has increased, and nosocomially acquired cases are becoming more common . Although viridans streptococci are currently responsible for a smaller proportion of cases than previously, this group of bacteria remains the most common cause of prosthetic value and native valve endocarditis . Staphylococci are the most important cause in some community hospitals, in nosocomial IE, and in IVDUs . IE is a multisystem disease, and patients may present with diverse clinical features . In the absence of direct histopathologic and microbiologic examination of valvular vegetations, the diagnosis of IE depends on the detection of endocardial abnormalities and the isolation of a pathogen from blood . Blood culture remains the most important laboratory test and yields the causative microorganism in 95% of patients . Echocardiography has become an important tool for detecting endocardial lesions . The clinical features of IE in IVDUs are somewhat different than those in other populations . The microbiology is distinctive, and right-sided involvement with septic pulmonary emboli is the most common clinical scenario in this group. Antimicrob Agents Chemother, 1996 Aug, 40(8), 1817 - 24 Streptococcus pneumoniae and Streptococcus pyogenes resistant to macrolides but sensitive to clindamycin: a common resistance pattern mediated by an efflux system; Sutcliffe J et al.; Macrolide-resistant Streptococcus pyogenes isolates from Finland, Australia, and the United Kingdom and, more recently, Streptococcus pneumoniae and S . pyogenes strains from the United States were shown to have an unusual resistance pattern to macrolides, lincosamides, and streptogramin B antibiotics . This pattern, referred to as M resistance, consists of susceptibility to clindamycin and streptogramin B antibiotics but resistance to 14- and 15-membered macrolides . An evaluation of the macrolide-lincosamide-streptogramin B resistance phenotypes among our streptococcal strains collected from 1993 to 1995 suggested that this unusual resistance pattern is not rare . Eighty-five percent (n = 66) of the S . pneumoniae and 75% (n = 28) of the S . pyogenes strains in our collection had an M phenotype . The mechanism of M resistance was not mediated by target modification, as isolated ribosomes from a pneumococcal strain bearing the M phenotype were fully sensitive to erythromycin . Further, the presence of an erm methylase was excluded with primers specific for an erm consensus sequence . However, results of studies that determined the uptake and incorporation of radiolabeled erythromycin into cells were consistent with the presence of a macrolide efflux determinant . The putative efflux determinant in streptococci seems to be distinct from the multicomponent macrolide efflux system in coagulase-negative staphylococci . The recognition of the prevalence of the M phenotype in streptococci has implications for sensitivity testing and may have an impact on the choice of antibiotic therapy in clinical practice. Am J Obstet Gynecol, 1996 Aug, 175(2), 406 - 10 The effect of timing of single-dose transplacental ampicillin-sulbactam therapy for prevention of neonatal group B streptococcal colonization and bacteremia in a rabbit model; McDuffie RS Jr et al.; OBJECTIVE: Our purpose was to evaluate the effect of maternal administration of ampicillin-sulbactam on group B streptococcal colonization and bacteremia in newborn rabbits . STUDY DESIGN: Before induction of labor, timed pregnant New Zealand White rabbits on day 29 of a 31-day gestation received no therapy or ampicillin-sulbactam 50 mg/kg intramuscularly as a single dose 2 to 8 hours before delivery . Labor was induced with oxytocin . After delivery, the oropharynx of each pup was inoculated with 10(9) cfu of type la group B Streptococcus . Cultures of each pup were taken from the oropharynx and anorectum daily and from the heart at death or after 96 hours . Ampicillin-sulbactam concentrations were determined at delivery in both mothers and pups . RESULTS: Thirteen animals were assigned to no therapy and 14 animals to ampicillin-sulbactam . Untreated pups had 100% oropharyngeal colonization at 24 hours . Pups treated with antibiotic were significantly less likely to have positive oropharyngeal cultures at 24 and 48 hours after birth than did untreated pups (24 hours 47% vs 100%, p < 0.0001; 48 hours 68% vs 91%, p = 0.0006) . For anorectal cultures treated pups were significantly less likely to have positive culture results . Heart cultures were also less likely to have positive results for treated animals at 48 and 72 hours than for untreated animals (48 hours 30% vs 96%, p = 0.0001; 72 hours 31% vs 71%, p = 0.03) . Treated pups had higher rates of survival at 48 hours (89% vs 62%, p < 0.0001) . When neonatal oropharyngeal colonization at 24 hours after birth was compared with length of time from maternal antibiotic injection to delivery, there was a significant polynomial relationship (r = 0.78, p < 0.05) . Ampicillin-sulbactam serum concentrations were highest 3 to 5 hours after injection . An inverse relationship existed between the rate of neonatal oropharyngeal colonization with group B streptococci at 24 hours after birth and neonatal ampicillin serum concentrations near birth (r = 0.733) . CONCLUSION: Transplacental treatment with a single intramuscular dose of ampicillin-sulbactam significantly decreased neonatal colonization and bacteremia after oral inoculation with type la group B Streptococcus . An effect of ampicillin-sulbactam was evident as early as 2 hours but maximal 3 to 5 hours after injection. Am J Obstet Gynecol, 1996 Aug, 175(2), 402 - 5 Ascending group B streptococcal genital infection in the rabbit model; McDuffie RS Jr et al.; OBJECTIVE: We investigated in a pregnant rabbit model the effects of intravaginal inoculation of type la group B streptococci and antibiotic intervention . STUDY DESIGN: We inoculated 10(4) to 10(6) cfu of type la group B streptococci into the upper vagina hysteroscopically at day 21 to 27 of a 31-day gestation . Initially we studied the natural history in 23 animals and then allocated the next 31 animals to receive either no therapy or ampicillin-sulbactam intramuscularly beginning immediately after inoculation . Outcomes were delivery, fever, positive cultures for group B streptococci, any live fetuses, and maternal death . RESULTS: Without antibiotic treatment upper vaginal inoculation led to frequent complications, namely, fever in 44% (15/34), delivery in 41% (14/34), positive endometrial cultures in 47% (15/32), and positive blood cultures in 26% (7/27) . Live fetuses were present in only 53% (18/34) . Animals treated with antibiotics were significantly less likely to have fever (p < 0.01), positive endometrial cultures (p < 0.01), or positive blood cultures (p = 0.03) and were more likely to have a live fetus (p = 0.04) than untreated animals were . CONCLUSION: Upper vaginal inoculation with type la group B streptococci in the rabbit led to an ascending infection of the upper genital tract, causing serious adverse outcomes in 40% with bacteremia in 26% . Early antibiotic intervention significantly improved outcomes . The susceptibility of the rabbit to ascending perinatal group B streptococci infection makes it an appealing model for further work pertinent to human disease. Microbiology, 1996 Aug, 142 ( Pt 8), 2311 - 20 The plasmin-binding protein Plr of group A streptococci is identified as glyceraldehyde-3-phosphate dehydrogenase; Winram SB et al.; Group A streptococci bind the serine protease plasmin with high affinity . Previously, a 41 kDa protein was identified as a candidate plasmin receptor protein (Plr) from group A streptococcal strain 64/14 . The plr gene encoding Plr was cloned and the deduced amino acid sequence of Plr had significant similarity to glyceraldehyde-3-phosphate dehydrogenases (GAPDHs) . In this study we have isolated cytoplasmic GAPDH of streptococcal strain 64/14 . This enzyme was examined, on both structural and functional levels, for its relatedness to the Plr of strain 64/14 purified from mutanolysin extract and to recombinant Plr . We report here that no differences were detected between streptococcal Plr and cytoplasmic GAPDH on the basis of antibody reactivity, plasmin-binding activity, GAPDH activity, N-terminal amino acid sequence, peptide map analysis by V8 protease digestion and amino acid composition analysis . Furthermore, the plr gene appears to be present as a single copy in group A streptococci. Infect Immun, 1996 Aug, 64(8), 3016 - 22 Cytokine production by human epithelial and endothelial cells following exposure to oral viridans streptococci involves lectin interactions between bacteria and cell surface receptors; Vernier A et al.; In order to examine the possible implication of human epithelial and endothelial cells in the pathogenesis of various diseases associated with oral viridans streptococci, we tested the immunomodulatory effects of 11 representative strains of oral viridans streptococci on human epithelial KB cells and endothelial cells . We then examined the possible role of two major adhesins from oral viridans streptococci, protein I/II and rhamnose-glucose polymers (RGPs), in this process . In this study we demonstrate that oral viridans streptococci are potent stimulators of interleukin-8 (IL-8) production from KB cells and of IL-6 and IL-8 production from endothelial cells . The ability of protein I/II and RGPs to contribute to these effects was then examined . Using biotinylated protein I/IIf and RGPs from Streptococcus mutans OMZ 175, we showed that these adhesins bind to KB and endothelial cells through specific interactions and that the binding of these molecules initiates the release of IL-8 from KB cells and of IL-6 and IL-8 from endothelial cells . These results suggest that protein I/IIf and RGPs play an important role in the interactions between bacteria and KB and endothelial cells in that similar cytokine profiles are obtained when cells are stimulated with bacteria or surface components . We also provide evidence that protein I/IIf binds to and stimulates KB and endothelial cells through lectin interactions and that N-acetyl neuraminic acid (NANA) and fucose present on cell surface glycoproteins may form the recognition site since binding and cytokine release can be inhibited by dispase and periodate treatment of cells and by NANA and fucose . These results demonstrate that oral viridans streptococci, probably by engaging two cell surface adhesins, exert immunomodulatory effects on human KB and endothelial cells. Laryngoscope, 1996 Aug, 106(8), 1010 - 3 Microbiology of subperiosteal orbital abscess and associated maxillary sinusitis; Brook I et al.; Aspirate of pus from eight subperiosteal orbital abscesses (SPOAs) and their corresponding infected sinuses were studied for aerobic and anaerobic bacteria . Polymicrobial flora was found in all instances, and the number of isolates varied from two to five . Anaerobes were recovered from all specimens . The predominant isolates were Peptostreptococcus spp, Prevotella spp, Fusobacterium spp, Staphylococcus aureus, and microaerophilic streptococci . Concordance in the microbiological findings between SPOA and the infected sinus was found in all instances . However, certain organisms were only present at one site and not the other . Fourteen beta-lactamase-producing organisms were present in nine specimens . These data confirm the importance of anaerobic bacteria in sinusitis and demonstrate their predominance in the associated SPOA. J Infect Dis, 1996 Aug, 174(2), 332 - 7 Interleukin-6 production by human neonatal monocytes stimulated by type III group B streptococci; Vallejo JG et al.; The subcellular components of type III group B streptococci (GBS) that contribute to the host inflammatory response were determined by measuring production of the proinflammatory cytokine interleukin (IL)-6 by cord blood monocytes . Monocytes were stimulated with encapsulated (COH1) or unencapsulated (COH1-13) whole type III GBS or with purified GBS components, including type III capsular polysaccharide (III-PS), group B antigen (GB-Ag), lipoteichoic acid (LTA), or Escherichia coli lipopolysaccharide . Monocytes exposed to COH1 and COH1-13 released similar amounts of IL-6 . GBS III-PS, GB-Ag, and LTA each induced IL-6 . However, IL-6 release by monocytes was significantly greater after stimulation by GB-Ag than by III-PS or LTA (P < .05) . Sera from 16 neonates with systemic GBS disease had IL-6 levels of 8 pg/mL to 4.28 ng/mL . GB-Ag is a potent inducer of IL-6 and may play an important role in tissue inflammation during GBS infection. Rev Assoc Med Bras, 1996 Jul-Sep, 42(3), 130 - 4 {In vitro susceptibility testing of 446 clinical isolates of gram-positive bacteria to new quinolones, carbapenems and cephalosporins}; Cereda RF et al.; OBJECTIVE: To assess the in vitro susceptibility of gram-positive bacteria isolated in the Sao Paulo Hospital against five fluoroquinolones, three carbapenems and three cephalosporins . MATERIALS AND METHOD: Susceptibility was tested in 77 isolates of streptococci, 38 enterococci, 25 S . aureus and 91 S . epidermidis . The strains were isolated in the Sao Paulo Hospital in June and July of 1992 . The susceptibility testing was performed by broth microdilution according to the procedure described by the national committee for Clinical Laboratory Standards (NCCLS) . The antimicrobial agents