Streptococci

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 the most important effects of aging is the decline of immune effectiveness . A study is described here on the primary (IgM) antibody response to phosphorylcholine (PC), an antigen expressed on the surface of the Streptococcus pneumoniae R36a, in aged (18-22 mo.) C57BL/6 mice . Preliminary data showed a significant decrease of PC-specific response in aged mice as compared to young/adult (3-4 mo.) syngeneic mice . In vitro studies showed that B cells from aged donors, retained the ability to produce amounts of anti-PC antibody comparable to that of B cells from young donors . In addition, B cells from young and aged donors were cultured in the presence of L3T4 or Lyt2 T cells obtained from donors of different ages . "Aged" L3T4 cells failed to augment the anti-PC response, as compared to the young ones, while the Lyt 2 cells, either from young or aged donors, showed no effects on the anti-PC response . These observations were confirmed by in vivo selective depletion of T cells subpopulations in both young and aged C57BL/6 mice . L3T4 cell-depleted young mice displayed a markedly reduced antibody response; in contrast, age-depleted mice did not show any significant modifications of the response as compared to normal aged mice . Furthermore, we observed that the selective depletion of Lyt 2 cells in both young and aged C57BL/6 did not alter the anti-PC response in any way.

J Chemother, 1994 Feb, 6(1), 53 - 7
Efficacy of a three-day course of azithromycin in the treatment of community-acquired pneumococcal pneumonia . Preliminary report; Uzun O et al.; Azithromycin is an azalide antibiotic with activity against many of the respiratory pathogens and with marked tissue affinity . In a prospective study, the efficacy of a short-course of azithromycin was evaluated in 25 patients with community-acquired pneumococcal pneumonia . Gram-positive diplococci were abundant in the sputum smears of all patients, and Streptococcus pneumoniae was isolated in the sputum cultures of 15; one patient had pneumococcal bacteremia, as well . Azithromycin was administered at a single dose of 1,000 mg on day 1, and 500 mg on subsequent days for a total of three days in 19 patients, five days in four patients, two and four days in one patient each . Defervescence occurred within 24 hours after the first dose . The overall clinical cure and bacteriologic eradication rates were 96% and 93%, respectively . One patient with pneumococcal bacteremia failed to respond and died in respiratory failure . Side-effects were encountered in three (12%) patients . In conclusion, three-day therapy with a total azithromycin dose of 1,500 mg seems effective and safe in patients with community-acquired pneumococcal pneumonia and no underlying pulmonary condition.

J Korean Med Sci, 1994 Feb, 9(1), 52 - 6
Serotypes of Streptococcus pyogenes isolated from healthy school children in Kangwon-do; Kim SJ et al.; Seventy-seven Streptococcus pyogenes strains isolated of children of three elementary schools located in Kangwon-do in spring, 1992 were serotyped with M, opacity factor (OF) and T typing antisera . In the M/OF typing results, M-78 (46.8%) and M-28 (22.1%) were most frequently encountered, while M-4 (6.5%), M-12 (5.2%), M-3 (1.3%), M-5 (1.3%) and M-6 (1.3%) were rarely observed . Twelve strains (15.6%) were not typable with M or OF typing system . In the T typing results, T-11 (35.1%) and T-28 (27.3%) were most common . We were able to identify 77.9% of S . pyogenes strains by T typing, 94.8% with T typing and OF typing . With the addition of M typing, 97.4% were typable . Through the serotypings, we could know the basic distribution of serotypes of S . pyogenes of healthy children which could be comparable to those of rheumatic fever, poststreptococcal glomerulonephritis and other severe streptococcal disease.

Aust N Z J Ophthalmol, 1994 Feb, 22(1), 69 - 72
Infectious crystalline keratopathy; Horsburgh B et al.; Two cases of typically appearing crystalline keratopathy both grew an alpha haemolytic streptococcus and had many of the features common to other cases . In one case, the use of topical and systemic antibiotics alone resulted in resolution of the disease, while in the second case even after corneal transplantation, a recurrence occurred which required further long-term antibiotics plus a repeat transplant.

Eur J Clin Microbiol Infect Dis, 1994 Feb, 13(2), 171 - 4
Cluster of an erythromycin-resistant variant of the Spanish multiply resistant 23F clone of Streptococcus pneumoniae in South Africa; Klugman KP et al.; A multiply resistant serotype 23F pneumococcus was cultured from a 3-year-old child with otitis media and five carriers at the child's day-care centre in South Africa . Attempts to eradicate carriage with mupirocin failed . The strains were identical to the Spanish clone of multiply resistant pneumococci by serotype, antimicrobial susceptibility pattern, restriction analysis of the penicillin-binding protein 1A, 2B and 2X genes and by multilocus enzyme electrophoresis . The data suggest that this clone has acquired erythromycin resistance . A possible link between the index case and residence of a family member in Spain was found.

J Endod, 1994 Feb, 20(2), 78 - 82
Bacterial retention in canal walls in vitro: effect of smear layer; Drake DR et al.; When dentin is planed by endodontic instruments, a smear layer forms . Whether this layer should be removed is unknown and controversial . This study was conducted to assess the effect of the smear layer on retention of bacteria using an in vitro root canal bacterial colonization model . Canals of 26 extracted human canines were step-back prepared using 2.5% NaOCl . Teeth were then randomly divided into two groups based on the type of high volume final flush: 1-20 ml of sterile saline (0.85% wt/vol) or (2-10 ml of 17% EDTA followed by 10 ml of 2.5% NaOCl which removes smear layer . Streptococcus anginosus (milleri) was cultured in trypticase soy broth supplemented with 0.5% yeast extract at 37 degrees C in 5% CO2 . Cells were harvested by centrifugation and resuspended in fresh media . Serial dilutions were performed to achieve inocula of 10(6) colony-forming units in a 30-microliters volume . Teeth were inoculated and incubated for 2 h in 5% CO2 at 37 degrees C . Following incubation, teeth were split and processed for microbiological analysis . Numbers of colonizing bacteria were determined by a spiral-plating system . Enumeration of the numbers of bacteria revealed a reproducible, order of magnitude difference (p = 0.0002) between teeth with smear layer (10(4) colony-forming units) versus teeth without smear layer (10(5) colony-forming units) . This suggests that smear layer produced during root canal therapy may inhibit bacterial colonization of root canals . One suggested mechanism is that smear layer may block bacterial entry into dentinal tubules.

J Endod, 1994 Feb, 20(2), 71 - 4
In vitro attachment of Streptococcus sanguis to the dentin of the root canal; Calas P et al.; The adhesion of a strain of Streptococcus sanguis (NCTC 7863) to the root canal dentin of bovine incisors was evaluated . Samples (104) were prepared and smear layer was created on the root canal surface with a tungsten carbide bur . The samples were divided into four groups, one of them serving as a control sample and the other three each receiving a different treatment: 6% citric acid for 2 min (group 3), 6% citric acid for 2 min + 6.25% sodium hypochlorite for 1 min (group 2), 6% citric acid for 10 min (group 4) . After sterilization, they were incubated, and adhesion was assessed by direct examination using a scanning electron microscope . The use of irrigation solutions significantly reduced the adhesion in the latter two groups only, with a reduction of 15% (group 2) and 18.7% (group 4) in the number of bacteria.

Bull Tokyo Dent Coll, 1994 Feb, 35(1), 9 - 15
Effect of seaweed extracts on Streptococcus sobrinus adsorption to saliva-coated hydroxyapatite; Saeki Y; The inhibitory effect of the extracts of seaweeds on the adsorption of Streptococcus sobrinus B13 to the tooth surface was investigated in vitro . Using saliva-coated hydroxyapatite beads (S-HA) as experimental salivary pellicle, extracts from Gloiopeltis furcata and Gigartina teedii (Rhodopheceae) strongly inhibited the adsorption of S . sobrinus B13 to S-HA . The G . furcata extract, which strongly inhibited the adsorption of S . sobrinus B13 to S-HA, was a high molecular weight sulfated polysaccharide . The result of I.R . analysis indicated that the active component in this extract of G . furcata was funoran.

J Exp Med, 1994 Feb 1, 179(2), 413 - 24
Selective anergy of V beta 8+ T cells in human immunodeficiency virus-infected individuals; Dadaglio G et al.; We have analyzed the V beta usage by CD4+ and CD8+ T cells from human immunodeficiency virus (HIV)-infected individuals in response to an in vitro stimulation with the superantigenic erythrogenic toxin A (ETA) of Streptococcus pyogenes . ETA amplifies specifically CD4+ and CD8+ T cells from control donors expressing the V beta 8 and the V beta 12 elements . When peripheral T cells from asymptomatic HIV-infected individuals were stimulated with ETA, there was a complete lack of activation of the V beta 8+ T cell subset, whereas the V beta 12+ T cell subset responded normally to the superantigen . This V beta-specific anergy, which was also observed in response to staphylococcal enterotoxin E (SEE), affected both CD4+ and CD8+ T cells and represented an intrinsic functional defect rather than a specific lack of response to bacterial superantigens since it was also observed after a stimulation with V beta 8 monoclonal antibodies . The V beta 8 anergic T cells did not express interleukin 2 receptors (IL-2Rs) and failed to proliferate in response to exogenous IL-2 or IL-4, suggesting that this anergy was not a reversible process, at least by the use of these cytokines . The unresponsiveness of the V beta 8 T cell subset is frequent since it was found in 56% of the patients studied, and comparison of the clinical status of responder vs . anergic patients indicated that the only known common factor between them was HIV infection . In addition, it is noteworthy that the anergy of the V beta 8 subset may be a very early phenomenon since it was found in a patient at Centers for Disease Control stage I of the disease . These data provide evidence that a dominant superantigen may be involved in the course of HIV infection and that the contribution of HIV has to be considered.

Oral Microbiol Immunol, 1994 Feb, 9(1), 29 - 34
Catabolite modification of acid tolerance of Streptococcus mutans GS-5; Belli WA et al.; The acid tolerance of Streptococcus mutans GS-5 in standard pH-drop assays was found to be affected by the sugar used in the assay and also by the sugar used for growth of the organism . For example, acid tolerance was lower when galactose was used as catabolite than when glucose was used, apparently because galactose/proton symport brought protons extruded by the F-ATPase back into the cell and thus reduced delta pH across the cell membrane . The acid tolerance of glycolysis was related directly to the capacities of the cells to produce acid glycolytically, or probably more correctly, to their capacities to produce adenosine triphosphate but not to acid tolerance of phosphotransferase systems for sugar uptake . Thus, glycolytic acid tolerance of S . mutans depends not only on environmental factors such as potassium or magnesium levels but also on the specific catabolites the organism is metabolizing or to which it has become metabolically adapted.

Oral Microbiol Immunol, 1994 Feb, 9(1), 25 - 8
Growth-inhibitory effect of pyrophosphate on oral bacteria; Drake D et al.; The purpose of this investigation was to determine whether pyrophosphate, the anticalculus component of tartar-control dentifrices, exerts antimicrobial activity against oral bacteria commonly found in supragingival plaque . Minimal inhibitory concentrations of pyrophosphate were determined for Streptococcus sanguis, Streptococcus mutans (serotype c), Actinomyces viscosus and Actinomyces naeslundii . All of the bacteria tested were susceptible to pyrophosphate with identical minimal inhibitory concentrations of 0.67% wt/vol (25 mM) . Bactericidal kinetics assays revealed that both S . mutans and A . viscosus were killed by pyrophosphate, with the latter being considerably more susceptible . The mechanism of killing was not due to high ionic strength, as comparable controls showed no loss in numbers of viable cells . Brief exposure (two 5-min incubations) of S . mutans to pyrophosphate and sodium dodecyl sulfate caused pronounced inhibition of growth over the 24-h test period . Under the constraints of the conditions used, these studies indicate that pyrophosphate and sodium dodecyl sulfate can substantially inhibit the growth of oral bacteria . These compounds may affect the oral microflora of patients who routinely use tartar-control dentifrices and mouthrinses.

J Mol Biol, 1994 Jan 28, 235(4), 1345 - 7
Crystallization, characterization and preliminary crystallographic studies of carbamate kinase of Streptococcus faecium; Marina A et al.; Crystals of carbamate kinase (E.C.2.7.2.2) suitable for high resolution studies have been obtained, using the hanging drop vapour diffusion technique, with polyethylene glycol 8000 and NaCl as precipitants at pH 6.5 and a temperature of 4 degrees C . Crystals of about 0.3 mm x 0.2 mm x 0.2 mm in size diffract to at least 3.2 A resolution and are stable to X-radiation for more than ten hours . The space group is P2(1)2(1)2(1), with unit cell dimensions a = 84.5 A, b = 99.6 A, c = 173.3 A . Density packing considerations are consistent with the presence of four to five monomers (M(r) of the monomer = 33,000) in the asymmetric unit, two dimers or even a tetramer being favoured by the results of cross-linking experiments of the enzyme in solution.

MMWR Morb Mortal Wkly Rep, 1994 Jan 21, 43(2), 23 - 6, 31
Drug-resistant Streptococcus pneumoniae--Kentucky and Tennessee, 1993; The mode of action of SA-FF22 et al.; Institut fur Medizinische Mikrobiologie und Immunologie, Universitat BonnSA-FF22 is a lanthionine-containing bacteriocidal peptide isolated from Streptococcus pyogenes strain FF22 . The peptide interacts closely with non-energised artificial phospholipid vesicles, as evidenced by a 'blue shift' in the fluorescent emissions associated with a tryptophan residue within the peptide sequence . Furthermore, SA-FF22 induced efflux of radiolabelled amino acids from artificially energised cytoplasmic membrane vesicles and arrested uptake of amino acids by intact cells . By measuring the decrease in membrane potential of both starved and energised SA-FF22-treated cells, and through the use of artificial planar membranes, a potential of approximately 100 mV was deduced as the minimum required to induce pore formation by SA-FF22 . This threshold potential is independent of the orientation of the applied voltage (i.e . trans or cis orientations are equally effective) . Single channel conductance measurements suggested that the pores formed by SA-FF22 are relatively unstable, short-lived and approximately 0.5-0.6 nm in diameter . This is somewhat smaller than those of the previously described, pore-forming lantibiotics and should not allow significant efflux of large molecules such as ATP . Thus, death of affected cells seems to result from membrane-potential disruption and subsequent exhaustion of the cells.

Vet Rec, 1994 Jan 15, 134(3), 60 - 4
Interaction between Streptococcus suis serotype 2 and porcine reproductive and respiratory syndrome virus in specific pathogen-free piglets; Galina L et al.; Secondary specific pathogen-free (sSPF) piglets were inoculated intranasally with Streptococcus suis serotype 2 alone, porcine reproductive and respiratory syndrome virus (PRRSV) alone, or with PRRSV followed by S suis . Uninfected piglets were used as controls . Pigs inoculated with PRRSV (ATCC VR-2332) followed by challenge with a virulent strain (87555) of S suis serotype 2 developed clinical signs, suppurative meningitis and large numbers of S suis in their tissues, including the brain and meninges . Pigs inoculated with PRRSV alone, S suis (87555) alone, or with PRRSV and the DH5 strain of S suis serotype 2 (lacking a protein associated with virulence) and the uninfected piglets did not develop clinical signs or lesions or have large numbers of bacteria in their tissues . The results suggest that PRRSV predisposes sSPF pigs to infection and disease caused by virulent S suis serotype 2 . Co-infection of piglets with PRRSV and a virulent strain of S suis may provide a useful model for the study of S suis septicaemia and meningitis.

Vet Rec, 1994 Jan 8, 134(2), 42 - 3
An unusual outbreak of Streptococcus bovis septicaemia in racing pigeons (Columba livia); De Herdt P et al.; In December 1991, an outbreak of Streptococcus bovis septicaemia occurred in a Belgian pigeon loft where 25 male and 25 female racing pigeons were housed . The main clinical signs included inability to fly and poor breeding results . None of the female pigeons and only one male pigeon was able to fly . Nine affected pigeons were necropsied . Histologically a tenosynovitis of the tendon of the deep pectoral muscle was observed in most of them and S bovis was isolated from the canalis triosseus or the shoulder joints of five of the nine pigeons . The pigeons were successfully treated with ampicillin administered in the drinking water for seven days.

Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique, 1994, 71, 115 - 24
{Acute epidemic hemorrhagic conjunctivitis (AEHC) in Madagascar 1991}; Bernardin P et al.; An epidemic of A.E.H.C . was broken out everywhere in Madagascar during hot season from September 1990 to May 1991 with an important acuteness in February and March . Clinical symptoms are those of A.E.H.C . to enterovirus with some particularities . Virological study shows cytopathogenic effect of enterovirus and microbiology shows the existence of several bacterial germs particularly staphylococcus epidermidis . The discovery of two cases of streptococcus pneumonia and the absence of chlamydia trachomatis make the originality of our cases . The efficacy of the association antibiotic and steroids is spectacular.

Dakar Med, 1994, 39(2), 179 - 84
{Purulent pleurisy in the child}; Ndiaye O et al.; We studied 122 cases of empyema in children . The mean age was 3 years . We found malnutrition in 33% of the patients . 60% of them had large pleural effusion and 56% associated pneumonia . Staphylococcus aureus (51%) and Streptococcus pneumoniae (18%) were the most frequently isolated bacterias in pleural fluid . The mortality rate was 6.5% . 53% of the children had closed chest tube drainage . There were minor abnormalities in pulmonary function tests . The best treatment of empyema in children is closed chest tube drainage and an antimicrobial therapy with antistaphylococcus antibiotic.

Dakar Med, 1994, 39(2), 175 - 8
{Cervical adenophlegmon (apropos of 57 cases)}; Ouoba K et al.; Neck adenitis remain a frequent occurrence in our areas . Within one year only, 57 cases were collected in the ORL department of University Hospital of Ouagadougou . Children were mostly affected (70% of cases) and the starting point or supposedly was mainly pharyngeal (67% of cases); streptococcus were the dominant microbes . Concerning the treatment, our preference was for wide antibiotherapy, in monotherapy but using wide spectrum, including staphylococcus aureus, due to its frequency in this pathology . But the primum movens remained the incision drainage . The post-operative period were regularly simple for our 57 patients.

J Clin Dent, 1994, 5(4), 110 - 3
Validation of the intraoral delta Ip system and use of the system to test the efficacy of Mentadent dentifrice; Kashket S et al.; Ongoing efforts within the oral care industry to improve dentifrices by the addition of anti-tartar compounds, bicarbonate and other agents, have necessitated the continuing evaluation of new products in order to assure their anti-caries effectiveness . However, clinical evaluation of new products is time consuming, prohibitively expensive and ethically questionable . Recently, a number of intraoral models have been developed that appear to be well-suited to evaluate new products . In the present study, an intraoral system was used that monitors short-term demineralization of surface enamel . Subjects wore appliances that contained Streptococcus mutans-coated blocks of bovine enamel and rinsed first with 15 ml of a 20% slurry of dentifrice and, after 30 minutes, with a 10% sucrose solution . Iodide penetrability (Ip) was determined before and after each intraoral exposure, and the difference, or delta Ip, was taken as the measure of demineralization . The model system responded linearly to increasing concentrations of fluoride in a series of standard dentifrice preparations . Mentadent, a fluoride toothpaste with baking soda and peroxide, was shown to reduce enamel demineralization and to provide protection comparable to a clinically tested dentifrice (Crest Regular) . These results established the validity of the delta Ip method, and demonstrated the efficacy of Mentadent according to the criteria established at the ADA Consensus Conference on Intraoral Models in 1990.

Am J Respir Cell Mol Biol, 1994 Jan, 10(1), 16 - 23
A non-radioisotopic method for tracing neutrophils in vivo using 5'-bromo-2'-deoxyuridine; Bicknell S et al.; Polymorphonuclear leukocytes (PMN) labeled in vivo with 5'-bromo-2'-deoxyuridine (BrdU) in donor animals were transferred to recipients to determine the rate of clearance of labeled PMN from the circulation, their margination within the vascular space, and migration into Streptococcus pneumoniae-induced inflammatory sites . The donor animals received intravenous infusions at 25 mg/kg/day of BrdU for 7 days when cytospins of leukocyte-rich plasma (LRP) showed that 80 +/- 2.3% PMN were labeled . The BrdU labeled cells were then transfused to serum-compatible recipients as either whole blood, leukocyte-rich plasma, or PMN purified from an equal volume of whole blood . Twenty-four hours after transfer, the distribution of BrdU-labeled PMN in the lung, liver, spleen, bone marrow, and gut was determined morphometrically and by Southern blot analysis of DNA extracted from these organs . BrdU-labeled PMN transfused as either LRP or purified PMN provided no advantage over transfusing whole blood . The half-life of BrdU-labeled PMN in the recipient circulation after transfusing whole blood was 270.4 min (95% confidence intervals, 248.5 to 296.4 min) . The majority of the BrdU-labeled DNA was found in the spleen, where DNA analysis showed that the white blood cells underwent programmed cell death by apoptosis . Four hours after infection with S . pneumoniae and 1 h after transfusion of labeled whole blood, BrdU-labeled PMN had migrated into the infected sites . We conclude that transfer of BrdU PMN in whole blood provides a simple, effective method of tracing labeled PMN in vivo.

Otolaryngol Head Neck Surg, 1994 Jan, 110(1), 110 - 4
The effect of surfactant on eustachian tube function in a gerbil model of otitis media with effusion; Fornadley JA et al.; The relationship of eustachian tube surfactant and otitis media with effusion on eustachian tube opening pressure was studied in a gerbil model . Injection of killed Streptococcus pneumoniae bacteria created a serous effusion that increased eustachian tube opening pressure . The introduction of exogenous surfactant to this system resulted in a dramatic decrease in eustachian tube opening pressure in both normal ears and those with effusion . Identifying means to increase surfactant in the eustachian tube could be beneficial in reducing persistent otitis media with effusion.

J Bacteriol, 1994 Jan, 176(2), 524 - 7
Properties of a Streptococcus salivarius spontaneous mutant in which the methionine at position 48 in the protein HPr has been replaced by a valine; Vadeboncoeur C et al.; HPr is a protein of the phosphoenolpyruvate:sugar phosphotransferase system (PTS) that participates in the concomitant transport and phosphorylation of sugars in bacteria . In gram-positive bacteria, HPr is also reversibly phosphorylated at a seryl residue at position 46 (Ser-46) by a metabolite-activated ATP-dependent kinase and a Pi-dependent HPr(Ser-P) phosphatase . We report in this article the isolation of a spontaneous mutant (mutant A66) from a streptococcus (Streptococcus salivarius) in which the methionine at position 48 (Met-48) in the protein HPr has been replaced by a valine (Val) . The mutation inhibited the phosphorylation of HPr on Ser-46 by the ATP-dependent kinase but did not prevent phosphorylation of HPr by enzyme I or the phosphorylation of enzyme II complexes by HPr(His-P) . The results, however, suggested that replacement of Met-48 by Val decreased the affinity of enzyme I for HPr or the affinity of enzyme II proteins for HPr(His-P) or both . Characterization of mutant A66 demonstrated that it has pleiotropic properties, including the lack of IIILman, a specific protein of the mannose PTS; decreased levels of HPr; derepression of some cytoplasmic proteins; reduced growth on PTS as well as on non-PTS sugars; and aberrant growth in medium containing a mixture of sugars.

Postgrad Med, 1994 Jan, 95(1), 109 - 10, 197
Recurrent pneumococcal meningitis . Search for occult skull fracture; Sponsel C et al.; Skull fractures, particularly those affecting the base of the brain and extending to the sinuses and petrous pyramids, are the most common cause of recurrent bacterial meningitis . Detection of sinus fracture can be difficult in children . Thin-section computed tomographic scanning aids the diagnosis in patients with a remote history of head injury . Other causes of recurrent bacterial meningitis include congenital cranial and spinal cord defects, foci of infection, and immune system disorders . Streptococcus pneumoniae is often the infectious organism . Treatment includes surgical repair of any anatomic defects and use of appropriate antibiotic therapy.

