Streptococcal

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 repeated chemotherapy.

Br Dent J, 1995 Jun 10, 178(11), 418 - 22
Comparative efficacy of oral doses of clindamycin and erythromycin in the prevention of bacteraemia; Aitken C et al.; Two antibiotics, clindamycin and erythromycin, were compared in a double-blind trial to test their efficacy in the prevention of post-dental extraction bacteraemia with streptococci in a group of 40 healthy patients . Tolerance to the oral doses was tested by questionnaire . Levels of drug in the serum were estimated using a microbiological assay . An in-vitro blood culture system was used as an analogy of the persistence of a bacteraemia in the presence of high levels of antibiotic . Isolates of streptococci were identified to species level . Minimum inhibitory concentrations of clindamycin and of erythromycin for each isolate were estimated . Results showed satisfactory levels of antibiotics in the blood for activity against oral streptococci . Clindamycin was slightly more effective than erythromycin in the prevention of post-extraction streptococcal bacteraemia but that efficacy was only 45% . Clindamycin as a single oral dose of 600 mg was well tolerated by patients compared with erythromycin 1.5 g.

Microb Pathog, 1995 Jun, 18(6), 401 - 15
Phase-shift of polysaccharide capsule expression in group B streptococci, type III; Sellin M et al.; The type-specific polysaccharide capsule is an important virulence determinant in group B streptococci (GBS) . The previously described inverse relationship between the buoyant density of a GBS-isolate and the capsular thickness was used to assess the frequencies of polysaccharide capsular phase-shift in clinical GBS, type III strains . Shift from intermediate density (ID) of parental strains, to high density (HD), i.e . shift from intermediate capsule thickness to poor encapsulation, was found to range from 1.2 x 10(-3) to 4.8 x 10(-6) . Shift from ID to low density (LD), i.e . shift to abundant encapsulation, ranged from 1.9 x 10(-4) to 1.1 x 10(-7) . Shifts were reversible in all cases, either directly (HD-->LD or vice versa) or through intermediate forms . Reversion frequencies were in some isolates as high as 10(-1) . Phase-shift frequencies differed more than a thousand-fold between compared strains . Differences in phenotypic shift between strains were validated using flow cytometry . Possible modulation of capsule expression by changes in culture conditions was assessed . Variation of temperature, oxygen-tension, and presence of human serum did not affect capsule expression . However, growth at pH below 5.5 decreased the amount of capsule bound native type III polysaccharide, probably through phenotypic modification rather than genetic shift . IS861, an insertion sequence which has been proposed a regulatory function on the GBS capsule expression, was found in multiple copies in the isolates investigated . No differences in copy number or location of IS861 between the differently encapsulated phenotypes were found.

Pathol Biol (Paris), 1995 Jun, 43(6), 530 - 3
{Use of azithromycin in ORL}; Gehanno P; If the demonstration of the interest to treat beta-haemolytic streptococcal pharyngitis is not to be done, the recommended antibiotics, most of the time, display the drawback of a treatment with one to three intakes daily for 10 days . The azithromycin, with its numerous properties, allows for the required treatment duration, to decrease the intakes number, thus facilitating the compliance . Its in vitro activity is very good on streptococci with a MIC90 of 0.06 mg/l . Its in vivo activity in animal, with experimental Streptococcus pyogenes infection models is identical to the amoxicillin activity, and better than those of other tested macrolides . One of the major characteristics of azithromycin in man is its most peculiar pharmacokinetic with an extended half life and very high tonsillar concentrations, for at least 10 days after the administration of the product at the 1.5 g dose regimen over 3 days . In streptococcal acute tonsillitis clinical studies, with a 1.5 g dose regimen over 5 days, clinical results and bacterial eradication are identical to those obtained in the Penicillin V groups . This administration facility should greatly improve the treatment compliance and lower the risks of a prematurely discontinued treatment.

J Med Microbiol, 1995 Jun, 42(6), 442 - 51
Identification and typing of pyogenic streptococci by enzyme electrophoretic polymorphism; Bert F et al.; Polyacrylamide-agarose gel electrophoresis was used to study polymorphism of lactate dehydrogenase (LDH), nucleoside phosphorylase (NSP), phosphoglucose isomerase (PGI), hydroxybutyrate dehydrogenase (HBD), adenylate kinase (ADK) and esterases of 44 strains of Streptococcus pyogenes, 25 group G streptococcal strains, 11 "S . equisimilis" strains, seven S . dysgalactiae strains, four S . canis strains, three S . equi strains and seven S . zooepidemicus strains . Analysis of LDH, NSP, PGI, HBD and ADK provided valuable interspecies differentiation, by showing that four groups of strains corresponded to the four known DNA homology groups . Esterases showed greater intraspecies variation than the other enzymes . The combined analysis of the six enzymes indicated 31 zymotypes among S . pyogenes, 14 in group G streptococci and 11 in "S . equisimilis" strains . This was shown to be an effective technique for typing pyogenic streptococci.

J Dent, 1995 Jun, 23(3), 177 - 81
Antibacterial activity of MDPB polymer incorporated in dental resin; Imazato S et al.; OBJECTIVES: Previously, we have reported that dental composite incorporating the new monomer methacryloyloxydodecylpyridinium bromide (MDB) showed no release of antibacterial components after being cured but still exhibited antibacterial activity against Streptococcus mutants on its surface . In this study, in order to elucidate the mechanism of the antibacterial effect of immobilized MDPB, the bactericidal activity of MDPB polymer in water-soluble and -insoluble form was investigated, and the effect of MDPB polymer on bacterial attachment was estimated . METHODS: Solutions of homo-polymer of MDPB and co-polymer of MDPB with acrylamide were prepared and the viability of seven major oral streptococci was determined after incubation with each polymer solution . For the estimation of bactericidal activity of insolubilized MDPB polymer, bacteria were kept in contact with cured unfilled Bis-GMA-based resin discs with or without MDPB, and the recovery of viable cells was measured . Attachment of streptococci to cured resin discs with or without MDPB was also compared using radiolabelled bacteria . RESULTS: Water-soluble homo-polymer of MDPB and co-polymer with acrylamide showed bactericidal activity against oral streptococci . However, cured resin incorporating MDPB, which is in water-insoluble form, had little bactericidal activity . Attachment of streptococci, including species which are early colonizers in dental plaque formation, to the cured resin containing MDPB was significantly less than to the control without MDPB . CONCLUSIONS: These results indicate that the bactericidal activity of MDPB polymer is reduced after immobilization, but MDPB on the surface of a resin-based material still shows a bacteriostatic effect and antiadhesion property against oral streptococci.

J Pediatr, 1995 Jun, 126(6), 931 - 3
Comparison of an optical immunoassay technique with two culture methods for the detection of group A streptococci in a pediatric office; Roddey OF Jr et al.; For detecting group A beta-hemolytic streptococci in an office setting, an optical immunoassay method was compared with two culture methods . The sensitivity and specificity of OIA as compared with 5% sheep blood agar cultures were 91.4% and 95.6%, and as compared with a Todd-Hewitt broth method were 90.4% and 94.1%, respectively.

J Infect Dis, 1995 Jun, 171(6), 1643 - 5
Protection of mice from group A streptococcal skin infection by interleukin-12; Metzger DW et al.; It has been shown that interleukin (IL)-12 induces cell-mediated immunity and provides significant protection against intracellular organisms . The ability of this cytokine to enhance immunity in a mouse model of group A streptococcal skin infection was studied . Outbred CD1 mice were injected for 3 consecutive days with 0.1 microgram of recombinant murine IL-12 before or after challenge with strain 64/14 group A streptococci . In both cases, in vivo IL-12 treatment significantly decreased the rate of death after infection and increased survival over the period of experimental observation . Thus, IL-12 may be useful for treatment of gram-positive bacterial infections . The time course of the experiments suggests that IL-12 is acting in this model system to enhance natural, rather than acquired, immunity.

Infect Immun, 1995 Jun, 63(6), 2295 - 301
Reactivation of arthritis induced by small bowel bacterial overgrowth in rats: role of cytokines, bacteria, and bacterial polymers; Lichtman SN et al.; Arthritis is often associated with intestinal diseases, but the etiology is not known . We developed a rat model whereby arthritis was reactivated by experimental small bowel bacterial overgrowth (SBBO) . Self-limited monoarticular arthritis was induced by intra-articular injection of 2 micrograms of rhamnose peptidoglycan-polysaccharide derived from group A streptococci into the ankle joints in female Lewis rats . Eleven days after intra-articular injection, when swelling was resolving, experimental SBBO induced by surgical creation of jejunal self-filling blind loops reactivated arthritis, but SBBO induced by creation of self-emptying blind loops, which minimally increases luminal bacteria, and sham operation did not (P < 0.001) . Increased joint diameters in rats with self-filling blind loops persisted for at least 56 days after surgery . Reactivation of arthritis due to SBBO was prevented by anti-tumor necrosis factor alpha antiserum and interleukin 1 receptor antagonist (P < 0.001), indicating that these cytokines mediate joint swelling secondary to intestinal injury . Recombinant bactericidal/permeability-increasing protein, an agent which neutralizes endotoxin, and metronidazole, which is active against anaerobic bacteria, prevented arthritis (P < 0.001), but polymyxin B (which also neutralizes endotoxin) and gentamicin had no effect . Mutanolysin, an enzyme which degrades peptidoglycan-polysaccharide from group A streptococci, exacerbated arthritis for the first 6 days but then diminished joint swelling from 12 to 21 days after surgery (P < 0.001) . These studies introduce a reproducible animal model of reactivation of arthritis secondary to intestinal injury and demonstrate a role for bacterial products from endogenous enteric organisms.

Pediatr Clin North Am, 1995 Jun, 42(3), 539 - 51
Antibiotic resistance in group A streptococci; Gerber MA; Although erythromycin resistance in GABHS has been a major problem in Japan and in Finland, it has not been a problem in the United States . The susceptibility of GABHS to the newer macrolide antibiotics seems to be similar to that of erythromycin . Comprehensive, community-wide programs to continuously monitor for erythromycin resistance in GABHS would be difficult to justify; however, because little is known about how erythromycin resistance in GABHS is acquired or spread, it would be reasonable to periodically monitor isolates of GABHS for erythromycin resistance . Despite more than four decades of use of penicillin in treating GABHS infections, no significant change has occurred in the in vitro susceptibility of GABHS to penicillin . The resurgence of severe, invasive GABHS infections and of acute rheumatic fever is not attributable to the emergence of strains of GABHS with increased resistance to penicillin . A substantial proportion of GABHS are currently resistant to tetracyclines, and these agents are inappropriate for treating GABHS infections . Although little recent information is available about the susceptibility of GABHS to sulfonamides, these agents have been shown to be ineffective in eradicating GABHS form the upper respiratory tract regardless of the in vitro sensitivities . GABHS have not been shown to be resistant to any of the commonly used oral cephalosporins; however, a great deal of variability exists among these agents in their activity against GABHS . Clindamycin resistance in GABHS has remained unusual . This agent is an alternative for treating GABHS infections due to macrolide-resistant strains in patients who cannot be treated with beta-lactam antibiotics.

Br J Dermatol, 1995 Jun, 132(6), 989 - 91
Occult Streptococcus pyogenes in cellulitis: demonstration by immunofluorescence; Shelley WB et al.; A 23-year-old man developed cellulitis and ascending lymphangitis of the right leg . Blood cultures and skin saline aspirates were sterile . Gram stain of the aspirate did not show any bacteria . Direct and indirect immunofluorescent staining with polyclonal and monoclonal antibodies to Streptococcus pyogenes revealed streptococci in the reticular dermis . The cellulitis resolved following treatment with intravenous cefazoline.

J Clin Microbiol, 1995 Jun, 33(6), 1584 - 7
Analysis of enzymatic activities for differentiation of two species of nutritionally variant streptococci, Streptococcus defectivus and Streptococcus adjacens; Beighton D et al.; Strains of nutritionally variant streptococci, Streptococcus defectivus (n = 10) and Streptococcus adjacens (n = 20), were studied for the production of glycosidic and proteolytic enzyme activities . S . defectivus strains produced neuraminidase and alpha-fucosidase, while S . adjacens strains produced only neuraminidase . The S . adjacens strains produced a very wide range of proteolytic activities with the ability to hydrolyze the majority of aminopeptidase substrates tested, while S . defectivus strains hydrolyzed only a minority of aminopeptidase substrates . These data provide additional phenotypic characteristics which may be useful in distinguishing between these two species and suggest that they may have different nutritional requirements.

QJM, 1995 Jun, 88(6), 415 - 20
Viridans streptococcal bacteraemia: a clinical survey; Sriskandan S et al.; The occurrence of viridans streptococcal bacteraemia (VSB) in a London postgraduate teaching hospital was analysed retrospectively . Over a 30-month period, 39 patients with VSB were identified, and the clinical significance of VSB was assessed for each, based upon clinical and laboratory information . Endocarditis accounted for only 13% of the total patients with apparent VSB . A greater proportion of patients with VSB originated from the haematology unit (21%) and in particular, the bone-marrow transplantation unit (15%) . VSB also occurred in patients with solid epithelial malignancies and in children aged < 12 months . Mortality associated with VSB was 7% . Viridans streptococci are emerging as important pathogens in previously unrecognized clinical settings, particularly hospitalized, immunocompromised patients.

Mol Immunol, 1995 Jun, 32(9), 669 - 78
Characterization of a gene coding for a type IIo bacterial IgG-binding protein; Boyle MD et al.; Two antigenic classes of non-immune IgG-binding proteins can be expressed by group A streptococci . One antigenic group of proteins is recognized by an antibody prepared against the product of a cloned fcrA gene (anti-FcRA) . In this study, the immunogen used to prepare the antibody that defines the second antigenic class was shown to be the product of the emm-like (emmL) gene of M serotype 55 group A isolate, A928 . The emmL55 gene expressed in E . coli produced an M(r) approximately 58,000 molecule which bound human IgG1, IgG2, IgG3 and IgG4, as well as horse, rabbit and pig IgG in a non-immune fashion . These properties are characteristic of the previously described type IIo IgG-binding protein isolated from this strain . In addition, the recombinant protein was reactive with human serum albumin and fibrinogen . The emmL 55 gene sequence was analysed and found to have the organization and sequence characteristics of a typical class I emm-like gene.

J Trop Pediatr, 1995 Jun, 41(3), 177 - 80
Neonatal sepsis in Dubai, United Arab Emirates; Koutouby A et al.; The case records of all neonates admitted to the neonatal unit of Al Wasl Hospital (Dubai) in a period of 60 months (May 1987-April 1992) were analysed . One-hundred-and-six neonates had confirmed sepsis . The most common causative organisms were Group B Streptococci (23 per cent), E . coli (17 per cent), Staph . epidermidis (17 per cent), and Klebsiella pneumoniae (16 per cent) . Group B Streptococcus presented as the most common organism in very early (< or = 24 hours) and early onset (2-6 days) of sepsis (34 per cent, 21/61), Klebsiella pneumoniae (24 per cent), Staphylococcal epidermidis (18 per cent) and Candida (13 per cent) were most common organisms causing late onset of sepsis (7-30 days) . Pseudomonas aeruginosa and Klebsiella pneumoniae had highest mortality (71 per cent, 5/7; and 59 per cent, 10/17, respectively) . Lowest mortality (4 per cent, 1/25) was observed in Group B Streptococcus sepsis . Prematurity, low birth weight, and nosocomial sepsis were high risk factors associated with fatal outcome.

Community Dent Oral Epidemiol, 1995 Jun, 23(3), 147 - 54
Oral health in adolescents from a small French town; Weissenbach M et al.; In France, caries are more prevalent in rural areas than in large cities . This study analyzed the relationship between number of oral health indices and some known risk factors (toothbrushing, sugar consumption, saliva components) and sociodemographic factors in adolescents from a small town . The sample included 112 children aged 12-14 in the north-east of France . School marks was found to be better linked with dental caries indices than the socio-occupational category of parents: gingival index (GI), DMFS, DMFT and caries severity (CS) significantly increased with decreasing school marks; oral plaque was related to socio-occupational of parents . The analysis using the regression method showed that the variance explained by the various factors studied was modest (between 23 and 30%) for GI, initial caries sites (IS), DS, DMFS, DMFT and CS, and was small for plaque (5%) and calculus (3%) . This would be due in part to the wide dispersion of these indices . The sex had a non-significant regression coefficient for all oral health indices investigated . For GI, only mutans streptococci (MS) and plaque had a significant regression coefficient . Calculus was explained by any factor considered . Only MS had a significant part in plaque . IS was explained by MS, toothbrushing and age . For DS, only toothbrushing, MS and sweet drinks during meals had a significant part . DMFS and DMFT were explained only by MS and age . CS was explained by MS, age, salivary buffer pH, salivary flow rate, and toothbrushing.

Oral Microbiol Immunol, 1995 Jun, 10(3), 175 - 82
Sucrose-dependent accumulation of oral streptococci and their adhesion-defective mutants on saliva-coated hydroxyapatite; Vickerman MM et al.; The adhesion and accumulation of oral streptococci on saliva-coated hydroxyapatite was examined in strains representing species that appear in initial plaque (Streptococcus sanguise FC1 and Streptococcus oralis C5) and in more mature plaque (Streptococcus gordonii G9B) . Washed cells of strains FC1 and C5 did not attach better to saliva-coated hydroxyapatite than did strain G9B, suggesting that the degree of initial adhesiveness does not alone account for the temporal appearance of these bacteria in dental plaque . Growing cells of each strain were also examined for their ability to accumulate on saliva-coated hydroxyapatite . The addition of sucrose to the medium promoted the accumulation of strain G9B more than it promoted the accumulation of strains FC1 and C5 . Sucrose also enhanced the accumulation of adhesion-defective mutants of each strain to levels similar to those of the respective parent strains . These results suggest that sucrose-dependent accumulation may facilitate the colonization of the tooth surface by these species of oral streptococci when adhesion is limited by reduced bacterial adhesiveness or limited pellicle-binding sites.

J Antimicrob Chemother, 1995 Jun, 35(6), 843 - 54
A double-blind randomized trial comparing the efficacy and safety of a 5-day course of cefotiam hexetil with that of a 10-day course of penicillin V in adult patients with pharyngitis caused by group A beta-haemolytic streptococci; Carbon C et al.; A 10-day course of penicillin is the antibiotic regimen currently recommended by the American Heart Association (AHA) as treatment for patients with tonsillitis caused by group A beta-haemolytic streptococci (GABHS), with the aim of preventing both the suppurative and non-suppurative complications of this infection . This prospective, multicentre, randomized, double-blind, double-dummy clinical trial was undertaken in order to compare the efficacy of, tolerability of and compliance with a 5-day course of cefotiam hexetil (CTM) 200 mg bd with that of a 10-day course of penicillin V (PEV) 1 megaunit (600 mg) tds, to investigate the significance of recovering GABHS during or after treatment and to evaluate the potential economic advantages of short-term regimens . Two hundred and fifty ambulatory adult patients with a presumptive diagnosis (based on a positive rapid antigen detection test) of GABHS tonsillitis were recruited in 60 centres; the diagnosis was subsequently confirmed by a positive culture of a throat swab . At the time of entry into the trial there was no statistically significant difference between the groups in terms of clinical symptoms . In an intention-to-treat analysis, both the clinical and bacteriological response rates at days 10 and 30 were comparable for each group i.e . 106 of 119 (89.1%) patients and 90 of 109 (82.6%) patients respectively in the CTM group and 103 of 117 (88.0%) patients and 92 of 107 (86.0%) patients respectively in the PEV group . The times until defervescence and resolution of symptoms were also similar . Of the 115 patients in each group who were assessed at day 90, there were three clinical relapses in the CTM group and seven in the PEV group . No non-suppurative complications of GABHS infection were detected . Tolerance was significantly better in the CTM group than in the PEV group, 14 of 119 (11.8%) patients and 26 of 117 (22.2%) patients in the former and latter groups respectively reporting adverse events . In three cases in each group treatment was discontinued prematurely because of adverse events; none of these in the CTM group was serious but one patient in the PEV group experienced a severe allergic reaction . Compliance in both groups was good during the first 5 days of therapy but, by the end of each course, 93.6% of patients in the CTM group had completed treatment, compared with 73.0% in the PEV group.(ABSTRACT TRUNCATED AT 400 WORDS)

J Dent Res, 1995 Jun, 74(6), 1280 - 8
Saliva protein binding to layers of oral streptococci in vitro and in vivo; Rudney JD et al.; This paper reports a system for measuring saliva protein binding to oral streptococci . Enamel chips with layers of Streptococcus gordonii Blackburn or Streptococcus oralis 10557 were incubated in vitro with whole saliva from eight persons . Blackburn bound significantly more amylase than 10557; no strain differences were seen for lysozyme or lactoferrin . There were significant correlations between saliva and bound amylase and lactoferrin . Blackburn and 10557 chips were then placed in ten subjects . Sites included the buccal left and right upper premolars and molars (UL, UR), labial upper central incisors (UC), and lingual lower central incisors (LL) . That study was repeated three months later; chips with Streptococcus sanguis 13379 were also placed then . Blackburn bound significantly more amylase than the other strains . Blackburn and 10557 both bound the most amylase at UL and UR, and the least amylase at UC . However, strain 13379 bound less amylase at UL . That strain also bound significantly less sIgA at UL . All three strains bound the least sIgA at UC . Lysozyme and lactoferrin binding showed few differences among sites or strains . Bound protein concentrations were significantly correlated across sites and strains within subjects, but not correlated with whole saliva . Strain differences may reflect species differences in amylase binding, or differences in species-specific sIgA titers . Site differences may indicate local variation in protein availability . Differences between chip correlations with whole saliva in vitro and in vivo suggest that the salivary film may be modified as it flows over tooth surfaces.

Biochim Biophys Acta, 1995 May 18, 1249(1), 65 - 71
Streptococcal protein MAG--a protein with broad albumin binding specificity; Jonsson H et al.; Protein MAG is a cell surface protein from Streptococcus dysgalactiae which binds alpha 2-macroglobulin (alpha 2M), serum albumin and immunoglobulin G (IgG) . In this work protein MAG was expressed in Escherichia coli, purified and analysed for its albumin-binding specificity . The binding of protein MAG to serum albumins of different species origin was studied in a dot-blot assay and compared with the binding of streptococcal protein G, so far the best studied bacterial albumin receptor . The albumin-binding of protein MAG was also characterized using real-time biospecific interaction analysis (BIA), and the ka, kd and the Kaff values for different albumins were determined . Amino acid sequence alignment revealed homology between the albumin-binding domain of protein MAG and earlier described streptococcal albumin receptors including protein G . However, the MAG protein was reactive with serum albumin from bovine, dog, goat, horse, human, mouse, pig, rat and sheep origin and therefore displays a broader albumin-binding profile than protein G concerning the albumins tested in this work . Comparison of the albumin-binding spectrum of protein MAG with the earlier described albumin receptors of various S . dysgalactiae strains and other streptococci, suggests that protein MAG is a new type of albumin receptor.

Ugeskr Laeger, 1995 May 15, 157(20), 2851 - 5
{Respiratory tract infections in general practice--the effect of a medical audit project}; Munck AP et al.; A medical audit of the management of respiratory tract infections was performed among 31 general practitioners in Funen county . The first registration of prescriptions in 1992 showed that broadspectrum antibiotics were used to a higher extent than seemed necessary . An intervention with courses, visits to the department of clinical microbiology and distribution of recommendations concerning diagnosis and treatment was performed . The intention was to give the necessary and only the necessary amount of antibiotics and when an antibiotic was indicated to use penicillin as often as possible . A new registration was made one year after the first one . The proportion of antibiotic prescriptions was reduced from 0.49 to 0.38 and the proportion of prescriptions of broadspectrum antibiotics was reduced from 0.21 to 0.12 . Detection of group A streptococci in tonsillitis was used more frequently in 1993 than in 1992 . Medical audit performed after this model seems a good instrument for changing prescription habits . Medical audit thus seems to be a useful tool in quality improvement in general practice.

FEMS Microbiol Lett, 1995 May 15, 128(3), 289 - 92
NAD(+)-glycohydrolase productivity of haemolytic streptococci assayed by a simple fluorescent method and its relation to T serotype; Karasawa T et al.; The ability of haemolytic streptococci to produce NAD(+)-glycohydrolase was investigated by a fluorescent assay . Enzyme production was found in 31 (91%) of 34 group A, 17 (61%) of 28 group C and eight (27%) of 30 group G isolates . The high producers were found in 22 (65%) of group A, one (4%) of group C and none of group G isolates . The high producers of the group A isolates belonged to T-1, T-3, T-4 or T-12 serotype . These results suggest that NAD(+)-glycohydrolase productivity of streptococci is closely related to specific Lancefield's groups or T serotypes.

J Chemother, 1995 May, 7 Suppl 1, 21 - 4
Cefetamet pivoxil in the treatment of pharyngotonsillitis due to group A beta-hemolytic streptococci: preliminary report; Gervaix A et al.; Penicillin therapy has considerably reduced the occurrence of serious late complications of streptococcal pharyngotonsillitis . However, treatment failure with this antibiotic is currently reported in up to 30% of the cases . Beta-lactamase production by the commensal flora of the tonsils, and poor compliance of patients have been implicated as the main causes of treatment failure . Cefetamet pivoxil is a new oral cephalosporin with a twice daily dosage and striking stability against beta-lactamases . We are conducting a prospective, randomized study in 120 children, comparing the efficacy of cefetamet pivoxil 10 mg/kg bid for 5 and 10 days and phenoxymethyl penicillin 25,000 U/kg tid for 10 days in the treatment of group A beta-hemolytic streptococcus (GABHS) pharyngotonsillitis . Children are enrolled after the positive culture of a throat swab and randomly assigned to one of the three groups . A follow-up check-up is performed at the end of the therapy (clinical check-up) and 3 to 5 days later (bacteriological check-up) . The preliminary analysis of 55 cases shows that in 88.9%, 100% and 87.5% of children GABHS was eradicated by 5 days or 10 days of cefetamet pivoxil, or 10 days of penicillin respectively (p = NS) . Side effect were mild and transient in cefetamet pivoxil-treated patients, but required cessation of treatment in 2 children treated with penicillin . These results suggest that cefetamet pivoxil therapy for 5 days eradicates GABHS from the throat in streptococcal pharyngotonsillitis as efficiently as cefetamet pivoxil or phenoxymethyl penicillin for 10 days.

Rev Neurol, 1995 May-Jun, 23(121), 656 - 60
{Meningitis due to streptococcus viridans}; Alba D et al.; Viridans Streptococci (VS) may cause meningitis although, in most cases, they are isolated as contaminants in CSF . However VS should not be systematically underestimated as contaminants in CSF without a suitable clinical and analytical evaluation . Meningitis as a result of VS is being diagnosed with increasing frequency, especially in new born babies . Classic predisposition factors and illnesses (traumatism, surgery and infection) have increased, one frequent pathogenic mechanism being rupture of the mucous membrane with subsequent meningitis . VS are normally sensitive to penicillin G . However VS may be resistant to penicillin (low affinity of PBP to penicillin) and cause serious infections, including meningitis . For this reason it is convenient to perform sensitivity tests on VS in vitro in isolation to determine the appropriate therapy.

