Ann Cardiol Angeiol (Paris), 1995 Sep, 44(7), 339 - 44 {Bacterial endocarditis in Morocco}; Bennis A et al.; This retrospective study was based on 157 cases of infectious endocarditis observed in the Cardiology department of Ibn Rochd Hospital in Casablanca between January 1983 and December 1994 . The mean age of the patients was 27.5 years (11 to 65 years) with a male predominance (62.8%) . Infectious endocarditis was secondary to rheumatic valvular heart disease in 63.% of patients and was primary in 29.9% of cases . Mitral or mitro-aortic valve involvement was clearly predominant . A portal of entry of the infection was identified in 63% of patients . It was dental in 64% of cases . Blood cultures were positive in 42% of cases with a predominance of unclassifiable Streptococci (37.8%) and coagulase-negative Staphylococci (25.7% of cases) . Echocardiography was very useful, particularly in the presence of negative blood cultures . It demonstrated specific lesions of infectious endocarditis in 73.2% of cases and revealed very large, mobile vegetations in every case complicated by systemic embolism . The clinical course was complicated by heart failure (47.8%), renal failure (14.6%) or neurological lesions (11.5%) . The global mortality was 28.7%, related to refractory heart failure in most cases. Plasmid, 1995 Sep, 34(2), 85 - 95 Development of a heterodimer plasmid system for the introduction of heterologous genes into streptococci; Shiroza T et al.; We have previously constructed a model secretion system for oral streptococci using the secretory domain of the Streptococcus mutans GS-5 gtfB gene . As an initial step in developing systems for secreting protein fusions containing a glucan-binding polypeptide from streptococci, a DNA fragment corresponding to the glucan-binding domain (GBD) of the glucosyltransferase-S enzyme from strain GS-5 was fused to the gtfB secretory domain . However, it was not possible to clone the hybrid gene into Escherichia coli-streptococcal shuttle plasmids using E . coli as host cells . Integration of the hybrid GBD gene into the Streptococcus gordonii chromosome was directly accomplished utilizing a strategy involving a novel heterodimeric plasmid system . The heterodimer was constructed by ligating together two plasmids each containing DNA fragments homologous with a corresponding region of the S . gordonii chromosome flanking the hybrid GBD gene following a double crossover recombination event . However, this single-copy integrant secreted limited quantities of the GBD protein . In order to achieve high-level expression of the protein, the hybrid GBD gene was integrated into resident plasmids in S . gordonii following construction of intermediate heterodimeric plasmids . These plasmids contained the GBD gene flanked by sequences homologous to regions of the resident plasmids . The presence of the GBD protein in culture fluids from transformants harboring the multicopy plasmids demonstrated the secretion of the functional GBD protein . The strategy successfully developed for secreting the GBD in the streptococci should be adaptable for other organisms for which gene transfer systems are available . In addition, these systems will allow the direct introduction of genetic constructs when the constructs cannot be stably maintained in shuttle vectors within intermediate hosts such as E . coli. Pediatr Infect Dis J, 1995 Sep, 14(9), 767 - 70 Increased incidence and severity of Streptococcus pyogenes bacteremia in young children; Moses AE et al.; An increase in the incidence and severity of bacteremia caused by group A streptococci was noted in 1993 and 1994 in the Hadassah University Medical Center, Jerusalem . During the 6-year period 1987 to 1992, 12 children with group A streptococcal bacteremia were hospitalized, whereas in 1993 and 1994 there were 17 patients, 5 of them with 1 each of the following severe clinical manifestations: meningitis and septic shock; streptococcal toxic shock syndrome; septic shock; pleural empyema; and fatal outcome . Our 29 patients with group A streptococcal bacteremia were younger than those reported in the literature: 10 (35%) were < 3 months of age; 17 (59%) were < 1 year old . Most children were previously healthy and only 3 had an underlying immunodeficiency predisposing to infection (1 case each): leukemia; Di George syndrome; and congenital nephrotic syndrome . Two children were recovering from varicella . The skin was the most common site of primary infection (16 of 29) . The average white blood cell (WBC) count was 18 150 cells/mm3 (range, 2200 to 34,200) . The cases were not related epidemiologically and were caused by a variety of M-protein types . Polymerase chain reaction amplification of the genes encoding exotoxins A (speA) and C (speC) was done on 19 isolates and disclosed 2 strains positive for speA and 5 positive for speC . One of the speA-positive isolates was from the single patient with toxic shock syndrome. Antimicrob Agents Chemother, 1995 Sep, 39(9), 2098 - 103 Effect of gentamicin dosing interval on therapy of viridans streptococcal experimental endocarditis with gentamicin plus penicillin; Gavalda J et al.; This study compares the effects of a total daily dose of gentamicin given once a day (q.d.) or three times a day (t.i.d.) in the therapy of experimental endocarditis in rabbits caused by penicillin-susceptible, penicillin-tolerant, or penicillin-resistant viridans streptococci . Four isolates were used in vivo: one penicillin susceptible (MIC < or = 0.03 microgram/ml), one penicillin tolerant (MBC/MIC, < or = 0.03/ > 32 micrograms/ml), and two penicillin resistant (MICs = 0.5 and 2 micrograms/ml) . Animals were infected with one of the four isolates and assigned to one of the following treatment regimens: no treatment, procaine penicillin at 1.2 million IU intramuscularly (i.m.) t.i.d., procaine penicillin plus gentamicin at 1 mg/kg of body weight i.m . t.i.d., procaine penicillin plus gentamicin at 3 mg/kg i.m . q.d., or procaine penicillin plus gentamicin at 1 mg/kg i.m . q.d . (only animals infected with the penicillin-susceptible isolate) . Serum drug concentrations measured 30 min after administration of 1.2 million IU of penicillin and 1 or 3 mg of gentamicin per kg were 22.6, 3.8, and 8.5 micrograms/ml, respectively . The reduced total daily dose of gentamicin was ineffective among animals infected with penicillin-susceptible viridans streptococci; treatment with 1 mg of gentamicin per kg per day plus penicillin was less effective (P < 0.05) than was treatment with 3 mg of gentamicin per kg per day plus penicillin . The 1-mg/kg/day gentamicin treatment regimen was not further studied . The gentamicin dosing interval did not significantly affect (q.d . versus t.i.d., P > 0.05) the relative efficacy of penicillin plus gentamicin for treatment of experimental endocarditis among animals infected with each of the four isolates tested. Antimicrob Agents Chemother, 1995 Sep, 39(9), 1938 - 47 In vivo efficacy of azithromycin in treatment of systemic infection and septic arthritis induced by type IV group B Streptococcus strains in mice: comparative study with erythromycin and penicillin G; Tissi L et al.; We compared the activities of azithromycin, erythromycin, and penicillin G in a mouse model of systemic infection and septic arthritis induced by type IV group B streptococci (GBS) . The in vitro and in vivo efficacy data for these drugs were analyzed relative to the pharmacokinetics of the drugs in sera, joints, and kidneys . Adult CD-1 mice were infected intravenously with 10(7) CFU of type IV GBS . Intraperitoneal drug administration was initiated with different dose regimens at different times after infection . A single dose of azithromycin (100 mg/kg) strongly reduced the incidence of articular lesions with respect to that with erythromycin or penicillin G . Treatment with azithromycin (three intraperitoneal administrations of 50 mg/kg at 12-h intervals) resulted in the complete prevention of arthritis . In contrast, erythromycin was poorly effective and penicillin G was effective only if inoculated 30 min after infection and at high doses (400,000 or 600,000 IU/kg) . Furthermore, azithromycin was able to cure about 70% of the mice when administered 7, 8, and 9 days after GBS infection . Azithromycin was much more active than erythromycin and penicillin G with respect to bacterial killing in the joints and kidneys . In fact, cultures from these tissues were always negative no matter what treatment schedule was employed . The pharmacokinetics of azithromycin account for its superior in vivo efficacy against type IV GBS . A longer half-life and higher levels of this drug in serum and tissues with respect to those for erythromycin or penicillin G were achieved . The high affinity of azithromycin for the joints strongly supports its potential value for therapy of septic arthritis, which is a severe and frequent clinical manifestation of GBS infection. Eur J Clin Microbiol Infect Dis, 1995 Sep, 14(9), 815 - 7 Evaluation of a rapid agglutination test for detection of group B streptococci in the gastric aspirates of neonates; Poilane I et al.; A rapid commercial agglutination test (Bactigen Strepto B) for detection of group B streptococci in gastric aspirates of neonates was evaluated . One hundred and sixty-one gastric samples were analyzed with conventional bacteriological techniques and with the commercial test after modification of the extraction technique . The sensitivity of the test relative to the culture technique was 90.4%, the specificity 94.2%, the positive predictive value 70.3% and the negative predictive value 98.5% . The commercial test could be performed in one hour and showed good sensitivity and specificity . If a test result was negative colonization could be excluded, obviating the need for empirical antibiotic therapy, whereas a positive result suggested colonization or neonatal infection with group B streptococci. J Ind Microbiol, 1995 Sep, 15(3), 176 - 85 Adhesin receptors of human oral bacteria and modeling of putative adhesin-binding domains; Cassels FJ et al.; Adherence by bacteria to a surface is critical to their survival in the human oral cavity . Many types of molecules are present in the saliva and serous exudates that form the acquired pellicle, a coating on the tooth surface, and serve as receptor molecules for adherent bacteria . The primary colonizing bacteria utilize adhesins to adhere to specific pellicle receptor molecules, then may adhere to other primary colonizers via adhesins, or may present receptor molecules to be utilized by secondary colonizing species . The most common primary colonizing bacteria are streptococci, and six streptococcal cell wall polysaccharide receptor molecules have been structurally characterized . A comparison of the putative adhesin disaccharide-binding regions of the six polysaccharides suggests three groups . A representative of each group was modeled in molecular dynamics simulations . In each case it was found that a loop formed between the galactofuranose beta (Galf beta) and an oxygen of the nearest phosphate group on the reducing side of the Galf beta, that this loop was stabilized by hydrogen bonds, and that within each loop resides the putative disaccharide-binding domain. J Bacteriol, 1995 Sep, 177(17), 5028 - 34 Use of a novel mobilizable vector to inactivate the scrA gene of Streptococcus sobrinus by allelic replacement; Buckley ND et al.; The virulence factors of the cariogenic bacterium Streptococcus sobrinus have been difficult to assess because of a lack of tools for the genetic manipulation of this organism . The construction of an Escherichia coli-Streptococcus shuttle vector, pDL289, that can be mobilized into S . sobrinus by the conjugative plasmid pAM beta 1 was described in a previous report . The vector contains pVA380-1 for replication and mobilization in streptococci, the pSC101 replicon for maintenance in E . coli, a kanamycin resistance marker that functions in both hosts, and the multiple cloning site and lacZ from pGEM7Zf(-) . pDL289 is stable with or without selection in several species of Streptococcus . In this study, a derivative with a deletion in the minus origin of the pVA380-1 component of pDL289 was constructed . This derivative, pDL289 delta 202, was less stable than pDL289 in Streptococcus gordonii Challis, Streptococcus mutans, and S . sobrinus . Both pDL289 and pDL289 delta 202 were mobilizable by pAM beta 1 into S . sobrinus, with frequencies of 3 x 10(-6) and 1 x 10(-7) transconjugants per recipient CFU, respectively . The cloned scrA gene of S . sobrinus 6715-10 coding for the EIISuc of the sucrose-specific phosphoenolpyruvate phosphotransferase system was interrupted by the insertion of a streptococcal spectinomycin resistance gene active in E . coli and streptococci . The interrupted scrA gene was subcloned into both pDL289 and pDL289 delta 202 . Each recombinant plasmid was introduced into the DL1 strain of S . gordonii Challis, which was then used as a recipient for the conjugative transfer of pAM beta 1 . The latter plasmid was used to mobilize each recombinant plasmid from S . gordonii Challis DL1 to S . sobrinus 6715-10RF . Subsequently, recombinants derived from a double-crossover event were isolated on the basis of resistance to spectinomycin and susceptibility to kanamycin . Recombinational events were confirmed by Southern hybridization, and the inactivation of the EII Suc in double crossovers was confirmed by phosphotransferase system assays . This is the first report of allelic replacement in S . sobrinus. Am J Gastroenterol, 1995 Sep, 90(9), 1528 - 9 Carcinoma of the colon presenting as Streptococcus sanguis bacteremia; Siegert CE et al.; Bacteremia by streptococci that normally inhabit the gastrointestinal tract has been associated with colon carcinoma . Such association is best known for Streptococcus bovis, but has also been reported for other streptococci . In the present communication a patient is described who presented with Streptococcus sanguis bacteremia and was subsequently found to suffer from an adenocarcinoma of the sigmoid . A possible association between bacteremia by commensal streptococci of both the upper and lower gastrointestinal tract and colon carcinoma is discussed. Scand J Immunol, 1995 Sep, 42(3), 359 - 67 Multiple ligand interactions for bacterial immunoglobulin-binding proteins on human and murine cells of the hematopoetic lineage; Axcrona K et al.; A group of bacterial Ig-binding surface proteins were studied: protein H and M1 are from Streptococcus pyogenes and interact with IgG, protein L is expressed by Peptostreptococcus magnus and shows affinity for Ig light chains, whereas protein LG is a chimeric construction combining the binding properties of protein L with the IgG-binding activity of protein G from group C and G streptococci . Proteins L and H coupled to Sepharose were mitogenic for human peripheral blood lymphocytes (PBL) and mouse splenic B cells, but not when added in soluble form . Differentiation to Ig secretion was induced by protein H-Sepharose in mouse splenic B cells but not in human PBLs . In FACS analysis FITC-labelled protein H stained virtually all CD19+ cells in human peripheral blood as well as a majority of the CD3+ population . Protein L bound the majority of the CD19+ population, but also a fraction of the CD19-/CD3 population . Protein M1 was not mitogenic but stained the entire CD19+ population and 70% of the CD3+ population . Identical staining patterns were observed with mouse splenocytes using B220 and T-cells receptor as lineage markers . The chimeric protein LG was a potent mitogen for mouse splenic B cells when added either coupled to Sepharose or in soluble form . In addition, protein LG induced differentiation to Ig secretion of the responding mouse splenic B cells . In FACS analysis, protein LG stained the entire CD19+ and the majority of the CD19-/CD3 lymphocyte population as well as all B220+ mouse splenocytes and a fraction of the splenic T cells . These data indicate that the bacterial proteins studied interact with surface structures of several leucocyte populations and can hence interfere with the immune system at multiple levels. Chest, 1995 Sep, 108(3), 688 - 94 Prosthetic valve endocarditis in the ICU . Prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision; Wolff M et al.; We carried out univariate and multivariate analysis of outcome among 122 patients with prosthetic valve endocarditis (PVE) admitted to our ICU between 1978 and 1992 . The predominant pathogens were Staphylococcus aureus (33%), streptococci (20%), coagulase-negative staphylococci (12%), enterococci (10%), and Gram-negative bacilli (9%) . At 4 months, overall survival was 66% (42 deaths) . Staphylococcus aureus was the main predictor of death (75% vs 15% with other pathogens) . In S aureus PVE, multivariate analysis identified the following predictors of death: prothrombin time < 30% (relative risk {RR}: 8.3), concomitant mediastinitis (RR: 4.9), heart failure (RR: 4.4), and septic shock (RR: 2.6) . In PVE due to other pathogens, prothrombin time < 30% (RR: 32.26), renal failure (RR: 7.31), and heart failure (RR: 6.07) were associated with death . In S aureus PVE, survival was higher in patients who received medical-surgical therapy than in those who received medical therapy alone (9/20 {45%} vs 0/20) (p < 0.01) . In PVE due to other pathogens, there was no difference in survival between patients who underwent prosthesis replacement (89%) and those who received only medical treatment (81%) . Among the 65 patients who underwent heart surgery, the mortality rate and incidence of postoperative paravalvular leakage did not correlate with positive prosthesis cultures . We conclude that non-S aureus and uncomplicated PVE may be managed without valve replacement but that prompt surgical intervention should be required in all other situations. Infect Immun, 1995 Sep, 63(9), 3715 - 7 Tumor necrosis factor alpha acts as an autocrine second signal with gamma interferon to induce nitric oxide in group B streptococcus-treated macrophages; Goodrum KJ et al.; Nitric oxide production by mouse macrophages treated with group B streptococci and gamma interferon was inhibited by cytochalasin B or by antibody neutralization of macrophage-derived tumor necrosis factor alpha . Phagocytosis-induced tumor necrosis factor alpha is responsible for group B streptococcus-induced nitric oxide production in interferon-treated macrophages. Kansenshogaku Zasshi, 1995 Sep, 69(9), 982 - 6 {Participation in causing O.M.E . with nasopharyngeal alpha-Streptococcus}; Fujimori I et al.; The role of normal pharyngeal flora in the defense mechanism against infections in the upper respiratory tract was studied in 50 children with otitis media with effusion (O.M.E.) . In the bacteriological study of the nasopharynx, the incidence of H . influenzae, S . pneumoniae, S . aureus, M . catarrhalis and group A Streptococcus was about 46%, 24%, 20%, 12% and 8%, respectively . The incidence of these species in the cases with O.M.E . was higher than that in the cases with chronic tonsilitis or control cases . In 41 O.M.E . cases with alpha-streptococci (82%), the incidence of alpha-streptococci with inhibitory activity against 5 pathogens (H . influenzae, S . pneumoniae, S . aureus, M . catarrhalis, group A Streptococcus) was examined . The detection rate of alpha-streptococcal strains with inhibitory activity against 5 pathogens derived from the nasopharynx in the cases with O.M.E . was significantly lower than that of the strain in the chronic tonsilitis cases and the control cases . Moreover, the detection rate of inhibitory alpha-streptococci from the nasopharynx was lower than that of from the tonsil . These findings suggest that the decline of inhibitory activity against pathogens by normal flora in nasopharynx is one of the factors causing O.M.E. J Dent Res, 1995 Sep, 74(9), 1618 - 24 The effect of fluorhydroxyapatite-derived fluoride on acid production by streptococci; Guha-Chowdhury N et al.; The effect of fluoride derived from fluorhydroxyapatite (FHAp) minerals on bacterial glycolysis under aerobic and strictly anaerobic conditions was studied to validate the claims that this mineral could be used as a reservoir of fluoride in plaque . To isolate the direct effect of fluoride on bacterial glycolysis from that of an indirect pH-buffering effect of hydroxyl or phosphate ions which are also dissolved from the mineral, we equalized the pH-fall time course of reactions by manually adding KOH or HCl . This ensured that pH effects on glycolysis were minimized . Under controlled pH-fall and strictly anaerobic conditions, fluoride derived from the dissolution of FHAp containing more than 30,100 ppm fluoride (i.e., when the substitution of OH by F in the mineral was greater than 80%) had a direct inhibitory effect on lactic acid production in Streptococcus mutans . Under free pH-fall and strictly anaerobic conditions, increasing amounts of fluoride in FHAp (starting as low as 2000 ppm fluoride), appeared to have a pronounced indirect inhibitory effect on lactic acid production . This was probably mediated through a reducing pH buffer effect of the mineral . Even in the presence of high-fluoride FHAp, only 0.01 to 0.025 mmol/L fluoride was found in the reaction mixtures, a probable result of non-stoichiometric dissolution of FHAp . In spite of such low levels of fluoride, marked inhibitory effects on bacterial glycolysis were demonstrated . The results of this study suggest that high-fluoride FHAp may serve as a reservoir of fluoride for the inhibition of anaerobic acid production by S . mutans. J Clin Microbiol, 1995 Sep, 33(9), 2480 - 2 Relative value of selective group A streptococcal agar incubated under different atmospheres; Pacifico L et al.; A commercially available selective group A streptococcal agar (ssA) was evaluated for the recovery of group A streptococci (GAS) in comparison with recovery from simultaneous cultures on conventional sheep blood agar (SBA) . Both sets of plates were incubated in air, 5% CO2, and anaerobically for 48 h, with a first reading taken at 24 h . A total of 402 (67.0%) GAS were isolated from the 600 specimens that were submitted . Recovery of GAS was significantly greater after 48 h of incubation than after 24 h of incubation for each medium-atmosphere combination . After 48 h of incubation, the sensitivities of GAS detection obtained by each culture technique were as follows: ssA-anaerobic atmosphere, 98.5%; SBA-anaerobic atmosphere, 89.5%; ssA-CO2 atmosphere, 88.0%; SBA-air, 86.5%; SBA-CO2 atmosphere, 82.0%; and ssA-air, 74.6% . There were no cultures positive in air or CO2 which were not positive anaerobically on either medium . The increased sensitivity of detecting positive GAS cultures when incubation was done in an ssA-anaerobic atmosphere for 48 h uncovered patients truly infected with the organisms. Acta Anaesthesiol Sin, 1995 Sep, 33(3), 195 - 8 The anesthetic management of a patient with streptococcal toxic shock-like syndrome--a case report; Liu K et al.; Streptococcal toxic shock-like syndrome (TSLS), a severe multisystem disorder with rapid progression and fulminant course, is caused by group A beta-hemolytic streptococcal (GAS) infection . The mortality rate is around 30% . It has been reported in the United States and Europe since the 1980s . The recent recognition of this syndrome is thought to stem from the appearance of more virulent strains of streptococci with a greater tendency to produce potent exotoxins than prior ones . Early diagnosis, treatment with penicillin, radical operative debridement and adjuvant therapy with immunoglobulin and plasma exchange may bear a favourable outcome . A case of TSLS who received surgical management in operating room is presented in this paper. Scand J Prim Health Care, 1995 Sep, 13(3), 217 - 21 Decentralized diagnostics of beta haemolytic streptococci group A--introduction of a developmental model for microbiological consultation in primary health care; Kinnunen K et al.; OBJECTIVE--To define and evaluate forms for introduction of decentralized diagnosis in primary care . DESIGN--The study was divided into three phases . Intervention I . An intensive course on microbiological diagnostics in cases of tonsillitis with information about rapid EIA-based test kits for beta haemolytic streptococci group A . Intervention II . External quality assurance of the decentralized test . Evaluation . Recording of changes in work practice and attitude regarding decentralized diagnosis by means of a questionnaire . PARTICIPANTS--Thirty-three GPs and 36 laboratory technicians from 37 primary health care centres (PHC) in the county of Ostergotland, Sweden . RESULTS--Thirty-one of the responding GPs (94%) considered that the information gained from quality assurance was useful . Twenty-nine GPs (88%) reported that they had changed their clinical practice to some extent, and 26 of the responding laboratory technicians (72%) reported that they had changed method after the interventions . CONCLUSION--Uniform acceptance was not achieved, but a large number of GPs and PHC laboratory technicians did conform to a rational-empirical strategy for change in clinical practice. Public Health Rep, 1995 Sep-Oct, 110(5), 607 - 17 Multidimensional causal model of dental caries development in low-income preschool children; Litt MD et al.; Despite the decline in the incidence of dental caries in the United States over the past several years, the condition remains a significant problem for the nation's poor children . Efforts to identify the factors responsible for caries development in samples of children of low socioeconomic status have primarily focused on a limited number of variables, and those have been predominantly biological (mutans streptococci, for example) . Resulting models of caries development have usually shown good sensitivity but poor specificity . They have had limited implications for treatment . In an effort to produce a comprehensive model of caries development, 184 low-income preschool children were clinically assessed for mutans streptococci and for decayed, missing, or filled surfaces of deciduous teeth twice, first at age 4 years (baseline) and again a year later (year 1 assessment) . As the clinical assessments were being done, caretakers were being interviewed to obtain data from five domains: demographics, social status, dental health behaviors, cognitive factors such as self-efficacy (self-confidence) and controllability, and perceived life stress . Data were analyzed using a structural equations modeling approach in which variables from all domains, plus baseline decayed missing and filled surfaces and baseline mutants, were used together to create a model of caries development in the year 1 assessment . Results confirmed earlier work that suggested that caries development at a 1-year followup was strongly dependent on earlier caries development . Early caries development in this sample was determined in part by mutans levels and by dental health behaviors . These behaviors themselves were accounted for partly by a cognitive factor.