J Infect Dis, 1994 Jan, 169(1), 212 - 4
Serotypes responsible for invasive Streptococcus pneumoniae infections among children in Connecticut; Shapiro ED et al.; Active prospective surveillance to identify the serotypes of Streptococcus pneumoniae responsible for invasive infections among children in Connecticut was conducted from July 1984 through March 1993 . S . pneumoniae isolates (722) recovered from normally sterile sites (98% from blood, 7% from both blood and cerebrospinal fluid) were serotyped by the Quellung reaction; 70% of the isolates were from children < 2 years old . Serotype 14 caused 29% of the infections . Seven serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) were responsible for 84% of the invasive infections overall and for 86% of the invasive infections among children < 2 years old . Formulations of polysaccharide-protein conjugate pneumococcal vaccines designed to prevent invasive infections in children in the United States should include these commonly isolated serotypes.

Infect Immun, 1994 Jan, 62(1), 60 - 4
Evidence that L-(+)-lactate dehydrogenase deficiency is lethal in Streptococcus mutans; Hillman JD et al.; In order to construct an effector strain for the replacement therapy of dental caries, we wished to combine the properties of low-level acid production and high-level colonization potential in a strain of Streptococcus mutans . To this end, we made a deletion in the lactate dehydrogenase (LDH) gene cloned from the bacteriocin-producing S . mutans strain JH1000 . However, we were unable to substitute the mutant for the wild-type allele by transformation with linear DNA fragments . The mutated gene, carried on a suicide vector, was shown by Southern analysis to integrate into the JH1000 chromosome to yield transformants carrying both the wild-type gene and mutated LDH gene . Three spontaneous self-recombinants of one heterodiploid strain were isolated by screening 1,500 colonies for a loss of the tetracycline resistance encoded by the gene used to mark the LDH deletion . In all three cases, Southern analysis showed that a loss of tetracycline resistance was accompanied by a loss of the mutated LDH gene, resulting in restoration of the wild-type genotype . However, screening the same number of colonies for self-recombinants that did not make lactic acid during anaerobic growth in Todd-Hewitt broth failed to identify clones in which the wild-type allele was lost . A second, simpler screening of more than 80,000 colonies grown aerobically on glucose tetrazolium medium to identify low-level-acid-producing colonies was also unsuccessful . These results are interpreted as indicating that LDH deficiency is lethal in S . mutans under the cultivation conditions used in these experiments . The physiological bases for this hypothesis are described.

Infect Immun, 1994 Jan, 62(1), 119 - 25
Lipoteichoic acid induces secretion of interleukin-8 from human blood monocytes: a cellular and molecular analysis; Standiford TJ et al.; Invasion by gram-positive and gram-negative bacterial organisms is characterized immunopathologically by the activation of mononuclear phagocytic cells, leading to the elaboration of macrophage-derived regulatory and chemotactic factors, and the resultant influx of inflammatory leukocytes . Little is known regarding the mechanisms by which gram-positive organisms initiate macrophage activation and subsequent inflammation . In this investigation, we postulated that lipoteichoic acid (LTA) purified from two different gram-positive bacterial species was an important signal for the expression of chemotactic cytokines from human peripheral blood monocytes (PBM) . In initial experiments, we demonstrated that cell-associated interleukin-8 (IL-8) was expressed by mononuclear phagocytes present in inflamed areas of endocardium in cases of acute Staphylococcus aureus endocarditis . We next demonstrated that LTA purified from either Staphylococcus aureus or Streptococcus pyogenes induced the time- and dose-dependent expression of IL-8 mRNA and protein from human PBM . The expression of IL-8 mRNA from LTA- but not lipopolysaccharide (LPS)-treated PBM was superinduced by concomitant treatment with cycloheximide, indicating that the expression of IL-8 mRNA from LTA-treated PBM was negatively controlled by repressor proteins . Furthermore, mRNA stability studies indicated that IL-8 mRNA was less stable in the presence of LTA than in the presence of LPS . Our findings indicate that LTA can induce the secretion of the polymorphonuclear leukocyte chemotactic factor IL-8 and that LTA may be an important cellular mediator of inflammatory cell recruitment that characterizes immune responses to gram-positive bacterial infections.

J Cancer Res Clin Oncol, 1994, 120(8), 479 - 84
Effects of group B Streptococcus toxin on long-term survival of mice bearing transplanted Madison lung tumors; Thurman GB et al.; GBS toxin is a polysaccharide exotoxin produced by group B Streptococcus . This organism causes sepsis and respiratory distress in human neonates (so-called early onset disease) . This disease is marked by a strong inflammatory response only in the lung, with pulmonary sequestration of granulocytes and extensive capillary endothelial damage, and occurs only during the first few days after birth . We have found that a similar inflammatory response can be induced by i.v . infusion of picomole quantities of GBS toxin in the developing vasculature of transplanted tumors in mice and can significantly retard the tumor growth . When optimum treatment with GBS toxin was started shortly after tumor implantation, a majority of tumors in the mice regressed and the mice remained tumor-free for over 5 months . Some tumors regressed in mice receiving short-term treatment with GBS toxin, but recurred after the treatment was stopped . Median survival times were extended by all regimens and all doses of GBS toxin tested . No evidence of toxicity to the vasculature of other tissues was observed . GBS toxin is being tested for cancer therapy in humans.

Acta Paediatr, 1994 Jan, 83(1), 35 - 9
Infective endocarditis in newborn infants with structurally normal hearts; Mecrow IK et al.; Twelve infants with structurally normal hearts were demonstrated to have intracardiac vegetations on echocardiography and diagnosed as having infective endocarditis . All were found in the right side of the heart, most frequently at the junction of the superior vena cava and the right atrium and in no case involved the tricuspid or pulmonary valves . Most were diagnosed in the course of investigation of repeatedly positive blood cultures, despite appropriate antibiotic therapy . Coagulase-negative staphylococci were isolated from blood culture in nine infants, and Streptococcus sanguis and Candida albicans from one each . All infants had had intracardiac central lines inserted to facilitate venous access, either by a percutaneous technique or as a formal surgical procedure . Eight (67%) were successfully treated and made a full recovery . Cardiac murmurs were absent in all of the cases . Echocardiography should be included in the investigation of all neonates with persistently positive blood culture, particularly when intracardiac lines have been sited . Right-sided, non-valvar lesions and infection with coagulase-negative staphylococci may carry a better prognosis than previously reported.

Stomatologiia (Mosk), 1994 Jan-Mar, 73(1), 13 - 4
{The reactions of periodontitis patients to the administration of bacterial allergens}; Britova AA; Analysis of the clinical picture of periodontitis and the results of allergologic tests with administration of hemolytic streptococcus and staphylococcus allergens indicated the formation in the patients of delayed type bacterial hypersensitivity which was weakly manifest and more characteristic of patients with medium-severe or grave periodontitis . Changes in the peripheral blood were also indicative of total body reaction to the local process in the periodontium; immune defense mechanisms were found strained and exhausted.

Lasers Surg Med, 1994, 14(2), 164 - 7
Comparative cell targeting in vitro using the CO2 laser; Talebzadeh N et al.; In keeping with current interest in bactericidal effects of lasers to treat localized infection, we examined the effect of CO2 laser light on three bacterial species . Cell monolayers were placed atop filters minimizing the presence of extracellular water . Samples were exposed to irradiance values between 0 and 520 W/cm2 for 0.1 s . Cell survival was determined by colony counts . There was logarithmic killing of the bacteria with increasing irradiance; 90% kill was effected at 180 W/cm2 for Escherichia coli, 350 W/cm2 for Streptococcus mutans, and 250 W/cm2 for Bacillus stearothermophilus . However, standard deviations suggest no significant difference between cell types . Our results show the bactericidal effect of the CO2 laser with no remarkable difference between Gram types . However, substantial cell kill was achieved at relatively low irradiance . Whereas selectivity of damage may not be afforded by the CO2 laser, it may minimize collateral damage.

Folia Microbiol (Praha), 1994, 39(1), 83 - 6
Conjugative transfer of tetracycline resistance in rumen streptococcal strains; Jonecova Z et al.; In 11% of tested Streptococcus bovis strains a conjugative transfer of tetracycline resistance was observed when mating experiments were carried out on membrane filters . The recipient strain used was S . bovis BM114 with chromosomal resistance to rifampicin . In addition, in two strains tetracycline resistance was transferred also to recipient strain Enterococcus faecium AL6 . The transfer frequencies were in the range of 10(-6) to 10(-3) . The donor strains were screened for the presence of plasmids and one up to four bands of plasmid DNA in all tested strains were revealed . In spite of that isolation of plasmid DNA was successful only in 53/4/114 transconjugants . Transconjugant 32/114 contained amylase activity which was higher than in the donor strain.

Intern Med, 1994 Jan, 33(1), 13 - 7
Multiple myeloma complicated with streptococcal endocarditis successfully treated by mitral valve replacement; Fukuzawa S et al.; A 63-year-old male patient with multiple myeloma developed congestive heart failure due to streptococcus endocarditis prior to the initiation of chemotherapy . Doppler echocardiographical examination revealed the presence of a large vegetation on the anterior mitral leaflet as well as the association of severe mitral regurgitation . Surgical repair (mitral valve replacement) was urgently undertaken and the postoperative course resulted in uneventful recovery . In immunodeficient patients with such a streptococcus sepsis, the possibility of infectious endocarditis should be taken into consideration and proper management is mandatory in these circumstances.

Pediatr Infect Dis J, 1994 Jan, 13(1), 49 - 56
Apparent lower rates of streptococcal toxic shock syndrome and lower mortality in children with invasive group A streptococcal infections compared with adults; Davies HD et al.; Since 1985 there have been worldwide reports of increases in severe invasive Group A streptococcal (IGAS) infections . We reviewed the charts of all children with IGAS infections (defined as isolation of Group A streptococcus from a normally sterile site) presenting to our institution over a 7-year period (January, 1985, to December, 1991) and the literature . Streptococcal toxic shock syndrome required hypotension and multisystem organ involvement . Twenty-four patients (mean age, 4.96 +/- 4.4 years) were identified with IGAS infection . One patient (presenting in 1989) met the criteria for probable streptococcal toxic shock syndrome and none died . Eight of 19 Group A streptococcal isolates tested were streptococcal pyrogenic exotoxin (SPE) A producers, most (90%) had the speC gene and all had the speB gene and produced the toxin . No M or T type predominated . The low rates of streptococcal toxic shock syndrome and fatalities among children with IGAS infection are consistent with other pediatric but not with adult series . The apparent differences in outcome of IGAS between children and adults were not explained by the virulence factors we examined and may warrant further investigation.

Mol Microbiol, 1994 Jan, 11(2), 323 - 30
Characterization of the mutX gene of Streptococcus pneumoniae as a homologue of Escherichia coli mutT, and tentative definition of a catalytic domain of the dGTP pyrophosphohydrolases; Mejean V et al.; We show that deletion of a gene of Streptococcus pneumoniae, which we call mutX, confers a mutator phenotype to resistance to streptomycin . Analysis of the DNA sequence changes that occurred in several streptomycin-resistant mutants showed that mutations are unidirectional AT to CG transversions . The mutX gene is located immediately downstream of the previously identified ung gene and genetic evidence suggests that the two genes are co-ordinately regulated . Nucleotide sequence determination reveals that the mutX gene encodes a 17,870 Da protein (154 residues) which exhibits significant homology with the MutT protein of Escherichia coli, a nucleoside triphosphatase (dGTP pyrophosphohydrolase) . The mutX gene complements the E . coli mutT mutator phenotype when introduced on a plasmid . Site-directed mutagenesis and analysis of nitrosoguanidine-induced mutT mutants suggest that a small region of high homology between the two proteins (61% identity over 23 residues) is part of the catalytic site of the nucleoside triphosphatase . Computer searching for sequence homology to MutX uncovered a second E . coli protein, the product of orf17, a gene of unknown function located near the ruvC gene . The region of high homology between MutX and MutT is also conserved in this protein, which raises the interesting possibility that the orf17 gene plays some role in determining mutation rates in E . coli . Finally, a small set of proteins, including a family of virus-encoded proteins and two evolutionarily conserved proteins encoded by an antisense transcript from the Xenopus laevis and human bFGF genes, were also found to harbour significant homology to this highly conserved region.

Eur J Clin Microbiol Infect Dis, 1994 Jan, 13(1), 33 - 4
Comparative activity of teicoplanin and vancomycin against 400 penicillin susceptible and resistant Streptococcus pneumoniae . The French Study Group; Goldstein FW et al.; The MICs of teicoplanin and vancomycin were determined for 400 penicillin-susceptible and -resistant strains of Streptococcus pneumoniae isolated during a multicenter study in 1992 . Teicoplanin displayed a four-fold better activity than vancomycin, with modal MICs of these agents being 0.06 and 0.25 micrograms/ml, respectively . These data warrant further studies with teicoplanin in the treatment of pneumococcal infections.

APMIS, 1994 Jan, 102(1), 3 - 12
Superantigens; Fleischer B; "Superantigens" is the term for a group of molecules that have in common an extremely potent stimulatory activity for T lymphocytes of several species . They stimulate CD4+, CD8+ and gamma delta + T cells by a unique mechanism: they cross-link variable parts of the T-cell receptor (TCR) with MHC class II molecules on accessory or target cells . The interaction site on the class II molecule and on the TCR is different from the peptide binding site; on the TCR it is the variable part of the beta chain (V beta) . The prototype superantigen is the staphylococcal enterotoxin B (SEB), member of a family of genetically related proteins produced by Staphylococcus aureus and Streptococcus pyogenes . These are soluble exotoxins of approximately 27 kd molecular mass . It is intriguing that this molecular mechanism of T-cell stimulation has been independently produced at least three times in evolution . Other pathogens producing superantigens are retroviruses (the Mouse Mammary Tumor Viruses) and a mycoplasma (Mycoplasma arthritidis) . Many additional candidate superantigens have been proposed, but in most cases unequivocal evidence for superantigen activity is still missing . There are several reasons why these molecules have aroused such tremendous interest in recent years . First, they have provided key information on tolerance mechanisms, both on the deletion of T cells in the thymus and on the induction of peripheral tolerance by anergy and apoptosis . Second, of all polyclonal T-cell stimulators they are the ones that most closely mimic the recognition of specific antigen . Finally, they have been recognized as important factors in the pathogenicity of the producing pathogens, inducing shock and immunosuppression . Whilst there is evidence that superantigens could be involved in the pathogenesis of certain human diseases, in most cases this is still very preliminary and indirect.

J Foot Ankle Surg, 1994 Jan-Feb, 33(1), 91 - 7
Bacterial pathogens in infected puncture wounds in adults with diabetes; Lavery LA et al.; Infections resulting from puncture wounds to the foot in diabetics appear not to have been previously reported in the medical literature . The purpose of this report is to describe bacterial pathogens identified from bone and soft tissue infections precipitated by a puncture injury in patients with diabetes . In a 7-year retrospective study, the authors evaluated 22 patients with osteomyelitis and 44 patients with soft tissue infections . Medical records and operative culture and sensitivity reports were reviewed . Staphylococcus aureus (68%), Streptococcus species (44%), and Enterococcus species (27%) were the most common pathogens identified . Pseudomonas was more common in cases of osteomyelitis (36%) than in soft tissue infections (18%) (p < 0.001) . Pseudomonas was more common in patients that had worn tennis shoes at the time of the puncture injury compared to patients that were barefoot or who wore some other type of footwear (p < 0.001) . Seventy-four percent of patients had polymicrobial infections . Anaerobes were identified in only seven patients (11%) . This study suggests that polymicrobial infections with few anaerobes are common in infected puncture wounds in diabetics . Pseudomonas is more common in bone infections and is associated with wearing tennis shoes at the time of injury.

Caries Res, 1994, 28(2), 94 - 8
Reduction in acid tolerance of Streptococcus downeii by fluoride and potassium laurate; Hayes ML; Streptococcus downeii MFe28 maintains a transmembrane pH gradient at low extracellular pH values using energy from glucose metabolism . The metabolic activity was measured in saturating glucose solutions using a pH-stat, and results were expressed as rates of titratable acid production at defined pH values . The tolerance to acid shock was studied in terms of the ability of cells to resume acid production at pH 8.0 following short-term exposure to low-pH environments . The results with control cells showed an optimum rate of acid production at pH 8.0 . The activity extended to pH 4.5 with a half-maximal rate at pH 5.4 . Addition of carbonyl cyanide-m-chlorophenylhydrazone, potassium laurate, or potassium fluoride inhibited acid production at lower but not at higher pH values . Inhibition by carbonyl cyanide-m-chlorophenylhydrazone and fluoride was found to be fully reversible at pH 8.0 when compared to control cells . In contrast, laurate inhibited irreversibly at pH values of 6.0 and below . The acid tolerance of S . downeii was severely compromised by laurate, and this action could be useful in dental caries control.

Enferm Infecc Microbiol Clin, 1994 Jan, 12(1), 17 - 20
{Current use of penicillin in community-acquired pneumococcal pneumonias}; Gaztelurrutia L et al.; BACKGROUND: A retrospective study was performed to know the clinical and microbiologic aspects of community-acquired pneumococcal pneumonia in adult patients admitted to a general hospital from 1990-1992 . METHODS AND RESULTS: The medical records of 55 patients, aged 20-86 years (man age: 58 year) were reviewed . Streptococcus pneumoniae was isolated from blood in 45 cases (81.8%), transparietal lung puncture in 5 (9.1%), pleural fluid 3 (5.5%) and protected specimen brushing (> 1,000 UFC/ml) in 2 (3.6%) Most isolated (80%) were sensitive to penicillin (CIM < 0.1 microgram/ml); intermediate (CIM > or = 0.1 microgram/ml) 9 (16.4%) and resistant (> 1 microgram/ml) 2 (3.6%) . Underlying diseases were present in 39 (70.9%) cases . All patients received empiric treatment with one or more antibiotics effective against Streptococcus pneumoniae . Only in 2 of the 9 cases treated with erythromycin the microorganism was resistant to this drug . Eleven patients died (20%), 5 died before to the fifth day of admission . Mortality was influenced by involvement of 2 or more lobes and immunosuppression (p < 0.05) . CONCLUSIONS: This study suggests that 80% of the community-acquired pneumococcal pneumonia in a population with a high prevalence rate of disease requiring hospital admission are very sensitive in vitro to penicillin in contrast with its seldom clinical use in the authors environment . No microorganism presented with CIM above 2 micrograms/ml . Mortality was not due to inadequate therapy but rather to the severity of the underlying disease.

Thorax, 1994 Jan, 49(1), 71 - 6
Re-evaluation of pneumonia requiring admission to an intensive care unit: a prospective study; Dahmash NS et al.; BACKGROUND--Appropriate treatment of severe community and hospital acquired pneumonias requiring admission to a medical intensive care unit depends on knowledge of the likely aetiological agents in any community . Little is known about the pattern and outcome of patients with such pneumonias in Saudi Arabia . METHODS--In a prospective study 113 patients with pneumonia were investigated in the medical intensive care unit at King Khalid University Hospital, Riyadh, Saudi Arabia between September 1991 and December 1992 . The diagnosis was established by microscopy and culture of sputum, blood culture, or serological examination . A standard proforma was used to collect demographic, clinical, and laboratory data . RESULTS--A microbiological diagnosis was made in 80% of the cases with a single pathogen accounting for 69% of the isolates and multiple pathogens for 11% . Pseudomonas aeruginosa was the most common infecting agent (16%), followed by Streptococcus pneumoniae (12%), Staphylococcus aureus (9%), and Mycobacterium tuberculosis (8%) . Pneumonia due to Legionella pneumophilia was diagnosed in three patients and infection due to Mycoplasma pneumoniae in two . These five cases were identified by serological examination . Gram negative rods were the predominant pathogens in both community and hospital acquired pneumonia . The aetiology of pneumonia was not identified in 20% of cases . The overall mortality was 37% . Patients with hospital acquired pneumonia had a higher mortality than those with a community acquired pneumonia . Similarly, a high mortality was found in patients who had a serious underlying disease, abnormal mental state, diastolic blood pressure < 60 mm Hg, blood urea > 7 mmol/l, abnormal liver function tests, serum albumin < 30 g/l, those who required mechanical ventilatory support, and those with APACHE II scores > 20 . CONCLUSIONS--This study highlights two major findings which differ from previous reports on the aetiology of pneumonia . Firstly, Gram negative rods were the predominant pathogens in community acquired pneumonia and secondly, M tuberculosis was an important cause of pneumonia in these patients, indicating that tuberculous pneumonia should be considered in the differential diagnosis of pneumonia in Saudi Arabia.

Z Kardiol, 1994 Jan, 83(1), 31 - 7
{Changes in infectious endocarditis--analysis of a disease picture in the last decade}; Schon HR et al.; The following retrospective study analyzes 51 patients aged 45.8 +/- 11 years with infective endocarditis diagnosed from January 1, 1980-December 31, 1989 . The aortic valve was mainly affected (59%) . 92% of patients showed predisposing factors or a directly related incident . Positive blood cultures were found in 63% of patients . The dominating bacterium was streptococcus viridans (31%) with decreasing tendency compared to the previous decade, followed by staphylococcus aureus (22%) with significantly increasing tendency . Clinical and laboratory findings were not different from those of the previous decade . Main complications in the early period of disease turned out to be acute heart failure (69%) and arterial embolism (41%) which was dependent on the severity of disease . Mortality within the initial 6 months was significantly lower than in the previous decade (16% vs 31%) . Patients undergoing heart-valve replacement within the first 6 months of disease (59%) had a mortality rate of 10%, which was significantly smaller than the 24% mortality rate of patients not being operated during the same period . Furthermore, patients with staphylococcus aureus endocarditis demonstrated a markedly worse early prognosis (6 month survival rate 28.6 +/- 17.2% vs 80.0 +/- 6.1% in patients with infective endocarditis other than staphylococcus aureus-related) . Late mortality was not different in the above-mentioned subgroups with a 5-year survival of more than 80% . However, surgically treated patients significantly improved their functional class in the follow-up period over medically treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Equine Vet J, 1994 Jan, 26(1), 22 - 8
Susceptibility of ponies to infection with Streptococcus pneumoniae (capsular type 3)
Blunden AS, Hannant D, Livesay G, Mumford JA.
Welsh Mountain ponies were inoculated with an isolate of Streptococcus pneumoniae, SPE 1618 (capsular type 3) recovered from the equine respiratory tract: 10 ml of a suspension of 10(8) or 10(9) cfu/ml were instilled intratracheally . Fever was observed after either dose but the greater concentration also produced coughing, ocular and nasal discharge, depression and enlargement of submandibular lymph nodes . Cytological evidence of infection was also observed in tracheal washings during the first week after inoculation and corresponded with isolation of S . pneumoniae from the washes . Morbid anatomical and histopathological examinations of selected animals revealed focal pneumonia affecting the ventral lung, especially the cardiac area and accessory lobe, with a propensity to affect the right lung . S . pneumoniae was isolated directly in pure culture from these lesions or was demonstrable by immunostaining of macrophages bearing specific capsular type 3 antigen . By 10 days after inoculation, the ponies were healthy and had developed antibodies to S . pneumoniae . S . pneumoniae was therefore a primary pathogen in the horse under the conditions of the challenge.

Can J Vet Res, 1994 Jan, 58(1), 49 - 54
Evaluation of the antibody response in pigs vaccinated against Streptococcus suis capsular type 2 using a double-antibody sandwich enzyme-linked immunosorbent assay; Blouin C et al.; A double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) was standardized for the detection of specific antibodies following vaccination with Streptococcus suis capsular type 2 bacterins . No statistically significant increase of antibody titers was detected in vaccinated piglets compared to the nonvaccinated control group, even if a minority of piglets demonstrated an important postvaccinal response . Three of four vaccinated sows showed a low antibody response to vaccine and specific immunity was detected in piglets of only one litter of these three sows . Passive protection studies showed that none of the sera from vaccinated piglets were protective for mice whereas serum obtained from hyperimmunized pigs gave protection.