Med Microbiol Immunol (Berl), 1995 May, 184(1), 17 - 22
Measuring resistance to phagocytosis of group A and G streptococci: comparison of direct bactericidal assay and flow cytometry; Schnitzler N et al.; M protein is thought to contribute to the ability of non-opsonized group A and group G streptococci (GAS and GGS, respectively) to resist phagocytosis by polymorphonuclear leukocytes . In previous studies, correlation between M protein expression and phagocytosis was determined by incubating these pathogens in human blood and comparing colony-forming bacterial counts prior to and after exposure to blood (direct bactericidal assay; DBA) . Here, we report the application of flow cytometry to measure GAS and GGS resistance to phagocytosis . The results of the assays were in complete agreement with those from DBAs . Nevertheless, flow cytometry was regarded as superior to DBA because of its speed and potential uses for quantitative studies . In addition, the use of anti-CD11b monoclonal antibody for granulocyte staining guaranteed a non-compromized granulocyte function . The optimized protocol for flow cytometry presented here could be utilized to directly measure the involvement of individual protein types in bacterial resistance to phagocytosis.

J Dent Res, 1995 May, 74(5), 1212 - 8
Quantifying the strength of bacterial adhesive interactions with salivary glycoproteins; Prakobphol A et al.; We adapted an assay that has been used to estimate the strength of eukaryotic cell-cell and cell-extracellular matrix adhesive interactions (McClay et al., 1981) to quantify the strength of bacterial (streptococci, fusobacteria, actinomyces) interactions with salivary receptors . Bacteria are centrifuged onto human submandibular/sublingual or parotid-saliva-coated microtiter wells . Plates are sealed with pressure-sensitive, double-sided tape which allows them to be inverted and centrifuged again . The force required to remove the bacteria from the coated wells is a direct measure of the adhesive strength of the interaction(s) being disrupted . The bacteria-saliva adhesive forces we detected ranged from 1.6 x 10(-8) dynes (Streptococcus sanguis 72-40) to > 1.1 x 10(-7) dynes (Actinomyces viscosus T14 V) . These forces were in the range to withstand the shear stress produced by salivary flow, which we calculated as approximately 6.1 x 10(-7) dynes.

J Appl Bacteriol, 1995 May, 78(5), 569 - 74
Bacteria in supragingival plaque samples can be killed by low-power laser light in the presence of a photosensitizer; Wilson M et al.; The purpose of this study was to determine whether bacteria in supragingival plaque samples could be killed by low-power laser light in the presence of a suitable photosensitizer . Plaque samples were obtained from 10 volunteers, treated with either toluidine blue O (TBO) or aluminum disulphonated phthalocyanine (AlPcS2), and then exposed to light from a helium/neon (HeNe) or gallium aluminium arsenide (GaAs) laser respectively . Following irradiation, substantial reductions were achieved in the total anaerobic count as well as in the number of viable streptococci and actinomyces present in the samples . In the absence of laser light, the sensitizers themselves had little effect on the viability of the bacteria in the plaque samples . The HeNe/TBO combination appeared to be more effective than the GaAs/AlPcS2 combination, achieving log10 reductions of 2.95, 5.40 and 3.34 in the total anaerobic count, streptococci and actinomyces respectively with a light energy dose of 1.31 J . If effective in vivo, lethal photosensitization may be useful as a means of eliminating plaque bacteria from a carious lesion prior to its restoration.

Am J Obstet Gynecol, 1995 May, 172(5), 1546 - 52
A randomized, prospective study of adjunctive ceftizoxime in preterm labor; Gordon M et al.; OBJECTIVE: Our purpose was to determine the effect of ceftizoxime in the prolongation of pregnancies receiving tocolysis for preterm labor . STUDY DESIGN: A prospective, randomized, double-blinded, placebo-controlled trial was conducted in patients with preterm labor between 24 and 35 weeks' gestation . A total of 545 patients with intact membranes and without chorioamnionitis who were receiving magnesium sulfate were screened . Exclusions were for advanced cervical dilatation, penicillin allergy, current antibiotic therapy, and failure to give informed consent . Of these, 117 consecutive, eligible, consenting patients were randomized to receive either 2 gm of ceftizoxime or a placebo every 8 hours . The primary end point was prolongation of gestation . Statistical comparisons were performed by use of unpaired two-tailed t tests and chi 2 analysis . RESULTS: Of the 58 ceftizoxime and 59 placebo patients, there was no difference in the interval to delivery (34.5 +/- 21.1 days vs 34.6 +/- 24.5 days, p = 0.99) and no difference in the rate of delivery before 37 weeks' gestation (60% in the ceftizoxime group vs 58% in the placebo group, p = 0.91) . Subanalyses of 61 subjects who received nine or more doses and who were group B streptococci negative, 69 patients at < or = 32 weeks on presentation, and 22 sets of twins all showed no differences in delivery interval or rate of delivery at < 37 weeks . The sample size of this study was sufficient to detect a 9-day difference in prolongation of pregnancy (alpha = 0.05, beta = 0.2) . CONCLUSIONS: Ceftizoxime had no effect on interval to delivery or duration of pregnancy in women treated for preterm labor.

Am J Obstet Gynecol, 1995 May, 172(5), 1540 - 5
Outcome of the Vaginal Infections and Prematurity Study: results of a clinical trial of erythromycin among pregnant women colonized with group B streptococci; Klebanoff MA et al.; OBJECTIVE: Our purpose was to determine whether erythromycin treatment of pregnant women colonized with group B streptococci would reduce the occurrence of low birth weight (< 2500 gm) and preterm (< 37 completed weeks) birth . STUDY DESIGN: In a double-blind clinical trial, 938 carriers of group B streptococci were randomized to receive erythromycin base (333 mg three times a day) or matching placebo beginning during the third trimester and before 30 weeks and continuing for 10 weeks or until 35 weeks 6 days of pregnancy . RESULTS: Pregnancy outcomes were available for 97% of randomized women; 14% of subjects withdrew from the trial . Birth weight < 2500 gm occurred in 8.6% of the erythromycin and 6.1% of the placebo recipients (relative risk 1.4, 0.9 to 2.2, p = 0.16) . Preterm delivery occurred in 11.4% of women randomized to erythromycin and in 12.3% randomized to placebo (relative risk 0.9, 95% confidence limits 0.6 to 1.3, p = 0.65) . Greater benefit of erythromycin in reducing these outcomes was not observed among women reporting the best compliance . CONCLUSIONS: In this study of pregnant women colonized with group B streptococci treatment with erythromycin was not shown to be effective at prolonging gestation or reducing low birth weight . Greater than anticipated complicating factors, including spontaneous clearance of the organism, use of nontrial antibiotics, and density of colonization, may have resulted in population sizes too small to detect a benefit of treatment . Future studies should take these factors into account in determining sample sizes.

J Med Microbiol, 1995 May, 42(5), 362 - 6
Post-antibiotic effect of azithromycin and erythromycin on streptococcal susceptibility to phagocytosis; Ramadan MA et al.; The effect of azithromycin and erythromycin on growth, cell surface hydrophobicity and the susceptibility to the bactericidal activity of human polymorphonuclear leucocytes (PMNL) was examined in four Streptococcus species . Exposure to either 10 x MIC azithromycin or erythromycin induced a post-antibiotic effect (PAE) of between 2.4 and 4.3 h . Erythromycin caused a longer PAE for S . sanguis than azithromycin under the same conditions . The cell surface charge (hydrophobic or hydrophilic) of the streptococci was altered significantly during PAE; loss of hydrophobicity was induced by both macrolides, and this effect was variable amongst the species . The decrease in hydrophobicity was not related to inhibition of growth . The effect of each drug during PAE on the interaction of opsonised suspensions of the streptococci with human PMNL revealed that erythromycin, and to a lesser extent azithromycin, increased susceptibility to the bactericidal activity of human PMNL; this effect was abolished following PAE . The present study clearly showed that PAE should not only be considered as delayed bacterial growth, but also as modulation of bacterial susceptibility to phagocytosis which may influence the outcome of the host-parasite relationship.

Am J Orthod Dentofacial Orthop, 1995 May, 107(5), 497 - 504
Effect of polyol gums on dental plaque in orthodontic patients; Isotupa KP et al.; Sixty 11- to 15-year-old children wearing fixed orthodontic appliances were given chewing gums containing polyol for daily use after meals and snacks, to study whether the chewing of gums that contained slowly fermentable polyols (xylitol and sorbitol) affects the amount of dental plaque and the number of mutans streptococci present in plaque and saliva . The 60 subjects were randomly divided into four groups, each of which was provided with a supply of 1.35 gm pellet-shaped gums for a period of 1 month, as follows: (1) xylitol; (2) sorbitol; (3) xylitol-sorbitol mixture I (3:2); and (4) xylitol-sorbitol mixture II (4:1) . In each group, two pellets with a total initial gum mass of 2.7 gm (maximum polyol dose per day: 10.5 gm), were used six times a day . The fresh and dry weight of dental plaque, collected at baseline and 28 days later from incisors, canines, and premolars from the area between gingival margin and the bracket, reduced in all groups, but most significantly (by 43% to 47%) in children receiving xylitol gum . The plaque and saliva levels of mutans streptococci did not change in the sorbitol group, but was significantly (in most cases) reduced by 13% to 33% in groups that received gum containing xylitol . Provided that the quantity of dental plaque and the plaque and salivary levels of mutans streptococci can be regarded as risk factors in dental caries, these results suggest that regular use of polyol gum--and especially gum that contains xylitol as the predominant sweetener--can reduce the caries risk in young patients wearing fixed orthodontic appliances.

Infect Immun, 1995 May, 63(5), 1827 - 34
Adherence of Candida albicans to a cell surface polysaccharide receptor on Streptococcus gordonii; Holmes AR et al.; Candida albicans ATCC 10261 and CA2 bound to cells of the oral bacteria Streptococcus gordonii, Streptococcus oralis, and Streptococcus sanguis when these bacteria were immobilized onto microtiter plate wells, but they did not bind to cells of Streptococcus mutans or Streptococcus salivarius . Cell wall polysaccharide was extracted with alkali from S . gordonii NCTC 7869, the streptococcal species to which C . albicans bound with highest affinity, and was effective in blocking the coaggregation of C . albicans and S . gordonii cells in the fluid phase . When fixed to microtiter plate wells, the S . gordonii polysaccharide was bound by all strains of C . albicans tested . The polysaccharide contained Rha, Glc, GalNAc, GlcNAc, and Gal and was related compositionally to previously characterized cell wall polysaccharides from strains of S . oralis and S . sanguis . The adherence of yeast cells to the immobilized polysaccharide was not inhibitable by a number of saccharides . Antiserum raised to the S . gordonii NCTC 7869 polysaccharide blocked adherence of C . albicans ATCC 10261 to the polysaccharide . The results identify a complex cell wall polysaccharide of S . gordonii as the coaggregation receptor for C . albicans . Adherent interactions of yeast cells with streptococci and other bacteria may be important for colonization of both hard and soft oral surfaces by C . albicans.

Gastroenterology, 1995 May, 108(5), 1396 - 404
Immunocytochemical evidence of Listeria, Escherichia coli, and Streptococcus antigens in Crohn's disease; Liu Y et al.; BACKGROUND/AIMS: Infectious agents have long been suspected of playing a role in the initiation of Crohn's disease . The objective of this study was to search for likely microbial agents in diseased tissues using immunocytochemical techniques . METHODS: Intestines and mesenteric lymph node specimens of 21 patients from two French families with a high frequency of Crohn's disease and from Connecticut were studied . The microbial agents searched for included Bacteroides vulgatus, Borrelia burgdorferi, Escherichia coli, Listeria monocytogenes, Streptococcus spp., bovine viral diarrhea virus, influenza A virus, measles virus, parainfluenza virus, and respiratory syncytial virus . RESULTS: Seventy-five percent of the patients with Crohn's disease (12 of 16) were positively labeled with the antibody to Listeria . Macrophages and giant cells immunolabeled for this antigen were distributed underneath ulcers, along fissures, around abscesses, within the lamina propria, in granulomas, and in the germinal centers of mesenteric lymph nodes . In addition, 57% (12 of 21) of the cases contained the E . coli antigen, and 44% (7 of 16) contained the streptococcal antigen . The immunolabeling for the latter two agents also occurred within macrophages and giant cells, distributed in a pattern similar to that of Listeria antigen . CONCLUSIONS: The results suggest that Listeria spp., E . coli, and streptococci, but not measles virus, play a role in the pathogenesis of Crohn's disease.

J Hosp Infect, 1995 May, 30(1), 65 - 72
Low birth weight and nosocomial infection of neonates in a neonatal intensive care unit; Drews MB et al.; A one year prospective surveillance of nosocomial infections (NI) in a neonatal intensive care unit (NICU) was performed . Among 229 neonates the infection rate was 27.1%, the infection proportion 20.1%, and the incidence density 21.9 infections per 1000 patient days . Infants were stratified into four birth weight categories . Degrees of infection ranged from 44.4% in the < or = 1000 g group to 10.1% in the > 2500 g group . Differences between the groups were statistically significant (P < 0.01) . The mean birth weight of infants with NI was significantly lower than that of infants without NI (1711 g, SD +/- 841 g vs . 2213 g, SD +/- 896 g; P < 0.01) . Mortality of < or = 1000 g babies was 44.4 and 7.6% in > 2500 g neonates . Major sites of infection were pneumonia (32.3%), blood-stream infections (27.4%), infections of the skin, and surgical site infections (11.3% each) . The predominant pathogen was Staphylococcus aureus (24.2%) whilst Gram-negative bacteria accounted for 22.7% of the total . Other major infective agents were Staphylococcus epidermidis, Escherichia coli, and Group B streptococci . It is concluded, that low birth weight was a major risk factor for the acquisition of NI in the observed NICU population.

Immunopharmacol Immunotoxicol, 1995 May, 17(2), 283 - 300
Effects of streptolysin O, picibanil (OK 432) and interferon alpha 2A on cytochrome P-450-dependent monooxygenases and arylamine N-acetyltransferase in rat liver; Hadasova E et al.; Streptolysin O, a thiol-activated exotoxin from group A beta-haemolytic streptococci, caused a dose-dependent depression of aniline hydroxylase, aminopyrine N-demethylase and ethylmorphine N-demethylase activities when added into the hepatic microsomal mixtures from male rats at concentrations 0.02-0.4 HU/mL in vitro . The activities of 7-ethoxycoumarin O-deethylase, 7-ethylresorufin O-deethylase and 7-pentylresorufin O-depentylase were not altered with the used concentrations of the toxin . Specific antibody against haemolytic action of streptolysin O added to incubation mixtures in vitro was not able to protect streptolysin-sensitive monooxygenases from the inhibition . The addition of streptolysin O (0.01-0.8 HU/mL) into the cytosol-containing medium did not significantly influence the activity of procainamide N-acetyltransferase . Immunomodulators picibanil (OK 432) and human recombinant interferon alpha 2A which are known to suppress oxidative metabolism in vivo in humans and animals, were without effect either on the cytochrome P-450-dependent monooxygenases or on the N-acetyltransferase activity when administered in vitro at the doses real in their clinical application (0.001-0.1 KE/mL of picibanil and 10-500 U/mL of alpha-interferon).

Pediatr Infect Dis J, 1995 May, 14(5), 372 - 5
The family pet as an unlikely source of group A beta-hemolytic streptococcal infection in humans; Wilson KS et al.; This study examines the possibility of the family pet serving as a reservoir for group A beta-hemolytic streptococcal infections in humans . We obtained oropharyngeal cultures from children with acute pharyngitis and concurrent oropharyngeal cultures from their household pets . Children with culture-proved group A beta-hemolytic streptococcal pharyngitis were detected in 26 of 42 households surveyed . Oropharyngeal cultures were also collected from a group of children without pharyngitis and their pets . Additionally 149 dogs and cats from a local veterinary hospital were cultured from 371 body sites including the oropharynx, axilla and vagina . All beta-hemolytic bacterial isolates were identified by colonial and microscopic morphology, catalase and pyrrolidonylarylamidase production, bacitracin susceptibility and serogrouping . No group A beta-hemolytic streptococci were recovered from any of the body sites surveyed from a total of 230 animals . Based on these findings, the family pet seems to be an unlikely reservoir for group A beta-hemolytic streptococci.

J Immunoassay, 1995 May, 16(2), 155 - 66
Evaluation of protein-A linked monoclonal antibody latex agglutination test for diagnosis of nuclear polyhedrosis virus (BmNPV) of silkworm Bombyx mori L; Shamim M et al.; The symptomology of BmNPV infection in Bombyx mori L depends on the stages of infection . Discernible symptoms develop at later stages of infection, which leads to improper diagnosis and poor crop yield with sericulturists . In the present study development of direct and protein-A linked monoclonal antibody latex (PALMAL) agglutination test for the detection of BmNPV infection in silkworm is described . Latex beads were precoated with protein-A and then sensitised with monoclonal antibody MA-231 (125 micrograms/ml) . PALMAL test could detect 1 x 10(5) nuclear polyhedra/test and is ten times more sensitive than the direct agglutination test employing purified polyclonal antibodies . No agglutination was observed in presence of B . thuringiensis, S . marcescens, N . bombycis, group-A streptococci, Staphylococcus aureus, E . coli and normal haemolymph protein indicating the specificity of the test . Fifty haemolymph samples collected from the field were evaluated by PALMAL test . Twenty one samples having infection other than BmNPV, failed to show positive agglutination . Twenty five samples having > or = 5 x 10(6) BmNPV/ml showed positive agglutination . However, 4 samples having < 5 x 10(6) BmNPV/ml failed to show positive agglutination thereby indicating the limit of sensitivity of the assay.

Clin Infect Dis, 1995 May, 20(5), 1169 - 73
Bacteremia due to viridans streptococci that are highly resistant to penicillin: increase among neutropenic patients with cancer; Carratala J et al.; We prospectively studied 260 episodes of bacteremia that occurred over a 6-year period in neutropenic patients with cancer . Twenty-three episodes were caused by viridans streptococci . Thirteen (57%) of these strains were penicillin-resistant (MICs of penicillin ranged from 0.25 micrograms/mL to 8 micrograms/mL) . Ten of the 13 penicillin-resistant strains (77%) were highly resistant to penicillin (MIC, > or = 4 micrograms/mL) . Rates of bacteremia due to highly penicillin-resistant viridans streptococci increased significantly from zero episodes per 1,000 admissions in 1987 to 17 episodes per 1,000 admissions in 1992 (P = .003) . In a comparison between penicillin-resistant and penicillin-susceptible viridans streptococci bacteremia, the administration of beta-lactam antibiotics during the previous 2 weeks was the only factor significantly associated with penicillin-resistant cases: 9 (69%) of 13 patients with penicillin-resistant bacteremia had received beta-lactams vs . 2 (20%) of 10 patients with penicillin-susceptible bacteremia (P = .036) . These findings may have significant clinical implications in the choice of both antimicrobial prophylaxis and empirical antibiotic regimens.

J Am Board Fam Pract, 1995 May-Jun, 8(3), 177 - 82
Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis; Joslyn SA et al.; BACKGROUND: The purpose of this study was to determine the accuracy of diagnosing group A beta-hemolytic streptococci (GABHS) with rapid antigen testing compared with throat culture methods commonly used . METHODS: Two separate studies were conducted . Initially, 182 patients with acute pharyngitis had both throat culture (sheep blood agar or Strep Select Agar) and rapid antigen detection screening tests (Directigen1-2-3 Group A Strep) performed . For the second study, a rapid antigen detection test (Directigen1-2-3 Group A Strep) was obtained from 614 patients . All subjects who screened negative (n = 469) received a throat culture . All subjects who screened positive (n = 145) were treated with antibiotics, and 31 of these patients received a throat culture . Statistical analyses included calculating sensitivity, specificity, positive and negative predictive values, and prevalence . RESULTS: For the initial 182 patients, the prevalence of GABHS was 12 percent . Sensitivity was 95.45 percent, specificity was 96.25 percent, positive predictive value was 77.78 percent, and negative predictive value was 99.35 percent . In the second group of subjects, four false-negatives were present (negative predictive value = 99.18 percent) . CONCLUSIONS: Results of these pilot studies indicate that an extremely low percentage (< 1 percent) of subjects with GABHS escaped detection with our rapid screening test methods . These results conflict with results from previous investigations, which have reported relatively low specificity and sensitivity of rapid antigen detection tests when compared with throat cultures . Results from this study support treatment protocols based on a rapid screening test as a single diagnostic test.

Pediatr Dent, 1995 May-Jun, 17(3), 192 - 8
Distribution and determinants of mutans streptococci among African-American children and association with selected variables; Dasanayake AP et al.; Prevalence of mutans streptococci (MS) and the effect of selected variables, including the early childhood use of antibiotics on the oral colonization of MS, were studied among 353, 5- to 12-year-old African-American children using a cross-sectional study . MS prevalence was estimated using pooled plaque and stimulated saliva samples (spatula) . Data on antibiotic use and other potential determinants of oral colonization of MS were obtained using a self-administered questionnaire . Antibiotic data were validated using health records of subjects . MS prevalence (92%, 95% Confidence Interval {CI} = 89-95%) was associated with dental caries (Odds Ratio {OR} = 2.5, 95% CI = 1.3-6.2), age (Chi for trend = 4.3, P = 0.04), increased frequency of sweet consumption (Chi for trend = 5.1, P = 0.02), and increased number of teeth in the mouth (unit OR = 1.3, 95% CI = 1.1-1.6) . Higher MS levels were associated with higher number of decayed teeth (P < 0.0001), and also, with having the mother as the primary caregiver during the second year of life (P = 0.02) . Furthermore, children who took antibiotics during early childhood and those who lived in the same household with many others during the second year of life had a higher MS prevalence than those who did not (OR = 8.3, 95% CI = 2.0-35.0; unit OR = 1.5, 95% CI = 1.03-2.2, respectively) . It is unclear why those exposed to antibiotics during the "window of infectivity" of MS exhibit a higher MS prevalence . Antibiotic-related oral ecological changes (i.e, lower levels of S . sanguis) and environmental changes (i.e., frequent exposure to sugar through most pediatric antibiotic preparations) may make the oral cavity more favorable for initial MS colonization.

J Clin Microbiol, 1995 May, 33(5), 1408 - 10
Comparison of two rapid streptococcal antigen detection assays with culture for diagnosis of streptococcal pharyngitis; Heiter BJ et al.; In this study, 801 pharyngeal specimens were cultured for group A streptococci and tested with the Biostar Strep A Optical Immunoassay (Strep A OIA) . The respective sensitivities and specificities were as follows: culture, 97.1 and 100%; Strep A OIA, 91.5 and 94.8% . Of the 801 specimens, 597 were also tested with the Abbott TestPack Strep A Assay (TP-ST) . For those specimens tested by all three methods, the respective sensitivities and specificities were as follows: culture, 98.1 and 100%; Strep A OIA, 92.3 and 95.4%; and TP-ST, 79.4 and 100% . The Strep A OIA is significantly more sensitive than TP-ST and compares favorably with culture.

J Clin Microbiol, 1995 May, 33(5), 1215 - 22
Comparison of phenotypic characteristics, DNA-DNA hybridization results, and results with a commercial rapid biochemical and enzymatic reaction system for identification of viridans group streptococci; Kikuchi K et al.; The rapid ID 32 Strep system (bioMerieux, Marcy l'Etoile, France) was evaluated for its ability to identify 21 species of viridans group streptococci; results were compared with DNA-DNA hybridization results and results of conventional physiological tests . A total of 171 strains of the 21 species including 147 clinical strains was analyzed . Of the 156 strains of species included in the database of this system, 136 strains (87%) were correctly identified . Incorrect identification occurred for 13 strains (8%), and no identification was given for 7 strains (5%) . It was difficult to differentiate S . mitis and S . oralis accurately with this system . Of the 17 strains identified as S . mitis by the rapid ID 32 Strep system, the results of DNA-DNA hybridization were in agreement for only 3 strains . S . crista and S . parasanguis, which are not included in the database, were identified as S . mitis or S . sanguis or were not identified, but S . parasanguis could probably be identified by using the rapid ID 32 Strep system because the biochemical profile is well characterized for this species . The rapid ID 32 Strep system can be used to differentiate most species for which phenotypic characteristics have been described if the database is revised according to recently reported amended criteria for the identification of viridans group streptococci . However, identification of a few species such as S . mitis and S . oralis is problematic with this system.

J Clin Microbiol, 1995 May, 33(5), 1154 - 7
Cost-effective, clinically relevant method for rapid identification of beta-hemolytic streptococci and enterococci; Kirby R et al.; Currently popular agglutination and coagglutination methods for the identification of beta-hemolytic streptococci, although rapid and simple to perform, are costly . Furthermore, they fail to distinguish between clinically relevant species and normal flora of the same serogroup . We investigated the use of a series of four physiologic tests to differentiate beta-hemolytic streptococci and enterococci into five clinically relevant groups . We also investigated the use of a new product, Visi-Spot, and evaluated an alternate method for the detection of beta-D-glucuronidase production . Our results suggest that for most routine processing of beta-hemolytic streptococci, physiologic tests are sufficiently rapid, more accurate, and far less costly to perform than serologic methods . The facility of our scheme is enhanced by the use of the Visi-Spot test and the substitution of a commercially available product for more traditional methods of detecting beta-D-glucuronidase.

Klin Monatsbl Augenheilkd, 1995 May, 206(5), 420 - 2
{Change in therapy of acute endophthalmitis: an analysis of 92 cases 1980-1993}; Wolfensberger TJ et al.; BACKGROUND: The aim of our study was to develop possible criteria for the choice of vitrectomy in the treatment of endophthalmitis . MATERIALS AND METHODS: Ninety-two patients with endophthalmitis who were seen between 1980 and 1993 were reviewed retrospectively and analysed regarding pathogenesis, bacteriological aetiology, as well as pre- and postoperative visual acuity comparing intravenous (i.v.) therapy alone to a combination with vitrectomy in 3 pretherapeutic visual acuity classes (class I < 0.02, class II 0.02- < 0.1 and class III > or = 0.1) . RESULTS: Endophthalmitis most commonly occurred after cataract extraction (39%) . The best prognosis regarding final visual acuity was found with Staph . epidermidis infection, the worst with Streptococci . Postoperative visual acuity in class I was significantly better after vitrectomy with 0.18 +/- 0.06 (Standard Error = SE) compared to i.v . therapy alone (0.06 +/- 0.03 SE) (p < 0.05 unpaired Student t-Test) . In class II, no such difference could be demonstrated . In class III, i.v . therapy yielded significantly better results (0.8 +/- 0.09 SE) than vitrectomy (0.53 +/- 0.14 SE), however only by comparing the final - but not the best - obtained posttherapeutic visual acuity . CONCLUSION: The more favourable results after vitrectomy in patients with very poor pretherapeutic vision suggest an important role of vitrectomy in the presence of extensive vitreous opacifications . The better outcome after i.v . therapy in patients with pretherapeutic vision > or = 0.1 could be influenced by the very short follow-up period which renders an evaluation of a potential loss of vision due to late complications after endophthalmitis impossible.