(ABSTRACT TRUNCATED AT 250 WORDS) Tidsskr Nor Laegeforen, 1995 Aug 30, 115(20), 2533 - 4 {Fulminant fasciitis in the head and neck region}; Meidell NK et al.; Deep interstitial infections of the head and neck are potentially life-threatening conditions because of the double threat of upper airway obstruction and production of bacterial toxins, which may result in spread of infection, sepsis and multiorgan failure . At an early stage the symptoms are rather diffuse . It is of critical importance however, to make an early diagnosis if a fatal outcome is to be prevented . We describe a patient with infection caused by group F streptococci, (Streptococcus anginosus or milleri), and discuss the diagnosis and treatment. Arch Intern Med, 1995 Aug 7-21, 155(15), 1641 - 8 Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users; Mathew J et al.; BACKGROUND: Intravenous drug use is an increasingly common condition predisposing to infective endocarditis . Data on infective endocarditis in intravenous drug users are limited . OBJECTIVE: To determine the clinical features, bacteriologic findings, site of involvement, complications, and mortality associated with infective endocarditis in intravenous drug users . METHODS: Cohort study of intravenous drug users with native valve infective endocarditis . RESULTS: A total of 125 cases of infective endocarditis occurred in 114 patients (84 cases {67%} in men and 41 cases {32%} in women) with a mean (+/- SD) age of 37 +/- 7 years . The tricuspid valve was involved in 58 cases (46%), the mitral valve in 40 cases (32%), and the aortic valve in 24 cases (19%) . The microorganisms identified included Staphylococcus in 82 cases (65.6%) and Streptococcus in 32 cases (25.6%) . Twenty-three patients (18%) underwent surgery, and two (9%) of them died . One hundred two patients (82%) were treated medically, and nine (9%) of them died . Fifteen patients (63%) with aortic valve involvement vs 17 patients (17%) without aortic valve involvement underwent surgery or died without surgery (odds ratio, 8.24; 95% confidence interval, 3.1 to 21.8) . Among the survivors, at least one major cardiovascular complication occurred in 79 cases (69.3%) . CONCLUSIONS: Infective endocarditis in intravenous drug users affects the right and left sides of the heart with approximately equal frequency . At present, more than 90% of cases of infective endocarditis in intravenous drug users in Chicago are caused by staphylococci or streptococci . Involvement of the aortic valve is predictive of increased morbidity and mortality in intravenous drug users with infective endocarditis . With medical treatment, and surgery when medical treatment fails, intravenous drug users with infective endocarditis have an in-hospital survival rate of 91%. J Biol Chem, 1995 Aug 4, 270(31), 18452 - 8 Hyaluronic acid synthesis operon (has) expression in group A streptococci; Crater DL et al.; The has operon is composed of three genes, hasA, hasB, and hasC that encode hyaluronate synthase, UDP-glucose dehydrogenase, and presumptively UDP-glucose pyrophosphorylase, respectively . Expression of the has operon was shown to be required for the synthesis of the hyaluronic acid capsule in group A streptococci . Previous studies indicated that some group A and group C streptococcal strains produce the hyaluronic acid capsule, while others do not . In addition, it was observed that encapsulated strains cultured in stationary phase of growth lose the hyaluronic acid capsule . Therefore, the molecular mechanisms controlling the expression of the hyaluronic acid capsule in group A streptococci was investigated . In this study, it was determined that all encapsulated and unencapsulated strains of group A streptococci as well as encapsulated group C streptococci analyzed possess the has operon locus . The acapsular phenotype was accounted for by the absence of hyaluronate synthase activity in the membrane and not the production of extracellular hyaluronidase . A has operon mRNA transcript was not expressed by unencapsulated strains of group A streptococci, whereas encapsulated strains of group A streptococci grown to mid to late exponential phase produced the hyaluronate capsule, as well as has operon mRNA . However, as the streptococci entered the stationary phase of growth, they became acapsular and this was concomitant with the loss of has operon mRNA transcript . These results were confirmed by primer extension analyses of RNA isolated from encapsulated and unencapsulated strains of group A streptococci as well as RNA prepared from encapsulated strains cultured in exponential and stationary phases of growth . Thus, the loss of has operon mRNA in unencapsulated group A streptococci, as well as growth phase regulation occurs at the previously mapped has operon promoter . These data suggested that the synthesis of the hyaluronic acid capsule for group A streptococci may be controlled by transcriptional mechanisms. Ophthalmology, 1995 Aug, 102(8), 1223 - 6 Streptococcal preseptal cellulitis complicated by the toxic Streptococcus syndrome; Ingraham HJ et al.; BACKGROUND: After decades of decline in the incidence of severe infections secondary to group A streptococci, a dramatic increase in the frequency and severity of infections with these organisms has been reported since 1984, including a "toxic Streptococcus syndrome," resembling staphylococcal toxic shock syndrome . To the authors' knowledge, this entity has never been described after ocular infection . METHODS: In a previously healthy 3-year-old boy, preseptal cellulitis developed secondary to minor trauma to the eyelid, progressing rapidly to hypotension, respiratory distress, and an erythrodermic desquamating rash . Ocular and blood cultures grew group A beta-hemolytic streptococci . Appropriate antibiotic coverage and management of systemic manifestations led to rapid improvement, although necrosis developed in the right upper anterior eyelid, requiring skin grafts . RESULTS: More than 3 years since the incident, the patient is free of infection and has a good cosmetic result after skin grafting and revisions for scarring and adhesions . CONCLUSIONS: Streptococcal preseptal cellulitis is not unusual, particularly after trauma . Ophthalmologists must be aware of the re-emergence of more virulent organisms with increased potential for morbidity and mortality. Indian J Med Res, 1995 Aug, 102, 56 - 9 Changing patterns of group B streptococcal serotypes associated with human infections; Radhakrishnan S et al.; One hundred strains of group B streptococci (GBS) isolated from diverse clinical specimens of patients seen in our hospital were subjected to serotyping by an indigenously prepared coagglutination system . Serotype NT/c was the most predominant (24%), followed by Ia (23%), II/c (12%) and Ib (11%) . Type Ia was the most predominant in all specimens except genital samples where NT/c was the most predominant . Comparison of the distribution of serotypes identified during 1975-78 with that of the present study showed a great increase in the prevalence of types NT/c, II/c and Ia and a dramatic decline of types III, Ia/c and Ib . Despite the inclusion of reagents for newer serotypes, IV and V two strains were nontypable indicating the prevalence of hitherto unidentified GBS serotypes in our community. Oral Microbiol Immunol, 1995 Aug, 10(4), 220 - 6 Insertional inactivation of binding determinants of Streptococcus crista CC5A using Tn916; Correia FF et al.; Intermicrobial binding plays an important role in the ecology of the oral cavity because it represents one mechanism by which specific bacteria colonize dental plaque . The formation of "corncobs", a morphologically distinct microbial unit composed of Streptococcus crista and Fusobacterium nucleatum, is a highly specific binding interaction that depends on the presence of polar tufts of fimbriae on the streptococci . We have used a genetic approach to examine the role of streptococcal cell surface components involved in the binding of S . crista to F . nucleatum . Such binding may be an important component of corncob formation . A method for the genetic transformation of S . crista was used to transfer the broad host range transposon, Tn916, into the bacteria . Cells were grown to early log phase in brain heart infusion broth containing 10% fetal calf serum . The competent cells were mixed with purified DNA from pDL916, a plasmid construct consisting of Tn916 and the streptococcal/Escherichia coli shuttle vector pDL278 . Over 300 transformants were screened for a reduction in binding to F . nucleatum . Five of the transformants showed a change in binding ranging from 59% to 29% of the positive control values . Southern blots revealed that the binding-deficient transformants contained the Tn916 element integrated into one of 4 different sites in the chromosome . The transposon, integrated into 4 different sites, appeared to be stable in the absence of selective pressure . Based on these findings, it appears that some strains of S . crista are naturally competent and that insertional inactivation methods can be used to facilitate the study of binding receptors in this group of oral streptococci. Microb Pathog, 1995 Aug, 19(2), 83 - 91 Correlation of epithelial cell invasiveness of group B streptococci with clinical source of isolation; Valentin-Weigand P et al.; Neonatal infections caused by Group B streptococci (GBS) may lead to pneumonia, sepsis, or meningitis indicating that GBS are able to invade tissues and enter the bloodstream from infected sites . In this study, we showed that the tissue invasiveness of GBS may be related to their ability to invade epithelial cells in vitro by correlating the degree of GBS invasion of cultured human respiratory epithelial cells with the clinical source of isolation . Among 77 isolates tested, those from invasive infections of neonates and adults were significantly (P < 0.001) more invasive than those from vaginal carriers and colonised neonates without clinical symptoms . Furthermore, isolates from the blood were more invasive (P < 0.05) than those from other sites . GBS invasion seemed to be mediated by bacterial surface proteins since trypsin treatments of streptococci significantly reduced their invasion into epithelial cells and invasiveness was not limited to a certain capsular serotype . The two major GBS surface protein antigens c and R, however, were not involved in the invasion process . These results indicate that in vitro invasion of cultured human cells reflects the in vivo invasive property of GBS and involves bacterial surface components different from known virulence factors such as capsule or protein antigens c and R. Aust N Z J Obstet Gynaecol, 1995 Aug, 35(3), 251 - 3 Evaluation of a rapid enzyme immunoassay for detection of genital colonization of group B streptococci in pregnant women: own experience and review; Hordnes K et al.; We have compared an enzyme immunoassay (ICON Step B, Hybritech) with cultures for demonstration of genital carriage of group B streptococci (GBS) in pregnant women, and studied the relationship between vaginal and rectal carriage of this organism . Pertinent literature has also been reviewed . Two hundred pregnant women at gestational week 17 were included . Swabs from the uterine cervix were tested for GBS by ICON Strep B immunoassay and ordinary cultures on blood agar . Additional swabs from the rectum were tested by cultures . The percentage of women with GBS in cervical secretions was 13.5% (27/200) by cultures and 4% (8/200) by the ICON Strep B immunoassay . The overall sensitivity of the immunoassay was 7.4%, and the specificity 96.5% . In conclusion, the sensitivity of rapid enzyme immunoassays is too low for accurate screening of GBS in the genital tract of pregnant women. J Lab Clin Med, 1995 Aug, 126(2), 137 - 43 Myositis and fasciitis associated with group A beta hemolytic streptococcal infections: development of a rabbit model; Piepmeier E Jr et al.; Group A streptococci produce a variety of clinical symptoms ranging from minor pharyngeal infections to life-threatening soft-tissue disease . A rabbit model is described for induction of myonecrosis and fasciitis with group A beta-hemolytic streptococci . Group A streptococcal infections have shown remarkable virulence in recent years, resulting in severe local tissue destruction and life-threatening toxicity . After subcutaneous injection into the thigh of 20 ml broth containing 10(5) to 10(9) cfu/ml, initial soft tissue infection rapidly progressed to rhabdomyolysis . The response of the rabbits to the infection was consistent with the human response. J Infect Dis, 1995 Aug, 172(2), 420 - 6 Group B streptococci elicit leukotriene B4 and interleukin-8 from human monocytes: neonates exhibit a diminished response; Rowen JL et al.; Neonatal monocytes have diminished function compared with adult cells . The ability