Vaccine, 1995, 13(8), 775 - 9 Immunization of mice by oral colonization with live recombinant commensal streptococci; Oggioni MR et al.; To test the use of recombinant streptococci as live vaccine vectors, colonization/immunization experiments were performed with Streptococcus gordonii expressing heterologous cell-surface antigens . Three isogenic strains of S . gordonii were used: a wild-type, a recombinant expressing the M6 protein of Streptococcus pyogenes, and a recombinant expressing the E7 protein of human papillomavirus type 16 as a fusion with the M6 protein . A single dose of live bacteria was used to inoculate outbred mice, and it was found that: (i) mice were stably colonized by a single intranasal/oral inoculum of S . gordonii; (ii) recombinant strains were equally effective as wild-type in colonizing mice; (iii) two months after the inoculum, oral/pharyngeal swabs of 83.3% of animals were still positive for isolation of S . gordonii; (iv) recombinant S . gordonii isolated from colonized mice were always positive for expression of the heterologous antigens; (v) live bacteria induced a systemic immune response, since sera of mice colonized with recombinant S . gordonii contained IgG specific for the heterologous cell-surface antigens; (vi) this immune response depended upon the effective colonization by live bacteria, since killed bacteria did not induce such a response. Microbios, 1995, 82(333), 207 - 16 Cell surface hydrophobicity and the net electric surface charge of group B streptococci: the role played in the micro-organism-host cell interaction; Nagao PE et al.; The cell surface hydrophobicity, net electric surface charge and cell adhesion of six group B streptococci strains were assessed . Treatment with trypsin reduced cytoadhesion of the six strains (80340, 90356, 85147, 90222, 90186 and 88641) and induced loss of surface negative charge in the other four strains (80340, 85147, 90222 and 90186) . The same treatment increased the surface hydrophobicity of three strains (90356, 90222 and 88641) . Neuraminidase treatment caused a decrease in the negative surface charge of all the strains resulting in significant increases in both cytoadhesion and surface hydrophobicity of five (80340, 90356, 85147, 90222 and 88641) and four (90356, 85147, 90222 and 88641) strains, respectively . This indicates that sialic acid residues are important anionogenic groups exposed on the streptococcal cell surface . Treatment of buccal epithelial cells with N-acetyl-beta-D-glucosaminidase made them less adherent for most of the strains (80340, 85147, 90222, 90186 and 88641) assayed. Methods Enzymol, 1995, 253, 385 - 97 Coaggregations among oral bacteria; Kolenbrander PE; The oral bacterial community appears to use coaggregation as a major mechanism for interbacterial adhesion and colonization of the host . Methods for measuring and evaluating the specificity of adhesion vary from the visual observation of the phenomenon to quantitative analyses . Not only is aggregation specificity reflected in the choice of partners but also in the fact that many are inhibited by galactosides and sialic acid . Each coaggregation between any two partners within a multigeneric coaggregate is independent of the others and can be shown to be distinct by using the radioactivity-based assay . By using the visual assay, it has been shown that members of the 17 genera of most frequently isolated oral bacteria exhibit coaggregation . With the exception of oral streptococci and a few oral actinomyces, the 17 genera do not exhibit intrageneric coaggregation . As a dynamic population, oral bacteria are in a constant flux of accretion and detachment, which are coupled to growth and death . This ecological community is amenable to intensive study, and the coaggregation assays described here are particularly suited to enhance progress in this study. FEMS Microbiol Lett, 1994 Dec 15, 124(3), 373 - 9 Comparison of amylase-binding proteins in oral streptococci; Gwynn JP et al.; Certain species of oral streptococci bind salivary amylase to their cell surface . The patterns of amylase-binding proteins produced by a range of streptococci have been compared by ligand blotting and several characteristics of the binding proteins