Antimicrob Agents Chemother, 1994 Jan, 38(1), 49 - 53
Genetics of oxacillin resistance in clinical isolates of Streptococcus pneumoniae that are oxacillin resistant and penicillin susceptible; Dowson CG et al.; It has recently been reported that penicillin-sensitive pneumococci may exhibit reduced susceptibility to oxacillin, resulting in their misclassification as being penicillin resistant by oxacillin disk testing . Intermediate oxacillin resistance (MIC, 1.0 microgram/ml) in three of these apparently unrelated penicillin-susceptible clinical isolates of Streptococcus pneumoniae isolated in the United Kingdom and in four Spanish isolates was shown to be solely due to the acquisition of a gene encoding an altered penicillin-binding protein (PBP), PBP2X . PBP2X genes cloned from typical penicillin-resistant isolates of S . pneumoniae that possessed high-level oxacillin resistance were shown to be able to transform susceptible isolates of S . pneumoniae to intermediate oxacillin resistance . In all instances, the intermediately oxacillin-resistant PBP2X transformants retained susceptibility to penicillin (MIC, 0.06 microgram/ml) . Under appropriate selective pressure, the acquisition of a low-affinity PBP2X by penicillin-susceptible pneumococci could result in an increasing number of false positives for penicillin resistance among isolates of S . pneumoniae screened with oxacillin . Additionally, these intermediately oxacillin-resistant isolates showed reduced susceptibility to cefotaxime, an agent likely to be prescribed in place of penicillin for the treatment of serious infections due to these apparently penicillin-resistant organisms.

Antimicrob Agents Chemother, 1994 Jan, 38(1), 122 - 5
In vitro selective antibiotic concentrations of beta-lactams for penicillin-resistant Streptococcus pneumoniae populations; Negri MC et al.; Therapeutic regimens containing beta-lactam antibiotics are selecting penicillin-resistant Streptococcus pneumoniae populations all over the world . The selective pressure after 4 h of exposure to different concentrations of amoxicillin, cefixime, cefuroxime, and cefotaxime for low-level or high-level penicillin-resistant S . pneumoniae was evaluated in an in vitro model with mixed populations with penicillin susceptibilities of 0.015, 0.5, 1, and 2 micrograms/ml . The antibiotic concentration selecting for low-level resistance strongly reduced the susceptible population . Increasing antibiotic concentrations tended to decrease the total proportion of penicillin-resistant bacteria because of reduced numbers of the low-level-resistant population . The antibiotic concentration selecting for high-level resistance produced fewer resistant populations, but most of the organisms selected represented high-level resistance . In general, amoxicillin was a good selector for the low-level-resistant population and a poor selector for high-level resistance; cefuroxime and cefotaxime were poor selectors for low-level resistance and better selectors than amoxicillin for high-level penicillin resistance . Cefixime was the best selector of low-level penicillin resistance . When only resistant populations were mixed, the strains with high-level resistance were selected even at low antibiotic concentrations . Determination of the effects of selective antibiotic concentrations on mixed cultures of bacteria expressing different antibiotic resistance levels may help researchers to understand the ecology and epidemiology of penicillin-resistant S . pneumoniae populations.

J Cataract Refract Surg, 1994 Jan, 20(1), 82 - 3
Corneoscleral abscess resulting from a broken suture after cataract surgery; Cameron JA et al.; An 82-year-old man had pain and decreased vision in his right eye 15 months after uncomplicated cataract surgery . Examination revealed a large corneoscleral abscess with a 2 mm x 1 mm area of fluorescein staining at the base of a broken protruding 10-0 nylon suture . Streptococcus pneumoniae was isolated from both the suture and base of the ulcer . Despite intensive topical, subconjunctival, and systemic antibiotics, a large corneal perforation developed, necessitating a 10 mm tectonic penetrating keratoplasty . Long-term follow-up of patients after cataract surgery is important and should include an inspection of the limbal wound and removal of loose or broken exposed sutures . Suture-related complications will be eliminated if clinical studies prove the safety and efficacy of sutureless cataract surgery.

J Clin Microbiol, 1994 Jan, 32(1), 246 - 8
Nosocomial epiglottitis associated with penicillin- and cephalosporin-resistant Streptococcus pneumoniae bacteremia; Daum RS et al.; We cared for a 4-year-old male with nosocomially acquired epiglottitis caused by Streptococcus pneumoniae . He had been receiving ceftazidime therapy when this infection was recognized . The S . pneumoniae isolate was of serotype 15B and was resistant to beta-lactam antibiotics, cephalosporins (including those with extended spectra), and trimethoprim-sulfamethoxazole . Clinicians and clinical microbiologists must be aware that cephalosporin susceptibility may no longer be assumed for penicillin-resistant S . pneumoniae isolates and that susceptibility testing for the extended-spectrum cephalosporins should be performed whenever this species is isolated from a normally sterile body fluid.

FEMS Microbiol Lett, 1994 Jan 1, 115(1), 19 - 26
Increase of capsular material thickness following in vivo growth of virulent Streptococcus suis serotype 2 strains; Quessy S et al.; Protein profile and capsular material thickness of Streptococcus suis serotype 2 strains were compared after in vitro and in vivo growth . Three virulent and one avirulent strains were used . These strains were grown in Brain Heart Infusion (BHI) broth, cells were collected by centrifugation, resuspended in a sterile saline solution and injected in diffusion chambers . The devices were then inserted in rat abdomens for 17 h . In vitro grown strains were also inoculated into fresh BHI broth and cultivated for 17 h at 37 degrees C . In vivo as well as in vitro grown bacteria were harvested by centrifugation, processed in a French pressure cell, treated with lysozyme and centrifuged to collect cell proteins for SDS-PAGE analysis . Transmission electron microscopy using polycationic ferritin labeling to stabilize capsular material was also carried out . No significant modification was noted in the protein profile for any strain after in vivo growth except for a 39 kDa protein of one virulent strain . On the other hand, an increase in thickness of capsular material was noted for the three in vivo grown virulent strains while no change was noted for the avirulent strain . This increase in capsular material thickness of virulent strains was accompanied by an increased resistance to killing by pig polymorphonuclear leukocytes . The capacity to produce more capsular material in vivo seems to be an attribute of some virulent S . suis serotype 2 strains.

Caries Res, 1994, 28(1), 35 - 42
An in vitro mouth model to test antiplaque agents: preliminary studies using a toothpaste containing chlorhexidine; Zampatti O et al.; The development of an in vitro model simulating the oral cavity has allowed the antiplaque activity of a toothpaste containing 0.004% chlorhexidine to be tested . The model is based on the continuous irrigation of bovine tooth samples with artificial saliva . Scanning electron microscopy showed homogeneous colonization of monobacterial plaque by Streptococcus mutans on dental surfaces under these model conditions . The enamel was colonized with regular cell clusters showing a globular appearance . The globules coalesced with increasing plaque thickness . Treatment with toothpaste containing 0.004% chlorhexidine showed a more marked inhibition of bacterial colonization on enamel surfaces than placebo paste lacking this antimicrobial agent . These results indicate that the toothpaste formulation is compatible with chlorhexidine . It is concluded that the in vitro model developed in this study is suitable for the testing of the antiplaque activity of antimicrobial agents, particularly when in a semisolid form such as in a toothpaste.

Jikken Dobutsu, 1994 Jan, 43(1), 85 - 93
{Investigation of the development of dermatitis in hypotrichotic rats--microbiological study}; Akimoto T et al.; The hereditary hypotrichotic (WBN/IIa-Ht) rat is affected by dermatitis characterized by erosions and crust formation on dorsal skin areas . The bacterial flora of this dermatitis and the normal skin of the hypotrichotic rat was examined . As controls the cutaneous flora of atrichotic and Wistar rats was examined, and the results compared with those in hypotrichotic rats . The total number of bacterial colonies from the lesions and normal skin of hypotrichotic rats were 3.9 x 10(5) to 1.16 x 10(8) CFU/cm2 and 1.6 x 10(3) to 1.8 x 10(4) CFU/cm2, respectively . In the lesions, overwhelming numbers of S . aureus were detected as almost pure cultures . In the normal skin, S . aureus was predominant, accounting for about 90% of all bacteria . The total number of bacterial colonies in the atrichotic rats was the same as in the hypotrichotic rats . The majority of the isolates were Staphylococcus sp., and about half of them were identified as S . aureus . The total number of bacterial colonies from the skin of individual Wistar rats varied extremely, ranging from 64 to 2.98 x 10(5) CFU/cm2 . The flora mainly consisted of coagulase-negative Staphylococcus (CNS), S . aureus, and alpha-hemolytic Streptococcus sp., and CNS was isolated most frequently . Histopathological examination of the eroded portions in hypotrichotic rats revealed many clusters of coccoid bacteria and neutrophilic cell infiltration of the epidermis . These findings suggest that the dermatitis in hypotrichotic rats was caused by S . aureus and affected by unknown traits of these rats.

Biokhimiia, 1994 Jan, 59(1), 96 - 101
{Analysis of key enzyme activities involved in aspartate amino acid biosynthesis in Streptococcus bovis}; Kal'cheva EO et al.; The first and the third steps in the aspartate biosynthesis pathway in Streptococcus bovis are catalyzed by two different forms of aspartokinase and a single homoserine dehydrogenase, respectively . These enzymes can be separated by ammonium sulfate fractionation and gel filtration on Sephadex G-200 . The two aspartokinase isozymes differ in molecular weights and are subject to differential regulation . The aspartokinase system of S . bovis is characterized by the absence of specific negative allosteric effectors among the end products of the synthesis of amino acids of the aspartic family . Homoserine dehydrogenase, which catalyzes the third step of the aspartic family amino acid synthesis, also has such negative effectors as threonine and methionine . The aspartokinase isozymes do not form multienzyme complexes with homoserine hydrogenase in S . bovis.

Jpn J Antibiot, 1994 Jan, 47(1), 84 - 92
{Clinical evaluation of cefpodoxime proxetil in otorhinolaryngological infections}; Takeuchi H et al.; In this study, we evaluated the clinical efficacy of cefpodoxime proxetil (CPDX-PR) in otorhinolaryngological infections . The subjects were 205 patients (85 men and 120 women) with various otorhinolaryngological infections, aged from 16 to 81 years (mean 49.2 years): 113 patients had acute infections, 25 patients had chronic infections and 67 patients had acute exacerbation of chronic infections . 1 . Clinical evaluation The overall efficacy rate was 75.6% . When classified by disease, the efficacy rate was 84.9%, 60.0%, 65.6% in acute infections, chronic infections and acute exacerbation of chronic infections, respectively . 2 . Bacteriological evaluation Frequencies of isolation of different organisms were studied: 49 strains of Staphylococcus aureus, 27 strains of Staphylococcus sp . and 15 strains of Streptococcus sp . were found in the decreasing order of frequencies . Antibacterial activities against S . aureus, Staphylococcus sp . and several other organisms were compared among CPDX-PR, ampicillin, cefaclor, cefteram and norfloxacin: CPDX-PR showed the highest activity . 3 . Side effect Mild urticaria was observed in only 1 patient . Abnormal laboratory test results were mild elevation of GOT and GPT in 3 of 43 patients . Based on the above results, we consider that CPDX-PR is useful for treatment of otorhinolaryngological infections.

Jpn J Cancer Res, 1994 Jan, 85(1), 93 - 100
Antitumor effect of intratumoral administration of biological response modifiers: induction of immunosuppressive acidic protein, a type of alpha 1-acid glycoprotein, in mice; Ebina T et al.; The antitumor effects of biological response modifiers (BRMs) in an experimental mouse model, the "double grafted tumor system" were analyzed . Male BALB/c mice received simultaneous inoculations of Meth-A fibrosarcoma cells on the right flank (10(6) cells) and left flank (2 x 10(5) cells) on day 0, and BRMs were injected intratumorally into the right tumor on days 3, 4 and 5 . PSK (a protein-bound polysaccharide preparation), interleukin-1 (IL-1) and cepharanthin (CR) cured not only the right, but also the left, non-treated tumor in a double grafted tumor system . OK-432 (a Streptococcus preparation) and BCG and tumor necrosis factor (TNF) cured the right tumor and inhibited the growth of the left tumor . Lentinan (a polysaccharide preparation) and IL-6 inhibited neither the right nor the left tumor . Immunosuppressive acidic protein (IAP) in serum was increased transiently soon after intradermal injection of PSK, CR, OK-432 and TNF in BALB/c mice . Lentinan, however, did not induce IAP . IAP in serum was gradually increased after intradermal inoculation of Meth-A tumor in BALB/c mice . The biochemical difference between PSK-induced IAP (early, inflammatory IAP) and Meth-A-induced IAP (late, tumor-induced IAP) was investigated by crossed affinity immunoelectrophoresis with concanavalin A . IAP of murine serum was separated into 4 peaks . IAP in normal mouse was rich in high-mannose type sugar chain (Peak 3) and contained no hybrid-type sugar chain (Peak 4), which was present in inflammatory and tumor-induced IAP . Inflammatory IAP was rich in biantennary sugar chain (Peak 2) and tumor-induced IAP was rich in tri-tetraantennary sugar chain (Peak 1).

Vet Res Commun, 1994, 18(1), 1 - 6
Potentiation of antibiotic activity by EDTA-tromethamine against three clinically isolated gram-positive resistant bacteria . An in vitro investigation; Farca AM et al.; The in vitro synergistic effects of combinations of EDTA-tromethamine and five antimicrobial agents (ampicillin, cephalexin, oxytetracycline, streptomycin and sulphadimethoxine) on three clinically isolated Gram-positive bacteria (Staphylococcus aureus, Staphylococcus hominis and Streptococcus faecium) were investigated . The bacteria had been isolated from three cases of canine otitis resistant to beta-lactam antibiotic therapy . The antimicrobial activity was evaluated by measuring the minimal inhibitory concentration for the antibiotics alone or in combination with EDTA-tromethamine . EDTA-tromethamine potentiated the activity of cefalexin against S . aureus and S . hominis, of oxytetracycline against S . aureus and S . faecium and of streptomycin against S . faecium . No significant effects were noted on the activity of oxytetracycline against S . hominis . The remaining combinations gave a slight synergistic effect . As previously shown for Gram-negative resistant bacteria, these data suggest that the association of EDTA-tromethamine and appropriate antibiotic therapy may be useful to overcome persistent infections of soft tissues in domestic animals.

J Fr Ophtalmol, 1994, 17(5), 355 - 7
{Infectious crystalline keratopathy occurring after penetrating keratoplasty}; Salabert D et al.; Infectious crystalline keratopathy is a chronic corneal infection, characterized by interlamellar opacities that are shaped like crystal formations . In the majority of cases, Streptococcus viridans is cultured . We report the case of a 74 year old man, presenting with corneal infection in a donor graft after penetrating keratoplasty . A Streptococcus sanguis was isolated . The clinical response to antibiotics was poor, with a slow and inexerable progression, leading to possible corneal regrafting.

Caries Res, 1994, 28(4), 251 - 6
Effect of sugar alcohols on the composition and metabolism of a mixed culture of oral bacteria grown in a chemostat; Bradshaw DJ et al.; Xylitol and sorbitol are effective as non-cariogenic sugar substitutes . A number of studies suggest that xylitol may have an additional, caries-reducing effect . This study examines the effect of xylitol and sorbitol, when pulsed together with glucose, on the composition and metabolism of a mixed culture of oral bacteria grown in a chemostat . In this system, xylitol had the effect of reducing the rate and extent of acid production when pulsed with glucose, compared with glucose pulsed alone, enabling acid-sensitive species to persist in greater numbers . Furthermore, the enrichment of Streptococcus mutans, observed following glucose pulses in the absence of pH control, was prevented by xylitol . In contrast, sorbitol had the opposite effects and S . mutans increased in proportion . The study provides evidence for a mechanism by which xylitol could affect the ecology of dental plaque and thereby reduce the rate of dental caries.

Bull Soc Pathol Exot, 1994, 87(2), 89 - 90
{The reduction of methicillin resistance in Streptococcus aureus in a hospital environment in Sousse (Tunisia)}; Mzoughi R et al.; The sensitivity of Staphylococcus aureus to the principal antibiotics has been studied in a hospital environment during the period of 1989 to 1992 . The resistance to methicillin was important in 1989, 1990, and 1991 (respectively 20.5; 24 and 25%) . It showed an important decrease in 1992: 5% . The outstanding point over this last period is the appearance of a lower number of multi-resistant strains: M penicillin, aminoglycosides, macrolides . These strains represented 9, 10 and 11.5% in 1989, 1990 and 1991 and only 4% in 1992 . This study indicates the need for increased control of the ecology and distribution of resistant strains.

Clin Infect Dis, 1994 Jan, 18(1), 91 - 3
Fatal group A streptococcal meningitis and toxic shock-like syndrome: case report; Jevon GP et al.; A previously healthy 8-year-old girl presented with flu-like symptoms, developed toxic shock-like syndrome, and died within 48 hours . At autopsy she was found to have purulent meningitis . The group A beta-hemolytic streptococcus isolated from her CSF was a member of clone ET 2 . This strain produced a variant form of streptococcal pyrogenic exotoxin A (SPEA 2) that has recently been associated with widespread toxic shock-like syndrome.

J Gynecol Obstet Biol Reprod (Paris), 1994, 23(4), 444 - 50
{Induced labor: a risk factor of maternal-fetal contamination during delivery?}; Goffinet F et al.; OBJECTIVE . This prospective study was conducted to determine the prevalence of maternal-fetal contamination at delivery in order to evaluate the factors of risk, particularly whether inducing delivery could be of additional help in selecting portage in mothers and infants . METHODS . Over a period of 4 months, samples were obtained from 360 mother/infant pairs . Vaginal sample at the beginning of labour, gastric sample from the infant at birth . RESULTS . Positive samples were obtained from 58 women (16.1%) and from 40 infants (11%) . Streptococcus B was largely predominant (60%) . The rate of maternal and neonatal carriers was significantly higher in pairs for which labour had been induced (n = 92) than in those with spontaneous labour (n = 268) . Taking into account solely the classical factors of risk (opening of the membranes > 12 h, T > or = 38 degrees C, prolonged labour, premature delivery, premature rupture of the membranes), only selected 37% of the infant carriers (1 criteria or more); when induced labour was added as a criteria of risk, 68.4% of the infant carriers were identified . Streptococcus B was the cause of 2 neonatal infections in this series . None of the classic risk factors was observed in either of these cases but labour had been induced in both . CONCLUSION . The fact that labour is induced appears to be an additional factor of risk of maternal and fetal colonization . Routine screening at 12 and 24 hours before inducing labour could lead to the discovery of a large number of maternal colonizations and would allow prophylaxic antibiotics to be prescribed during labour . This protocol should be evaluated in a randomized prospective study involving a large number of cases in order to identify the beneficial effect in terms of neonatal morbidity and mortality.

Scand J Infect Dis Suppl, 1994, 93, 55 - 62
Resistant pneumococci: a renewed threat in respiratory infections; Goldstein FW et al.; The emergence of penicillin-resistant Streptococcus pneumoniae (PRSP) is an international problem which has been compounded by the development of high-level, multiple resistance to other beta-lactam antibiotics . Resistance develops in a 'step-wise' but unpredictable manner due to the mutation of penicillin-binding proteins (PBP) . This results in a high degree of heterogeneity between bacterial strains . Such mutations can result in the rapid emergence of antibiotic resistance, including extended-spectrum cephalosporins, with reported minimum inhibitory concentration (MIC) values of up to 32 mg/l . The effective treatment of diseases caused by such organisms is dependent upon rapid assessment of antibiotic sensitivities . Therefore, MIC values of a range of antibiotics must be determined in cases of treatment failure and in serious pneumococcal infections . However, pharmacokinetic properties, as determined by the inhibitory quotient, which reflect drug concentrations attainable in different tissues, should also be considered . Beta-lactam antibiotics with good inhibitory activity against pneumococci include: amoxycillin, cefotaxime, ceftriaxone, cefpirome and imipenem . Nevertheless, as the prevalence of PRSP strains is likely to increase, new therapeutic strategies may have to be adopted.

Microbiol Immunol, 1994, 38(2), 139 - 47
Cytoplasmic membrane-associated protein (CAP) isolated from Streptococcus pyogenes: as a new bacterial superantigen; Sato H et al.; A protein isolated from the cytoplasmic membranes of Streptococcus pyogenes (cytoplasmic membrane-associated protein, CAP) stimulated human T cells in vitro to induce their mitogenic response . This CAP-induced T cell proliferation required the presence of nylon-adherent accessory cells (AC) of either autologous or allogeneic origin in the reaction mixtures . In addition, the reaction was inhibited by monoclonal antibodies (mAbs) against major histocompatibility complex (MHC) class II molecules, HLA-DR and -DQ, but not -DP . Human lymphoid cell lines positive for HLA-DR but not those lacking it were also effective as AC for the reaction . A binding test using fluorescein-labeled protein revealed that CAP bound to the adherent monocytes and HLA-DR+ but not to -DR- lymphoid cell lines . The proliferative response of T cells to CAP was, however, not inhibited by the addition of the lysosomotrophic agent NH4Cl to the reaction mixtures . These results suggest that the presentation of CAP by AC to human T cells is mediated through binding of the protein to the MHC class II molecules but without being processed in the AC . The proliferative response of T cells was also found to be inhibited by addition of anti-CD2, -CD3 or -T cell receptor (TcR) mAbs . A major population responding to CAP was CD3+4+8- T cells . CAP also appears to stimulate T cells bearing V beta 8 sequences much more selectively than T cells bearing other V beta s . These results indicate that this streptococcal membrane protein, CAP, may be a new protein belonging to a group of bacterial superantigens.

Vet Res, 1994, 25(2-3), 227 - 34
Risk factors for transmission of Streptococcus agalactiae infection between Danish dairy herds: a case control study; Agger JF et al.; A group of 152 Danish dairy herds infected with Streptococcus agalactiae during 1992 was compared with 177 randomly selected control herds in order to identify factors of importance for the transmission of this bacteria between herds . The diagnosis was based on a laboratory microbiological test on a bulk tank milk sample, and management information was collected by telephone interviews with the farmers . Results from logistic regression clearly indicate that purchase of cows or heifers increases the risk of a new Streptococcus agalactiae herd infection . Hygiene management risk factors inside the farm were also identified.

J Perinat Med, 1994, 22(1), 45 - 52
Premature rupture of membranes in early pregnancy . Neonatal prognosis; Botet F et al.; The aim of the study was to establish neonatal prognosis in cases of PROM onset in early pregnancy . Pregnancies included in a multicenter study . Group (E) are 16 pregnant women with PROM between 23 and 27 weeks of gestation . Group (D) are 22 pregnant women with PROM between 28 and 30 weeks of gestation . Group (E) women delivered between 24-36 weeks (x = 29.25 w; SE 0.92; confidence 95%: 27.2-31.2 w) . 5/16 newborns died, two in the delivery room and three in the first days of life . Survival in this group was 11/16 (68.75%) . 8/14 suffered from respiratory distress syndrome (RDS), severe in six . 2/14 newborns suffered from early onset sepsis and 6/14 intraventricular hemorrhage (IVH) . Group (D) women delivered between 28-36 weeks (x 30.48 w; SE 0.38; confidence 95% 29.6-31.2 w . Only one newborn died from sepsis (Streptococcus agalactiae) . Survival in this group was 21/22 (95.45%) . 5/21 newborns suffered from RDS, severe only in one . Early onset sepsis in 2/22 and IVH 6/21 . Infection has a high incidence in newborn infants with PROM . Mortality is related to respiratory distress syndrome . The most common problems are respiratory distress syndrome and intraventricular hemorrhage.