tested were: ciprofloxacin, ofloxacin, levofloxacin, grepafloxacin (formerly OPC 17116), DU-6859, imipenem, meropenem, biapenem, ceftazidime, cefepime and FK-037 . RESULTS: The best in vitro activity was demonstrated by the new fluoroquinolones, especially DU 6859 . Among the commercially available compounds, the fluoroquinolones ciprofloxacin and ofloxacin (81% susceptibility) and the carbapenem imipenem (74% susceptible) were the most active compounds . The highest resistance rates were shown by enterococci and oxacillin-resistant staphylococci . CONCLUSIONS: The results of the present study showed that the in vitro activities of the new carbapenems are similar to that of imipenem and the fourth generation cephalosporins are more active than ceftazidime against gram-positive bacteria . In addition, the newer fluoroquinolones were four to sixteen-fold more active than that showed by the commercially available compounds of this class, especially against enterococci and oxacillin-resistant staphylococci . These results indicate that these newer fluoroquinolones should be further evaluated in clinical trials. Dent Mater, 1996 Jul, 12(4), 227 - 9 Antibacterial activity of silver ions implanted in SiO2 filler on oral streptococci; Yamamoto K et al.; OBJECTIVE: To evaluate the role of silver ions in composite resin dental materials, an in vivo investigation was conducted into the antibacterial effect of SiO2 filler implanted with silver ions on oral streptococci . METHODS . SiO2 filler samples (0.1g) were implanted with silver ions . The effect of the filler with silver ions (Ag+ filler) was tested on oral streptococci bacteria . These bacterial strains had been isolated predominantly from composite resin surfaces . The organisms tested were anaerobically cultured in 5 mL Trypticase Soy Broth containing 0.5 per cent yeast extract at 37 degrees C for 10-12 h . Each bacterial strain was adjusted to a concentration of 1 x 10(6) cells per mL with reduced transport fluid (RTF) . Ag+ filler was immersed in 1 mL of RTF and anaerobically incubated 2, 6 and 12 h to study the antibacterial effect . The survival of bacteria was then estimated by culturing on TSBY agar plates . A plate with approximately 100 discrete colonies was chosen from the serial agar cultures, and the number of colonies was counted at each sampling time . RESULTS: The Ag+ filler showed significantly more antibacterial activity than the control filler without silver ions . SIGNIFICANCE: These results indicate that the antibacterial effect found in this study was due to the silver ions released by the Ag+ filler and that it may be useful to add this filler to composite resin dental materials for secondary caries protection. Plasmid, 1996 Jul, 36(1), 9 - 18 Characterization of IS199 from Streptococcus mutans V403; Macrina FL et al.; The complete nucleotide sequence of the insertion sequence IS199 has been determined . This novel element was found in Streptococcus mutans V403 where DNA hybridization studies suggested that it was present in multiple copies on the genome . IS199 is 1220 bp and appears unique to the mutans streptococci . A limited epidemiological survey revealed this element to occur infrequently in this group (4/50 strains examined) . IS199 belongs to the IS3 family of procaryotic insertion sequence elements . It contained tandem open reading frames (ORFs) reminiscent of the structure of the IS3 class . Additionally, the larger of the two ORF products (ORFB) exhibited amino acid sequence similarities to comparable proteins from IS3 and other elements of this family . Transposition of IS199 gave rise to a 3-bp target site duplication . We were able to insert an antibiotic resistance gene into IS199 enabling us to follow the transposition of this element in S . mutans V403. Vaccine, 1996 Jul, 14(10), 944 - 8 Recombinant, octavalent group A streptococcal M protein vaccine; Dale JB et al.; One of the major obstacles to the development of group A streptococcal M protein vaccines is the multiplicity of M serotypes expressed by these organisms . In this study, we have constructed a recombinant, hybrid M protein that contains type-specific aminoterminal fragments of eight different M proteins . We show that the purified hybrid recombinant protein is immunogenic in rabbits and evokes antibodies that react with native M proteins from the respective streptococcal serotypes . In addition, the immune sera evoked by the octavalent protein opsonized six of the eight serotypes of streptococci, indicating that the majority of the M protein fragments contained protective epitopes that retained their native conformations in the hybrid protein . None of the antisera raised against the octavalent protein crossreacted with human heart tissue . These studies indicate that multivalent, hybrid M proteins may be used to elicit broadly protective immune responses against multiple serotypes of group A streptococci. Zhonghua Yi Xue Za Zhi (Taipei), 1996 Jul, 58(1), 18 - 23 Analysis of 109 cases of infective endocarditis in a tertiary care hospital; Weng MC et al.; BACKGROUND: Early diagnosis and treatment can benefit the outcome of patients with infective endocarditis . The older diagnostic criteria (von Reyn criteria) relied upon tissue pathology and blood culture results, but the sensitivity was low . A newly proposed criteria, Duke criteria which apply echocardiographic findings as a major factor in diagnosis, have shown a better sensitivity in the diagnosis of infective endocarditis . METHODS: From 1984 to 1994, 120 episodes of endocarditis in 119 patients were reviewed retrospectively . One hundred and nine episodes fulfilling the Duke criteria were enrolled . The demographic data, antecedent disease, predisposing factors for infective endocarditis including systemic disease, prosthetic valve, intravenous drug abuse, dental or surgical manipulation, culture results, echocardiographic findings, complications and outcome were recorded and analyzed . RESULTS: Sixty-six percent (72/109) was definite endocarditis, and 34% (37/109) was possible endocarditis, as categorized by Duke criteria . Eleven percent (12/109) of the patients were rejected by von Reyn criteria . The common possible predisposing factors were rheumatic heart disease, congenital heart disease, mitral valve prolapse, dental manipulation and intravenous drug abuse . Both patients with positive blood culture and negative blood culture results had one-fourth mortality rate . A notably higher mortality rate was found in patients with S . aureus endocarditis as compared with those of endocarditis caused by viridans streptococci(44% vs . 8%, p < 0.05) . Patients with echocardiographic vegetations had a higher mortality rate (32% vs . 11%, p < 0.05) and more peripheral or organ embolic events (26% vs . 6%, p < 0.05) than those without vegetation . CONCLUSIONS: The Duke criteria are more sensitive than the von Reyn criteria for diagnosis of infective endocarditis . S . aureus endocarditis carried a higher mortality rate than viridans streptococci endocarditis . The present study also indicated that patients with discernible valvular vegetation on echocardiogram had a high mortality rate and occurrence of peripheral or organ embolic events . However, there was no statistical significance in the development of congestive heart failure and CNS complications between the patients with and without vegetation. Pediatr Dermatol, 1996 Jul-Aug, 13(4), 292 - 3 Staphylococcal blistering dactylitis: report of two patients; Woroszylski A et al.; Two children with staphylococcal blistering distal dactylitis (BDD), a condition usually caused by streptococci, are reported . Etiologic distinction in BDD can be made only bacteriologically . Staphylococci are increasingly the cause of bacterial cutaneous infections. Clin Infect Dis, 1996 Jul, 23(1), 97 - 100 Comparison of clinical characteristics of group A streptococcal bacteremia in children and adults; Begovac J et al.; This report reviews 55 cases of bacteremia due to group A streptococci (GAS) in patients treated at the University Hospital of Infectious Diseases, in Zagreb, Croatia, during the period 1974-1994 . Clinical findings for 27 children (age, < 18 years) were compared with those for 28 adults . A clear predominance of the respiratory tract as a primary focus of infection in younger patients was observed (P = .00006) . Children were more frequently colonized by GAS in their throats than were adults (P = .04) . Suppurative osteoarticular metastatic foci were more often found in children (P = .02) . Acute underlying conditions were more common in children (P = .04), whereas chronic underlying conditions were more common in adults (P = .00005) . The case fatality rate was 23% among children (6 of 27) and 50% among patients aged > 60 years (5 of 10) . The course of bacteremia due to GAS was benign in eight children (29.6%) and 12 adults (42.8%) . Our experience suggests that there are significant differences in the presentation of bacteremia due to GAS in children and adults. Int J Oral Maxillofac Implants, 1996 Jul-Aug, 11(4), 443 - 9 Experimental salivary pellicles formed on titanium surfaces mediate adhesion of streptococci; Edgerton M et al.; The goal of this study was to characterize salivary components of titanium pellicles and to determine how experimental pellicles affect adhesion of several strains of streptococci to titanium surfaces . Titanium experimental pellicles were formed by incubation of fresh human parotid or human submandibular-sublingual saliva on pure titanium beads . Pellicle was recovered from the beads using sodium dodecyl sulfate buffer and was subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting to identify adsorbed salivary components . Streptococcus anginosus, S . oralis, and S . salivarius recovered from in vivo titanium plaque and five reference strains of streptococci were used in adhesion assays to titanium beads with and without experimental salivary pellicles . The experimental pellicle formed on titanium was found to be composed of selected proteins from human parotid and human submandibular-sublingual saliva . Salivary alpha-amylase and proline-rich proteins were found in all experimental pellicles, while sIgA, high-molecular weight mucin, and proline-rich glycoproteins were detected in one of the experimental pellicles examined . Adhesion of fresh isolates and reference stains of S . anginosus, S . oralis, and S . salivarius to saliva-coated titanium was reduced compared to that of titanium without saliva coating . However, adhesion of laboratory strains of S . gordonii and S . sanguis was found to be significantly greater to experimental pellicles of human submandibular-sublingual saliva than was the adhesion of the fresh isolates, suggesting that streptococci-colonizing implant surfaces may be inherently less adhesive than other bacterial strains . This study found that salivary pellicles are selectively formed on titanium and mediate in vitro adhesion of streptococci. J Am Acad Child Adolesc Psychiatry, 1996 Jul, 35(7), 913 - 5 Case study: acute basal ganglia enlargement and obsessive-compulsive symptoms in an adolescent boy; Giedd JN et al.; Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAs) may arise when antibodies directed against invading bacteria cross-react with basal ganglia structures, resulting in exacerbations of obsessive-compulsive disorder (OCD) or tic disorders . This is a report of severe worsening of obsessive-compulsive symptoms in an adolescent boy following infection with group A beta-hemolytic streptococci for whom serial magnetic resonance imaging scans of the brain were acquired to assess the relationship between basal ganglia size, symptom severity, and treatment with plasmapheresis . These data provide further support for basal ganglia-mediated dysfunction in OCD and the potential for immunological treatments in PANDAs patients. Rofo, 1996 Jul, 165(1), 36 - 42 {The MR tomographic diagnosis of intra- and paraspinal abscesses}; Lanfermann H et al.; PURPOSE: Analysis of the MRT signals and their extent from intra- and paraspinal abscesses with reference to predisposing factors, their causes and localisation . PATIENTS AND METHODS: The histories and MRT findings in 34 Patients with intra- and paraspinal abscesses were evaluated retrospectively . Most of the patients (24/34) were older than 50 years . A second peak was below 30 years . RESULTS: 27/34 patients had some underlying disease which predisposed to infection, e.g., diabetes mellitus . The most common causal organisms were Staph . aureus (53%) and streptococci (15%) . In 23/34 cases (68%), the abscesses were in the thoraco-lumbar or lumbar region, while only 6/34 occurred in the upper two-thirds of the thoracic spine and only 5/34 in the cervical region . In only 8/34 was the abscess confined to two vertebral lengths; in the remaining patients it was much more extensive . Intraspinal abscesses were about twice as large as the vertebral components and 1.5 times greater than paravertebral abscesses . The age of the abscesses could be estimated approximately from the signals . CONCLUSIONS: Contrast enhanced MRT permits detailed analysis of the compartments and exact estimation of the extent of the lesions and permits accurate monitoring of treatment. Infect Immun, 1996 Jul, 64(7), 2850 - 2 Interleukin-10 protects neonatal mice from lethal group B streptococcal infection; Cusumano V et al.; We