to recruit neutrophils through elaboration of chemoattractants has not been evaluated in humans . The pattern of chemoattractant release induced by group B streptococci (GBS) also is unknown . Adult and cord blood monocytes were stimulated with GBS . Supernatants were used as the attractant in blind well chambers; migration to neonatal supernatants was diminished . Interleukin-8 (IL-8) and leukotriene B4 (LTB4) were released in greater quantities by adult monocytes in response to either GBS or lipopolysaccharide . Opsonization of GBS was not required for IL-8 release . Adult monocytes released more LTB4 when stimulated with unopsonized GBS than with opsonized GBS; the neonate's LTB4 production did not increase . IL-8 and LTB4 accounted for the majority of chemoattractant activity released in response to GBS . Decreased production of LTB4 and IL-8 may contribute to the neonate's poor host response to GBS. Infect Immun, 1995 Aug, 63(8), 3088 - 93 Immunization of rats with synthetic peptide constructs from the glucan-binding or catalytic region of mutans streptococcal glucosyltransferase protects against dental caries; Taubman MA et al.; Previously, we have described peptide constructs from two regions of glucosyltransferase (GTF) of mutans streptococci . A putative catalytic site in the amino-terminal half of the molecule and a repeated glucan-binding site in the carboxyl-terminal half of GTF were the regions upon which sequences were based . The present study explored the effects of immunization with these peptide constructs (called CAT or GLU) and with streptococcal GTFs from Streptococcus sobrinus and S . mutans on immunological, microbiological, and disease parameters . Groups of immunized Sprague-Dawley rats were infected with either 10(8) S . sobrinus 6715 or 10(8) S . mutans SJ32 organisms . Serum immunoglobulin G antibody levels, determined by enzyme-linked immunosorbent assay, to the respective peptide constructs and to the appropriate streptococcal GTF were significantly increased (after immunization) prior to infection and at the end of the experiment . Also, serum antibody from CAT-, GLU-, and S . sobrinus GTF-immunized rats inhibited S . sobrinus GTF-mediated insoluble glucan synthesis (all) and S . mutans GTF-mediated soluble glucan synthesis (all except anti-GLU) from sucrose . Immunization with the CAT or GLU peptide construct resulted in significantly reduced smooth surface and sulcal caries after infection with S . sobrinus . Sulcal dental caries after infection with S . mutans SJ32 were also significantly reduced in CAT- and GLU-immunized rats . Thus, immunization with peptides whose sequences are based on putative functional domains of mutans streptococcal GTF are protective toward a cariogenic S . sobrinus or S . mutans infection. Ann Intern Med, 1995 Aug 1, 123(3), 205 - 15 Antimicrobial prophylaxis in bone marrow transplantation; Momin F et al.; OBJECTIVE: To review the efficacy of antimicrobial prophylaxis in bone marrow transplantation . DATA SOURCES: English-language articles identified through a MEDLINE search (1975 to 1994) and through the bibliographies of selected articles . STUDY SELECTION: Articles on the use of antimicrobial agents for the prevention of infections in bone marrow transplant recipients and neutropenic patients with cancer . DATA SYNTHESIS: Use of quinolones reduces the incidence of gram-negative bacillary infections but increases the frequency of infections caused by streptococci and staphylococci before marrow engraftment . Death associated with alpha-hemolytic streptococcal bacteremia is of concern and may justify the use of penicillin for prophylaxis . Conflicting data exist regarding prophylaxis with vancomycin . Although ganciclovir has diminished the incidence of infection and disease caused by cytomegalovirus in seropositive recipients, drug-induced myelotoxicity, emergence of resistant virus, and cost are major concerns . High-dose acyclovir may suppress reactivation of cytomegalovirus . Acyclovir prevents herpes simplex virus infection, but its prolonged use to prevent reactivation of varicellazoster virus is not cost-effective and remains controversial . Fluconazole prevents colonization and infection with Candida species other than C . krusei and Torulopsis glabrata before marrow engraftment . Elevation of cyclosporine concentrations because of interaction between azoles and cyclosporine requires close monitoring of plasma drug levels . Optimal chemoprophylaxis is not available against aspergillus or fungal infections that develop after engraftment . Trimethoprim-sulfamethoxazole decreases the incidence of Pneumocystis carinii infection and "late" bacterial infections in recipients of allogeneic transplants who have chronic graft-versus-host disease . CONCLUSION: Available antimicrobial agents can prevent common bacterial, viral, and "early" fungal infections . However, the few studies that address antimicrobial prophylaxis in bone marrow transplantation have not always shown a survival benefit . Toxicity and cost-effectiveness of prophylactic strategies should be critically evaluated. Drugs Aging, 1995 Aug, 7(2), 110 - 6 Does the potential for development of streptokinase antibodies change the risk-benefit ratio in older patients? Brugemann J, de Graeff PA, van der Meer J, Lie KI. In patients with acute myocardial infarction (MI), quick initiation of thrombolytic therapy is the best strategy for improvement of survival and reduction of morbidity . Streptokinase, a purified product of haemolytic streptococci, is the most commonly administered agent . The compound anistreplase (a complex of streptokinase to plasminogen), is available but currently not often used . The non-antigenic competitor for these two compounds for the indication of MI is alteplase (recombinant tissue plasminogen activator, rt-PA) . Due to former use of streptokinase or its derivative anistreplase, patients may develop specific antibodies to the foreign protein, whereas cross-reacting antibodies may be due to streptococcal infections . These antibodies may neutralise streptokinase or its derivative in case of (re)administration and may mediate adverse events, sometimes serious . Since advanced age by itself is certainly not a contraindication to thrombolytic therapy, and because reinfarction occurs frequently, the benefit-risk ratio of re-exposure to streptokinase or its derivative is decreased in the elderly who present with reinfarction . In the framework of tailored thrombolytic therapy, alteplase or urokinase appear to be the drugs of choice in these patients. Rev Clin Esp, 1995 Aug, 195(8), 541 - 5 {Bacteremia caused by group A and B beta-hemolytic Streptococcus in adults}; Ramos JM et al.; In order to know the epidemiological, clinical and evolutive characteristics of bacteriemia caused by beta-hemolytic streptococci groups A and B, a retrospective investigation was undertaken of 48 bacteremic episodes observed in adult patients for 10 years (1985-1994) . Twenty-two episodes were caused by Group A beta-hemolytic streptococci (GAS) and 26 by Group B beta-hemolytic streptococci (GBS) . Patients with GAS bacteremia (GASB) had a lower mean age than patients with GBS bacteremia (GBSB) (p = 0.03) . Infection with immunodeficiency virus was more common in patients with GASB than in patients with GBSBA (27 and 4%, respectively; p = 0.04); in contrast, diabetes mellitus was more common in patients with GBSB than in patients with GASB (27 and 5%, respectively) (p = 0.04) . Nine (41%) patients with GBSB were i.v . drug abusers; nevertheless, none of the subjects with GBSB were i.v . drug abusers (p < 0.001) . The proportion of bacteremia without demonstrable source due to GBS (41%) was significantly higher than that due to GAS (9%) (p = 0.02) . Five (23%) patients with GASB and other five (20%) patients with GBSB had fatal outcomes, but only in two (9%) and three (12%) cases, respectively, was death directly attributed to bacteremia . In conclusion, bacteremias caused by GAS and GBS have different epidemiological characteristics but similar prognosis. J Clin Microbiol, 1995 Aug, 33(8), 2114 - 7 Report of cases of and taxonomic considerations for large-colony-forming Lancefield group C streptococcal bacteremia; Carmeli Y et al.; Traditionally, group C streptococci include four species: Streptococcus equisimilis, S . zooepidemicus, S . equi, and S . dysgalactiae, the first three of which are group C beta-hemolytic streptococci (GCBHS) . However, many of the beta-hemolytic streptococci carrying Lancefield group C antigen isolated from clinical specimens are S . milleri . These organisms can be differentiated by colony size . We retrospectively collected data concerning large-colony-forming GCBHS bacteremia that occurred during a period of 8 years at the Massachusetts General Hospital . A total of 222 cases of beta-hemolytic streptococcal bacteremia were identified; data on the Lancefield grouping were available in 192 cases: 45 cases (23.6%) were group A, 96 cases (50%) were group B, 7 cases (3.6%) were group C (large colony forming), and 44 cases (22.9%) were group G . The medical records for cases of large-colony-forming GCBHS bacteremia were reviewed . In one case, the isolate was thought to be a contaminant; the other six cases are reported (five males and one female; mean age, 55 years) . All patients had severe underlying conditions, and none had a history of exposure to animals . The clinical syndromes included two cases of cellulitis and one case each of endocarditis, myocardial infarction complicated by infection, pneumonia, and myofasciitis . The diagnoses for two patients with endovascular infections were delayed . Three of the six patients had fatal outcomes, and other two, after prolonged hospitalization, were transferred to a long-term rehabilitation center . We concluded that the severe outcomes reflect delay in diagnosis and treatment as well as the severity of the underlying diseases . The taxonomy of GCBHS is discussed . More reports differentiating large- and small-colony-forming GCBHS are needed. Int Dent J, 1995 Aug, 45(4), 245 - 54 A study into the prevention of fissure caries using an antimicrobial varnish; Bratthall D et al.; The aim of this study, performed in Bangkok, was to evaluate the possibility of reducing fissure caries development using an antimicrobial varnish, Cervitec . Children aged 7-8 years and 12-13 years, 251 in each age group, with at least 2 sound contra-lateral permanent molars, were selected . A split mouth method was used with one test and one control tooth within the same jaw . At baseline and after two years all children were investigated for DMFS and DMFT . In addition, the size of any cavities was estimated . From 200 children, plaque samples of test and control occlusal surfaces were collected at baseline and after one year and processed to estimate the number of mutans streptococci . Mutans streptococci in saliva were estimated by the Strip mutans method . Cervitec varnish, containing 1 per cent chlorhexidine and thymol was applied at baseline, after 3-4 and after 8-9 months . The results showed that: Cervitec varnish reduced fissure caries development significantly; the levels of salivary mutans streptococci at baseline were significantly correlated with caries status at baseline and with total caries increment over the two-year period; caries development in a fissure was significantly correlated to the level of plaque mutans streptococci at that same site; three months after the last varnish application, a certain reduction of mutans streptococci in plaque could be seen in the test teeth; comparing the size of the lesions, more large cavities were found in the untreated teeth . It is concluded that varnishes should be considered as further options for prevention of fissure caries, possibly in more individualised programmes or in combination with already established methods. Eur J Obstet Gynecol Reprod Biol, 1995 Aug, 61(2), 135 - 41 Randomized study of vaginal chlorhexidine disinfection during labor to prevent vertical transmission of group B streptococci; Adriaanse AH et al.; OBJECTIVE: To evaluate the effect of vaginal disinfection with chlorhexidine gel during labor on vertical transmission of group B streptococcus, as a method to prevent vertical transmission and subsequent neonatal early onset group B streptococcal disease . STUDY DESIGN: A prospective study with randomization of 1020 parturients to one of three groups as soon as labor started . In all parturients, anus, introitus and cervix were cultured semiquantitatively . Two groups were treated double-blindly with 10 ml of either a 0.3% chlorhexidine gel or a placebo gel, applicated around the portio and into the fornices . If labor still continued, a second application was given after 10 h . The third group received no treatment . Ear, pharynx and umbilicus of all newborns were also cultured semiquantitatively . RESULTS: Nine hundred and eighty one women were evaluated . The overall incidence of group B streptococcal carriership was 19.4% . Vertical transmission was 52.4% in the chlorhexidine group, 71.4% in the placebo group and 66.7% in the control group (P = 0.069) . When testing the transmission rates for the chlorhexidine versus the combined placebo plus control group (69.3%), the difference was 16.9% (P = 0.026) . CONCLUSION: Vaginal disinfection