Int Urol Nephrol, 1994, 26(2), 205 - 8
A new sclerosant therapy for testicular hydrocele with aspiration and injection of OK-432; Yamamoto M et al.; Twenty patients with testicular hydrocele were treated with a new sclerosing therapy consisting of intrascrotal injection of OK-432 (group A Streptococcus pyogenes of human origin) . The median observation period after treatment was 6 months (range 2-13 months) . Eighteen patients required only one treatment . Two patients had recurrences and received repeat injection . There have been no serious side effects except for fever of 2-3 days' duration and local inflammatory reaction . Sclerotherapy with OK-432 is an efficient and easy method which can be recommended as a primary treatment for hydrocele.

Caries Res, 1994, 28(3), 156 - 60
Genetic variation in experimental dental caries in four inbred strains of rats; Kanamoto T et al.; The relative contribution of the host genetic effect on the susceptibility to dental caries was examined . Four inbred strains of male rats (BN/Sea, F344/Ms, PVG/cSea, and WKA/Sea) were inoculated with Streptococcus mutans and fed a cariogenic diet . The caries scores of the molar teeth were compared among these four strains, and the degree of genetic determination was estimated by analysis of variance . Statistically significant differences in caries scores were found among these strains (F344 > WKA > PVG/c > BN), and a high degree of genetic determination was obtained.

Ter Arkh, 1994, 66(4), 19 - 21
{Neurocirculatory dystonia: views on its etiology, pathogenesis and methods of therapy}; Nesterenko AO et al.; Basing on their psychophysiological, immunological and clinical findings, the authors emphasize the role of chronic infection, occupational hazards, adaptation to new climatic and social environment in pathogenesis of neurocirculatory asthenia (NA) . The disease is also associated with sensitization to streptococcus, allergization, adverse effects of circulating immune complexes, impaired relationships between CNS and immune system . It is suggested that NA arises consequently to genetic determination of regulation process desynchronization . A new effective NA treatment is proposed comprising in addition to conventional treatment a course of UHF-inductothermia to the chest and anterior mediastinum conducted in conditions of short-term and low-intensity regimen of the exposure.

Caries Res, 1994, 28(5), 342 - 7
Composition and flow rate of saliva and caries development in young rats following administration of lithium; O'Connell AC et al.; Lithium carbonate (Li2CO3), an antipsychotic medication, was investigated to determine the effects on the stimulated flow and composition of saliva and on caries development in rats . Lithium carbonate was delivered via osmotic pumps at 10, 15 and 60 mg/kg/day . All animals were infected with Streptococcus sobrinus 6715 and fed a cariogenic diet . Lithium administration exerted a caries-protective effect on sulcal surfaces, though the reduction in caries scores was statistically significant only for the groups receiving Li2CO3 at 10 and 60 mg/kg/day compared to control animals (p +/- 0.05, ANOVA) . There were no detectable alterations in protein concentration, electrophoretic profiles, or flow rates of stimulated parotid and submandibular saliva associated with the decreased sulcal caries incidence . Weight gain, water consumption and the populations of total cultivable flora recovered were not influenced by the administration of lithium . Investigation into the mechanisms of the sulcal caries reduction will require further exploration of changes caused by lithium on salivary gland function.

Caries Res, 1994, 28(5), 329 - 34
The effect of mineral-derived zinc ions on in vitro glucose metabolism of Streptococcus mutans NCTC 10449; Scheie AA et al.; Mouthrinses containing zinc ions inhibit plaque acidogenicity, but the effect is transient . Zinc-containing apatite or zinc phosphate precipitated within dental plaque might serve as a reservoir for zinc ions, thus providing prolonged inhibition of acid formation . Zinc-containing fluorhydroxyapatite was prepared from solutions containing CaCl2, KH2PO4, NaF and increasing amounts of ZnCl2 (0.0, 0.005, 0.02, 0.1, 0.2 or 1 mM; minerals No . 1-6, respectively) by raising the pH with ammonia . Zinc phosphate tetrahydrate (mineral No . 7) was prepared in a similar manner from a solution containing ZnCl2 and KH2PO4 only . Dense cell suspensions of Streptococcus mutans NCTC 10449 were incubated with 14C-glucose and one of the test minerals (No . 1-7) . Glycolysis was allowed to proceed, with or without pH control, in a pH-stat . Samples were withdrawn at 1, 2, and 3 min, and extracellular glycolytic metabolites were identified by HPLC . Mineral No . 7 inhibited glycolysis and any pH fall almost completely . With the pH fixed at 5.5, reduction of glucose consumption and lactate formation was 83 and 93%, respectively, compared to the no-zinc control mineral (No . 1) . No changes in glucose consumption or lactate formation were evident in the presence of minerals No . 2-6 . All apatitic minerals had a buffering effect and, in the absence of pH control, glycolysis was increased due to the higher pH . Detectable levels of fluoride were not released by any mineral into the incubation mixture, and zinc only by minerals No . 6 and 7 in greater than trace amounts.(ABSTRACT TRUNCATED AT 250 WORDS)

Tex Heart Inst J, 1994, 21(3), 231 - 5
Mycotic aneurysm of the left anterior descending coronary artery after aortic endocarditis . A case report and brief review of the literature; Reece IJ et al.; This report concerns a 29-year-old man with recent Streptococcus viridans endocarditis on a bicuspid aortic valve who was found to have a mycotic aneurysm of the left anterior descending coronary artery and infective erosion and thinning of the posterior wall of the ascending aorta 1.5 to 3.5 cm above the origin of the left coronary artery, a combination of lesions not previously reported . Mycotic aneurysm of the coronary arteries affects less than 1% of patients with infective endocarditis, and there are few reports of the management of these rare lesions . The surgical management of this patient is presented with a brief review of the available literature.

Rev Inst Med Trop Sao Paulo, 1994 Jan-Feb, 36(1), 51 - 7
Acute respiratory infections in children from a deprived urban population from Uruguay; Hortal M et al.; To obtain base line data on incidence, duration, clinical characteristics and etiology of acute respiratory infections (ARI), 276 children from deprived families living in Montevideo were followed during 32 months . The target population was divided into two groups for the analysis of the results: children aged less than 12 months and those older than this age . During the follow-up period 1.056 ARI episodes were recorded . ARI incidence was 5.2 per child/year . It was 87% higher in infants than in the older group, as was the duration of the episodes . Most of the diseases were mild . Tachypnea and retractions were seldom observed, but 12 children were referred to the hospital, and 2 infants died . Viral etiology was identified in 15.3% of the episodes . RSV was the predominant agent producing annual outbreaks . Moderate to heavy colonization of the upper respiratory tract by Streptococcus pneumoniae (32.3%) and Hemophilus sp . (18.9%) was recorded during ARI episodes . This community-based study furnish original data on ARI in Uruguay . It enabled to assess the impact of these infections on childhood.

Drug Chem Toxicol, 1994, 17(3), 401 - 36
Immunotoxicity of 2,4-diaminotoluene in female B6C3F1 mice; Burns LA et al.; 2,4-Diaminotoluene (DAT) has been demonstrated to be a potent carcinogen . The present studies were carried out to determine the toxic and immunotoxic potential of DAT . Mice exposed to DAT at 25-100 mg/kg per day for 14 days by gavage showed a 42% increase in liver weight and a slight decrease in spleen weight . Histopathologic evaluation of selected organs showed the liver to be the major target with morphological changes which were dose dependent . The high dose (100 mg/kg) was associated with moderate centrilobular necrosis . No abnormal structure was noted in the spleen, lungs, thymus, kidney or mesenteric lymph nodes . The liver toxicity was associated with an elevation in alanine aminotransferase activity . The only change noted in selected hematologic parameters was a 64% increase in peripheral blood leukocytes . Mice exposed to DAT showed a decreased IgM and IgG response to sheep erythrocytes . The decrease was not a function of a decreased number of B cells because the number of B cells increased dose dependently . Proliferative capacity of immunocompetent cells was not impaired by exposure to DAT as measured by the response to several mitogens . The delayed hypersensitivity response to keyhole limpet hemocyanin in mice exposed to DAT was increased . Natural killer cell activity was decreased dose dependently and may represent a spleen cell pool shift because the number of B cells increased in the presence of a decreasing spleen size . Serum C3 was suppressed at the high dose of DAT . Phagocytosis by splenic macrophages, but not peritoneal macrophages, was inhibited by DAT exposure . DAT exposure for 14 days decreased host resistance to the bacteria, Streptococcus pneumoniae and Listeria monocytogenes, while host resistance to the pulmonary tumor model, B16F10, and the PYB6 fibrosarcoma was unaffected by DAT exposure . These data indicate that DAT is hepatotoxic and perturbs the differentiation and maturation of leukocytes.

Drug Chem Toxicol, 1994, 17(3), 359 - 99
Immunotoxicity of mono-nitrotoluenes in female B6C3F1 mice: II . Meta-nitrotoluene; Burns LA et al.; The nitrotoluenes are chemicals used in dyes, agricultural products, pharmaceuticals and explosives . In the present studies, the toxicology and immunotoxicity of meta-nitrotoluene (m-nitrotoluene) were evaluated . Mice, exposed to m-nitrotoluene at dose levels of 200, 400 and 600 mg/kg/body weight for 2 weeks by gastric gavage, gained body weight over the treatment period to a slightly greater extent than the control groups . Of the selected organs weighed, the liver and kidney of mice exposed to m-nitrotoluene were increased in weight while the thymus weight was decreased . The liver of mice exposed to m-nitrotoluene, but not ortho-nitrotoluene, showed slight to moderate swelling of the hepatocytes adjacent to the central veins . The hepatocyte swelling appeared to be reversible and there was no evidence of necrosis . The hematology and serum chemistries examined were unaffected by m-nitrotoluene exposure although there were modest decreases in the percentage of polymorphonuclear leukocytes and eosinophils in differential blood counts . Bone marrow cellularity and the number of CFU/M and CFU/GM were unaffected by m-nitrotoluene exposure . m-Nitrotoluene suppressed the IgM response to sRBC and the DHR response to KLH . There was a slight (8%) decrease in the percentage of B lymphocytes in the spleen . The response to the T cell mitogens was suppressed by as much as 39% . Fc-mediated adherence and phagocytosis of chicken erythrocytes and NK cell activity were increased dose dependently in mice exposed to m-nitrotoluene . Several immune parameters were unaffected by exposure to m-nitrotoluene, including the IgG response to sRBC, responses to the B cell mitogen LPS and to allogeneic cells, and serum interferon levels . Resistance to Streptococcus pneumoniae and Plasmodium yoelii were unaffected also . Resistance to the tumor model PYB6 was increased . Exposure of mice to m-nitrotoluene decreased resistance to Listeria monocytogenes . The decreased resistance to L . monocytogenes may be related to an effect on T cells, evidenced by a decrease in T cell numbers and in the DHR.

Drug Chem Toxicol, 1994, 17(3), 317 - 58
Immunotoxicity of mono-nitrotoluenes in female B6C3F1 mice: I . Para-nitrotoluene; Burns LA et al.; para-Nitrotoluene (p-nitrotoluene) is used primarily as an intermediate in the production of various dyes, explosives, pharmaceuticals, and in the production of rubber and agricultural products . Previous investigations indicated that p-nitrotoluene was mutagenic in the Ames Test and that other mono-substituted nitrotoluenes bound covalently to hepatic macromolecules . The objective of these studies was to evaluate the potential immunotoxicity of p-nitrotoluene in mice exposed by the oral route . Mice exposed to p-nitrotoluene (200-600 mg/kg) daily for 14 days showed modest dose-dependent increases in liver and spleen weights . The livers of mice exposed subchronically to 400 and 600 mg/kg showed a mild to moderate swelling of the hepatocytes adjacent to the central veins; this swelling appeared to be reversible and there was no evidence of necrosis . The proportion of monocytes in blood was decreased in mice treated with p-nitrotoluene or toluene . Serum chemistries, bone marrow cellularity and the number of CFU-M and CFU-GM were unaffected . Immunologic investigations showed p-nitrotoluene suppressed the IgM response to sRBC and the DHR response to KLH . There was a 24% decrease in the percentage of CD4+ T lymphocytes in the spleen . There was no dose-dependent alteration of peritoneal macrophage numbers or differential count, unstimulated natural killer cell activity, response to B cell mitogen LPS, C3 activity or interferon levels . Exposure of mice to p-nitrotoluene decreased resistance to Listeria monocytogenes but not to Streptococcus pneumoniae, Plasmodium yoelii or the B16F10 melanoma, and increased resistance to the PYB6 tumor . These studies indicated that the immune system is an important target for toxicity of p-nitrotoluene . The decreased host resistance to L . monocytogenes can be attributed to the decrease in T lymphocytes and to a decreased delayed hypersensitivity response to KLH.

Drug Chem Toxicol, 1994, 17(3), 221 - 69
Immunotoxicity of 180 day exposure to polydimethylsiloxane (silicone) fluid, gel and elastomer and polyurethane disks in female B6C3F1 mice; Bradley SG et al.; Millions of people have been exposed to silicones which are present in consumer goods such as cosmetics and toiletries, processed foods and household products . In addition, silicones have been used extensively in medical practice as a lubricant in tubing and syringes, and as implantable devices . A silicone widely used in medical practice is polydimethylsiloxane . This study was undertaken to determine the immunotoxicologic potential of long term exposure to the principal constituents of breast implants: silicone fluid, silicone gel and silicone elastomer . An alternative covering for devices containing silicone gels, polyurethane, was also included in the study . Silicone fluid and gel were injected subcutaneously into female B6C3F1 mice (1 ml/mouse) and 6 mm disks of silicone elastomer or polyurethane were implanted subcutaneously . There were no treatment-related deaths or overt signs of toxicity during the 180 day exposure . None of the tested materials had notable effects on body or organ weights, erythrocytes or leukocytes in the blood, blood chemistries such as alanine aminotransferase, urea nitrogen, glucose, albumin or total protein, or serum CH 50 or C3 levels . The cellularity of the bone marrow and responses to CSF-GM and CSF-M were normal . The tested silicones and polyurethane marginally reduced the level of Ig+ cells in the spleen but did not consistently alter the distribution of T cell surface markers . The antibody response to sheep erythrocytes was not markedly altered, nor were proliferative responses to concanavalin A, phytohemagglutinin, lipopolysaccharide or allogeneic cells . Reticuloendothelial function was normal, as was phagocytosis of chicken erythrocytes and Covaspheres by adherent peritoneal cells . Natural killer cell activity was depressed in all silicone treatment groups and in mice implanted with polyurethane . No silicone or polyurethane treatment group displayed altered susceptibility to a challenge with Listeria monocytogenes, Streptococcus pneumoniae or the B16F10 tumor . The only consistent effect of 180 day exposure to silicone materials or polyurethane was a modest depression of natural killer cell activity.

Drug Chem Toxicol, 1994, 17(3), 175 - 220
Subchronic 10 day immunotoxicity of polydimethylsiloxane (silicone) fluid, gel and elastomer and polyurethane disks in female B6C3F1 mice; Bradley SG et al.; Millions of people have been exposed to silicones because of the widespread use in consumer products such as cosmetics and toiletries, food products, household products and paints . Silicones have wide use in medical practice, including lubricants in tubing and syringes, and as implantable devices . The most prevalent silicone in medical use is polydimethylsiloxane . This study was undertaken to determine the subchronic immunotoxicologic potential of the principal constituents of breast implants: silicone fluid, silicone gel and silicone elastomer . An alternative covering for devices containing silicone gels, polyurethane, was also included in the study . Silicone fluid and gel were injected subcutaneously into female B6C3F1 mice (1 ml/mouse) and 6 mm disks of silicone elastomer or polyurethane were implanted subcutaneously . There were no treatment-related deaths or overt signs of toxicity . None of the tested materials had notable effects on body or organ weights, erythrocytes or leukocytes in the blood, blood chemistries such as alanine aminotransferase, urea nitrogen, glucose, albumin or total protein . The cellularity of the bone marrow and responses to CSF-GM and CSF-M were normal . The tested silicones did not alter the distribution of B cells and T cells in the spleen, but polyurethane perturbed the distribution of CD4+CD8+ and CD4-CD8- T cells . The antibody response to sheep erythrocytes was not markedly altered, nor were proliferative responses to concanavalin A, phytohemagglutinin, lipopolysaccharide or allogeneic cells . Reticuloendothelial function was normal, but polyurethane evoked an enhanced phagocytosis of Covaspheres by adherent peritoneal cells . Natural killer cell activity and serum complement were not altered . All silicone materials afforded modest protection to a challenge with Listeria monocytogenes that killed 40 to 58% of control mice . Host resistance to Streptococcus pneumoniae or the B16F10 tumor was not affected by any of the treatments . There is a pattern indicative of some perturbation of T cell differentiation in mice implanted with a polyurethane disk.

Vet Res Commun, 1994, 18(3), 155 - 63
Isolation, characterization and protection studies in mice of a streptomycin-dependent mutant of Streptococcus suis type 1/2; Foster N et al.; An avirulent, streptomycin-dependent (Str-D) mutant of Streptococcus suis type 1/2 was produced and characterized by its antimicrobial susceptibility, growth kinetics, biochemical reactions and reversion rate . Homologous and heterologous vaccine trials in mice resulted in complete protection against challenge with S . suis types 1 and 1/2 and partial protection against challenge with S . suis type 2.

Ukr Biokhim Zh, 1994 Jan-Feb, 66(1), 30 - 40
{Rumen bacterial metabolism as affected by extracellular redox potential}; Kalachniuk HI et al.; The redox potential (Eh) in the digestive tract of ruminants varies mostly within the ranges from -300 to +200 mV, in the rumen medium: from -130 to -200 mV . Eh and pH changes are of a linear character . Enhanced fermentation moves Eh towards negative values and improves growth of microorganisms . Eh values become even more negative as affected by Na2S, NaOH, cysteine and NaHSO3 . Addition of picrate, sodium nitrate, hydrochloric acid, copper sulphate, gaseous oxygen and particularly heavy metals (silver and mercury) promotes positive Eh values and inhibits metabolism . Optimum Eh values for Megasphaera elsdenii are more negative, than those for Streptococcus bovis . In the process of S . bovis growth, the production of lactate, VFA, CH2O2 and NH3 increases, Eh and pH values decrease . More positive Eh values inhibit metabolism and growth rates of Selenomonas ruminantium, Bacteroides amylophilus, Bacteroides succinogenes and Streptococcus bovis to different degrees.

Retina, 1994, 14(3), 206 - 11
Posttraumatic endophthalmitis . Causative organisms, treatment, and prevention; Alfaro DV et al.; BACKGROUND: Posttraumatic endophthalmitis is a rare complication of penetrating eye injuries that results in blindness in potentially salvageable eyes . METHODS: 36 cases of posttraumatic endophthalmitis were evaluated retrospectively to determine which factors were associated with visual loss . All cases were treated with intravenous and intraocular antibiotics . Pars plana vitrectomy was performed in 15 (41.7%) cases as an adjunct to treatment . RESULTS: Patients ranged in age from 18 months to 83 years, and included 30 men (83%) and 6 women (17%) . Intraocular foreign bodies were present in 6 patients (16.7%), 9 (25%) had corneal lacerations, 13 (36.1%) had corneoscleral or scleral lacerations, and 8 (22.2%) had ocular trauma of unknown type . Of the 36 eyes, 21 (58.3%) had positive culture results, and 10 of these (27.8%) had multiple organisms . The most common isolates were Staphylococcus species (26.5%), Streptococcus species (20.6%), and Bacillus species (14.7%) . In 4 cases the diagnosis was made 6 or more years after injury . Final visual acuity was 20/200 in 8 eyes (22.2%) and 20/300 in 1 eye . In 17 cases (47.2%), the eye was salvaged but visual acuity was 5/200 or worse, and 10 eyes (27.8%) were lost to enucleation or phthisis bulbi . CONCLUSION: Prompt diagnosis and early treatment with intraocular and systemic antibiotics are important in the successful management of posttraumatic endophthalmitis . The use of pars plana vitrectomy was associated with a good visual outcome when used in select cases.

Med Dosw Mikrobiol, 1994, 46(1-2), 73 - 7
{Biocenosis of the vagina and infection with Chlamydia trachomatis}; Giedrys-Kalemba S et al.; The authors have examined 379 women for infection by Chlamydia trachomatis, performing vaginal smears and routine bacterial cultures . C . trachomatis was discovered in 33.2% of the women, most frequently accompanied by erosion of the collum, cervicitis and CIN-Ca . Women with C . trachomatis had the following levels of vaginal purity: 1-44.4%, 2-23.0%, 3 and 4-29.4%, 3.2% -leukocytes only . Leukocytes were present in significantly more women with level 1 of vaginal purity than in the control group . Additional infections (Gardnerella vaginalis, Streptococcus agalactiae, Candida albicans, Escherichia coli and Trichomonas vaginalis) were found in only a small percentage of women with C . trachomatis, just as in controls . The presence of leukocytes or level 1 of vaginal hygiene with leukocytes may favour C . trachomatis, just as in controls . The presence of leukocytes or level 1 of vaginal hygiene with leukocytes may favour C . trachomatis infection, therefore these cases should be subjected to a more thorough examination.

Dev Biol Stand, 1994, 82, 163 - 70
Protective immunity elicited by rBCG vaccines; Stover CK et al.; The live attenuated Mycobacterium bovis strain Bacille Calmette-Guerin (BCG) is still widely used as a vaccine against tuberculosis and therefore offers potential advantages as a safe, live vaccine vehicle for the expression and delivery of protective recombinant antigens . As an attenuated intracellular bacterium residing in macrophages, BCG would seem to be particularly suited for eliciting cellular responses and not humoral responses . Efforts to improve the potential for recombinant BCG (rBCG) vaccines to elicit protective humoral responses were undertaken by developing vectors systems which export or secrete foreign antigens . Expression of the OspA antigen of Borrelia burgdorferi, as a chimaeric membrane-associated lipoprotein, resulted in high-titred protective humoral responses when compared to cytoplasmic or secreted expression of OspA . Expression of the PspA antigen of Streptococcus pneumoniae as a secreted or membrane-associated lipoprotein by rBCG did not result in higher-titred humoral responses in comparison to PspA expressed cytoplasmically but apparently improved the quality of protective PspA specific antibodies . Based on these pre-clinical studies, rBCG vaccines for Lyme and pneumococcal diseases are being developed for clinical trials in humans . The potential for eliciting mucosal responses to antigens delivered by rBCG was also investigated . Nasal immunization was superior at eliciting substantial lasting mucosal responses at multiple mucosal sites and also resulted in systemic responses comparable to those obtained with parenteral immunization.

Eur J Pediatr, 1994, 153(9 Suppl 2), S7 - 11
Nitric oxide; Milner AD; Although persistent pulmonary hypertension of the newborn (PPHN) has been considered to be a relatively rare condition, there is increasing evidence that pulmonary vasoconstriction is a common finding in moderate and severe respiratory distress syndrome . High pressure, high rate ventilation may overcome this problem but it is associated with an unacceptably high incidence of pneumothorax and chronic lung disease . Vasodilators including tolazoline, prostacyclin and nitroprusside have a nonspecific effect, often producing systemic as well as pulmonary hypotension . Nitric oxide (NO) offers an exciting alternative therapy . NO is produced by the conversion of arginine to citrulline by NO synthase in the vascular endothelial cells . The NO then diffuses through to the underlying smooth muscle leading to relaxation . It then combines with haemoglobin to form small quantities of methaemoglobin, preventing spread of its effect elsewhere . The main potential toxic effect is due to the rapid conversion of NO to nitrogen dioxide in the presence of oxygen . Animal studies have shown that concentrations of NO up to 100 ppm are safe and also effective in relieving vasoconstriction induced by hypoxia, thromboxane analogues and infusions of group B haemolytic streptococcus . Preliminary studies on adults with respiratory distress syndrome have been encouraging showing reductions in pulmonary artery pressure and improvements in oxygenation without any changes in systemic blood pressure . Two small studies indicate that NO therapy is both effective and safe when given to full term babies with PPHN . Further data are urgently needed to find optimal concentrations so that multicentre studies can be carried out.