investigated . Streptococcus gordonii was the most homogeneous species and almost all strains produced proteins migrating with molecular mass 82 kDa and 20 kDa . Other species were more heterogeneous, releasing proteins that resolved at 87 or 82 kDa and/or between 20 and 36 kDa . Binding of amylase to the 82/87-kDa proteins on ligand blots was prevented by amylase inhibitors, amylase substrates and periodate treatment but these had limited or no effect on amylase binding to 20-36 kDa proteins . Also, the 20 kDa protein of S . gordonii Challis was released into culture medium before the 82-kDa protein . These data suggest that there is significant variation in amylase-binding proteins among streptococci and that the high and low molecular mass proteins differ in the way they interact with salivary amylase. Proc Natl Acad Sci U S A, 1994 Dec 6, 91(25), 12238 - 42 Critical role of the group A streptococcal capsule in pharyngeal colonization and infection in mice; Wessels MR et al.; To study the role of the group A streptococcal capsule in pharyngeal colonization, we used two acapsular mutants derived from a type 24 strain of group A Streptococcus by transposon mutagenesis . One mutant had a stable acapsular phenotype due to a transposon-associated chromosomal deletion of essential capsule synthetic genes, while the second mutant could revert to the encapsulated phenotype at a low frequency (< 10(-4)) upon spontaneous excision of the transposon from the capsule-synthesis region of the chromosome . Both acapsular mutants were sensitive to phagocytic killing in vitro and had reduced virulence in mice after intraperitoneal challenge . Mice inoculated intranasally with the stable acapsular mutant rapidly cleared the organisms from the pharynx, and no mice died . In contrast, throat cultures of animals challenged with the revertible mutant yielded many encapsulated revertants, and mortality was similar to that of animals challenged with the parent strain . The rapid emergence of a population of encapsulated revertants in the pharynx implies that the capsule conferred a powerful selective advantage in this environmental niche . Together with the complete avirulence of the stable acapsular mutant, these observations indicate that the hyaluronic acid capsule plays a critical role in colonization and infection of the pharynx by group A streptococci. Presse Med, 1994 Dec 3, 23(38), 1753 - 7 {Bacterial epidemiology of pharyngitis in pediatric private practice}; Cohen R et al.; OBJECTIVES: While viruses are usually the causal agents of common sore throat in children, bacterial infections cannot be distinguished solely on the basis of clinical presentation . Thus most physicians in France prefer to prescribe antibiotics in order to prevent rheumatismal complications of group A streptococcal infections . We updated current epidemiological data on bacterial pharyngitis in paediatric out-patient clinics . METHODS: A prospective study was conducted from March 1 to June 1, 1992 by 9 physicians . Throat swabs were obtained from 102 controls and from 307 patients with acute pharyngitis . Samples were transferred to the same bacteriology laboratory for examination . RESULTS: The mean age of the children was 6.1 years for patients and 7.2 years for controls . Throat swabs were inoculated for culture within a mean delay of 22.6 hours . Cultures were performed on Columbia blood medium with nalidixic acid and colistin then incubated in CO2 enriched atmosphere and on trypticase blood soy medium + 3.5% NaCl . Group A streptococcal strains were identified by search for beta-haemolysis and latex characterisation of group A polyosides . Group A streptococcal strains were found in 8.8% of the controls and 36.8% of the patients . Groups B, C or G streptococci were found in 10.8 et 11.4% of the controls and patients respectively (NS) . Arcanobacterium haemolyticum was never isolated . Clinical association of sore throat, erythematous pharyngitis, fever > 38 degrees C and cervical lymph nodes was found in only 33.63% of the sore throat cases with group A streptococcal infection and in 7.73% of those without group A streptococcal infection (p < 0.0001, sensitivity 33%, specificity 92%) . CONCLUSION: These results emphasize the