investigated the role of interleukin-10 (IL-10) in a neonatal mouse model of lethal group B streptococci (GBS) sepsis . Plasma IL-10 levels significantly increased at 24 and 48 h after GBS inoculation . Neutralization of IL-10 with specific antibodies had no effect on lethality . Administration of recombinant IL-10 at 20 or 4 h before challenge, but not at later times, resulted in decreased tumor necrosis factor alpha levels and improved survival . IL-10 could be potentially useful for the treatment of GBS sepsis. Infect Immun, 1996 Jul, 64(7), 2787 - 93 Identification of an immunoglobulin A binding motif located in the beta-antigen of the c protein complex of group B streptococci; Jerlstrom PG et al.; The beta-antigen of the c protein complex of group B streptococci contains two immunoglobulin A (IgA)-binding domains called A and B . A 73-amino-acid segment in domain A is responsible for most of the IgA-binding activity . To identify the IgA binding motif, the 73-amino-acid domain was divided into 60 14-amino-acid overlapping peptides spot synthesized onto a cellulose membrane . A 20-residue putative antigenic epitope was identified and expressed as a fusion protein . The fusion protein was purified by fast protein liquid chromatography and used to raise rabbit antiserum . By use of a membrane with spot-synthesized peptide amino acids of decreasing length (from 14 to 6 amino acids), the major antigenic epitope recognized by the anti-fusion protein antibodies was mapped to motif MLKKIE . Anti-fusion protein antibodies inhibited the binding of IgA to group B streptococci . This inhibition could be blocked by the peptide containing the motif MLKKIE . These results indicate that the motif MLKKIE is located in the IgA-binding site . The IgA-binding domain of beta-antigen from three group B streptococcal strains reacted with the anti-fusion protein antibodies, and their coding sequences gave positive signals in Southern hybridization . The sequences of beta-antigen from these strains were amplified by PCR, and sequence analysis showed them to be identical . The results indicate that the motif MLKKIE is required for IgA binding and is present in different group B streptococcal strains. Infect Immun, 1996 Jul, 64(7), 2548 - 55 Identification of isp, a locus encoding an immunogenic secreted protein conserved among group A streptococci; McIver KS et al.; The protein Mga (mga), which is required for transcription of several virulence genes of group A streptococci (GAS), including the antiphagocytic M protein, was suggested to act as the response regulator element of a bacterial two-component pathway . To investigate whether a gene encoding a cognate sensor protein is located upstream of mga, 3.1 kb of DNA 5' of the mga translational start site was cloned from serotype M6 GAS strain JRS4 . Sequence analysis of this region revealed two adjacent open reading frames, a previously described orf and a new locus, isp (immunogenic secreted protein), which could encode proteins of 9 and 59 kDa, respectively . Inactivation of either open reading frame had no significant effect on transcription of the gene encoding M protein (emm) under normal growth conditions, suggesting that neither isp nor orf is involved in the Mga regulatory circuit . A protein migrating at an apparent molecular weight of 65,000 was produced when isp was transcribed and translated in vitro . The predicted isp product (Isp) contains an amino-terminal signal sequence region homologous to that found in bacterial secreted proteins, and expression of isp in Escherichia coli resulted in the presence of Isp in the periplasmic fraction . Convalescent-phase serum from a patient with an active GAS infection recognized forms of Isp both from the periplasm of E . coli and the supernatant of a GAS strain . Both isp and orf are highly conserved among strains of GAS, as shown by hybridization analyses. Infect Immun, 1996 Jul, 64(7), 2467 - 73 Entry and intracellular survival of group B streptococci in J774 macrophages; Valenti-Weigand P et al.; The mouse macrophage-like cell line J774 was used to analyze opsonin-independent entry and survival of group B streptococci (GBS) . Efficient entry of GBS in J774 cells occurred within 5 min postinfection, and streptococci persisted intracellularly without loss of viability for at least 8 h . At 24 h postinfection, 30% of the total intracellular GBS was recovered from macrophages . Inhibition studies using different biochemical modulators of cellular functions showed that bacterial entry seemed to involve nonglycosylated J774 surface structures different from known receptors such as fibronectin-binding integrins . Internalization of GBS by J774 cells occurred by a microfilament-dependent phagocytosis-like process also involving participation of receptor-mediated endocytosis . Prior opsonization of GBS with human serum containing anti-GBS antibodies did not affect bacterial entry but significantly reduced the intracellular survival of GBS . Transmission electron microscopic analysis confirmed these findings and demonstrated that both opsonized and nonopsonized bacteria were contained within phagosomes during the whole infection period . Transmission electron microscopy further revealed that decreased intracellular survival rates of opsonized GBS appeared to be due to increased lysosomal activities of the macrophages . These results suggest that in the absence of opsonins, GBS are able to enter and persist efficiently in macrophages by evading intracellular antibacterial activities commonly associated with opsonin-mediated uptake. Infect Immun, 1996 Jul, 64(7), 2415 - 9 Differential effects of the streptococcal fibronectin-binding protein, FBP54, on adhesion of group A streptococci to human buccal cells and HEp-2 tissue culture cells; Courtney HS et al.; We have previously demonstrated that fibronectin mediates streptococcal adhesion to host cells and that streptococci interact primarily with the N-terminal domain of fibronectin . FBP54 is a 54-kDa protein from group A streptococci that binds fibronectin . In this report, we show that the N-terminal domain of fibronectin reacts with FBP54 and preferentially blocks streptococcal adhesion to buccal epithelial cells . FBP54 blocked adhesion to human buccal epithelial cells by 80% in a dose-related fashion . In contrast, FBP54 had little effect on adhesion of group A streptococci to HEp-2 tissue culture cells . The fibronectin-binding domain of FBP54 has been localized to the first 89 N-terminal residues of the protein . Experiments using affinity-purified antibodies to this region indicated that the N terminus of FBP54 is exposed on the surface of streptococci in a manner that can interact with immobilized receptors . Analysis of sera from patients with post-streptococcal glomerulonephritis and acute rheumatic fever indicated that FBP54 is expressed in vivo and is immunogenic in the human host . These data indicate that FBP54 is a streptococcal adhesin that is expressed in the human host and that preferentially mediates adhesion to certain types of human cells. Infect Immun, 1996 Jul, 64(7), 2387 - 90 Conservation of the C5a peptidase genes in group A and B streptococci; Chmouryguina I et al.; The chromosome of group B streptococci (GBS) contains a gene which is related to the C5a peptidase gene (scpA) of group A streptococci (GAS) . scpA encodes a surface-associated peptidase (group A streptococcal C5a peptidase {SCPA}) which specifically cleaves C5a, a major chemoattractant generated in serum by activation of complement . The entire scpA-like gene (scpB) was cloned from a GBS strain and sequenced . The gene encodes an open reading frame of 3,450 bp, which corresponds to a deduced protein (SCPB) of 1,150 amino acids with a molecular weight of 126,237 Da . Nucleotide and deduced amino acid sequences of SCPB were found to be highly homologous to those of SCPAs from GAS . Unexpectedly, scpA12 is more similar to scpB than to another GAS gene, scpA49 . The sequence 5' of the open reading frame, including transcription start and a termination site in the signal sequence, is also similar to that of scpA, although less conserved than the coding sequences . The near identity of GBS and GAS peptidases is consistent with horizontal transmission of the scp gene between these species . Recombinant SCPB was expressed in Escherichia coli by using the expression vector plasmid pGEX-4T-1 and was shown to be identical in size to the enzyme extracted from the parental GBS strain 78-471. Am J Dent, 1996 Jun, 9(3), 93 - 5 Effect of an antiseptic mouthrinse on salivary microbiota; DePaola LG et al.; PURPOSE: To evaluate the effect of rinsing with original formulation Listerine Antiseptic (LA) on the level of viable salivary bacteria for periods up to 1 hour . MATERIALS AND METHODS: In this double-blind, controlled, cross-over study, unstimulated saliva was collected from 25 subjects, serially diluted, and cultured on selective and non-selective media under aerobic and anaerobic conditions . Streptococci, Veillonella sp., and total aerobic and anaerobic flora were enumerated just prior to and 2, 15, 30, and 60 minutes after rinsing for 30 seconds with either 20 ml of LA or a 5% hydroalcohol control rinse . RESULTS: After the control rinse, total flora cultivated on MM10 agar exhibited a non-significant (P > 0.05) 10%-20% decrease relative to baseline . In contrast, rinsing with LA resulted in a significant (P < 0.05) 60%-65% decrease from baseline in all four microbial groups at 2 minutes; except in the case of Veillonella, the significant decreases were sustained up to 60 minutes . Total Listerine group aerobic, anaerobic and streptococcal counts were significantly lower than placebo (P < 0.05) . The significant reduction in salivary bacterial levels seen in the Listerine group for up to 60 minutes suggests that this antiseptic mouthrinse may have use clinically as a pre-procedural rinse to decrease the level of viable microorganisms in aerosols generated during dental procedures. Community Dent Oral Epidemiol, 1996 Jun, 24(3), 164 - 8 Salivary mutans streptococci and dental caries patterns in pre-school children; Thibodeau EA et al.; Recent studies have suggested that the identification of caries as discrete patterns may be valuable in describing and predicting caries experience on an individual basis . The purpose of this study was to assess the association between levels of salivary mutans streptococci and the prevalence, incidence and distribution of caries patterns in the primary dentition . A cohort of pre-school children (n = 146, mean age 3.8 yr) were examined for dental caries and sampled for salivary mutans streptococci (SMS) at baseline and once annually for 2 yr . Children's tooth surfaces were categorized into four patterns: pit/fissure, maxillary anterior, posterior proximal, and buccal/lingual smooth surface . Salivary mutans streptococci were enumerated using a tongue blade technique, and were categorized as low (0 CFU), moderate (1-50 CFU) and high (> 50 CFU) . At year 2, children with high baseline SMS had the 1) highest prevalence of caries (87%) and the highest dmfs (9.15); 2) highest prevalence of each pattern, and 3) greatest number of patterns . Among children with the pit/fissure pattern, those with high baseline SMS had the greatest pit/fissure dmfs after 2 yr . Results show that baseline SMS levels were associated with both cross-sectional and longitudinal caries experience, numbers of caries patterns, and the prevalence and severity of those patterns. Pediatr Emerg Care, 1996 Jun, 12(3), 203 - 4 Group A beta-hemolytic streptococcal epiglottitis as a complication of varicella infection; Belfer RA; A rare complication of varicella in an otherwise normal host is described: epiglottitis caused by group A beta-hemolytic streptococci (GABHS) . The resurgence of invasive disease secondary to GABHS is discussed . The rarity of GABHS bacteremia and epiglottitis in the context of varicella is emphasized. Ann Trop Paediatr, 1996 Jun, 16(2), 123 - 7 The prevalence of group A streptococcal throat carriage in Al Ain, United Arab Emirates; Dawson KP et al.; The aim of this study was to establish the carrier rate of group A beta haemolytic streptococci in school children in Al Ain, United Arab Emirates . One thousand and two randomly selected school children aged 5-7 years had their throats swabbed twice for both culture and direct antigen detection of group A streptococci . One hundred and fourteen children (11.3%) had both a positive antigen and culture test, while 216 (21.6%) had antigen-positive tests only and 16 (1.5%) had a positive culture only . Thus, the combination of culture and antigen detection revealed a carrier rate of 35.4% in the children examined . We conclude that in an affluent but isolated desert area on the Tropic of Cancer, group A streptococcal carriage rate is high . Antigen detection is superior to culture techniques in asymptomatic carrier studies. Arch Mal Coeur Vaiss, 1996 Jun, 89(6), 671 - 7 {Prognostic factors of prosthetic valve endocarditis . Apropos of 122 cases}; Witchitz S et al.; The prognostic factors of 122 patients suffering from prosthetic valve endocarditis between 1978 and 1992 were studied by univariate and multivariate analysis . The principal causative organisms were Staphylococcus aureus (33%), streptococci (20%), coagular-negative staphylococci (12%), enterococci (10%) and gram-negative bacilli (9%) . The 