Kansenshogaku Zasshi, 1994 Apr, 68(4), 544 - 8 {Case report: infective endocarditis caused by Streptococcus agalactiae}; Uno M et al.; A 42-year-old male was admitted to our hospital because of high grade fever on October 6, 1992 . He had no history of cardiac and underlying disease . For the past 10 days, he had complained of high grade fever and noticed arthralgia on his left shoulder . Physical examination on admission revealed that there was a body temperature of 39.0 degrees C and tenderness in the left shoulder . There were no abnormal findings for the chest or abdomen . On the second hospital day, he developed a diastolic murmur which had not been present on admission . And blood culture was positive for Streptococcus agalactiae . Ultrasonic-cardiogram indicated the presence of vegetation . He was diagnosed as infective endocarditis and treated with PCG 20 million units/day, IPM/CS 2 g/day and ISP 400 mg/day . But he was not responding to the chemotherapy . Aortic valve replacement was done on 22nd, October . Valve surgery succeeded and he became well after that time . Endocarditis caused by S . agalactiae is extremely rare, and is an important condition which carries a high mortality . Only seven cases of S . agalactiae endocarditis have been reported in Japan . It is difficult to treat these cases with antibiotic therapy alone . Therefore, we suggest that early surgery should be considered in infective endocarditis caused by S . agalactiae. J Clin Microbiol, 1994 Apr, 32(4), 906 - 11 Distribution of serotypes and antimicrobial resistance of Streptococcus pneumoniae strains isolated in Brazil from 1988 to 1992; Sessegolo JF et al.; Forty-two serotypes were identified among 288 Streptococcus pneumoniae strains isolated from patients living in Brazil . Serotyping was determined by the capsular typing test (Quellung reaction) . Types 14 (10.4%), 6B (9.8%), 23F (8.0%), 5 (7.3%), 19F (6.9%), 6A (6.0%), and 1 and 4 (4.6%) were the most commonly identified strains . Two hundred twenty (76.4%) of the strains were of serotypes that are included in the 23-valent pneumococcal polysaccharide vaccine . If vaccine-related serotypes are also considered, the proportions of coverage in the vaccine are 82.3% (if type 6B alone is added) and 85.7% (if all the vaccine-related types are considered to be cross-protecting) . Decreased susceptibility to penicillin, which was identified by using the 1-microgram oxacillin disk method as a screening test, was detected in 70 (26.7%) strains . The MICs of nine antimicrobial agents were determined by using the procedures recommended by the National Committee for Clinical Laboratory Standards . Seventy (35.9%) of the strains were resistant to tetracycline, 57 (29.2%) were resistant to sulfamethoxazole-trimethoprim, 3 (1.5%) were resistant to rifampin, 2 (0.80%) were resistant to penicillin, and 1 (0.5%) was resistant to chloramphenicol . The two penicillin-resistant strains were also resistant to or had decreased susceptibilities to cephalosporins . Forty-seven (17.9%) of the strains were intermediately resistant to penicillin, 17 (8.7%) were intermediately resistant to tetracycline, 13 (6.7%) were intermediately resistant to chloramphenicol, 12 (6.1%) were intermediately resistant to erythromycin, and 6 (3.1%) were intermediately resistant to rifampin. Int Immunol, 1994 Apr, 6(4), 561 - 8 Induction of phosphocholine-specific antibodies in X-linked immune deficient mice: in vivo protection against a Streptococcus pneumoniae challenge; Kenny JJ et al.; X-linked immune deficient (XID) mice are susceptible to infection with Streptococcus pneumoniae because they fail to mount an immune response to the immunodominant phosphocholine (PC) epitope on the bacterial cell wall . It is difficult to induce PC-specific antibodies in XID mice because PC-specific B cells expressing the T15-, M167- and M603 idiotype (Id), which provide protection against S . pneumoniae, are deleted in these mice via an antigen-specific, receptor-mediated process . In addition, the standard PC hapten, p-diazophenylphosphocholine (DPPC), induces high affinity phenylphosphocholine (PPC)-specific antibodies in XID mice, which are not protective against S . pneumoniae . We have used a novel PC hapten, p-nitrophenyl-6-(O-phosphocholine)hydroxyhexanoate (EPC), to induce PC-specific antibodies in XID mice . The immune response to EPC-keyhole limpet hemacyanin (KLH) is dominated by IgG1, VH1+, T15-Id-, PC-inhibitable antibodies . A small IgM anti-PC response having a consistent T15-Id+ component is also induced in XID mice, whereas normal mice produce a large IgM response dominated by T15-Id+ antibodies . The immune response to EPC-KLH remains predominantly PC-inhibitable even after multiple immunizations, while the response to DPPC-KLH becomes dominated by PPC-specific antibodies . C.CBA/N mice immunized twice with EPC-KLH are protected against 10(4) S . pneumoniae while as few as 10 bacteria are 100% lethal for the unimmunized controls . The ability of EPC-protein to induce a long-lived, PC-specific response should make this hapten a potential TD vaccine candidate for S . pneumoniae. Pediatr Nephrol, 1994 Apr, 8(2), 211 - 3 Streptococcus pneumoniae-induced hemolytic uremic syndrome: a case for early diagnosis; Erickson LC et al.; Hemolytic uremic syndrome associated with infection by neuraminidase-producing Streptococcus pneumoniae usually presents with fulminant pneumonia and has a high mortality rate . Post-pneumococcal hemolytic uremic syndrome may occur earlier in life than classical hemolytic uremic syndrome . We describe an 18-month-old male with hemolytic uremic syndrome, S . pneumoniae pneumonia, and T-antigen activation characteristic of neuraminidase activity . We have summarized the features of this case and 11 previously reported children . As the use of blood products containing IgM may aggravate this disorder, early recognition of hemolytic uremic syndrome associated with S . pneumoniae neuraminidase production may lead to improved patient outcome through the judicious use of blood products. Scand J Dent Res, 1994 Apr, 102(2), 109 - 12 Effect of a combined chlorhexidine and NaF mouthrinse: an in vivo human caries model study; Ullsfoss BN et al.; Chlorhexidine (CHX) is probably the most widely used and the most potent chemical plaque inhibitory agent, whereas fluoride (F-) is the only truly accepted anticaries agent available at present . As they have discrete mechanisms of action, a combination effect of these agents on human dental caries may exist . The inhibitory effect of CHX on the formation of, and acid production in, plaque may reduce a relatively extreme cariogenic challenge sufficiently for it to be overcome by the local F- concentrations achieved by brushing or rinses . The aim of this study was to evaluate the possible caries inhibitory effect of combining 2.2 mM CHX mouthrinses used twice daily with daily 11.9 mM NaF rinses in an in vivo human caries model using plaque-retaining bands on premolars scheduled for extraction . Nine subjects (a total of 28 teeth) were fitted with the bands for 4 wk . Saliva and plaque samples were collected before and after the study period for bacterial cultures, and the tooth surfaces were analyzed by microradiography after careful tooth extractions . The combination of CHX and F- rinses resulted in enamel mineral loss only slightly higher than that observed in "sound" enamel and clearly less than with F- rinses alone . Both total plaque bacteria and Streptococcus mutans were reduced by CHX rinses, confirming the discrete mechanisms of action. Oral Microbiol Immunol, 1994 Apr, 9(2), 70 - 6 In vitro activation of the classical pathway of complement by a streptococcal lipoteichoic acid; Monefeldt K et al.; The purpose of this study was to find whether a glycerolphosphate-containing lipoteichoic acid prepared from Streptococcus sobrinus OMZ 176 cells would activate the classical pathway of complement while in solution . Reference activators were lipopolysaccharide from Escherichia coli 0111:B4 and heat-aggregated immunoglobulin G . Serum samples were taken from healthy students . Analysis through crossed immunoelectrophoresis showed that lipoteichoic acid caused an almost complete dissociation of the C1qrs macromolecule . All activators decreased the area of and slowed the electrophoretic mobility of the C4 protein peaks, with lipoteichoic acid causing the most pronounced alterations . Electroimmunoassays showed that lipoteichoic acid separately, yielded detectable amounts of free C1r2s2 subunits; it also generated significantly more trimer complexes between C1r, C1s and C1 inhibitor (C1INH) than did the other two activators . Lipoteichoic acid was, however, a comparatively weak inducer of tetramer C1INH-C1r-C1s-C1INH complexes . Analysis through Western blotting showed that all activators accelerated consumption of C1r, induced complex formations between C1INH and C1s and produced cleavage products of C2 . Altogether, the immunochemical analysis gave clear evidence of classical pathway activation by lipoteichoic acid, but its activation profile differed from those seen with lipopolysaccharide and aggregated immunoglobulin G. Zentralbl Veterinarmed B, 1994 Apr, 41(2), 90 - 100 Prepartum antibiotic therapy with a cephapirin dry-cow product against naturally occurring intramammary infections in heifers; Owens WE et al.; Intramammary infusion of a dry-cow antibiotic preparation containing 300 mg of cephapirin benzathine into 18 Jersey heifers, 10-12 weeks prepartum, resulted in cure rates of existing intramammary infection (IMI) of 96% (24/25), 100% (4/4), and 90% (28/31) for Staphylococcus aureus, Streptococcus species, and Staphylococcus species, respectively . Cure rates of IMI that had been treated with a lactating-cow therapy containing 200 mg cephapirin benzathine at parturition were 62.5% (15/24), 100% (22/22), and 100% (3/3) for Staphylococcus aureus, Streptococcus species, and Staphylococcus species, respectively . Initial somatic cell counts (SCC) of secretions from infected quarters were greater than from uninfected quarters . At 2 months postpartum, the SCC of milk from treated and cured quarters were reduced in comparison with quarters that remained infected . Cephapirin benzathine was present at detectable concentrations in 94, 80, 68, and 61% of treated quarters at 1, 2, 3, and 4 weeks after infusion of the cephapirin dry-cow product, respectively . At parturition, 24% of treated quarters were positive for antibiotic, however, no quarters remained positive for antibiotic at 5 days postpartum . An additional 40 heifers from a commercial herd were sampled and infused in all quarters with the cephapirin dry-cow product at 16-20 weeks prepartum . Cure rates for the commercial herd were 94% (29/31), 94% (16/17), 100% (44/44), and 100% (3/3), respectively, for quarters infected by S . aureus, Streptococcus species, Staphylococcus species, and coliforms. Isr J Med Sci, 1994 Apr, 30(4), 275 - 8 An outbreak of foodborne streptococcal throat infection; Shemesh E et al.; Streptococcal pharyngitis is a common disease of epidemic nature, usually transmitted by saliva droplets . We present an epidemiologic analysis of an outbreak of streptococcal pharyngitis in a military unit involving 75 soldiers . The causing organism was Streptococcus pyogenes (group A beta hemolytic Streptococcus, T28 M56), which was isolated from 53 affected individuals . The source of the epidemic was probably an army cook . The infection was transferred by a cabbage salad to individuals who became symptomatic within 24-48 h . This epidemic is a reminder of an exceptional route of streptococcal dissemination and one of the largest outbreaks of foodborne streptococcal pharyngitis documented. Wiad Lek, 1994 Apr, 47(7-8), 252 - 6 {Use of ciprofloxacin and metronidazole in prophylaxis of surgical wound infection in surgical treatment of laryngeal cancer}; Michalska W et al.; The purpose of the work was determination of bacterial flora in laryngeal malignant tissue and postoperative scar in patients who were prophylactically given 2 x 200 mg ciprofloxacine intravenously and 1.5 mg metronidazole for five days starting on the day of the operation . Laryngeal cancer specimens from 55 patients and swabs from postoperative scar from 30 patients were investigated bacteriologically . In the cultures from the malignant tissue and scar numerous micro-organisms were obtained which could be the cause of surgical wound infection . In the cultures from the scar the frequency of isolation of enterococci and Streptococcus viridans was found to be decreased while the frequency of staphylococci and Streptococcus haemolyticys isolation was increased . Despite the presence of pathogens, in none case clinical manifestations of wound infection were observed. Diagn Microbiol Infect Dis, 1994 Apr, 18(4), 211 - 4 Serotypes of Streptococcus pneumoniae causing meningitis in southern India . Use of new direct latex agglutination antigen detection tests in cerebrospinal fluid; Sridharan G et al.; The utility of a new latex agglutination (LA) test to directly determine serotypes of Streptococcus pneumoniae in cerebrospinal fluid (CSF) was assessed in prospective evaluation at a referral hospital in southern India . Samples from 18 ill patients with Gram-positive organisms in CSF were tested . The presence of C polysaccharide or specific serotype antigen (types 1, 3, 4, 5, 6, 12, 14, 18, 19, and 23) of S . pneumoniae was detected by slide LA test . Pneumococcal antigen was detected in 17 (94%) of 18 CSF specimens; in 14 (78%) the serotype was determined directly . Serotypes 1, 5, 6, 19, 23, 7, 10, 34, and 38 were found in these patients . A quellung test of the cultured isolates confirmed the serotypes . Information regarding the serotype distribution of pneumococci in varied geographic locations is important for the design and evaluation of pneumococcal vaccines . The slide LA tests seemed useful in detecting S . pneumoniae antigens and in determining the serotype, and have promise in simplifying the gathering of serotype data. Rev Port Cardiol, 1994 Apr, 13(4), 329 - 34, 292 {Pulmonary valve endocarditis caused by Streptococcus bovis}; Pontes J et al.; The authors report a case of isolated infective endocarditis of the pulmonary valve due to Streptococcus bovis in a 62-year-old male presented with delayed fever of unknown origin . There were no predisposing factors such as i.v . drug abuse or congenital heart disease . The clinical course was complicated with an epidose of pulmonary emboli occurring after the onset of treatment . The patient responded to the appropriate antibiotics without requiring valve surgery . The association of Streptococcus bovis endocarditis and bacteremia with colonic neoplasia has been reported in the literature . In this case the evaluation of the colon was negative. West Afr J Med, 1994 Apr-Jun, 13(2), 81 - 6 Significance of antibiotics resistance amongst clinical bacterial isolates in Lagos; Rotimi VO et al.; In vitro susceptibility of several strains of six different species of clinical facultative pathogens involved in nosocomial infections in our hospital was investigated by a series of disc diffusion, broth dilution and Chequerboard titration testing . With disc diffusion method all the test strains, except Streptococcus pyogenes, were resistant to penicillin . 