Klin Lab Diagn, 1994, (4), 37 - 9
{Enzyme immunoassay test system for detection of antibodies to Streptococcus pyogenes group-specific A polysaccharide in blood droplets on paper}; Shevelev BI et al.; An enzyme immunoassay-based test system has been developed to assess the level of specific antibodies to A polysaccharide which permits analysis of material (droplets of native sera or blood eluate) collected on filter paper . Special variants of the test system permit separate detection of IgA, IgG, and IgM antibodies . The test system is fit for clinical and epidemiologic studies.

Scand J Infect Dis, 1994, 26(3), 301 - 5
Increasing resistance to penicillin in Streptococcus pneumoniae in southern Sweden; Ekdahl K et al.; The susceptibility to penicillin of 6 prevalent pneumococcal types isolated from nasopharynx in 1992 was compared with that of corresponding types from 1980-82 . The 6 types or groups, 6, 9, 14, 15, 19 and 23, constituted 78% of consecutive isolates . 19/204 isolates in 1992 were intermediately resistant (MIC 0.12-1.0 mg/l) in comparison with 1/194 from 1980-82 (p < 0.001) . Resistant strains (MIC > or = 2 mg/l) were not found . Of group 15, no fewer than 10/31 isolates were intermediately resistant, which may support the clonal origin and spread of penicillin-resistant pneumococci . At least 5.0% of nasopharyngeal isolates are now intermediately resistant to penicillin . This figure is substantially higher than the 2% earlier reported in Sweden.

J Hosp Infect, 1994 Jan, 26(1), 51 - 5
Are thermolabile splints a source of nosocomial infection?
Faoagali JL, Grant D, Pegg S.
The aim of this study was to determine whether thermolabile splints used on burned patients became colonized with microbes from the underlying burn or were capable of contaminating burn wounds, and to determine whether the current thermoplastic splint decontamination regimen was effective at removing contaminating bacteria . One hundred and thirty-one standardized swab samples were collected from 28 splints before and after cleaning, and from burn wounds of 10 patients . Qualitative bacterial cultures and identification of isolates were performed . Just over one third of all splints sampled before cleaning were contaminated with bacteria . This compared with over half of the burn wound samples and 17% of the splints sampled after cleaning . Most of the isolates were Gram-positive species including coagulase-negative staphylococci (18), Staphylococcus aureus (12), Bacillus spp . (17) and one isolate of viridans streptococcus . Only five Gram-negative isolates were detected . On only one occasion did the wound and the splint before cleaning have the same organism isolated . Cold disinfection every 24 h was adequate to decontaminate thermolabile splints used on burn patients provided the burn bacterial count was low and care was taken to handle the splints in order to avoid re-contaminating them with health care workers' flora . Thermolabile splints could be a source of burn colonization microbes, but with adequate ward cleaning they were not found to be a problem in our practice.

Cancer, 1994 Jan 1, 73(1), 125 - 34
High-dose cisplatin, etoposide, and cyclophosphamide with autologous stem cell reinfusion in patients with responsive metastatic or high-risk primary breast cancer; Somlo G et al.; BACKGROUND . This study was designed to establish the feasibility of combining high-dose cisplatin, etoposide, and cyclophosphamide followed by stem cell rescue in patients with responsive metastatic or high-risk primary breast cancer . METHODS . Eligibility criteria included the presence of high-risk primary breast cancer (Stage II with 10 or more involved axillary nodes or Stage IIIA or B) or Stage IV disease in complete or partial response; physiologic age 50 years or younger; Karnofsky performance status of 80% or greater; and creatinine clearance of 80 ml/minute or greater . Chemotherapy consisted of escalating doses of cisplatin (50-150 mg/m2 intravenously {IV}) given on days -12 and -5, etoposide (30 mg/kg IV) given on days -12 and -5, and cyclophosphamide (100 mg/kg IV) on day -3 . On day 0, autologous bone marrow with or without peripheral stem cells, or granulocyte colony-stimulating factor primed peripheral stem cells alone were reinfused . RESULTS . Thirty patients were enrolled in this study . Twenty-eight patients demonstrated no evidence of persistent renal damage after treatment . Two patients suffered symptomatic peripheral neuropathy, and one patient required a hearing aid 3 months after therapy . Hematopoietic toxicities were acceptable . There were two fatalities; Streptococcus viridans bacteremia and adult respiratory distress syndrome developed in one patient; and one patient who received 262 mg/m2 of cisplatin died of renal failure . Twelve of 18 assessable patients with Stage IV disease are without evidence of progression; 3 of these patients are progression-free at 11+, 12+, and 32+ months . With a median follow-up of 16+ months (range, 4-31 months), 7 patients of the group of 11 treated with high-risk primary breast cancer are without evidence of disease . CONCLUSIONS . The Phase II dose of cisplatin when given on a day -12 and day -5 schedule in combination with etoposide and cyclophosphamide has been established at a total of 250 mg/m2 . Dose-limiting toxicity has been defined as renal failure, and response rates were comparable to previously reported high-dose chemotherapeutic regimens.

Akush Ginekol (Mosk), 1994, (6), 31 - 3
{Characteristics of the course of pregnancy and labor, fetal and neonatal outcome in group B Streptococcus carriers}; Kosheleva NG et al.; A retrospective analysis of the course of pregnancy, labor and its outcome for the fetus and newborn in 103 women in whose lochia group B Streptococcus was found showed a high incidence of pregnancy complications (threatened abortions in 36.9%, late gestosis in 40.7%; high incidence (21.3%) of acute respiratory viral infections during pregnancy; 27.5% of women suffered from chronic pyelonephritis . Preterm labor occurred in 21.7% of cases . Preterm escape of amniotic fluid and rapid parturition took place in 43.7% of women . Perinatal mortality was 12.6% . Pathomorphologic examination of newborns who died in labor or later revealed intrauterine pneumonia in all the cases . Coincidence of the agent serotypes in the mother and child confirmed the fact of intrauterine infection.

Eur J Cancer, 1994, 30A(12), 1741 - 4
Local injection of OK-432/fibrinogen gel into head and neck carcinomas; Kumazawa H et al.; Immunotherapy with biological response modifiers (BRM) is a possible strategy against head and neck solid tumours . However, the rapid disappearance of BRM from the tumour area is one of the reasons for its limited clinical application . In this pilot study, fibrinogen gel containing OK-432 (a compound composed of attenuated Streptococcus pyogenes), an inducer of natural killer cells and T-cell cytotoxity, was injected directly into head and neck solid tumours of 15 patients . A dose of 5 Klinische Einheiten (KE) of OK-432 was reconstituted in 1 ml aprotinin and mixed with fibrinogen, the latter to maintain the OK-432 locally . 3 patients showed tumour regression, and in addition, we observed histological changes in the injected tumour of all patients . These results suggest that OK-432/fibrinogen gel generates a local immune response, leading to tumour regression.

Rev Neurol (Paris), 1994, 150(5), 370 - 6
{Bacterial abscesses of the spinal cord . Review of the literature (73 cases)}; Candon E et al.; Intramedullary spinal cord abscesses are an uncommon entity with 73 cases reported in the literature; the first case was reported in 1830 . Sixty-seven percent of abscesses occur in the first 4 decades of life . Staphylococcus and Streptococcus are the most common organisms; 25% of patients have negative intraoperative cultures . The primary source of the infection could be found, in only 45% of patients . Most of these infections are secondary to metastatic spread from infections of the lung, endocarditis, genitourinary tract; 10 reports have described an intramedullary abscess secondary to a dermal sinus . The signs and symptoms depend on the location of the lesion; the thoracic spine is the most commonly area involved . Patients are usually divided into three clinical groups; acute onset (symptoms less than 1 wk), subacute onset (symptoms up to 6 wk), and chronic course (symptoms more than 6 wk) . Patients with the acute form are more likely to have a fever and an elevated white blood cell count and may show either a partial or complete transverse myelitis picture . The patients with chronic abscesses are less likely to have fever and leukocytosis, and their symptoms often mimic those of an intramedullary spinal tumour . The erythrocyte sedimentation rate tends to be elevated in all patients regardless of their clinical findings . CSF cultures are usually sterile . Plain x-rays of the spine are often normal . A myelogram in conjunction with a computed tomographic scan may show the intramedullary lesion . MRI studies usually demonstrate intramedullary lesions with exceptional clarity; the use of gadolinium with T1-weighted MRI studies enhances the abscess wall.(ABSTRACT TRUNCATED AT 250 WORDS)

Biotherapy, 1994, 7(3-4), 261 - 9
Cytokines as potential vaccine adjuvants; Nohria A et al.; There is a compelling clinical need for adjuvants suitable for human use to enhance the efficacy of vaccines in the prevention of life-threatening infection . Candidate populations for such vaccine-adjuvant strategies include normal individuals at the two extremes of life, as well as the ever increasing population of immunocompromised individuals . In addition, adjuvants that would increase the efficiency of vaccination with such vaccines as those directed against hepatitis B and Streptococcus pneumoniae would have an even greater general use . Cytokines, as natural peptides intimately involved in the normal immune response, have great appeal as potential adjuvants . An increasing body of work utilizing recombinant versions of interleukin-1, -2, -3, -6, -12, gamma-interferon, tumor necrosis factor, and granulocyte-monocyte-colony stimulating factor has shown that cytokines do have vaccine adjuvant activity . However, in order to optimize adjuvant effect and minimize systemic toxicity, strategies in which the cytokine is fused to the antigen, or the cytokine is presented within liposomes or microspheres appear to be necessary to make this a practical approach suitable for human use . There is much promise in this approach, but there is much work to be accomplished in order to optimize the pharmacokinetics of cytokine administration as well as its side effect profile.

Anaesthesiol Reanim, 1994, 19(6), 162 - 3
{Toxic shock syndrome caused by Streptococcus pyogenes}; Loer S et al.; Necrotizing fasciitis and myositis due to Lancefield group A beta-haemolytic streptococcal infection is a medical emergency . Survival depends on aggressive early wound management as well as high-dose intravenous antibiotics . We report about a 28-year-old man with fulminant necrotizing fasciitis and myositis of his right arm, in whom many features of the toxic shock syndrome were present, including profound hypotension and renal failure . After extensive surgical debridement with amputation of his arm in combination with high-dose intravenous penicillin G the patient recovered from this serious infection.

Eur Arch Otorhinolaryngol, 1994, 251(7), 393 - 8
Early structural changes in the rat tympanic membrane during pneumococcal otitis media; Magnuson K et al.; The early inflammatory reaction in the rat tympanic membrane was studied during the first 36h following inoculation of Streptococcus pneumoniae type 3 in the middle ear cavity . Otomicroscopic examination showed only minor signs of inflammation in the early stages although changes at the light microscopic level were pronounced . This reaction differed significantly between the pars flaccida and pars tensa of the tympanic membrane . Three hours after inoculation, edema and infiltration with polymorphonuclear leukocytes and macrophages were found in the pars flaccida whereas in the pars tensa no polymorphonuclear leukocytes were noted until after 12h . This reaction was most prominent after 36h . In the pars flaccida, mitoses occurred frequently among the cells of the simple squamous epithelium, which changed into a double-layered cuboidal epithelium . These findings demonstrate that an inflammatory reaction starts earlier in the pars flaccida than in the pars tensa of the tympanic membrane.

Zh Nevropatol Psikhiatr Im S S Korsakova, 1994, 94(4), 12 - 4
{The antibacterial and antiviral immunity of patients with trigeminal neuralgia}; Mordvinov GV; The levels of antibodies to bacterial (tuberculin, staphylococcus, pneumococcus, streptococcus) and viral (herpes, measles, rubella, parotiditis, influenza) antigens were determined in 39 patients with trigeminal neuralgia (TN) aggravation of which 25 were untreated, while 14 had received a course of the cadaveric nerve specific tissue therapy, 46 healthy subjects and 31 patients with trigeminal neuropathy served control . The study proved that TN patients had significantly increased levels of herpes virus antibodies (p < or = 0.01) . The above tissue therapy stimulated production of antibodies to rubella and parotiditis viruses.

Infection, 1994, 22 Suppl 3, S161 - 6
Treatment of severe infections caused by penicillin-resistant pneumococci . Role of third generation cephalosporins; Rubinstein E et al.; Penicillin resistance occurred soon after the discovery of penicillin, first in the test tube and subsequently in patients . The prevalence of invasive pneumococcal disease has been estimated to be as high as 15-18/100,000 in the elderly population and even higher in AIDS patients, children and the very old . While prevention with pneumococcal vaccine seems the most reasonable solution, under-utilization of the vaccine and an increase in the number of immuno-compromised individuals has limited the success of this approach . Streptococcus pneumoniae is conventionally classified as penicillin-susceptible (MIC < 0.125 mg/l), penicillin-intermediate (MIC 0.125-1.0 mg/l) and penicillin-resistant (MIC > or = 2 mg/l) . In many countries, penicillin resistance in pneumococci is on the increase and in some areas penicillin intermediate and resistant isolates reach 60% . As a consequence, a switch of therapy from penicillin to other agents is mandatory in infections caused by penicillin-resistant strains . Benzyl-penicillin, however, can be used for most infections caused by penicillin-intermediate and all infections caused by penicillin-sensitive strains . Third generation cephalosporins, and in particular cefotaxime, are an optional alternative, particularly in view of their low MICs against penicillin-susceptible and -intermediate and some penicillin-resistant strains, and the easily achievable therapeutic concentrations in serum, pulmonary tissues and other compartments in which pneumococcal infections occur . Third generation cephalosporins have a high safety record and can be administered to children, pregnant women and the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)

Prog Clin Biol Res, 1994, 388, 125 - 35
Rabbit CAP18 derived peptides inhibit gram negative and gram positive bacteria; Larrick JW et al.; CAP18 (cationic antimicrobial protein of 18 kDa) was originally isolated from rabbit granulocytes using as an assay the agglutination of Re-lipopolysaccharide coated erythrocytes . The C-terminal 37 amino acids of CAP18 comprise the LPS-binding domain called RNIP, reactive nitrogen inhibitory peptide . Synthetic RNIP has broad antimicrobial activity versus both gram positive {IC50 = 130-200 nM} and gram negative bacteria {IC50 = 20-100 nM) . Susceptible strains include Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Streptococcus pyogenes . Antimicrobial activity is highly dependent upon peptide structure . Although a 32 amino peptide resulting from truncation of five amino acids from the C terminus of RNIP is highly active, other fragments of RNIP including truncation of its N-terminus do not exhibit antimicrobial activity . Unlike previously characterized antimicrobial peptides derived from granulocyte proteins RNIP is active in serum . RNIP or a derivative peptide may have therapeutic potential for bacterial sepsis.

Rev Belge Med Dent, 1994, 49(3), 15 - 21
{Salivary concentration of Streptococcus mutans in children and adolescents in Basel}; Buttner M; The search for a feasible method to estimate the caries risk in humans is going on since several years . Such risk assessments should especially be performed in persons clinically suspected to be at risk . The quantitative determination of Streptococcus mutants (SM) in whole saliva has been proposed to serve as a measure of the caries risk . SM tests have been performed in 1991 in a group of 5743 5 to 16 year old children and adolescents living in the city of Basle . Levels of SM in whole saliva were correlated with caries prevalence both in the deciduous and permanent teeth . SM tests have equally become a helpful pedagogic instrument used to motivate patients for individual prophylactic activities.

Drugs Exp Clin Res, 1994, 20(4), 127 - 47
An in vitro characterization of cefditoren, a new oral cephalosporin; Felmingham D et al.; Cefditoren (ME 1206) is a new cephalosporin available for oral administration as the pivaloyloxymethyl ester (ME 1207) . The effect of medium formulation . pH, cation concentration and inoculum on the in vitro activity of cefditoren was investigated prior to determining its comparative antibacterial potency against a wide range of clinical bacterial isolates, its bactericidal activity against susceptible strains and the duration of its post-antibiotic effect (PAE) . Cefditoren was shown to possess a broad-spectrum of cidal antibacterial activity against both Gram-positive and Gram-negative species with stability to many beta-lactamases of clinical importance . Its activity against Gram-positive species was similar to augmentin and cefuroxime, but superior to that of cefaclor and cefixime, while its beta-lactamase stability was similar to that of cefixime and ceftazidine, characterizing it as a third generation cephalosporin . Investigation of the effect of laboratory variables on the in vitro activity of cefditoren indicates that it will present no special problems when tested in the clinical setting against bacterial pathogens . PAE of 0.9 h, or greater, for Staphylococcus spp, Streptococcus pneumoniae and Moraxella catarrhalis may support the use of an extended dose-interval when cefditoren is used for the treatment of respiratory tract infections.

Acta Vet Hung, 1994, 42(1), 3 - 14
Data on the effects of the probiotic "Lacto Sacc"; Kovacs-Zomborszky M et al.; The effects of the probiotic "Lacto Sacc" on the lactic acid concentration, pH value and microbiological status of the intestinal content and faeces, as well as the ileal digestibility of different nutrients and essential amino acids were studied in growing pigs into which a T-cannula had been inserted surgically at the proximal part of the duodenum and at the distal part of the ileum . No differences were found between the control and the experimental group in the measured parameters of the chyme samples taken from the duodenum . As a result of "Lacto Sacc" feeding, lactic acid concentration of the ileal content increased from 4.77% to 7.22% while its pH value decreased significantly (P < 0.05) from 7.39 to 6.42 . The Streptococcus count was also significantly (P < 0.01) elevated . At the same time, the Escherichia coli count decreased significantly (P < 0.001) as a function of the elevated lactic acid concentration . The ileal digestibility of nutrients and essential amino acids improved by 1.3-16.1% . The favourable change observed in the microbiological status is attributed to the higher lactic acid concentration and the resulting lower pH, which adversely affect the survival of E . coli . Further studies are needed to reveal the factors responsible for the improved digestibility of nutrients.

Ann Fr Anesth Reanim, 1994, 13(5 Suppl), S138 - 44
{Antibiotic prophylaxis in hepatobiliary surgery}; Chalfine A; Today, hepatic and biliary surgery includes conventional biliary surgery, laparoscopic surgery, interventional radiology, endoscopy and hepatic resection surgery . In conventional biliary surgery, the benefit of antibiotic prophylaxis has been demonstrated . Among the risk factors, some are specific (age > 65 years, gallstones in the common bile duct with or without jaundice, history of acute cholecystitis or of biliary surgery) and the others are non specific such as the CDC new index risk (for scoring from 0 to 3, wound infection rates are respectively 1.36, 2.01, 7.11, 11.54%) . The targets for antibiotics used in conventional biliary surgery are E . coli, Klebsiella and Streptococcus . In biliary laparoscopic surgery, the rate of infectious complications and results of antibiotic prophylaxis have not been assessed . However, in laparoscopic surgery, the use of an antibiotic prophylaxis similar to that employed in conventional biliary surgery seems logical . In interventional radiology and endoscopy, the modalities and the benefit of antibiotic prophylaxis have not yet been assessed . Infections (angio-cholecystitis) secondary to these procedures are frequent and severe . They are due to multiresistant hospital microorganisms . Antibiotic prophylaxis regimens for hepatic resections have not yet been assessed and are the same as for conventional biliary surgery.

Scand J Infect Dis, 1994, 26(6), 755 - 7
Bilateral pulmonary abscesses caused by Streptococcus pyogenes: diagnostic importance of fiberoptic bronchoscopy; Clementsen P et al.; A patient with bilateral pulmonary abscesses caused by Streptococcus pyogenes is described . This bacterium is an uncommon cause of pneumonia . Metastatic foci of infection, e.g . abscess formation, may follow bacteremic spread of S . pyogenes . However, such complications are rare and the occurrence of bilateral pulmonary abscesses has not been described earlier . In the present case the diagnosis was established by fiberoptic bronchoscopy with bronchial washing.

Rev Elev Med Vet Pays Trop, 1994, 47(3), 285 - 7
{Studies on subclinical mastitis in caprine dairy herds in Morocco}; el Idrissi AH et al.; To determine the prevalence and causes of subclinical caprine mastitis, an investigation based on bacteriological diagnosis was carried out in three dairy herds (A, B and C) respectively constituted of Saanen, Alpine and a local breed, Draa . Among 287 samples analysed in the study 98 teats (34%) were infected . Coagulase-negative Staphylococci were the most frequently isolated (43% of total isolated bacteria) followed by Bacillus spp . (27%) and Staphylococcus aureus (13%) . Other bacteria isolated were Pseudomonas spp . (6%), Streptococcus spp . and coliforms (5%) and Micrococcus spp . (2%) . No Mycoplasma was recovered . The epidemiologic study showed the significant effect of the type of herd husbandry and breed as well as the number and month of lactation.

Vox Sang, 1994, 67(4), 337 - 44
Antibody Fc functional activity of intravenous immunoglobulin preparations treated with solvent-detergent for virus inactivation; Yang YH et al.; We report here results of in vitro comparisons of the Fc functional activity of a second-generation intravenous immunoglobulin (IGIV) preparation (Venoglobulin-I) and a third-generation IGIV product that includes a deliberate virus-inactivation step (Venoglobulin-S) . Both formulations showed equivalent Fc-mediated function against viral antigens (rubella, influenza A, and influenza B) by single-radial hemolysis test, and against group B Streptococcus, Staphylococcus aureus and Escherichia coli by opsonophagocytosis assay . In addition, we showed by three different immunochemical reactions and by HPLC analysis that both preparations consisted of mostly monomeric IgG and contained very low levels of complement-fixing IgG aggregates . However, IgG aggregation induced by heating at 63 degrees C markedly enhanced fixation of Clq and C3 and binding to Raji cells, indicating that the IgG molecules retained their complement-fixing capacity . Thus, the incorporation of a virus inactivation step in the manufacture of our third-generation IGIV did not alter the Fc functional activities of the IgG, as measured by these in vitro assay systems.

Neurochirurgie, 1994, 40(5), 296 - 300
{Medicosurgical approach of intracranial pyogenic bacterial suppurations in Abidjan . Analysis of 26 clinical cases}; Bissagnene E et al.; We report 19 cases of cerebral abscesses and 7 cases of subdural empyemas in 5 months to 63 years old patients (1983-1991) . Bacteriological agents in 13 cases are . 6 Staphylococcus aureus, 5 negative Gram bacilli, 1 Streptococcus, 1 pneumococcus . Predisposing factors are sepsis of adjacent organs (42%), septicemia (19%), post-traumatic and post-surgical infections (19%) . Lethality is 11.5% . The authors stress the interest of CT scan and bacteriological studies now available in Abidjan with the creation of the Department of Neurosurgery.

Folia Biol (Praha), 1994, 40(6), 349 - 58
T-cell mediated immunosuppression and its implications for the development of protective immunity; Baker PJ et al.; The mechanisms by which regulatory CD4- CD8+ suppressor T cells (Ts) and CD4+ CD8- amplifier T cells (Ta) influence the magnitude of the antibody response to the capsular polysaccharide antigen of type III Streptococcus pneumoniae are reviewed in detail . This represents the best-characterized experimental model system available for demonstrating how subsets of T cells act in a negative and positive manner to control the magnitude of an antibody response . The fact that transferred Ts and Ta elicit their effects in athymic immunized mice affirms, that such regulatory T cells are antigen-specific and act on immune B cells to produce the effects observed . The ability of the lipid A and the inner core-region oligosaccharide fractions of bacterial lipopolysaccharide to abolish and increase the expression of Ts function, respectively, is examined with respect to its immunomodulatory potential and its possible role in enhancing the virulence of Gram-negative bacteria.