4 month survival rate was 66% (42 deaths) . The main predictive factor for death was infection with S . aureus (75% vs 15% with other organisms) . In S . aureus infection, multivariate analysis identified the following predictive factors for death: a prothrombin ratio less than 30% (RR = 8.3), mediastinitis (RR = 4.9), cardiac failure (RR = 4.4) and septic shock (RR = 2.6) . In cases of infection with other organisms, the following factors were predictive of death: a prothrombin ratio of less than 30% (RR = 32.26), renal failure (RR = 7.31) and cardiac failure (RR = 6.07) . In patients with S . aureus infection, survival was better after than without surgery: 9/20 (45%) versus 0/20 (p < 0.001) . In infection with other organisms, there was no difference in a survival after surgical (89%) or medical therapy (81%) . Chronic endocarditis relapses over 1 to 5 years was observed in 9 cases . All patients were reoperated a total number of 18 times with 5 deaths . Very prolonged antibiotic therapy is recommended in these patients . The authors conclude that endocarditis not due to S . aureus and without complications may be treated medically . Rapid reoperation is necessary in all other cases. J Clin Microbiol, 1996 Jun, 34(6), 1448 - 52 Molecular epidemiology of impetiginous group A streptococcal infections in aboriginal communities of northern Australia; Gardiner DL et al.; Group A streptococcal infections among the Aboriginal communities of the Northern Territory of Australia are endemic, with a concurrently high rate of the postinfection sequelae of rheumatic fever and acute post-streptococcal glomerulonephritis . The majority of the group A streptococcal isolates from the Northern Territory are not typeable by M typing . We recently developed a novel genotyping method, Vir typing . A preliminary study using this method discriminated all the M-nontypeable (MNT) isolates . Vir typing is based on restriction fragment length polymorphisms of the 4- to 7-kb Vir regulon of group A streptococci, which contains a number of genes, including emm (the gene for M protein) . A total of 407 isolates of group A streptococci obtained from four Aboriginal communities over a 4-year period were typed by this genotyping method . Forty-two distinct genotypes were found among the isolates, including 22 among the MNT isolates . The correlation between Vir type and M type was good . This genotyping method allows the characterization of all group A streptococcal isolates from Aboriginal communities in the Northern Territory . We also propose that Vir typing be used in conjunction with M typing for epidemiological surveillance in geographical regions where the majority of isolates are MNT. Am J Obstet Gynecol, 1996 Jun, 174(6), 1934 - 7; discussion 1937-40 Intrapartum factors in early-onset group B streptococcal sepsis in term neonates: a case-control study; McLaren RA et al.; OBJECTIVE: A case-control study was used to (1) examine the intrapartum characteristics of term neonates with early-onset group B streptococcal sepsis and (2) determine what percentage of patients meet The American College of Obstetricians and Gynecologists guideline for intrapartum administration of antibiotics . STUDY DESIGN: Twenty-one women delivered of term neonates who contracted early-onset group B streptococcal sepsis were matched with 63 mothers who were colonized with group B streptococci . The women were matched for race, age, parity, and gestational age . A Student t test and chi2 analysis were performed . Significance was defined as p < 0.05 . RESULTS: The attack rate was 2.1 instances of sepsis per 1000 live births . For both groups, the maternal demographics and the actual birth weights were similar . Case mothers compared with controls had longer labor (11.4 +/- 6.9 vs 5.8 +/- 4.3 hours, p < 0.0001), had longer time elapsed between rupture of membranes and delivery (10.3 +/- 6.4 vs 3.2 +/- 3.6 hours, p < 0.0001); required oxytocin more often (76% vs 32%, p < 0.001); required more pelvic examinations (6 or more; 71% vs 46%, p < 0.05); and had a significantly higher cesarean section rate (33% vs 3%; p < 0.001) . Only 10% (2 of 21) of case mothers met The American College of Obstetricians and Gynecologists guideline for chemoprophylaxis . CONCLUSION: The American College of Obstetricians and Gynecologists guideline for chemoprophylaxis identifies only 10% of women whose term newborns contract early-onset group B streptococcal sepsis. Am J Obstet Gynecol, 1996 Jun, 174(6), 1725 - 31; discussion 1731-3 Fetal and maternal endocrine responses to experimental intrauterine infection in rhesus monkeys; Gravett MG et al.; OBJECTIVE: Our purpose was to describe the temporal and quantitative relationships among intrauterine infection, fetal-placental steroid biosynthesis, and preterm labor in a nonhuman primate model . STUDY DESIGN: On approximately day 130 of gestation (term 167 days) chronically instrumented rhesus monkeys (Macaca mulatta) were infected with 10(6) colony-forming units of group B streptococci either by intraamniotic (n = 4) or choriodecidual (n = 2) inoculation . As controls, four additionally chronically instrumented noninfected monkeys were followed up to spontaneous parturition . Amniotic fluid and maternal and fetal arterial blood were serially sampled in all monkeys (both before and after infection) for progesterone, estrone, estradiol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, and cortisol by specific radioimmunoassays, and uterine activity was continuously recorded . RESULTS: Spontaneous parturition was preceded by gradual and significant increases in the plasma concentrations of fetal dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione and fetal and maternal levels of estrone, estradiol, and progesterone but not by changes in cortisol . In contrast, infection-associated parturition (either intraamniotic or choriodecidual) was characterized by abrupt increases in fetal dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, progesterone, and cortisol but not by increases in maternal or fetal estrone or estradiol . Infection-associated steroid changes occurred concurrently with or after increases in uterine activity . CONCLUSION: Infection-associated preterm parturition is associated with dramatic increases in fetal adrenal steroid biosynthesis but not by corresponding increases in placental estrogen biosynthesis . This suggests that fetal stress in accompanied by placental dysfunction and that infection-associated parturition is not dependent on the increased estrogen biosynthesis observed in spontaneous parturition. Infect Immun, 1996 Jun, 64(6), 2122 - 9 Identification of a fibronectin-binding protein (GfbA) in pathogenic group G streptococci; Kline JB et al.; Attachment to eukaryotic cell surfaces is an essential step in the establishment of colonization and infection by bacterial pathogens . This report examines the adherence capabilities of pathogenic group G streptococci and demonstrates that certain group G streptococcal clinical isolates express a fibronectin-binding protein . This protein, termed GfbA for group G streptococcal fibronectin-binding protein, mediates adherence to human skin fibroblasts (HSF) . The gene encoding this protein, gfbA, was isolated, and the complete DNA sequence of gfbA was determined . From this sequence GfbA was predicted to be a 580-amino-acid protein (molecular weight = 64,979) with significant amino acid identity to the group A streptococcal fibronectin-binding proteins SfbI and protein F (PrtF) (76 and 78% identity, respectively) . GfbA contains regions with notable identity to the fibronectin-binding repeat domains of PrtF . gfbA(+) strains were able to bind to HSF, and preincubation of the gfbA(+) strains with fibronectin blocked this adherence . In addition, gfbA(+) strains were able to bind radiolabeled fibronectin, and this binding was inhibited with addition of excess unlabeled fibronectin . gfbA-negative strains were not able to bind either the HSF or radiolabeled fibronectin . DNA homologous to gfbA was found in 36% of the group G streptococcal isolates examined . Since not all group G streptococcal strains examined contained gfbA, this suggests there might be other tissue-specific adherence molecules expressed by these pathogenic strains. Infect Immun, 1996 Jun, 64(6), 1956 - 60 Iron starvation causes release from the group A streptococcus of the ADP-ribosylating protein called plasmin receptor or surface glyceraldehyde-3-phosphate-dehydrogenase; Eichenbaum Z et al.; In many pathogenic bacteria, iron starvation serves as an environmental signal that triggers the expression of virulence factors, many of which are found on the cell surface or secreted into the culture supernatant . Using the chelating agent nitrilotriacetic acid, we have established conditions for iron starvation of the important human pathogen Streptococcus pyogenes (the group A streptococcus) and determined that iron limitation results in the specific appearance of several new proteins in the culture supernatant . One of these supernatant proteins is the ADP-ribosylating protein known as streptococcal plasmin receptor (Plr) or as the streptococcal surface glyceraldehyde-3-phosphate-dehydrogenase because of its other activities . Upon iron starvation, Plr is specifically released into the culture supernatant in a time-dependent manner, and its appearance in the supernatant is not accompanied by induction of plr mRNA synthesis . Release of Plr from the bacteria may be important for the virulence of group A streptococci and the manifestation of diseases. Curr Eye Res, 1996 Jun, 15(6), 697 - 9 Bacterial contamination of anaerobic vitreous cultures: using techniques employed for endophthalmitis; Chern KC et al.; PURPOSE . To investigate the occurrence of contaminated cultures of vitreous specimens from non-infected eyes obtained using anaerobic techniques employed for endophthalmitis . METHODS . Vitreous specimens were obtained using meticulous sterile techniques employed for endophthalmitis from seventeen patients undergoing pars plana vitrectomy for non-infective indications: vitreous hemorrhage (12 eyes), retinal detachment (3), Coat's disease (1), and congenital dislocated lens(1) . Vitreous specimens were inoculated in the operating room onto an anaerobic blood agar plate and into thioglycolate broth . Bacterial growth occurring before 10 days was considered positive . RESULTS . Three organisms were isolated from three separate eyes . One colony of Staphylococcus species was isolated on an anaerobic blood agar plate on day 3 . A single colony of Propionibacterium acnes grew on an anaerobic blood agar plate on day 6 . Alpha-hemolytic streptococci grew from thioglycolate broth on day 10 . CONCLUSIONS . Growth as detected in this study might represent contaminating rather than an infecting organism in an eye suspected of having endophthalmitis. Pediatrics, 1996 Jun, 97(6 Pt 2), 971 - 5 Antibiotic resistance: relationship to persistence of group A streptococci in the upper respiratory tract; Gerber MA; Despite the use of penicillin for more than 40 years in treating GABHS infections, there has been no significant change in the in vitro susceptibility of GABHS to penicillin . Reported failures to eradicate GABHS from the upper respiratory tracts of patients with pharyngitis and the apparent resurgence of serious Group A streptococcal infections and their sequelae probably are not related to the emergence of penicillin resistance . Although erythromycin resistance in GABHS had been a major problem in Japan and continues to be a major problem in Finland, it has not been a problem in this country . The susceptibility of GABHS to the newer macrolide antibiotics appears to be similar to that of erythromycin . Comprehensive, community-wide programs to continuously monitor for erythromycin resistance in GABHS would be difficult to justify . However, because little is known about how erythromycin resistance in GABHS is acquired or spread, it would be reasonable to periodically monitor isolates of GABHS for erythromycin resistance . A substantial proportion of GABHS are currently resistant to tetracyclines and these agents are inappropriate for treating GABHS infections . Although little recent information is available about the susceptibility of GABHS to sulfonamides, these agents have been shown to be ineffective in eradicating GABHS from the upper respiratory tract regardless of the in vitro sensitivities . GABHS have not been shown to be resistant to any of the commonly used oral cephalosporins; however, there is a great deal of variability among these agents in their activity against GABHS . Clindamycin resistance in GABHS has remained unusual . This agent is an alternative for treating GABHS infections due to macrolide-resistant strains in patients who cannot be treated with beta-lactam antibiotics . There is no reason, based on the in vitro susceptibilities of GABHS, to change the current recommendations for treating GABHS infections with penicillin and for using erythromycin for patients who are allergic to penicillin. Tijdschr Diergeneeskd, 1996 May 15, 121(10), 288 - 90 {Streptococci or slurry pit ventilation?