46% of the Klebsiella aerogenes and 73% of the Pseudomonas strains were generally resistant to cefotaxime . The minimum inhibitory concentration (MIC) of the antibiotics correlated well with the results of the disc diffusion tests . Synergistic effects were demonstrated by various combinations of gentamicin, ampicillin, clindamycin, colistin, cefoxitin, and ceftriazone against resistant strains of S . aureus, Pseudomonas aeruginosa, Escherichia coli and Klebsiella aerogenes . Against S . aureus the effect of gentamicin/clindamycin demonstrated indifference . The need for stringent caution is strongly advocated in the selection of combination therapy for serious infections caused by some hospital bacterial strains particularly in acute care units . The clinical microbiologist should be consulted at all times during the process of selection of an appropriate combined therapy for expert guidance. Vet Microbiol, 1994 Apr, 39(3-4), 361 - 7 Encapsulation of Streptococcus uberis: influence of storage and cultural conditions; Matthews KR et al.; Streptococcus uberis (n = 100) isolated from bovine mammary secretions were assessed by India ink for expression of capsule . Organisms were evaluated under four conditions; (1) after primary culture on blood agar, (2) following 5 passages on blood agar, (3) after 5 passages in Trypticase Soy Broth (TSB), and (4) after storage in 10% skim milk . Strains from primary culture (44 of 100) were positive for an unstained halo (capsule) by the India ink method . Number of strains expressing capsule decreased greatly after passage and following storage . Freeze-etching followed by electron microscopy confirmed results of India ink preparations . Strains were also cultured in various media to determine influence of medium components on capsule expression . Todd-Hewitt medium supplemented with either serum or egg yolk enhanced the size of capsule expressed . Results of this study may aid researchers investigating the pathogenicity of S . uberis. Blood, 1994 Apr 1, 83(7), 1929 - 34 Effect of priming polymorphonuclear leukocytes with cytokines (granulocyte-macrophage colony-stimulating factor {GM-CSF} and G-CSF) on the host resistance to Streptococcus pneumoniae in chinchillas infected with influenza A virus; Abramson JS et al.; Patients infected with influenza A virus (IAV) are at increased risk for bacterial superinfections, and this occurs in association with depressed polymorphonuclear leukocyte (PMNL) function . Recently, we reported that in vitro exposure of human PMNL to granulocyte-macrophage colony-stimulating factor (GM-CSF) reverses IAV-induced cell dysfunction . The present study used an established animal model of IAV infection to examine whether G-CSF and/or GM-CSF can overcome IAV-induced PMNL dysfunction and thereby prevent secondary infections . Preliminary studies determined a dosing schedule of these cytokines that caused significant priming of chinchilla PMNL . In subsequent studies, animals were inoculated intranasally with IAV (day 1) followed 3 days later by Streptococcus pneumoniae, and administered daily intraperitoneal injections with a cytokine or placebo on days 3 through 9 . Animals had blood obtained on multiple occasions for PMNL studies, and were followed-up for evidence of pneumococcal disease . Both cytokines caused significant priming of the PMNL chemiluminescence response and this was associated with reversal of the IAV-induced PMNL dysfunction . However, neither cytokine decreased the incidence of pneumococcal disease. Biochem Biophys Res Commun, 1994 Mar 30, 199(3), 1297 - 304 Complete amino acid sequence and comparative molecular modelling of HPr from Streptococcus mutans Ingbritt; Dashper SG et al.; The heat-stable phosphocarrier protein (HPr) of Streptococcus mutans was extracted from whole cells using sodium lauroylsarcosinate/EDTA and purified to homogeneity by a single-step, ion-exchange chromatographic procedure . The complete amino acid sequence of the protein was determined from peptides generated by trypsin, alpha-chymotrypsin, endoproteinase Glu-C, and cyanogen bromide treatment . The HPr from S . mutans contains 86 or 87 amino acyl residues, depending on removal of the N-terminal Met and the protein shows high sequence homology with HPr from other Gram-positive bacteria . The predicted tertiary structure of the S . mutans HPr, from model building by homology, is an open-faced beta-sandwich consisting of two alpha-helices and a four-stranded antiparallel beta-sheet. Eur J Biochem, 1994 Mar 15, 220(3), 819 - 26 The type-III Fc receptor from Streptococcus dysgalactiae is also an alpha 2-macroglobulin receptor; Jonsson H et al.; We have cloned and sequenced the gene for a type-III Fc receptor from a Streptococcus dysgalactiae strain isolated from bovine mastitis and report here the complete sequence of the gene . The 1992-nucleotides-long open reading frame codes for a protein of 664 amino acids with a predicted molecular mass of 72 kDa (including the signal peptide) . The C-terminal part of the protein is very similar to other streptococcal type-III receptors but contains five homologous IgG-binding domains compared to two or three in earlier reported Fc receptors of this type . Upstream of the IgG-binding domains, there is a unique sequence containing short repeated motifs . Subcloning different parts of the gene and expressing them as maltose-binding fusion proteins revealed that the upstream part is mediating binding to the plasma proteinase inhibitor alpha 2-macroglobulin after its complex formation with proteases . In contrast to earlier described type-III Fc receptors, this molecule does not bind human serum albumin. JAMA, 1994 Mar 2, 271(9), 695 - 7 A cluster of invasive pneumococcal disease in young children in child care; Cherian T et al.; OBJECTIVE--To investigate a cluster of invasive pneumococcal disease in children 8 to 26 months of age, using standard microbiological procedures and ribosomal DNA gene-restriction patterns to characterize the outbreak strain . DESIGN--Outbreak investigation . SETTING--A family child-care home with six children in Baltimore, Md . RESULTS--During an 8-day period, three of the six children in the family child-care home had febrile illnesses with pneumococcal bacteremia, and a fourth had purulent pneumococcal conjunctivitis . Type 12F Streptococcus pneumoniae was isolated from the four ill children and from the nasopharynges of the two healthy children . Ribotyping revealed all outbreak isolates had an identical ribotype pattern . Administration of rifampin to the children did not eradicate carriage of the organism . CONCLUSIONS--Our data demonstrate that child care provides an opportunity for outbreak of invasive pneumococcal disease in young children . This observation suggests a need for increased alertness for clusters of pneumococcal disease in young children in child-care facilities and underscores the necessity for a pneumococcal vaccine that is effective in infants and young children. Antimicrob Agents Chemother, 1994 Mar, 38(3), 432 - 7 In vivo activities and penetration of the two components of the streptogramin RP 59500 in cardiac vegetations of experimental endocarditis; Fantin B et al.; We evaluated the in vivo activity and the diffusion of radiolabelled RP 57669 (RPI) and RP 54476 (RPII), the two components of the injectable streptogramin RP 59500, alone or in combination, in aortic vegetations from experimental endocarditis in rabbits . RPI and RPII demonstrated in vitro bacteriostatic and bactericidal synergy against a clinical strain of Staphylococcus aureus resistant to methicillin and susceptible to erythromycin . In experimental staphylococcal endocarditis, RP 59500 was as effective as vancomycin and significantly more effective than RPI (P < 0.01) and RPII (P < 0.05) . Autoradiography studies showed different patterns of distribution into cardiac vegetations infected with Streptococcus sanguis for {14C}RPI and {14C}RPII . {14C}RPI was homogeneously distributed throughout the vegetations whereas {14C}RPII showed a decreasing gradient of concentration between the periphery and the core of the vegetation, with an approximately 2:1 ratio . {14C}RPI diffused approximately 2 to 4 times more than {14C}RPII into the core of the vegetations . Since the injected ratio of RPI and RPII is 30:70 in RP 59500, the actual RPI:RPII ratio in the core of the vegetation may range from 0.8 to 1.7, a ratio which remains compatible with the in vivo synergism demonstrated between the two components. J Pediatr Surg, 1994 Mar, 29(3), 371 - 5 Linoleic acid enhances mitogen response and survival of septic weanling rats; Andrassy RJ et al.; Immunologic responses to various dietary fats and concentrations remain controversial . The authors examined the effect of dietary omega-3 and omega-6 polyunsaturated fatty acids (PUFA) on the immune system of weanling rats . Male weanling Sprague-Dawley rats were fed special liquid diets based on a standard enteral formula: (I) control: 2.2% calories as safflower oil (linoleic acid), (II) omega-3: 2.2% calories as safflower oil and 30% calories as cod liver oil (linolenic acid), and (III) omega-6: 32.2% calories as safflower oil . Body weight and caloric intake were measured daily . Rats were fed special diets for 18 days, at which time they were subjected to either septic challenge with 2 x 10(3) colony forming units of Streptococcus pneumoniae (eight rats per diet group) or killed and a splenocyte mitogen assay performed (four rats per diet group) . Supplementation with omega-6 resulted in prolonged survival after bacterial challenge (control, 30.5 +/- 0.5 hours; omega-3, 31.6 +/- 0.5; not significant; omega-6, 39.8 +/- 5.0; P < .05) . A significant difference in mitogenic stimulation was seen with omega-3 and omega-6 in response to PHA (control, 10,856 +/- 3,342; omega-3, 14,605 +/- 3,042; P < .05; omega-6, 35,737 +/- 7,596; P < .05) and with omega-6 only in response to LPS (control, 3,543 +/- 1,083; omega-3, 8,777 +/- 1,269; omega-6, 10,101 +/- 3,008) . Previous studies have suggested that diets high in omega-6 PUFA are immunosuppressive because of an increase in the production of the dienoic prostaglandins.(ABSTRACT TRUNCATED AT 250 WORDS) Harefuah, 1994 Mar 1, 126(5), 251 - 2, 303 {Left-sided group A streptococcal endocarditis and mitral valve prolapse}; Hayek T et al.; Group A beta-hemolytic streptococcus is an infrequent cause of endocarditis . Left-sided endocarditis in intravenous drug abuse is likewise uncommon; it carries a poor prognosis . A case of left-sided group A beta-hemolytic streptococcal endocarditis in a 20-year-old male drug addict with mitral valve prolapse is presented . This association has not been reported previously. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1994 Mar-Apr, 35(2), 163 - 9 Serious suppurative group A beta-hemolytic streptococcal infection in previously well children: report of six cases; Huang FY et al.; Recently, among adults and children, an increase in the incidence of invasive disease caused by group A beta hemolytic streptococcus (GABHS) has been noted . From December 6, 1981 to January 19, 1991, we experienced six cases of serious infection caused by GABHS in previously well children . Among them, five cases were found in recent two years . The clinical manifestations were varied . One child had sepsis, one had streptococcal toxic shock-like syndrome, two had pyogenic arthritis, and the other two newborn infants had empyema and cellulitis associated with sepsis . Early diagnosis and treatment with appropriate antibiotic are necessary for a good outcome . In addition, empyema and pyoarthritis of the hip often need surgical drainage. Minerva Stomatol, 1994 Mar, 43(3), 95 - 101 {3 different methods for evaluating Streptococcus mutans in the saliva}; Petti S et al.; Three different methods for detection and count of Streptococcus mutans in saliva have been compared with a microbiological method in order to estimate their efficacy and practicality . The study has been carried out on fifty children of six-eleven years old . The first method (stamp method) derives from that of Kohler and Bratthall, improved on the sampling, without saliva stimulation and, hence, more rapid . Furthermore, using a tongue depressor with a shovel-like extremity, we can either restrict the area where the grown colonies must be counted, avoiding any mistake, and stamp the spatula in the centre of the plate, not in the border, as the original method described, pressing it with the same force in every part, so that almost all the saliva collected can be plated on the Streptococcus mutans selective medium . As stated by this method, a tongue depressor is pressed first on the subject's tongue, then on a plate containing the medium . After incubation, the Streptococcus mutans colonies are counted on the plate's area limited by the stamp of the extremity of the spatula . According to Emilson we can also discriminate Streptococcus mutans and Streptococcus sobrinus colonies . The second method is a "strip mutans test" (Dentocult): saliva is stimulated making the subject chew a piece of paraffin and then it is collected passing a plastic spatula for ten times on the child's tongue . The spatula is introduced into a tube containing a liquid medium selective for Streptococcus mutans and then incubated.