Respiration, 1994, 61 Suppl 1, 3 - 7
Current concepts of immune interventions in children with respiratory diseases; Bellanti JA et al.; In addition to their role in oxygen transport and ventilation, the lungs serve as an important defense function consisting of nonspecific and specific components . The nonspecific factors include aerodynamic filtration, mucociliary apparatus, bronchoalveolar fluid flow and lymphohematogenous drainage (anatomic systems) as well as phagocytosis and inflammation; the specific factors include B-cell immunity (IgG, A, M, D and E) and T-cell immunity (cell-mediated immunity) . In the lungs, specialized lymphoid tissues in contact with epithelium (bronchus-associated lymphoid tissues; BALT) function in local antibody (secretory IgA) and cell-mediated immunity responses to foreign antigens . Based upon these considerations, a number of therapeutic interventions have been developed to enhance various components of lung defense . These include substances which enhance both nonspecific elements (leukocyte transfusion, plasma, nonspecific immunostimulants, e.g., immunoactive bacterial extracts) as well as specific elements (vaccines, intravenous gammaglobulin, plasma, interferons, cytokines) . The need for further development and utilization of new immune interventions is underscored by the large number of infants and children who suffer from recurrent respiratory infections, who have either maturational immaturity (e.g . small for gestational age newborn), genetically determined (e.g . cystic fibrosis) or acquired defects (e.g . AIDS) of lung defense mechanisms . The emergence of antibiotic-resistant bacterial organisms, e.g . Streptococcus pneumoniae, poses an additional need for new immune interventions.

Acta Neuropathol (Berl), 1994, 88(2), 143 - 50
Expression of basic fibroblast growth factor, nerve growth factor, platelet-derived growth factor and transforming growth factor-beta in human brain abscess; Liu HM et al.; We correlated the histopathological findings of six human brain abscesses with the expression of basic fibroblast growth factor (bFGF), nerve growth factor (NGF), platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF beta) . The clinical courses ranged from 1 month to 1 year and viridans streptococcus was the major pathogen . In early abscesses, we demonstrated strong bFGF and moderate NGF and PDGF immunoreactivities in neutrophils and monocytes/macrophages infiltrating the abscess wall and in the fibrin layer lining the abscess center . In the subacute cases, growth of capillaries and fibroblasts into the fibrin layer and deposition of collagen resulted in the formation of a mesodermal layer between the abscess center and the outer gliotic layer . The proliferative non-neural cells (endothelial cells, fibroblasts and glial cells) expressed mild to strong bFGF, NGF and PDGF immunoreactivities, while strong TGF beta staining was seen in the extracellular matrix . A loss of growth factor expression and increased fibrosis was seen in the chronic case . These findings suggest that bFGF, NGF, PDGF and TGF beta produced by the continued influx of leukocytes and by the proliferating non-neural cells may mediate various steps of defense mechanisms and wound healing such as angiogenesis, fibrogenesis and gliosis.

Microbios, 1994, 79(319), 121 - 9
Influence of growth rate on the relative activities of free and bound dextranase and dextranase inhibitor in continuous cultures of Streptococcus sobrinus; Wellington JE et al.; The rate of growth of Streptococcus sobrinus was a major factor governing the activity of free dextranase and free dextranase inhibitor in continuous culture filtrates . Depending on the growth conditions, a variable proportion of dextranase and dextranase inhibitor was combined in a tightly bound enzyme-inhibitor (EI) complex . Dissociation of the EI complexes revealed that the total productivity (free + bound) of both the enzyme and the inhibitor increased with growth rate, and that the activities of the enzyme and inhibitor released from the EI complex greatly exceeded their free activities, when the dilution rate (D) was high (D, 0.45 h-1) . At low growth rate (D, 0.05 h-1), all the enzyme was bound to the inhibitor, and no free dextranase could be determined in culture filtrates; by contrast, at high growth rate (D, 0.45 h-1), all the inhibitor was bound to dextranase in the active EI complex, leaving active dextranase but no free inhibitor.

Microbios, 1994, 79(319), 101 - 8
An in vitro study to assess the efficacy of antiplaque agents in mouthwash formulations; Frost MR et al.; A rapid and simple in vitro test to evaluate antiplaque mouthwash formulations for their effectiveness in preventing the formation of dental plaque micro-organisms was investigated . Streptococcus mutans grown in brain heart infusion broth containing 5% sucrose was used as the plaque-inducing micro-organism and polymethylmethacrylate (Perspex) strips provided the substrate for the deposition of plaque . Over a period of 3 days the strips were treated twice daily with mouthwash . The Perspex strips were then stained using a plaque disclosing agent, and plaque development was measured using a double beam visible spectrophotometer . The colour intensity of the strips was recorded by laser colour copy to allow visual comparison of results . Two novel antiplaque mouthwash formulations, containing 0.05% cetyl pyridinium chloride and 0.05% chlorhexidine gluconate respectively were compared with a commercially available product and a placebo . The technique provides a simple, reproducible in vitro test which is sufficiently sensitive to differentiate between similar formulations.

J Refract Corneal Surg, 1994 Jan-Feb, 10(1), 38 - 40
Viability of bacteria in glycerin and ethanol preserved sclera; Dailey JR et al.; BACKGROUND: Sclera is commonly preserved in glycerin or ethanol before being used for ophthalmic surgery . The purpose of this study was to determine the ability of bacteria to survive in sclera preserved in glycerin or ethanol . METHODS: Fresh sclera was inoculated with Staphylococcus aureus, Streptococcus pneumoniae, or Pseudomonas aeruginosa and transferred to preservative vials containing glycerin, 95% ethanol, or trypticase soy broth (control) and stored at room temperature . Pieces of sclera were removed from preservative at designated intervals over a 14-day period . The sclera was then homogenized, plated on blood agar, and incubated at 37 degrees C . Colonies were counted at 24, 48, and 72 hours . RESULTS: S . pneumoniae, P . aeruginosa, and S . aureus were recovered from glycerin preserved sclera for up to 12 hours, 1.5 days, and 8 days, respectively . No bacteria was recovered from the ethanol preserved sclera . CONCLUSIONS: Bacteria cannot be recovered from ethanol preserved sclera but can survive in glycerin preserved sclera for at least 8 days . Ethanol may offer advantages over glycerin as a scleral preservative due to its greater antibacterial activity.

Ann Trop Paediatr, 1994, 14(1), 47 - 51
Meconium aspiration syndrome and neonatal outcome in a developing country; Malik AS et al.; The outcome in 148 inborn meconium-stained neonates was studied prospectively over a 5-month period . Fifty-three infants (38.5%) developed meconium aspiration syndrome (MAS) . There was a significantly higher rate of MAS (p < 0.001), mechanical ventilation (p < 0.016) and hospital stay (p < 0.016) in neonates with meconium in the trachea than in neonates with no meconium in the oropharynx . The incidence of MAS was significantly higher and the duration of hospital stay longer in outborn than in inborn infants (p < 0.022)PIP: Between January 1 and May 31, 1991, of a total 975 admissions, 164 (79 boys, 85 girls) meconium-stained neonates were admitted to the neonatal nursery of the Hospital Universiti Sains Malaysia (HUSM) within 12 hours of delivery . (148 born at HUSM, 16 born outside the hospital) . 56 (38%) of the inborn infants were found to have meconium in the trachea . A total of 64 neonates developed meconium aspiration syndrome (MAS) of whom 53 were inborn and 11 outborn . Of the 53 inborn neonates with MAS, only 31 had meconium in the trachea . 6 neonates who had positive blood cultures were excluded from the MAS group . The organisms isolated were group B Streptococcus, Staphylococcus epidermidis, and Klebsiella species . The average birth weight of the neonates with MAS was 3.320 kg (range 1.950-4.800 kg) . Five babies, whose weights fell below the 10th percentile for their gestational ages, were considered small for gestational age (SGA); 36 were postterm, 25 were term, and 3 were preterm . 11 neonates required mechanical ventilation . Mean duration of ventilation was 4.82 days (range: 1-12 days) . 8 infants developed complications including persistent fetal circulation, pneumothorax, and acute renal failure . One baby who had severe birth asphyxia developed cerebral palsy . Three mothers of the neonates with MAS had prolonged rupture of membranes, 3 had prolonged labor, and 6 had pyrexia at the time of delivery . Three neonates (2 girls, 1 boy) died . Two were delivered at home and 1 at HUSM . 11 of the 16 meconium-stained infants born outside developed MAS . Three of them required mechanical ventilation, all developed complications, and 2 of them died . The risk of MAS was twice as great when meconium was present in the trachea than when it was not, but the absence of meconium from the oropharynx did not guarantee freedom from MAS . Babies born outside the hospital had very high morbidity .

Biol Pharm Bull, 1994 Jan, 17(1), 29 - 33
A microplate assay for sialidase activity using plant lectin binding to N-acetyllactosamine; Onodera S; This paper presents a sensitive assay for sialidase activity based on the specific binding of lecting to N-acetyllactosamine . The substrate used for sialidase assay is fetuin (30-100 ng/50 microliters) with sialylated oligosaccharides, which was then coated on a 96-well microtiterplate . After removing sialic acids from the terminal positions of the glycoconjugate glycans by sialidase, it was subjected to biotin-labeled lectin (Ricinus communis agglutinin 120), which binds specifically to N-acetyllactosamine . This was followed by the addition of a peroxidase conjugated avidin-biotin complex . The amount of bound peroxidase was determined by a colorimetric assay . The sensitivity was enhanced 1000- to 10,000-fold compared to the colorimetric assay using a synthetic substrate such as 2-O-(p-nitrophenyl)-N-acetyl-alpha-D-neuraminic acid (PNPN) . In the established method, only very small amounts of substrate and sialidase were required; therefore, it can be applied to the quantitative assay of some sialidases from Vibrio cholerae, streptococcus, the influenza virus and rat liver.

Infect Immun, 1994 Jan, 62(1), 319 - 24
Cloning and nucleotide sequence analysis of psaA, the Streptococcus pneumoniae gene encoding a 37-kilodalton protein homologous to previously reported Streptococcus sp . adhesins; Sampson JS et al.; Gene psaA, which encodes the Streptococcus pneumoniae 37-kDa protein, was cloned in Escherichia coli, and its complete nucleotide sequence was determined . Analysis of the sequence of the 2.4-kb cloned fragment revealed three open reading frames (ORFs) . ORF2, which is 933 bp long, was identified as psaA . The two other ORFs identified flank psaA . ORF1, located upstream of psaA, is 836 nucleotides long and encodes a protein with a calculated molecular mass of 29,843 Da . The sequence for ORF3, located downstream of psaA, was only partially determined . Northern (RNA) blot analysis of pneumococcal RNA suggests that psaA is transcribed as part of a polycistronic message . Analysis of the primary structure of the protein encoded by this gene indicated significant similarity to two previously reported streptococcal proteins, SsaB (80% similarity) and FimA (92.3% similarity), from S . sanguis and S . parasanguis, respectively . These two homologous proteins have been shown to be associated with bacterial adhesion, and the possibility of a similar role for PsaA is hypothesized.

Gene, 1993 Dec 22, 136(1-2), 27 - 34
Phosphotransferase system of Streptococcus salivarius: characterization of the ptsH gene and its product; Gagnon G et al.; The Streptococcus salivarius ptsH gene encoding histidine-containing phosphocarrier protein (HPr) of the phosphotransferase system (PTS) has been cloned, sequenced, and found to be part of a ptsH, ptsI operon . Upstream from ptsH, putative -35 and -10 boxes and a Shine-Dalgarno sequence highly similar to the Escherichia coli consensus regulatory elements were identified . A second promoter, located in the ptsH coding sequence was also observed and is sufficient for the expression of the S . salivarius ptsI gene, encoding enzyme I of the PTS in E . coli {Gagnon et al., Gene 121 (1992) 71-78} . The amino acid sequence of S . salivarius HPr, inferred from the ptsH sequence, shared identity varying between 37 and 76% with known HPr from other bacteria . Moreover, the S . salivarius HPr shared 78% identity with an HPr-like protein of Aspergillus fumigatus, a eukaroytic mold that does not possess a functional PTS . Expression analysis of S . salivarius HPr in E . coli demonstrated that (i) S . salivarius ptsH is expressed in E . coli under the control of its own promoter, (ii) S . salivarius HPr synthesized by E . coli is completely processed by methionine aminopeptidase, and (iii) S . salivarius HPr is phosphorylated in vivo by E . coli enzyme I . It was also observed that, in E . coli, the copy number of pUC18 bearing S . salivarius ptsH was reduced more than 25-fold, as compared to pUC18 without an insertion.

Biochem J, 1993 Dec 15, 296 ( Pt 3), 671 - 4
Characterization of the solution properties and conformation of pneumolysin, the membrane-damaging toxin of Streptococcus pneumoniae; Morgan PJ et al.; Pneumolysin is a membrane-damaging toxin produced by Streptococcus pneumoniae . In order to understand fully the mode of action of this toxin, it is necessary to have an appreciation of the size, self-association behaviour and solution conformation of pneumolysin . A combination of analytical ultracentrifugation methodologies has shown that pneumolysin lacks self-association behaviour in solution and has provided a weight-average M(r) (M omega) of 52,000 +/- 2000, which was in agreement with that derived from the amino acid sequence . By determining a sedimentation coefficient (S20,w0) of 3.35 +/- 0.10 S, it was possible to suggest a model for the gross solution conformation of pneumolysin monomers . Spectroscopic methods provide additional secondary and tertiary structure information.

Arch Intern Med, 1993 Dec 13, 153(23), 2679 - 84
A comparison of Streptococcus pyogenes (group A streptococcal) bacteremia at an urban and a suburban hospital . The importance of intravenous drug use; Navarro VJ et al.; BACKGROUND: There has been a recent resurgence of severe infections with Streptococcus pyogenes, including bacteremias and a toxic shock-like syndrome . The purpose of this study was to examine the influence of intravenous drug use on the incidence, clinical epidemiology, and severity of S pyogenes bacteremia . METHODS: We conducted a retrospective survey of medical records at a 500-bed tertiary care urban hospital and at a nearby 500-bed suburban university-affiliated hospital . All patients from each hospital with documented S pyogenes bacteremia from January 1, 1979, to December 31, 1989, were included . We examined demographic and clinical data from cases at the two institutions, serologic findings from a subset of isolates from the urban hospital, and factors associated with mortality from S pyogenes bacteremia by stepwise logistic regression analysis . RESULTS: Ninety-five cases of S pyogenes bacteremia were identified, with 65% (62 cases) occurring at the urban center . Intravenous drug use occurred more frequently at the urban center (P < .005); the injecting drug users were significantly younger than the non-drug-using population (P = .001) . Infection with the human immunodeficiency virus occurred in a subset of the injecting drug users at the urban center . Cellulitis and cutaneous abscesses were the most common sources of bacteremia at both centers . During the study period, the numbers of S pyogenes bacteremias increased at the urban center (P = .007), accompanied by a significant increase in the proportion of infections associated with parenteral drug use (P = .003) . There was no change in the prevalence of any T type throughout the study period and no clustering of T types among injecting drug users . The overall mortality was 23% (20/89) . By logistic regression analysis, age older than 65 years (relative risk {RR}, 14; 95% confidence interval {CI}, 3.2 to 68) and the presence of the toxic shock-like syndrome (RR, 36; 95% CI, 2.2 to 600) were significantly associated with mortality due to S pyogenes bacteremia . CONCLUSIONS: Intravenous drug use accounted for an increase in cases of S pyogenes bacteremia at an inner-city hospital . However, advanced age and the toxic shock-like syndrome were the most important predictors of mortality.

Tidsskr Nor Laegeforen, 1993 Dec 10, 113(30), 3712 - 4
{Puerperal infections . From Semmelweis to current problems}; Bjoro K; Maternity hospitals began to be established in the middle of the 18th century to relieve the distress of the poor . As the number of lying-in hospitals increased, so did the cases of puerperal sepsis . The death rate from puerperal sepsis in Norway was high and remained so until 1934 . Semmelweis studied the maternal mortality rates in two obstetric clinics in Vienna for the years 1841-46 . He declared that puerperal fever was transmitted by the doctors who taught in the dissecting room and went straight from there into the labour wards . I 1847 he instructed all doctors or students to scrub their hands in a solution of chloride of lime before they delivered, examined or touched any patient . The haemolytic streptococcus was finally proved to be the cause of puerperal sepsis by Louis Pasteur in 1879 . There was a significant drop in mortality rates in maternity hospitals after the introduction of antiseptic and aseptic techniques around 1880 . Deaths from puerperal fever paralleled deaths from erysipelas, and both conditions declined after 1934 . Puerperal fever and pelvic inflammation is still a clinical problem . The author discusses sexually transmitted diseases and multibacterial causes.

J Biol Chem, 1993 Dec 5, 268(34), 25402 - 8
Characterization of the Streptococcus pneumoniae maltosaccharide regulator MalR, a member of the LacI-GalR family of repressors displaying distinctive genetic features; Puyet A et al.; The gene encoding a transcriptional repressor of the maltosaccharide utilization operons of the Gram-positive bacterium Streptococcus pneumoniae (malR) has been cloned and sequenced . The genetic structure of the locus reveals the presence of an upstream gene necessary for growth on maltotetraose medium (malA) . The phenotype of malR- and malA- mutants obtained by interruption of the coding regions suggests that both genes could belong to the same transcription unit . Two copies of a DNA motif consisting of three conserved regions of 59, 42, and 49 nucleotides were found located upstream and downstream of the malA-malR putative operon . These DNA structures are almost identical to the reported Box sequences associated with several genes of S . pneumoniae . The protein encoded by malR was visualized and partially purified after selective expression in Escherichia coli, whereas the product of malA was identified in vitro . The amino acid sequence of MalR displays similarities with the Lac and Gal family of repressors . The highest similarities were found when comparing MalR with the E . coli MalI repressor, which is related with an indirect induction pathway of the maltose regulon . The significance of these similarities is discussed in terms of the possible evolutionary pathways followed by structural and regulatory genes of sugar utilization systems in bacteria.

Semin Dermatol, 1993 Dec, 12(4), 331 - 5
Staphylococcal and streptococcal pyodermas; Feingold DS; The pathophysiology, clinical features, and therapy of the common pyodermas, those caused by Staphylococcus aureus and Streptococcus pyogenes, are reviewed.

J R Soc Med, 1993 Dec, 86(12), 712 - 5
Control of neonatal group B streptococcal infection; Steele RW; Group B beta-haemolytic streptococcus (GBS) is the leading cause of life-threatening perinatal infection in developed countries . As immunization of women is not yet available, selective intrapartum chemoprophylaxis appears to be the best current strategy for preventing disease . All pregnant women should be screened for GBS at 26 to 28 weeks gestation . During labour, all colonized women with risk factors for invasive GBS neonatal infection should be treated with intravenous penicillin or ampicillin . Risk factors include preterm labour, premature rupture of membranes, intrapartum fever, multiple births, prolonged rupture of membranes, maternal diabetes, previous sibling with invasive GBS disease, and maternal GBS bacteriuria . The latter two categories warrant chemoprophylaxis regardless of maternal colonization status.

J Pharm Sci, 1993 Dec, 82(12), 1218 - 20
In vitro evaluation of the antimicrobial activities of selected lozenges; Richards RM et al.; The in vitro antimicrobial activities of 10 lozenges (Merothol, Merocets, Merocaine, Strepsils (two varieties), Dequacaine, Dequacets, Zensyls, Tyrozets, and Labosept) were determined by use of a microtiter counting method with Streptococcus pyogenes, Staphylococcus aureus, and Candida albicans as the test organisms . Merothol, Merocets, Merocaine, and both Strepsils formulations all reduced the counts of both S . aureus and S . pyogenes suspensions by approximately 6 log cycles within 5 and 20 min, respectively . Merothol, Merocets, and Merocaine also caused a reduction in the counts of the C . albicans suspension approximately 5 log cycles within 40 min, but no other lozenge formulation showed rapid and marked activity against C . albicans . Dequacaine and Dequacets showed marked but much slower activities against this yeast . Zensyls caused an approximately 6-log-cycle reduction in bacterial counts within 40 min, and Dequacaine, Dequacets, and Tyrozets showed marked but slower antibacterial activities . This work confirmed by a statistically sound in vitro method the in vivo antibacterial activities reported for Merothol, Merocets, and Merocaine, demonstrated equivalent antibacterial activities for Strepsils, and indicated that Merothol, Merocets, and Merocaine also showed marked activities against C . albicans.

Pediatr Dermatol, 1993 Dec, 10(4), 366 - 7
Streptococcal vulvovaginitis in girls; Dhar V et al.; Group A beta-hemolytic Streptococcus (GAHS) was isolated from 18% of swabs submitted to a district microbiology laboratory from girls with vulvovaginitis, a figure similar to that from a contemporary British study . This suggests that vulvovaginitis is more commonly associated with GAHS than reported previously . This could represent either an increase in frequency of the condition or better recognition of it.

Pediatr Infect Dis J, 1993 Dec, 12(12 Suppl 3), S134 - 41
Comparison of clarithromycin and penicillin VK suspensions in the treatment of children with streptococcal pharyngitis and review of currently available alternative antibiotic therapies; Still JG et al.; In a randomized investigator-blinded study, 506 children ages 6 months to 12 years with positive rapid direct antigen tests for Group A beta-hemolytic Streptococcus (GABHS) received treatment with either clarithromycin suspension, 7.5 mg/kg twice daily, or penicillin VK suspension, 13.3 mg/kg three times per day for 10 days . Signs and symptoms of pharyngitis or tonsillitis were evaluated and throat cultures were obtained before treatment, once during treatment and 4 to 6 days and 19 to 25 days posttreatment . All GABHS isolates were susceptible in vitro to clarithromycin . Successful clinical responses at the end of treatment were demonstrated in 169 of 176 (96%) evaluable clarithromycin-treated patients and 179 of 191 (94%) evaluable penicillin-treated patients . GABHS was successfully eradicated at end of treatment in 168 of 183 (92%) evaluable clarithromycin-treated patients compared with 162 of 199 (81%) evaluable penicillin-treated patients (P = 0.004) . There were no significant changes in hematologic or serum chemistry parameters in either group . Both drugs were well-tolerated . The incidence and nature of adverse events were similar in the clarithromycin and penicillin groups, except for gastrointestinal complaints reported in 35 of 250 (14%) clarithromycin recipients compared with 12 of 256 (5%) penicillin recipients (P < or = 0.001) . The results indicate that twice daily clarithromycin was as safe and effective as three times daily penicillin VK in the treatment of children with streptococcal pharyngitis or tonsillitis . Clarithromycin was statistically superior to penicillin VK in the eradication of GABHS.

Kansenshogaku Zasshi, 1993 Dec, 67(12), 1219 - 22
{Fulminant streptococcal infection and sudden death in a pregnant woman: a case report}; Udagawa H et al.; A case of fulminant streptococcal infection occurring in a 28-year-old pregnant female is reported . She initially developed pharyngitis and high fever during the 33rd week of gestation . This was treated with oral piperacillin for two days with temporary amelioration . Recurrence of high fever, however, was noted shortly thereafter, which was followed by stillbirth of twin babies, and subsequent development of refractory hypotension and demise of the mother . Autopsy revealed presence of numerous cocci and fibrin thrombi in systemic circulation, and this was thought to be the immediate cause of her death . The causative organism was identified as Streptococcus pyogenes, M3, T3, and was found to be producing streptococcal pyrogenic exotoxin A in vitro . The underlying mechanism for this serious infection remains unknown.

Kansenshogaku Zasshi, 1993 Dec, 67(12), 1155 - 9
{Studies on hemolytic streptococcal infection: 1) . Outbreak of group C hemolytic streptococcal infection in Formosan squirrels}; Fukuyama M et al.; Between mid-October to mid-November 1992, of 500 freely-ranging Formosan and striped squirrels kept at Garden Y in the suburbs of Kanagawa Prefecture, 414 (82.8%) suddenly died one after another by bleeding from the nasal and oral cavities after developing a mild facial swelling . Isolation of microbes including viruses were carried out from the Formosan squirrels that had suddenly died . Various organs from these animals were histologically examined . 1 . In bacteriological tests, beta-hemolytic streptococcal strains were isolated in a pure culture from 5 (83.3%) of 6 Formosan squirrels that had died suddenly . By serological analysis, 14 isolated strains were serotyped as group C according to the classification of Lancefield . From their biochemical characteristics, these were identified as Streptococcus equi subsp . zooepidemicus . A drug sensitivity test revealed that ABPC, PCG, SBPC, CMX and CPZ are highly sensitive against the isolates . 2 . In the virological test, the viral isolation was applied for three blind passages by primary cultured kidney cells of Formosan squirrels, but no evidence of CPE was obtained . 3 . At autopsy, a pathological change was detected mainly in the lungs . Histopathological examinations revealed severe hypertrophic changes of the alveolar wall in the entire pulmonary lobe . Severe congestion, hemorrhagic pneumonia, neutrophils and macrophages infiltration were observed in the hypertrophic alveolar wall . In the other cases, thrombi were observed in the branches of the pulmonary artery . Other organs demonstrated no remarkable histopathological changes . 4 . Streptococcal strains were not isolated from the pharynx in all of the employees working at this garden.