necessity either to treat all pharyngitis or to do throat swabs or rapid group A streptococcal tests for diagnosis. J Biol Chem, 1994 Dec 2, 269(48), 30113 - 6 Cloning and expression of the gene for group B streptococcal hyaluronate lyase; Lin B et al.; Group B streptococci (GBS) are a major cause of serious human perinatal infections . Most clinical isolates of GBS secrete hyaluronate lyase, and production of high levels of the enzyme has been associated with strain virulence . Degenerate oligonucleotide primers, designed on the basis of the amino acid sequences of tryptic peptides prepared from the purified enzyme, permitted the polymerase chain reaction amplification from GBS chromosomal DNA of a 363-base pair internal DNA fragment of the GBS hyaluronate lyase gene (hylB) . This DNA fragment was used as a probe to screen a lambda phage library of GBS chromosomal DNA fragments . Sequence analysis of positive clones identified an open reading frame capable of coding for a 111-kDa protein . Since no single clone was found to contain the entire gene it was necessary to reconstruct the gene from two plasmids containing inserts with suitable overlapping sequences . When this reconstructed gene was transformed into Escherichia coli, high level expression of hyaluronate lyase activity was obtained. Gene, 1994 Dec 2, 150(1), 135 - 40 Characterization and distribution of insertion sequence IS1239 in Streptococcus pyogenes; Kapur V et al.; The human pathogenic bacterium Streptococcus pyogenes causes pharyngitis, acute rheumatic fever, glomerulonephritis and toxic-shock-like syndrome . The bacterium synthesizes several extracellular products, including the recently described streptococcal superantigen SSA, a molecule that shares considerable homology with several Staphylococcus aureus enterotoxins . While studying allelic variation at the ssa locus, six isolates expressing serotypes M4, M23, M33, M41, M43, and provisional type PT4854, were identified that had PCR products about 40-bp larger than expected, and one isolate (M15) had an amplified fragment that was more than 1-kb larger than expected . All six isolates have a 34-bp insert located 103 bp 5' of the ssa start codon . The larger product is a result of a 1110-bp insertion at the analogous location . The complementary strand of this insert has a 981-bp open reading frame that potentially encodes a 326-amino-acid polypeptide with substantial homology to the Escherichia coli IS30 transposase . Results of Southern blot analysis showed that at least twelve copies of the sequence are present in the serotype M15 S . pyogenes isolate . This element, designated IS1239, is the first simple insertion sequence described in group-A streptococci . Results of PCR screening showed that 26 of 78 (33%) S . pyogenes isolates expressing distinct M protein serotypes contained sequences with homology to IS1239, which means that the element is widely distributed in the species. J Pediatr, 1994 Dec, 125(6 Pt 1), 939 - 47 Effect of different surfactants on pulmonary group B streptococcal infection in premature rabbits; Sherman MP et al.; OBJECTIVES: To evaluate the effects of different surfactants on pulmonary infection with group B streptococci in premature rabbits and to examine the effects of different surfactants on pulmonary alveolar macrophage function of newborn rabbits . MODEL: Preterm and term rabbit pups . METHODS: Rabbit pups were infected with GBS aerosols followed by intratracheal administration of either calf lung surfactant extract, minced porcine lung surfactant (Curosurf), synthetic surfactant (Exosurf Neonatal), minced bovine lung surfactant (Survanta), human amniotic fluid-derived surfactant, rabbit surfactant, saline vehicle, or no treatment . Intrapulmonary clearance of GBS was determined by comparing bacterial counts in left lungs cultured immediately after aerosol infection with similarly infected lungs analyzed 4 hours after surfactant therapy . Phagocytosis of streptococci was ascertained by microscopic examination of the right lungs fixed in situ at 4 hours . For comparison, an in vitro method was used to measure growth of GBS in the different surfactants . RESULTS: Preterm animals had a sixfold increase in pulmonary bacterial growth compared