Laryngorhinootologie, 1995 May, 74(5), 322 - 4
{Gas producing anaerobic infection of the neck}; Mohadjer C et al.; In this article, we report on two cases of gas-forming necrotising fasciitis of the neck admitted to our university hospital . In both patients, large gas-forming abscesses were detected by CT scan . Microbiologic smears revealed a mixed flora of aerobic and anaerobic bacteria, predominantly anaerobic streptococci . Emergency surgery with debridement and drainage, appropriate antibiotic therapy, and intensive care were performed . One 58-year-old patient with no concommittent disease recovered well after fourteen days . The other 71-year-old patient with diabetes mellitus and renal insufficiency died despite adequate therapy as a result of metabolic disturbances.

Kansenshogaku Zasshi, 1995 May, 69(5), 597 - 601
{A case report of toxic shock-like syndrome due to group A streptococcal infection in an alcoholic}; Ono Y et al.; A 47-year-old male with a history of alcohol abuse had a sore throat on June 8, 1994 . On June 13, he had swelling and pain on his right fore-arm . He had tense swelling, redness and pain on the right lower abdomen, left upper arm and left lower leg with high fever and noticed erythema and blisters on his back of the right hand on June 18, which gradually expanding to the entire fore-arm . He was admitted to the local hospital on July 2, where he was operated with excision of the skin and drainage for an abdominal subcutaneous abscess and was given three antibiotics and an intravenous immunoglobulin preparation . Although he showed transient hypotension and moderate liver dysfunction, his condition improved day by day under such treatment . He was transferred to our hospital on July 7 because of the unknown etiology . Aspirate from the abscess contained gram-positive cocci in chains, and group A streptococci were isolated . Panipenem/betamipron was used for an antibiotic during roughly two weeks and excision of the skin and drainage for abscess was performed twice . His skin lesions were continued to improve, normalizing peripheral white blood cell counts, serum levels of CRP and the liver function . On July 24, the antibiotic was changed to intravenous ampicillin and administered for 16 days and amoxicillin was given orally after that, and he was discharged on August 16 . An isolate of the infecting Streptococcus pyogenes produced pyrogenic exotoxin A, B and the serotype was T-3 type.

Eur Heart J, 1995 May, 16(5), 687 - 91
Treatment with various antibiotics of experimental endocarditis caused by penicillin-resistant Streptococcus sanguis; Martinez F et al.; BACKGROUND: Streptococcus sanguis currently accounts for one-half of viridans streptococci . Treatment has become complicated due to the increase in resistance to penicillin and cephalosporins . The aim of the study was to assess the efficacy of various antibiotics as monotherapy and in association with gentamicin, in a experimental model of infective endocarditis in rabbits . The effects were compared with a control group and a group given classical penicillin-gentamicin treatment . MATERIAL AND METHODS: Infective endocarditis was induced in 180 rabbits with a clinical isolate of Streptococcus sanguis . Treatment was started 48 h after infection, and lasted 5 days . The animals were divided into nine groups of 20 rabbits: G1, untreated controls; G2, penicillin-gentamicin; G3, clindamycin-gentamicin; G4, imipenem; G5, imipenem-gentamicin; G6, teicoplanin; G7, teicoplanin-gentamicin; G8, vancomycin and G9, vancomycin-gentamicin . Response to therapy was evaluated by mortality curves, as negative blood cultures, concentration of S . sanguis in aortic vegetations and rate of sterilization of vegetations . RESULTS: Vegetation weight was significantly lower in treated groups than in controls; lower weights were found in G5, 6, and 9 . G9 sterilized 75% of the vegetations . Death occurred in 25% of the control group and in 4.76% of G6 and 7 . Blood cultures became negative most rapidly in G9 . CONCLUSIONS: Combined treatment with vancomycin-gentamicin may be highly efficacious in patients with endocarditis caused by penicillin-resistant Streptococcus sanguis . Other combinations, such as imipenem-gentamicin and teicoplanin-gentamicin, may be also advantageous.

Diagn Microbiol Infect Dis, 1995 May-Jun, 22(1-2), 111 - 7
Cefotaxime for treatment of neonatal sepsis and meningitis; Odio CM; Neonatal sepsis is a clinical syndrome characterized by systemic signs and symptoms, and bacteremia during the first month of life . The incidence is relatively low (one to eight cases/1000 live births), yet the risk of mortality is approximately 25% . Meningitis in the neonate is usually a sequela of bacteremia; however, it is discussed with neonatal sepsis, because they commonly share etiology and pathogenesis . The incidence of meningitis is usually a fraction of the number of infants with sepsis, varying in different settings from one-fourth to one-third . The mortality rate is high, varying in some series from 15%-50% . There are two major forms of presentation of neonatal sepsis . Early-onset disease presents as a fulminant, multisystemic illness during the first 5-7 days of life; late-onset disease is more commonly recognized after the first weeks of life . Because different microorganisms are responsible for the two forms of disease, the choice of antimicrobial agents also differs . Some organisms such as Escherichia coli, group B streptococci, and Listeria monocytogenes may be responsible, whereas other pathogens such as Staphylococcus aureus and S . epidermidis, and Pseudomonas aeruginosa are usually associated with late-onset disease . Classic initial (empiric) treatment of neonatal sepsis and meningitis consists of ampicillin and an aminoglycoside . With the advent of the third-generation cephalosporins, however, the empiric antimicrobial approach for neonatal sepsis and meningitis has changed in most centers . Third-generation cephalosporins cover more of the pathogens implicated in neonatal sepsis and meningitis, except for the enterococci and L . monocytogenes.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Microbiol, 1995 May, 33(5), 1296 - 301
Development of PCR-based hybridization protocol for identification of streptococcal species; Bentley RW et al.; 16S rRNA of Streptococcus agalactiae, S . uberis, and S . parauberis was bound to streptavidin-coated magnetic beads by using a biotinylated oligonucleotide probe complementary to a highly conserved region of the molecule . In-solution hybridization of radiolabelled oligonucleotide probes to immobilized 16S rRNA allowed the specific identification of S . agalactiae and S . parauberis but not S . uberis . PCR was used to amplify a species-specific region of the 16S rRNA gene from these species . One of the PCR primers was biotinylated at the 5' end to allow purification of the amplified product on streptavidin-coated magnetic beads and subsequent denaturation to yield immobilized single-stranded DNA . Radiolabelled oligonucleotide probes were hybridized in solution to the single-stranded target molecule and enabled species-specific identification of the target organism . This protocol overcame problems associated with hybridization of the S . uberis-specific probe to 16S rRNA in solution . A similar procedure may enable the specific detection of other streptococci which exhibit a species-specific sequence in this region of the gene.

J Immunol, 1995 May 1, 154(9), 4536 - 45
Characterization of T cell epitopes restricted by HLA-DP9 in streptococcal M12 protein; Dong RP et al.; Interaction of the HLA-DP9 (DPA1*0201/DPB1*0901) molecule and M protein of serotype 12 (SS95/12) streptococci, a main component of the streptococcal cell wall Ag, has been investigated to decipher peptide-binding capacity and T cell activation in the context of the HLA-DP molecule . Seven antigenic peptides (amino acids 19-25) restricted by the HLA-DP9 molecule were identified in M12 protein, using M12 protein- or peptide-specific T cell lines from naturally exposed individuals . The binding affinity of each peptide to the HLA-DP9 molecule was measured by fluorescence intensity of biotinylated peptides bound to L cell transfectants expressing HLA-DP9, followed by treatment with avidin-fluorescence . Binding of biotinylated peptides to the HLA-DP9 molecule was inhibited by an excess amount of corresponding nonbiotinylated peptides and other nonbiotinylated peptides, indicating that the peptides were bound to the HLA-DP9 molecule at a single binding site . Seven synthetic peptides containing the T cell epitopes restricted by the HLA-DP9 molecule had high binding affinity to the HLA-DP9 molecule . Comparison of the amino acid sequences of truncated analogues that could bind to the HLA-DP9 molecule and/or activate T cells suggested an HLA-DP9-specific binding motif, composed of a positively charged residue (R or K) at position 1, a hydrophobic residue (A, G, or L) at position 6, and another hydrophobic residue (L or V) at position 9 . Analysis of single amino acid-substituted analogues suggested that the positively charged amino acid in the motif served as a key anchor residue for binding to the HLA-DP9 molecule, which differs from the binding motif to the HLA-DR molecules.

Microb Pathog, 1995 May, 18(5), 345 - 54
Characterisation of group A streptococcal isolates from tropical Australia with high prevalence of rheumatic fever: probing for signature sequences to identify members of the family of serotype 5; Hartas J et al.; The prevalence of rheumatic heart disease (RHD) in Northern Territory Aboriginal communities is high, but there is a low isolation rate of historically rheumatic fever associated M types (such as M5) of group A streptococci (GAS) . Many isolates are M non-typable (MNT) . Serology suggests that the population is exposed to M5-like isolates; some RHD patients having high IgM or IgG titres to two M5 B-repeat region peptide epitopes, B1 (KQQESK) and B4 (EQKSKQ) . To identify relatives of M5 in our collection of GAS, oligonucleotide probes to the B1 and B4-repeat regions shared by M5 and a local M5-like isolate, were used to screen 101 isolates for the presence of signature sequences . In all, 28% of the tropical Australian isolates contained the signature sequences, identifying members of the M5 family . The 5' region of the genes for M proteins from three members of the M5 family fell into two sequence types . Hybridisation to probes based on these sequences suggested that among tropical Australian isolates there are at least three distinct sequence types that contained the M5 signature sequences . These results suggest that a considerable number of M5 family GAS are circulating in tropical Australia.

J Theor Biol, 1995 Apr 21, 173(4), 415 - 26
Variation of multifunctional surface binding proteins--a virulence strategy for group A streptococci?
Boyle MD.
Variation in surface antigens has been well recognized as a mechanism by which pathogenic organisms can avoid elimination and remain as potential pathogens in immunocompetent individuals . A variety of viral and parasitic organisms elude the immune system by varying their surface antigenic structures . Other persistent human pathogens, for example group A streptococci, are associated with cyclic variation in the severity of infections without any major change in their surface antigenic structures . Recent analysis of group A streptococcal proteins, in particular surface M and M-like proteins, has documented the existence of an array of multifunctional surface proteins which have the ability to bind to a variety of normal human plasma proteins, extracellular matrix components and human cells . The ability to change the functional activities of these surface molecules by genetic recombination among members of a closely related M protein supergene family has now been reported . In this paper, the potential importance of generating functional heterogeneity in surface binding proteins of group A streptococcus is discussed . The role of these proteins in enabling an organism to sense its environment and express the appropriate virulence factors is proposed as an explanation for the periodic changes in the frequency and severity of invasive group A streptococcal infections that can occur in the absence of a toxic-shock-like syndrome.

J Immunol, 1995 Apr 15, 154(8), 4203 - 12
Autoantibody germ-line gene segment encodes VH and VL regions of a human anti-streptococcal monoclonal antibody recognizing streptococcal M protein and human cardiac myosin epitopes; Quinn A et al.; Cross-reactivity of anti-streptococcal Abs with human cardiac myosin may result in sequelae following group A streptococcal infections . Molecular mimicry between group A streptococcal M protein and cardiac myosin may be the basis for the immunologic cross-reactivity . In this study, a cross-reactive human anti-streptococcal/anti-myosin mAb (10.2.3) was characterized, and the myosin epitopes were recognized by the Ab identified . mAb 10.2.3 reacted with four peptides from the light meromyosin (LMM) tail fragment of human cardiac myosin, including LMM-10 (1411-1428), LMM-23 (1580-1597), LMM-27 (1632-1649), and LMM-30 (1671-1687) . Only LMM-30 inhibited binding of mAb 10.2.3 to streptococcal M protein and human cardiac myosin . Human mAb 10.2.3 labeled cytoskeletal structures within rat heart cells in indirect immunofluorescence, and reacted with group A streptococci expressing various M protein serotypes, PepM5, and recombinant M protein . The nucleotide sequence of gene segments encoding the Ig heavy and light chain V region of mAb 10.2.3 was determined . The light chain V segment was encoded by a V kappa 1 gene segment that was 98.5% identical with germ-line gene humig kappa Vi5 . The V segment of the heavy chain was encoded by a VH3a gene segment that differed from the VH26 germ-line gene by a single base change . VH26 is expressed preferentially in early development and encodes autoantibodies with anti-DNA and rheumatoid factor specificities . Anti-streptococcal mAb 10.2.3 is an autoantibody encoded by VH and VL genes, with little or no somatic mutation.

J Bacteriol, 1995 Apr, 177(7), 1703 - 11
Purification, characterization, and specificity of dextranase inhibitor (Dei) expressed from Streptococcus sobrinus UAB108 gene cloned in Escherichia coli; Sun JW et al.; The dextranase inhibitor gene (dei) from Streptococcus sobrinus UAB108 was previously cloned, expressed, and sequenced . Its gene product (Dei) has now been purified as a single band with apparent molecular mass of 43 kDa, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The specific activity of Dei increased 121-fold upon purification . Most Dei activity (91.2%) was located in the periplasmic fraction from recombinant Escherichia coli cells . Dei competitively inhibits dextranase (Dex) . This competitive inhibition mechanism has been further shown by detection and recovery of the intermediate enzyme-inhibitor (Dex-Dei) complex by gel filtration technology using fast protein liquid chromatography . Calibration of their molecular masses indicated that native Dei exists as a tetramer, Dex exists as dimer, and the Dex-Dei complex consists of two Dex molecules with two Dei molecules . Deletion analysis indicates that the intact Dei molecule is essential for Dei activity but not for glucan binding and immune cross-reaction . Dei is a special kind of glucan-binding protein with ability to inhibit Dex with high specificity . It can inhibit endogenous Dex, which can make more branches in glucan with the cooperation of the glucosyltransferase GTF-I . This inhibition cause the accumulation of water-soluble glucan . The latter reaction product can inhibit plaque formation and adherence of the mutans group of streptococcal cells . Dei derived from S . sobrinus UAB108 can inhibit only Dex from S . sobrinus (serotypes d and g), S . downei (previously S . sobrinus, serotype h), and S . macacae (serotype h) . This finding suggests that Dei is another important protein existing in some serotypes of the mutans group of streptococci which participates in sucrose metabolism through its interaction with Dex.

Am Surg, 1995 Apr, 61(4), 297 - 303
Ticarcillin/clavulanate compared with clindamycin/gentamicin (with or without ampicillin) for the treatment of intra-abdominal infections in pediatric and adult patients; Dougherty SH et al.; Combinations of penicillins with beta-lactamase inhibitors have become acceptable treatments for mixed bacterial infections . The objective of this multicenter, randomized, open-label study was to compare the efficacy, safety, and tolerance of ticarcillin/clavulanate with clindamycin/gentamicin (with or without ampicillin) when administered to adult and pediatric patients with intra-abdominal infections . A total of 993 patients 2 years of age or older were entered in this trial if they had suspected or bacteriologically documented intra-abdominal infection . Of these, 341 were determined at the time of operation to have intra-abdominal infection . Cure rates at the time of final assessment were 79%, 80%, and 82% for ticarcillin/clavulanate, and clindamycin/gentamicin without or with ampicillin, respectively (P = 0.829, Cochran-Mantel-Haenszel) . The most frequent reason for failure was development of an intra-abdominal abscess (6% of patients overall), followed by wound infections (4%), and persistent fever (3%) . Two patients who had received ticarcillin/clavulanate and five who had received clindamycin/gentamicin required discontinuation of the study regimen because of adverse drug reactions . The bacteria isolated most frequently from study failures were E . coli, B . fragilis, Pseudomonas, and Streptococci . In this study, ticarcillin/clavulanate was as effective as the combination of clindamycin/gentamicin for the treatment of intra-abdominal infections.

Infect Immun, 1995 Apr, 63(4), 1440 - 5
Cloning and sequence analysis of a protective M-like protein gene from Streptococcus equi subsp . zooepidemicus; Timoney JF et al.; Streptococcus equi subsp . zooepidemicus, a Lancefield group C streptococcus, is a frequently isolated opportunist pathogen from a variety of animal hosts, including the horse . Previous studies have indicated that equine strains carry antigens with characteristics of the antiphagocytic M proteins on the Lancefield groups A and G streptococci . We have cloned a protective M-like protein gene (SzPW60) of an equine strain of S . equi subsp . zooepidemicus W60 and determined its sequence . This gene encodes a protein with a molecular weight of 40,123 which protects mice against subsp . zooepidemicus but not subsp . equi, stimulates antibodies which opsonize subsp . zooepidemicus but not equi, and reacts with antiserum to the protein of the parent strain . The predicted amino acid structure shows significant homology with the carboxy termini of groups A and G M proteins but no other homology . The M-like protein, although showing an extensive region of alpha helix, lacks the A, B, and C repeats found in group A M proteins and has a shorter signal sequence . A proline-rich region upstream from the LPSTGE motif contains 20 repeats of the tetrapeptide PEPK . The presence of this repeat region may account for the slow migration of the M-like protein in sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

Pediatr Infect Dis J, 1995 Apr, 14(4 Suppl), S7 - 11
Pharyngitis/tonsillitis: European and United States experience with cefpodoxime proxetil; Dajani AS; Most authorities continue to recommend penicillin as the treatment of choice for group A streptococcal pharyngitis . If penicillin is used, 10 days of treatment are necessary to achieve a clinical and bacteriologic cure . The usually recommended penicillin V dose is 250 mg (400,000 IU) three times daily . Twice daily dosing is acceptable to some authorities if compliance is good . However, oral penicillin fails to eradicate group A streptococci from the pharynx in up to 17% of cases; in some studies 30% failure rates have been reported . Several European and United States studies indicate that a variety of oral cephalosporins, when used for 10 days, are significantly superior to penicillin V in eradicating group A streptococci from the pharynx . For example cefpodoxime proxetil given twice daily for 10 days is comparable to penicillin V given three times daily for 10 days in achieving a clinical cure and appears to be significantly superior to penicillin in eradicating group A streptococci from the pharynx . Preliminary studies from Europe and the United States strongly suggest that 5-day therapy with cefpodoxime (or other selected oral cephalosporins) is at least as effective, clinically and microbiologically, as 10-day therapy with penicillin V . Further clinical trials are warranted to confirm the adequacy of 5-day treatment and to assess the efficacy of cefpodoxime and other agents in preventing rheumatic fever.

J Clin Microbiol, 1995 Apr, 33(4), 1022 - 4
Difficulties encountered in identification of a nutritionally deficient streptococcus on the basis of its failure to revert to streptococcal morphology; Bottone EJ et al.; Difficulties were encountered in the recognition of a nutritionally deficient streptococcus which continued to display aberrant morphologic forms (especially bulbous swellings and filament formation) despite provision of growth factors . With isolates displaying diverse morphologic entities not characteristic of a given species, e.g., Streptobacillus moniliformis or Erysipelothrix rhusiopathiae, nutritionally deficient streptococci should be considered.

J Clin Microbiol, 1995 Apr, 33(4), 1016 - 8
Evaluation of a modified nitrous acid extraction latex agglutination kit for grouping beta-hemolytic streptococci and enterococci; Petts DN; The rapid and accurate identification of the Lancefield group of beta-hemolytic streptococci and enterococci is an important procedure in clinical laboratories . Latex agglutination techniques are more rapid and technically less demanding than traditional extraction-precipitation methods . Prolex (Pro-Lab Diagnostics, Richmond Hill, Ontario, Canada) is a latex agglutination kit which contains modified nitrous acid reagents to extract antigens and can be used to detect group D antigen in streptococci and enterococci, as well as group A, B, C, F, and G antigens . A total of 302 strains of streptococci and enterococci were tested with this kit . All streptococci of groups A (41 strains), B (39 strains), C (35 strains), D (3 strains), F (10 strains), and G (48 strains) were correctly grouped, as were 125 (97%) of 129 strains of enterococci . Prolex is a reliable method for grouping the beta-hemolytic streptococci and enterococci most frequently encountered in clinical laboratories.

Aust Dent J, 1995 Apr, 40(2), 121 - 8
Degradative enzymes of oral streptococci; Willcox MD et al.; Members of the Streptococcus sanguis group (SSG) and Streptococcus milleri group (SMG) were screened for their ability to produce glycosidase, arylamidase (peptidase), protease, dextranase and glycosyltransferase activities . Species within each group produced unique patterns of activity . The most commonly produced glycosidases were beta-D-glucosidase, beta-D-galactosidase, N-acetyl-beta-D-glucosaminidase and N-acetyl-beta-D-galactosaminidase and the least commonly produced glycosidase activity was beta-fucosidase with Streptococcus intermedius (SMG) being the only species capable of producing the activity . For arylamidase activity, the most commonly produced type was lysine-arylamidase . Glycosidase and arylamidase activities were localized to particular sub-cellular fractions . alpha-galactosidase was found only in culture supernatant fluids whereas N-acetyl-beta-D-glucosaminidase was found in all fractions; the culture supernatant, cell wall, cell membrane and cytoplasm . No arylamidase activity was seen in culture supernatants . Phe-arg-arylamidase was found only in cytoplasmic fractions whereas val-pro-argarylamidase was found in cell walls, cell membranes and cytoplasmic fraction . Protease activity was measured as the degradation of bovine serum albumin (BSA) and casein . Casein was degraded by a number of strains whereas no species/strains were able to degrade BSA . Streptococcus intermedius, Streptococcus constellatus (SMG), Streptococcus mitior and Streptococcus defectivus (SSG) were the only species that produced hyaluronidase and no species produced chondroitin sulphatase . The groups were also examined for their abilities to produce glycosyltransferase and dextranase . Strep . sanguis, Streptococcus gordonii, Streptococcus mitis and Streptococcus oralis produced glucosyltransferase and, with the exception of the latter species, fructosyltransferase . No species within the SMG was capable of producing either glycosyltransferase.(ABSTRACT TRUNCATED AT 250 WORDS)

Antimicrob Agents Chemother, 1995 Apr, 39(4), 990 - 5
Comparative in vitro activities of L-695,256, a novel carbapenem, against gram-positive bacteria; Malanoski G et al.; The in vitro activity of a prototype 2-aryl carbapenem, L-695,256, against gram-positive bacteria was examined . All streptococci and oxacillin-susceptible and -resistant staphylococci were inhibited at concentrations of < or = 0.125, < or = 0.125, and 4 micrograms/ml, respectively . The activity of L-695,256 was superior to that of imipenem against other organisms intrinsically resistant to beta-lactams.

Antimicrob Agents Chemother, 1995 Apr, 39(4), 894 - 8
Chlorhexidine susceptibilities of mutans streptococcal serotypes and ribotypes; Gronroos L et al.; The susceptibilities of 379 clinical mutans streptococcal isolates to chlorhexidine (CHX) were tested by agar dilution according to the standards of the National Committee for Clinical Laboratory Standards . Isolates were obtained from saliva samples of 34 young mothers who had high or moderate salivary levels of mutans streptococci at baseline . Samples were collected on three occasions, before childbirth, when each child was 6 months old, and 1 year later . Of these isolates, 50% were inhibited at 1 microgram of CHX per ml, 90% were inhibited at 2.0 micrograms/ml, and all were inhibited at 4.0 micrograms/ml . The MICs for Streptococcus mutans isolates (serotypes c, e, and f) were lower than those for Streptococcus sobrinus isolates (serotypes d and g) . In some subjects, the MICs for isolates of the same serotype were different . This phenomenon was studied by ribotyping isolates (n = 45) from selected subjects (n = 7) . It was found that if there were intraindividual differences in the MICs for isolates of the same serotype, then the ribotypes of these isolates were different . In order to decrease the mutans streptococcal infection risk for children, 24 mothers (test group) brushed their teeth periodically with a gel that contained 0.3% CHX digluconate and 0.2% NaF, pH 5.8, between the second and third sampling occasions . The gel was used twice a day for the first 10 days of each month . Development of resistant strains during CHX-NaF gel use was not detected . The serotype distribution of isolates from the test group after 1 year of periodic CHX-NaF gel use did not differ from that at baseline . Periodic CHX-NaF gel brushing did not lead to lower salivary mutans streptococcal counts.

Kansenshogaku Zasshi, 1995 Apr, 69(4), 455 - 60
{Typing of group B streptococci by pulsed-field gel electrophoresis}; Tanaka D et al.; Restriction endonuclease (Sma I) digestion patterns of chromosomal DNAs from 459 group B streptococci (GBS) isolated in two hospitals (C and S) in Toyama Prefecture were analysed by pulsed-field gel electrophoresis (PFGE) . Results were summarized as follows . 1) One hundred thirty eight isolates of GBS serotype Ia, 174 of serotype III, 102 of serotype JM-9 and 45 of serotype NT-6 were further divided into 56, 41, 36 and 19 PFGE types, respectively . 2) Appreciable differences in the distribution of PFGE types were not observed between C and S hospital isolates, nor among specimens from which GBS strains were isolated . 3) Long-term inspection of 5 patients, from whom the same serotype strains were repeatedly isolated, revealed that some changes in PFGE types were observed in 2 patients, but not in the other 3.

Med Clin (Barc), 1995 Apr 1, 104(12), 458 - 60
{Cytokines and nitric oxide in streptococcal toxic shock syndrome}; Martin MC et al.; The plasma levels of endotoxin, tumor necrosis factor- alpha (TNF-alpha), interleukin -1 beta (IL-beta), IL-6, IL-8 and the nitrites and nitrates (NO2-/NO3-) as stable metabolites of nitric oxide (NO) were studied in the plasma of 2 patients with the streptococci toxic shock syndrome (STSS) associated to necrotizing fasciitis . A plasma profile of inflammatory mediators with high cytokine concentrations and NO2-/NO3- were observed with circulating endotoxin not being detected in plasma . The first patient died of fulminant refractory shock while the second survived following subacute evolution . The mediators profile, which was much higher in the first case, coincided with clinical severity . These data suggest that the cytokines and NO may have a role in the physiopathology of STSS and the severity of it is related to the levels of these mediators in the acute phase.

J Med Microbiol, 1995 Apr, 42(4), 246 - 50
Distribution of serovariants of group B streptococci in isolates from England and Norway; Kvam AI et al.; The distribution of capsular polysaccharide antigen (CHO) types, surface-exposed c proteins alpha (c alpha) and beta (c beta) and an R-protein antigen was examined in 334 group B streptococci (GBS) isolates from three groups of patients hospitalised in England and Wales or Norway . The isolates were from 108 carriers, 67 cases of neonatal infection and 154 cases of adult infection . Each group contained all CHO types (Ia, Ib, II, III, IV, V and NT); type III strains predominated except in the adult infected group . Strains within each CHO type could be further subdivided by the protein markers into five subtypes by a combined typing system . The proportion of type Ib and type III strains in the neonatal infection cases and of type Ib strains in the adult infection cases significantly outnumbered isolates of these serotypes among the carrier strains . Twenty-nine different serovariants were identified; 24, 13 and 23 serovariants among the carrier, neonatal infection and adult infection isolates, respectively . Certain CHO antigen-protein associations were identified, notably those between Ia/c alpha, Ib/c alpha beta and III/R . The proportion of invasive isolates that expressed protein was not higher than in the carrier isolates . All CHO-type Ib isolates contained a c protein, but 7% of the Ib isolates did not contain any of these proteins . These findings indicate that this combined typing approach may be useful in examining epidemiological problems associated with GBS.