}; van der Wolf PJ; This article describes a case of disturbed behaviour in weaners resulting in mutilation . The mutilations mainly consisted of ear biting and ear necrosis . During some periods all weaners were affected . Deaths occurred as a result of sepsis and meningitis, caused by Streptococcus suis type 1 . There were many runts . The stable was as follows: the sections contained 160 weaners; the floor consisted of plastic slats with a 1-metre-deep slurry pit . The weaners were medicated extensively for the Streptococci, to little effect . A ventilation expert was called in and the diagnosis was 'variable air distribution patterns resulting in slurry pit ventilation' . To solve the problem a number of modifications were made to the ventilation system . The solution was found in attaching flaps under the floor, hanging down into the slurry at every pen partition and in the middle across the entire length of each section . In this manner all air circulation in the slurry pit was effectively ended . Thus in conclusion, mutilative behaviour, eg . ear biting and ear necrosis, can be caused by draught . Medication can provide temporary relief, but does not solve the problem . Only ending the air circulation in the slurry pit provided a lasting solution. Bull Tokyo Dent Coll, 1996 May, 37(2), 77 - 92 Inhibitory effects of funoran on the adherence and colonization of oral bacteria; Saeki Y et al.; Funoran, a sulfated polysaccharide extracted from the seaweed Gloiopeltis furcata, strongly inhibited the adsorption of mutans streptococci to saliva-coated hydroxyapatite (S-HA) used as an experimental pellicle and strongly desorbed cariogenic mutans streptococci pre-adsorbed to S-HA . Colonization inhibition and anticariogenic effects of funoran were also investigated in experimental rats . The colonization of Streptococcus cricetus E49 inoculated on the molar teeth of experimental rats administered funoran was less frequent than that in a funoran-free group . The mean buccal and lingual, sulcal, and total caries scores of rat groups administered funoran were significantly lower than those of the funoran-free group . The inhibitory effect of funoran on periodontopathic bacterial attachment was studied in vitro . Funoran strongly inhibited the adsorption of Porphyromonas gingivalis, Fusobacterium nucleatum, and actinomyces species to S-HA and collagen-coated hydroxyapatite (Co-HA) and apparently inhibited their attachment to the human gingival fibroblast Gin-1 cell line . The present study indicates that funoran inhibits colonization by cariogenic and periodontopathic bacteria and excludes them from human oral cavity. Microb Pathog, 1996 May, 20(5), 275 - 85 Lateral genetic transfers between group A and G streptococci for M-like genes are ongoing; Sriprakash KS et al.; Previously we described a long-polymerase chain reaction (PCR) method to amplify a 4-7 kb target containing most of the components of the vir regulon (mga, emm-like genes and scpA) in a number of group A streptococcus (GAS) isolates . In contrast to GAS, strains of human group G streptococcus (GGS) gave approximately 1.6 or 1.8 kb products . Sequence analysis of the amplified products issued from GGS templates revealed a mosaic consisting of upstream sequence from mga (the gene for positive regulator of vir regulon), an unidentified open reading frame, a short segment of emm (the gene for M protein, an antiphagocytic molecule) and an upstream sequence of scp (C5a-peptidase gene) . A full length scpG is present immediately downstream from the mosaic segment in the human GGS genome . The GGS PCR fragment did not code for mga or full length emm . All human GGS isolates are known to code for emm but the gene is separated from scpG by at least 10 kb . Our data, obtained using long-PCR and unrelated strains of GGS, confirm this . We could not detect a homologue of mga in human GGS by hybridization analysis . The mosaic sequence suggests that enbloc transfer of the vir regulon from GAS to a GGS progenitor may have occurred, following which deletion and rearrangement events may have taken place . Partial nucleotide sequences of emm corresponding to the variable domain of M proteins from three local GGS isolates were determined . One sequence (emmGGS6) is 99% identical to emm from a geographically separated isolate of GGS recently described.3 emmGGS6 also has significant homology with emm from a GAS strain (STDONALD) isolated from the same geographical area as was GGS6 . The two emm sequences (emmGGS6 and emmSTDONALD) revealed frameshift-compensatory frameshift mutations relative to each other, contributing to lower amino acid homology between the two predicted M proteins . Since emmSTDONALD has no known relatives within the 80 or so emm sequences in the database, we speculate that it could have been laterally acquired from GGS . Horizontal transfers between GGS and GAS may be ongoing. Diagn Microbiol Infect Dis, 1996 May, 25(1), 47 - 51 The comparative antimicrobial activity of levofloxacin tested against 350 clinical isolates of streptococci; Biedenbach DJ et al.; The global trend of increasing tolerance and outright resistance to penicillin among streptococcal species becomes even more problematic when considering the coresistance patterns to other commonly used alternative therapies . Levofloxacin is a fluoroquinolone with excellent bioavailability properties that affords potential use in the treatment of a wide variety of infections caused by Gram-positive organisms such as streptococci . We evaluated the antistreptococcal activity (350 strains) of levofloxacin compared with other fluoroquinolones, beta-lactams (penicillin and cephalosporins), erythromycin, and vancomycin against beta- and alpha-hemolytic streptococci including penicillin-resistant strains of pneumococci and species within the viridans group . With the exception of one strain, all isolates were inhibited by levofloxacin concentrations of < or = 2 micrograms/ml including all penicillin-resistant viridans group and pneumococcal strains . This activity was superior to that of comparison fluoroquinolones, all beta-lactams, and erythromycin, whereas all strains remained susceptible to vancomycin . Time-kill results established that levofloxacin is bactericidal against most streptococci and has enhanced activity when combined with gentamicin . These results suggest that levofloxacin alone or in combination with an aminoglycoside may prove useful as an alternative to conventional therapeutic approaches of commonly encountered or serious streptococcal infections. Med Microbiol Immunol (Berl), 1996 May, 185(1), 39 - 47 Different alleles of the fcrA/mrp gene of Streptococcus pyogenes encode M-related proteins exhibiting an identical immunoglobulin-binding pattern; Krebs B et al.; The majority of group A streptococci (GAS, Streptococcus pyogenes) express immunoglobulin (Ig)-binding proteins . The genes encoding these proteins belong either to the emm or the emm-related (fcrA/mrp and enn) gene family and are located in close proximity on the GAS genome, where they form part of the vir regulon . In the present study analysis of sequence data of the 5' terminal portions of the fcrA/mrp genes from GAS isolates representing 37 different M serotypes led to a classification of six different types . Thus, although fcrA/mrp genes exhibit an allelic polymorphism, they do not display the high degree of N-terminal sequence diversity found among emm genes . The nucleotide sequences of the fcrA/mrp genes from 3 GAS isolates, belonging to serotypes M8, M9, and M13 and representing newly characterized fcrA/mrp gene types, are reported . Analysis of the Ig-binding properties of recombinant FcrA/Mrp8, 9, and 13 proteins, demonstrated a similar Ig-binding profile being reactive with human IgG subclasses 1, 2, and 4 . This pattern is identical to that previously described for other recombinant fcrA/mrp4, 49, 64/14 and 76 gene products, indicating that this property is not affected by the N-terminal variability . Evidence for recombination between an fcrA/mrp and an mga gene was observed in an M-type 33 strain isolate providing further support for the concept of gene rearrangement contributing to the diversity of vir regulon gene products. Eur J Clin Microbiol Infect Dis, 1996 May, 15(5), 365 - 71 Seven-year review of bacteremia caused by Streptococcus milleri and other viridans streptococci; Salavert M et al.; The Streptococcus milleri group is associated with a spectrum of serious suppurative infections that have not been well defined . The purposes of this study were to ascertain the clinical significance of Streptococcus milleri bacteremia and to determine the epidemiological, clinical, and microbiological features of these infections compared to those caused by other viridans streptococci . All cases of streptococcal bacteremia observed in a Spanish hospital in the period from January 1988 to December 1994 were reviewed . Of 137 cases of Streptococcus milleri infection, 33 (24%) were documented cases of bacteremia . Twenty-four patients were men (mean age 57.8 +/- 17.4 years) . The majority of infections were abdominal in origin (20/33), the most frequent diagnoses being cholangitis/cholecystitis (18%) and appendicitis (12%) . The origin of infection could not be established in three cases . Nine cases of bacteremia (27%) were polymicrobial . Six patients (18%) had septic shock; in four the infection was polymicrobial, and in two the infection was of abdominal origin . Eighteen of the 33 patients (54%) required surgery . Five patients died . All 33 Streptococcus milleri isolates were susceptible to penicillin . Twenty-two cases of bacteremia caused by other viridans streptococci were observed during the same period . There were no statistically significant differences between the two groups in terms of age, sex, mortality, rate of polymicrobial infection, rate of nosocomial acquisition of bacteremia, or the occurrence of shock . An abdominal origin of infection was more frequent in Streptococcus milleri bacteremia (p = 0.0001); a cardiovascular origin was more frequent in the viridans group (p = 0.01), as was a diagnosis of endocarditis (p = 0.004) . Four patients with viridans streptococci bacteremia required surgery versus 18 patients with Streptococcus milleri bacteremia (p = 0.01) . Viridans streptococci were notably less susceptible to penicillin (89%), clindamycin (79%), and erythromycin (79%). J Clin Periodontol, 1996 May, 23(5), 465 - 70 The effect of mouthrinses containing zinc and triclosan on plaque accumulation, development of gingivitis and formation of calculus in a 28-week clinical test; Schaeken MJ et al.; Experimental mouthrinses containing 0.4% zinc sulphate and 0.15% triclosan, which differed in base formulations were compared to a commercially available non-active control mouthrinse . Following baseline clinical examinations for plaque, gingival bleeding and calculus, the volunteers were provided with a dental prophylaxis and given oral hygiene instruction, stratified into 3 groups and given 1 of 3 mouthrinses . Further clinical assessments were performed after 4, 16 and 28 weeks . Salivary mutans streptococci were also monitored during the study . At 4 weeks, plaque and calculus scores in all groups were low compared to baseline . During the remainder of the study, these improvements were not maintained and both plaque and calculus levels increased in all groups . Plaque was significantly lower (P < 0.05) than in the control at all time points . Calculus was significantly lower (P < 0.05) than in the control at all time points . Calculus was significantly lower at week 28 for experimental mouthrinse group 2 . Gingival bleeding also decreased in the initial 4 weeks but increased thereafter in the control group . In contrast, gingival bleeding was significantly (P < 0.05) lower in the two experimental groups than in the control group . No significant changes in mutans streptococci were observed. Res Microbiol, 1996 May, 147(4), 273 - 7 Septicaemia caused by phenotypic variants of group A streptococci; Geslin P et al.; Clinical isolates (115) of Streptococcus pyogenes responsible for septicaemia were investigated to determine whether invasiveness may be correlated with a large variety of strains, or concerns only particular phenotypes . Irrespective of their clinical origin, the strains studied displayed seven of the ten biotypes described within this species . As already observed in a series of strains isolated from pharyngitis, a restricted association between M-types and biotypes was demonstrated; each M-type corresponded to a sole biotype . However, the proportion of biotypes 3, 5 and 7 was higher in the septicaemia series than in the pharyngitis series, with a larger variety of M-types and with more non-typable strains . Despite these differences, the restricted associations between these characters were concordant in both series . These results demonstrate that streptococcal septicaemias appear to be caused by a wide variety of strains, suggesting that multiple factors may be involved in the invasiveness of the bloodstream during streptococcal infections. Clin Diagn Lab Immunol, 1996 May, 3(3), 321 - 5 Immune responses to the R4 protein antigen of group B streptococci and its relationship to other streptococcal R4 proteins; Fasola EL et al.; The R antigen, a trypsin-resistant protein observed in group A, C, F, G, and L streptococci, has also been found in group B streptococci (GBS) . Although four species of the R antigen have been described for GBS, the R4 protein is the most prevalent in GBS isolates recovered from humans . This study examined the prevalence of antibodies against