with a slight decrease in intrapulmonary GBS in term animals when all were delivered by cesarean section (p < 0.05) . In premature rabbits, GBS proliferation was lowest in animals treated with Exosurf Neonatal and highest in animals receiving Curosurf and human amniotic fluid-derived surfactant (p < 0.05) . None of the surfactants promoted accelerated growth of GBS in comparison with control animals . Similar growth of GBS was seen in in vitro cultures . Intrapulmonary phagocytosis of GBS in premature pups was not altered by any of the surfactants . In term rabbit pups, the following measures of macrophage population kinetics remained normal at 1 and 24 hours after surfactant administration: viability, cell numbers based on lung lavage, and in vivo incorporation of thymidine . CONCLUSIONS: Surfactants used in clinical practice do not accelerate the in vivo growth of group B streptococci in the lungs of preterm rabbits . Some surfactants inhibit streptococcal proliferation . The effects of different surfactants are not explained by changes in macrophage function. Epidemiol Infect, 1994 Dec, 113(3), 455 - 62 Clonal diversity of Streptococcus pyogenes within some M-types revealed by multilocus enzyme electrophoresis; Haase AM et al.; Twenty-two reference isolates and 30 local isolates of group A Streptococci were classified into 36 electrophoretic types (ET) on the basis of allozyme variation at 27 enzyme loci . Local isolates were characterized by a high frequency of M-non typable strains . M-type and ET were more closely associated in local isolates from an endemically-infected population; nevertheless, amongst the local isolates there were also strains of the same ET type with different M-types . A possible explanation is that genetic exchange between strains may introduce different M-types into strains of defined ET when these are exposed to strong selection in the presence of heavy loads of infection . In contrast to the reported clustering of strains associated with toxic shock-like syndrome into two closely related ET clones, we found no relationship of ET phenotype to acute poststreptococcal glomerulonephritis or rheumatic fever. Arch Biochem Biophys, 1994 Dec, 315(2), 431 - 7 Characterization of the group B streptococcal hyaluronate lyase; Pritchard DG et al.; Hyaluronate lyase is one of several proteins secreted by group B streptococci which are believed to contribute to strain virulence . Characterization of the purified enzyme revealed that it degrades hyaluronan by a mechanism different from that of other previously studied hyaluronidases . Instead of randomly cleaving hyaluronan chains leading to a continuous decrease in average chain size, the group B streptococcal enzyme initially yields primarily unsaturated disaccharides . The observation that most of the free reducing ends generated during group B streptococcal hyaluronate lyase digestion are present in the unsaturated disaccharide units supports the conclusion that they are released primarily from the ends of the hyaluronan chains . Furthermore, the experimental evidence is consistent with a mode of action by which the enzyme initially makes a random cut in a hyaluronan chain and then processively moves along the chain releasing disaccharide units . Group B streptococcal hyaluronate lyase also slowly degrades chondroitin sulfate, and its desulfation greatly increases the reaction rate . A preferential cleavage of unsulfated residues is consistent with the observed extensive release of free chondroitin sulfate chains following very limited digestion of aggrecan from bovine nasal cartilage. J Bacteriol, 1994 Dec, 176(23), 7372 - 4 Characterization of CMP-N-acetylneuraminic acid synthetase of group B streptococci; Haft RF et al.; The capsular polysaccharide is a critical virulence factor for group B streptococci associated with human infections, yet little is known about capsule biosynthesis . We detected CMP-Neu5Ac synthetase, the enzyme which activates N-acetylneuraminic acid (Neu5Ac, or sialic acid) for transfer to the nascent capsular polysaccharide, in multiple group B streptococcus serotypes, all of which elaborate capsules containing Neu5Ac . CMP-Neu5Ac synthetase isolated from a high-producing type Ib strain was purified 87-fold . The enzyme had apparent Km values of 7.6 for Neu5Ac and 1.4 for CTP and a pH optimum of 8.3 to 9.4, required magnesium, and was stimulated by dithiothreitol . This is the first characterization of an enzyme involved in group B streptococcus capsular polysaccharide biosynthesis. J Bacteriol, 1994 Dec, 176(23), 7213 - 22 Cloning and DNA sequencing of the dextranase inhibitor gene (dei) from Streptococcus sobrinus; Sun JW et al.; Some dextranase-deficient (Dex-) mutants of Streptococcus sobrinus UAB66 (serotype g) synthesize a substance which inhibits dextranase activity (S.