J Infect Dis, 1995 Apr, 171(4), 871 - 8
Distribution of fibronectin-binding proteins among group A streptococci of different M types; Natanson S et al.; Binding of fibronectin by group A streptococci (GAS) promotes adherence to epithelial cells . The fibronectin-binding activity and the presence of prtF, a gene encoding a fibronectin-binding protein, were studied among 109 strains . Fifty-six strains of 42 different M types possessed prtF-related genes, and 89% of these strains bound fibronectin at high levels . The prtF-related genes varied in the number of repeats that constitute one of its two fibronectin-binding domains . Fifty-three strains of 21 different M types lacked prtF . Thirty-nine of these (74%), representing 13 different M types, bound fibronectin at very low levels . However, 9 (17%), of 5 different M types, bound fibronectin at high levels . The presence of prtF and the capacity to bind fibronectin correlated strongly with the M type of various strains of GAS . This correlation may suggest the existence of a relationship between fibronectin binding and the pathogenic potential of GAS.

J Infect Dis, 1995 Apr, 171(4), 1038 - 41
Intranasal immunization with recombinant group A streptococcal M protein fragment fused to the B subunit of Escherichia coli labile toxin protects mice against systemic challenge infections; Dale JB et al.; A fusion gene named LT-B-M5 was constructed encoding the entire B subunit of Escherichia coli labile toxin (LT-B), a 7 amino acid proline-rich linker, and 15 amino-terminal amino acids of type 5 streptococcal M protein . The purified LT-B-M5 was immunogenic in rabbits and evoked antibodies against a synthetic peptide copy of the amino-terminus of M5 (SM5{1-15}) and the native M5 protein and opsonic antibodies against type 5 streptococci . The hybrid protein retained the ganglioside-binding activity of LT-B and was tested in mice for its immunogenicity after local administration . Mice that were immunized intranasally with LT-B-M5 developed serum antibodies against SM5(1-15) and were significantly protected from death after intraperitoneal challenge infections with type 5 streptococci . The data show that protective systemic immune responses may be evoked after intranasal immunization with a fragment of M protein fused to LT-B.

Oral Microbiol Immunol, 1995 Apr, 10(2), 98 - 101
Influence of toothbrushing, eating and smoking on Dentocult SM Strip mutans test scores; Schlagenhauf U et al.; The Dentocult SM Strip mutans test (D-SM, Vivadent) is a popular method for estimating salivary mutans streptococci and is clinically used for the detection of potential caries risk patients . The influence of toothbrushing, eating and smoking on the reliability of D-SM test scores was assessed in 30 subjects aged 21-39 years . All experiments were performed 24 h after professional tooth cleaning in the morning of 3 consecutive days . On day 1 immediately before and 30 min after toothbrushing, D-SM tests were taken and total salivary colony-forming units per ml were determined . Following the same protocol, the influence of a standardized breakfast and of smoking was evaluated on day 2 and on day 3 respectively . Although all parameters significantly decreased the salivary colony-forming units per ml, only the standardized breakfast induced significant changes in the D-SM test results . Eating therefore should be avoided prior to the performance of the D-SM test.

Oral Microbiol Immunol, 1995 Apr, 10(2), 102 - 9
Delmopinol interactions with cell walls of gram-negative and gram-positive oral bacteria; Rundegren J et al.; The main purpose of the present study was to investigate the influence of delmopinol hydrochloride on the cell surface morphology of gram-negative and gram-positive bacterial cells by using transmission electron microscopy . A second purpose was to evaluate the extraction of cell wall material caused by delmopinol and the binding of radiolabelled delmopinol to the various strains . Fresh isolates and type strains of gram-negative rods associated with periodontal disease, Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, and strains of the gram-positive streptococci Streptococcus sanguis, Streptococcus mutans and Streptococcus salivarius, were exposed to 3.2 mM (0.1%) or 6.4 mM (0.2%) delmopinol hydrochloride from 1 to 90 min . For electron microscopy the cells were fixed and negatively contrast-stained . Treatment with 6.4 mM delmopinol for 1 min resulted in marked ultrastructural changes of cell wall components and the outer cell membrane of the 3 gram-negative species compared with control cells, whereas the gram-positive streptococci treated with delmopinol showed little or no morphologic alteration as compared with untreated cells . The result from the electron microscopy was confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of proteins released from bacterial cells treated as for electron microscopy . More material was extracted from the gram-negative rods than from the gram-positive cocci . Significantly more delmopinol bound to the gram-negative rods than to the streptococci . It appears that the amphiphilic properties of delmopinol make gram-negative rods more vulnerable to delmopinol than gram-positive streptococci.

Eur Heart J, 1995 Apr, 16 Suppl B, 75 - 9
Antibiotic treatment of streptococcal and enterococcal endocarditis: an overview; Francioli P; The management of streptococcal and enterococcal endocarditis has changed in recent years with the development of effective new regimens that are easier to administer, but resistance to commonly used antibiotics has appeared, especially among enterococci . Beta-lactam antibiotics either alone or in combination are suitable for most patients with viridans streptococci . Streptococci bovis, and S . pneumoniae, but alternative regimens are necessary for special situations . Group B, C and G streptococci respond best to the combination of a penicillin and an aminoglycoside . Enterococci are relatively resistant to penicillins and cephalosporins and strains resistant to beta-lactams, glycopeptides and aminoglycosides have become more common lately . Strategies are proposed dependent on the resistance of the organisms, but it is recognized that medical failure is not uncommon and surgical removal of the infected valve may be the only curative treatment.

Eur Heart J, 1995 Apr, 16 Suppl B, 39 - 47
Late prosthetic valve endocarditis; Horstkotte D et al.; Prosthetic valve endocarditis remains an extremely serious complication, with a low but increasing incidence . 'Late' endocarditis, occurring more than 60 days after surgery, is relatively infrequently associated with staphylococci, Gram-negative bacteria and fungi so characteristic of the endocarditis that occurs earlier . A probable source of infection can be found in 25%-80% of patients, the most frequent causes being dental procedures, urological infections and interventions, and indwelling catheters . The most common organisms are S . epidermidis, S . aureus, viridans streptococci and enterococci . The general principles of antibiotic treatment are similar to those for native valve endocarditis, but antibiotic treatment needs to be more prolonged and dosages should be used which result in maximal, nontoxic concentrations . Oral anticoagulants should be stopped and replaced by intravenous heparins . Surgical reintervention is called for if there are large highly mobile vegetations in the mitral position or within 72 h if there are cerebral thrombo-embolic episodes.

Farmaco, 1995 Apr, 50(4), 265 - 72
Synthesis and antimicrobial evaluation of 4-phenyl-3-isoquinolinoyl-hydrazones; Vittorio F et al.; 2-Methyl-1-oxo-1,2-dihydro-3-carbazoyl-4-phenylisoquinoline 2, 1-methoxy-7 and 1-chloro-3-carbazoyl-4-phenylisoquinoline 12 as well as a series of their 2-hydrazono-derivatives 3 a-i, 8 a-i and 14 a-i were synthesized and evaluated for their antibacterial and antifungal activities, in vitro . Compound 3 h was fairly active against Staphylococcus aureus, Staphylococcus epidermidis and streptococci group B.

Patol Fiziol Eksp Ter, 1995 Apr-Jun, (2), 21 - 3
{Experimental therapy of a local infectious-inflammatory process in rats using a lincomycin film}; Stel'makh VA; Implantation of a lincomycin film in granulomotomy resulted in an intensified therapeutical process of a pyo-inflammatory proliferative focus caused by subcutaneous administration of pathogenic Staphylococci, Streptococci, and Pneumococci to albino rats . As compared to the routine surgical tools, this technique provided a two-fold reduction in the periods of healing of wounds and their dissemination . At the same time there was a decrease in the manifestation rate of the pyo-necrotic component of inflammation and an improvement of the general status of the experimental animals.

Tierarztl Prax, 1995 Apr, 23(2), 119 - 22
{Insertion of fine needle biopsy in the diagnosis of nocardia mastitis in cattle}; Weissenbock H et al.; 68 udder quarters of 31 cows suspicious of acute or chronic nocardia mastitis were investigated by fine needle aspiration biopsy (FNA) of udder tissue and by bacteriological examination (BE) of milk samples . The results were compared . Nocardia mastitis was diagnosed in seven cows with corresponding cytological and bacteriological findings, in four cows with positive FNA and negative BE, and in nine cows with negative FNA and positive BE . In eleven animals nocardia mastitis was diagnosed neither cytologically nor bacteriologically . In some of these cases, however, mastitis could be attributed to other pathogens (streptococci, staphylococci, fungi) . The FNA is recommended as an additional tool for mastitis diagnosis.

J Formos Med Assoc, 1995 Apr, 94(4), 172 - 7
Streptococcal toxic shock syndrome in southern Taiwan; Wann SR et al.; This report outlines our experience with streptococcal toxic shock syndrome (STSS) at the Veterans General Hospital-Kaohsiung during the period October 1990 to November 1993 . Group A streptococci were isolated from blood or normally sterile tissue in association with hypotension and multi-organ failure in the eight cases studied . A primary focus of infection was identified in seven cases, including pneumonia (1), septic arthritis (1) and soft-tissue infections (5) . The remaining patient suffered from hyperglycemic hyperosmolar non-ketotic coma and Group A streptococcal bacteremia, without an obvious focus of infection . There were four cases of bacteremia . Clinical complications included acute renal failure in all eight cases, disseminated intravascular coagulation in five cases, liver involvement in two cases, adult respiratory distress syndrome in one case and soft-tissue necrosis in five cases . All isolates were sensitive to penicillin, and most patients were treated with intravenous penicillin G, with or without other antibiotics (gentamicin or clindamycin) . Of the six patients with soft-tissue infection, two underwent amputation of the infected limb, and one patient underwent sono-guided pigtail drainage of psoas muscle abscess . Three of the patients died . STSS may be uncommon in Taiwan, but it is not rare . Early recognition of STSS (facilitated by Gram stain and culture), prompt debridement and drainage, and adequate antibiotic treatment with penicillin or clindamycin, or both, are necessary for control of such lethal infections.

Arch Oral Biol, 1995 Apr, 40(4), 345 - 51
Differences in the detection and enumeration of mutans streptococci due to differences in methods; Dasanayake AP et al.; Different methods reported for assessing mutans streptococci (MS) make the direct comparisons of results across studies difficult . To quantitate the variations of MS estimates attributable to differences in method, stimulated and unstimulated saliva samples and oral swab samples were compared with pooled dental-plaque samples . Detection of MS in stimulated saliva samples was in excellent agreement with the presence of MS in pooled plaque samples . MS detection in unstimulated saliva samples, however, was significantly discordant with that in either pooled plaque or oral swab samples . When caries status was used as the criterion of validity of MS estimates, stimulated saliva samples demonstrated a sensitivity (94%) similar to that of pooled plaque samples, but exhibited a lower specificity (11%) than that of pooled plaque samples (17%) . As a result, the measure of association between MS and caries was biased (towards null) when MS status was based on stimulated saliva samples . Interestingly though, in enumerating MS, stimulated saliva samples yielded significantly higher levels of MS (about 1.5 log10 increase) with a lower variability compared to unstimulated saliva samples . The use of different culture media for detection of MS gave different results as well . MS detection was poor (kappa = 0.31) and MS levels were lower (p = 0.0001) when samples were grown on glucose-sucrose-potassium tellurite-bacitracin agar compared to mitis-salivarius-bacitracin agar . Together with the relative ease of sampling and processing, these findings collectively justify the use of plaque samples for the qualitative assessment of MS and stimulated saliva samples for the quantitative assessment of MS, while providing a basis for adjustment of estimates when comparing results across studies.

PCR Methods Appl, 1995 Apr, 4(5), 288 - 93
Vir typing: a long-PCR typing method for group A streptococci; Gardiner D et al.; We have developed a new procedure (Vir typing) for typing Streptococcus pyogenes, by amplifying the entire 5- to 7-kb variable vir regulon by long PCR . The amplified DNA is then cleaved with HaeIII and visualized by ethidium bromide fluorescence after agarose gel electrophoresis . A simple procedure for preparing DNA of sufficiently high quality from 96 samples was employed simultaneously . This DNA was also used to develop a random amplified polymorphic DNA (RAPD) procedure . The discriminatory power of the two DNA-based procedures was compared with previous methods, M typing, and multilocus enzyme electrophoresis . Both procedures were highly discriminatory, but the stoichiometric yield of restriction fragments in Vir typing allows unambiguous interpretation of results.

Pathology, 1995 Apr, 27(2), 172 - 6
The MicroScan WalkAway diagnostic microbiology system--an evaluation; McGregor A et al.; The MicroScan WalkAway is an automated bacterial identification and susceptibility testing system that has only recently been marketed in Australasia . We evaluated the performance of the instrument using MicroScan Rapid fluorescent panels to determine the identity and antibiotic susceptibilities of 100 Gram negative and 100 Gram positive organisms representing both common clinical isolates and selected organisms of interest . MicroScan results were compared with those obtained by conventional biochemical identification, and antibiotic susceptibility testing using agar dilution following the National Committee on Clinical Laboratory Standards guidelines . MicroScan and reference identifications were in agreement for 93% of Gram negative organisms . MicroScan results were available within 2 hrs . Additional tests were required to confirm the identity of 9 isolates but on only 2 occasions would a definitive identification been delayed beyond 24 hrs . Very major or major discrepancies were seen in 2% and minor discrepancies in 8% of Gram negative susceptibility tests . Susceptibility results were available within 7 hrs but could not be obtained for 13 slow growing organisms . With Gram positive organisms MicroScan agreed with the reference identification of 87% of isolates cultured on horse and 90% of those cultured on sheep blood agar . Discrepancies that occurred in the identification of some streptococci made us question the suitability of MicroScan as the sole means of identifying these organisms . All identifications were available within 24 hrs and the requirement for additional tests was minimal . Susceptibility results closely matched those obtained by agar dilution with < 1% major and 7% and 9% minor discrepancies occurring with sheep and horse blood respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagn Microbiol Infect Dis, 1995 Apr, 21(4), 219 - 21
Fatal endocarditis due to Aerococcus urinae; Skov RL et al.; Aerococcus species are Gram-positive cocci having Gram-stain characteristics of staphylococci (i.e., form clusters), but biochemical and growth characteristics resembling streptococci and enterococci (i.e., catalase-negative, alpha-hemolytic growth on blood agar) . A case of fatal endocarditis due to Aerococcus urinae is presented . Endocarditis should be suspected and, if confirmed, treated aggressively when A . urinae is recovered from blood cultures.

Int J Syst Bacteriol, 1995 Apr, 45(2), 406 - 8
Determination of 16S rRNA sequences of Streptococcus mitis and Streptococcus gordonii and phylogenetic relationships among members of the genus Streptococcus; Kawamura Y et al.; We determined the 16S rRNA sequences of the type strains of Streptococcus mitis and Streptococcus gordonii and calculated the phylogenetic distances between those organisms and other members of the genus Streptococcus . The viridans group streptococci were separated into five phylogenetic groups; we named these groups the anginosus group, the mitis group, the salivarius group, the bovis group, and the mutans group . S . mitis and S . gordonii clustered in the mitis group together with Streptococcus pneumoniae, Streptococcus oralis, Streptococcus sanguis, and Streptococcus parasanguis at levels of sequence homology of more than 96% . Within this group, S . mitis, S . oralis, and S . pneumoniae exhibited more than 99% sequence homology with each other, although the DNA-DNA similarity values for their total chromosome DNAs were less than 60%.

J Am Acad Child Adolesc Psychiatry, 1995 Mar, 34(3), 307 - 11
Case study: a new infection-triggered, autoimmune subtype of pediatric OCD and Tourette's syndrome; Allen AJ et al.; A review of clinical observations and literature reports leads to the hypothesis that, via a process analogous to Sydenham's chorea, infections with group A beta-hemolytic streptococci, among others, may trigger autoimmune responses that cause or exacerbate some cases of childhood-onset obsessive-compulsive disorder (OCD) or tic disorders (including Tourette's syndrome) . If this hypothesis is correct, then immunological treatments should lead to decreased symptoms in some cases . Four cases with abrupt, severe onset or worsening of OCD or tics are presented from an open treatment study . All were boys aged 10 to 14 years . One had OCD, one had Tourette's syndrome, and two had both OCD and Tourette's syndrome . Clinically and on standardized rating scales, their symptoms were in the moderate to very severe range . Two had evidence of recent group A beta-hemolytic streptococci infections, and the others had histories of recent viral illnesses . Two were treated with plasmapheresis, one with intravenous immunoglobulin, and one with immunosuppressive doses of prednisone . All had a clinically significant response immediately after treatment . Diagnostic criteria are provided that describe these cases of pediatric, infection-triggered, autoimmune neuropsychiatric disorders (PITANDs) . Suggestions are made regarding the evaluation and management of patients who may have this condition.

Medicine (Baltimore), 1995 Mar, 74(2), 63 - 73
The current spectrum of infectious glomerulonephritis . Experience with 76 patients and review of the literature; Montseny JJ et al.; To identify the demographic, clinical, and pathologic features and the prognosis of renal disease in a series of patients with infectious or postinfectious proliferative glomerulonephritis (GN), data were collected from records of 76 adult patients admitted from 1976 to 1993 to 2 neighboring suburban hospital nephrology units, whose catchment population consists of patients living in a suburban borough of Paris with a below-average socioeconomic status . Thirty-four patients (45%) were alcoholics, diabetics, or intravenous illicit-drug users . Sixty-six patients presented with acute nephritic and/or nephrotic syndrome . Acute renal failure was present in 56 (76%) and required dialysis in 14 . The diagnostic workup comprised at least 1 renal biopsy in each case . The patient's background, site of infection, clinical course, laboratory variables, and, when available, bacteriologic findings were analyzed in each case to interpret the evolution of the disease . Initial renal biopsy disclosed endocapillary GN in 44 patients, crescentic GN in 26, and membranoproliferative GN in 6 . Ten patients had endocarditis . Staphylococci and Gram-negative strains, not streptococci, were the most common bacteria identified . The origin of sepsis was mainly the oropharynx (21), the skin (19) and the lung (14); 19 cases involved multiple sites of infection . Eight patients died (11%), and 20 (26%) recovered renal function, but GN followed a chronic course in 38 (50%), rapidly requiring maintenance dialysis in 6 . Poor prognostic factors included age over 50 years, purpura, endocarditis, and glomerular extracapillary proliferation . Twenty-six patients underwent repeat renal biopsy 1 month to 11 years after the initial presentation . The main finding, irrespective of the interval since the first biopsy, was that ongoing or new iatrogenic infection acquired during hospitalization was almost invariably acquired during hospitalization was almost invariably associated with developing glomerular proliferative changes . This study shows that infectious proliferative GN remains common, but that its epidemiology has changed from what was observed until 2 decades ago . The responsible bacteria, when identified, now comprise a majority of staphylococci and Gram-negative strains, in contrast to the streptococci which predominated 3 decades ago . Infectious GN affects with increasing frequency patients with an underlying condition responsible for immunosuppression, especially alcoholism, even in the absence of cirrhosis . Destructive glomerular proliferation persists, especially but not exclusively until infection has been eradicated, and despite rescue treatment with corticosteroids and/or cytostatic drugs . Thus, the prognosis is poor, and infectious GN often ends in renal death . Infection continues in this decade to represent a frequent and probably often overlooked cause of end-stage renal failure.(ABSTRACT TRUNCATED AT 400 WORDS)

J Med Microbiol, 1995 Mar, 42(3), 161 - 4
Comparison of streptococci of serological group B isolated from healthy carriers and active disease in Chile; Lammler C et al.; Serotyping of 50 streptococcal strains of serological group B isolated from human clinical specimens in Chile revealed mainly the serotypes Ia, II and III, either alone or in combination with protein antigens c or R . No significant difference in serotype distribution was detected between group B streptococci isolated from cervical swabs from clinically healthy women and those isolated from various pathological processes . Determination of antibiotic susceptibility of the bacteria demonstrated resistance to tetracycline and minocycline in 29 isolates . All 29 tetracycline-resistant cultures hybridised with a gene probe for tet(M) . Again, no differences were detected between the group B streptococcal isolates of various origins.

J Infect Dis, 1995 Mar, 171(3), 601 - 6
M proteins of group G streptococci: mechanisms of resistance to phagocytosis; Campo RE et al.; Group G streptococci that express M protein and resist phagocytosis in human blood (virulent strains) were compared with strains of groups G and A that are readily phagocytosed (avirulent) . Virulent group G streptococci were less effective (P < .05) as activators of the alternative complement pathway (ACP) than were avirulent streptococci . In immunofluorescence studies, C3 bound more avidly to avirulent than to virulent group G streptococci . Resistance of virulent group G strains to ACP opsonization and to phagocytosis was markedly diminished by removal with pepsin of the type-specific portion of the M molecule . Preincubation with fibrinogen did not diminish ACP activation or C3 binding by virulent group G and A streptococci but did exert an antiphagocytic effect . Given the similarity of M proteins of groups G and A in structure and function, other microbial constituents are likely responsible for differences in the spectra of illnesses attributable to the two serogroups.

J Infect Dis, 1995 Mar, 171(3), 593 - 600
Group A streptococcus-liposome ELISA antibody titers to group A polysaccharide and opsonophagocytic capabilities of the antibodies; Salvadori LG et al.; Antibodies reactive with group A streptococci (GAS) carbohydrate were studied by ELISA and in an indirect bactericidal assay . The ELISA used GAS carbohydrate covalently bound to phosphatidylethanolamine incorporated into liposomes so that both precipitating and nonprecipitating antibodies were measured . Sera from children from different geographic areas exhibited marked differences in levels of anti-GAS carbohydrate antibody, which increased with age . The antibodies were predominantly of IgG . In bactericidal assays, most of these sera promoted phagocytosis of several type-specific M-positive strains . Opsonization was also related to serum levels of anti-GAS carbohydrate antibodies . These opsonizing antibodies were depleted from the serum by absorption of the sera on an N-acetyl-D-glucosamine affinity column . Antibody eluted from this column could partially restore opsonization of GAS . Anti-GAS carbohydrate antibodies play a major role in these opsonophagocytosis assays.

J Bacteriol, 1995 Mar, 177(5), 1399 - 401
Subinhibitory concentrations of antibiotics affect cell surface properties of Streptococcus sobrinus; Wu Q et al.; Several antibiotics, at subinhibitory concentrations, caused an increase in the ability of Streptococcus sobrinus to bind alpha-1,6-glucans, whereas other antibiotics decreased glucan binding . In every case, glucan binding was inversely proportional to cell surface hydrophobicity . High levels of glucan-binding activity resulted in low levels of hydrophobicity, whereas low levels of glucan binding caused high levels of cellular hydrophobicity . The results show that low concentrations of antibiotics may modulate lectin and hydrophobin adhesins in streptococci.

Infect Immun, 1995 Mar, 63(3), 785 - 93
Immunopathological activities of extracellular products of Streptococcus mitis, particularly a superantigenic fraction; Matsushita K et al.; Previously, we prepared extracellular products, fractions F-1 and F-2 of Streptococcus mitis 108, an isolate from the tooth surface of an infant, and showed that F-1 exhibited inflammatory cytokine-inducing activities . In the present study, we present evidence that fraction F-2 induced human T-cell proliferation in the presence of irradiated human peripheral blood mononuclear cells and selectively activated T cells bearing V beta 2 and V beta 5.1 in the T-cell receptor . F-1, on the other hand, stimulated human gingival fibroblasts to support the T-cell proliferation in the same way as human gamma interferon or Prevotella intermedia lipopolysaccharide (LPS) . Fraction F-1 also primed gingival fibroblasts to support the production of interleukin-2 and gamma interferon by the T cells upon stimulation with F-2 . Human gingival fibroblasts stimulated with fraction F-1, like those stimulated by P . intermedia LPS and human gamma interferon, exhibited human leukocyte antigen (HLA)-DR mRNA expression and cell surface HLA-DR molecules as detected by enzyme-linked immunosorbent assay . An anti-HLA-DR monoclonal antibody inhibited T-cell proliferation in response to F-2, probably through inactivating the accessory function of HLA-DR-bearing fibroblasts . T cells activated with F-2 in the presence of irradiated peripheral blood mononuclear cells exhibited definite cytotoxic effects against fibroblasts and squamous carcinoma cells originating from human oral tissues . These findings are strongly suggestive of an association of extracellular products of viridans streptococci with pathogenesis of oral mucosal diseases, particularly those disorders in gingiva which are accompanied by heavy infiltration of T cells.

Biosci Biotechnol Biochem, 1995 Mar, 59(3), 372 - 7
Evaluation of acidogenicity of commercial isomaltooligosaccharides mixture and its hydrogenated derivative by measurement of pH response under human dental plaque; Kaneko T et al.; The acidogenicity of commercially available isomaltooligosaccharides mixture (IMO) and its hydrogenated derivative (IMO-H) were evaluated by the in vivo pH response under dental plaque of six subjects (aged 25-28) using intraoral apparatus . The apparatus, an indwelling pH sensor of a hydrogen ion-sensitive field effect transducer (ISFET), was placed on the buccal site of the mandibular first molar, and the plaque was accumulated for four days . The test sugars were applied with three methods-dropping the solution directly on the plaque, rinsing the oral cavity with the solution, and sucking a candy made of the test sugar (weight 3-4 g) . IMO could not be evaluated as a type of sugar with low acidogenicity, especially by the candy method, but IMO-H could be evaluated as a type of sugar with very low acidogenicity in a similar manner as maltitol or sorbitol in all type of applications . The acidogenic response of dental plaque should be assumed to be closely related to salivary parameters such as the secretion rate or to mutans streptococci level of subjects and types of application.

Biosci Biotechnol Biochem, 1995 Mar, 59(3), 363 - 6
Expression of streptolysin O gene in Bacillus subtilis; Yamada S et al.; Streptolysin O (SLO) is a hemolytic, extracellular protein produced by Streptococcus pyogenes . A hybrid gene consisting of the promoter and signal sequence fused to the region encoding the mature sequence of the slo gene was constructed to secrete SLO in Bacillus subtilis . To increase secretion of SLO into the culture supernatant, several SLO expression vectors containing various combinations of promoters and pre-pro sequences were constructed . B . subtilis harboring pPA consisting of the P-43 promoter and the coding sequence of the pre region of the alkaline protease gene that was fused to the pro-mature region of the slo gene secreted SLO into media . The degree of hemolytic activity was found to be about 40-fold higher in the geneticaly engineered B . subtilis strain than that of S . pyogenes . Recombinant SLO was reacted with patients' sera infected by group A streptococci.