with a chlorhexidine gel during labor modestly reduces group B streptococcal vertical transmission . Because the method is cheap, simple and safe, it should be considered for routine use . Our results indicate that it may reduce the incidence of early onset group B streptococcal sepsis by 2-32%. Eur J Oral Sci, 1995 Aug, 103(4), 264 - 6 Mutans streptococci and dental caries prevalence in a group of Latvian preschool children; Kohler B et al.; Paraffin-stimulated saliva samples were collected from 140 children 3- and 4-yr old attending nine nursery schools in Latvia . The salivary levels of mutans streptococci were rated from zero to 3 after being cultured on a commercially available strip selective for these microorganisms . Of the children, 29.3% were rated at zero (approximately < 10(4) cfu per ml saliva) . This group of children demonstrated the lowest mean caries prevalence dmfstot = 1.5 (SD 1.9) . The highest dmfstot was found among children in class 2 (38.6%; approximately > 10(5)-10(6) cfu/ml) and class 3 (12.1%; approximately > 10(6) cfu/ml) with a mean caries prevalence of 6.5 (SD 5.8) and 6.4 (SD 6.0), respectively . The study demonstrates the association between high caries prevalence and high salivary levels of mutans streptococci in the young child . It is suggested that early identi-fication of mutans streptococci-colonized children might be of value in selecting at caries risk children for preventive measures. Infect Immun, 1995 Aug, 63(8), 2968 - 75 A protein G-related cell surface protein in Streptococcus zooepidemicus; Jonsson H et al.; This work describes the cloning and sequencing of a gene encoding a plasma protein receptor from Streptococcus zooepidemicus . This receptor, termed protein ZAG, is a 45-kDa protein that binds alpha 2-macroglobulin (alpha 2M), serum albumin, and immunoglobulin G (IgG) . The IgG-binding activity is located in the C-terminal part of the molecule and is mediated by two repeated domains highly homologous to each other as well as to the corresponding domains in streptococcal type III Fc receptors . The IgG-binding profile of protein ZAG is similar to that previously reported for S . zooepidemicus . Binding to serum albumin is mediated by a short amino acid sequence in the middle of the molecule . This domain shows homology to previously described albumin-binding proteins from streptococci, and the albumin-binding profile of protein ZAG is similar to that of streptococcal protein G . The N-terminal part of protein ZAG, which mediates binding to the plasma proteinase inhibitor alpha 2M, is composed of a unique stretch of amino acids . Protein ZAG competes for the same, or nearby, binding site(s) in alpha 2M as do two recently described Streptococcus dysgalactiae receptors, although the sequences of the alpha 2M-binding domains in these three receptors show only minor sequence similarities. Infect Immun, 1995 Aug, 63(8), 2833 - 9 Binding of native alpha 2-macroglobulin to human group G streptococci; Muller HP et al.; Binding of human alpha 2-macroglobulin (alpha 2M) to group G streptococci and to their immunoglobulin G (IgG)-binding proteins (protein G) was investigated . Native alpha 2M bound specifically to strain G-148 with an apparent dissociation constant of (2.2 +/- 1.5) x 10(-9) M . Proteinase-complexed alpha 2M did not compete for the binding sites, and 125I-labelled proteinase-complexed alpha 2M did not bind to the bacteria . Binding of native alpha 2M to the cells was not affected by IgG or protein G consisting of only IgG-binding domains . 125I-labelled recombinant protein G did not bind to native or proteinase-complexed alpha 2M . However, a lysate of G-148 cells inhibited binding of alpha 2M to the bacteria, and immobilized wild-type protein G bound alpha 2M directly from fresh human plasma . In 13 group G streptococcal isolates, IgG-binding proteins were immunologically identified as protein G . In 11 isolates, these molecules reacted also with alpha 2M and human serum albumin (HSA) . Western blots (immunoblots) of two wild-type protein G variants revealed identical bands reactive with goat IgG, HSA, and native alpha 2M . Digestion of wild-type protein G with clostripain destroyed in both variants the binding sites for alpha 2M but not for albumin and IgG . N-terminal fragments of protein G (lacking the IgG-binding region) bound both alpha 2M and HSA, whereas a similar HSA-binding peptide lacking the first 80 amino acids did not react with alpha 2M . Our findings are consistent with a specific binding site for native alpha 2M in the N-terminal region of protein G and suggest that binding of alpha 2M via IgG-binding proteins may be a general feature of human group G streptococci. J Autoimmun, 1995 Aug, 8(4), 601 - 13 Antigenic specificity of lymphocytes isolated from valvular specimens of rheumatic fever patients; Yoshinaga M et al.; T cell lines were established from both valvular specimens and peripheral blood lymphocytes from seven patients with well documented rheumatic heart disease . These cell lines were stimulated with either PHA or streptococcal antigens . Proliferation assays revealed that both valvular and peripheral blood T cell lines reacted to cell wall (CW) and cell membrane (CM) antigens obtained from rheumatic fever associated group A streptococci and not to nephritogenic strains . None of the cell lines reacted to M protein, myosin or other mammalian cytoskeletal proteins . The unique reactivity of rheumatic fever T cell lines only to cellular structures obtained from rheumatogenic strains suggests that these lines react to epitopes specific for antigens obtained from these strains. Acta Paediatr, 1995 Aug, 84(8), 922 - 6 Effect of surfactant on nitroblue tetrazolium reduction of polymorphonuclear leucocytes stimulated with type Ia group B streptococci; Herting E et al.; Activation of polymorphonuclear leucocytes (PMN) was investigated after incubation of adult human PMN and group B streptococci (GBS) type Ia with a type-specific polyclonal antiserum and a modified porcine surfactant (Curosurf) . The level of oxidative metabolism of PMN was studied using a micromethod modification of the nitroblue tetrazolium (NBT) reduction test . GBS alone did not stimulate significant oxygen metabolite release from PMN, and incubation of PMN with surfactant alone resulted in decreased NBT reduction . After opsonization of GBS with a specific antibody, PMN were activated and the increased oxygen metabolite release was not suppressed when surfactant was added to the system . We conclude that the encapsulated GBS strain investigated needs opsonization with specific antibody to increase oxidative metabolism of PMN, and that incubation of PMN and opsonized GBS with surfactant does not interfere with NBT reduction. Acta Odontol Scand, 1995 Aug, 53(4), 226 - 9 Mouth-rinsing with chlorhexidine causes a delayed, temporary increase in the levels of oral viridans streptococci; Vaahtoniemi LH et al.; The indigenous oral flora of 27 volunteers was monitored longitudinally over a 4-week period . Bacteria attached on buccal epithelial cells were counted by microscopy . Salivary bacterial colonies and the presence of alpha-hemolysis were examined after aerobic culturing on blood agar plates . The buccal and salivary bacterial counts were stably maintained in most subjects in the two repeated base-line samplings taken at 1-week intervals . Rinsing with a chlorhexidine mouthwash 45 min before sampling dramatically reduced the amount of epithelial cell-adherent bacteria . One day after the chlorhexidine rinse, however, the numbers of the epithelial cell-adherent bacteria exceeded the base-line level, and a similar decrease-increase pattern of changes was detected for the salivary alpha-hemolytic streptococcal counts . The non-hemolytic salivary bacterial counts were not affected by chlorhexidine . Subsequent weekly samplings showed no difference from the base-line samplings . The chlorhexidine-induced, delayed increase of viridans streptococci on oral epithelial surfaces should be considered a possible risk factor in medically compromised patients. Vet Microbiol, 1995 Aug, 45(4), 331 - 7 Tetracycline resistance determinants among streptococci of serological group G and L; Soedarmanto I et al.; In the present study 56 streptococci of serological group G and L isolated from various animal species and from humans were investigated for tetracycline and minocycline resistance and for the presence of genes conferring this combined resistance . Among the 45 group G streptococci, 2 isolates from dogs, 3 from cattle and 2 from humans, respectively, as well as all 11 group L streptococci isolated from cattle, pigs or poultry were resistant to tetracycline and simultaneously to minocycline . The restriction endonuclease digested and blotted DNA-preparation of the tetracycline-and minocycline resistant group G streptococci from dogs and humans hybridized with the tet (M) gene probe, those from bovines with the tet (O) gene probe . Six group L streptococci carried the gene tet (M), whereas 5 isolates harboured the gene tet (O) . The tet (M)-and tet (O) gene probes recognized complementary sequences on EcoRI-fragments of various sizes. Microb Drug Resist, 1995 Summer, 1(2), 103 - 9 Beta-Lactam antibiotic resistance in gram-positive bacterial pathogens of the upper respiratory tract: a brief overview of mechanisms; Tomasz A et al.; Streptococcus pneumoniae and Group A Streptococci are frequent colonizers and major causative agents of disease in the upper respiratory tract of humans . In spite of the immense and common selective pressure of beta-lactam antibiotics against both of these bacterial species during the last four to five decades, penicillin-resistant strains of group A streptococci have not been described in the clinical literature as of 1994 . This is particularly puzzling since penicillin-resistant mutants of this bacterium have been isolated repeatedly in the laboratory and such mutants carry altered penicillin-binding proteins (PBPs) with reduced drug affinities, i.e., a basic mechanism identical to the one seen in penicillin-resistant isolates of Streptococcus pneumoniae that have emerged in large numbers and at numerous locations and have spread explosively all over the globe by the beginning of the 1990s . The reasons for this contrasting situation are not clear . In Streptococcus pneumoniae the resistance mechanism to penicillin appears to originate in recombinational events between ancestral pneumococcal cells and as yet unidentified extra species DNA donors and probably involves the process of genetic transformation for which this bacterium has a remarkable hormonally controlled mechanism . The integration of foreign DNA sequences in the pneumococcal PBP genes leads to the remodeling of at least four of the five PBPs that change in their kinetic properties and increase in the penicillin resistance level of the bacteria also seems to involve increased production of the low-affinity binding proteins. Emerg Infect Dis, 1995 Jul-Sep, 1(3), 69 - 78 Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment; Stevens DL; Since the 1980s there has been a marked increase in the recognition and reporting of highly invasive group A streptococcal infections with or without necrotizing fasciitis associated with shock and organ failure . Such dramatic cases have been defined as streptococcal toxic-shock syndrome . Strains of group A streptococci isolated from patients with invasive disease have been predominantly M types 1 and 3 that produce pyrogenic exotoxin A or B or both . In this paper, the clinical and demographic features of streptococcal bacteremia, myositis, and necrotizing fasciitis are presented and compared to those of streptococcal toxic-shock syndrome . Current concepts in the pathogenesis of invasive streptococcal infection are also presented, with emphasis on the interaction between group A Streptococcus virulence factors and host defense mechanisms . Finally, new concepts in the treatment of streptococcal toxic-shock syndrome are discussed. Diagn Microbiol Infect Dis, 1995 Jul, 22(3), 267 - 73 Viridans streptococci isolated from the bloodstream . Relevance of species identification; Jacobs JA et al.; Over a 4-year-period, 104 isolates belonging to the viridans streptococci were recovered from the blood and identified to the species according to Beighton and co-workers . Streptococcus oralis was the species most frequently recovered from patients in the hematology unit {29 of 39 (74%)} . Streptococcus mitis ranked second {seven of 39 (18%)} . Both species were associated with oromucositis . Isolates presently identified as S . oralis are mainly those previously identified as S . mitis or Streptococcus sanguis II . Streptococcus milleri was most frequently isolated in the patients from the general hospital population {28 of 65 (43%) isolates}: Streptococcus anginosus (n = 20), Streptococcus constellatus (n = 4), and Streptococcus intermedius (n = 4) . In 14 episodes from the general hospital population, clinical significance was judged questionable . From this part of the laboratory, clinical significance could not be predicted from the number of blood cultures grown, nor from the delay of growth detection . The Rapid ID 32 Strep system agreed well with the identifications according to the scheme of Beighton et al., whereas the API 20 Strep system did not. Clin Ther, 1995 Jul-Aug, 17(4), 613 - 21 A double-blind, multicenter comparative study of two regimens of clindamycin hydrochloride in the treatment of patients with acute streptococcal tonsillitis/pharyngitis; Gallegos B et al.; In a double-blind, prospective, randomized, multicenter study, 164 patients with a clinical and bacteriologic diagnosis of acute streptococcal tonsillitis/pharyngitis were enrolled to compare the efficacy and safety of two regimens of clindamycin . A rapid identification test of Group A beta-hemolytic streptococci (GABHS) was used to initiate the therapy; however, a positive tonsillar/pharyngeal culture was required at pretreatment to determine if the patient was assessable . Another culture was repeated at least 2 days after the 10 days of drug therapy . From 164 patients enrolled (mean age, 27.7 years; range, 14 to 60 years), 141 were assessable for efficacy; 22 patients were excluded because they did not have a positive culture at pretreatment and 1 patient did not complete the study due to a side effect (rash) . All patients were included in the safety analysis . Patients received either clindamycin hydrochloride capsules 150 mg four times per day (QID) or clindamycin hydrochloride capsules 300 mg two times per day (BID) and placebo capsules BID for 10 days . There were no significant differences between groups in terms of demographics, medical history, and evolution of symptoms . The clinical efficacy rate in the two groups at day 12 was as follows: QID group--cured, 64 (92.8%) of 69 patients; improved, 5 (7.2%) of 69 patients; BID group--cured, 67 (93.1%) of 72 patients; improved, 5 (6.9%) of 72 patients . There were no significant differences between the groups . Both regimens were well tolerated with only 1 patient in the QID group who did not complete the therapy due to a rash.