(ABSTRACT TRUNCATED AT 250 WORDS) Eur J Pediatr, 1994 Mar, 153(3), 174 - 8 Successful intravenous immunoglobulin therapy for recurrent pneumococcal otitis media in young children; Ishizaka A et al.; Serum immunoglobulin levels and naturally occurring antibody titres against Streptococcus pneumoniae were measured in seven children aged 1-1.9 years with recurrent pneumococcal acute otitis media (AOM) . Three of them had low IgG2 levels . Mean antibody levels of anti-pneumococcal IgG1 and anti-pneumococcal IgG2 were significantly lower in patients when compared to those of healthy controls and children who had less frequent episodes of AOM . Following treatment with intravenous immunoglobulin (IVIG) for 6 months, anti-pneumococcal IgG1 and IgG2 antibody levels increased and the number of episodes of AOM decreased in all patients . Following the discontinuation of IVIG therapy, no AOM episode occurred . Serum levels of anti-pneumococcal IgG1 and IgG2 were normal, which were measured in three subjects at 5, 6, and 12 months after the cessation of IVIG therapy . These results suggested that delayed maturation of anti-pneumococcal antibody production caused recurrent AOM and this condition was corrected by IVIG therapy. J Am Vet Med Assoc, 1994 Mar 1, 204(5), 768 - 75 Epidemiologic and immunologic characteristics of Streptococcus equi infection in foals; Hamlen HJ et al.; A 2-phase study was performed to characterize the effects of Streptococcus equi infection in unexposed and previously exposed foals . In phase I, 22 weanling foals involved in a naturally occurring S equi epizootic were studied, along with a comparison group of 11 unexposed foals, matched for age, sex, and breed . Six months later (phase II), an epizootic was experimentally induced in previously exposed and unexposed foals from phase I . The prevalence and duration of clinical signs, the relative risk of developing disease, bacteriologic culture results, hematologic responses, and mucosal and serum immunologic responses were determined . Disease protection in phase-I and -II foals was associated with high values for serum S equi M protein-specific IgG at the onset of the epizootic (P < 0.02 for phase 1 and P < 0.01 for phase II), and with a rapid (within 2 weeks of exposure) mucosal S equi M protein-specific IgG response (P < 0.05 for phase I and P = 0.01 for phase II). Int J Pediatr Otorhinolaryngol, 1994 Mar, 29(1), 1 - 9 An experimental study of cefixime in the treatment of Streptococcus pneumoniae otitis media; Magit AE et al.; Previous studies using the chinchilla animal model demonstrated that the third generation cephalosporin cefixime (Suprax) with split dosing was as effective as ampicillin in sterilizing the middle ear cleft when infected with S . pneumoniae . In this investigator-blinded, randomized trial, a single daily dose of cefixime (8 mg/kg per day) performed as well as split dosing of cefixime (8 mg/kg every 8 h) and ampicillin (150 mg/kg every 8 h) in the time to sterilization of the middle ear cleft . No statistically significant differences were noted between groups in otoscopy or tympanometry . All antibiotic regimens performed better than saline control (P < 0.0001) with regard to time to sterilization of the middle ear cleft . The results of this study support the daily administration of cefixime as an effective agent for the treatment of otitis media due to its extended half-life and broad antibiotic spectrum. J Periodontol, 1994 Mar, 65(3), 211 - 8 Adherence of oral microorganisms to guided tissue membranes: an in vitro study; Wang HL et al.; Microorganisms can adhere and colonize on an exposed guided tissue regeneration (GTR) membrane thus developing a nidus of infection . The purpose of this study was to compare early bacterial adhesion to three different GTR membranes . Expanded polytetrafluoroethylene, polyglactin 910, and collagen were used as the test membranes . In part I of this study 15 different oral microbes were used to compare their relative ability to adhere to the membranes . Six of the most strongly adherent bacteria (Actinomyces viscosus, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus mutans, Fusobacterium nucleatum, and Selenomonas sputigena) were selected for part II of this study . The membranes were placed in tubes containing broth cultures containing identical concentrations (1 x 10(8) cells/ml) of these bacteria at 37 degrees C . Membranes were placed in tubes of media without bacteria as controls . At 4, 6, 12, and 24 hours, the bacterial cultures were decanted and the membranes in the tubes were agitated gently in reduced transfer fluid (RTF) 4 times to remove non-adherent bacteria . Each tube was then sonicated for 30 seconds in 10 ml RTF to detach adherent bacteria . The detached adherent bacteria were counted using a Petroff-Hausser chamber . Data were analyzed by using the SAS program . Analysis of variance was used to test for differences between multiple means . Results showed S . mutans had the strongest attachment to the collagen membrane at 4 and 6 hours . Selenomonas sputigena had the lowest adherence capability to all test membranes . Polyglactin 910 had significantly (P < 0.05) lower S . mutants adherence than either the ePTFE or the collagen membrane at 4 and 6 hours.(ABSTRACT TRUNCATED AT 250 WORDS) J Dent Res, 1994 Mar, 73(3), 692 - 4 Criteria for the assessment of adverse effects of chemotherapy on the oral microflora; Sandham HJ; Any assessment of an antimicrobial agent for the prevention of dental caries must include a consideration of its possible adverse effects on the oral flora . It must include an examination of the resistance developed by the target pathogens and either developed by, or inherently present in, microorganisms that are known to cause opportunistic infections (yeasts, enteric organisms, Pseudomonas, clostridia, and Staphylococcus aureus) . Streptococcus pyogenes should also be included . Insofar as possible, these assessments should be done in preliminary experiments, both in vitro and clinical, rather than in caries trials, so that the large numbers of subjects will not be submitted to unnecessary exposure to the formulation . It must be recognized that some combinations of agent, vehicle, and frequency are more prone than others to cause adverse effects on the oral flora, and will also influence the length of the test period that should be utilized . The microbial assessments should be done on subjects prior to use of the agent, at appropriate frequencies during therapy, and approximately 2 months after the cessation of therapy . Currently, requirements to assess the state of gingival or periodontal health by microbiological examination seem unjustified, because of the relative lack of strong evidence for their diagnostic or predictive value (Ranney, 1989) and because of the ease with which direct measurements of clinical signs and symptoms can be made . Consequently, only the latter should be required. J Dent Res, 1994 Mar, 73(3), 637 - 43 Pilocarpine alters caries development in partially-desalivated rats; O'Connell AC et al.; This study examined the effect of pilocarpine on caries and saliva composition in rats with compromised salivary gland function . Eight litters of specific-pathogen-free female Sprague-Dawley rats were divided into five groups for surgery . Partial desalivation was performed in either of three ways: (1) Both parotid ducts were ligated; (2) both submandibular/sublingual (SM/SL) glands were excised, or (3) one parotid duct was ligated, and submandibular/sublingual glands were removed unilaterally . Completely desalivated animals and unoperated animals served as positive and negative controls, respectively . One week following surgery, groups were subdivided so that half of each group had osmotic pumps implanted which delivered pilocarpine HCl (24 mg/kg/day) . All animals were infected with Streptococcus sobrinus 6715 and fed cariogenic diet ad libitum for 28 days . Caries scores, microbiological data, and saliva flow rate and composition were determined for all animals . Animals which had both SM/SL glands removed and received pilocarpine developed significantly lower sulcal caries (p < or = 0.05) compared with the animals that had both SM/SL removed but did not receive pilocarpine . The concentration of protein in parotid saliva in these pilocarpine-treated animals was unaffected, and no differences were observed in the electrophoretic profiles on SDS-PAGE . Pilocarpine appears to exert its greatest caries-protective effect when the parotid glands remain intact. J Immunol, 1994 Mar 1, 152(5), 2214 - 21 Repertoire diversity of antibody response to bacterial antigens in aged mice . IV . Study of VH and VL gene utilization in splenic antibody foci by in situ hybridization; Yang X et al.; Mouse Abs against a bacterial epitope, the phosphorylcholine (PC) hapten are encoded by the T15 genes VH1(S107) and V kappa 22 . It has been shown that PC-specific hybridomas from aged animals often express IgV gene families other than T15 . To determine the extent of this age-dependent molecular shift in the anti-PC response, we examined antibody-forming cells (AFC) in individual young (2 to 4 month) and aged (20 to 24 month) mice by an in situ RNA hybridization . Mice were immunized either with PC coupled to keyhole limpet hemocyanin or with a Streptococcus pneumoniae strain R36a vaccine . Frozen splenic sections were prepared, and the clusters of PC-specific AFC (i.e., antibody foci) were identified by immunocytochemical staining . The adjacent splenic sections were hybridized with digoxigenin-labeled VH1(S107) and V kappa 22 DNA probes and with a C mu DNA probe as a control . The splenic sections were examined for 1) the number of Ab foci hybridized with the T15 probes, and 2) the estimated proportion of VH1+ and V kappa 22+ AFC within each focus . The results were comparable regardless of the form of PC Ag administered . Virtually all Ab foci (> 85%) in young mice hybridized with the T15 probes and were occupied by the VH1+/V kappa 22+ AFC . In aged mice, the fraction of PC-binding Ab foci that hybridized with a given T15 probe varied from 35% to > 85%; T15+ AFC always represented a minor population of the focus (< 50%), the remaining PC-specific AFC being C mu + but T15- . Also, there appeared to be a greater loss of the V kappa 22 expression relative to the VH1(S107) . Thus it appears that the T15+, PC-reactive B cells in aged mice responded to the Ag but that they could not dominate the response . The possibility of an intrinsic molecular change in the aging B cells in discussed. Chemotherapy, 1994 Mar-Apr, 40(2), 73 - 9 Morphological alterations of Staphylococcus aureus and Streptococcus pyogenes exposed to cefdinir, a new oral broad-spectrum cephalosporin; Hatano K et al.; Affinity for penicillin-binding proteins (PBPs) and the morphological alteration of Staphylococcus aureus 209-P JC and Streptococcus pyogenes C-203 exposed to cefdinir were studied . Although cefdinir was bactericidal against both strains, the extent of the decrease in colony-forming units (CFU) was similar in a fairly wide range of concentrations . Transmission electron microscopy of S . aureus 209-P JC revealed that cefdinir induced thickening of the cross wall and frequent cell lysis at low concentrations . The lytic sites were seen at the site of septum formation . In S . pyogenes C-203, cefdinir induced thickening of the peripheral wall and cross wall, and protoplast-like cells were observed during the incubation period . Cefdinir showed high affinity for all PBPs of S . aureus 209-P JC and S . pyogenes C-203 . The drastic changes in the morphology of S . aureus and S . pyogenes were caused by binding of cefdinir to all PBPs. Scand J Immunol, 1994 Mar, 39(3), 275 - 80 All forms of human IgA antibodies bound to antigen interfere with complement (C3) fixation induced by IgG or by antigen alone; Nikolova EB et al.; Polyclonal human secretory IgA1 and IgA2 antibodies to a bacterial protein antigen Streptococcus mutans AgI/II, and polyclonal human serum IgA1 and IgA2 antibodies to staphylococcal alpha-toxin, were found to interfere with antigen-mediated C3b fixation . In fluid phase, immune complexes of antigen and IgA failed to fix C3b, whereas antigen-IgG complexes did fix C3b . Partial removal of glycan chains with Streptococcus mitis SK96 glycosidases diminished the capacity of IgA antibodies to interfere with antigen-mediated C3b fixation by the alternative complement pathway . The authors conclude that native serum or secretory IgA antibodies suppress C3b fixation, and that the glycan chains play a significant role in maintaining this property. Proc Natl Acad Sci U S A, 1994 Mar 1, 91(5), 1863 - 7 The type I macrophage scavenger