Clin Infect Dis, 1995 Mar, 20(3), 582 - 7
Streptococcal meningitis complicating diagnostic myelography: three cases and review; Gelfand MS et al.; Bacterial meningitis is a rare complication of myelography . Most reported cases are due to miscellaneous streptococci, but the source of these organisms is uncertain . The differential diagnosis of chemical meningitis caused by the contrast material vs . bacterial meningitis may be difficult . We recently treated three patients with streptococcal meningitis following myelography performed with the contrast medium iopamidol . We discuss the diagnostic and therapeutic approach to postmyelography meningitis.

Recenti Prog Med, 1995 Mar, 86(3), 115 - 7
{The multiresistance of Streptococcus pneumoniae: a global danger}; Tarasi A; S . pneumoniae causes several serious and potentially life-threatening community-acquired diseases, and there are 5 million deaths per year globally . In multidrug-resistant clones (those with resistance to erythromycin, tetracycline, chloramphenicol, penicillin, and trimethoprim-sulfamethoxazole), treatment of even relatively localized pneumococcal infection may require hospitalization because of the need to use parenteral vancomycin . Thanks to the tremendous increase in the size of populations at high risk, and to the increased mobility of human populations the problem has been amplified to one of global dimensions: during the last decade multidrug-resistant clones have been clinically isolated in Spain, South Africa, Hungary, USA, Croatia, and South Korea . In Italy, epidemiologic data are unknown . Pneumococci would have developed resistance modifying the PBP genes, probably acquiring foreign DNA from taxonomic related streptococci and became global pathogens because of geographic spread of multidrug-resistant clones during the 1990s . These theses have been demonstrated using a relatively new technique of molecular epidemiology: Pulsed-Field Gel Electrophoresis, able to recognize chromosomal similarity among clinical isolates . About 50% of the pharmaceutical company had either reduced or phased out their natibacterial programs five years ago . There are relatively few new drugs ready for introduction today, and promising agents are still in the development stage and will require more years of testing for clinical efficacy.

Immunology, 1995 Mar, 84(3), 440 - 5
Effects of fibronectin and group B streptococci on tumour necrosis factor-alpha production by human culture-derived macrophages; Peat EB et al.; Group B streptococci (GBS) are an important cause of sepsis and shock in the new-born . We have previously reported that GBS induce the production of tumour necrosis factor-alpha (TNF-alpha) by human monocytes and culture-derived macrophages . We have also shown that fibronectin (FN) promotes interaction between GBS and human phagocytes . In the present study, we investigated the effect of FN and GBS on the production of TNF-alpha by adult and neonatal culture-derived macrophages . We report that soluble FN alone was a strong stimulus for the production of TNF-alpha by culture-derived macrophages (FN 50 micrograms/ml = 623.33 +/- 47 pg/ml TNF, versus media alone 3 +/- 1.5 pg/ml; P < 0.0001) . While GBS also induce the production of TNF-alpha by macrophages, the addition of FN to GBS had more than an additive effect on TNF-alpha levels . FN-mediated TNF-alpha production by macrophages was inhibited by both soluble arginine-glycine-aspartic acid (RGD) peptide (71%; P < 0.0001) and anti-beta 3-integrin monoclonal antibody 7G2 (54%; P < 0.0001) . Neonatal culture-derived macrophages produced significantly more TNF-alpha in response to GBS (356.4 pg/ml +/- 27.7) than adult cells did (222.0 pg/ml +/- 21.0; P = 0.037), and dramatically more in response to FN alone (neonatal 1931.0 pg/ml +/- 23.0 versus adult 463.5 43.5 pg/ml; P < 0.0001) . FN may contribute to the high levels of TNF-alpha production implicated in the pathophysiology of GBS sepsis and shock.

Kansenshogaku Zasshi, 1995 Mar, 69(3), 327 - 32
{Properties of a hemolysin produced by group C streptococci isolated from hemolytic streptococcal infection in formosan squirrels}; Suzuki J et al.; The hemolysin produced by group C streptococci (GCH) has an isoelectric point (pI) of 5.6 and a molecular weight of 32,000 and shows hemolytic activity in the absence of 2-mercaptoethanol (2-ME) . The hemolytic activity of GCH was compared to that of streptolysin S (SLS) . These hemolysins did not differ with respect to the binding and release of hemoglobin (Hb) . GCH was bound to phospholipids on the membranes of target erythrocytes, followed by the rapid released of K+ and slow Hb release after a relatively long lag time . GCH showed a lower hemolytic efficiency than SLS, reflecting the fact that these hemolysins destroy erythrocytes by slightly different mechanisms.

Anat Anz, 1995 Mar, 177(2), 119 - 24
Uptake of a gram-positive bacterium (Streptococcus pneumoniae R36a) by the M cells of rabbit Peyer's patches; Regoli M et al.; The epithelium associated with the lymphoid follicles of Peyer's patches differs from the villi epithelium by the presence of M cells . The main function of these cells is to take up antigens (inert material, viruses and bacteria) from the intestinal lumen . The M cells are able to internalize various different gram-negative bacteria . In order to show the M cells ability to interact and take up a gram-positive bacterium, we exposed rabbit Peyer's patches to Streptococcus pneumoniae R36a . Using the isolated ileal loop technique, Peyer's patches were incubated with a bacterial suspension for varying periods (15, 30, 60, 100 minutes) . The bacteria were found outside and inside the M cells . The internalized streptococci could be found in the M cell cytoplasm, in the cytoplasmic "pockets" and inside the intraepithelial lymphoid cells . The finding of internalized bacteria with their damaged walls suggests the possibility that M cells are able to modify internalized antigens in the same way as the antigen presenting cells.

Neth J Med, 1995 Mar, 46(3), 153 - 5
Septic shock caused by group G beta-haemolytic streptococci as presenting symptom of acute myeloid leukaemia; Eskens FA et al.; A patient with rapidly fatal septic shock caused by group G beta-haemolytic streptococci as presenting symptom of acute myeloid leukaemia is presented . Although the association of septic shock due to Group G beta-haemolytic streptococci and different kinds of malignancy is known, presentation of acute myeloid leukaemia in this form is rare.

Immunol Today, 1995 Mar, 16(3), 145 - 9
Psoriasis: a T-cell-mediated autoimmune disease induced by streptococcal superantigens?
Valdimarsson H, Baker BS, Jonsdottir I, Powles A, Fry L.
Psoriasis is a T-cell-mediated disease that can be triggered by infection with group A beta-haemolytic streptococci . It is proposed that psoriatic skin lesions are initiated by exotoxin-activated T cells, and persist because of specific T cells that react both with streptococcal M protein and a skin determinant, possibly a variant of keratin . As discussed here by Helgi Valdimarsson and colleagues, cytokines released by the superantigen (SAg)-stimulated T cells could induce or enhance the expression of the crossreactive autoantigen, leading to the rescue and activation of autoreactive T cells . In this way, the SAg-determined T-cell receptor V beta phenotype would be maintained by T cells in psoriatic lesions.

Zh Mikrobiol Epidemiol Immunobiol, 1995 Mar-Apr, (2), 18 - 21
{The M-protein heterogeneity of Streptococcus pyogenes strains isolated from clinically healthy and ill children in an organized collective}; Bitko SA et al.; The study of the kinetic curves of the lysis of group A S . pyogenes cell-walls (cells), serovars 29 and 12 M, variants M+ and M-; with endo-N-acetyl-muramidase revealed that the kinetics of the lysis of virulent and avirulent strains was different: variant M- was lyzed faster than M+ . This difference in the cell-wall lysis of both variants made it possible to use this method for the identification of M+ and M- states of the strains . 18 group A S . pyogenes cultures were studied . The cultures isolated from healthy and sick children in an organized group belonged to variants both M+ and M- . The pepsin fragments of M-proteins of group A S . pyogenes, type M 1, isolated in dynamics from a carrier and a patient, were studied . Their amino acid compositions were studied, and differences between them were established . The data thus obtained indicate that heterogeneity is characteristic of both the surface structure of streptococci and the individual components of their surface, in particular, M-protein.

Arch Inst Cardiol Mex, 1995 Mar-Apr, 65(2), 115 - 9
{Antibodies against extracellular products of group A Streptococcus . Diagnostic importance in acute rheumatic fever}; Robles G et al.; Streptococcal throat infection is a sine qua non for the development of rheumatic fever (RF) in genetically susceptible people . Demonstration of such infection is not easy . In overt RF less than 10% of patients still carry streptococci in their throat and immunologic methods are required to identify antibodies against streptococcal products (SP) . Humoral response against SP was studied in children and adults with and without RF . Antistreptolysin O (ASO) showed a non-gaussian distribution, and reference value was established as percentile . Adults have a 97 percentile of 227, in children 90 percentile was 451 . When RF was present all cases, except one, showed higher values . When antibodies against SP besides ASO were sought by an agglutination test (Streptozyme tm), people below 15 years of age showed low titers in 15 out of 28 cases . In contrast, high titers were the rule in children suffering RF . High ASO titer correlated with high Streptozyme value . These methods are capable to recognize an specific immune response against Group A Beta hemolytic streptococci, and are valuable tools in the diagnosis of RF.

J Commun Dis, 1995 Mar, 27(1), 27 - 31
Prevalence, group pattern, T pattern and seasonal variation of beta haemolytic streptococci in and around Shimla; Verma A et al.; One hundred and seventy two strains of beta haemolytic streptococci were isolated from various clinical specimens over a period of one year . Group A was isolated in 69.70% and group C in 16.80 percent . Majority of the strains were isolated during winter season and only 21.00 percent in summer 93.30 percent strains were bacitracin sensitive and all were sensitive to penicillin . The most common T pattern among group A was found to be 5/11/12/27/44 followed by 3/13/B 3264.

ASDC J Dent Child, 1995 Mar-Apr, 62(2), 118 - 22
Validity of the mother's recall of her child's antibiotic use; Dasanayake AP et al.; We compared the mother's recall of her child's antibiotic use with the information obtained from the child's health records, while studying the association between antibiotic use and prevalence of mutans streptococci among 102 (5-12 years) inner-city black children . Poor recall of the mother (concordance ratio = 62 percent; kappa = 0.18, p = 0.06) and the lower frequency reported by her (p = 0.02) biased the positive association between child's antibiotic use during the second year of life and oral presence of mutans streptococci toward the null value (Odds Ratio {OR} based on health records = 3.1, 95 percent Confidence Interval {CI} = 1.03-9.3; OR based on mother's recall = 1.6, 95 percent CI = 0.44-5.8) . Multiple logistic regression analysis failed to identify any significant determinant of the accuracy of the mother's recall . Since mothers considerably underestimate child's use of antibiotics, at least among inner-city low income blacks, this method of data collection should be limited to circumstances where no other options are available, and such results should be interpreted with caution.

Mol Microbiol, 1995 Mar, 15(5), 907 - 16
Role of the conserved C-repeat region of the M protein of Streptococcus pyogenes; Perez-Casal J et al.; The surface-located M protein functions to protect Streptococcus pyogenes (the group A streptococcus) from phagocytosis by polymorphonuclear leukocytes . It has been suggested that this protection results from the ability of M protein to bind factor H, a serum protein that can inhibit the activation of complement . Among different serological variants of M protein, the C-repeat domain is highly conserved and is exposed on the bacterial surface . This domain has been implicated in binding to complement factor H and in M-protein-mediated adherence of streptococci to human keratinocytes in the cutaneous epithelium . In this study, we constructed an S . pyogenes mutant strain which expresses an M6 protein from which the entire C-repeat domain was deleted . As predicted, this mutant did not adhere well to human keratinocytes and was unable to bind to factor H . Unexpectedly, the mutant was able to survive and multiply in human blood . Therefore, while the binding of factor H and the facilitation of adherence to keratinocytes appear to involve recognition of the C-repeat domain, a region of the M-protein molecule distinct from the C-repeat domain confers upon S . pyogenes its ability to resist phagocytosis.

Mol Microbiol, 1995 Mar, 15(5), 849 - 63
The fimA locus of Streptococcus parasanguis encodes an ATP-binding membrane transport system; Fenno JC et al.; The gene encoding fimA, a 36 kDa fimbrial adhesion of Streptococcus parasanguis FW213, is highly conserved in all four genetic groups of sanguis streptococci . FimA-like peptides were produced by all strains tested . The nucleotide sequence directly upstream of fimA contains two open reading frames, ORF5 and ORF1, whose deduced protein products are homologous to members of a superfamily of ATP-binding cassette membrane transport proteins, including both prokaryotic and eukaryotic uptake and export systems . The amino acid sequence of FimA contains the consensus prolipoprotein cleavage site (LxxC) common to the 'periplasmic' binding proteins of Gram-positive transport systems . The deduced product of ORF5 is a 28.6 kDa membrane-associated protein that has the consensus binding site for ATP (GxxGxGKS) . It shares significant homology with AmiE of Streptococcus pneumoniae as well as with Escherichia coli proteins involved in iron(III) uptake . Allelic-replacement mutagenesis of ORF5 resulted in greatly increased resistance to aminopterin . These data demonstrate functionality with the amiE locus as well . The deduced product of ORF1 is an extremely hydrophobic integral membrane protein of 30.8 kDa with a pattern of six potential membrane-spanning regions, typical of a component of these types of transport system . The nucleotide sequence downstream of fimA, ORF3, encodes a 20 kDa protein having 78% identity with the 20 kDa protein encoded downstream of ssaB, a fimA homologue in S . sanguis 12 . It also exhibits significant homology with bacterioferritin co-migratory protein (Bcp) of E . coli K-12 . Allelic-replacement mutagenesis in the fimA locus of FW213 showed that (i) expression of fimA was initiated at a site far upstream of the fimA start codon, and (ii) expression of fimA was not linked to expression of ORF3 . Northern blots probed with internal fragments of ORF5, ORF1, fimA or ORF3 hybridized to the same transcript of 3.3 kb, which suggested that these loci were transcribed as a polycistronic message . The ORF3 probe also hybridized to a 540 bp transcript consistent with the size of ORF3 alone and supportive of the mutagenesis data of non-linkage . Strains mutated in fimA continued to produce fimbriae, indicating that FimA was not the fimbrial structural subunit . Immunoelectron microscopy revealed FimA was localized at the tips of the fimbriae of FW213 . This is the first study that demonstrates that an adhesin which binds a bacterial cell to a substrate is associated with an ATP-binding cassette.

J Perinatol, 1995 Mar-Apr, 15(2), 157 - 9
Bacterial concentration and blood volume required for a positive blood culture; Brown DR et al.; We attempted to define the minimum blood volume and bacterial concentration required to obtain a positive blood culture with the use of placental blood and an in vitro technique . Known amounts of either Escherichia coli or group B beta-hemolytic streptococci were added to heparinized placental blood specimens . Blood samples of 0.25, 0.5, and 1.0 ml containing bacteria were inoculated into 30 ml of a commercially available broth culture medium, incubated for 24 hours, and examined for bacterial growth . Samples of at least 0.25 ml blood containing more than 10 colony-forming units of bacteria per milliliter resulted in a positive blood culture for 131 of 132 samples . On the basis of these data, we suggest that if 0.25 ml of blood is sampled and the specimen contains more than 10 colony-forming units per milliliter of E . coli or group B beta-hemolytic streptococci, the blood culture is almost certain to be positive.

Microb Pathog, 1995 Mar, 18(3), 153 - 66
Analysis of the interaction of group A streptococci with fibrinogen, streptokinase and plasminogen; Wang H et al.; Group A streptococci demonstrate a number of distinct ways to interact with the human fibrinolytic system to acquire unregulatable cell-surface enzymatic activity . Interactions between bacteria, fibrinogen, streptokinase and plasminogen resulted in acquisition of cell-associated enzymatic activity that can lyse fibrin clots despite the presence of the major physiological plasmin inhibitor, alpha 2-antiplasmin . Western blot analysis of extracted streptococcal surface proteins suggested that binding of fibrinogen to M or M-related proteins mediated the capture of streptokinase-plasminogen complexes to the bacteria . The enzymatic complex formed by reaction of bacteria with fibrinogen, streptokinase and plasminogen was found to be more stable in human plasma than pre-formed plasmin bound directly to the same bacteria strain.

Oral Dis, 1995 Mar, 1(1), 43 - 8
Clinical, microbiological and ultrastructural features of angular cheilitis lesions in Southern Chinese; Dias AP et al.; OBJECTIVE: To obtain baseline data on angular cheilitis in Southern Chinese . DESIGN: A cross-sectional investigation of the clinical, microbiological and ultrastructural features of the condition . SUBJECTS AND METHOD: Thirty six Chinese adults with angular cheilitis; 28 controls matched for age and sex, with no inflammation . Clinical examination, swabs of lesions for microbiology, impressions of lesions for ultrastructure, using replica technique . MAIN OUTCOME MEASURES: Severity of lesions, associated signs and symptoms, incidence and type of microorganisms, ultrastructural features . RESULTS: Of a total 68 lesions 32 were bilateral and four unilateral . Forty four (65%) were mild (Type I) and the remaining 24 (35%) moderate (Type II) . Infective agents were isolated from 37 (54%) lesions; pure growth of Candida spp and Staph . aureus was noted in nine lesions each; a mixed growth of the two in II, beta-haemolytic streptococci in three and a mixed flora including coliforms in the other five . Candida spp were present in one control, beta-haemolytic streptococci in two and coliforms in four others . Scanning electron microscopy revealed natural topography of the angular skin with sparse colonisation by bacteria and yeasts . CONCLUSIONS: Angular cheilitis in Southern Chinese seems to be characterised by a milder clinical presentation and classic infective agents of the disease: Candida spp and Staph . aureus.

Zentralbl Veterinarmed B, 1995 Mar, 42(1), 42 - 50
Characteristic properties of streptococci of serological group L; Sippel K et al.; This study was designed to characterize further 88 streptococci of serological group L, isolated from bovines, pigs, poultry and humans . Most group L streptococci from bovines grew as granular sediment with long chains in fluid media and with compact colonies in soft agar . Most group L streptococci from pigs grew with a uniform turbidity in fluid media, short chains, and with diffuse colonies in soft agar . The biochemical characteristics, determined with the Strepzym identification system, revealed no significant differences between the group L streptococci of various origins . A positive opacity factor reaction could mainly be observed with group L streptococci from bovines and humans, but was less pronounced with group L streptococci from pigs and poultry . In addition, 27 group L streptococci reacted with type antigen X or R and 9 cultures with M1 or M6 specific antiserum . The determination of antibiotic resistance patterns revealed that all group L streptococci were resistant to tetracycline and minocycline, part of the cultures were resistant to chloramphenicol, erythromycin and gentamicin, and all cultures were susceptible to penicillin, bacitracin, cefoxitin and nitrofurantoin . All these data allowed an individual characterization of group L streptococci, possibly useful for epidemiological studies.

J Reprod Immunol, 1995 Mar, 28(3), 247 - 62
Systemic and mucosal antibody responses to group B streptococci following immunization of the colonic-rectal mucosa; Hordnes K et al.; The cervico-vaginal mucosa is poorly designed for inducing a mucosal immune response, but it can effect such a response evoked at other mucosal sites . This study was undertaken to determine whether colonic-rectal immunization with group B streptococci (GBS) might induce a local cervico-vaginal immune response . Mice were immunized with either fragmented GBS rectally, whole GBS rectally, or whole GBS subcutaneously . Cholera toxin (CT) was used as an adjuvant for the rectal immunizations . Following colonic-rectal immunization with whole GBS, the mean anti-GBS IgA antibody level in vaginal secretions was 735 kU/ml, with individual values reaching 3480 kU/ml . Corresponding levels of IgA antibodies never exceeded 10 kU/ml in serum and intestinal secretions, or 90 kU/g in feces . In vaginal secretions IgA antibodies to GBS also constituted a much larger fraction of total IgA than in serum, intestinal secretions and feces . Immunizations with fragmented GBS produced much lower IgA responses . Anti-GBS IgA response at the inductive site in the colon-rectum was not significant, as opposed to a strong anti-CT IgA response . Except in serum, the anti-GBS IgG responses to colonic-rectal immunizations were generally low, or absent . The results may provide a basis for the development of mucosal vaccines against GBS-infection.

N Z Med J, 1995 Feb 22, 108(994), 53 - 4
Peritonsillar infection in Christchurch 1990-2: microbiology and management; Muir DC et al.; AIM . To review the management and microbiology of peritonsillar infection in Christchurch . METHOD . The hospital records of patients admitted acutely to Christchurch Hospital with peritonsillar infection between January 1990 and December 1992, were reviewed . RESULTS . 109 patients were admitted with peritonsillar infection, of which 74 (68%) were found to have a peritonsillar abscess . Of these 74, needle aspiration was performed in 22, incision and drainage in 15, both aspiration and drainage in 31, and acute tonsillectomy in 6 . Interval tonsillectomy was performed in 35 patients . Sixteen pathogenic bacterial groups or species were cultured from 39 aspirates . Of the total number of bacteria isolates, obligate anaerobes were cultured in 48%, and group A beta-haemolytic streptococci in 29%, while aerobic beta-lactamase producing bacteria were cultured in only 6% . CONCLUSION . Central to the management of peritonsillar abscess is drainage . This was commonly achieved by needle aspiration and/or incision . As beta-lactamase producing organisms are infrequent, penicillin remains the antibiotic of choice . Metronidazole may be required in a non responding patient, particularly if resistant anaerobes are cultured.

Infect Immun, 1995 Feb, 63(2), 663 - 71
Involvement of bactericidal factors from thrombin-stimulated platelets in clearance of adherent viridans streptococci in experimental infective endocarditis; Dankert J et al.; Platelets activated with thrombin release bactericidal factors . We studied the role of the susceptibility of viridans streptococci to these bactericidal factors in the development of infective endocarditis (IE) . By using the experimental endocarditis rabbit model, the initial adherence and the development of IE were assessed for 10 viridans streptococcal strains differing in their susceptibilities to releasate (material released) from thrombin-activated platelets . Six strains were susceptible and four strains were resistant to these releasates . The numbers of vegetations (VGs) colonized at 5 min and 48 h after intravenous challenge with 10(4) CFU were determined . At 5 min after challenge, significantly more VGs were colonized with bacteria of the six platelet releasate-susceptible strains than with bacteria of the four releasate-resistant strains (P < 0.005) . In the releasate-susceptible group of strains, the number of colonized VGs decreased significantly between 5 min and 48 h after intravenous inoculation (P < 0.001) . Such a decrease was not observed with the releasate-resistant strains . As a result, the final developments of IE due to releasate-susceptible and -resistant strains were not significantly different . The releasate-susceptible strain 1 and the releasate-resistant strain 2 were selected for more detailed experiments . Rabbits were killed at 5 and 30 min and 2, 4, and 48 h after inoculation . The number of culture-positive VGs as well as the number of adherent bacteria on the individual VGs were determined . The 90% infective dose for each strain was 10(5) CFU . At low inoculum concentrations (10(3) and 10(4) CFU) a larger proportion of the inoculated bacteria of both strains was found to be adherent on VGs than at higher challenge doses . The number of culture-positive VGs as well as the number of adherent bacteria per VG decreased rapidly in the first 30 min after challenge with strain 1 but not after challenge with strain 2 . Additional experiments with the platelet releasate-susceptible strain S224 and the platelet releasate-resistant stain S182 confirmed the data obtained with strains 1 and 2 and indicated that releasate-susceptible strains disappeared from the VGs with time, whereas releasate-susceptible strains persisted . In vitro studies with VGs excised 5 min after challenge with stain 1 or 2 showed that clearance of the releasate-susceptible strain 1 was not caused by complement bactericidal activity or surface phagocytosis by polymorphonuclear cells . Bacterial cells of strain 1 adherent on excised VTGs were rapidly cleared by exposure to fresh clotting blood or to releasates from thrombin-stimulated platelet suspension.(ABSTRACT TRUNCATED AT 400 WORDS)

Infect Immun, 1995 Feb, 63(2), 622 - 31
DNA sequence of the serum opacity factor of group A streptococci: identification of a fibronectin-binding repeat domain; Rakonjac JV et al.; The serum opacity factor (SOF) is a group A streptococcal protein that induces opacity of mammalian serum . The serum opacity factor 22 gene (sof22) from an M type 22 strain was cloned from an EMBL4 library by screening for plaques exhibiting serum opacity activity . DNA sequencing yielded an open reading frame of 3,075 bp . Its deduced amino acid sequence predicts a protein of 1,025 residues with a molecular weight of 112,735, a size that approximates that of the SOF22 protein isolated from both the original streptococcal strain and Escherichia coli harboring the cloned sof22 gene . The molecule is composed of three domains: an N-terminal domain responsible for the opacity reaction (opacity domain), a repeat domain with fibronectin-binding (Fn-binding) activity, and a C-terminal cell attachment domain . The C-terminal end of SOF22 is characterized by a hexameric LPXTGX motif, an adjacent hydrophobic region, and a charged C terminus, which are the hallmarks of cell-bound surface proteins found on nearly all gram-positive bacteria . Immediately upstream of this cell anchor region, SOF22 contains four tandem repeat sequence blocks, flanked by prolinerich segments . The repeats share up to 50% identity with a repeated motif found in other group A streptococcal Fn-binding proteins and exhibit Fn-binding activity, as shown by subcloning experiments . According to deletion analysis, the opacity domain is confined to the region N terminal to the repeat segment . Thus, SOF22 is unique among the known Fn-binding proteins from gram-positive bacteria in containing an independent module with a defined function in its N-terminal portion . Southern blot analysis with a probe from this N-terminal region indicates that the opacity domain of SOF varies extensively among different SOF-producing M types.