-Y . Wanda, A . Camilli, H . M . Murchison, and R . Curtiss III, J . Bacteriol . 176:7206-7212, 1994) . This substance produced by the Dex- mutant UAB108 was designated dextranase inhibitor (Dei) and identified as a protein . The Dei gene (dei) from UAB108 has been cloned into pACYC184 to yield pYA2651, which was then used to generate several subclones (pYA2653 to pYA2657) . The DNA sequence of dei was determined by using Tn5seq1 transposon mutagenesis of pYA2653 . The open reading frame of dei is 990 bp long . It encodes a signal peptide of 38 amino acids and a mature Dei protein of 292 amino acids with a molecular weight of 31,372 . The deduced amino acid sequence of Dei shows various degrees of similarity with glucosyltransferases and glucan-binding protein and contains A and C repeating units probably involved in glucan binding . Southern hybridization results showed that the dei probe from UAB108 hybridized to the same-size fragment in S . sobrinus (serotype d and g) DNA, to a different-size fragment in S . downei (serotype h) and S . cricetus (serotype a), and not at all to DNAs from other mutans group of streptococci. Infect Immun, 1994 Dec, 62(12), 5227 - 33 Superantigenic properties of the group A streptococcal exotoxin SpeF (MF); Norrby-Teglund A et al.; Streptococcal pyrogenic exotoxin F (SpeF), previously referred to as mitogenic factor, is a newly described potent mitogen produced by group A streptococci . To investigate whether this protein belongs to the family of microbial superantigens, we analyzed the cellular and molecular requirements for its presentation to T cells and compared it with the known streptococcal superantigen pyrogenic exotoxin A (SpeA) and the nonspecific polyclonal T-cell mitogen phytohemagglutinin (PHA) . SpeF and SpeA were efficiently presented by autologous antigen-presenting cells (APCs) and an allogeneic B lymphoma cell line, Raji . In contrast, the monocytic cell line U937, which does not express major histocompatibility complex (MHC) class II molecules, failed to present SpeF as well as SpeA but supported the response to PHA . Thus, the presentation of SpeF by APCs was class II dependent but not MHC restricted . The requirement for HLA class II was further supported by the ability of anti-HLA-DQ monoclonal antibody to block the SpeF-induced proliferative response by 75 to 100% . Paraformaldehyde (PFA) fixation of autologous APCs resulted in an impaired ability of SpeF and SpeA to induce optimal T-cell proliferation . In contrast, fixation of Raji cells did not affect the induced proliferation . The stimulatory effect of PHA remained unaffected by both the use of PFA-fixed APCs and the addition of the HLA class II-specific monoclonal antibodies . The addition of a supernatant enriched in interleukin 1 and interleukin 6 to fixed autologous APCs resulted in an increased SpeF-induced response; thus, the impairment was not due to a requirement for processing, but, rather, costimulatory factors produced by metabolically active APCs were needed . SpeF was found to preferentially activate T cells bearing V beta 2, 4, 8, 15, and 19, as determined by quantitative PCR . The data presented clearly show that SpeF is a superantigen . We also studied the prevalence of the speF gene in clinical isolates by Southern blot analyses, and the gene could be detected in 42 group A streptococcal strains, which represented 14 serotypes. Pediatr Dermatol, 1994 Dec, 11(4), 293 - 303 Impetigo: an overview; Darmstadt GL et al.; This article reviews in detail the pathogenesis, clinical characteristics and management of impetigo in children . Impetigo is the most common bacterial skin infection