receptor binds to gram-positive bacteria and recognizes lipoteichoic acid; Dunne DW et al.; Macrophage scavenger receptors exhibit unusually broad binding specificity for polyanionic ligands and have been implicated in atherosclerosis and various host defense functions . Using a radiolabeled, secreted form of the type I bovine macrophage scavenger receptor in an in vitro binding assay, we have found that this receptor binds to intact Gram-positive bacteria, including Streptococcus pyogenes, Streptococcus agalactiae, Staphylococcus aureus, Enterococcus hirae, and Listeria monocytogenes . Competition binding studies using purified lipoteichoic acid, an anionic polymer expressed on the surface of most Gram-positive bacteria, show that lipoteichoic acids are scavenger receptor ligands and probably mediate binding of the receptor to Gram-positive bacteria . Lipoteichoic acids, for which no host cell receptors have previously been identified, are implicated in the pathogenesis of septic shock due to Gram-positive bacteria . Scavenger receptors may participate in host defense by clearing lipoteichoic acid and/or intact bacteria from tissues and the circulation during Gram-positive sepsis . Since scavenger receptors have been previously shown to bind to and facilitate bloodstream clearance of Gram-negative bacterial endotoxin (lipopolysaccharide), these receptors may provide a general mechanism for macrophage recognition and internalization of pathogens and their cell surface components. Laryngoscope, 1994 Mar, 104(3 Pt 1), 321 - 4 Bacteriology of antrum in adults with chronic maxillary sinusitis; Erkan M et al.; Swabs of 126 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria during endoscopy . Bacterial growth was present in 113 of 126 specimens (90%) . Anaerobic bacteria were isolated in 100 of 113 culture-positive specimens (88%) . Anaerobes only were recovered in 59 cases (52%) and, in 41 (36%), they were mixed with aerobic or facultative bacteria . Aerobic or facultative bacteria were present in 13 cases (12%) . A total of 323 isolates (2.8 per specimen), 228 (2.3 per specimen) anaerobes and 95 (1.7 per specimen) aerobes or facultatives, were isolated . The predominant anaerobic organisms were anaerobic cocci and Bacteroides species; the predominant aerobes or facultative bacteria were Streptococcus species and Staphylococcus aureus . These findings indicate the major role of anaerobic organisms in chronic sinusitis. Eur J Biochem, 1994 Mar 1, 220(2), 455 - 62 Elucidation of the structure of SA-FF22, a lanthionine-containing antibacterial peptide produced by Streptococcus pyogenes strain FF22; Jack RW et al.; The antibacterial peptide SA-FF22, produced by the pathogen Streptococcus pyogenes strain FF22 was purified and features of its primary and secondary structure were characterised . Mass spectrometry demonstrated the pure peptide had a mass of 2794Da while, amino acid analysis revealed the presence of the unusual, thioether amino acids lanthionine and 3-methyllanthionine; thus SA-FF22 is a member of the group of antibacterial polypeptides termed lantibiotics . Furthermore, amino acid sequencing showed a unique sequence which was blocked at position 23 by a residue of the unsaturated amino acid 2,3-didehydrobutyrine . Carboxypeptidase-Y digestion could be used to demonstrate that serine occupies the C-terminal position only after complete oxidation of the thioether amino acid bridges, suggesting that the three-dimensional structure of the native peptide may prevent access of the enzyme to the C-terminus . Fragmentation of the native peptide with a variety of proteolytic enzymes failed to yield a peptide containing less than all three of the cross-linked lanthionine and methyllanthionine residues and demonstrated that all three thioether bridges overlapped . Analysis of the circular dichroism of SA-FF22 in various concentrations of 2,2,2-trifluoroethanol in water, SDS micelles and in the presence of artificial phospholipid vesicles suggested that there is significant change in its secondary structure from aqueous to lipophilic environments. Crit Care Med, 1994 Mar, 22(3), 506 - 14 Thromboxane and pulmonary morphometry in the development of the pulmonary hypertensive response to group B streptococcus; Barefield ES et al.; OBJECTIVE: To clarify the mechanism of the development of a severe pulmonary hypertensive response to group B streptococcus . DESIGN: Prospective, randomized controlled trial . SUBJECTS: Twelve chronically instrumented and six age-matched uninstrumented newborn piglets . INTERVENTIONS: Six animals received eight injections of group B streptococcus over an 11-day period (control group) . Six additional animals (pretreatment group) were given 3 mg/kg of dazmegrel, a thromboxane synthase blocking agent, before each dose of group B streptococcus to prevent the pulmonary hypertensive response and to control for any secondary arterial remodeling . MEASUREMENTS AND MAIN RESULTS: Hemodynamic measurements, pulmonary arterial morphometry, and thromboxane concentrations were examined in the instrumented animals . Lungs from the uninstrumented piglets were examined to determine morphometric norms for this population . The animals given only group B streptococcus developed a significant pulmonary hypertensive response after five daily doses (+6.8 +/- 2.0 {SEM} mm Hg, p < .05) which became pronounced after eight doses (+13.2 +/- 1.0 mm Hg) . Pulmonary hypertension was not observed in the pretreatment group when dazmegrel was given; however, on the final day in this group, dazmegrel was withheld before group B streptococcus dosing and a significant pulmonary hypertensive response was observed (+20 +/- 1.6 mm Hg) . The medial thickness of pulmonary arteries was not different between the two groups nor when compared with that of six normal, uninstrumented animals . Plasma thromboxane B2 concentrations were determined from blood samples taken before and after group B streptococcus infusion at the first, seventh and eighth (final) dosing . Thromboxane concentrations increased significantly on days 7 and 8 in the control group (578 +/- 312 to 752 +/- 372 pg/mL, 638 +/- 201 to 1462 +/- 295 pg/mL, respectively) and on day 8 in the pretreatment group (545 +/- 160 to 705 +/- 187 pg/mL) . CONCLUSIONS: We conclude that the development of potentiated pulmonary hypertension is not due to pulmonary arterial remodeling, but is associated with increased thromboxane production. Am J Respir Cell Mol Biol, 1994 Mar, 10(3), 284 - 9 Heat-killed pneumococci and pneumococcal capsular polysaccharides stimulate tumor necrosis factor-alpha production by murine macrophages; Simpson SQ et al.; Tumor necrosis factor-alpha (TNF) is an important humoral mediator of sepsis and endotoxin-induced shock . However, Streptococcus pneumoniae, a gram-positive organism, is the most common causative agent of community-acquired pneumonia and sepsis . We hypothesized that the pathogenesis of pneumococcal pneumonia and sepsis involves pneumococcus-stimulated TNF synthesis, and we tested that hypothesis in vitro by comparing heat-killed type III and type V pneumococcus and 23-valent purified pneumococcal capsular polysaccharides with Escherichia coli and purified lipopolysaccharide (LPS) as stimuli for TNF production by the murine macrophage cell line RAW 264.7 . We evaluated TNF production in response to various doses and times of exposure to these agents, as well as the effects of indomethacin on TNF production in response to these agents . Stimulation with both types of heat-killed pneumococcus resulted in TNF production in a dose-response fashion, as did stimulation with E . coli . Fewer type III pneumococci (10 bacteria/ml) were required to stimulate significant TNF secretion than either type V pneumococcus or E . coli, but the overall dose-response curves of the three bacteria were similar . The dose-response curves for pneumococcal capsular polysaccharides and LPS were very similar, although at the highest concentration pneumococcal capsular polysaccharides stimulated more TNF secretion than did LPS (469 versus 213 U/ml) . The kinetics of pneumococcus-stimulated TNF secretion were identical to the kinetics of LPS-stimulated TNF secretion . In the presence of indomethacin, pneumococcus-stimulated TNF production decreased by 87.5%, as compared with pneumococcus alone . In contrast, LPS with indomethacin stimulated 19.5% more TNF than LPS alone.(ABSTRACT TRUNCATED AT 250 WORDS) J Bacteriol, 1994 Mar, 176(5), 1542 - 5 L-(+)-lactate dehydrogenase deficiency is lethal in Streptococcus mutans; Chen A et al.; The previously cloned gene for L-(+)-lactate dehydrogenase (LDH) from Streptococcus mutans was mutagenized in vitro . An Escherichia coli transformant which expressed a thermolabile LDH activity was identified . The ldh(Ts) gene was introduced into S . mutans on a suicide vector to create a heterodiploid expressing both wild-type and thermolabile LDH activities . Self-recombinants which had only one ldh gene were isolated . One of these clones expressed only the thermolabile LDH activity . This isolate grew well at 30 degrees C but did not grow at 42 degrees C under a variety of cultivation conditions, thereby proving that LDH deficiency is lethal in S . mutans in the absence of compensatory mutations. Infect Immun, 1994 Mar, 62(3), 1101 - 8 Cloning and nucleotide sequence of the Streptococcus pneumoniae hyaluronidase gene and purification of the enzyme from recombinant Escherichia coli; Berry AM et al.; A gene bank of Sau3A1-generated Streptococcus pneumoniae type 23 DNA fragments was constructed in Escherichia coli K-12 with the low-copy-number cosmid vector pOU61cos . Clone lysates were screened by immunoblotting using a mouse antiserum raised against a crude pneumococcal hyaluronidase preparation . One immunoreactive clone was isolated, and it produced high level of hyaluronidase activity . This clone contained a recombinant cosmid (designated pJCP800) with an approximately 35-kb DNA insert, and the putative hyaluronidase coding sequence was subcloned into pBluescript SK as a 3.8-kb PstI-ClaI fragment (designated pJCP802) . The complete nucleotide sequence of this insert was determined . The region included an open reading frame sufficient to encode a polypeptide with an M(r) of 107,751 . An active hyaluronidase with an M(r) of approximately 89,000 was purified to homogeneity from E . coli DH5 alpha(pJCP802) . N-terminal amino acid sequence analysis of the purified protein suggested that translation initiation was occurring primarily at a TTG codon within the major open reading frame . However, immunoblot analysis using antiserum raised against the purified 89-kDa hyaluronidase indicated that E . coli DH5 alpha(pJCP802) also expressed the 107-kDa form of the enzyme . This antiserum labelled a 107-kDa protein in partially purified hyaluronidase preparations from S . pneumoniae . The hyaluronidase activity in this pneumococcal extract was also neutralized by the antiserum. Microb Pathog, 1994 Mar, 16(3), 221 - 8 Anti-pneumolysin activity of commercially available alpha 1-antitrypsin is due to cholesterol impurities; Rubins JB et al.; Pneumolysin (PLY), the principal cytolytic toxin of Streptococcus pneumoniae, may be important in the pathogenesis of acute lung injury during pneumococcal pneumonia . However, the local host defenses that limit PLY injury to lung tissues have not been characterized . We investigated the ability of a commercial preparation of alpha 1-antitrypsin (alpha 1-AT), a major plasma anti-proteinase, to inhibit PLY . At normal plasma concentrations, the alpha 1-AT preparation prevented PLY injury to bovine pulmonary artery endothelial cells, rat alveolar epithelial cells, and human erythrocytes . The alpha 1-AT preparation selectively inhibited thiol-activated bacterial toxins; it was inactive against snake venom hemolysins, mastoparan, and oxygen-stable bacterial toxins . Biochemical characterization of the alpha 1-AT preparation and comparison with other available alpha 1-AT preparations revealed that this inhibitory activity was due to contamination with nanomolar concentrations of cholesterol . Characterization of non-immune human plasma anti-pneumolysin activity showed that beta-lipoprotein fractions contain the major inhibitory activity . We caution other investigators that the inhibition of bacterial virulence by these alpha 1-AT preparations may indicate toxin-mediated, rather than protease-mediated, mechanisms. Zentralbl Bakteriol, 1994 Mar, 280(4), 497 - 506 Purification and characterization of hyaluronidase from Streptococcus agalactiae; Ozegowski JH et al.; Hyaluronidase from two different strains of Streptococcus agalactiae was purified and characterized . The purification was performed successively by chromatography and rechromatography on phenylsepharose, gel filtration with FPLC on Superdex G 200 and isoelectric focusing . The purified hyaluronidase had an isoelectric point of 8.75 and a molecular weight of approximately 116,000 D . It showed maximal enzyme activity at pH 6.30 and 40 degrees C . The Michaelis constant was estimated to be 8.17 x 10(-2) mg/ml . Hyaluronidase was stimulated only by Mg++ and inhibited by Zn++, Al , Cu++ and Fe++ at a final concentration of 10 mmol/l, respectively . The enzyme splitted hyaluronic acid and in low amounts dermatan sulphate and chondroitin sulphate A . Additionally, synthetic polyanions (like polymers of gentisic acid with formaldehyde and hydroxy sulphonic acid with formaldehyde) turned out to be also potent inhibitors of the enzyme. Med J Malaysia, 1994 Mar, 49(1), 17 - 23 Early onset neonatal septicaemia in a level II nursery; Malik AS et al.; A prospective study of 486 high risk neonates admitted to a level II nursery in a relatively poor and rural area of Malaysia was carried out to