Mol Microbiol, 1995 Feb, 15(3), 581 - 9
Group B streptococci adhere to a variant of fibronectin attached to a solid phase; Tamura GS et al.; Group B streptococci (GBS) are the leading cause of neonatal pneumonia and meningitis . Adherence of GBS to host tissues may play an important role in the pathogenesis of infection . The host molecules which mediate GBS adherence to host tissues are unknown . Many bacterial pathogens adhere to fibronectin, an important component of the extracellular matrix (ECM) . Some pathogens adhere to both immobilized and soluble fibronectin, while others adhere to immobilized fibronectin, but not to soluble fibronectin . Previous data indicated that GBS do not adhere to soluble fibronectin . We studied the ability of GBS to adhere to immobilized fibronectin . Forty-five per cent of the input inoculum of COH1, a virulent GBS isolate, adhered to fibronectin immobilized on polystyrene . COH1 did not adhere to the other ECM proteins tested (laminin, type I collagen, vitronectin, and tenascin) . Nine out of nine GBS strains from human sources tested adhered specifically to fibronectin at levels varying from 4-60% . We considered the possibility that GBS were adherent to a contaminant in the fibronectin preparation . Properties of fibronectin, including the presence of an immunologic epitope of fibronectin and binding to collagen, were verified to be properties of the molecule to which GBS adhere . COH1 adhered to fibronectin captured by a monoclonal antibody to fibronectin (FN-15), confirming that the molecule to which GBS adhere bears immunologic determinants of fibronectin . Adherence of COH1 to fibronectin was inhibited by collagen, confirming that the molecule to which GBS adhere binds to collagen . These data strongly suggest that GBS adhere to fibronectin, and not to a contaminant.(ABSTRACT TRUNCATED AT 250 WORDS)

Eur J Surg, 1995 Feb, 161(2), 73 - 6
Early thoracoscopic debridement and drainage as definite treatment for pleural empyema; Sendt W et al.; OBJECTIVE: To report our experience with early thoracoscopic debridement and drainage in the treatment of pleural empyema in the fibrinopurulent or early organising phase . DESIGN: Prospective open study . SETTING: District hospital, Germany . SUBJECTS: 10 Patients operated on between August 1991 and April 1993 . INTERVENTIONS: Double lumen intubation, followed by thoracoscopic opening of the empyema, evacuation of all pus under vision, debridement of the lung, irrigation of the thoracic cavity and insertion of a chest drain . MAIN OUTCOME MEASURES: Morbidity and mortality . RESULTS: Cultures taken during the operation grew no pathogens in five cases; Streptococcus pneumoniae, and haemolytic streptococci (once in combination with Staphylococcus aureus), were cultured in two cases each; and Mycobacterium tuberculosis in one . Chest drains were removed a mean of 8.5 days after operation . All patients were well without signs of infection 1-21 months later, and in no case was conversion to open operation necessary . CONCLUSION: Early thoracoscopic debridement and drainage is a safe and effective alternative to open treatment of patients with pleural empyema in the fibrinopurulent or early organising phase.

Lett Appl Microbiol, 1995 Feb, 20(2), 92 - 7
Enumeration of intestinal enterococci and interfering organisms with Slanetz-Bartley agar, KF streptococcus agar and the MUST method; Niemi RM et al.; The recovery of intestinal species of enterococci and streptococci and potentially interfering nonfaecal species was measured on KF streptococcus agar, Slanetz-Bartley agar and in a medium based on 4-methylumbelliferyl-beta-D-glucoside (MUST method) using pure cultures . Both of the solid media yielded high recoveries of the target species . Their selectivity was better at elevated incubation temperature but nonfaecal Enterococcus and Staphylococcus species were not eliminated even at the elevated temperature . The MUST method tended to give slightly lower recoveries than the agar cultivation methods with some target species at 44 degrees C but recoveries were better at 41 degrees C.

Eur J Clin Microbiol Infect Dis, 1995 Feb, 14(2), 92 - 8
Randomized evaluation of benzathine penicillin V twice daily versus potassium penicillin V three times daily in the treatment of group A streptococcal pharyngitis . Pharyngitis Study Group; Kaufhold A; In a randomized, prospective, multicenter study the clinical and bacteriological efficacies of three dosage schedules with two different salts of oral penicillin V suspensions (regimen 1: potassium salt of penicillin V, 50,000 U/kg of body weight per day in three divided doses; regimen 2: benzathine salt of penicillin V, 50,000 U/kg of body weight per day in two divided doses; and regimen 3: benzathine salt of penicillin V, 100,000 U/kg of body weight in two divided doses) for the treatment of streptococcal pharyngitis were evaluated . Children with clinical signs of acute pharyngitis and a positive throat culture for group A beta-hemolytic streptococci (GABHS) were eligible . There was no difference between the treatment groups with respect to the overall clinical success rate . Eradication of the original serotype of GABHS from throat cultures was achieved in 87.1% (regimen 1), 85.5% (regimen 2) and 87.7% (regimen 3) of patients . The incidence of potential drug-related adverse events was significantly higher in patients treated with regimen 3 . The results of this and earlier studies strongly suggest that oral penicillin given twice daily should be the recommended treatment for the initial treatment of pharyngitis due to GABHS . Doubling the total daily dose is not beneficial in the usual clinical setting . Because of its favorable pharmacokinetics, the benzathine salt of penicillin V appears to be well suited for a twice-a-day dosage schedule.

Kansenshogaku Zasshi, 1995 Feb, 69(2), 133 - 8
{Isolation of alpha-streptococci with inhibitory activity against pathogens, in the oral cavity and the effect of tobacco and gargling on oral flora}; Fujimori I et al.; We investigated the distribution of oral alpha-streptococci with inhibitory activity against pathogens, which compose an oral defense mechanism . Detection rate of alpha-streptococci with inhibitory activity against S . pyogenes and S . aureus derived from the tonsil was higher than in other portions, the tongue, cheek, gingiva, or saliva . It has suggested that tonsillar bacterial flora are mainly a defense mechanism . The oral flora in healthy smokers was compared with healthy non-smokers to investigate the influence of tobacco on oral bacterial flora . The results showed that the detection rate of S . aureus in smokers was higher while that of alpha-streptococci with inhibitory activity against S . aureus was lower . However, the detection rate of alpha-streptococci with inhibitory activity against S . pyogenes in smokers was as high as in non-smokers . It is suggested that it was easy for S . aureus to adhere to the oral mucosa in smokers, and was considered to influence the strain which produces beta-lactamase for medical treatment . We investigated the influence of gargling on oral bacterial flora by comparing the amount of bacteria before and after gargling with popidine-iodine gargle and saline solution . It was shown that alpha-streptococci, a main component of normal oral flora were decreased after gargling in both smokers and non-smokers . Furthermore, it was shown that group A Streptococcus was not decreased after gargling, and it was concluded that use of gargle medicinal mouth wash in bacillus carriers should be studied further.

Clin Infect Dis, 1995 Feb, 20(2), 372 - 86
Subdural empyema: analysis of 32 cases and review; Dill SR et al.; Thirty-two patients with subdural empyema at the University Hospital (Birmingham, AL) during the period from June 1970 through June 1992 were identified retrospectively . Clinical presentations of patients, methods of diagnosis, results of microbiological tests, types of therapy used, and outcomes of patients are presented and compared with those found in prior reports . The patients were separated into three groups based on the etiology of their disease: sinusitis, trauma and/or neurosurgery, and other miscellaneous causes . Sinusitis accounted for 56% of the cases; the predominant organisms isolated from these patients were anaerobes and streptococci . No cases occurred secondary to otitis media . The overall mortality rate was 9%; however, 55% of patients had neurological deficiency at the time they were discharged from the hospital . Factors that affected survival were age (P < .007) and level of consciousness at presentation (P < .008).

J Dairy Res, 1995 Feb, 62(1), 51 - 60
Staphylococci in heifer mastitis before and after parturition; Myllys V; Aseptic udder quarter secretion samples (n = 1112) from 200 mastitic and 65 non-mastitic control heifers from 160 different farms were collected for bacteriological examination and in vitro antimicrobial susceptibility testing . Coagulase-negative staphylococci (CNS) were the most frequently isolated bacteria (57.8%) . The percentage of Staphylococcus aureus was 20.1, of streptococci 11.3 and of other pathogens 10.8 . Staph . simulans, Staph . hyicus, Staph . xylosus and Staph . chromogenes were the most common CNS . Staph . simulans and Staph . hyicus were most frequently found in clinical samples after parturition, whereas other CNS were equally or more often found in control samples . Most CNS infections detected in the prepartum period were eliminated spontaneously or with antibiotic treatment during early lactation, but the infected quarters were more susceptible to new infection by other pathogens . Milk N-acetyl-beta-glucosaminidase activities were measured to monitor changes in inflammation . Among the CNS infections, N-acetyl-beta-glucosaminidase activities were highest for Staph . hyicus and lowest for Staph . xylosus in the lactating mammary gland of heifers . CNS were resistant to trimethoprim-sulphonamide, ampicillin and erythromycin . Staph . aureus was more resistant than CNS to beta-lactamase-sensitive penicillins.

J Dairy Res, 1995 Feb, 62(1), 39 - 50
Patterns of intramammary infection and clinical mastitis over a 5 year period in a closely monitored herd applying mastitis control measures; Hillerton JE et al.; The udder health of a research herd of between 160 and 220 Friesian cows run on a commercial basis has been monitored closely, including detailed bacteriological study, over 5 years . The five point mastitis control plan had been in use for several years prior to this study and was continued with minor alterations to the management of the plan, more detailed bacteriological monitoring and increased encouragement to apply it . It has proved possible to make a substantial improvement in the udder health of the herd . The percentage of infected cows fell from 21.9 to 12.0 and the percentage of infected quarters from 7.3 to 3.3 . The main benefit has been a drastic reduction in the rate of clinical and subclinical mastitis caused by coagulase-positive staphylococci . However the total incidence of clinical mastitis did not change substantially, averaging around 30 cases/100 cows per year . This was largely because environmental mastitis organisms were responsible for 65% of all clinical cases . The results showed marked differences in the patterns of infection due to the environmental mastitis pathogens, Gram-negative bacteria and aesculin-hydrolysing streptococci, suggesting different mechanisms of invasion of the gland.

Indian J Med Res, 1995 Feb, 101, 64 - 5
Long-term preservation of streptococci; Brahmadathan KN et al.; Strains of 12 T types of group A streptococci preserved by sand desiccation and stored at 4 degrees to 10 degrees C were regularly sub-cultured to check their viability . For this, streptococci coated onto sand particles mixed with sterile sheep blood were inoculated into Todd-Hewitt broth with added blood and incubated for 24 to 48 h . Checking for viability every six months showed that group A streptococci could be preserved by this method for 21 yr . Our study shows that sand desiccation is a convenient and cheap method for the long-term preservation of streptococci in laboratories where other methods of preservation are not feasible on a regular basis.

Curr Opin Pediatr, 1995 Feb, 7(1), 13 - 8
Neonatal group B streptococcal infections; Boyer KM; Group B streptococci remain a leading cause of life-threatening neonatal infection worldwide . The current estimate of incidence in the United States is 1.8 cases per 1000 live births, with a case-fatality ratio of 10% to 20% . Advances in understanding of the pathogenesis of septic shock and meningitis are yielding new approaches to the treatment of these serious infections . Selective intrapartum chemoprophylaxis with ampicillin has been shown to be both effective and cost effective and is gaining more widespread acceptance as a preventive measure . Conjugate vaccines consisting of type-specific group B streptococci capsular polysaccharides coupled to tetanus toxoid or protein membrane antigens of group B streptococci have been shown to prevent neonatal infection in a mouse model of maternal immunization . Such vaccines are now in trials of safety and immunogenicity in humans.

J Dent Res, 1995 Feb, 74(2), 681 - 5
The fidelity of initial acquisition of mutans streptococci by infants from their mothers; Li Y et al.; Previous cross-sectional studies using bacteriocin profiles, serotyping, or genotyping suggest that mothers are the principle source of mutans streptococci (MS) to their infants . This study determined the commonality of MS genotypes between mothers and their infants at the time of initial acquisition . Oral bacteria of mothers and their infants were monitored from birth for approximately 3 years at three-month intervals . Genotypes of MS in infants appeared identical to those present in mothers in approximately 71% of 34 mother-infant pairs studied . Interestingly, female infants acquired MS genotypes identical to their mothers' with significantly greater fidelity than male infants (88% vs . 53%) . Homology of genotypes between mothers and their infants at initial acquisition strongly suggests that MS strains were transmitted from mother to infant and that this transfer exhibited gender specificity . In no instance did we observe homology of genotypes between fathers and infants or fathers and mothers, further supporting the notion that acquisition of MS in humans follows maternal lines . Although the prevalence of dental caries was low in this young child population (11/34; 32%), we observed that male children who harbored the same genotype as their mothers had a 13 times greater likelihood of having caries than female children who acquired their mothers' strain; this difference was statistically significant (p < 0.01) . Although we do not know the biological mechanisms governing fidelity of acquisition between a mother and her infant, our data suggest that caries outcome may be, in part, determined by both the source of MS and the presence of a specific genotype of MS.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Microbiol, 1995 Feb, 33(2), 356 - 63
M or M-like protein gene polymorphisms in human group G streptococci; Schnitzler N et al.; Many group G streptococci (GGS) isolated from infected humans (but not from animal sources) express M or M-like proteins with biological, immunochemical, and genetic features similar to those of group A streptococci (GAS) . To further elucidate the recently proposed M-like protein gene (emmL gene) polymorphisms in GGS, Southern blots of genomic DNAs from 38 epidemiologically unrelated GGS strains isolated from human specimens and 12 GGS strains recovered from animal sources were hybridized with oligonucleotide probes designed to specifically detect GAS M class I and M class II M protein (emm) genes . All human-associated GGS strains showed DNA homology to the GAS M class I emm gene probe, whereas no hybridization was found with DNA from any of the animal-associated strains . The emmL genes from all human isolates were amplified by PCR, and the complete sequence of the emmL gene of the Rebecca Lancefield grouping strain D166B was determined . Again, this gene exhibited the structural features typical for emm genes of M class I GAS . The 5' regions of the PCR-amplified emmL genes of the remaining 37 human GGS strains were sequenced . This region showed a sequence diversity similar to that known for GAS emm genes . When strains whose N-terminal emmL gene sequences showed a homology of > 95% were defined as belonging to one genetic type, 30 strains were segregated into six distinct genetic types, whereas the remaining 8 strains each exhibited a unique emmL gene sequence . A high degree of homology between the N-terminal emmL gene segments of six GGS strains and the corresponding regions of either the emm12 or the emm57 gene of GAS was found, suggesting a horizontal gene transfer between strains of these species of beta-hemolytic streptococci . Besides a further understanding of the evolution of GGS emmL genes, the observed emmL gene polymorphisms in GGS could provide the basis for a molecular subspecies delineation of strains and offers the potential of typing GGS for epidemiological purposes.

Aust Dent J, 1995 Feb, 40(1), 36 - 8
Endodontic cellulitis 'flare-up' . Case report; Matusow RJ; Endodontic cellulitis involves facial swelling which can vary from mild to severe and can occur as a primary case or a flare-up following initial treatment of asymptomatic teeth with periapical lesions . The microbial spectrum in primary cases involves a significant mixture of anaerobic and facultative aerobic microbes, chiefly streptococci . In a previous study, cultures from flare-up cases, utilizing the same anaerobic techniques as in primary cases, revealed an absence of obligate anaerobes and an 80 per cent incidence of facultative aerobic streptococci . These cases also revealed a significant time lapse from onset of symptoms to the cellulitis phase . No sex or age factors were noted in the primary or flare-up cases . The purpose of this case report is to restate a traditional theory, namely, the alteration of the oxidation/reduction potential (Eh), as a major factor for endodontic cellulitis flare-ups; to confirm the pathogenic potential of oral facultative streptococci; and that asymptomatic endodontic lesions tend to exist with mixed aerobic/anaerobic microbial flora.

Oral Microbiol Immunol, 1995 Feb, 10(1), 26 - 34
Intrafamilial similarity in immunoblot profiles of salivary immunoglobulin A antibody activity to oral streptococci; Widerstrom L et al.; Analysis of the salivary immunoglobulin A (IgA) antibody activity to antigens separated from oral streptococci was carried out on 49 individuals in 11 families . The aim of this study were to i) study the human salivary IgA activity within families to antigens separated from reference strains of Streptococcus mutans, Streptococcus sobrinus and Streptococcus parasanguis and ii) to search for potential differences in the salivary IgA activity to the streptococcal antigens several years apart . The immunoblot revealed similarity in saliva IgA response within the families . A majority of the bands, approximately 7 (median) for each extract was found in both child and parent . A few bands (approximately 3) were found in parents but not in children . Only one to two bands were found in children's saliva without a corresponding band in any of the parents . The antibody activity of saliva samples obtained several years apart was essentially unchanged, especially considering the total number of bands . Differences in the relative intensity of the bands could be seen, and a few bands appeared only in some immunoblots for a specific subject . For 3 of 4 children participating in the longitudinal study, more bands against mutans streptococci appeared with age.

Oral Microbiol Immunol, 1995 Feb, 10(1), 19 - 25
Clonal diversity of the Streptococcus mitis biovar 1 population in the human oral cavity and pharynx; Hohwy J et al.; A total of 250 isolates of oral streptococci were recovered from swabs of oropharyngeal surfaces of 3 members of one family . All isolates were examined by biochemical and serological means, and 106 isolates were identified as Streptococcus mitis biovar 1 . These were typed by restriction endonuclease analysis using the enzymes EcoRI and HaeIII and further characterized by their whole-cell polypeptide profile patterns in sodium dodecyl sulfate-polyacrylamide gel electrophoresis . In addition, rabbit antisera raised against 8 reference strains of oral streptococci were used to characterize representative isolates both by their carbohydrate and protein antigens by Ouchterlony and Western blot analyses . Very limited biochemical diversity was observed among the 106 S . mitis biovar 1 isolates . In contrast, 24 different genotypes defined by restriction endonuclease analysis were detected, and each individual carried 6-13 types . Limited sharing of genotypes was observed between the 3 members of the same family and between the pharyngeal and buccal mucosa of single individuals . The antigenic analyses showed remarkable antigenic diversity between the 24 genotypes . The results provide a basis for studying the population dynamics of an oral commensal species and its interaction with the salivary immune system.

Comp Immunol Microbiol Infect Dis, 1995 Feb, 18(2), 137 - 44
Patterns of prostaglandin E2 and leukotriene B4 production in inflammation induced by peptidoglycan-polysaccharide polymers of bacterial cell walls; Yoshino S; The changing levels of prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) were compared over a period of 1 h to 15 days in two kinds of inflammatory responses induced in the rat air pouch by chemically similar polymers of peptidoglycan-polysaccharide (PG-PS) isolated from cell walls of group A streptococci . The smaller polymers (100 s, average mol . wt 5.3 x 10(6)) induced a more severe acute response over the first 24 h, whereas, from 3 to 15 days the larger polymers (10 p, average mol . wt 5 x 10(8)) induced greater chronic inflammation, as measured by pouch fluid volume, number of infiltrating cells and weight of granulation tissue . The most prominent difference between the two kinds of responses in the pattern of PGE2 and LTB4 were: (a) A shift between 1 to 6 h to much higher production of PGE2 in the exudate induced by large polymers . During this time the level of LTB4 also increased, but continued to be higher in the exudate induced by small polymers . (b) The sustained production of relatively high levels of LTB4 and PGE2 in the large polymer exudate at 15 days . Changes such as these indicate that this model is useful for analyzing mediators which regulate the evolution of acute into chronic inflammation.

Int Dent J, 1995 Feb, 45(1 Suppl 1), 77 - 92
Xylitol: a review of its action on mutans streptococci and dental plaque--its clinical significance; Trahan L; Many mechanisms have been proposed to explain the caries preventive effect of xylitol as a total or partial dietary sugar substitute . This article reviews the current knowledge of the effect of xylitol on the microbial population of dental plaque, particularly on mutans streptococci, in the light of an ecological concept of the oral environment and of the potential clinical significance . A noncariogenic commensal plaque flora constitutes the biotic component of a balanced ecosystem compatible with dental health . Dietary sugars, particularly sucrose, and sugar substitutes are abiotic environmental factors that can shift the delicate balance of the ecosystem towards a more or less cariogenic microbiota . Most dietary sugars are fermented by plaque microorganisms, favour the establishment of a cariogenic microflora and contribute to bacterial virulence . The vast majority of plaque bacteria, however, are incapable of fermenting xylitol into cariogenic acid end-products . There is no evidence that the plaque microbiota can adapt to metabolise xylitol or can be enriched with xylitol-metabolising cells even after long exposure to xylitol . Accumulated intracellularly as a non-metabolisable metabolite by mutans streptococci, xylitol inhibits its growth in vitro and reduces the amount of plaque and the number of mutans streptococci in both the plaque and saliva of xylitol consumers . When present in the oral environment xylitol not only prevents a shift of the bacterial community towards a more cariogenic microflora but also selects for a mutants population that was shown to have weakened virulence factors in preliminary in vitro experiments and in rats . Further research is needed to fully understand the clinical importance in the prevention of caries of this xylitol-selected population.

Int Dent J, 1995 Feb, 45(1 Suppl 1), 65 - 76
Xylitol chewing gum and dental caries; Tanzer JM; There is an extensive peer-reviewed literature on xylitol chewing gum as it pertains to effects on tooth decay in human subjects, on human dental plaque reduction, on inhibition of dental plaque acid production, on inhibition of the growth and metabolism of the mutans group of streptococci which are the prime causative agents of tooth decay, on reduction of tooth decay in experimental animals, and on xylitol's reported contribution to the remineralisation of teeth . The literature not only supports the conclusion that xylitol is non-cariogenic but it is now strongly suggestive that xylitol is caries inhibitory, that is, anti-cariogenic in human subjects, and it supplies reasonable mechanistic explanation(s).

Eur J Oral Sci, 1995 Feb, 103(1), 61 - 2
A simple method for monitoring mutans streptococci in young children; Pienihakkinen K et al.; The study assessed the practicability of the Dentocult-SM STRIP MUTANS test in children, using dental floss to transfer the dental plaque to the strip . The subjects were children of 2-3 yr (n = 365) and 5-6 yr (n = 398) . The mutans streptococci count on the strip was found to be a good indicator of infection and was surprisingly accurate in the prediction of the 3-yr caries increment.

Eur J Oral Sci, 1995 Feb, 103(1), 36 - 41
The toothpick method in relation to other plaque sampling techniques for evaluating mutans streptococci; Wennerholm K et al.; The aim of the present study was to compare the use of toothpicks with other sampling methods for determination of mutans streptococci on different tooth surfaces . In nine persons with > 10(5) CFU per ml saliva of mutans streptococci, plaque samples were taken from 90 buccal and lingual surfaces, 108 occlusal surfaces and 90 approximal surfaces with toothpicks . The prevalence of mutans streptococci on these tooth surfaces was compared with samples taken at four 1-week intervals on the same tooth surfaces with a carver (buccal/lingual surfaces), a needle (occlusal surfaces) or a dental floss (approximal surfaces) . Each sample was plated on MSB agar and the presence of mutans streptococci was expressed on a scale varying from 0 to 4 . On two of the sampling occasions the amount of plaque, mirrored by total viable counts on blood agar, was also determined . Only for buccal/lingual plaque samples was a difference in total counts between methods noted and then with higher total recoveries obtained after sampling with toothpicks . More surfaces were found to be positive for mutans streptococci when samples were taken with a toothpick than with a carver, needle or floss . On surfaces positive for mutans streptococci the colonization score was higher in samples taken with a toothpick than with a carver or a needle while samples taken with a floss showed a tendency to higher levels of mutans streptococci than samples collected with a toothpick . The data indicate that the results indicate that the results obtained by using toothpicks for evaluating the prevalence of mutans streptococci on individual tooth surfaces compare favorably with the other methods tested.

J Biol Chem, 1995 Jan 6, 270(1), 347 - 53
Isolation and characterization of a novel collagen-binding protein from Streptococcus pyogenes strain 6414; Visai L et al.; In this report we have analyzed the binding of collagen to Streptococcus pyogenes strain 6414 . This binding was rapid, specific, and involved a limited number of receptor molecules (11,600 copies per cell) . When the proteins in a streptococcal lysate were blotted onto a nitrocellulose filter and probed with 125I-labeled collagen, a prominent collagen-binding protein of 57 kDa was identified as well as minor 130-150-kDa components . The major 57-kDa protein was isolated by affinity chromatography on collagen-Sepharose followed by gel filtration chromatography . The 57-kDa protein purified from S . pyogenes was used to raise a monospecific antibody which also reacted with a collagen-binding protein of similar molecular size isolated from Streptococcus zooepidemicus . The two collagen-binding proteins from streptococci have a similar amino acid composition and isoelectric points . Isolated collagen-binding protein was specifically recognized by 125I-collagen in a solid-phase binding assay and displayed an affinity for the ligand quite similar to that exhibited by intact bacteria (Kd = 3.1 versus 3.5 x 10(-9) M, respectively) . Surface-labeled bacteria attached to microtiter wells coated with different collagen types and the 57-kDa protein blocked the adhesion to collagen substrate . We propose that the 57-kDa protein is an adhesin involved in the attachment of streptococci to host tissues.

Biol Neonate, 1995, 68(5), 342 - 353
Cardiopulmonary effects of tumor necrosis factor-alpha in the piglet: influence of cyclooxygenase inhibition; Osiovich H et al.; Tumor necrosis factor-alpha (TNF) is believed to play an important role in mediating many of the pathophysiologic changes accompanying bacterial sepsis . In order to characterize the cardiopulmonary responses to TNF in a young animal model and to determine to what extent these changes were secondary to cyclooxygenase byproducts, three groups of mechanically ventilated piglets received an infusion of either TNF, indomethacin followed by TNF (Indo+TNF) or neither (control) . Compared to controls at 120 min, TNF resulted in the following changes beginning 30-60 min after the infusion began: mean pulmonary artery pressure (Ppa) increased from 1.7 +/- 0.3 to 4.4 +/- 0.7 kPa (13 +/- 2 to 33 +/- 5 mm Hg) (p < 0.001); cardiac output (CO) fell from 0.28 +/- 0.05 to 0.20 +/- 0.07 liters/kg/min (p < 0.01); mean arterial blood pressure (Psa) decreased from 9.5 +/- 1.2 to 7.9 +/- 1.9 kPa (71 +/- 9 to 59 +/- 14 mm Hg) as did pH from 7.49 +/- 0.04 to 7.13 +/- 0.17 (p < 0.001) . Dynamic lung compliance (Cdyn) also decreased; however, pulmonary resistance (RI) remained unchanged . Thromboxane B2 (TxB2) rose in all animals at 60 min coincident with Psa elevation and was significantly blocked by Indo (p < 0.03) . In the Indo+TNF group the early TNF-induced rise in Psa was blunted compared to the TNF group {2.9 +/- 1.2 vs . 3.6 +/- 0.8 kPa (22 +/- 3 vs . 27 +/- 6 mm Hg; p < 0.04)} as were the late decreases in pH and Psa (p < 0.04) . There were no significant changes in Cdyn secondary to Indo . Although delayed, the hemodynamic changes observed with TNF infusion are similar to those reported for piglets receiving group B streptococci; however, in contrast to the latter the early changes secondary to TNF are only mildly effected by indomethacin . The significant improvement in the late occurring hypotension and acidosis suggests that TNF may act in part via the cyclooxygenase pathway as a mediator of the late hypotension associated with sepsis.

Autoimmunity, 1995, 22(2), 95 - 106
Immunological mimicry between retinal S-antigen and group A streptococcal M proteins; Lerner MP et al.; Immunological mimicry between host and microbial proteins has been suggested as a potential mechanism in the development of uveitis in humans . In this study immunological crossreactivity between anti-streptococcal monoclonal antibodies (MAbs) and the human eye was investigated . In indirect immunofluorescence, we demonstrated novel immunological crossreactivity of two anti-streptococcal MAbs (27 and 112) with the rod outer (and inner) segments of the retina of the human eye . In further studies, retinal S-Ag, a uveitogenic protein in the rod outer (and inner) segments, was found to react with the anti-streptococcal MAbs . In addition, several uveitogenic peptides of S-Ag were recognized by the anti-streptococcal MAbs . In the ELISA and Western immunoblot, anti-S-Ag MAbs crossreacted with group A streptococci and the streptococcal M protein further demonstrating sites of antigenic similarity . Homology between the retinal S-Ag and streptococcal M protein was observed in amino acid sequences repeated in the B repeat region of the streptococcal M5 protein . These data show that retinal S-antigen has immunological similarities with streptococcal M protein, a major virulence determinant and strong bacterial cell surface antigen.