the R4 antigen by Western blot (immunoblot) (WB) in sera from 40 mothers colonized with GBS serotype II and III and from 26 noncolonized mothers; 92.5% of the colonized mothers had anti-R4 antibodies, compared with 54% of the noncolonized mothers (P < 0.001) . Findings of antibodies in neonatal cord sera (n = 14) were concordant with maternal results by WB analysis for 71% of mother-infant pairs colonized with serotype II and for 57% of pairs colonized with serotype III . Of mothers known to be colonized with type II/R4 or III/R4, 100% (n = 12) had antibody against R4 by WB . This study also evaluated the prevalence of antibody to the GBS R4 antigen in 48 sera from individuals with high and low group A streptococcal anti-DNase B titers . Of those individuals with an anti-DNase B titer of > 640, 64% had a positive WB for anti-R4 antibody, compared with 30% of individuals with low anti-DNase B titers (P < 0.05) . The R4 antigen of GBS had immunologic identity to the R4 antigen of group A streptococci . Overall, the findings suggested that antibodies to the streptococcal R4 antigen were commonly present in GBS-colonized mothers and that transplacental passage of these antibodies occurred . The presence of antibody to R4 in non-GBS-colonized individuals may be due to immunologic responses to past exposure to the R antigen present in GBS or other streptococcal groups. APMIS, 1996 May, 104(5), 339 - 49 The effect of oral commensal bacteria on candidal adhesion to denture acrylic surfaces . An in vitro study; Nair RG et al.; The effect of four different species of oral bacteria (Streptococci (X 2); Escherichia; Porphyromonas) on the adhesion of Candida albicans and Candida krusei to denture acrylic surfaces was studied using a previously described in vitro adhesion assay . Clear acrylic strips immersed in known concentrations of bacterial suspensions and incubated for 45 min to 1 h, at 37 degrees C, were transferred to yeast suspensions of known concentrations and incubated for a similar period, and the adherent yeasts were quantified using an image analysis system . Pre-exposure to different bacterial concentrations resulted in suppression of candidal adhesion to varying degrees . Of three selected concentrations, exposure to the highest bacterial concentration (10(6) organisms/ml) resulted in a consistent reduction in candidal adhesion, except for E . coli-C . albicans and S . salivarius-C . albicans combinations . Candidal adhesion was significantly reduced on pre-exposure to S . sanguis and P . gingivalis, but not E . coli . There were also significant differences in relative adhesion between C . albicans and C . krusei . Taken together, these results indicate that the adhesion of yeasts to acrylic strips is modulated both by the quantity and the quality of pre-existing bacterial flora on acrylic surfaces. Obstet Gynecol, 1996 May, 87(5 Pt 1), 779 - 84 Bacteremia shortly after placental separation during cesarean delivery; Boggess KA et al.; OBJECTIVE: To assess frequency, risk factors, and microbiology of bacteremia within 15 minutes of placental separation during cesarean delivery . METHODS: Ninety-three women undergoing cesarean delivery after a minimum of 4 hours of labor or ruptured membranes were compared with 26 women not in labor undergoing cesarean . Blood cultures for aerobic and anaerobic bacteria were obtained within 15 minutes of delivery of the placenta and before prophylactic antibiotic administration . Chorioamnionic membranes were also cultured . Demographic, labor, delivery, and postpartum characteristics were abstracted from the medical record . RESULTS: Bacteremia was detected in 13 (11%) of 119 women . Bacteremia occurred in 13 (14%) of 93 women after labor or rupture of membranes compared with zero of 26 women not in labor (P = .02) . Isolates included group B streptococcus (n = 5), Gardnerella vaginalis (n = 5), Streptococcus pneumoniae (n = 1), Peptostreptococcus sp (n = 1), and mixed flora of Prevotella bivia, G vaginalis, and viridans streptococci (n = 1) . Bacteremia was associated with earlier median gestational age, lower median birth weight, and a positive chorioamnionic membrane culture . After adjustment for gestational age, intrauterine monitoring was also significantly associated with bacteremia . CONCLUSION: Bacteremia was common after labor in this population, especially in preterm deliveries and those with positive chorioamnionic-placental culture . Many of the isolates are capable of causing endocarditis . Appraisal of the risk of bacteremia and the risk of bacterial endocarditis should be made in individual patients to assess the need for antibiotic prophylaxis. Lett Appl Microbiol, 1996 May, 22(5), 375 - 7 A method for evaluating the cariogenicity of oral bacteria using radio-labelled synthetic hydroxyapatite; Yamaguchi R et al.; Radioactive hydroxyapatite was synthesized using 45Ca to evaluate the cariogenicity of oral streptococci . Discs prepared from it were suspended in media containing sucrose, then inoculated with Streptococcus mutans or Streptococcus sanguis . The radioactivity in the supernatant fluid was measured at specified time intervals . Released 45Ca in the supernatant fluids markedly increased in both species during the experimental period, while Strep . mutans showed much higher decalcification than Strep . sanguis . The present method would be useful for semi-quantitative evaluation of bacterial decalcification ability. Arch Dis Child, 1996 May, 74(5), 462 - 3 Enteroviral pharyngitis diagnosed by reverse transcriptase-polymerase chain reaction; Sharland M et al.; The role of enteroviruses in childhood pharyngitis was investigated using enteroviral specific reverse transcriptase-polymerase chain reaction (RT-PCR) . Viral/bacterial throat swabs were taken from 50 children with acute pharyngitis and 26 controls . A positive culture was identified in only 26% of children with pharyngitis (adenovirus 10%, group A streptococci 2%), and none of the controls . Enteroviral RT-PCR was positive in 8% of the pharyngitis group and none of the controls . Enteroviruses are an important cause of pharyngitis in childhood. J Med Microbiol, 1996 May, 44(5), 372 - 80 Degradation and utilisation of chondroitin sulphate by Streptococcus intermedius; Shain H et al.; Streptococcus intermedius, part of the 'Streptococcus milleri group', has the ability to produce glycosaminoglycan depolymerising enzymes (hyaluronidase and chrondroitin sulphate depolymerase) which is unique amongst the viridans streptococci and may contribute to their virulence in brain and liver abscesses . The growth of S . intermedius strain UNS 35 was studied in basal medium supplemented with chondroitin sulphate A (CS-A, sulphated at position 4 of the N-acetylgalactosamine moiety) or chondroitin sulphate C (CS-C, sulphated at position 6 of the N-acetylgalactosamine moiety) as the major carbohydrate source . CS-A but not CS-C supported the growth of S . intermedius . Extracellular degradation of CS-A resulted in the initial accumulation of 2-acetamido-2-deoxy-3-O-(beta-D-gluco-4-delta-enepyranosyluronic acid)-D-galactose (deltaUA GalNAc-0S), and low levels of 2-acetamido-2-deoxy-3-O-(beta-D-gluco-4-delta-enepyranosyl uronic acid)-4-O-sulpho-D-galactose (deltaUA GalNAc-4S) in the medium with GalNAc-0S being subsequently utilised during bacterial growth . Metabolic end-products included formate and ethanol but not lactate, indicating that growth was probably carbon-limited . The CS-A contained 30% CS-C, which was also depolymerised resulting in the formation of 2-acetamido-2-deoxy-3-O-(beta-D-gluco-4-delta-enepyranosyluronic acid)-6-O-sulpho-D-galactose (deltaUA GalNAc-6S) in the culture supernate, but this unsaturated disaccharide was apparently not utilised during growth . The results indicate that S . intermedius produced CS-AC depolymerase, which was inducible and extracellular, and sulphatase activity . Experiments with authentic deltaUA GalNAc-4S and deltaUA GalNAc-6S demonstrated that deltaUA GalNAc4S rather than deltaUA GalNAc-6S was the preferred substrate for the sulphatase . Therefore, it is suggested that the CS-AC depolymerase of S . intermedius may play a role in the destruction of CS in host tissues, facilitating bacterial spread, and also in bacterial nutrition by the liberation of nutrients at the site of infection. Infect Immun, 1996 May, 64(5), 1643 - 52 Colonization in the rectum and uterine cervix with group B streptococci may induce specific antibody responses in cervical secretions of pregnant women; Hordnes K et al.; We have studied the relationships between genital or rectal carriage of group B streptococci (GBS) with the levels of systemic and mucosal antibodies to GBS in 200 women at about week 17 of pregnancy . Secretions from the uterine cervix were collected with absorbent cylindrical wicks for quantification of antibody levels with whole cell enzyme-linked immunosorbent assay . GBS were cultured from the cervix (with or without concomitant rectal colonization) of 13.5%, from the rectum (with or without concomitant cervical colonization) of 12%, and from both culture sites of 8.5% of the women . Serotypes Ia, II, and III were predominant . Compared with culture-negative women, the group of women colonized rectally had markedly elevated levels of both immunoglobulin A (IgA) and IgG antibodies to GBS in cervical secretions and also had a moderate but significant elevation of IgA antibodies in sera . Women colonized only in the cervix had increases of specific IgA and IgG antibodies in cervical secretions, but their serum antibody levels were not elevated . In cervical secretions, the increase in antibody levels in the groups of colonized women was most pronounced for the IgG isotype, indicating a mucosal immune response involving IgG as well as IgA . A close correlation was found among the levels of antibodies to each of the three GBS serotypes tested . Evidence for such cross-reacting antibodies to different serotypes of GBS, as well as to group A streptococci, was also obtained from absorption experiments . Altogether, our results show that undiluted secretions for antibody determination can be easily collected from the uterine cervix with absorbent wicks and demonstrate that colonization of GBS in the rectum and the uterine cervix may induce a systemic as well as a pronounced local immune response in the female genital tract . The findings may have implications for the development of a mucosal vaccine against GBS disease. Infect Immun, 1996 May, 64(5), 1600 - 8 Defining antibody targets in Streptococcus oralis infection; Burnie JP et al.; Immunoblotting of sera from 12 neutropenic patients with Streptococcus oralis septicemia and 18 patients with endocarditis due to viridans group streptococci revealed immunodominant S . oralis antigens at 85 and 180 kDa . The former cross-reacted with a mouse monoclonal antibody to hsp90 . The latter was identified by sequencing positive clones obtained by screening a genomic expression library of S . oralis with pooled sera from patients who had been infected with S . oralis . Antibody eluted from one of these clones reacted with the 180-kDa antigen of S . oralis . Southern blotting confirmed the origin of the clone from S . oralis . The derived amino acid sequence showed 76.2% homology with the PAc protein precursor of Streptococcus mutans and 73.8% homology with the SpaA protein precursor of Streptococcus sobrinus . Epitope mapping of the derived amino acid sequence with sera from patients with viridans group streptococcal endocarditis delineated nine epitopes . Peptides 1 (TMYPNRQPGSGWDSS) and 2 (WYSLNGKIRAVDVPK), representing two of these epitopes, and peptide 3 (YEVEKPLEPAPVAPS), representing the repeat proline region, were synthesized . These three peptides were used to screen a phage antibody display library derived from a patient who had recovered from S . oralis infection . Two of the human recombinant antibodies produced (SORAL 3 and SORAL 4 against peptide 3) and a human recombinant antibody (B3.7) against the conserved epitope (LKVIRK) of hsp90 gave statistically significant protection, compared with control groups, in a mouse model of lethal S . oralis infection. Infect Immun, 1996 May, 64(5), 1495 - 501 Hyaluronate capsule and surface M protein in resistance to opsonization of group A streptococci; Dale JB et al.; The major virulence determinant of group A streptococci is the ability to resist opsonization and phagocytic ingestion . The present studies were performed to compare the mechanisms of resistance to opsonization of type 18 and type 24 streptococci and to determine the relative roles of M protein-fibrinogen interaction and the hyaluronate capsule in preventing phagocytic ingestion and killing . By use of parent strains and acapsular transposon mutants in the presence and absence of fibrinogen, we show that type 18 and type 24 streptococci rely on somewhat different mechanisms for resistance to opsonization . Type 24 streptococci bound fibrinogen avidly to their surfaces, and encapsulated organisms were completely resistant to opsonization only in the presence of fibrinogen . In contrast, type 18 streptococci bound 10-fold less fibrinogen than type 24 streptococci and were fully resistant to phagocytosis only when they expressed capsule . The general structural characteristics of the amino-terminal halves of type 18 and type 24 M proteins differed in that type 18 M protein