of children . Most cases of nonbullous impetigo and all cases of bullous impetigo are caused by Staphylococcus aureus . The remainder of cases of nonbullous impetigo are due to group A beta hemolytic streptococci (GABHS) . GABHS colonize the skin directly by binding to sites on fibronectin that are exposed by trauma . In contrast, S . aureus colonizes the nasal epithelium first; from this reservoir, colonization of the skin occurs . Patients with recurrent impetigo should be evaluated for carriage of S . aureus . Superficial, localized impetigo may be treated successfully in more than 90% of cases with topical application of mupirocin ointment . Impetigo that is widespread or involves deeper tissues should be treated with a beta-lactamase-resistant oral antibiotic . The choice of antibiotics is affected by the local prevalence of resistance to erythromycin among strains of S . aureus, antibiotic cost and availability, and issues of compliance. Pediatr Infect Dis J, 1994 Dec, 13(12), 1110 - 6 Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study; Beck-Sague CM et al.; For identification of risk factors for bloodstream infection (BSI) among neonatal intensive care unit patients, prospective 6-month studies in three neonatal intensive care units were conducted . BSI was diagnosed in 42 of 376 (11.2%) enrolled infants . Pathogens included coagulase-negative staphylococci, Candida sp., Group B streptococci and Gram-negative species . Patients with BSIs were more likely to die during their neonatal intensive care unit stay than were patients who did not acquire BSIs (6 of 42 vs . 11 of 334, P = 0.007) . BSI rate was highest in infants with birth weight < 1500 g (relative risk (RR) = 6.8, P < 0.001), those treated with H-2 blockers (RR = 4.2, P < 0.001) or theophylline (RR = 2.8, P < 0.001) and those with admission diagnoses referable to the respiratory tract (RR = 3.7, P < 0.001) . Infants who developed BSI were more severely ill on admission than other infants (median physiologic stability index 13 vs . 10 (P < 0.001) and were of lower gestational age (28 vs . 35 weeks, P < 0.001) . In logistic regression analysis, risk of BSI was independently associated only with very low birth weight, respiratory admission diagnoses and receipt of H-2 blockers . Risk of isolation of a pathogen from blood culture was independently associated with Broviac, umbilical vein or peripheral venous catheterization > 10, 7 or 3 days, respectively, at one insertion site . Rate of isolation of a pathogen was higher (9 of 59 (15%)) within 48 hours of a measurable serum interleukin 6 concentration than an interleukin 6 level of 0 pg/ml (10 of 159 (6%), P = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS) Pediatr Infect Dis J, 1994 Dec, 13(12), 1075 - 8 Decline of erythromycin resistance of group A streptococci in Japan; Fujita K et al.; Six hundred seventy isolates from children with Group A streptococcal infections from 1981 through 1990 were typed serologically and their antibiotic susceptibilities were determined . There were 479 isolates from patients with pharyngitis, 133 from those with scarlet fever, 35 from those with suppurative infection and 23 from those with nonsuppurative disease . The prevalent M serotypes were 12, 4, 1, 3 and 28 . None of the 670 isolates were resistant to penicillin G and cephalexin . Resistance rates of isolates to erythromycin and lincomycin was 22.2% in 1981 and 1982, but a marked decrease was noted after 1983 and only one has been resistant since 1986 . Nineteen of 21 erythromycin-resistant isolates were M type 12, and two others were M types 4 and 28 . Chloramphenicol resistance was similar to that of erythromycin, and the tetracycline resistance rate decreased gradually from 60% to less than 20%. Clin Infect Dis, 1994 Dec, 19(6), 1110 - 22 A 45-year perspective on the streptococcus and rheumatic fever: the Edward H . Kass Lecture in infectious disease history; Denny FW Jr; Rheumatic fever has been considered a major problem among civilians in the United States and elsewhere for 100 years but was not recognized as a concern among the U.S . military until World War II . At that time the only available control measure was antimicrobial prophylaxis of recurrent rheumatic