Stomatologiia (Mosk), 1995, 74(6), 32 - 4
{Bacterial activity in the products of laser destruction of human dental enamel and dentin}; Belikov AV et al.; Viability of Streptococci, Staphylococci, and Bacillus subtilis in products of destruction of hard dental tissues of man by submillisecond pulses emmitted by erbium lasers YAG:Er and YSGG:Cr,Er was investigated . Bacterial viability was found to depend on the energy density and duration of laser exposure . Possible mechanisms of bacterial destruction by pulses of submillisecond duration emmitted by erbium laser are discussed.

Microbiol Immunol, 1995, 39(11), 853 - 60
Sequence analysis of the Streptococcus mutans Ingbritt dexA gene encoding extracellular dextranase; Igarashi T et al.; The complete nucleotide sequence (3,747 bp) of the dextranase gene (dexA) and flanking regions of the chromosome of Streptococcus mutans Ingbritt (serotype c) were determined . The open reading frame for dexA was 2,550 bp, ending with a stop codon TGA . A putative ribosome-binding site, promoter preceding the start codon, and potential stem-loop structure were identified . The presumed dextranase protein (DexA) consisting of 850 amino acids was estimated to have a molecular size of 94,536 Da and a pI of 4.79 . The nucleotide sequence and the deduced amino acid sequences of S . mutans dexA exhibited homologies of 57.8% and 47.0%, respectively, to those of Streptococcus sobrinus dex . The homologous region of dex of S . sobrinus was in the N-terminal half . The C terminus of DexA consisted of a hexapeptide LPQTGD, followed by 7 charged amino acids, 21 amino acids with a strongly hydrophobic character, and a charged hexapeptide tail, which have been reported as a common structure of C termini of not only the surface-associated proteins of Gram-positive cocci but also the extracellular enzymes such as beta-fructosidase of S . mutans and dextranase of S . sobrinus . The DexA protein had no significant homology with the glucosyltransferases, the glucan-binding protein, or the dextranase inhibitor of mutans streptococci.

Ann Med Interne (Paris), 1995, 146(6), 413 - 8
{Neurologic complications of infectious endocarditis}; Gergaud JM et al.; Ten patients with neurological complications (NC) among a retrospective series of 53 consecutive cases of infective endocarditis were studied: 6 males and 4 females, mean age 60 years . NC were present at admission in 6 cases: 2 generalized seizures, 4 strokes, associated with 2 meningeal syndromes . Four cases of NC occurred during hospitalization: 1 stroke with come, 1 transient ischaemic attack, 2 generalized seizures . Blood cultures were positive in 7 cases: 6 group D Streptococci, 1 Gram negative bacillus . Five digestive portal of entry were identified . Cerebrospinal fluid was purulent in 1 patient, aseptic in 1, haemorragic in 2, and normal in 1 . Cranial computed tomography revealed: infarct in 4 cases, brain abscess in 1 case, absence of abnormality in 1 case . There was no angiographic documentation . Antimicrobial therapy was maintained 5 to 6 weeks . Two patients underwent cardiac surgery . Two patients died of subarachnoid haemorrage . Comparison of patients with NC, and the 43 without NC, revealed two different point: vegetations were more frequent in the NC (8 cases out of 10) than without NC (19 cases out of 43) (p = 0.04) . Streptoccus was often more found in NC (6 cases out of 6) than without NC (6 cases out of 24) (p < 0.01) . Compared with the previously reported studies, where Staphylococcus was usually described, our results showed a higher frequency of Streptococcus D bovis, an older age, a higher frequency of stroke and digestive portal of entry . Vegetations were more frequent with NC than without.

Dev Biol Stand, 1995, 85, 333 - 41
Lipoprotein receptors in oral streptococci; Jenkinson HF et al.; Streptococcus gordonii produces cell-surface lipopolypeptides that have been implicated in the determination of cell adherence and aggregation properties . SarA lipopolypeptide produced by S . gordonii is highly similar to the oligopeptide-binding protein AmiA in Streptococcus pneumoniae and to the OppA and SpoOKA oligopeptide-binding proteins in Bacillus subtilis . Insertional mutagenesis was used to inactivate the genes encoding SarA (76kDa) lipoprotein and a related 78-kDa lipoprotein denoted SarG . SarA- mutants were defective in serum-induced aggregation, competence, growth on complex nitrogen sources, and ability to colonize the oral cavity . Conversely, SarG- mutants were unaltered in the above properties, but were deficient in growth on simple nitrogen sources . It is proposed that SarA plays a central role in environmental sensing of extracellular factors by streptococci leading to modulation of cell-surface composition and growth responses of cells.

Caries Res, 1995, 29(6), 455 - 60
Evaluation of the in vitro cariogenic potential of Streptococcus mutans strains isolated from 12-year-old children with differing caries experience; Chestnutt IG et al.; The limited usefulness of caries activity tests based solely on counts of mutans streptococci has been recognised increasingly . Such tests do not account for potential differences in cariogenicity of Streptococcus mutans strains harboured by individual patients . Hence, this study describes the evaluation of a simple and inexpensive method involving the dissolution of powdered hydroxyapatite as a means of determining the cariogenic potential of 64 freshly isolated strains of S . mutans from 24 children . Whilst it is apparent that differences between strains isolated from individuals could be demonstrated using this test, the variability observed was such that it was not possible to relate in vitro cariogenicity to actual clinical caries experience.

Drugs, 1995, 49 Suppl 2, 58 - 66
Activity of quinolones against gram-positive cocci: clinical features; Giamarellou H; The potential role of the commercially available fluoroquinolones in the treatment of Gram-positive infections is discussed on the basis of data obtained from animal experiments and clinical trials . In respiratory tract infections, and particularly in community-acquired pneumonia, it is evident that the presently available quinolones cannot be prescribed empirically as first-line therapy because of their borderline activity against Streptococcus pneumoniae and anaerobes . Reports of pneumococcal seeding in other tissues during quinolone therapy render their administration a debatable issue . Experience in endocarditis is limited to the use of ciprofloxacin plus rifampicin in intravenous drug users with right-sided Staphylococcus aureus endocarditis . Patients with staphylococcal osteomyelitis are included among cases of other bone infections . In noncontrolled studies ciprofloxacin, ofloxacin and pefloxacin attained a staphylococcal eradication rate ranging from 70 to 100%, while the addition of rifampicin has been proven to reduce the emergence of resistant mutants during therapy . In soft tissue and skin structure infections that also involve Gram-negative bacteria, ciprofloxacin and ofloxacin eradicated 72.6 and 89% of staphylococci, respectively; however, the presence of diabetes or vascular disease compromised the success of treatment . In staphylococcal peritonitis complicating continuous ambulatory peritoneal dialysis, results with ciprofloxacin given intravenously or intraperitoneally were promising . In infections in neutropenic hosts, success of prophylaxis or therapy is still not clear, since colonisation and breakthrough bacteraemias with viridans streptococci and staphylococci have been reported . Furthermore, therapeutic results are compromised by the low response rate in Gram-positive infections . Despite the reported clinical efficacy of the newer fluoroquinolones, physicians should be alerted to the emergence of staphylococci resistant to fluoroquinolones, mainly methicillin-resistant variants.

Drugs, 1995, 49 Suppl 2, 139 - 43
The use of quinolones as therapy in granulocytopenic cancer patients . Comparison with other antimicrobials; Krcmery V Jr; Quinolones are valuable antimicrobial agents for prevention and therapy of febrile neutropenia . However, as with other groups of antibacterials, there are limitations to the use of quinolones in immunocompromised hosts: they should not be used in those neutropenic patients receiving ciprofloxacin or ofloxacin for prophylaxis, because of the risk of infection with resistant Gram-negative, or less susceptible Gram-positive, organisms . There are also insufficient data to support monotherapy of febrile neutropenia with quinolones, although some studies using higher ciprofloxacin dosages have reported encouraging results . More data on this issue, including use in paediatric cancer patients, are required . Quinolones are indicated for empirical therapy in combination with agents active against Gram-positive organisms, such as broad spectrum penicillins with or without beta-lactamase inhibitors, or in combination with vancomycin or teicoplanin . Some studies have shown that a combination of cefotaxime or ceftriaxone may provide better coverage against streptococci, but there are insufficient data on the combination of quinolones with third generation cephalosporins . A specific group of patients with low risk mild to moderate neutropenia with solid tumours may benefit from oral therapy with quinolones in combination with either an aminopenicillin with a beta-lactamase inhibitor or clindamycin . After 10 years of quinolone use in febrile neutropenia, these agents can still be regarded as valuable drugs of choice; however, the incidence of resistance among staphylococci and Pseudomonas spp., especially in centres using quinolones as prophylaxis, is increasing.

Scand J Infect Dis, 1995, 27(3), 221 - 8
Is penicillin the appropriate treatment for recurrent tonsillopharyngitis? Results from a comparative randomized blind study of cefuroxime axetil and phenoxymethylpenicillin in children . The Swedish Study Group; Holm S et al.; The efficacy of cefuroxime axetil compared with phenoxymethylpenicillin (PcV) was studied in group A beta-haemolytic streptococci (GAS) culture-proven tonsillitis in children aged 3-12 years with a history of at least 1 episode of tonsillopharyngitis requiring antibiotic therapy during the previous 3 months . This was a comparative, randomized, investigator-blind, multicentre study . A total of 236 children received either cefuroxime axetil suspension or PcV syrup . Inclusion criteria were a positive, rapid, group A strep test verified by bacteriological culture and clinical signs and symptoms of tonsillopharyngitis . Cefuroxime axetil treatment gave a significantly higher bacteriological eradication rate and clinical cure rate than PcV . At day 2-5 post treatment the eradication rates were 99/114 (87%) for cefuroxime axetil vs 61/109 (56%) for PcV (p < 0.001) . The clinical cure rates were 98/114 (86%) and 73/109 (67%) respectively (p < 0.01) . Up to 21-28 days post-treatment, 9/114 (8%) cefuroxime axetil patients and 37/109 (34%) PcV patients were treatment failures or had recurrence/reinfection of GAS tonsillopharyngitis (p < 0.001) . More than 90% of the patients who experienced bacteriological treatment failure at either the first or second follow-up had the same serotype isolated pre- and post-treatment . During the study period, 21/114 (18%) patients in the cefuroxime axetil group and 50/109 (46%) patients in the PcV group received additional antibiotics (p < 0.001) . No serious adverse events were noted and the mild adverse events were equally distributed among the patients in the 2 study groups: 15% for cefuroxime axetil and 14% for PcV.

Caries Res, 1995, 29(5), 396 - 401
Sucrose retention and colonization by mutans streptococci at different sites of the dentition; Wennerholm K et al.; The correlations between the retention and elimination of sucrose at different oral sites and the colonization by mutans streptococci at the same sites were tested in 10 subjects with > 10(5) mutans streptococci per millilitre of saliva . Paraffin-stimulated saliva was collected and plaque samples were taken with a toothpick from all the buccal surfaces except the third molars . One week after the plaque sampling, the sucrose clearance was determined . After a mouth rinse with 10 ml of a 10% sucrose solution, pre-weighed filter paper discs were placed at representative buccal sites of the interdental papilla between molars, premolars and incisors in the upper and lower jaw . The samples were collected 0.5, 2.5, 5.5, 8.5 and 12.5 min after rinsing . Analysis of the sucrose concentration was made using an enzymatic method . The oral sugar clearance was slower in the anterior region of the upper jaw than in the posterior regions and in the central region of the lower jaw . The frequency of mutans streptococci decreased towards the anterior teeth, with Streptococcus sobrinus predominating over Streptococcus mutans . A negative correlation was observed in the upper jaw between sugar clearance and retention and the prevalence of mutans streptococci, whereas the opposite tendency was observed in the lower jaw.

Caries Res, 1995, 29(5), 343 - 8
Prediction of dental caries development in 1-year-old children; Grindefjord M et al.; Dietary habits, oral hygiene, fluoride exposure and occurrence of mutans streptococci were studied in 1-year-old children (n = 786) as well as the socio-economic and immigrant background of their parents . The purpose was to evaluate the predictive ability of variables studied in 1-year-old children that could be used to identify children at risk for early caries development . In a multivariate logistic regression analysis, the variables significantly associated with caries at 3.5 years of age were immigrant background (p < 0.001), mother's education (p < 0.001), consumption of sugar-containing beverages (p < 0.001), mutans streptococci (p < 0.05) and candy (p < 0.05) . The probability of caries development was 87% when all the variables associated with caries were present at 1 year of age . The relative risk (odds ratio) of those children to develop manifest caries at 3.5 years of age was estimated to be 32 times higher than in the children where corresponding risk factors were not present . The results indicate that prediction at 1 year of age, built on risk factors associated with dental caries, can provide an indication of possible preventive interventions.

Caries Res, 1995, 29(1), 62 - 7
Comparison of the efficacy of 40% chlorhexidine varnish and 1% chlorhexidine-fluoride gel in decreasing the level of salivary mutans streptococci; Pienihakkinen K et al.; The aim of the study was to compare the efficacy of a 40% chlorhexidine (CHX) varnish (EC40, Certichem, Nijmegen, The Netherlands) with a 1% CHX-0.2% NaF gel in decreasing the level of salivary mutans streptococci (MS) . The subjects were screened for a high level of MS using a Dentocult-SM strip method (Orion Diagnostica, Finland) . In varnish groups with fluoride (VCHXF, n = 20) and without fluoride (VCHX, n = 19), the CHX varnish was applied on dry teeth using an ampoule and an anesthetic syringe with blunt needle, and removed after 15 min . In group VCHXF an additional 2.26% fluoride varnish (Duraphat, Woelm Pharma GmbH, Eschwege, Germany) was applied . The CHX-NaF gel treatment included the application of the gel with rubber cups and dental tape for 5 min on three occasions during a week in group GCHXF (n = 21) . The level of MS (MSB agar) was significantly lower after 4 weeks than at baseline in VCHX (p < 0.001) and VCHXF (p < 0.05), but not after 12 weeks . In GCHXF a significant decrease (p = 0.001) was observed after 4 weeks only with the strip method . In VCHX and VCHXF the strip values for MS were still reduced after 12 weeks . In VCHX and GCHXF a small, although statistically significant, increase was observed in the total number of microorganisms after 4 and 12 weeks . Opinions on taste sensations associated with the treatments were generally negative, but least negative in the VCHXF group; fewer side effects were also reported in the VCHXF group.(ABSTRACT TRUNCATED AT 250 WORDS)

Caries Res, 1995, 29(1), 54 - 61
Effects of sugar restriction on Streptococcus mutans and Streptococcus sobrinus in saliva and dental plaque; Wennerholm K et al.; The effect of sugar restriction on the oral levels of mutans streptococci was studied in 20 subjects fulfilling three criteria: (1) having more than 300,000 CFU mutans streptococci/ml saliva, (2) harbouring both Streptococcus mutans and Streptococcus sobrinus in saliva, and (3) eating sugar frequently . The subjects were randomly divided into a test group (n = 12), who were asked to refrain from using sugar-containing foods between meals and to reduce sugar in main meals for 6 weeks, and a control group (n = 8), who did not receive any dietary advice . Saliva and plaque samples were collected at baseline and at 3, 6 and 12 weeks . The results showed that the levels of S . mutans and S . sobrinus decreased in saliva and plaque during the 6-week sugar restriction period . The decrese in mutans streptococci was more pronounced on buccal than on approximal tooth surfaces . Both species seemed to react in a similar way to the sugar restriction in saliva as well as in dental plaque . At the follow-up examination at 12 weeks, i.e . 6 weeks after completing the sugar restriction period, the numbers of S . mutans and S . sobrinus had increased again, but were still lower when compared to the baseline values.

Arch Dermatol, 1995 Jan, 131(1), 73 - 7
Streptococcal toxic shock-like syndrome; Wolf JE et al.; BACKGROUND: After decades marked by a decrease in the incidence and severity of scarlet fever and streptococcal soft-tissue infections, invasive infections with group A streptococci have reemerged as a global public health problem . Sporadic outbreaks of a rapidly progressive disorder characterized by fever, shock, desquamating rash, and multiorgan system failure often associated with severe suppurative soft-tissue infection have recently been recognized in young, otherwise-healthy adults . Referred to as streptococcal toxic shock-like syndrome, this acute, progressive, often fatal illness appears to be related to an overall change in the virulence of group A streptococci and the reappearance of highly mucoid exotoxin-producing strains . However, the relationship between virulence factors, epidemiological features, and precise pathogenesis of these infections remains unclear . OBSERVATIONS: The 80% incidence of soft-tissue involvement in streptococcal toxic shock-like syndrome and the high frequency of progression to necrotizing fasciitis, myositis, or even death are unprecedented . The type and extent of tissue injury, systemic toxicity, and multiorgan system failure associated with this syndrome appear to be mediated by streptococcal pyrogenic exotoxins via the induction of biologically potent endogenous cytokines . The observed increase in the incidence and severity of invasive group A streptococcal infections coincides with the resurgence of genetically related, highly virulent strains of Staphylococcus pyogenes that express an invasive phenotype and carry a specific gene for pyrogenic exotoxin A . CONCLUSIONS: The changing spectrum of invasive group A streptococcal infections has prompted a reexamination of the microorganism and its diverse clinical manifestations . A clonal basis for increased virulence expression is supported epidemiologically . As the incidence of streptococcal toxic shock-like syndrome appears to be increasing, it is imperative that clinicians become familiar with the presentation of this syndrome so they can diagnose and treat it in a timely and effective manner.

Infect Immun, 1995 Jan, 63(1), 9 - 20
The group A streptococcal virR49 gene controls expression of four structural vir regulon genes; Podbielski A et al.; Within a genomic locus termed the vir regulon, virR genes of opacity factor-nonproducing (OF-) group A streptococci (GAS) are known to control the expression of the genes encoding M protein (emm) and C5a peptidase (scpA) and of virR itself . Within the corresponding genomic locus, opacity factor-producing (OF+) GAS harbor additional emm-related genes encoding immunoglobulin G- and immunoglobulin A-binding proteins (fcrA and enn, respectively) . The virR gene region of the OF+ GAS M-type 49 strain CS101 was amplified by PCR, and 2,650 bp were directly sequenced . An open reading frame of 1,599 bp exhibited 76% overall homology to published virR sequences . By utilizing mRNA analysis, the 5' ends of two specific transcripts were mapped 370 and 174 bp upstream of the start codon of this open reading frame . The deduced sequences of the corresponding promoters and their locations differed from those of previously reported virR promoters . Transcripts from wild-type fcrA49, emm49, enn49, and scpA49 genes located downstream of virR49 were characterized as being monocistronic . The transcripts were quantified and mapped for their 5' ends . Subsequently, the virR49 gene was inactivated by specific insertion of a nonreplicative pSF152 vector containing recombinant virR49 sequences . The RNA from the resulting vir-mut strain did not contain transcripts of virR49, fcrA49, emm49, or enn49 and contained reduced amounts of the scpA49 transcript when compared with wild-type RNA . The mRNA control from the streptokinase gene was demonstrated not to be affected . When strain vir-mut was rotated in human blood, it was found to be fully sensitive to phagocytosis by human leukocytes . Thus, the present study provides evidence that virR genes in OF+ GAS could be involved in the control of up to five vir regulon genes, and their unaffected regulatory activity is associated with features postulated as crucial for GAS virulence.

Infect Immun, 1995 Jan, 63(1), 73 - 81
Human immunoglobulin G (IgG) Fc receptor IIA (CD32) polymorphism and IgG2-mediated bacterial phagocytosis by neutrophils; Sanders LA et al.; Human immunoglobulin G (IgG) Fc receptor IIa (Fc gamma RIIa; CD32) is expressed on phagocytes, triggers phagocytosis, and represents the sole Fc receptor for IgG (Fc gamma R) capable of interaction with IgG2, the main IgG subclass induced in response to bacterial capsular polysaccharides . The two genetically determined structurally different allotypes of human Fc gamma RIIa, the products of the Fc gamma RIIa-R131 and IIa-H131 alleles, have functionally different reactivities with human IgG2 . In humans, the Fc gamma RIIa-H131 allotype is known to interact efficiently with complexed human IgG2, whereas the IIa-H131 allotype does so only poorly . This polymorphism may therefore have implications for IgG2-mediated phagocytosis of encapsulated bacteria and susceptibility to bacterial infections . Phagocytosis of IgG2-opsonized bacteria by homozygous Fc gamma RIIa-R/R131, heterozygous IIa-H/R131, and homozygous IIa-H/H131 polymorphonuclear cells (PMN) was compared . A higher phagocytic capacity of IgG2-opsonized group B type III streptococci by PMN of homozygous H/H131 individuals compared with PMN from homozygous R/R131 individuals was observed (P = 0.001), while heterozygous IIa-H/R131 PMN showed intermediate phagocytosis . In this model system, IgG2-mediated phagocytosis was independent of the Fc gamma RIIIb-NA1/NA2 allelic polymorphism.

Infect Immun, 1995 Jan, 63(1), 271 - 9
Group B streptococci (GBS) injure lung endothelium in vitro: GBS invasion and GBS-induced eicosanoid production is greater with microvascular than with pulmonary artery cells; Gibson RL et al.; Neonatal group B streptococcal (GBS) sepsis and pneumonia cause lung endothelial cell injury . GBS invasion of the lung endothelium may be a mechanism for injury and the release of vasoactive eicosanoids . Pulmonary artery endothelial cells (PAEC) and lung microvascular endothelial cells (LMvEC) were isolated from neonatal piglets and were characterized as endothelial on the basis of morphology, uptake of acyl low-density lipoprotein, factor VIII staining, and formation of tube-like structures on Matrigel . PAEC and LMvEC monolayers were infected with COH-1 (parent GBS strain), isogenic mutants of COH-1 devoid of capsular sialic acid or all capsular polysaccharide, or a noninvasive Escherichia coli strain, DH5 alpha . Intracellular GBS were assayed by plate counting of colony-forming units resistant to incubation with extracellular antibiotics . All GBS strains invaded LMvEC significantly more than PAEC, showing that the site of lung endothelial cell origin influences invasion . DH5 alpha was not invasive in either cell type . Both isogenic mutants invaded PAEC and LMvEC more than COH-1 did, showing that GBS capsular polysaccharide attenuates invasion . Live GBS caused both LMvEC and PAEC injury as assessed by lactate dehydrogenase release; heat-killed GBS and DH5 alpha caused no significant injury . Supernatants from PAEC and LMvEC were assayed by radioimmunoassay for prostaglandin E2 (PGE2), the stable metabolite of prostacyclin (6-keto-PGF1 alpha), and the thromboxane metabolite thromoxane B2 . At 4 h, live COH-1 caused no significant increases in eicosanoids from both PAEC and LMvEC . At 16 h, live COH-1, but not heat-killed COH-1, caused a significant increase in 6-keto-PGF1 alpha greater than PGE2 from LMvEC, but not PAEC . We conclude that live GBS injure and invade the lung microvascular endothelium and induce release of prostacyclin and PGE2 . We postulate that GBS invasion and injury of the lung microvasculature contribute to the pathogenesis of GBS disease.

Infect Immun, 1995 Jan, 63(1), 149 - 53
Location of the complement factor H binding site on streptococcal M6 protein; Fischetti VA et al.; The surface M protein of group A streptococci binds factor H, a regulatory protein of the alternative complement pathway, which may contribute to the antiphagocytic activity of the M molecules . To locate the factor H binding domain in the alpha-helical coiled-coil structure of the M molecule, the M protein was cleaved with pepsin at pH 5.8, which separates the molecule approximately in half . Western blot (immunoblot), amino acid sequence, and mass spectrometric analyses revealed that factor H bound to a 14.6-kDa C-terminal fragment of the M molecule . Competitive inhibition of factor H binding to the 14.6-kDa fragment with M protein peptides localized the binding site to amino acids 256 to 292 . This segment is located within the surface-exposed region of the M6 protein, identified as the C-repeat region, whose sequence is conserved among heterologous M and M-like molecules . These studies also identified a second pepsin-susceptible site with the sequence ELAK located within the cell wall-associated region of the M molecule.

J Infect Dis, 1995 Jan, 171(1), 85 - 92
A role for fibrinogen in the streptokinase-dependent acquisition of plasmin(ogen) by group A streptococci; Wang H et al.; Acquisition of plasmin(ogen) by group A streptococci occurs by two distinct pathways . In addition to the well-characterized direct interaction of plasmin with cell-surface receptors on group A streptococci, a second pathway dependent on streptokinase and a nonplasminogen factor(s) present in human plasma was identified . The role of streptokinase in the second pathway was not merely as a plasminogen activator, since substitution of the plasminogen activator urokinase did not result in the capture of plasmin(ogen) by bacteria in the presence of plasminogen-depleted plasma . However, if streptokinase was added to plasmin that had been generated by treatment of plasminogen with urokinase, the ability of the bacteria to capture plasmin in the presence of plasminogen-depleted plasma was restored . Fibrinogen present in human plasma was identified as the major factor required for streptokinase-dependent uptake of plasmin(ogen) by group A streptococci.

Scand J Infect Dis, 1995, 27(1), 17 - 8
Arcanobacterium haemolyticum and streptococcal pharyngitis in army conscripts; Carlson P et al.; Arcanobacterium haemolyticum was found in 1.4% and beta-haemolytic streptococci in 23% of throat cultures from army conscripts with sore throat (n = 498) . 38% of the beta-haemolytic streptococci were of group A . Patients culture-positive for A . haemolyticum or beta-haemolytic streptococci had pharyngeal exudate, cervical lymphadenopathy and ear ache significantly more often--but cough less often--than culture-negative patients . The pharyngeal colonization rate of healthy conscripts (n = 232) by A . haemolyticum was 0.4% and by beta-haemolytic streptococci, 6.5%.

Microb Pathog, 1995 Jan, 18(1), 53 - 65
Streptokinase activity among group A streptococci in relation to streptokinase genotype, plasminogen binding, and disease manifestations; Tewodros W et al.; Certain genotypic variants of streptokinase (ska) of beta-hemolytic streptococci group A have been associated with acute post-streptococcal glomerulonephritis (APSGN) . In our earlier studies on strains isolated from Ethiopian children with various streptococcal disease manifestation, we reported an even distribution of streptokinase genotypes with no association to disease patterns . Considering the possibility that strains could differ in their ability to secrete the protein, levels of streptokinase activity in culture supernatants of these strains were determined by a plasminogen activation assay using a synthetic tripeptide, H-D-valyl-leucyl-lysin-p-nitroaniline, as a substrate . Of the 53 streptococcal group A strains, ten (19%), which belonged to genotype ska4 and ska8, did not activate human plasminogen . These strains did not activate bovine, sheep, horse, rabbit or porcine plasminogens either . They represented at least five M protein and non-typeable serotypes, and were characterized by high human plasminogen binding activity . Six of the 53 strains (11%) harbouring genotype ska3 and ska7 showed low levels of human plasminogen activation . Strains of ska1 and ska2, 37/53, activated human plasminogen at a higher level (p < 0.005) . Levels of plasminogen activation were not significantly different among the ska1 and ska2 strains associated with various streptococcal disease manifestations . Antibody levels against streptokinase were higher (p < 0.05) in convalescent sera from acute rheumatic fever and APSGN patients in comparison with sera from other patient categories and healthy controls . Streptokinase genotype and in vitro streptokinase production do not correlate directly to streptococcal disease manifestation, indicating a probable significance of additional streptococcal and/or host factors in the initiation of APSGN.