Ann Otol Rhinol Laryngol, 1993 Dec, 102(12), 954 - 60
Arachidonic acid metabolites in experimental otitis media and effects of anti-inflammatory drugs; Goldie P et al.; Previous studies have shown that arachidonic acid (AA) metabolites are important in the pathogenesis of otitis media with effusion . The AA metabolites in 4 different experimental models for otitis media were analyzed, and the effect of anti-inflammatory drugs was studied . Purulent otitis media was induced in rats by inoculation of Streptococcus pneumoniae in the tympanic bulla, serous otitis media by blocking the tympanal orifice of the eustachian tube, and mucoid otitis media by combining the two procedures . Middle ear effusion was also induced by stimulating the external auditory canal with cold air . Indomethacin and hydrocortisone were used to inhibit AA metabolism in the latter model . Lipoxygenase products dominated in the purulent and cold air otitis media models . Cyclooxygenase products dominated in the mucoid and serous models . Indomethacin inhibited accumulation of middle ear effusion in the cold air otitis media model, whereas hydrocortisone did not . Apart from AA metabolites, other mechanisms and mediators appear to be responsible for the increased vessel permeability observed in the cold air otitis media model, such as interactions between mast cells and nerves in the middle ear mucosa.

J Clin Pathol, 1993 Dec, 46(12), 1124 - 5
Antimicrobial activity of cytotoxic drugs may influence isolation of bacteria and fungi from blood cultures; Peiris V et al.; The potential antimicrobial activity of cyclophosphamide, vincristine, and adriamycin against Gram positive and negative bacteria and Candida albicans was examined . The time taken for different microbial inocula to turn a simulated blood culture positive in the presence of different concentrations of these drugs was measured . Doxorubicin retarded the growth of Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus sanguis in a concentration dependent manner . Cyclophosphamide and vincristine showed minimal antimicrobial activity . Escherichia coli and Pseudomonas aeruginosa were unaffected by any of the drugs . An inoculum dependent effect was seen with some combinations of microbial inocula and cytotoxic drug concentrations.

Mol Gen Genet, 1993 Dec, 241(5-6), 579 - 85
Characterization of the effectors required for stable inheritance of Streptococcus pyogenes pSM19035-derived plasmids in Bacillus subtilis; Ceglowski P et al.; The low-copy-number and broad-host-range pSM19035-derived plasmid pBT233 is stably inherited in Bacillus subtilis cells . Two distinct regions, segA and segB, enhance the segregational stability of the plasmid . Both regions function in a replicon-independent manner . The maximization of random plasmid segregation is accomplished by the recombination proficiency of the host or the presence of the pBT233 segA region . The segA region contains two open reading frames (orf) {alpha and beta} . Inactivation or deletion of orf beta results in SegA- plasmids . Better than random segregation requires an active segB region . The segB region contains two orfs (orf epsilon and orf zeta) . Inactivation of either of the orfs does not lead to an increase in cell death, but orf zeta- plasmids are randomly segregated . These results suggest that pBT233 stabilization relies on a complex system involving resolution of plasmid oligomers (segA) and on the function(s) encoded by the segB region.

Am Surg, 1993 Dec, 59(12), 791 - 6
Susceptibility of intra-abdominal isolates at operation: a predictor of postoperative infection; Hopkins JA et al.; Antimicrobial resistance of operative site flora was correlated with postoperative infection in 175 patients undergoing operation for intra-abdominal sepsis: Diagnoses for study patients were acute or gangrenous appendicitis in 48 (27%), complicated appendicitis in 98 (56%), perforated viscus other than appendix in 21 (12%), and eight (5%) had other intra-abdominal infections . One hundred thirty-six (78%) patients were males . The average age was 33 +/- 14 years, average number of hospital days was 11.6 +/- 13.5, and average number of days on antibiotics was 6.9 +/- 2.5 . Overall recovery without infection was 75 per cent (131/175) . Analysis of susceptibility of 939 intraoperative isolates indicated a significant relationship (P = 0.0002) between resistance to the empiric antimicrobials received and postoperative infection . Of 131 patients with resolution of the intra-abdominal infection, 57 (44%) had resistant isolates while 36 (82%) of 44 patients with postoperative infectious complications had resistant isolates . Streptococcus Group D, Escherichia coli, and Bacteroides fragilis were the most prevalent resistant organisms isolated from both intra- and postoperative cultures . Other variables that were significantly different between those without complications and those who had complications were, respectively: average age 31 versus 38; admission WBC 14.5 versus 16.7; and diagnosis, acute appendicitis 28 per cent versus 2 per cent . A stepwise logistic regression analysis confirmed the predictive value of intraoperative isolate resistance, age, and admission WBC, in that order, on outcome.

J Dent Res, 1993 Dec, 72(12), 1559 - 65
Interaction of the salivary glycoprotein EP-GP with the bacterium Streptococcus salivarius HB; Schenkels LC et al.; The interaction of the human salivary glycoprotein EP-GP with a number of oral bacterial species, following incubation with human whole saliva, has been investigated . EP-GP could be detected with a specific monoclonal antibody, by means of ELISA or by electrophoresis in combination with Western Transfer . The results indicated that EP-GP is bound only by Streptococcus salivarius, and not by the other tested strains of bacteria, Actinomyces viscosus, A . naeslundii, Actinobacillus actinomycetemcomitans, Bacteroides fragilis, S . gordonii, S . oralis, S . sanguis, S . mitis, S . mutans, S . sobrinus, S . rattus, S . constellatus, and S . anginosus . Binding of EP-GP to S . salivarius is mediated by a protein-protein interaction, which was found to be pH-dependent with a maximum binding between pH 5 and 6 . For further characterization of the binding of EP-GP to S . salivarius, four mutants were tested, each of them lacking different cell wall antigens . EP-GP was bound to all mutants in amounts comparable with the wildtype, in spite of the different surface antigen compositions . We were able to identify a 27-kD EP-GP binding protein, by extraction of S . salivarius-cell wall antigens and electrophoretic techniques . In addition to EP-GP, S . salivarius also bound two other salivary proteins, namely, secretory IgA and low-molecular-weight mucin (MG-2).

Chest, 1993 Dec, 104(6), 1927 - 9
Septic pulmonary embolism due to periodontal disease; Christensen PJ et al.; Three weeks following a toothache, a 56-year-old man developed cough, sputum, fever, and pleuritic chest pain . He had mild periodontal disease and his chest radiographs and chest computed tomographic (CT) scans showed multiple pulmonary nodules . The CT scan strongly suggested septic pulmonary embolism . Aspirated pus from one of the nodules yielded pure growth of Streptococcus intermedius . Lesions resolved with antimicrobial therapy . The usual predisposing factors for septic pulmonary embolism were absent, and, the isolation of S intermedius from the pus, the antecedent toothache, and periodontal disease all suggested the gingiva as the source . We hypothesize that periodontal infection led to bacteremia, seeding of the lungs, and multiple anaerobic pulmonary abscesses, akin to reported instances of infective endocarditis from dental foci without any prior dental procedures . To our knowledge, this presentation of septic pulmonary embolism is unprecedented.

Mol Immunol, 1993 Dec, 30(17), 1573 - 82
Specific V gene usage in anti-phosphorylcholine IgE antibodies; Lotscher M et al.; Three hybridomas from phosphorylcholine(PC)-KLH immunized BALB/c mice producing IgE antibodies against the PC hapten were investigated for their fine specificity to the hapten and usage of V gene segments in H- and L-chains . All three IgE antibodies recognize the entire azophenyl-PC hapten . They are T15 Id negative and do not bind to the natural PC determinant expressed by the Streptococcus carbohydrate R36A . T15 Id positive IgE antibodies could neither be elicited by immunization in detectable amounts nor generated by the cell fusion technique . By using the Southern blot technique and nucleotide sequence analysis of PCR amplified VHDJH and VLJL rearrangements, we have demonstrated that the three IgE anti-PC hybridomas use the VH1-DSP2-JH2, the VHOX1-DSP2-JH3 or the VH36-60-D-JH2 gene segment combinations for the H chain together with the V kappa 1C-J kappa 1, V kappa 1C-J kappa 2 or V lambda 1-J lambda 1 genes for the L chains . Except for the VH36-60, the same gene segments were found in different combinations in anti-PC antibodies of other Ig classes than IgE . However, high rates of somatic mutations are expressed in both VH1 of the H chain and in V kappa 1C of the L chain . The VH36-60 is expressed in antibodies with the major Id of the azophenyl-arsonate (Ars) response and VHOX1 generally contributes to the phenyl-oxazolone specificity . This suggests that these V genes are involved in the recognition of the azophenyl moiety of the coupled PC hapten . Thus PC-KLH specific IgE antibodies utilize mutated VH1 and/or VH/VL gene segment combinations which are involved in binding of the azophenyl spacer . These IgE are therefore specific for azophenyl-phosphorylcholine, unlike antibodies normally expressed against the Streptococcus PC determinant in mice . The genetic diversity and the high mutation rates indicate that the specific B cells develop later in the immune response . Thus, they represent newly generated specificities of so-called group II anti-PC antibodies and are not isotype-switch descendants from already existing T15 Id positive IgM antibodies.

J Bacteriol, 1993 Dec, 175(23), 7561 - 70
Analysis of Streptococcus pyogenes promoters by using novel Tn916-based shuttle vectors for the construction of transcriptional fusions to chloramphenicol acetyltransferase; Geist RT et al.; We have developed a series of shuttle vectors based on the conjugative transposon Tn916 that have been designed for the analysis of transcriptional regulation in Streptococcus pyogenes and other gram-positive bacteria . Designated the pVIT vectors (vectors for integration into Tn916), the vectors are small, stable plasmids in Escherichia coli to facilitate the fusion of promoters from cloned S . pyogenes genes to a promoterless gene which encodes chloramphenicol acetyltransferase . The vectors each contain one or more small regions of Tn916 to direct the integration of the transcriptional fusion into the transposon via homologous recombination following transformation of S . pyogenes or other suitable gram-positive hosts . Integration can be monitored by the inactivation or replacement of an antibiotic resistance determinant in modified derivatives of Tn916 . Promoter activity can then be quantitated by the determination of chloramphenicol acetyltransferase-specific activity . In addition, since integration is into loci that do not disrupt the conjugative transpositional functions of Tn916, the vectors are useful for analysis of regulation in strains that are difficult or impossible to transform and can be introduced into these strains by conjugation following transformation of an intermediate host . The promoters for the genes which encode both the M protein and protein F of S . pyogenes were active in pVIT vectors, as was the region which controls transcription of mry, a trans-acting positive regulator of M protein expression . However, neither of the two characterized promoters for mry demonstrated activity when independently analyzed in pVIT-generated partial diploid strains, suggesting that regulation of mry is more complex than predicted by current models . The broad host range of Tn916 should make the pVIT vectors useful for analysis of regulation in numerous other bacterial species.

Pediatrics, 1993 Dec, 92(6), 761 - 7
Penicillin-resistant systemic pneumococcal infections in children: a retrospective case-control study; Tan TQ et al.; OBJECTIVE . To determine whether there are any risk factors that differentiate children with systemic infections due to Streptococcus pneumoniae relatively or fully resistant (minimum inhibitory concentration > 0.1 microgram/mL) to penicillin from those children with infections due to S pneumoniae susceptible to penicillin . DESIGN . Retrospective case-control study . SETTING . A large children's hospital . PARTICIPANTS . Forty-three children with systemic penicillin-resistant S pneumoniae infections identified at Texas Children's Hospital over the 51-month period from January 1989 through March 1993 . Each case had one or two controls matched only for age and date of S . pneumoniae infection . Sixty-six controls were selected from a group of 341 children with susceptible isolates . OUTCOME MEASURES . Variables compared included gender, race, diagnosis, underlying conditions, past hospitalization, geographic area of residence, antibiotic use in past month, amoxicillin-clavulanic acid use in past month, and outcome . RESULTS . Thirty-seven patients (86%) had relatively resistant isolates (minimum inhibitory concentration range 0.125 to 1.0 microgram/mL) and six patients (15%) had fully resistant isolates (minimum inhibitory concentration range 2.0 to 8.0 micrograms/mL) . Thirty-three percent of the cases vs 36% of the controls had underlying conditions . Seventy-one percent of the cases vs 39% of the controls had received antibiotics in the previous month . Compared with their matched controls, the patients with penicillin-resistant systemic pneumococcal infections were more likely (P = .02) to have received a course of antibiotics within the month prior to their infection . CONCLUSION . The only identified associated risk factor in children who developed a systemic penicillin-resistant pneumococcal infection appears to have been the use of antibiotics within the month prior to their infection.

Infect Immun, 1993 Dec, 61(12), 5426 - 30
Virulence of two Streptococcus pyogenes strains (types M1 and M3) associated with toxic-shock-like syndrome depends on an intact mry-like gene; Perez-Casal JF et al.; The major virulence factor of Streptococcus pyogenes, the M protein, is positively regulated at the transcriptional level by mry in the M type 6 strain studied . We show here that in two S . pyogenes strains isolated from cases of toxic-shock-like syndrome, a type M1 strain and a type M3 strain, an mry-like gene is also required for resistance to phagocytosis.

Infect Immun, 1993 Dec, 61(12), 5401 - 5
Hemin utilization is related to virulence of Streptococcus pneumoniae; Tai SS et al.; Streptococcus pneumoniae is a causative agent for bacterial pneumonia, otitis media, meningitis, and bacteremia . Mechanisms for acquisition of iron by this organism under low-iron conditions were investigated . Siderophore production was not detected by either chemical or biological methods . Its utilization of iron-containing compounds found in human hosts was tested . Both hemin and hemoglobin supported the full growth of S . pneumoniae in a culture lacking other iron sources, while lactoferrin and transferrin failed to do so . A mutant defective in hemin utilization was isolated and was less virulent than wild-type S . pneumoniae in experimental animals.

Infect Immun, 1993 Dec, 61(12), 5021 - 8
Inactivation of the Streptococcus mutans wall-associated protein A gene (wapA) results in a decrease in sucrose-dependent adherence and aggregation; Qian H et al.; A 0.8-kb HindIII-BamHI internal fragment of the Streptococcus mutans wall-associated protein A gene (wapA) was ligated to the 5.1-kb HindIII-BamHI fragment of the chimeric Streptococcus-Escherichia coli plasmid pVA891 (Emr Cmr) . The resulting construct was used to transform S . mutans GS-5, and erythromycin-resistant mutants were isolated and analyzed . Directed mutagenesis of the wapA gene by plasmid insertion through homologous recombination was demonstrated by Southern blot hybridization with the wapA and pVA891 probes . Stable mutants were obtained, and the alteration of the wapA gene by insertional inactivation was associated with a significant decrease in S . mutans sucrose-dependent aggregation and binding to smooth surfaces . Thus, WapA may play an important role in the colonization of the tooth surface by S . mutans and in the buildup of dental plaque . These findings provided an explanation for previous studies which indicated that WapA was effective in the prevention of dental caries in animal models . Thus, the use of recombinant WapA in the preparation of a safe and effective human dental vaccine should be investigated further.

Infect Immun, 1993 Dec, 61(12), 4994 - 5000
Identification of the surface component of Streptococcus defectivus that mediates extracellular matrix adherence; Tart RC et al.; Bacterial attachment to host tissue is considered to be a crucial primary step in pathogen infection . Previous studies have shown that Streptococcus defectivus adheres specifically to cell-secreted extracellular matrix (ECM) . Though generally not exposed in vivo, this host tissue is exposed at endothelial cell junctions and sites of tissue injury . In this report, we identify a ca . 200-kDa surface protein of S . defectivus involved in ECM adherence . Nitrous acid-derived mutant strains that were unable to bind ECM and which failed to adsorb adhesin-specific antibody from polyclonal inhibitory sera were isolated . A surface protein (ca . 200 kDa) was absent from ECM-nonadherent mutants, indicating its involvement in ECM attachment . Additionally, affinity-purified antibody to the ca . 200-kDa protein inhibited whole-cell S . defectivus ECM attachment, whereas antibody to the same region of the nonadherent mutant cell wall-associated protein profile did not . Furthermore, solubilized cell wall-associated protein extracts of parent but not mutant strains bound ECM, confirming the significance of this protein in ECM adherence . Therefore, we propose that the ca . 200-kDa protein is the major S . defectivus surface component that mediates the ECM attachment of these organisms.

Biochem Mol Biol Int, 1993 Dec, 31(6), 1167 - 75
Cloning of a Streptococcus sobrinus oligo-isomaltosaccharide synthase gene and characterization of its product; Hayakawa M et al.; A Streptococcus sobrinus gene coding for a glucosyltransferase (GTF)-S was cloned into Escherichia coli, using the bacteriophage lambda L47.1 and the plasmid vector pACYC184 . The MD124 clone obtained expressed a 155 kDa GTF-S which did not react with any antisera against GTF-S1, -S2 and -I enzymes . The recombinant enzyme (designated rGTF-S3) was homogeneously purified from the MD124 cell-extract and characterized . The purified rGTF-S3 synthesized primer-independently alpha-1,6-linked linear oligosaccharides from sucrose . The dependence upon the sucrose concentration was diphasic, and the respective Km values were 1.3 and 25 mM . The properties except the Km values were similar to those of oligo-isomaltosaccharide synthase from S . sobrinus AHT.

Eur J Clin Microbiol Infect Dis, 1993 Dec, 12(12), 928 - 37
Genetic characterization of plasmid-encoded multiple antibiotic resistance in a strain of Listeria monocytogenes causing endocarditis; Hadorn K et al.; One susceptible and two multiply resistant isolates of Listeria monocytogenes from a patient suffering from prosthetic valve endocarditis are described . They could not be distinguished by several typing methods . Two isolates were resistant to chloramphenicol, macrolide/lincosamide/streptogramin antibiotics and tetracycline . The resistance determinants were located on a 39 kb plasmid pWDB100 that was transferable by filter mating to several gram-positive bacteria . Evidence was obtained to support the hypothesis that the resistant variant had primarily infected the patient's blood and prosthetic valve, and later lost the resistance plasmid . The three resistance determinants showed homology to other known markers, cat221/cat223, ermB and tetM, which are frequently found in different gram-positive genera . Plasmid pWDB100 showed extensive homology to the Streptococcus agalactiae broad-host-range plasmid pIP501 . It was also very similar to two listerial plasmids found in France . Thus, plasmid pWDB100 and the homologous plasmids from France, although isolated in geographically distant regions, may illustrate spread of a plasmid and its relatives.

Glycoconj J, 1993 Dec, 10(6), 435 - 9
Depolymerization of hyaluronan by sonication; Kubo K et al.; High molecular weight hyaluronan (M(r) 400,000) obtained from human umbilical cord was depolymerized by sonication for 10 h into small molecules and finally into molecules of constant size (M(r) 11,000) . The molecular size of the depolymerized hyaluronan was unaltered even under different conditions of sonication . After sonication, the main sugar residues at the reducing and non-reducing termini of depolymerized hyaluronan were N-acetylglucosamine (86%) and glucuronic acid (98%), respectively . Hyaluronans derived from rooster comb (M(r) 1 x 10(6)) and Streptococcus zooepidemicus (M(r) 1.2 x 10(6)) were depolymerized into molecules of different but characteristic sizes by sonication . On the other hand, neither chondroitin sulfate nor glycogen was depolymerized by sonication . These results suggest that high molecular weight hyaluronan may have some weak linkages related to N-acetylglucosamine in the chain, which are extremely sensitive to sonication . At present, however, the nature of these linkages is still unclear.

Oral Microbiol Immunol, 1993 Dec, 8(6), 355 - 60
The binding of delmopinol and chlorhexidine to Streptococcus mutans and Actinobacillus actinomycetemcomitans strains with varying degrees of surface hydrophobicity; Freitas LB et al.; This study evaluated the binding of chlorhexidine and the new surface-active anti-plaque agent delmopinol hydrochloride to Streptococcus mutans and Actinobacillus actinomycetemcomitans cells with various cell surface hydrophobicities . The influence of saliva concentration on the binding of these compounds was also investigated . The radiolabeled compounds were incubated with bacteria and the cells were recovered using a centrifugal filtering technique . Delmopinol had higher binding to the hydrophilic variant strains than to the hydrophobic parent strains; chlorhexidine had higher binding to hydrophobic than to hydrophilic A . actinomycetemcomitans strains and higher binding to hydrophilic than to hydrophobic S . mutans strains . The presence of salivary films decreased the binding of both compounds . Both delmopinol and chlorhexidine had stronger affinity to A . actinomycetemcomitans cells than to S . mutans cells . At equimolar concentrations, delmopinol had a lower binding to all strains tested than chlorhexidine . The high reversibility of the delmopinol binding might be related to a higher diffusion rate and solubility compared with that of chlorhexidine . The amphiphilicity of both molecules is an important feature in their retention to S . mutans and A . actinomycetemcomitans strains of varying hydrophobicities and could play an important role in the substantivity of delmopinol or chlorhexidine in the oral cavity.

J Antimicrob Chemother, 1993 Dec, 32(6), 843 - 52
Influence of the pre-treatment duration of infection on the efficacies of various antibiotic regimens in experimental streptococcal endocarditis; Cremieux AC et al.; The influence of the pre-treatment duration of infection on the efficacies of three different antibiotic regimens was investigated in a rabbit model of subacute endocarditis caused by a novel, nutritionally-variant species, Streptococcus adjacens strain GaDT . Treatment was initiated either 6 or 10 days after bacterial inoculation (days 7 and 11 respectively) and comprised procaine penicillin (150,000 IU/kg bd), alone or combined with tobramycin (12 mg/kg od), teicoplanin (10 mg/kg bd), all administered by the intramuscular route for 4 days . The MICs and MBCs of penicillin, tobramycin and teicoplanin were 0.015 and 1 mg/L, 8 and 16 mg/L and 0.25 and 256 mg/L respectively . In the control rabbits, the mean (+/- S.D.) weights of the vegetations were 25 +/- 16 mg on day 7 and 45 +/- 34 mg on day 11 (P = 0.06) . The mean (+/- S.D.) reductions in the number of cfu in the vegetations of the treated groups of animals after completion of therapy which had been started on days 7 and 11, compared with the mean numbers of cfu in the vegetations of the untreated controls on days 7 and 11 (delta log10 cfu/g), were 4.0 +/- 1.3 and 2.1 +/- 1.5 respectively for penicillin (P < 0.05), 3.2 +/- 1.8 and 2.4 +/- 1.8 respectively for teicoplanin and 5.4 +/- 1.2 and 5.2 +/- 1.2 respectively for the combination of penicillin and tobramycin . The increase in the size of the vegetations and changes in the metabolism of the bacteria within the vegetations between days 7 and 11, as demonstrated by electron microscopy, might explain why penicillin was more effective earlier in the course of the disease and why the influence of the duration of infection before treatment was initiated, varied according to the antibiotic regimen . These results suggest that the use of bactericidal regimens, such as the combination of penicillin and tobramycin, which are equally effective in reducing the bacterial counts in vegetations which have been infected for both long and short periods could minimize the risk of relapse in patients with endocarditis in whom there have been long delays before initiating treatment and/or who have large vegetations.