(ABSTRACT TRUNCATED AT 250 WORDS) Mem Inst Oswaldo Cruz, 1995 Jul-Aug, 90(4), 529 - 34 Penicillin tolerance among beta-hemolytic streptococci and production of the group carbohydrates, hemolysins, hyaluronidases and deoxyribonucleases; Avelino CC et al.; Penicillin tolerance among 67 strains of beta-hemolytic streptococci was examined by determining the ratio of the minimal bactericidal concentration to the minimal inhibitory concentration as 32 or greater . Tolerance was demonstrated in 15 group A strains and in 11.7, and 4 of groups B, C and G, respectively . Thereafter the effects of a subminimal inhibitory concentration (1/2 MIC) of penicillin on the bacterial products of four tolerant and four nontolerant strains (two of each Lancefield group) were analyzed and compared . The antibiotic caused a marked increase in the expression of the group carbohydrates for strains of group B . Penicillin was found to reduce the cell-bound hemolysin activities of the four tolerant strains and to increase the activity of the other (free) form of nontolerant groups A, C and G hemolysins . Penicillin caused an increase in the extracellular hyaluronidase activities of one group A and groups B, C and G streptococci . With added antibiotic the production of deoxyribonuclease by tolerant groups A, C and G was greatly enhanced and that of the group B streptococcus was arrested. J Antimicrob Chemother, 1995 Jul, 36(1), 209 - 13 SYN987, SYN1193, and SYN1253, new quinolones highly active against gram-positive cocci; Kitzis MD et al.; SYN987, 1193 and 1253 are new fluorinated quinolones with enhanced activity against Gram-positive bacteria . The MICs of SYN 987, 1193 or 1253 were studied by an agar dilution method against 88 streptococci (including penicillin resistant Streptococcus pneumoniae), 30 enterococci and 62 Staphylococcus aureus . SYN 987, 1193 and 1253 were 2 to 4 times more active than sparfloxacin and 16-64 times more active than older fluoroquinolones against all streptococci and ciprofloxacin-resistant S . aureus . This study demonstrates that SYN 987, 1193 and 1253 are extremely potent antibacterial agents which deserve further evaluation. J Infect, 1995 Jul, 31(1), 55 - 7 Meningitis due to oral streptococci following percutaneous glycerol rhizotomy of the trigeminal ganglion; James EA et al.; Percutaneous rhizotomy of the trigeminal ganglion is an established technique in the management of trigeminal neuralgia . Meningitis has been reported as a complication of radiofrequency rhizotomy . We report two cases in which percutaneous glycerol injection of the trigeminal ganglion was followed by meningitis due to oral streptococci . While initial laboratory features might be considered consistent with meningitis due to Streptococcus pneumoniae, optimal therapy is likely to differ as a consequence of current antimicrobial susceptibility patterns. J Infect Dis, 1995 Jul, 172(1), 277 - 81 Incidence of antibiotic resistance in Listeria species; Charpentier E et al.; To define the prevalence of antibiotic resistance in Listeria species pathogenic for humans and animals, 1100 isolates (60 from cases of listeriosis and 1040 from food and environment) collected worldwide were screened . Of the 61 tetracycline- and minocycline-resistant strains (37 Listeria monocytogenes), 57 harbored tet(M); 4 non-L . monocytogenes isolates contained tet(S) . One Listeria innocua isolate was also resistant to streptomycin and contained the tet(M) and aad6 genes . An L . monocytogenes isolate was trimethoprim-resistant, a characteristic not reported previously in Listeria species, because of the presence of a yet-uncharacterized gene . Three clinical isolates of L . monocytogenes were resistant to low levels of streptomycin . Since the tet(M), tet(S), and aad6 genes are common in enterococci and streptococci, these data suggest transfer from the latter to Listeria species . Uniform susceptibility to tetracycline, minocycline, trimethoprim, and streptomycin cannot be assumed any longer for Listeria species. Infect Immun, 1995 Jul, 63(7), 2645 - 51 Mucosal immunogenicity of polysaccharides conjugated to a peptide or multiple-antigen peptide containing T- and B-cell epitopes; Lett E et al.; In this study we investigated the mucosal and systemic responses to two T-cell-independent polysaccharides, a serogroup f polysaccharide (formed of rhamnose glucose polymers {RGPs}) from Streptococcus mutans OMZ 175 and a mannan from Saccharomyces cerevisiae, covalently conjugated either to a linear peptide (peptide 3) or to a multiple-antigen peptide (MAP), both derived from S . mutans protein SR, an adhesin of the I/II protein antigen family of oral streptococci . Peptide 3 and MAP, which contained at least one B- and one T-cell epitope, were tested as carriers for the polysaccharides and as protective immunogens . Intragastric intubation of rats with the conjugates (RGPs-peptide 3, RGPs-MAP, mannan-peptide 3, and mannan-MAP) associated with liposomes produced salivary immunoglobulin A (IgA) antibodies which reacted with RGPs or mannan, peptide 3 or MAP, protein SR, and S . mutans or S . cerevisiae cells . Administration of conjugate boosters to the animals showed that both carriers conjugated to the polysaccharides were able to induce, in immunized animals, a salivary antipolysaccharide IgA memory . In contrast, animals primed and challenged with unconjugated polysaccharide showed no anamnestic response . Rats orally immunized with the conjugates also developed systemic primary antipolysaccharide and antipeptide IgM antibody responses which were characterized by a switch from IgM to IgG during the course of the secondary response . Data presented here demonstrated that both peptide 3 and the MAP construct can act as good carriers for orally administered polysaccharides . Unexpectedly, the use of a MAP did not further improve the immunogenicity of polysaccharides at the mucosal level; nevertheless, such a construct should be of great interest in overcoming the problem of genetic restriction induced by linear peptides. Am J Obstet Gynecol, 1995 Jul, 173(1), 241 - 2 Necrotizing fasciitis in the puerperium; Rowan JA et al.; A case of necrotizing fasciitis in a healthy woman taking a nonsteroidal antiinflammatory drug in the puerperium is presented . The role of increased virulence of group A streptococci and the association of necrotizing fasciitis with nonsteroidal antiinflammatory drugs is reviewed. Medicine (Baltimore), 1995 Jul, 74(4), 176 - 90 Group B streptococcal bacteremia in adults . Five years' experience and a review of the literature; Colford JM Jr et al.; The importance of group B streptococcus (GBS) as a cause of serious infectious disease among adults is not widely appreciated . In adults, the modes of acquisition and transmission are unknown . Since most hospital-based studies of GBS bacteremia in adults consist of small numbers of patients, the clinical spectrum of disease is not well described . Our retrospective study reviews the clinical features, antimicrobial therapy, and risk factors for mortality of 32 adult patients (18 women and 14 men) with GBS bacteremia and compares the proportion of isolates from the different beta-hemolytic streptococci sero-groups . We found that 39% of isolates from adult blood cultures were group B, a frequency nearly identical to that of group A streptococcal bacteremia . Most (66%) adult patients were more than 50 years old . Primary bacteremia was the most frequent clinical diagnosis, occurring in 7 (22%) of 32 patients . Nonhematologic cancer was the most frequently associated condition (25%) . Nineteen percent of the patients had diabetes mellitus . The overall mortality rate was 31% and was significantly associated with increasing age . Our results are compared to those obtained by a review of all 5 previous comparable studies and demonstrate that GBS bacteremia is a serious infection in adults with increased mortality related to advancing age. J Pharmacol Exp Ther, 1995 Jul, 274(1), 494 - 8 Effect of combination therapy with OK432 and recombinant human interferon-alpha A/D on atrial natriuretic peptide gene expression in mice with viral myocarditis; Kanda T et al.; The effects of combination therapy with the immunomodulators OK432 (derived from the Su strain of Streptococcus pyogenes A3; 1 unit corresponds to 0.1 mg of dried streptococci dissolved in 0.1 ml of saline) and human recombinant interferon-alpha A/D (IFN) on cardiac atrial natriuretic peptide (ANP) gene expression and myocardial hypertrophy were examined in a murine model of viral myocarditis with congestive heart failure . Therapy was started 24 h after inoculation with encephalomyocarditis virus and was continued for 14 days . The plasma ANP concentration in untreated infected mice was significantly (P < .01) increased on day 10 (115 +/- 48 pg/ml) and day 30 (43 +/- 22 pg/ml) after inoculation relative to that in uninfected controls (5 +/- 4 pg/ml), whereas plasma ANP levels in treated mice were significantly (P < .01) reduced on day 10 (14 +/- 13 pg/ml) and day 30 (11 +/- 9 pg/ml) in comparison with untreated infected mice . The atrial and ventricular ANP messenger RNA (mRNA) concentrations in untreated mice showed increases of approximately 1.4- and 29.3-fold, respectively, on day 10 and increases of 1.8- and 34-fold, respectively, on day 30 compared with the concentration in uninfected controls . Combined OK432 and IFN significantly (P < .01) reduced the increase in ANP mRNA concentration in ventricles to 6.0- and 6.7-fold on days 10 and 30, respectively . Neither OK432 nor IFN monotherapy reduced the ANP mRNA concentrations in atria and ventricles compared with those in untreated controls.(ABSTRACT TRUNCATED AT 250 WORDS) J Invest Dermatol, 1995 Jul, 105(1 Suppl), 37S - 42S The role of superantigens in skin disease; Leung DY et al.; Staphylococcus aureus and streptococci secrete a large family of exotoxins involved in the pathogenesis of toxic-shock-like syndromes and have been implicated in several autoimmune disorders . These toxins act as prototypic superantigens capable of binding to major histocompatibility complex proteins on antigen-presenting cells outside the antigen peptide-binding groove and can thereby stimulate cytokine release from macrophages . The superantigen-major histocompatibility complex unit is recognized primarily by the variable region of the T-cell receptor beta chain, and by engaging this region, can activate a large portion of the T-cell repertoire . It is thought that the capacity of these toxins to cause the massive stimulation of T cells and accessory cells such as macrophages, Langerhans cells, and activated keratinocytes accounts for most of their pathologic effects . The current review examines the evidence that implicates a role for these superantigens in the pathogenesis of certain skin diseases. J Neuropathol Exp Neurol, 1995 Jul, 54(4), 531 - 9 Brain injury in experimental neonatal meningitis due to group B streptococci; Kim YS et al.; We have characterized the pattern of brain injury in a rat model of meningitis caused by group B streptococci (GBS) . Infant rats (12-14 days old; n = 69) were infected intracisternally with 10 microliters of GBS (log10(2.3) to 4.5 colony-forming units) . Twenty hours later, illness was assessed clinically and cerebrospinal fluid was cultured . Animals were either immediately euthanized for brain histopathology or treated with antibiotics and examined later . Early GBS meningitis was characterized clinically by severe obtundation and seizures, and histopathologically by acute inflammation in the subarachnoid space and ventricles, a vasculopathy characterized by vascular engorgement, and neuronal injury that was most prominent in the cortex and often followed a vascular pattern . Incidence of seizures, vasculopathy and neuronal injury correlated with the inoculum size (p < 0.01) . Early injury was almost completely prevented by treatment with dexamethasone . Within days after meningitis, injured areas became well demarcated and showed new cellular infiltrates . Thirty days post-infection, brain weights of infected animals treated with antibiotics were decreased compared to uninfected controls (1.39 +/- 0.18 vs 1.64 +/- 0.1 g; p < 0.05) . Thus, GBS meningitis in this model caused extensive cortical neuronal injury resembling severe neonatal meningitis in humans. J Bacteriol, 1995 Jul, 177(13), 3830 - 6 Purification and characterization of a 52-kilodalton immunoglobulin G-binding protein from Streptococcus suis capsular type 2; Serhir B et al.; We previously reported that group D streptococci exhibited immunoglobulin G (IgG)-binding activity and that a 52-kDa IgG-binding protein was present in all Streptococcus suis strains examined (B . Serhir, R . Higgins, B . Foiry, and M . Jacques, J . Gen . Microbiol . 