determine the incidence, the spectrum of micro-organisms and predisposing factors in relation to early onset septicaemia . The incidence of proven or probable septicaemia was 57.61 per 1000 high risk newborns over 1.5 kg . The case fatality was 10.71 per cent . Coagulase negative staphylococci, Streptococcus Group B and Klebsiella species were the most commonly isolated organisms . Meconium staining of liquor was the most common risk factor for admission to the nursery, and prematurity was the most significant risk factor for early neonatal infection (P < 0.005) followed by small for gestational age (P < 0.04) . Although the incidence of septicaemia was quite high in the level II nursery, the mortality rate was comparable to established figures. Eur J Clin Microbiol Infect Dis, 1994 Mar, 13(3), 247 - 8 Fulminant septicaemia due to Streptococcus milleri infection in a previously healthy adult; Flanagan PG et al.; A 59-year-old previously healthy female developed purulent pharyngitis leading rapidly to neck cellulitis, septicaemic shock and fatal cardiac arrest despite appropriate antibiotic therapy . Streptococcus milleri was isolated from a submandibular abscess, cellulitic neck tissue and blood cultures . Fulminant septicaemia due to this group of organisms is relatively uncommon and usually occurs in the immunocompromised or otherwise chronically unwell. Arkh Patol, 1994 Mar-Apr, 56(2), 44 - 9 {Current variants of streptococcal lung damage}; Ioakimova KG; 78 autopsy cases of pneumonia provoked by different groups of hemolytic streptococcus are studied . These cases comprise 14.1% among bacterial pneumonia children who died because of inadequate antibacterial treatment . Some variants of streptococcal pneumonia corresponded to those found before the World War II, though the most grave necrotic forms are found seldom . Severe pleurisy as a complication of pneumonia was found in 35.9% of cases, having a character of pleural empyema (23.1%) . In 5 children empyema developed without pneumonia, as a result of streptococcal spread from the mediastinum or by lymphogenic pathway. J Infect, 1994 Mar, 28(2), 185 - 91 Endocarditis due to high level gentamicin resistant Enterococcus faecium; Das SS et al.; We describe the first reported case in the literature of bacterial endocarditis caused by Enterococcus faecium that was highly resistant to gentamicin . The case is unusual in that it followed a successfully treated Streptococcus sanguis endocarditis . The micro-organism was susceptible only to the glycopeptide antibiotics, vancomycin and teicoplanin and to agents such as pristinamycin and daptomycin which are not routinely available for treatment . It illustrates the therapeutic dilemma posed by serious infections with such micro-organisms and supports previous observations that early heart valve replacement surgery may be necessary to achieve cure of endocarditis due to enterococci which are highly resistant to gentamicin . It further emphasises the importance of screening for high-level aminoglycoside resistance in enterococci in all life threatening enterococcal infections, including endocarditis, septicaemia and meningitis when aminoglycoside-penicillin synergy is required for successful treatment. Arch Oral Biol, 1994 Mar, 39(3), 177 - 84 Enamel dissolution in relation to fluoride concentrations in the fluid of dental plaque-like layers of precultured Streptococcus sobrinus; Luoma H et al.; Two experiments were conducted to find out what concentration of fluoride (F), when added as NaF to the fluid of an in vitro caries model, would be sufficient for full protection of the underlying enamel during a long (20 or 40 h) fall in 'plaque' pH . An existing caries model with bovine enamel and Streptococcus sobrinus 'plaque' was employed, while the fluid phase was initially either fully or partially saturated with tricalcium phosphate . In the model with fully saturated and more strongly buffered fluid, a 10 parts/10(6) addition of F to the fluid phase caused no inhibition of the pH fall . In the model with partially saturated and weakly buffered fluid, prevention of the pH fall increased along with increase of added F from 2 to 20 parts/10(6) . In each model, the 10 parts/10(6) addition of F was associated with complete prevention of the increase of calcium (Ca) in the fluid phase . In the partially saturated, weakly buffered model, findings on the inorganic P of the fluid phase agreed with findings on Ca . The findings for microhardness of the enamel surface indicated a complete prevention of the enamel softening through the 10 parts/10(6) F additive . Enamel F content was elevated by the fermentation, and even more so when F was added with sugar to the fluid phase . The Ca content of Strep . sobrinus cells was reduced when incubated with sucrose for 40 h and, especially, with sucrose and F.(ABSTRACT TRUNCATED AT 250 WORDS) Can J Microbiol, 1994 Mar, 40(3), 224 - 7 Regulation of two aspartokinase isozymes in Streptococcus bovis; Kalcheva EO et al.; Streptococcus bovis has been found to contain two distinct aspartokinases that can be separated by gel filtration chromatography . One of these isozymes elutes on Sephadex G-200 gel filtration at a molecular weight greater than 250,000 . The molecular weight of the other isozyme is approximately 125,000 . The earlier peak of aspartokinase activity is slightly inhibited by meso-diaminopimelate, while the second peak is sensitive to inhibition by lysine . The latter aspartokinase is not formed when the organism is grown in a medium containing more than 1 mM lysine . The level of lysine-sensitive aspartokinase is decreased during the growth cycle, whereas diaminopimelate-sensitive activity is little affected by the growth conditions . The regulatory properties of the two aspartokinases suggest that they may play different physiological roles. Arch Pediatr, 1994 Mar, 1(3), 264 - 7 {Septicemia due to Streptococcus milleri with pulmonary complications}; Balloul H et al.; BACKGROUND--Streptococcus milleri can occasionally cause serious septicemia, that is often complicated by abscesses, particularly pulmonary . CASE REPORT--A 12.5 year-old boy was admitted because he had suffered from fever for 6 days . He also had headache, diffuse abdominal pain, chills and a cough . Laboratory investigations showed leukocytes: 9,300/mm3 (PMN: 6,700/mm3; lymphocytes: 1,400/mm3; monocytes: 1,200/mm3); hemoglobin: 12.5 g/dl; platelets: 106,000/mm3; sedimentation rate: 120 mm at 1 hour; blood fibrinogen: 5.6 g/l and C-reactive protein: 193 mg/l . His chest X-rays was normal . Four blood cultures showed Streptococcus milleri . The patient was given amoxicillin (150 mg/kg/d) plus gentamicin (3 mg/kg/d) . Two foci of dental infection were found and treated by tooth extraction . Blood cultures remained positive 2, 3 and 6 days after onset of treatment and a second chest X-rays and CT scan showed several bilateral pulmonary abscesses . Cardiac ultrasonographs showed no valvular vegetations . The patient was then given ceftriaxone (100 mg/kg/d) plus rifampicin (20 mg/kg/d) and netilmicin (6 mg/kg/d) . Blood culture was negative two days later, but the fever persisted and ceftriaxone was then successfully replaced by vancomycin (40 mg/kg/d) for three weeks . CONCLUSION--There are several reasons for the apparent resistance to treatment of this potentially severe infection; they are discussed by the authors. Microbiologia, 1994 Mar-Jun, 10(1-2), 19 - 26 {Pathogenicity and pneumococcal capsular genes}; Garcia E et al.; Pneumococci remain to be one of the most prominent human pathogens . Increasing efforts are being dedicated to the development of improved vaccines with wider specificity . Since a clear understanding of the genetics of capsular types in Streptococcus pneumoniae is missing, our efforts are oriented to characterize, at the molecular level, the genes involved in capsular polysaccharide biosynthesis . We have cloned and sequenced a chromosomal DNA fragment of a clinical isolate of type 3 pneumococcus and showed that it contains a type 3 specific gene as well as genes common to other serotypes. Diagn Microbiol Infect Dis, 1994 Mar, 18(3), 141 - 4 Detection of group B Streptococcus . Comparison of solid and liquid culture media with and without selective antibiotics; Altaie SS et al.; A total of 952 consecutive vaginal swabs were obtained from patients who attended obstetric or gynecologic clinics affiliated with the Children's Hospital of Buffalo, New York . Swabs were cultured comparatively on 5% sheep blood agar (BA), selective sheep blood agar containing 1.25 micrograms/ml trimethoprim-23.75 micrograms/ml sulfamethoxazole (SXT), and Lim broth (Todd-Hewitt broth containing 1% yeast extract, 10 micrograms/ml colistin, and 15 micrograms/ml nalidixic acid) . A total of 168 swabs (18%) were positive (by at least one method) for group B Streptococcus (GBS) . The overall agreement among the three techniques was 90% (858 of 952); 94 specimens (10%, 94 of 952) had discrepant results, and 74 of these (44%, 74 of 168) were positive, only by Lim as opposed to two (1%) and 0 by BA and SXT, respectively . There were only two (2%, 2 of 168) false negative for Lim as compared with 82 (49%) for BA and 86 (51%) for SXT . Thus, the sensitivity of GBS detection by BA, SXT, and Lim is 51%, 49%, and 99%, respectively . These data suggest that the use of Lim broth increases the recovery rate of GBS by 48% after 48 h while the use of the SXT plate reduced the recovery rate by 2% as compared with the conventional BA plate. Nagoya J Med Sci, 1994 Mar, 57(1-4), 69 - 76 Bacteriological evaluation of a new air turbine handpiece for preventing cross-contamination in dental procedures; Masuda K et al.; An autoclavable air turbine handpiece, Air Flushing Clean System (AFCS) (Osada Electric Co., Ltd., Tokyo, Japan) was developed for use in dentistry with the objective of reducing cross-contamination . Its potential for bacterial contamination was investigated in vitro using two bacterial strains (Streptococcus mutants ATCC 25175 and Staphylococcus aureus FDA 209 P) . In theory, this device should prevent cross-contamination of the internal water and air lines of the handpiece, by maintaining an internal positive pressure even after the turbine is stopped . In the present study, this AFCS device was found to reduce the bacterial contamination within the air turbine handpiece more effectively than the conventional handpiece used according to accepted protocol . The reduction of such contamination by the AFCS is in keeping with the recent objective of the American Dental Association to reduce cross-contamination during dental procedures. Arch Mal Coeur Vaiss, 1994 Mar, 87(3), 349 - 55 {Conservative surgery in the treatment of infectious mitral valve insufficiency}; Michel PL et al.; In order to analyse the results of conservative mitral valve surgery in the treatment of mitral regurgitation due to infective endocarditis, the authors reviewed the cases of 48 patients operated between 1974 and April 1993 (36 operations having been performed after 1989, a period during which only 3 patients underwent mitral valve replacement for the same indication) . Thirty-four patients were operated after sterilisation of the infective endocarditis, and 14 patients were treated during the active phase . There were 32 men and 16 women with an average age of 45 +/- 13 years . In two thirds of the cases, the causative organism was a streptococcus . Half of the patients were operated during the acute stage because of their poor haemodynamic status, 5 because of residual bacterial vegetations after one or more embolic events and two because of the infection itself . On the other hand, patients were operated after the infective phase because of severe mitral regurgitation, responsible for severe symptoms (NYHA Class III) in 16 cases . From the anatomical point of view, the peroperative finding of 14 patients operated in the acute phase included dilatation of the annulus (N = 9), ruptured chordae (N = 9), perforation (N = 8) or vegetations (N = 8); in the patients operated later, the incidence of perforation and vegetations was much lower (20%) whereas dilatation of the annulus was almost constant (91%).