contained only one complete B repeat, whereas type 24 M protein contained five complete B repeats, a structural difference which could potentially be related to the differences in fibrinogen binding between the two serotypes . Immunofluorescence assays of complement deposition were used in combination with 125I-C3 binding assays to show that encapsulated type 24 streptococci were fully resistant to opsonization by C3 only in the presence of plasma . Encapsulated and unencapsulated type 18 streptococci were equally opsonized by C3 in either plasma or serum, yet only encapsulated organisms resisted phagocytic killing in blood . The results of this study indicate that opsonization by C3 does not necessarily lead to phagocytic ingestion and that the hyaluronate capsule and M proteins are variably important in resistance to different group A streptococci to opsonization and phagocytic killing. Proc Natl Acad Sci U S A, 1996 Apr 30, 93(9), 4131 - 6 Group B streptococci escape host immunity by deletion of tandem repeat elements of the alpha C protein; Madoff LC et al.; Group B streptococci (GBS) are the most common cause of neonatal sepsis, pneumonia, and meningitis . The alpha C protein is a surface-associated antigen; the gene (bca) for this protein contains a series of tandem repeats (each encoding 82 aa) that are identical at the nucleotide level and express a protective epitope . We previously reported that GBS isolates from two of 14 human maternal and neonatal pairs differed in the number of repeats contained in their alpha C protein; in both pairs, the alpha C protein of the neonatal isolate was smaller in molecular size . We now demonstrate by PCR that the neonatal isolates contain fewer tandem repeats . Maternal isolates were susceptible to opsonophagocytic killing in the presence of alpha C protein-specific antiserum, whereas the discrepant neonatal isolates proliferated . An animal model was developed to further study this phenomenon . Adult mice passively immunized with antiserum to the alpha C protein were challenged with an alpha C protein-expressing strain of GBS . Splenic isolates of GBS from these mice showed a high frequency of mutation in bca--most commonly a decrease in repeat number . Isolates from non-immune mice were not altered . Spontaneous deletions in the repeat region were observed at a much lower frequency (6 x 10(-4)); thus, deletions in that region are selected for under specific antibody pressure and appear to lower the organism's susceptibility to killing by antibody specific to the alpha C protein . This mechanism of antigenic variation may provide a means whereby GBS evade host immunity. Biochem J, 1996 Apr 15, 315 ( Pt 2), 577 - 82 Structure of a group C streptococcal protein that binds to fibrinogen, albumin and immunoglobulin G via overlapping modules; Talay SR et al.; Pathogenic streptococci express surface proteins that bind to host serum proteins . A novel multiple-ligand-binding protein has now been identified in a species belonging to serotype C streptococci . This protein binds to fibrinogen, albumin and IgG and was therefore designated FAI protein . The structure of the fai gene has been determined, and deletion analysis and expression of FAI fusion polypeptides revealed that the binding domain for fibrinogen and IgG is located within the nonrepetitive N-terminal half of the protein . A 93-amino acid peptide retained the ability to bind both proteins, whereas a 56-amino acid subpeptide only bound fibrinogen . IgG-binding activity required the complete fibrinogen-binding domain and an additional 37 amino acids C-terminal to it, and albumin-binding activity was only obtained with a polypeptide reflecting the complete surface-exposed region of FAI protein indicating that the binding sites for each ligand were located on overlapping modules . Signal sequence, C repeat region and C-terminus revealed high homology to group A streptococcal M proteins whereas the N-terminal region containing the fibrinogen/IgG-binding domains is completely different and exhibits no similarity to any other previously characterized protein . Thus FAI protein exhibits a framework structure that might have evolved in group C streptococci via fusion of unrelated sequences, thereby generating an albumin-binding domain in the functional context of multiple-ligand-binding activity. Zhongguo Zhong Yao Za Zhi, 1996 Apr, 21(4), 242 - 3 inside backcover {Antimicrobial properties of Flos Lonicerae against oral pathogens}; Sun Y et al.; The antimicrobial effect of Flos Lonicerae on oral pathogens was studied . The results showed that 73.9% of the tested pathogens were inhibited at a concentration below 6.25mg/ml . Streptococci mutants, actinomyces viscosus and bacteroides melaninogenicus were comparatively more sensitive to Flos Lonicerae. Cytokine, 1996 Apr, 8(4), 300 - 4 Proinflammatory cytokine production by human peripheral blood mononuclear cells stimulated with cell-free supernatants of Viridans streptococci; Soto A et al.; Viridans streptococci (VS) have become recognized as an increasingly important cause of bacteraemia in neutropenic patients undergoing chemotherapy . Surprisingly, VS bacteraemia is associated with toxic shock-like syndrome (TSLS) and adult respiratory distress syndrome (ARDS), features not seen in non-neutropenic patients with viridans streptococcal bacteraemia . The mechanism by which these Gram-positive bacteria cause hypo-tension in the absence of endotoxin is not known . In this study, we have analysed the ability of cell-free bacterial supernatants derived from VS to induce the production of a number of cytokines from human peripheral blood mononuclear cells (PBMC) . These cytokines were tumour necrosis factor alpha (TNF-alpha), tumour necrosis factor beta (TNF-beta) and interleukin 8 (IL-8) . All 59 strains were able to induce these proinflammatory cytokines . We conclude that VS do produce secreted products which are able to stimulate the production of cytokines which may be important in the pathogenesis of shock caused by these bacteria. Mater Med Pol, 1996 Apr-Jun, 28(2), 49 - 56 Infective endocarditis--changes in the microbiological profile; Dudkiewicz B et al.; The clinical material from 120 patients, with clinical diagnosis of infectious endocarditis (IE) (65 patients with IE on native valves and 55 patients with IE on artificial valves, i.e . mechanical or biological prosthesis) treated during the period of 1986-1994 was investigated . Sixty positive cultures were obtained from the valves and 40 positive cultures from the blood, which accounted for 76% and 60% of the confirmed IE cases, respectively . Bacteriological confirmation of IE was obtained in 91 (75.8%) patients, 80.2% of the isolated microorganisms being gram-positive bacteria, 17.6% gram-negative, and 2.2%-fungi . The most frequently isolated bacteriawere coagulase-negative staphylococci . They accounted for 40.5% of infections in the IE patients on native valves, and for 63.3% in those with artificial valves . Streptococci were isolated from 11.8% of the patients with IE on native valves and from only 2% of cases of IE on artificial valves . The multiresistant strains were most frequently isolated from the patients with IE on artificial valves. Antimicrob Agents Chemother, 1996 Apr, 40(4), 891 - 4 Emergence of high rates of antimicrobial resistance among viridans group streptococci in the United States; Doern GV et al.; Three hundred fifty-two blood culture isolates of viridans group streptococci obtained from 43 U.S . medical centers during 1993 and 1994 were characterized . Included were 48 isolates of "Streptococcus milleri," 219 S . mitis isolates, 29 S . salivarius isolates, and 56 S . sanguis isolates . High-level penicillin resistance (MIC, > or = 4.0 micrograms/ml) was noted among 13.4% of the strains; for 42.9% of the strains, penicillin MICs were 0.25 to 2.0 micrograms/ml (i.e., intermediate resistance) . In general, amoxicillin was slightly more active than penicillin . The rank order of activity for five cephalosporins versus viridans group streptococci was cefpodoxime = ceftriaxone > cefprozil = cefuroxime >> cephalexin . The percentages of isolates resistant (MIC, > or = 2 micrograms/ml) to these agents were 15, 17, 18, 20, and 96, respectively . The rates of resistance to erythromycin, tetracycline, and trimethoprim-sulfamethoxazole were 12 to 38% . Resistance to either chloramphenicol or ofloxacin was uncommon (i.e., < 1%) . In general, among the four species, S . mitis was the most resistant and "S . milleri" was the most susceptible. Pediatr Res, 1996 Apr, 39(4 Pt 1), 622 - 4 Microbiologic studies on the small intestine in Kawasaki disease; Yamashiro Y et al.; In an attempt to elucidate the etiology of Kawasaki disease (KD), the microflora of the small intestine was investigated in 15 Japanese KD patients . The range of bacterial species adhering to the lumen of the jejunum of KD patients was quite different from that of controls . A wider variety of bacteria was isolated from jejunal biopsies in the acute phase of KD as compared with those from control children . Gram-positive cocci were isolated from KD patients predominantly . Notably, five kinds of streptococci and two kinds of staphylococci were isolated only from KD patients . Further investigation of the microflora of the small intestine of KD patients may provide clues to clarify the pathogenesis of this disease. Pediatr Res, 1996 Apr, 39(4 Pt 1), 609 - 15 Effects of ATP-magnesium chloride on the cardiopulmonary manifestations of group B streptococcal sepsis in the piglet; Ali A et al.; Low dose ATP-MgCl2 is reported to cause selective pulmonary vasodilation during hypoxic and thromboxane mimetic-induced constriction . In addition, it has been shown to increase cardiac output and improve cellular function during circulatory shock . Based on these properties we hypothesized that ATP-MgCl2 might ameliorate the cardiopulmonary manifestations of sepsis secondary to group B streptococci (GBS) . We studied 14 anesthetized, mechanically ventilated piglets who received a continuous infusion of GBS (7.5 x 10(7) colony-forming units/kg/min) and were randomly assigned to a treatment group that received a continuous infusion of ATP-MgCl2 at 0.6 mumol/kg/min or a control group that received normal saline as placebo . Comparison of the hemodynamic measurements, pulmonary mechanics, and arterial blood gases over the first 120 min of ATP-MgCl2 infusions with those of the control group revealed the following: GBS infusion caused significant increases in mean pulmonary artery pressure, pulmonary vascular resistance (PVR), mean systemic arterial blood pressure, systemic vascular pressure (SVR), and PVR/SVR ratio with decreases in cardiac output and stroke volume . ATP-MgCl2 caused significant reduction in mean pulmonary artery pressure (p < 0.001), PVR (p < 0.0001), mean systemic arterial blood pressure (p < 0.003), SVR (p < 0.01), and PVR/SVR ratio (p < 0.03) with improvement in cardiac output (p < 0.001) and stroke volume (p < 0.01) . The partial pressure of arterial O2 (p < 0.04), and pH (p < 0.001) were higher and the partial pressure of arterial CO2 (p < 0.02) lower in ATP-MgCl2-treated animals . Also dynamic lung compliance was higher (p < 0.001) and pulmonary airway resistance lower (p < 0.001) in treated animals . Median survival in control animals was 153 min, whereas all treated animals survived to 240 min (p < 0.001) . These data demonstrate that ATP-MgCl2 ameliorates the deleterious cardiopulmonary manifestations of GBS sepsis and results in improved survival in a young animal model. Diagn Microbiol Infect Dis, 1996 Apr, 24(4), 213 - 9 Survey of antimicrobial activity of four commonly used third generation cephalosporins tested against recent bacterial isolates from ten American medical centers, and assessment of disk diffusion test performance . AST Surveillance Group; Fuchs PC et al.; Over 2,000 clinical isolates from ten American medical centers were tested for susceptibility to cefotaxine, ceftriaxone, ceftizoxime, and ceftazidime by both broth microdilution and disk diffusion methods . Typically resistant (e.g . enterococci) and highly susceptible (e.g . streptococci) isolates showed no change in susceptibility patterns compared to previous surveys . Pseudomonas aeruginosa and Stenotrophomonas maltophilia exhibited significant decreases in susceptibility to these cephalosporins . Among Escherichia coli and Klebsiella spp isolates, two to three percent were resistant to one of the four drugs whereas they were very susceptible to the other three . Of the four antibiotics, the cefotaxime disk diffusion test results correlated best with the microdilution results . With the other three drugs the disk diffusion test yielded 1 to 9% more susceptible test results and 1 to 20% fewer resistant test results than broth microdilution when testing gram negative bacilli . The clinical significance of such discrepancies is not known, but the impact on antibiotic susceptibility surveys and antibiogram comparisons could be significant. J Clin Microbiol, 1996 Apr, 34(4), 953 - 8 Sequencing emm-specific PCR products for routine and accurate typing of group A streptococci; Beall B et al.; Rapid sequence analysis of specific PCR products was used to accurately deduce emm types corresponding to the majority of the known group A streptococcal (GAS) M serotypes . The study involved 95 M type reference GAS