J Antimicrob Chemother, 1995 Jan, 35(1), 67 - 74
Differences in penicillin-binding protein patterns of penicillin tolerant and non-tolerant group A streptococci; van Asselt GJ et al.; The penicillin-binding proteins (PBPs) of five penicillin tolerant group A streptococci and their isogenic non-tolerant strains, and seven unrelated non-tolerant group A streptococci were compared . PBPs from late logarithmic cultures were labelled in vitro with 3H-benzylpenicillin and analysed by SDS-PAGE and fluorography . The PBP patterns for all non-tolerant strains were identical . This pattern differed markedly from that for penicillin tolerant strains, both qualitatively and quantitatively . The most striking change in penicillin tolerant strains was decreased binding of 3H-penicillin to PBP 3 and increased binding to PBP 5, while PBP 2a was replaced by a new PBP (PBP 2a') of lower electrophoretic mobility . Tolerance was lost during storage but could be restored by consecutive transfers on to penicillin gradient agar plates . At the same time the PBP profiles of these strains became identical to those found for stable tolerant strains . These results suggest the possibility that PBP 2a' and PBP 5 in combination with other PBP alterations play a role in penicillin tolerance found in group A streptococci.

Akush Ginekol (Mosk), 1995, (1), 15 - 8
{Infection and bacterial colonization of urogenital system in pregnancy, its effect on the clinical course of pregnancy, fetus and newborn}; Bashmakova MA et al.; Colonization/infection of the genitals with Mycoplasma, group B Streptococci, and Chlamydia was studied in pregnant women . The course of gestation in women colonized with microorganisms was frequently aggravated by threatened spontaneous abortions, high incidence of hydramnion, late gestoses, pyelonephritis . For the newborns a reduced body mass and increased perinatal morbidity and mortality were characteristic . Transfer of microorganisms to the fetus and newborn was observed in 40-50% of cases and was not always associated with development of a disease . In cases of lethal outcomes of a neonatal disease pneumonia and placentitis were the constant morphological manifestations of the infection . In streptococcal and mycoplasmic infection the inflammation in the placenta was diffuse, involving the decium both in the placenta and in the extraplacental membranes.

J Infect, 1995 Jan, 30(1), 63 - 5
Necrotising fasciitis: quantitative characteristics of the 1994 British media outbreak; Pennington TH; A small number of cases of necrotising fasciitis in England caused by group A streptococci became the focus of a massive amount of media attention during May 1994 . This report presents quantitative data on the interaction between journalists and a microbiologist during this period, and discusses possible explanations of the event.

J Med Microbiol, 1995 Jan, 42(1), 67 - 72
Identification of pioneer viridans streptococci in the oral cavity of human neonates; Pearce C et al.; Three hundred and sixty-seven strains of pioneer streptococci isolated from the mouths of 40 healthy, full-term infants during the first month of life were examined by two taxonomic schemes that incorporated biochemical and physiological characteristics, IgA1 protease production and glycosidase activities . Streptococcus mitis biovar 1 and S . oralis comprised 55.0% of the pioneer streptococci isolated from neonates . S . salivarius constituted 25.3% of the isolates, while S . anginosus, S . mitis biovar 2, S . sanguis and S . gordonii accounted collectively for 11.4% . Difficulties in identifying streptococci were encountered and 8.4% of the 367 isolates could not be assigned to a recognised species.

Br Vet J, 1995 Jan-Feb, 151(1), 17 - 25
A study of mastitis bacteria and herd management practices to identify their relationship to high somatic cell counts in bulk tank milk; Fenlon DR et al.; Thirty dairy herds, selected to cover a wide range of bulk tank somatic cell count (BTSCC) values, were used to study the relationship between the levels of the principal species of mastitis-causing bacteria, herd management practices and the BTSCC . A good correlation was found between the number of mastitis streptococci (Streptococcus agalactiae, S . dysgalactiae and S . uberis) found in bulk tank milk and the BTSCC . Staphylococcus aureus was less significantly correlated to BTSCC, but was of increasing importance in borderline BTSCC herds, where lower excretion levels into milk were unlikely to trigger hygiene penalties and so alert producers to the presence of a significant mastitis problem . High BTSCC herds had significantly lower yields and were less likely to use a post-milking teat dip or to have a regular programme of milking machine maintenance or automatic cluster removal . These herds also tended to buy in replacements rather than breed their own . Overall the management of high BTSCC herds showed less commitment to implementing mastitis control procedures than herds with a consistently low BTSCC.

Zentralbl Bakteriol, 1995 Jan, 282(1), 67 - 82
Isolation and characterization of a mitogen characteristic of group A streptococci (Streptococcus pyogenes); Gerlach D et al.; It has been supposed for many years that group A streptococci may elaborate more than the three well known erythrogenic toxins A, B or C (ETA, ETB, ETC) . The analysis of the culture supernatant of streptococcal strain 27297 carrying neither genes for ETA nor ETC revealed mitogenic activity at pH 7.3 in isoelectric focusing . This mitogen of strain 27297 was purified by hydrophobic adsorption to Phenyl-Sepharose following FPLC chromatography on a Mono S column resulting in two proteins with mitogenic activity called AX and BX, respectively . Both differed in only one aminoterminal residue . The mitogenic activity of BX lacking one aminoterminal arginine was found to be about 100 times higher than that of AX . The aminoterminus of BX does not correspond to a predictable cleavage site for signal peptidase . We assume that BX was produced after translation by cleavage of the mature protein or the AX molecule with streptococcal proteinase (ETB) or an arginylaminopeptidase which is detectable on whole cells . The purified proteins BX and AX showed molecular weights of about 27 kDa in SDS electrophoresis and isoelectric points of 8.3 (AX) and 7.3 (BX) in isoelectric focusing, respectively . Both proteins were produced by practically all group A strains tested but not by groups B, C, G or H streptococci . Therefore, AX or BX seem to be proteins characteristic of group A streptococci.

Eur J Clin Microbiol Infect Dis, 1995, 14 Suppl 1, S26 - 32
Invasive streptococci; Spencer RC; Before the introduction of antibiotics, serious infections caused by Streptococcus pyogenes (Lancefield Group A streptococci) were common . Before World War II, this bacterium was responsible for as many as 50% of postpartum deaths and was the major cause of death in patients with burns . Also common were the sequelae of streptococcal infections-rheumatic fever and post-streptococcal glomerulonephritis . With the use of penicillin, however, Streptococcus pyogenes was believed to be virtually eliminated as a pathogen . The organism was consigned to the history books, but not for long . In the mid-1980s, focal resurgences of rheumatic fever began to be reported from different areas in the USA, such as Salt Lake City, Utah . In such communities, where increases in cases of rheumatic fever had been reported, the serotypes M-1, 3, 5, 6 and 18 were isolated which, on culture, produced characteristic mucoid colonies . At the same time, reports of increases in invasive streptococcal disease began to surface in both the USA and Europe . Two syndromes were described; invasive streptococcal infection, occurring in previously healthy children and adults, commonly associated with septicaemia resulting from a deep focus of infection such as bone or lung; and streptococcal toxic shock syndrome, involving a cutaneous focus, accompanied by necrotizing or bullous soft tissue changes . Septicaemia is rare in streptococcal toxic shock syndrome, but the most characteristic feature is one of rapidly progressing multi-organ failure . A high proportion of the strains of Streptococcus pyogenes associated with this condition are serotype M-1, and fatality rates approaching 50% have been reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Caries Res, 1995, 29(2), 159 - 62
Streptococci and actinomyces inhibit regrowth of Streptococcus mutans on gnotobiotic rat molar teeth after chlorhexidine varnish treatment; van der Hoeven JS et al.; Clinical studies suggest that the long-term suppression of mutans streptococci on tooth surfaces after intensive chlorhexidine therapy is mainly due to bacterial interference . Other streptococci and also Actinomyces naeslundii are proposed to inhibit regrowth of mutans streptococci after suppression by the agent . We have tested this hypothesis in gnotobiotic rats associated with Streptococcus mutans alone, or associated with S . mutans and strains of Streptococcus oralis, Streptococcus sanguis, Streptococcus gordonii, Streptococcus mitis biovar I, and A . naeslundii . Left lower jaws in these rats were treated with concentrated chlorhexidine varnish, and the return of S . mutans on the treated jaws monitored . In mono-associated rats, S . mutans regained the level of the untreated right lower jaw in approximately 1 week . In contrast, S . mutans remained suppressed for several weeks in rats multi-associated with other streptococci and actinomyces strains . The suppression was more pronounced in the rats fed on basal diet with little free sugars than in rats fed on a sucrose-containing diet . Counts of other streptococci recovered quickly from the intensive chlorhexidine treatment, but A . naeslundii remained suppressed for at least 1 week . The findings demonstrate the crucial importance of the oral microflora in controlling regrowth of mutans streptococci after chemotherapy.

Caries Res, 1995, 29(2), 148 - 53
Salivary mutans streptococci and incidence of caries in preschool children; Thibodeau EA et al.; The aim of this study was to assess the relationship between salivary mutans streptococcus (SMS) levels and the prevalence and incidence of dental caries in 148 children (mean baseline age 3.8 years) of low socioeconomic status . Caries data (dmfs) and semiquantitative SMS counts were obtained at baseline and annually for 2 years . The children were classified during each of the 3 years as low (0 colony-forming units; CFU), moderate (1-50 CFU), or high (> 50 CFU) caries risk based on total SMS counts . The results indicated that the prevalence of dental caries increased with SMS levels at baseline and generally in both assessment years . At baseline the mean dmfs of the children classified as low, moderate, or high caries risk was 0.15, 1.44, and 3.36, respectively, while the mean dmfs of the same children at year 2 was 1.18, 3.10, and 7.87, respectively . The mean dmfs of the high-caries-risk group increased by 79% between baseline and year 1 and by 30% between year 1 and year 2 . At year 2, 50% of the children in the low- and 47% in the moderate-caries-risk groups were caries free as compared with 11% in the high-caries-risk group . Thirty-three percent of the children examined remained in the same caries risk category from baseline to year 2; the incidence (delta dmfs) of dental caries in those children designated as low, moderate, and high caries risk during this period was 1.44, 3.36, and 10.07, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

FEMS Immunol Med Microbiol, 1995 Jan, 10(2), 145 - 9
Inhibition of saliva-induced oral streptococcal aggregation by blood group glycoproteins; Ciopraga J et al.; The inhibition of saliva-induced oral streptococcal aggregation with anti-sera (anti-A, anti-B, anti-AB and anti-B treated with galactose), normal human serum (NHS), blood group-specific lectins (UEA-I, HBA, GPA, BSI-B4, GS-I), non-specific blood group lectins (MPA, SBA) and carbohydrates (galactose, N-acetylgalactosamine, L-fucose) was studied . Streptococcal species and strains included S . mutans 318, S . mutans 10449, S . mutans NG-8, S . salivarius and S . cricetus HS-6 . The saliva was obtained from three subjects with secretor status (2 blood group B persons, 1 blood group A person) . The data obtained from experiments performed with S . mutans 10449 and S . mutans NG-8 suggest the involvement of the H-antigenic determinant in the aggregation mechanism of the first strain and of the group B determinant for the second strain . The aggregation of S . salivarius only by B saliva might be related to a galactose-specific lectin on this strain and to some properties of its cell surface (hydrophobicity and the fibrillar surface layer) . S . cricetus HS-6 aggregation was inhibited in different degrees by all the inhibitors used . The results demonstrate that interactions between oral streptococci and salivary components depend on the strain and species and on the individual saliva samples.

Cornea, 1995 Jan, 14(1), 49 - 55
Efficacy and safety of gentamicin and streptomycin in Optisol-GS, a preservation medium for donor corneas; Smith TM et al.; Increasing reports of gentamicin-resistant bacteria contaminating donor corneas and causing endophthalmitis have indicated that preservation of corneal storage media with 100 micrograms/ml of gentamicin alone needs reevaluation . We investigated the stability and possible cytotoxicity of streptomycin as a supplement to gentamicin in Optisol corneal storage medium . The combination of gentamicin and streptomycin in Optisol solution was stable at room temperature for at least 4 weeks and inhibited the growth of Staphylococcus aureus, S . epidermidis, alpha hemolytic streptococci, Streptococcus Group D, Propionibacterium acnes, Escherichia coli, and diphtheroids, but not Pseudomonas aeruginosa . The addition of vancomycin did not significantly improve the antibacterial effectiveness of the gentamicin and streptomycin combination when stored at 4 degrees C . The growth of 15 of 20 clinical ocular isolates of Ps . aeruginosa was suppressed by the gentamicin-streptomycin combination . Streptomycin in concentrations of up to 1,000 micrograms/ml did not decrease the mitotic activity of corneal endothelial cells as evaluated by the in vitro incorporation of tritiated thymidine or cause cytotoxicity . The addition of 200 micrograms/ml of streptomycin to Optisol corneal storage medium containing 100 micrograms/ml of gentamicin may significantly improve activity against gentamicin-sensitive and gentamicin-resistant contaminants.

J Clin Microbiol, 1995 Jan, 33(1), 260 - 1
Evaluation of a new immunologic test kit for rapid detection of group A streptococci, the Abbott Testpack Strep A plus; Laubscher B et al.; We compared the Testpack Strep A plus (TPSAP) enzyme-linked immunosorbent assay test for group A beta-hemolytic streptococcal (GAS) antigen rapid detection with blood agar culture in 454 pediatric patients with clinical pharyngitis . Of the 454 patients, 118 (25.9%) had positive oropharyngeal cultures for GAS . TPSAP sensitivity was 89.9% (106 of 118) and specificity was 95.8% (322 of 336) . We conclude that the TPSAP is specific enough to indicate treatment for a patient with a positive test but that a negative test should be confirmed by culture.

Scand J Infect Dis, 1995, 27(2), 171 - 2
Primary group A streptococcal peritonitis; Graham JC et al.; Primary peritonitis caused by Group A beta-haemolytic streptococci (GAS) is extremely rare and is usually only seen in the presence of underlying disease . This report describes the case of a previously fit young woman who developed primary GAS peritonitis . She had a laparotomy performed at which large amounts of intra-peritoneal pus was identified but no focus of infection was found . Broad spectrum antibiotics were initially used, these were changed to intravenous benzylpenicillin when GAS was isolated . She made a good recovery and was discharged 2 weeks after admission on oral amoxycillin . The organism was serotyped as T3/M3/R3 (opacity factor negative) and it is interesting that the same serotype was isolated from a throat swab taken from her daughter . We also discuss the possible routes of infection and the epidemiology of invasive GAS disease.

Scand J Infect Dis, 1995, 27(2), 125 - 30
Correlation between serum TNF alpha and IL6 levels and severity of group A streptococcal infections; Norrby-Teglund A et al.; The multiorgan failure syndrome caused by group A streptococci (GAS) designated streptococcal toxic shock syndrome (STSS) is believed to be mediated by cytokines induced by superantigens . In order to study the relationship between superantigen production, cytokine levels in patient sera, and clinical GAS manifestation we examined acute-phase sera and strains from 25 patients with GAS bacteremia . The patients had various disease manifestations, including STSS (44%), erysipelas (28%), septicemia (24%), wound infections (16%), and pneumonia (12%) . Serotype T1M1 dominated, representing 56% of the isolates, but also strains of other serotypes were identified . The strains were found to produce the streptococcal pyrogenic exotoxins (Spe) A, B, and F, as determined by immuno-blot analyses . There was no difference in amounts of toxin produced between strains isolated from patients with different manifestations of disease . Levels of TNF alpha, IL1 alpha, IL6, IL8, and IFN gamma in acute-phase sera were determined by use of ELISA and RIA assays . The analyses showed higher levels of IL6 in sera from patients with STSS than in sera from patients with bacteremia without shock . TNF alpha was elevated in sera from patients with STSS, as compared to sera from patients with uncomplicated pharyngotonsillitis . No increase in the levels of IL1 alpha, IL8, and IFN gamma could be found in the patient sera and there was no difference in the level of those cytokines between the various patient categories.

Caries Res, 1995, 29(4), 280 - 4
Toothbrushing and the occurrence of salivary mutans streptococci children at day care centers; Raitio M et al.; Risk factors for the occurrence of salivary mutans streptococci (MS) were surveyed in 677 children aged 1-8 years (4.9 +/- 1.2; mean +/- SD) at 20 municipal day care centers in Oulu . As a part of an intervention program to reduce the spread of infectious diseases, toothbrushing was discontinued in 10 centers, the other 10 serving as controls . The test for MS was performed on 506 children before the 8-month intervention, on 358 at the end and on 345 on both occasions . Past caries experience was recorded from the children's dental health cards (dmf) . Dental health habits were evaluated by means of questionnaires filled in by the parents . The occurrence of MS varied from 43.4 to 48.0% . Although those children who cleaned their teeth regularly at home carried less MS than those who did so irregularly (46.4 vs . 64.9%, p < 0.001), the withdrawal of toothbrushing at the day care center did not increase the incidence of MS . The occurrence of MS was increased by consumption of sweets containing sucrose (p < 0.01) and reduced by the regular use of fluoride tablets (p < 0.02) . Logistic modeling showed a positive MS test to be associated significantly with older age (p < 0.01) and female sex (p < 0.05) in addition to toothbrushing at home (p < 0.001) . The children with positive tests had significantly higher mean (+/- SD) dmf than those with negative ones (1.6 +/- 2.7 vs . 0.3 +/- 1.2, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Scand J Infect Dis Suppl, 1995, 96, 34 - 7
Empiric monotherapy in neutropenia: a realistic goal?
Del Favero A, Bucaneve G, Menichetti F.
Infection remains the major cause of morbidity and mortality for cancer patients who become granulocytopenic as a result of chemotherapy . Treatment is instituted at the first sign of infection and before the identification of the causative pathogen (empiric treatment) . For many years, standard empiric treatment has been combination therapy with beta-lactams and aminoglycosides . The advent of new broad spectrum antibiotics, such as ceftazidime, has introduced the possibility of empiric monotherapy . However, ceftazidime has only modest activity against infections due to Gram-positive organisms, which presently account for at least 50% of infections in neutropenic patients, and resistance to ceftazidime in Gram-negative organisms has been documented . Meropenem is a new carbapenem with a broad antibacterial spectrum with greater in vitro activity than ceftazidime against staphylococci, streptococci and many Gram-negative bacteria . A comparative study of intravenous meropenem (1 g 8-hourly) and ceftazidime (2 g 8-hourly) in the empiric treatment of febrile neutropenic patients with haematological malignancies has been conducted . In an open, randomised trial of the treatment of 338 febrile episodes, all patients survived to 72 hours on both treatments, and meropenem was found to be at least as clinically effective as ceftazidime in eradicating both Gram-positive and Gram-negative infections . Early modification of treatment (48-72 hours) was required for approximately 40% of patients but occurred less frequently in patients treated with meropenem than with ceftazidime . Tolerability of both treatments was good . Meropenem should be compared with standard combination therapy in a large randomised trial before adopting it as empiric monotherapy for febrile neutropenic patients.

Microbios, 1995, 82(332), 141 - 7
Group A streptococci: evaluation of in vitro resistance to two macrolides; Millesimo M et al.; In recent years an increase in severe group A streptococcal infections has been observed . The possible relation between the failure of therapy and an increase of resistance to antibiotics, which are often used for streptococcal infections (clarithromycin and erythromycin), has been assessed in vitro . Streptococcus pyogenes strains tested for susceptibility were isolated in different years from pharyngotonsillar swabs of symptomatic children and typed; another nine strains came from the American Type Culture Collection . The evaluation of antimicrobial activity demonstrated that the percentage of resistance of these bacteria to the two macrolides was 4, 4.4 and 15.5%, respectively, for strains isolated in 1990, 1991 and 1994 . Clarithromycin showed a better antistreptococcal, above all bactericidal, activity . The presence of M protein in streptococci does not seem to modify the kinetic activity of the two drugs, while a slower bactericidal effect was observed against capsulated strains . The resurgence of severe group A Streptococcus infections may be due to an increase in the circulation of strains with a capsule expression, which is critical also for resistance to phagocytic killing.

Caries Res, 1995, 29(3), 198 - 203
Detection of mutans streptococci in secondary carious lesions using immunofluorescent techniques and confocal laser scanning microscopy; Gonzalez-Cabezas C et al.; Secondary caries is one of the major reasons causing restoration failure; however, little is known of its microbial etiology, mainly because of the difficulties in eliminating bacterial contamination during collection and sample preparation . Therefore, the purpose of this study was to investigate the feasibility of immunofluorescent techniques and confocal laser scanning microscopy for identification and quantification of bacteria in secondary carious lesions . Thirty-six extracted human teeth, clinically diagnosed as having secondary caries, were used in the study . The teeth were sectioned in half across the secondary carious lesion . One half of each tooth was processed using the Brown and Hopps histologic staining method for bacterial detection . Sections (100 microns thick) were obtained from the other half of each tooth for immunofluorescence labeling to detect and identify mutans streptococci in the subsurface of the lesion using confocal imaging techniques . Mutans streptococci were detected in 88.9% of the samples analyzed with the immunofluorescent technique . The Brown and Hopps histopathologic examination demonstrated evidence of bacteria in 94.4% of the samples . In addition, quantification of bacteria was conducted by digitalization of confocal images . The results indicated that the immunofluorescence confocal laser scanning microscopy technique was sensitive and specific for detection and quantification of mutans streptococci in secondary carious lesions.

Caries Res, 1995, 29(3), 188 - 91
Effect of an antibacterial varnish on mutans streptococci in plaque from enamel adjacent to orthodontic appliances; Twetman S et al.; The effect of an antibacterial varnish (Cervitec) on the levels of mutans streptococci in plaque adjacent to bonded orthodontic brackets was evaluated in 18 children using a split-mouth technique with a placebo varnish control . The test varnish contained 1% chlorhexidine and 1% thymol as active ingredients . Both varnishes were applied on four occasions during a 3-month period, and plaque was subsequently collected between 1 week and 6 months after the onset of treatment . All teeth involved in the study were carefully examined and clinically assessed for enamel demineralization prior to onset of the fixed appliances and immediately after debonding . The results showed a more frequent growth of mutans streptococci in the dental plaque collected from placebo-treated quadrants as compared with the test quadrants on all sampling occasions . The proportion of mutans streptococci within the plaque microflora was significantly (p < 0.05-0.01) lower on the test sides than on the opposite sides at the 1-week and 1-month examinations . The incidence of incipient enamel lesions around the brackets and along the gingival margin was generally low, and no differences were found between the test and placebo varnish treated quandrants at the time of debonding . The results suggest that mutans streptococci in plaque from orthodontic patients can be suppressed effectively by topical applications of an antibacterial varnish.

J Wildl Dis, 1995 Jan, 31(1), 75 - 8
Fulminant Streptococcus pneumoniae meningitis in a lion-tailed macaque (Macaca silenus) without detected signs; Graczyk TK et al.; A 3-month-old lion-tailed macaque (Macaca silenus) infant that died on 2 February 1985 in the Baltimore Zoo (Baltimore, Maryland, USA) due to fulminating Streptococcus pneumoniae meningitis had congested, edematous lungs, and thickened and congested brain leptomeninges with a grayish-yellow fluid within the subarachnoid brain space . From bacterial cultures made postmortem of the subarachnoid brain space fluid, cerebrospinal fluid, throat secretions, nasal secretions, and lung fluid, we isolated pure cultures of group B streptococci, alpha hemolytic S . pneumoniae, type 19F (capsular) . We also isolated Staphylococcus aureus and S . hemolytica from antemortem nasal and throat bacterial cultures from all 13 animals of the M . silenus colony . Streptococcus pneumoniae meningitis in M . silenus has not been previously reported.

Eur J Cardiothorac Surg, 1995, 9(6), 330 - 4
Surgery in native valve endocarditis: indications, results and risk factors; Dodge A et al.; Seventy-nine patients (mean age 49 years) underwent valve replacement or repair for active (58.2%) or healed (41.8%) native valve endocarditis between 1976 and 1992 . The most common indication for surgery was congestive heart failure (73.4%), followed by multiple systemic emboli (21.5%) . Emergency operation was necessary in 27.8% of the cases . Operative mortality was 3.8% (3 patients) and late mortality 15.1% (12 patients) . Streptococci were the most common infecting agents (41.8%), followed by Staphylococcus aureus (11.4%) . No organisms were isolated in 27 cases (34.2%) . Follow-up spanned 379.8 patient-years with a maximum of 15.8 years . Fifteen late valve-related events (periprosthetic leak, recurrent endocarditis, thrombo-embolic events and hemolysis) and 20 other late complications (anticoagulant-related hemorrhage, arrhythmias or congestive heart failure) occurred in 22 patients . The linearized rate for all late complications is 5.8% per patient-year . The influence of eight preoperative variables on overall mortality and late valve-related complications was assessed: age, valve(s) affected, active or healed infection, bacteriology, annular abscess, emergency or elective surgery, preoperative renal function and NYHA class . Only Staphylococcus aureus (P = 0.0012) was a significant predictor of late valve-related complications . Furthermore, no difference in survival or in valve-related complications was found between the active and healed infections.

Schweiz Monatsschr Zahnmed, 1995, 105(11), 1403 - 11
{The dental health of permanently resident schoolchildren in 16 Zurich rural communities in 1992}; Steiner M et al.; Between 1964 and 1992, caries prevalence (DMFT) of permanently resident school children in 16 communities in the Canton of Zurich decreased by 85 to 87% . In the ten- to fourteen-year-olds, the reduction amounted to 25-29% in the period of 1988 to 1992 . In 1992, the fourteen-year-olds had only 1.90 DMFT and 2.49 DFS, the average DS being 0.28 . The 21% children with the highest caries experience showed only 9 DFS on average . Such a low caries activity does not favour positive cost-benefit results for individual intensive prevention . From 1964 to 1984 caries prevalence in primary teeth of 7-year-old children decreased to the level of 1.81 dmft; the further reduction to 1.55 dmft in 1992 was not significant . Few primary molars were lost prematurely . According to a saliva-test, 59% of the children aged 10 to 12 with high concentrations of mutans streptococci were free of caries; by comparison, 80% of the children with the lowest mutans-test value, were free of caries . In spite of the easy availability and the multiple usages of fluorides (dentifrices with either 250 or 1000-1500 ppm F, domestic salt, gels with 12,500 ppm F and rinsing solutions with 230 ppm F since 1986-88), only 16% of the children showed signs of dental fluorosis.

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