139:2953-2958, 1993) . The objective of the present study was to purify and characterize this protein . Pig IgG were immobilized through their Fab fragments to ECH-Sepharose 4B, and the protein was purified by affinity chromatography . Electron microscopy observations of the purified material showed filamentous structures with a diameter of approximately 4 nm; these structures were not observed when the material was treated with either urea or ethanolamine . Electrophoretic and Western immunoblot analyses showed that the 52-kDa protein constituted the bulk of the recovered material . This protein was stained with either Coomassie brilliant blue or silver nitrate; it reacted with a large variety of mammalian IgG, human IgG (Fc) fragments, human IgA, and other human plasma proteins . The 52-kDa protein exhibited lower IgG-binding affinities than protein A and protein G . However, it was able to compete with protein A and protein G for binding to human IgG . In addition, it bound chicken IgG with high affinity . This last property differentiated the 52-kDa protein of S . suis from the six IgG-binding proteins described to date . The 52-kDa protein displayed similar affinities for untreated and deglycosylated pig IgG . The N-terminal amino acid sequence (SIITDVYAXEVLDSXGNPTLEV) revealed no homology with any bacterial proteins in the Swiss-Prot database . Its isoelectric point of approximately 4.6 and its amino acid composition, rich in aspartic and glutamic acids, showed that it had some similarities with other IgG-binding proteins . In this report, we have purified and characterized a 52-kDa IgG-binding protein from S . suis capsular type 2 . Although this protein shares some similarities with other IgG- and/or IgA-binding proteins, it is unique in reacting with chicken IgG. Clin Diagn Lab Immunol, 1995 Jul, 2(4), 484 - 6 Analysis of immunoglobulin G-binding-protein expression by invasive isolates of Streptococcus pyogenes; Raeder R et al.; Invasive group A streptococcal isolates collected as part of a Centers for Disease Control and Prevention surveillance study were analyzed for expression of immunoglobulin G (IgG)-binding proteins . Two IgG-binding phenotypes of group A isolates of the M1 serotype were identified . The first group expressed a surface protein that bound all four human IgG subclasses (type IIo) and was recognized by rabbit anti-serotype M1-specific antiserum but not by normal rabbit serum . The second group expressed an IgG-binding protein that was also recognized by the anti-serotype M1 antiserum but demonstrated significant nonimmune reactivity only with human IgG3 (type IIb) . Analysis of extracts of the isolates for reactivity with human IgA, fibrinogen, and albumin was also performed . The importance of the binding of human plasma proteins to pathogenic group A streptococci remains to be established. Pediatr Hematol Oncol, 1995 Jul-Aug, 12(4), 387 - 92 High-dose cytosine arabinoside and viridans streptococcus sepsis in children with leukemia; Rossetti F et al.; We report three cases of fulminant sepsis due to viridans streptococci in leukemic children treated with high-dose cytosine arabinoside (Ara-C) . The major predisposing factors to this occurrence are the presence of oropharingeal mucositis, which is the entry of streptococci into the bloodstream, and the use of antibiotic prophylactic regimens against gram-negative bacteria . In order to avoid fatal events during viridans streptococci sepsis, specific measures such as penicillin prophylaxis or early antibiotic treatment are needed . We suggest that the prompt empiric use of a glycopeptide antibiotic in addition to the conventional association of a beta-lactam plus an aminoglycoside may significantly decrease the mortality rate due to fulminant streptococci sepsis while the patient is severely neutropenic . In this regard, our current policy considers the addition of an anti-gram-positive antibiotic to the first-choice fever treatment in neutropenic patients who have received high-dose Ara-C. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1995 Jul-Aug, 36(4), 286 - 8 Orbital cellulitis in children: clinical analysis of 16 cases; Juan CM et al.; Orbital cellulitis, defined as eyelid erythema and edema, proptosis and/or ophthalmoplegia, with or without visual acuity loss, is a rare, but severe infectious disease . The medical records were reviewed of 16 children, aged 18 years or under, who were admitted at Chang Gung Memorial Hospital with a diagnosis of orbital cellulitis during the period from January 1977 to June 1993 . The 16 children included 13 males and 3 females . The mean age of the patients was 5.6 years . Sinusitis, diagnosed clinically and radiologically in eight cases, was the most common predisposing factor . From pus or blood in five patients, these pathogens were isolated: Staphylococcus aureus (2), viridans streptococci (1) and mixed bacterial flora (2) . All of the patients were treated with systemic antibiotics . The mean duration of fever after initiation of antibiotic therapy was 2.9 days . Four patients subsequently developed complications: subperiosteal abscess (2), orbital abscess (1), and bacteremia (1) . Five patients received surgical treatment . No mortality was reported . After a follow-up period of 1-2 months, no sequelae were found among any of these 16 patients. Pediatr Infect Dis J, 1995 Jul, 14(7 Suppl), S102 - 7 Ceftibuten vs . penicillin V in group A beta-hemolytic streptococcal pharyngitis . Members of the Ceftibuten Pharyngitis International Study Group; Pichichero ME et al.; The efficacy and safety of a 10-day course of ceftibuten oral suspension (9 mg/kg once daily) were compared with those of penicillin V (25 mg/kg/day in 3 divided doses) in children 3 to 18 years old treated for symptomatic pharyngitis and scarlet fever caused by group A beta-hemolytic streptococci (Streptococcus pyogenes) . The study was prospective, randomized, multicenter and investigator-blinded; patients were randomized in a 2:1 ratio (ceftibuten:penicillin V) . Overall clinical success (cure/improvement) at the primary end point of treatment (5 to 7 days posttherapy) was achieved in 97% (285 of 294) of ceftibuten-treated patients vs . 89% (117 of 132) of penicillin V-treated patients (P < 0.01) . Elimination of infecting streptococci 5 to 7 days posttherapy was achieved in 91% (267 of 294) of ceftibuten-treated patients vs 80% (105 of 132) of penicillin V-treated patients (P < 0.01) . A significant rise in anti-streptolysin O or anti-DNase B was observed in approximately 30% of patients in both treatment groups . No patient developed rheumatic fever or nephritis . Treatment-related adverse events were similar between the two groups; mild vomiting (2%) was most frequently reported . These data suggest that once daily ceftibuten is as safe as and more effective than three times daily penicillin V for the treatment of group A beta-hemolytic streptococcal pharyngitis. J Periodontal Res, 1995 Jul, 30(4), 252 - 7 Characteristics of multimodal co-aggregation between Fusobacterium nucleatum and streptococci; Takemoto T et al.; The co-aggregation characteristics between Fusobacterium nucleatum and streptococci were examined to clarify the adherence factors participating in the co-aggregation . Nineteen strains of F . nucleatum were classified into 8 groups according to co-aggregation titer and inhibition by L-arginine, L-lysine and N-acetyl-D-galactosamine (or lactose) . The inhibition activity was, however, very different from strain to strain . With two fusobacterial strains, two inhibitors, which were both inhibition negative on their own, completely inhibited the co-aggregation when used together in a mixture . In some co-aggregation pairs, the protease treatment of F . nucleatum inactivated one of the adherence factors, and resulted in the change of inhibition characteristics . These results indicate the multimodal co-aggregation of F . nucleatum with streptococci mediated by L-arginine-sensitive, L-lysine-sensitive, N-acetyl-D-galactosamine-sensitive and in some resistant factors, and that the adherence factor or factors participating the co-aggregation change according to the co-aggregation partners. J Dent Res, 1995 Jul, 74(7), 1360 - 6 Salivary amylase promotes adhesion of oral streptococci to hydroxyapatite; Scannapieco FA et al.; Recent studies have demonstrated that several species of oral streptococci, such as Streptococcus gordonii, bind soluble salivary alpha-amylase . The goal of the present study was to determine if amylase immobilized onto a surface such as hydroxyapatite can serve as an adhesion receptor for S . gordonii . Initially, human parotid saliva was fractionated on Bio-Gel P60, and fractions were screened for their ability to promote adhesion of S . gordonii to hydroxyapatite . Fractions containing alpha-amylase and proline-rich proteins promoted the adhesion of {3H}-labeled S . gordonii to hydroxyapatite . Similar findings were obtained with purified amylase and acidic proline-rich protein 1 (PRP1) . Incubation of S . gordonii G9B in the presence of starch and maltotriose increased the binding of this strain to amylase-coated hydroxyapatite, while the adhesion of S . sanguis 10556 to amylase-coated hydroxyapatite was not affected by these saccharides . These results suggest that amylase may serve as a hydroxyapatite pellicle receptor for amylase-binding streptococci . Furthermore, starch and starch metabolites may enhance the adhesion of amylase-binding streptococci to amylase in dental pellicles to augment the formation of dental plaque. J Clin Periodontol, 1995 Jul, 22(7), 527 - 32 A 6-month home-usage trial of 0.1% and 0.2% delmopinol mouthwashes (II) . Effects on the plaque microflora; Elworthy AJ et al.; The effects of 0.1% and 0.2% delmopinol mouthwashes on supragingival plaque flora were investigated in a 6-month home-use study . 141 subjects were studied from whom plaque was collected at baseline, 12, 24, and 36 weeks . Overall, there were no consistent effects on microscopic or total counts . However, there was a significant reduction in the proportion of dextran-producing streptococci in the active groups compared to the control group throughout treatment . There was no colonisation by Candida or Gram-negative aerobic bacilli in the active groups nor was there any decrease in susceptibility to delmopinol . Delmopinol appears to mediate its anti-plaque effect without causing a major shift in bacterial populations, although dextran-producing bacteria appear to be affected, which may have relevance to this agent's mode of action. Clin Nephrol, 1995 Jul, 44(1), 8 - 13 Streptokinase gene variable region classification in streptococci: lack of correlation with post-streptococcal glomerulonephritis; Okada K et al.; To investigate a possible causal role of streptokinase (SKase) in acute post-streptococcal glomerulonephritis (APSGN), the major variable region of SKase genes of Streptococcus pyogenes strains isolated from patients with and without APSGN were analyzed using the polymerase chain reaction, restriction enzyme analysis and the direct sequencing of SKase genes . In the APSGN-associated strains, six of nine revealed mutant classes corresponding to the nephritogenic classes I and II proposed by Johnston et al . {1992}, the remaining three belonged to non-nephritogenic classes . In twenty strains not associated with APSGN, seventeen belonged to classes I and II, while three were from other classes . The major variable region of the SKase gene shows no apparent relation with induction of APSGN in humans, suggesting that unique classes of streptococcal SKase do not play a role in the pathogenesis of APSGN. Arch Dis Child Fetal Neonatal Ed, 1995 Jul, 73(1), F46 - 7 Group B streptococcal infection: when does vertical transmission take place? Michie CA, Blumberg R. Expression of CD45 isoforms was used to estimate when group B streptococci had infected a child born with low Apgar scores who subsequently died . The measure suggested that infection was present more than 24 hours before