(ABSTRACT TRUNCATED AT 250 WORDS) Clin Infect Dis, 1994 Mar, 18(3), 324 - 35 Pharmacological, toxicologic, and microbiological considerations in the choice of initial antibiotic therapy for serious infections in patients with cirrhosis of the liver; Westphal JF et al.; Infection remains a leading cause of death among patients with cirrhosis of the liver . The high level of susceptibility of these patients to septicemic infection is accounted for by decreased reticuloendothelial function and impairment of several components of cell-mediated and humoral immunity . Escherichia coli and Streptococcus pneumoniae are the pathogens most frequently involved and must be covered by any empirical antibiotic regimen administered to seriously ill cirrhotic patients . In addition, antibiotic therapy in this situation must take into account cirrhosis-induced changes in the kinetic and dynamic behavior of antibacterial agents . Given the great toxic potential of aminoglycosides in liver cirrhosis, these agents should be used very cautiously . The third-generation cephalosporins are currently advocated for the treatment of severe infections in cirrhotic patients because of their high level of intrinsic activity against the most commonly encountered pathogens as well as their safe use at high doses for patients with liver insufficiency . The role of the quinolones deserves further clinical evaluation; the limited activity of these agents against S . pneumoniae is undoubtedly a drawback to their use as empirical monotherapy . Despite the potent antibacterial agents that have recently become available, the overall prognosis of these patients is difficult to improve because it remains closely related to the severity of their underlying liver disease. J Dent Res, 1994 Mar, 73(3), 661 - 70 The lipopolysaccharide of Porphyromonas gingivalis is not antigenically cross-reactive with that of other species; Ni Eidhin D et al.; Large numbers of Porphyromonas, Prevotella, and Bacteroides strains were screened by 3 monoclonal antibodies (MAbs) and 8 rabbit antisera raised against Porphyromonas gingivalis, in order to detect any possible recognition of non-P . gingivalis surface antigens by these immunoreagents . All three MAbs, which were LPS-specific, extensively recognized LPS from 10 P . gingivalis strains in immunoblotting, whereas they recognized none of the 34 non-P . gingivalis strains . Rabbit antisera were similarly specific for P . gingivalis cells in immunofluorescence and with LPS in grid-blotting, but several of them recognized LPS from one Prevotella melaninogenica and 5 Prevotella intermedia strains in Western blotting . Since several pre-immune sera and an irrelevant serum raised to a Streptococcus species recognized up to 5 of these preparations, we exclude that the reactions were due to antigens shared by P . gingivalis and Prevotella . Rather, we consider that they were false-positive reactions due to natural antibodies, stimulated in a non-specific manner upon immunization with P . gingivalis, in animals whose immune systems were sensitized to Prevotella species before immunization. Infect Immun, 1994 Mar, 62(3), 799 - 808 Epitope specificity of rabbit immunoglobulin G (IgG) elicited by pneumococcal type 23F synthetic oligosaccharide- and native polysaccharide-protein conjugate vaccines: comparison with human anti-polysaccharide 23F IgG; Alonso de Velasco E et al.; Streptococcus pneumoniae type 23F capsular polysaccharide (PS23F) consitss of a repeating glycerol-phosphorylated branched tetrasaccharide . The immunogenicities of the following related antigens were investigated: (i) a synthetic trisaccharide comprising the backbone of one repeating unit, (ii) a synthetic tetrasaccharide comprising the complete repeating unit, and (iii) native PS23F (all three conjugated to keyhole limpet hemocyanin {KLH}) and (iv) formalin-killed S . pneumoniae 23F . All antigens except the trisaccharide-KLH conjugate induced relatively high anti-PS23F antibody levels in rabbits . The epitope specificity of such antibodies was then studied by means of an inhibition immunoassay . The alpha(1-->2)-linked L-rhamnose branch was shown to be immunodominant for immunoglobulin G (IgG) induced by tetrasaccharide-KLH, PS23F-KLH, and killed S . pneumoniae 23F: in most sera L-rhamnose totally inhibited the binding of IgG to PS23F . Thus, there appears to be no major difference in epitope specificity between IgG induced by tetrasaccharide-KLH and that induced by antigens containing the polymeric form of PS23F . Human anti-PS23F IgG (either vaccine induced or naturally acquired) had a different epitope specificity: none of the inhibitors used, including L-rhamnose and tetrasaccharide-KLH, exhibited substantial inhibition . These observations suggest that the epitope recognized by human IgG on PS23F is larger than the epitope recognized by rabbit IgG . Both human and rabbit antisera efficiently opsonized type 23F pneumococci, as measured in a phagocytosis assay using human polymorphonuclear leukocytes. Presse Med, 1994 Feb 19, 23(7), 325 - 8 {Endocarditis caused by Cardiobacterium hominis}; Lecluse E et al.; The incidence of endocarditis due to Cardiobacterium hominis is probably underestimated because clinical presentations vary greatly and culture of this Gram negative germ is difficult . A 48-year-old man with a past history of post-streptococcic aortic regurgitation was hospitalized twice within 1 week for fever (38 degrees C) and junctional tachycardia which responded to amiodarone . Subsequently, infero-apical necrosis was documented . Based on the result of the laboratory tests, coronary embolism was suspected although 12 blood cultures were negative . The patient recovered well with a standard antibiotic treatment . Fifteen days later, the blood cultures revealed Cardiobacterium hominis . Antibiotic therapy was adapted and aortic valve replacement was programmed . Two months later the patient died from uncontrollable left heart failure . A 63-year-old man who had had mitral valve replacement 10 years earlier for Streptococcus mitis endocarditis was hospitalized for fever (38 degrees C) and a painful left calf . Phlebocavography eliminated deep vein thrombosis and a complete cardiac work-up was inconclusive . Endocarditis was suspected although blood cultures were negative . The patient was given oral penicillin and discharged after one week . Three months later, the patient was again febrile (38 degrees C) and suffered a cerebral vascular event . Fourteen days after blood sampling, cultures revealed Cardiobacterium hominis . The patient's haemodynamic status worsened and valve replacement with atrioplasty was performed . Outcome after 4 years follow-up has been favourable . Endocarditis due to Cardiobacterium hominis, a saprophitic germ of the upper airway and the female genital tract, has been reported in 64 cases in the literature . The clinical picture is often limited to fever and a heart murmur and laboratory tests show an accelerated erythrocyte sedimentation rate and hyperleukocytosis . Inflammatory type anaemia is often found due to the latency of the endocarditis . Complications are frequent and can be fatal due to massive pulmonary emboli, cerebral vascular events or irreversible heart failure . C . hominis is sensitive to amoxycillin and netilmicin . Surgical treatment of the valvulopathy is indicated. Arch Pathol Lab Med, 1994 Feb, 118(2), 128 - 33 Real-time molecular epidemiologic analysis of an outbreak of Streptococcus pyogenes invasive disease in US Air Force trainees; Musser JM et al.; OBJECTIVE--To determine if molecular epidemiologic techniques, including comparative automated DNA sequencing of polymorphic virulence genes, could be used in the course of a bacterial disease outbreak to unambiguously determine clonal relationships among implicated strains . DESIGN--Strains recovered from all patients with invasive infections and a sample of carriers were analyzed by multilocus enzyme electrophoresis and automated DNA sequencing of a gene encoding an extracellular protease and a highly polymorphic part of the streptokinase gene . SETTING--A US Air Force training facility in San Antonio, Tex . PATIENTS--A squadron with about 800 Air Force trainees, including three recruits with invasive Streptococcus pyogenes infections . RESULTS--Multilocus enzyme electrophoresis and automated DNA sequencing of polymorphic virulence genes unambiguously defined person-to-person spread of an otherwise rare S pyogenes clone in the course of the disease outbreak and clarified strain relationships in real time . CONCLUSIONS--Molecular strain characterization techniques can be employed rapidly in a disease outbreak to definitively resolve complex relationships among pathogenic bacteria, infer patterns of clone spread, and help formulate rational public health control measures . The approach has broad applicability to other infectious agents. Am Fam Physician, 1994 Feb 1, 49(2), 434 - 42 Group B streptococcal disease in the perinatal period; Platt MW et al.; Group B streptococcus is the major cause of neonatal sepsis in the United States . It is estimated that 2,000 infants die annually of syndromes related to group B streptococcus infection . In the early-onset syndrome, transmission is from mother to child, either in utero or during birth . Pneumonia is the most common presentation in infants who develop symptoms during the first seven days of life . The principal manifestation of late-onset infection is meningitis, which occurs in 85 percent of this group . Although group B streptococcus infection is normally remediable with penicillin therapy, rapid diagnosis and treatment are necessary to prevent the serious consequences of the disease . A vaccine is under development, although the cost-effectiveness of a widespread immunization program for a disease with such a low frequency is still unknown . The potentially serious outcomes of this infection, however, make it a major problem for physicians involved in neonatal care. Laryngoscope, 1994 Feb, 104(2), 191 - 6 Cytokines in experimental otitis media with effusion; Johnson MD et al.; Studies in the authors' laboratory have recently demonstrated the presence of potent inflammatory cytokines such as interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF alpha) in human middle ear effusions . The clinical significance of this finding has not been fully elucidated because of the limitations of human studies . We hypothesized that the chinchilla model of otitis media may be an appropriate system with which to study the role of cytokines in otitis media with effusion . To begin to investigate this possibility, 30 chinchillas underwent surgical blockage of the eustachian tube (ET) to promote effusion development . After 2 weeks, examination by otoscopy demonstrated 27 ears to have developed an effusion . Next, all middle ear clefts, in random manner, were either injected with heat-killed Streptococcus pneumoniae 1 x 10(6) in 0.1 mL normal saline, injected with 0.1 mL normal saline alone, or received no injection at all . Middle ear effusions were obtained and analyzed for IL-1 beta and TNF alpha by enzyme-linked immunosorbent assay (ELISA) . This study demonstrated a significant correlation between IL-1 beta and the presence of an effusion (P < .001) . Additionally, increased TNF alpha levels correlated with bacterial component presence (P < .001), i.e., mean TNF alpha level was 108, 10.8, and 0 pg/mL in bacteria, normal saline, and noninjected ears, respectively . These findings would suggest that cytokine expression may relate to specific pathological conditions and that the chinchilla model for otitis media with effusion (OME) could be used to further explore the role of cytokines in OME. J Lab Clin Med, 1994 Feb, 123(2), 241 - 6 Comparison of antibody activity against various microorganisms in intravenous immunoglobulin preparations determined by ELISA and opsonic assay; Hiemstra PS et al.; In the present study the level of antimicrobial antibodies and the phagocytosis-promoting activity in immunoglobulin preparations produced for intravenous use were assessed . The level of antibodies directed against various microorganisms in six immunoglobulin preparations was determined by using an enzyme-linked immunosorbent assay (ELISA) and was shown to be either equal to or higher than that of pooled normal human serum . All preparations were able to promote phagocytosis of Staphylococcus aureus, Escherichia coli K12, and Streptococcus pyogenes by human granulocytes . Substantial differences among the various preparations in antibody activity were noted . In particular, Intraglobulin, chemically modified by beta-propiolactone treatment, exhibited little activity in both the ELISA and the phagocytosis assay . In contrast, IVIG SRC, Gamimmune, Sandoglobulin (treated at low pH in presence or absence of trace amounts of pepsin), and Gammagard (treated by ion-exchange chromatography) showed good activity in both assays . Comparison of the results of the ELISA and phagocytosis assay for the various preparations indicated a good correlation except for S . aureus with a moderate (strain 42D) or high (strain Cowan I) protein A content . These data indicate that the antibody activity of immunoglobulin preparations against various microorganisms determined by ELISA can be used to predict their opsonic activity. Infect Immun, 1994 Feb, 62(2), 442 - 8 M protein mediates streptococcal adhesion to HEp-2 cells; Wang JR et al.; Streptococcus pyogenes adheres to human epithelial cells in vitro and in vivo . To identify adhesins, cell wall components were extracted from S . pyogenes M6 with alkali or by treatment with mutanolysin and lysozyme . HEp-2 cells were incubated with extracts of S . pyogenes M6 and then analyzed by Western blot (immunoblot) assays, using antibodies to S . pyogenes . Only one streptococcal component (62 kDa) was bound to HEp-2 cells and was identified serologically as M6 protein . Experiments with pepsin-cleaved fragments of M protein indicated that the binding site was located at the N-terminal half of the molecule . M protein was bound selectively to two trypsin-sensitive surface components, 97 and 205 kDa, of HEp-2 cells on nitrocellulose blots of sodium dodecyl sulfate-polyacrylamide gels . Tritium-labeled lipoteichoic acid bound to different HEp-2 cell components, 34 and 35 kDa, in a parallel experiment, indicating that lipoteichoic acid was not complexed with M protein and does not mediate M-protein binding . The four HEp-2 components were unrelated to fibronectin since they did not react with specific antibodies . An M-protein-deficient (M-) strain of streptococcus (JRS75), grown in chemically defined medium, showed 73% less adhesion activity to HEp-2 monolayers than an M+ strain (JRS4) . Streptococcal adhesion was insensitive to competitive inhibition by selected monosaccharides . These results indicate that M protein binds directly to certain HEp-2 cell membrane components and mediates streptococcal adhesion. Rinsho Shinkeigaku, 1994 Feb, 34(2), 186 - 9 {Bacterial cerebritis developed from purulent meningitis--serial CT and MRI study of a case}; Terai S et al.; A 54-year-old woman was admitted to our hospital because of purulent meningitis caused by Streptococcus pneumoniae during a long-term administration of prednisolone for the treatment of bronchial asthma . After admission, both antibiotics and