P R Health Sci J, 1993 Dec, 12(4), 291 - 3
Identification of Streptococcus mutans from human dental plaque using the RapID STR System; Oletta CA et al.; The identification of Streptococcus mutans from dental plaque samples with rapid systems, such as the RapID STR System, has not been recommended by the manufacturers . In this study, we evaluated the use of the above method for the identification of 34 human dental plaque Streptococcus mutans strains which had been identified previously by conventional procedures . The results obtained demonstrate that 88.2% of the Streptococcus mutans strains tested were identifiable by the rapid method.

Eur Heart J, 1993 Dec, 14 Suppl K, 51 - 3
Dental infections as a risk factor for acute myocardial infarction; Mattila KJ; The so-called classic risk factors of coronary heart disease (CHD) do not explain all its clinical and epidemiological features . Recent evidence suggests that certain infections, among them dental infections, are involved in the pathogenesis of CHD . Case-control studies have revealed an association between dental infections and acute myocardial infarction and chronic coronary heart disease . A large epidemiological survey revealed an association between missing teeth and CHD and a recent 14-year follow-up of 9760 individuals showed that periodontitis is associated with an increased risk of coronary heart disease . Preliminary results suggest that the severity of dental infections correlates with the extent of coronary atheromatosis . Individuals with severe dental infections also have higher level of von Willebrand factor antigen, leukocytes and fibrinogen . Streptococcus sanguis has been shown to aggregate human platelets in vitro . The mechanism behind the association between dental infections and CHD could be the effect of bacteria on the cells taking part in the pathogenesis of atherosclerosis and arterial thrombosis.

Pediatr Nephrol, 1993 Dec, 7(6), 737 - 8
Acute post-streptococcal glomerulonephritis in an 8-month-old girl; Li Volti S et al.; We describe a middle class Sicilian girl who at 8 months of age suffered acute post-streptococcal glomerulonephritis documented by clinical hist a positive type 12 beta-haemolytic streptococcus throat culture, a raised anti-sterptolysin O titre and a low C3 rising to normal after 8 weeks

Zentralbl Veterinarmed B, 1993 Dec, 40(9-10), 707 - 14
Antiphagocytic effect of the capsule of Streptococcus uberis; Almeida RA et al.; Non-opsonized encapsulated and non-encapsulated strains of Streptococcus uberis were incubated with bovine mammary macrophages and the percentage of phagocytosis and intracellular killing were determined . Seventy-seven percent of macrophages ingested non-encapsulated organisms with a killing rate of 75% . In contrast, 48% of macrophages ingested encapsulated bacteria with a killing rate of 35% . When strains were opsonized with homologous antiserum, differences were detected in the percentage of phagocytosis (84% vs . 48%) and intracellular killing (52% vs . 35%) of the encapsulated strain only . Effects were partially abolished when antiserum was absorbed with purified capsule, or when macrophages were pre-treated with purified capsular material . Electron microscopy of mammary macrophages incubated with the encapsulated strain of S . uberis showed the microorganism in contact with the macrophage cell membrane without signs of membrane activation . In contrast, the non-encapsulated strain induced formation of pseudopods and membrane ruffling . These results suggest that capsule may protect S . uberis from phagocytosis which may be due to a direct interaction of capsular material with macrophages.

Zentralbl Veterinarmed B, 1993 Dec, 40(9-10), 697 - 706
Growth curve, capsule expression and characterization of the capsular material of selected strains of Streptococcus uberis; Almeida RA et al.; The pattern of lectin agglutination, expression of capsule during the growth curve, and chemical composition of the capsule were examined in strains of Streptococcus uberis isolated from bovine mastitis . Lectin agglutination was conducted on 40 strains of S . uberis and 82.5% and 77.5% of the strains showed agglutination titers (> or = 1:128) with wheat germ agglutinin and concanavalin A, respectively . Capsule expression during the growth curve and its chemical composition was determined in one strain of S . uberis (UT 101), using a nonencapsulated strain of S . uberis (UT 102) as a negative control . Both strains were grown in Todd-Hewitt Broth (THB) with and without 20% milk whey . Strain UT 101 grown in THB or THB with 20% whey showed maximum numbers of colony forming units per ml (cfu/ml) at 12 hours, with a lag phase ending after 2 hours of growth . Maximum cfu/ml of UT 102 in THB was at 14 hours and 16 hours in THB 20% whey with a lag phase that ended at 2 hours of growth . Higher number of viable bacteria and increased capsule expression of UT 101 were detected in suspensions grown in THB 20% whey than in THB alone . Capsule expression of S . uberis UT 101 was maximal at 10 hours and decreased after 12 hours of growth . In contrast, S . uberis UT 102 showed negligible percentage (< 2%) of encapsulated bacteria during the entire growth curve . Chemical analysis of capsular material and the pattern of lectin agglutination suggest that hyaluronic acid is the major component . These results will be useful for understanding the pathogenesis of infections caused by S . uberis.

Clin Infect Dis, 1993 Dec, 17(6), 1063 - 4
Rhabdomyolysis associated with bacteremia due to Streptococcus pneumoniae: case report and review; Spataro V et al.; We report a case of bacteremic Streptococcus pneumoniae pneumonia associated with rhabdomyolysis and review seven other cases of pneumococcal infections associated with bacteremia and rhabdomyolysis . Most of these cases were complicated by transient myoglobinuric renal failure, and some patients required dialysis . Two patients died, but their deaths were not directly related to rhabdomyolysis . We discuss mechanisms that may be involved in rhabdomyolysis associated with pneumococcal infections . Rhabdomyolysis is a rare but potentially serious complication of a common disease.

Clin Infect Dis, 1993 Dec, 17(6), 1037 - 40
Thrombotic microangiopathy associated with Streptococcus pneumoniae bacteremia: case report and review; Myers KA et al.; Thrombotic microangiopathy, a disease within the clinical spectrum of thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome, was recognized in a previously healthy 50-year-old woman who presented with pneumococcal bacteremia complicated by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, and disorientation . After treatment with plasma exchange and antibiotics, the patient's clinical condition improved . Discontinuation of plasma exchange resulted in a relapse of thrombocytopenia and microangiopathic hemolytic anemia that responded to reinitiation of this intervention . The production of the enzyme neuraminidase by Streptococcus pneumoniae is thought to contribute to the pathogenesis of the thrombotic process . Although pneumococcal infection has been associated with hemolytic-uremic syndrome in children, review of the literature on adults revealed only one such case (in a patient who had undergone splenectomy in the remote past) . This report therefore documents an unusual complication of pneumococcal bacteremia in an immunocompetent adult.

Clin Infect Dis, 1993 Dec, 17(6), 1006 - 11
Bacteremia due to Enterococcus avium; Patel R et al.; Enterococcus avium, formerly "group Q streptococcus," has rarely been reported as a pathogen in humans . To determine the clinical significance of this organism, we reviewed the records of all patients whose blood cultures were positive for E . avium who were seen at our institution from 1986 through 1991 and identified nine cases of bacteremia due to E . avium . All isolates were believed to be clinically significant . Five of nine cases developed in patients with significant gastrointestinal illnesses . The remaining clinical scenarios included intravenous catheter sepsis and factitious disorders . E . avium bacteremias were polymicrobial in seven cases; in six cases, the coisolates were gastrointestinal organisms . These observations suggest that E . avium bacteremia most often originated from a gastrointestinal tract source . We conclude that, though rare, E . avium can be pathogenic in humans and that E . avium bacteremia is associated with gastrointestinal abnormalities.

APMIS, 1993 Dec, 101(12), 933 - 8
Effects of xylitol/sorbitol combinations on bacterial growth and metabolism in Streptococcus sobrinus OMZ 176; Assev S et al.; Combinations of the non-cariogenic sugar alcohols xylitol and sorbitol are widely used as sucrose substitutes in lozenges and chewing-gums . In S . sobrinus OMZ 176 xylitol inhibits the metabolism of sorbitol, and the xylitol-induced bacterial growth inhibition of S . sobrinus OMZ 176 has been shown to be enhanced by sorbitol . In combination with xylitol the sorbitol transport changes from a pts- to a non-pts transport, while the transport of xylitol is unaffected by the presence of sorbitol . It would be of interest to know how much xylitol has to be added to a sorbitol-containing medium to inhibit the metabolism of this sugar alcohol . In the present study no optimal inhibitory concentrations of xylitol/sorbitol combinations were found . Growth and acid production in S . sobrinus OMZ 176 are essentially the same for xylitol: sorbitol ratios in the range from 1:7 to 7:1 . The presence of intracellular xylitol metabolites seems to be essential.

Bol Med Hosp Infant Mex, 1993 Dec, 50(12), 854 - 60
{The resistance and serotyping of 83 strains of Streptococcus pneumoniae isolated from asymptomatic carriers and ill children}; Calderon-Jaimes E et al.; Eight-three isolates of Streptococcus pneumoniae obtained from children hospitalized with several infections in Mexico City and Cuernavaca, and from healthy children attending a day-care center in Cuernavaca, from January to September 1992, were screened for antimicrobial resistance patterns by in vitro susceptibility testing against antimicrobial agents of potential use in the treatment of diseases caused by S . pneumoniae (39 infected patients and 44 from healthy children) . 21.6% of strains were resistant to penicillin, 52% of the strains were multiresistant without a commun pattern . Children attending a day-care center had a higher rate of S . pneumoniae strains resistant to one or more antimicrobial than hospitalized children . Serotypes or serogroups 6, 23F, 14 and 19 were most prevalent . There are evidence that strain 23F has an intercontinental link, this strain is associated with disseminated diseases and multiresistance to antimicrobials . The results indicate that changes can occur in the susceptibility of S . pneumoniae and that selective susceptibility testing and epidemiologic studies in hospitalized patients and children in day-care centers are necessary.

Semin Respir Infect, 1993 Dec, 8(4), 294 - 9
Pneumococcal vaccine in the prevention of community-acquired pneumonia: a skeptical view of cost-effectiveness; Simberkoff MS; Streptococcus pneumoniae (pneumococcus) is an important pathogen that causes pneumonia, bacteremia, and meningitis in adults . In recent years, pneumococcal isolates resistant to penicillin have become increasingly prevalent in the U.S . For these reasons, wide use of the pneumococcal vaccine has been advocated . Pneumococcal vaccines have been proven to be effective in preventing the invasive complications of S pneumoniae infection . The efficacy of pneumococcal vaccines in preventing non-bacteremic pneumonia in high-risk subjects, however, has not been proven . The current pneumococcal vaccine is limited because it includes the antigens of the serotypes known to be associated with invasive infection, and it elicits a thymus-independent, B-cell response that evokes no memory and a poor immunologic response in many of the patients at greatest risk for pneumococcal infection . In the absence of data concerning efficacy of the pneumococcal vaccine against pneumonia, it is difficult to argue that it is cost-effective for this purpose . I concur with the recommendations for use of pneumococcal vaccine to prevent bacteremia, but I am skeptical about the vaccine's efficacy against pneumonia . More data and an improved vaccine are necessary.

Mol Microbiol, 1993 Dec, 10(5), 1049 - 55
Protein F: an adhesin of Streptococcus pyogenes binds fibronectin via two distinct domains; Sela S et al.; The binding of Streptococcus pyogenes to fibronectin (FN) enables the adherence of this pathogen to target epithelial cells, which is the first necessary step for initiation of infection . Binding is mediated by a bacterial surface protein termed protein F . Here we provide the complete structure of protein F and identify two domains responsible for binding to fibronectin . The first domain is located towards the C-terminal end of the molecule and is composed of five repeats of 37 amino acids that are completely repeated four times and a fifth time partially . The second domain is adjacent to the first domain and is located on the N-terminal side of it . It is composed of a single stretch of 43 amino acids . Protein F expressed in Escherichia coli completely blocked the binding of fibronectin to S . pyogenes . However, mutant proteins that contained only one or the other of the two domains were only capable of partial blockage of binding . Complete blockage of binding of fibronectin could be achieved when a protein extract containing the N-terminal domain was mixed in a binding reaction with a protein extract containing the C-terminal domain . Similarly, a purified recombinant protein containing the two domains only, blocked the binding completely . In contrast, a purified recombinant protein containing just the C-terminal domain, blocked the binding partially . A clone exclusively expressing the C-terminal domain, completely blocked the binding of the 30 kDa N-terminal fragment of fibronectin to S . pyogenes, whereas a clone expressing the N-terminal domain failed to block the binding of this FN fragment.(ABSTRACT TRUNCATED AT 250 WORDS)

Arch Dis Child, 1993 Dec, 69(6), 685 - 8
Polyarteritis nodosa associated with streptococcus; David J et al.; Twelve children are described with an essentially benign vasculitic illness in association with streptococcal infection . They demonstrated characteristic clinical features of nodular cutaneous polyarteritis with fever . Laboratory findings showed an acute phase response associated with raised antistreptolysin and antihyaluronidase titres in all patients and a positive throat culture for beta haemolytic streptococcus in three patients . Ten required corticosteroids . Two patients had systemic involvement with abnormal arteriography; both had appreciably raised white cell counts (> 40 x 10(9)/l) . They may represent a subset of poststreptococcal vasculitis, requiring cytotoxic treatment for effective disease control.

Lett Appl Microbiol, 1993 Dec, 17(6), 297 - 9
SbvI restriction endonuclease from Streptococcus bovis; Vanat I et al.; Restriction endonuclease SbvI, an isoschizomer of HaeIII, has been isolated from rumen amylolytic bacterium Streptococcus bovis II/1 . SbvI was purified from cell extract by phosphocellulose chromatography and heparin-Sepharose chromatography . The recognition sequence of SbvI was identified by digestion of pBR322, pUC9 and lambda-DNA and comparing the cleavage patterns obtained with computer-derived data . SbvI recognizes the 4-bp palindrome, 5'-GGCC-3' and cleaves DNA after the second G in the sequence, producing blunt ends.

Dtsch Med Wochenschr, 1993 Nov 26, 118(47), 1714 - 21
{Pulmonary valve endocarditis, bilateral deep vein thrombosis amd recurrent pulmonary emboli}; Faber L et al.; A 57-year-old obese man with hypertensive heart disease and long-standing varicose veins developed recurrent bouts of fever, lung infiltrations, cardiac arrhythmias and increasing dyspnoea . On admission multiple lung emboli and bilateral deep vein thromboses were confirmed . The echocardiogram demonstrated floating vegetations on all three pulmonary valve cusps . Biochemical tests indicated an inflammatory constellation (ESR 62/105 mm, C-reactive protein 13.3 mg/dl), partial respiratory insufficiency (pO2 54.6 mm Hg; pCO2 29 mm Hg) . Streptococcus bovis was grown from several blood cultures . Conservative treatment over several weeks, complicated by "drug fever", with penicillin G (10 mega IU four times daily) and gentamicin (80 mg twice daily intravenously), later vancomycin (500 mg four times daily intravenously), then roxithromycin (150 mg three times daily by mouth), as well as maintenance anticoagulation with heparin (800-1,200 IU/h intravenously, later 15,000 IU subcutaneously twice daily), followed by phenprocoumon, contained the disease . One year after onset of treatment a good functional results had been achieved.

Presse Med, 1993 Nov 20, 22(36), 1818 - 9
{Vancomycin in meningitis caused by penicillin G resistant Streptococcus pneumoniae}; Longuet P et al.; We report two cases of penicillin G-resistant pneumococcal meningitis in adults, with clinical and bacteriological failure of amoxicillin and negative or incomplete response to third generation cephalosporins . Meningitis occurred in a man treated for myeloma and in an elderly woman under prolonged intermittent amoxicillin therapy for chronic otitis . Such situations are known as exposing to pneumococcal meningitis and to resistance of the strain involved to penicillin G . Both patients were cured by vancomycin in continuous infusion associated with rifampicin or fosfomycin . Contrary to third generation cephalosporins, which have higher minimal inhibitory concentrations, vancomycin and rifampicin are still fully active against penicillin G-resistant pneumococcal strains . Thus, vancomycin administered in continuous infusion and associated with rifampicin and fosfomycin deserves to be tried as first-line treatment of pneumococcal meningitis in patients at risk of resistance to penicillin G.

FEMS Microbiol Lett, 1993 Nov 15, 114(1), 67 - 71
Activation of bovine plasminogen by Streptococcus uberis; Leigh JA; Culture filtrate from Streptococcus uberis was found to activate bovine and equine plasminogen but not that from rabbit, human or porcine plasma . In contrast, streptokinase from a Lancefield group C Streptococcus activated human plasminogen but not that from bovine, porcine and rabbit plasma . Very slight activity was observed against equine plasminogen . Plasmin was detected by hydrolysis of skimmed milk protein in agarose . The activation of bovine plasminogen by S . uberis culture filtrate resulted in the formation of three polypeptides with molecular masses of 56, 26 and 21 kDa . This is the first report of a streptokinase activity from this species.

FEMS Microbiol Lett, 1993 Nov 15, 114(1), 61 - 6
Isolation and sequence analysis of the pmi gene encoding phosphomannose isomerase of Streptococcus mutans; Sato Y et al.; A gene encoding a phosphomannose isomerase from Streptococcus mutans GS-5 was identified immediately downstream from the fructokinase gene, scrK . Nucleotide sequence analysis of this region revealed an open reading frame (ORF) specifying a putative protein of 316 amino acids . The gene cloned in Escherichia coli expressed strong phosphomannose isomerase activity . The deduced amino acid sequence of the pmi gene has no significant similarity with any of the previously reported phosphomannose isomerase enzymes . Insertional inactivation of the upstream gene, scrK, in S . mutans also drastically reduced phosphomannose isomerase activity and the ability of the organism to utilize mannose as a sole carbon source . These results suggest that the S . mutans pmi gene constitutes an operon with the scrK gene.

FEMS Microbiol Lett, 1993 Nov 15, 114(1), 31 - 6
Inhibition of coaggregation between Porphyromonas gingivalis and Streptococcus oralis by fibrinogen fragments; Nagata H et al.; The localization of regions of fibrinogen that inhibit coaggregation between Porphyromonas gingivalis and Streptococcus oralis was investigated . The coaggregation was inhibited by A alpha and gamma chains, but not by B beta chain . The inhibitory activity of fragment D was more potent than that of fragment E . Some cyanogen bromide-treated fragments isolated from A alpha and gamma chains including the NH2-terminal 148-207 amino acid residues of A alpha chain (A alpha 148-207) and gamma 1-78 showed inhibitory activities . A alpha 148-207 was further digested with lysyl endopeptidase . A alpha 158-176 and A alpha 192-206 which contained four and two arginine residues, respectively, retained the inhibitory activities . When the arginine residues of these two peptides were modified by phenylglyoxal, the inhibitory activities were much reduced . These findings suggest that the arginine residues of some specific regions of fibrinogen may play an important role in the inhibition of the coaggregation.

J Biol Chem, 1993 Nov 15, 268(32), 23946 - 53
Fibronectin receptors from Streptococcus dysgalactiae and Staphylococcus aureus . Involvement of conserved residues in ligand binding; McGavin MJ et al.; The nucleotide sequence of two genes encoding fibronectin (Fn) receptors FnBA and FnBB of Streptococcus dysgalactiae S2 revealed the presence of repeated motifs (called RA1-A3 and RB1-B3, respectively) which encode Fn binding activity (Lindgren, P.-E., McGavin, M . J., Signas, C., Guss, B., Gurusiddappa, S., Hook, M., and Lindberg, M . (1993) Eur . J . Biochem . 214, 819-827) . Synthetic peptides of 32-37 amino acids, corresponding to individual repeated motifs, were assayed for the ability to inhibit Fn binding to cells of S . dysgalactiae . Within the RA motifs, peptide A2 was 10-fold more active than either A1 or A3, while in the RB motifs, only B3 was active . The same level of activity is observed when these synthetic peptides were assayed for inhibition of Fn binding to cells of Staphylococcus aureus . Likewise, synthetic peptides corresponding to the RD1-D3 motifs, which comprise a ligand binding domain in a Fn receptor from S . aureus, inhibit binding of Fn to both S . aureus and S . dysgalactiae . Assays of chemically modified peptides and peptide fragments derived from chemical or proteolytic cleavage suggest that a conserved core sequence, defined as ED(T/S) (X9,10)GG(X3,4)(I/V)DF, within a 30-amino acid-long segment is present in the active RA and RD motifs . Analyses of the importance of individual residues of this core sequence indicate that the ED(T/S) motif is nonessential, whereas the GG and the (I/V)DF together with additional acidic residues in the C-terminal half of the peptide are required for activity.

Bull Tokyo Dent Coll, 1993 Nov, 34(4), 167 - 71
Disinfectant effects of "Taisalite" and "Taifresh Ace" containing Irgasan DP300 against MRSA and HIV; Yamanaka A et al.; Sterilization and disinfection in dental clinics and laboratories are important in controlling disease vectors such as methicillin-resistant Staphylococcus aureus (MRSA) and human immunodeficiency virus (HIV) . We determined the inactivation of disinfectant effects of "Taisalite" and "Taifresh Ace" containing Irgasan DP300 on MRSA, Streptococcus pyogenes, Candida albicans, and HIV . Exposure for 10 seconds to 50% or 5% Taisalite solution inactivated HIV completely . HIV was also completely inactivated by 10 minutes of exposure to 50% or 5% of Taifresh Ace solution . Taisalite possessed strong bactericidal activity against S . pyogenes and MRSA . C . albicans was resistant to 10 to 30 second exposures to Taisalite . MRSA and C . albicans were killed completely by exposure to 90% Taifresh Ace solution for 10 minutes . S . pyogenes was not highly sensitive to Taifresh Ace . The present study showed that Irgasan DP300 containing Taisalite is an excellent disinfectant against HIV and MRSA and that Taifresh Ace is a useful detergent against these micro-organisms.

J Immunol, 1993 Nov 1, 151(9), 4743 - 52
Purification and characterization of chimeric human IgA1 and IgA2 expressed in COS and Chinese hamster ovary cells; Morton HC et al.; Ag-specific chimeric human IgA molecules, of the two human subclasses, IgA1 and IgA2, have been expressed in two mammalian cell systems . Analysis of the secreted IgA molecules, purified in milligram quantities from stable Chinese hamster ovary transfectants by Ag affinity chromatography, has allowed a direct comparison of the biologic properties of the two subclasses . HPLC gel filtration analysis revealed that in both subclasses, the IgA molecules associate predominantly into dimers . The monomer units are presumed to interact noncovalently, inasmuch as no dimers are evident when the antibodies are subjected to SDS-PAGE . The recombinant antibodies are glycosylated, inasmuch as a lectin blotting procedure revealed that the H chains of both subclasses are recognized by Con A . When subjected to digestion by preparations of IgA1-specific proteases secreted by two pathogenic streptococcal strains, Streptococcus sanguis and Streptococcus oralis, the recombinant IgA molecules behave just as their natural equivalents . Thus, only the chimeric IgA1 molecule is cleaved, with the IgA2 remaining intact . In terms of interaction with natural effector molecules, both recombinant IgA isotypes were shown to interact with Fc alpha receptors on calcitriol-stimulated HL-60 cells with similar affinity, but neither antibody was found to interact with human C1q . The expression system described readily permits manipulation of the human IgA genes, which should lead to a fuller molecular understanding of how this important antibody mediates its function.

Vaccine, 1993 Nov, 11(14), 1429 - 36
Protein-conjugated synthetic di- and trisaccharides of pneumococcal type 17F exhibit a different immunogenicity and antigenicity than tetrasaccharide; Alonso de Velasco E et al.; Overlapping synthetic disaccharide, trisaccharide and tetrasaccharide, derived from pneumococcal polysaccharide type 17F (PS17F), were coupled to keyhole limpet haemocyanin (KLH) . The conjugates were tested in mice . The disaccharide-KLH and especially trisaccharide-KLH, in combination with Quil A, induced high titres of high-avidity anti-PS17F IgG . Both conjugates protected mice against challenge with Streptococcus pneumoniae 17F . Tetrasaccharide-KLH, although able to elicit anti-tetrasaccharide antibodies, induced a minimal non-protective anti-PS17F IgG response of low avidity . The tetrasaccharide-KLH conjugate, in contrast to the other conjugates, failed to bind rabbit anti-PS17F IgG.

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