delivery, thus distinguishing perinatal infection as the primary event which preceded intrapartum asphyxia in this case. Curr Opin Rheumatol, 1995 Jul, 7(4), 299 - 305 Rheumatic fever and poststreptococcal reactive arthritis; Gibofsky A et al.; Rheumatic fever is a catastrophic illness in many parts of the world, particularly in developing nations, where the incidence has been estimated to be between 10 and 15 million new cases each year . In the United States, rheumatic fever had become a rarity, having virtually disappeared by the mid 1960s . Of increasing concern, however, was the abrupt rise in the incidence of rheumatic fever in the United States in the mid 1980s, with reported "outbreaks" in middle-class communities in five cities and two military camps . Recently, a number of cases of poststreptococcal reactive arthritis have been reported . On close examination, however, these are most likely alternate clinical presentations of rheumatic fever . It is widely accepted that rheumatic fever occurs following an overactive immune response by a genetically susceptible host to oropharyngeal infection with group A beta-hemolytic streptococci . Nevertheless, details of pathogenesis at a level allowing more effective intervention remain obscure . The question of pathogenesis holds a deep interest, because rheumatic fever is one of the few autoimmune diseases with a known infectious etiology. Adv Dent Res, 1995 Jul, 9(2), 122 - 4 The effects of non-fluoridated and fluoridated milk on experimental caries in rats; Stosser L et al.; The aim of the present investigation was to determine the caries-protective potential of non-fluoridated and fluoridated milk and to compare the efficacy of different compounds of fluoride as additives to milk . OM rats were maintained in three experiments in a frequency-controlled feeding machine of Konig et al . (1968) or, during one study, in metabolic cages with diet MIT 200 for three weeks . They received (1) milk with Ca-Fluoride {solubilized by KA1-Sulfate}, (2) NaF, (3) NaMFP, and (4) Na-Silicofluoride . Controls were supplied with water or NaF solution of the same concentration of 10 or 15 ppm F . In addition, raw milk was provided ad libitum for the rats in a preliminary test . At the beginning and the end of the experiments, the pH of milk, its fluoride concentration, the body weight gain, the caries score, the fluoride concentration of the outermost enamel surface, the percentage of the interproximal bacteria, and the fluoride ingestion and excretion were determined . The raw milk significantly reduced the animal caries score by around 40% . This effect was lower but reproducible under programmed feeding with milk of a reduced fatty content (1.5%) . The addition of Ca-Fluoride, which was not totally ionized (6.5 ppm F), reduced the caries score again by around 40% . Increasing concentrations of NaF (5, 10, 15 ppm F), Na-Silicofluoride, or NaMFP showed similar caries-inhibiting effects without remarkable influence of the fluoride dosage used . The percentage of streptococci ranged from 30 to 60 in the fluoridated milk and control groups as well . The increasing fluoride deposition in the enamel reflected the various fluoride dosages offered . The rats receiving non-fluoridated milk or distilled water had a significantly higher incidence of dental caries than those receiving fluoridated milk . The permanent availability of fluoride during the animal tests caused a higher caries-inhibiting effect than in clinical human studies reported. Antimicrob Agents Chemother, 1995 Jul, 39(7), 1580 - 8 Antimicrobial activity of MDL 63,246, a new semisynthetic glycopeptide antibiotic; Goldstein BP et al.; MDL 63,246 is a semisynthetic derivative of the naturally occurring glycopeptide antibiotic MDL 62,476 (A40926) . It was more active in vitro against Staphylococcus aureus and coagulase-negative staphylococci than MDL 62,476, teicoplanin, and vancomycin and was more active than mideplanin (MDL 62,873) against some isolates . MDL 63,246 had excellent activity against streptococci and teicoplanin-susceptible enterococci, and it also had in vitro activity against some VanA enterococcal isolates . It was more active than teicoplanin and vancomycin against acute staphylococcal, streptococcal, and enterococcal septicemia in immunocompetent and neutropenic mice . It was highly efficacious in reducing the bacterial load in the hearts of rats in staphylococcal endocarditis experiments and the bacterial load of Staphylococcus epidermis in a high infection model in neutropenic mice . The excellent in vivo activity of MDL 63,246 appears to correlate both with its in vitro antibacterial activity and with its long half-life in rodents. Antimicrob Agents Chemother, 1995 Jul, 39(7), 1565 - 8 In vitro and in vivo effects of penicillin and clindamycin on expression of group A beta-hemolytic streptococcal capsule; Brook I et al.; Encapsulation of group A beta-hemolytic streptococci (GABHS) is an important virulence factor . The changes that occur in the frequency of encapsulation of GABHS during pharyngotonsillitis, in 20 patients treated with penicillin and 20 treated with clindamycin, were investigated . The effects of subinhibitory concentrations of these agents were also evaluated in vitro . At day 4, 8 of 10 (80%) GABHS isolates recovered from children treated with penicillin were encapsulated, compared with 1 of 5 (20%) of those from children treated with clindamycin (P < 0.05) . Two days following 10 days of therapy, GABHS was eliminated from 13 of the 20 (65%) children treated with penicillin and from all treated with clindamycin (P < 0.05) . At that time, six of the seven GABHS isolates recovered in patients treated with penicillin were encapsulated . GABHS were not detected after 4 days of therapy in those treated with clindamycin . Incubation of GABHS isolates with one-half of the MIC of clindamycin reduced the frequency of encapsulation, compared with that after incubation with one-half of the MIC of penicillin (12.5 versus 67.5%) . These data illustrate the superiority of clindamycin over penicillin in reducing the expression of a capsule by GABHS. Antimicrob Agents Chemother, 1995 Jul, 39(7), 1425 - 9 RP 59500 prophylaxis of experimental endocarditis due to erythromycin-susceptible and -resistant isogenic pairs of viridans group streptococci; L'Heriteau F et al.; RP 59500 is a new injectable streptogramin composed of two synergistic components (quinupristin and dalfopristin) which are active against a number of erythromycin-susceptible and -resistant gram-positive bacteria . The following experiments investigate the ability of RP 59500 to prevent experimental endocarditis due to either of two erythromycin-susceptible streptococcal isolates or their constitutively erythromycin-resistant Tn916 delta E transconjugants . RP 59500 had low MICs (0.125 to 0.5 mg/liter) for all four test organisms and was substantially bactericidal in vitro . Rats with catheter-induced aortic vegetations were given single-dose antibiotic prophylaxis 30 to 60 min before bacterial inoculation through a computerized pump system which permitted the simulation of drug kinetics for humans produced by either 7 mg of RP 59500 per kg of body weight or 1 g of vancomycin . Single-dose RP 59500 prophylaxis successfully prevented endocarditis due to both the erythromycin-susceptible parent strains and their erythromycin-resistant derivatives in rats challenged with the minimal inoculum infecting 90% of controls . In addition, RP 59500 also prevented infection in animals challenged with fivefold-larger inocula of the erythromycin-susceptible parent strains . Vancomycin successfully prevented endocarditis due to any of the four test organisms . These results underline the in vivo efficacy of RP 59500 against both erythromycin-susceptible and -resistant streptococci . Such good results against the resistant strains would not be expected with erythromycin or clindamycin, which are the standard macrolidelincosamide-streptogramin antibiotics used for endocarditis prophylaxis in humans . An oral form of RP 59500 which might advantageously replace some of the older prophylactic regimens is currently being developed. Pediatr Med Chir, 1995 Jul-Aug, 17(4), 295 - 7 {Prevalence of group B beta-hemolytic Streptococcus colonization in a sample of 23,312 pregnant women and newborn infants}; Bagnani A et al.; We report the prevalence of colonization of Group B Streptococci in a given population referred to a limited area in the north-west of Italy . 23.312 pregnant women were tested . Group B Streptococci have been isolated from genital cultures in 0.18-13.2% (mean 8.18) . The prevalence of Group B streptococcal colonization from ear, throat and ocular cultures of newborn infants from colonized mothers was 11.55% . Incidence of infection in neonates has varied from 0 to 2.33% (1.5 per 1000 live births). Arch Mal Coeur Vaiss, 1995 Jul, 88(7), 993 - 8 {Comparative outcome of aortic valve endocarditis with or without annular abscess}; Stchepinsky O et al.; Annular abscess is a not uncommon but serious complication of aortic valve endocarditis . The aim of this retrospective study was to evaluate the prognosis of aortic valve endocarditis with and without annular abscess . Between January 1981 and 1989, 122 consecutive cases of aortic endocarditis fulfilling the diagnostic criteria of Duke University were admitted to hospital . Group I included 40 cases with aortic ring abscess confirmed at surgery, in 35 patients; group II comprised 43 cases of operated aortic valve endocarditis without annular abscess in 41 patients and group III comprised 38 cases of aortic valve endocarditis treated medically without echocardiographic or angiographic signs of annular abscess in 36 patients . The patients in group III were significantly older than those in group I (57 +/- 14 years vs 44 +/- 17 years; p < 0.001) . From the clinical point of view, endocarditis of prosthetic valves was slightly more common, but without reaching statistical significance, in group I, but the abscess was associated with more severe cardiac failure . Systemic embolism, atrioventricular block and pericardial effusion were equally common in the three groups . On the other hand, endocarditis with annular abscess was more often the result of infection with streptococci A, B, C or pneumoniae, than forms without abscess (22.5% vs 5% and 3% respectively in the 3 groups; p < 0.05) . Of the patients treated surgically, destructive lesions of the valves were more common in cases of abscess (57.5% vs 35%; p < 0.05): the hospital mortality was higher in cases of abscess (17.5% vs 7%).(ABSTRACT TRUNCATED AT 250 WORDS) Mol Microbiol, 1995 Jul, 17(1), 137 - 45 Characterization of a novel fibronectin-binding surface protein in group A streptococci; Kreikemeyer B et al.; Streptococcus pyogenes interacts with host fibronectin via distinct surface components . One of these components is the Sfbl protein (streptococcal fibronectin-binding protein, now specified as class I), an adhesin that represents a protein family with characteristic features . Here we present the complete structure of a novel fibronectin-binding protein of S . pyogenes, designated Sfbll, which is distinct from the previously described Sfbl proteins . The sfbll gene originated from a lambda EMBL3 library of chromosomal DNA from group A streptococcal strain A75 and coded for a 113 kDa protein exhibiting features of membrane-anchored surface proteins of Gram-positive cocci . The expression of biologically active fusion proteins allowed the determination of the location of the fibronectin-binding domain within the C-terminal part of the protein . It consisted of two and a half repeats which share common motifs with fibronectin-binding repeats of other streptococcal and staphylococcal proteins . Purified recombinant fusion protein containing this domain competitively inhibited the binding of fibronectin to the parental S . pyogenes strain . Furthermore, polyclonal antibodies against the binding domain specifically blocked the Sfbll receptor site on the streptococcal surface . No cross-reactivity could be detected between anti-Sfbll antibodies and the sfbl gene product, and vice versa, indicating that the two proteins do not share common immunogenic epitopes . Southern hybridization experiments performed with specific sfbll gene probes revealed the presence of the sfbll gene in more than 55% of 93 streptococcal isolates tested . The majority of the strains also harboured the sfbl gene, and 86% carried at least one of the two sfb genes. Lancet, 1995 Jun 24, 345(8965), 1607 - 9 Viridans streptococcal bacteraemia in patients with neutropenia; Richard P et al.; Viridans streptococcal bacteraemia is frequent in neutropenic patients . 25 neutropenic patients with viridans streptococcal bacteraemia were compared with 64 control patients . Exposure to repeated chemotherapy or cytarabine were independent risk-factors for streptococcal bacteraemia . The use of carboxyureidopenicillins and a stay in laminar-airflow rooms were protective . In a further cohort study of 49 patients, oral streptococci with the same ribotype as blood isolates were recovered from all 7 bacteraemic patients . The oral cavity is a portal of entry for viridans streptococci bacteraemia in neutropenic patients, especially after oral mucosal damage induced by repeat