strains and a survey of 74 recent clinical isolates . A high percentage of agreement between M type serology and the previously published 5' sequences of the emm genes of M type reference strains was noted . The 5' sequences for six established M protein genes--the emm-32, emm-34, emm-38, emm-40, emm-42, and emm-71 genes--were determined to supplement the existing emm sequence database . Rapid sequence analysis differentiated serologically M-nontypeable strains and was used to establish the probable. Methods, 1996 Apr, 9(2), 233 - 47 Bacterial Cell Wall Polymer-Induced Granulomatous Inflammation Sartor RB, Herfarth H, Van Tol EAF. Local or systemic injection of peptidoglycan-polysaccharide polymers, which are the primary structural components of cell walls of nearly all bacteria, leads to acute inflammation, which can develop into chronic, spontaneously relapsing, granulomatous inflammation in a number of organs . Evolution into chronic granulomatous inflammation is dependent upon persistence of poorly biodegradable cell wall polymers within tissues, genetically determined host susceptibility, and generation of a T-lymphocyte-mediated immune response . Intraperitoneal injection of peptidoglycan-polysaccharide fragments from group A streptococci or selected intestinal bacteria into susceptible Lewis rats leads to chronic, spontaneously reactivating erosive arthritis and hepatic granulomas . Subserosal (intramural) injection of poorly biodegradable cell wall fragments into the distal intestine of Lewis rats induces chronic, spontaneously relapsing granulomatous enterocolitis with associated arthritis, hepatic granulomas, anemia, and leukocytosis . Chronic inflammation does not occur in T-lymphocyte-deficient rats and is prevented by cyclosporin-A therapy and degradation of peptidoglycan by the muralytic enzyme, mutanolysin . Moreover, resistant Buffalo and Fischer F344 rats, the latter sharing identical MHC antigens with Lewis rats, develop only acute inflammation with no chronic granulomatous response . Peptidoglycan-polysaccharide polymers activate almost every limb of the inflammatory response . Blockade of specific pathways suggests that interleukin-1, transforming growth factor-beta, plasma kallikrein, and T lymphocytes are dominant mediators of peptidoglycan-polysaccharide-induced arthritis, hepatic granulomas, and enterocolitis . Because of the similarity of immune mechanisms of these rat models to human disease, bacterial cell wall-induced inflammation provides unique opportunities to study pathogenic mechanisms of granuloma formation in response to ubiquitous microbial agents and to test novel therapeutic agents. Eur J Clin Microbiol Infect Dis, 1996 Apr, 15(4), 291 - 6 Prospective study of 288 episodes of bacteremia in neutropenic cancer patients in a single institution; Gonzalez-Barca E et al.; Trends in causative organisms and sources of infection were studied in a series of 288 episodes of bacteremia in neutropenic cancer patients observed in a single institution from 1986 to 1993 . The incidence of bacteremia increased significantly from 20 episodes per 1000 admissions in 1986 to 50 episodes per 1000 admissions in 1993 (p = 0.00001) . Over the study period, a continuous increment in gram-positive bacteremia, which reached 81% of episodes in 1993 (p = 0.000001), was observed . Conversely, the incidence of gram-negative bacteremia remained stable . Coagulase-negative staphylococci and viridans group streptococci were the most commonly isolated pathogens . Bacteremia caused by coagulase-negative staphylococci increased from 3 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.0001), and viridans group streptococci bacteremia increased from 0 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.000001) . The upward trend in gram-positive bacteremia appeared to be related to a significant increase in both intravascular catheters (p = 0.003) and oral mucositis (p = 0.003) as sources of infection . Specific strategies to prevent chemotherapy-induced mucositis and catheter-related bacteremia merit further investigations. Eur J Pediatr, 1996 Apr, 155(4), 327 - 30 IgA nephropathy presenting clinicopathological features of acute post-streptococcal glomerulonephritis; Okada K et al.; A 5-year-old Japanese girl was affected with acute nephritis . The patient had hypo-complementaemia and an elevation of anti-streptolysin O with positive throat culture of Group A streptococci . Four weeks after onset of the disease, serum complement level returned to normal, but proteinuria increased into the nephrotic range with a deterioration in renal function . Four weeks after onset, light microscopy of a renal biopsy showed diffuse endocapillary proliferation, and immunofluoroscopy revealed predominant IgA deposition in the mesangium . Electron microscopy showed electron dense deposits in the mesangial and subendothelial area, but subepithelial deposits were not found in the glomeruli . Histological diagnosis was IgA nephropathy, while her clinico-serological features were typical of acute post-streptococcal glomerulonephritis . Conclusion: These results suggest that in some patients, IgA nephropathy may be triggered by streptococcal infection and misdiagnosed as acute post-streptococcal glomerulonephritis if renal histological examinations are not done. Biochem Mol Med, 1996 Apr, 57(2), 134 - 8 Purification of NADH: hypothiocyanite oxidoreductase in Streptococcus sanguis; Courtois PH et al.; NADH: hypothiocyanite oxidoreductase (NHOR) activity, found in some oral Streptococci, is postulated to protect these microorganisms against salivary peroxidase-produced hypothiocyanite . NHOR, however, has not been purified so far . The purification of NHOR from crude extracts of Streptococcus sanguis NCTC 7863 strain (by ultrafiltration and anion-exchange chromatography) revealed one fraction of 125 +/- kDa . However, SDS-PAGE electrophoresis provided a single protein of 21.1 +/- 1.2 kDa . This last discovery suggests that NHOR enzyme is a hexameric complex having six subunits. Mol Microbiol, 1996 Apr, 20(2), 403 - 13 Tandem genes encode cell-surface polypeptides SspA and SspB which mediate adhesion of the oral bacterium Streptococcus gordonii to human and bacterial receptors; Demuth DR et al.; The highly conserved antigen I/II family of polypeptides produced by oral streptococci are believed to be colonization determinants and may mediate adhesion of bacterial cells to salivary glycoproteins absorbed to cells and tissues in the human oral cavity . Streptococcus gordonii is shown to express, on the cell surface, two antigen I/II polypeptides designated SspA and SspB (formerly Ssp-5) that are the products of tandemly arranged chromosomal genes . The structure and arrangement of these genes is similar in two independently isolated strains, DL1 and M5, of S . gordonii . The mature polypeptide sequences of M5 SspA (1539 amino acid (aa) residues) and SspB (1462 aa residues) are almost wholly conserved (98% identical) in the C-terminal regions (from residues 796 in SspA and 719 in SspB, to the respective C-termini), well-conserved (84%) at the N-terminal regions (residues 1-429), and divergent (only 27% identical residues) within the intervening central regions . Insertional inactivation of the sspA gene in S . gordonii DL1 resulted in reduced binding of cells to salivary agglutinin glycoprotein (SAG), human erythrocytes, and to the oral bacterium Actinomyces naeslundii . Further reductions in streptococcal cell adhesion to SAG and to two strains of A . naeslundii were observed when both sspA and sspB genes were inactivated . The results suggest that both SspA and SspB polypeptides are involved in adhesion of S . gordonii cells to human and bacterial receptors. Glycobiology, 1996 Apr, 6(3), 281 - 8 Comparison of NMR and molecular modeling results for a rigid and a flexible oligosaccharide; Xu Q et al.; Three-bond heteronuclear coupling constants (3JCH) are extremely useful in describing flexible models for oligosaccharides . We show that antiphase methods for measuring 3JCH in oligosaccharides have limited reliability but that the coupling constants can be reliably measured in natural abundance by quantitative J-correlation methods . Interpretation of 3JCH data for a pentasaccharide (lacto-N-fuco-pentaose 2) from human milk are consistent with a rigid model for the Lewis(a) trisaccharide epitope but for an antigenic tetrasaccharide fragment from the cell wall polysaccharide of viridans streptococci, 3JCH data imply a considerably more flexible model . Nuclear Overhauser effect (NOE) data are reported for a heptasaccharide repeating unit isolated from the cell wall polysaccharide of Streptococcus gordonii 38 . The results for a tetrasaccharide fragment are similar to data reported for the same fragment in the cell wall polysaccharide from S.mitis J22 . This result implies a similar conformation for the tetrasaccharide fragment in the polysaccharide and in the heptasaccharide and also implies that anisotropy of motion is not significant in the interpretation of the nuclear Overhauser effects in the polysaccharide . Interpretation of the NOE results for the tetrasaccharide fragment, like the 3JCH data, implies a flexible model with three conformations in fast exchange . The results of the two experimental techniques are combined with molecular modeling results including molecular dynamics simulation to provide a clear delineation between flexible and rigid oligosaccharide epitopes . The blood group Lewis(a) trisaccharide antigenic determinant is highly restricted in its motions by steric interactions while the antigenic tetrasaccharide fragment of the S.gordonii 38 heptasaccharide is considerably more mobile . We propose that some branched oligosaccharides are relatively rigid and some are flexible depending on subtle details of the linkages. J Antimicrob Chemother, 1996 Apr, 37(4), 783 - 95 Elimination of bacteraemia after dental extraction: comparison of erythromycin and clindamycin for prophylaxis of infective endocarditis; Hall G et al.; Erythromycin and clindamycin are currently recommended for antibiotic prophylaxis of infective endocarditis in predisposed patients allergic to penicillin undergoing oral invasive procedures . Thirty-eight healthy patients were randomized to receive either erythromycin (1 g) or clindamycin (0.6 g) orally 1.5 h prior to dental extraction . Blood samples for microbiological investigation were collected before, during and 10 min after surgery and were processed by lysis filtration under anaerobic conditions . The incidence of bacteraemia with viridans streptococci was 79% in the erythromycin group and 74% in the clindamycin group . No statistically significant difference was noted in incidence or magnitude of bacteraemia with viridans streptococci or anaerobic bacteria between the two groups, at any sampling time . Ninety-six aerobic and 133 anaerobic strains recovered from the blood samples were tested for their susceptibility to erythromycin and clindamycin as well as to penicillin V and ampicillin . The antimicrobials were found to be highly active against the majority of bacteria except for some enterococci, staphylococci and veillonella . Protection from endocarditis by prophylaxis with erythromycin or clindamycin must be due to elimination of bacteria at a later stage in the development of the disease, rather than by elimination of bacteria from blood during the short period of postoperative bacteraemia. Am J Vet Res, 1996 Apr, 57(4), 526 - 8 Efficacy of florfenicol for treatment of clinical and subclinical bovine mastitis; Wilson DJ et al.; OBJECTIVE--To evaluate efficacy of florfenicol treatment for bovine mastitis caused by Streptococcus agalactiae, Staphylococcus aureus nonagalactiae streptococci, coagulase-negative staphylococci, Escherichia coli, Klebsiella sp, and others . DESIGN--Double blind study with cases randomly assigned to 1 of 2 treatment groups . SAMPLE POPULATION--861 cows/10 commercial dairy farms . PROCEDURE--Experimental (750 mg of florfenicol) or control (200 mg of cloxacillin) treatment was administered by intramammary infusion every 12 hours for 3 treatment to all cases . Treatments were randomly assigned identified only by numerical labels . To retain blinding, the longer withdrawal time was adhered to for all cases . Cases remained in the study only if there was no other treatment . Quarter samples were recultured 14, 21, and 28 days later . If all samples after day 1 were culture negative, the case was defined as cured . If only 1 of the follow-up results was positive, the case was considered cured if the day-28 somatic cell count was < 300,000/ ml . Failure of treatment was defined as 2 or more culture positive follow-up samples . RESULTS--Florfenicol and cloxacillin did not differ significantly in efficacy versus clinical (n = 85) or subclinical (n = 71) bovine mastitis, or for any etiologic agent (X2) . Overall cure rates for mastitis were: Str agalactiae, 5 of 8 (63%); Sta aureus, 5 of 54 (9%); Streptococcus sp, 16 of 35 (46%); Staphylococcus sp, 7 of 33 (21%); E coli, 5 of 11 (46%); Klebsiella sp, 3 of 6 (50%); others, 1 of 9 (11%); and all cases, 42 of 156 (27%) . CONCLUSIONS--Florfenicol did not offer any advantage over cloxacillin in efficacy against bovine mastitis . Overall cure rates were low . As with most mastitis treatment regimens poor efficacy may be partly attributable to the short duration of treatment.