steroids were given, which resulted in her good general and neurological condition, and the normal protein and glucose content in her cerebrospinal fluid three weeks later . However, post-contrast computerized tomography (CT) at this time showed various size of multiple irregular high-densities devoid of capsular component in the white matter of the bilateral cerebral hemisphere . MRI examination revealed that the lesions were of low intensity on the T1-weighted sequence whereas high on T2-weighted sequence . Gd-DTPA enhanced the T1-weighted images on these lesions . These findings may indicate that the lesions were at the pre-encapsulation stage of cerebritis, because the lesions were gradually reduced and disappeared after the subsequent antibiotic therapy . It is emphasized that patients with purulent meningitis under steroid therapy require careful observation for the risk of bacterial cerebritis. Ophthalmic Surg, 1994 Feb, 25(2), 88 - 91 Late onset endophthalmitis associated with filtering blebs; Phillips WB 2nd et al.; A consecutive series of 71 cases of late onset endophthalmitis (defined as onset of symptoms at least 2 weeks after surgery) were reviewed to determine the association of this entity with glaucoma surgery filtering blebs and to identify any predisposing factors . Sixteen cases were associated with filtering blebs and two with inadvertent blebs following cataract surgery . Onset of endophthalmitis ranged from 24 days to 20 years after surgery (mean, 6.9 years) . Possible contributing factors included trauma, vitreous wicks, and bleb leak . Twelve cases were culture-positive, with 5 cases of Staphylococcus epidermidis; 2, Staphylococcus aureus; 4, Streptococcus; and 1, Pseudomonas . There were no cases of Hemophilus . The more virulent organisms were generally associated with a poor visual outcome . The organisms recovered in this series were similar to those found in postoperative endophthalmitis not associated with filtering blebs. Ophthalmic Surg, 1994 Feb, 25(2), 110 - 1 Restoration of intraocular pressure after streptococcus endophthalmitis with vitrectomy; Wallace RT et al.; A bleb infection and subsequent endophthalmitis developed in the left eye of a 68-year-old man who had had a trabeculectomy . Vitreous injections of vancomycin and gentamicin were given, and vitreous cultures grew alpha-Streptococcus . Postoperatively, as the intraocular inflammation resolved, intraocular pressure (IOP) markedly decreased secondary, in our judgment, to ciliary body ischemia . A pars plana vitrectomy relieved the tractional bands and restored the IOP. FEMS Immunol Med Microbiol, 1994 Feb, 8(2), 109 - 17 Immune modification of the pathogenesis of Streptococcus uberis mastitis in the dairy cow; Hill AW et al.; Two groups of 4 cows were vaccinated subcutaneously with live Streptococcus uberis strain 0140J or a surface extract derived from the same strain, at 14 days prior to the cessation of lactation (drying off) and at calving . Both groups also received an intramammary administration of the surface extract 7 days after drying off . A third group of unvaccinated animals acted as controls . Following intramammary challenge of two quarters per cow with the vaccine strain, all quarters on control cows and those vaccinated only with surface extract developed clinical mastitis . However, only 12.5% of challenged quarters on cows which were vaccinated with live bacteria developed clinical mastitis . In addition, the numbers of bacteria in the milk following challenge were 10(5) times higher from the control and extract vaccinated cows than those which received live vaccine . Serum levels of S . uberis specific IgG2 were elevated in the animals vaccinated with the live organism when compared to that of either extract-vaccinates or controls, whilst S . uberis specific levels of IgG1 and IgM were similar in all groups throughout the experiment . Specific antibody levels in milk were unaffected by vaccination . Despite increased levels of IgG2, no increase in opsonic activity was detected in any serum or milk samples . Peripheral blood lymphocytes from animals vaccinated with live organisms showed a considerable increase in proliferative response to S . uberis antigen in vitro when compared with lymphocytes from control and extract-vaccinated animals . These results suggest that neutrophils and specific opsonising antibody may not form the major defence against infection with S . uberis. Zhonghua Yi Xue Za Zhi (Taipei), 1994 Feb, 53(2), 109 - 15 Infective endocarditis in infants and children during the past ten years; Chen SC et al.; BACKGROUND . Infective endocarditis occurs infrequently in the general pediatric population, but is often associated in patients with underlying heart disease . Even today it remains a serious threat leading to relevant mortality in all pediatric groups, in spite of better antibiotic treatment and prophylactic measures for endangered persons . This retrospective analysis reports experience here with infective endocarditis in children . METHODS . The clinical and laboratory findings in 28 children with 30 episodes of infective endocarditis, from July 1984 to June 1993, were reviewed retrospectively . RESULTS . Twenty-one children (75 percent) had congenital heart disease, three (11 percent) had rheumatic heart disease and four (14 percent) had no underlying cardiac abnormality prior to presentation . Twenty-six (87 percent) of the 30 episodes had positive blood cultures . The most common organism isolated was streptococcus viridans (14 percent), followed by staphylococcus aureus (7 percent) . Echocardiography identified vegetation in 21 of 28 (75 percent) patients . Twenty children were successfully treated medically . Four developed complications requiring surgery, of whom two died . A total of six children (21 percent) died of the disease or its complications . There were a high case fatality rate for children below the age of two years (75 percent), and children without an underlying cardiac abnormality (50 percent) . CONCLUSIONS . It was concluded that patient survival is dependent on several factors which include early diagnosis, appropriate antimicrobial therapy and aggressive surgical intervention. Acta Paediatr Jpn, 1994 Feb, 36(1), 88 - 90 An outbreak of group B streptococcus infection in a neonatal nursery and subsequent trial for prophylaxis of nosocomial transmission; Takayanagi T et al.; An outbreak of sepsis and meningitis caused by group B streptococcus occurred in three very low birthweight infants . To prevent further nosocomial transmission, immune globulin and ampicillin sodium were administered intravenously to other very low birthweight infants . After this prophylaxis, no other infants were involved in this outbreak . Immuno- and chemoprophylaxis may be considered as procedures to prevent nosocomial infection for very low birthweight infants. Clin Infect Dis, 1994 Feb, 18(2), 253 - 4 Streptococcus bovis bacteremia and meningitis associated with Strongyloides stercoralis colitis in a patient infected with human immunodeficiency virus; Jain AK et al.; We present a case of human immunodeficiency virus (HIV) infection complicated by Streptococcus bovis meningitis and bacteremia and severe Strongyloides stercoralis colitis . The association between S . bovis infection and strongyloidiasis has not been described previously . This case highlights the importance of searching for larvae of S . stercoralis as part of the evaluation of the gastrointestinal tract of patients with bacteremia or meningitis due to certain enteric organisms . The role of HIV infection in the development of severe S . stercoralis colitis in association with S . bovis bacteremia and meningitis is unclear. Scand J Dent Res, 1994 Feb, 102(1), 30 - 3 Effect of fluoride on the rate of dentin apposition and caries progression in young and old Wistar rats; Kortelainen S et al.; The effect of fluoride in drinking water on the progression of dentinal caries and dentin apposition was studied separately in young and old Wistar rats . The animals were inoculated with Streptococcus sobrinus and fed ad libitum on a 43% sucrose diet and distilled water supplemented with 0, 1, or 19 ppm fluoride . After a 7-wk (young) or 13-wk (adult) cariogenic challenge, the areas of dentinal caries and dentin apposition were quantified after tetracycline staining . Fluoride in the drinking water reduced the progression of dentinal caries and the speed of dentin formation in the young animals but only the progression of dental caries in the adult ones . Both the progression of carious lesions in the dentin and the rate of dentin apposition were 10 times faster during primary dentinogenesis. Scand J Dent Res, 1994 Feb, 102(1), 26 - 9 Dental plaque inhibition by a combination of triclosan and polydimethylsiloxane (silicone oil); Ellingsen JE et al.; It has previously been shown that a toothpaste which contains triclosan and polydimethylsiloxane (silicone oil) improved gingival health in a test panel with established gingivitis more markedly than usually observed when testing commercial triclosan-containing toothpastes . In the present study the mode of action of combinations of silicone oil and triclosan was investigated . An in vitro experiment showed that triclosan was retained in a thin layer of silicone oil on the inner surfaces of test tubes that had been treated with the combination of triclosan and silicone oil . This triclosan was slowly released and inhibited the growth of bacteria in the test tubes . Silicone oil alone and in combination with triclosan was able to inhibit polysaccharide adhesion to the test tubes in the presence of a strain of Streptococcus sobrinus and a sucrose-containing medium . Corresponding in vivo experiments showed similar results; teeth topically treated with silicone oil and triclosan showed a marked plaque reduction, and those treated with silicone oil alone showed a moderate reduction, as compared with a placebo . The silicone oil plus 0.3% triclosan combination inhibited plaque formation also on proximal surfaces . It appears likely that this combination provides a reservoir of triclosan in the thin layer of silicone oil which binds strongly to teeth because of its low surface tension . Triclosan is then slowly released into saliva because of its low solubility in this fluid. Jpn J Antibiot, 1994 Feb, 47(2), 161 - 9 {beta-lactamase activity in sputum of patients with community-acquired lower respiratory tract infections}; Deguchi K et al.; beta-Lactamase production and activities in sputa of patients with community-acquired lower respiratory tract infections (LRTI) were determined and following results were obtained: 1) Suspected causative organisms frequently isolated were H . influenzae and Streptococcus pneumoniae . Similar results were previously reported . 2) Various beta-lactamase producing indigenous bacteria were detected . In many cases these indigenous beta-lactamase producing strains were isolated even when suspected causative bacteria were not beta-lactamase producers . 3) beta-Lactamase activities were detected from 61.5% of the sputa tested . Remaining activities of antibiotics added to the sputa were highly correlated with detection of beta-lactamases produced by suspectedly causative and indigenous strains and with presence of beta-lactamase activities in the sputa . Sulbactam/cefoperazone was stable in sputa than other antibiotics tested . 4) We concluded that the beta-lactamase produced by indigenous strains can be one of the factors of indirect pathogenicity in the community-acquired LRTI. J Clin Microbiol, 1994 Feb, 32(2), 578 - 80 Identification of Streptococcus suis isolated from swine: proposal for biochemical parameters; Tarradas C et al.; A study was made of the biochemical profiles of 59 strains serotyped as Streptococcus suis, isolated from diseased and clinically healthy pigs . The following parameters are proposed for the identification of the species: Voges-Proskauer negativity, hydrolysis of esculin positivity, trehalose positivity, negativity for growth in 6.5% NaCl, and absence of beta-hemolysis on sheep blood agar . S . suis serotype 2 is negative for hippurate, pyrrolidonylarylamidase, and mannose. J Clin Microbiol, 1994 Feb, 32(2), 531 - 2 Optical immunoassay for streptococcal pharyngitis: evaluation of accuracy with routine and mucoid strains associated with acute rheumatic fever outbreak in the intermountain area of the United States; Daly JA et al.; The Strep A OIA (BioStar, Inc., Boulder, Colo.) rapid detection system is an intriguing technology that utilizes an immunoassay relying on changes in reflected light to directly detect group A streptococcal antigen from specimens . In this evaluation, 424 routine pediatric throat specimens and 20 simulated oropharyngeal specimens with added mucoid (M type 3, 18) strains were cultured and tested by the Strep A OIA . The respective sensitivities and specificities were as follows: Strep A OIA versus enhanced broth culturing, 84.2 and 95.7%; and streptococcus-SXT agar (BBL Microbiology Systems, Cockeysville, Md.) culturing versus enhanced broth culturing, 82.9 and 98.6% . The Strep A OIA is an 8-min, technologist-friendly, accurate technique with an 89.4% agreement with traditional culturing. J Clin Microbiol, 1994 Feb, 32(2), 469 - 72 Loofah sponges as reservoirs and vehicles in the transmission of potentially pathogenic bacterial species to human skin; Bottone EJ et al.; Loofah sponges are natural products used as exfoliative beauty aids . As a consequence of tracing a case of Pseudomonas aeruginosa folliculitis to a contaminated loofah sponge, we assessed the role of loofah sponges in supporting the growth of a wide variety of bacterial species . Our data show growth enhancement of sterile loofah fragments for numerous gram-negative (Pseudomonas, Xanthomonas, and Klebsiella) and gram-positive (Enterococcus and group B Streptococcus) species of human and environmental origin . Furthermore, hydrated new, unused loofah sponges undergo a shift in bacterial flora from sparse colonies of Bacillus spp . and Staphylococcus epidermidis to a predominantly gram-negative flora . The growth-promoting potential of loofah sponges (and other exfoliatives) can be further augmented by desquamated epithelial cells entrapped in the loofah fibrous matrix . Therefore, as loofah sponges (and other exfoliatives) can serve as a reservoir and a vehicle for the transmission of potentially pathogenic species to the human skin, we recommend their decontamination with hypochlorite (10%) bleach at regular intervals. Fukuoka Igaku Zasshi, 1994 Feb, 85(2), 57 - 67 {Quantitative analysis of the binding of peptides to HLA molecules role of polymolphic HLA molecules in the immune response}; Toida N; We established HLA-peptide binding assay system, using biotinylated peptide and HLA class II transfectants to make clear the interaction of peptides and HLA molecules . By using this system and T cell proliferation assay, we analyzed the effect of polymorphism of DR4 subtypes on responding to M12(4) peptide which derived from M12 protein of Streptococcus . We found amino acid residue which determines T cell recognition is DR beta-74 (Glutamate to Alanine) on this peptide . Using this system, we expect to understand the mechanisms of immune response associated with HLA class II molecules. FEMS Microbiol Lett, 1994 Feb 1, 116(1), 107 - 12 Inactivation of the streptokinase gene prevents Streptococcus equisimilis H46A from acquiring cell-associated plasmin activity in the presence of plasminogen; Malke H et al.; The streptokinase gene of Streptococcus equisimilis H46 was inactivated by plasmid insertion mutagenesis to study the relationship between elaboration of streptokinase and acquisition of cell-associated plasmin activity after incubation of wild-type and mutant cells in media containing plasminogen or plasmin . The results showed that H46A binds both the zymogen and active enzyme, generates surface-associated plasmin activity in the presence of plasminogen when producing streptokinase, and expresses its plasmin(ogen) receptor(s) independently of a functional streptokinase gene . At least part of the plasmin(ogen) binding capacity may be due to the glyceraldehyde-3-phosphate dehydrogenase type of receptor molecule, as judged by the detection of the corresponding gene. Arch Dis Child, 1994 Feb, 70(2), 145 - 6 Perianal infection with beta haemolytic streptococcus; Wright JE et al.; A prospective study of 50 children with beta haemolytic streptococcal perianal infection and related disorders identified oedematous perianal skin and cracking on parting the buttocks, forming superficial multiple fissuring, as the characteristic features of such infection, and confirmed the value of skin culture in its diagnosis . Treatment by oral amoxycillin with clavulanic acid and a topical ointment containing bacitracin was effective in all patients. Nippon Rinsho, 1994 Feb, 52(2), 495 - 501 {Bacterial endophthalmitis}; Ooishi M et al.; Bacterial endophthalmitis is generally considered to be the most severe and vision-threatening form of ocular infection . It may follow ocular surgery, trauma or microbial keratitis, -exogenous endophthalmitis-, or derived from a blood borne organism-endogenous endophthalmitis . The most common organisms causing exogenous endophthalmitis were gram positive bacteria, including Coagulase negative Staphylococcus, Staphylococcus aureus . Streptococcus pneumoniae and other streptococcal species . On the other hand, endogenous cases were mainly due to gram negative bacteria, including Klebsiella pneumoniae and Escherichia coli . Antimicrobial agents should be chosen based on the usual sensitivity of known or suspected pathogens . Aminoglycosides are almost universally used, combined with cephems and fluoroquinolone topically, subconjunctivally, parenterally and intravitreally . Vancomycin is applied in MRSA infection . In severe cases, vitrectomy with intravitreal antibiotics, corticosteroid are performed most effectively. Nippon Rinsho, 1994 Feb, 52(2), 479 - 84 {Incurable bacterial skin infection}; Nishijima S et al.; The most dominant species isolated from bacterial skin infection is always Staphylococcus aureus (S . aureus) . The frequency of isolation of methicillin resistant S . aureus (MRSA) has recently been increasing in skin infections . MRSA is resistant to many kinds of antibiotics, therefore, MRSA infections is incurable, in many cases . MRSA are isolated most often from infectious decubitus or leg ulcers, in compromised hosts . S . aureus is etiologically related to atopic dermatitis . Simultaneously with S . aureus, there is a increasing frequency of isolation of Streptococcus pyogenes (S . pyogenes) in atopic dermatitis . S . pyogenes infections are much more severe because patients infected with S . pyogenes have fever and/or concurrent kidney disorders . In these skin disorders, there is severe skin damage or defect, so that, it may be very difficult to eradicate MRSA in decubitus, ulcers and S . pyogenes in atopic dermatitis. Nippon Rinsho, 1994 Feb, 52(2), 322 - 6 {Virulence factors of drug resistant strain}; Kaku M et al.; The incidence of methicillin resistant Staphylococcus aureus and penicillin resistant Streptococcus pneumoniae have been increasing in Japan . These resistant strains produce toxins and extracellular enzymes working as virulence factors of infection . Some of these toxins and extracellular enzymes are introduced here . The difference of virulence between MRSA and MSSA is not clear but some of MRSA strains are known to produce new type cytotoxins . The difference of virulence factors between penicillin resistant S . pneumoniae and penicillin sensitive S . pneumoniae were not observed. Br J Ophthalmol, 1994 Feb, 78(2), 142 - 8 An antimicrobial effect associated with rabbit primary aqueous humour; Diamond JP et al.; Viability curves were recorded for a variety of bacteria suspended in rabbit primary aqueous humour . Controls included neat rabbit serum, dilute rabbit serum (1/50), dilute heat treated fetal bovine serum (1/50), and balanced salt solution . Rabbit aqueous humour was bactericidal in vitro for Staphylococcus aureus and Pseudomonas aeruginosa . Micrococcus spp, Streptococcus pneumoniae and Escherichia coli were not affected . The factor mediating the bactericidal effect survives filtration (0.2 micron porosity) and freezing in liquid nitrogen (-196 degrees C) but is labile when stored in air at temperatures of 4 degrees C, 25 degrees C, and 37 degrees C for 1 hour . The bactericidal effect was stable when aqueous humour was stored in an atmosphere of 5% CO2 at 37 degrees C for 3 hours . The antibacterial component in rabbit aqueous humour has yet to be identified. J Trauma, 1994 Feb, 36(2), 198 - 201 Management of petrous bone fractures in children: analysis of 127 cases; Glarner H et al.; Petrous bone fractures (PBF) in children are relatively frequent . They are mostly diagnosed after collisions and falls . The complications typically associated with PBF were different types of hearing disorders in 69.1% of the patients who had audiometry, liquorrhea in 16.5%, palsy of cranial nerves in 10.8% (facial nerve palsy in 9.4%), bacterial meningitis, stenosis of the external ear canal, and posttraumatic cholesteatoma in 0.7% of the fractures each . Most complications were transient; 8.6% of the patients underwent surgery because of PBF-related complications and 9.4% suffered from severe, irreversible sequelae . Management of PBF in children requires an interdisciplinary approach between pediatric surgeons and pediatric ear, nose, and throat (ENT) specialists . It basically includes daily examination for cranial nerve palsy, liquorrhea, and meningitis during hospitalization as well as routine audiometric examination and antibiotic prophylaxis . Routine vaccination against Streptococcus pneumoniae as a new standard procedure and subtotal petrosectomy after transverse fracture as a new surgical modality are strongly recommended in order to lower the incidence of posttraumatic meningitis . Severe complications such as persistent hearing loss, persistent liquorrhea, cranial nerve palsy, and posttraumatic meningitis require aggressive diagnostic and therapeutic measures in order to minimize further morbidity and irreversible deficits. J Med Microbiol, 1994 Feb, 40(2), 118 - 23 A mechanism of pathogenicity of "Streptococcus milleri group" in pulmonary infection: synergy with an anaerobe; Shinzato T et al.; The relationship between Streptococcus constellatus, one of the species of the "Streptococcus milleri group", and Prevotella intermedia was studied in a model of pneumonia in mice and in vitro to elucidate mechanisms of pathogenicity in "S . milleri group"-associated pulmonary infection . Acute pneumonia with or without empyema and lung abscess in mice with mixed infection resulted in 60% mortality rate, but there was only 10% mortality and mild pneumonia in each separate infection . Bacterial clearance of organisms, especially S . constellatus, in mixed infection was delayed . Enhancement of growth of S . constellatus was demonstrated when cultured with P . intermedia; growth was also stimulated by a culture filtrate of P . intermedia which also inhibited bactericidal activity of human neutrophils . In an examination of infectivity and bacterial clearance of S . constellatus with P . intermedia culture filtrate in vivo, there was 20% mortality and delayed clearance of S . constellatus, although the infection was not as severe as that produced by the combination of both organisms . These results suggest that P . intermedia may act with S . constellatus in the production of pulmonary infections by stimulating its growth and suppressing bactericidal activity of the host. J Med Microbiol, 1994 Feb, 40(2), 110 - 4 An appraisal of the virulence factors associated with streptococcal endocarditis; Manning JE et al.; Platelet aggregation is believed to be a virulence factor in infective endocarditis . Other factors may be adhesion to components of thrombotic vegetations, particularly platelets, fibronectin and fibrinogen . Two strains from the Streptococcus sanguis group (SSG) were chosen for comparative study on the basis that one aggregated both human and rat platelets and the other lacked this capacity . Both strains caused endocarditis in the rat model but the aggregating strain was found in higher numbers in the excised vegetations . The nonaggregating strain was unable to bind to human or rat platelets but could bind insoluble fibronectin, insoluble fibrinogen and platelet-fibrin clots from both sources, albeit to a lesser extent than the aggregating strain . These results suggest that whereas adhesion to, and aggregation of, platelets are not essential events in the initiation of the pathogenesis of experimental endocarditis, they may be factors contributing to virulence. J Bacteriol, 1994 Feb, 176(4), 1052 - 9 Inactivation of the Porphyromonas gingivalis fimA gene blocks periodontal damage in gnotobiotic rats; Malek R et al.; Fimbrial production by Porphyromonas gingivalis was inactivated by insertion-duplication mutagenesis, using the cloned gene for the P . gingivalis major fimbrial subunit protein, fimA . by several criteria, this insertion mutation rendered P . gingivalis unable to produce fimbrilin or an intact fimbrial structure . A nonfimbriated mutant, DPG3, hemagglutinated sheep erythrocytes normally and was unimpaired in the ability to coaggregate with Streptococcus gordonii G9B . The cell surface hydrophobicity of DPG3 was also unaffected by the loss of fimbriae . However, DPG3 was significantly less able to bind to saliva-coated hydroxyapatite than wild-type P . gingivalis 381 . This suggested that P . gingivalis fimbriae are important for adherence of the organism to saliva-coated oral surfaces . Further, DPG3 was significantly less able to cause periodontal bone loss in a gnotobiotic rat model of periodontal disease . These observations are consistent with other data suggesting that P . gingivalis fimbriae play an important role in the pathogenesis of human periodontal disease. Pathol Biol (Paris), 1994 Feb, 42(2), 157 - 62 {Comparative in vivo and in vitro study of bacterial colonization by Streptococcus mutans on dental surfaces in axenic rats and in an artificial model of the oral cavity}; Zampatti O et al.; The study of bacterial colonization by Streptococcus mutans on dental surfaces of rat have been undertaken in vivo in gnotobiotic rat, and in vitro in an artificial mouth model, in order to validate the suitability of such a model . The study of colonization by Streptococcus mutans with time showed a similar kinetic of the monobacterial plaque formation in the two experimentations . Three phases were observed . A logarithmic phase in the earliest hours after inoculation of bacterium, followed by an exponential phase, and finally a stabilization phase of the monobacterial plaque formed in this way from the third day . Nevertheless, if the kinetic is the same, it is observed a more important colonization of dental surfaces in rat . This phenomenon was explained by the simplification of biological conditions encountered in the in vitro model . In particular, it is noticed the important saliva action . It is concluded that the in vitro model developed simulate suitably the conditions of the oral environment encountered in vivo. Immunobiology, 1994 Feb, 190(1-2), 127 - 37 Antibody response in aged C57BL/6 mice: T helper cells are responsible for the decline of the primary antibody response to a bacterial antigen in aging; Nicoletti C; One of t