fever . Subsequent studies, conducted primarily by the Streptococcal Diseases Laboratory of the Armed Forces Epidemiological Board, demonstrated that rheumatic fever could be prevented by the treatment of patients with streptococcal pharyngitis and by the administration of penicillin for the prophylaxis of streptococcal infections in large groups . With the use of available preventive measures, rheumatic fever virtually disappeared by the 1970s . In 1985, however, rheumatic fever and severe streptococcal infections reappeared, first in the Rocky Mountain area . It is speculated that this reappearance was due to special strains of group A streptococci and--in severe cases--the production of pyrogenic exotoxins . At present, cases continue to occur but not at the level seen in the late 1980s. APMIS, 1994 Dec, 102(12), 925 - 30 Phase variation in streptococci of serological group B . Characteristic properties of isolates from human and bovine infection; Salasia SI et al.; Encapsulation is thought to be a critical virulence factor in streptococci of serological group B . In the present study two encapsulated low-density variants could be separated from their unencapsulated original strains by Percoll gradient centrifugation . The original strains had been isolated from human endocarditis and bovine mastitis . Type antigen preparations of the encapsulated human and bovine group B streptococcus reacted with type III- and type IV-specific antiserum, respectively . No comparable reactions could be observed with their unencapsulated parent strains . In contrast to the original strains, the encapsulated variants grew with uniform turbidity in fluid medium and formed diffuse colonies in soft agar . The original strains grew as granular sediment and formed compact colonies in soft agar . In addition, the original strains appeared to have a more hydrophobic surface and showed significantly greater adherence to epithelial cells . In contrast to the nonencapsulated parent strains, the encapsulated variants were less phagocytosed by polymorphonuclear leukocytes . These findings may help our understanding of the pathogenic importance of phase variants in infections with this bacterial organism. Am J Vet Res, 1994 Dec, 55(12), 1723 - 8 Pathologic findings of experimentally induced Streptococcus uberis infection in the mammary gland of cows; Thomas LH et al.; Twenty-five quarters of 12 dairy cows, 3 to 8 years old, with a bacteriologic history of freedom from infection with Streptococcus uberis were inoculated via the teat canal with S uberis (23 quarters) or sterile medium (2 quarters) . The cows were sent to slaughter 1, 3, or 6 days later . Acute inflammatory response involving accumulation of large numbers of polymorphonuclear, neutrophilic leukocytes (neutrophils) in the secretory acini was recognized after 24 hours in infected cows . After 6 days, the neutrophil response was still evident, but infiltration of septa by lymphocytes, septal edema, extensive vacuolation of secretory cells, focal necrosis of alveoli, small outgrowths of the secretory and ductular epithelium, and widespread hypertrophy of the ductular epithelium also were recognized . Early stages of involution and fibrosis also were evident at that stage . Streptococci were identified by immunoperoxidase labeling, free or phagocytosed, in macrophages; in the alveolar lumina, adherent to damaged secretory or ductular epithelium; in the subepithelium and septal tissue; and in lymphatic vessels and lymph nodes . The importance of the macrophage as the primary phagocytic cell is highlighted, and doubt is cast on the value of the exuberant neutrophil response by the host in defense of the gland. Am J Vet Res, 1994 Dec, 55(12), 1697 - 702 Prevalence of aerobic bacteria in bronchoalveolar lavage fluids from healthy pigs; Hensel A et al.; Fiberoptic bronchoscopy was performed in pigs to assess bacterial contamination of bronchoalveolar lavage fluids (BALF) obtained by use of the method and to determine the aerobic bacterial species in bronchoalveolar airways of healthy pigs . Bacterial contamination of BALF caused by insertion of the bronchoscope was evaluated, using a chromogenic bacterial tracer strain, and was found to be 0.22% of total colony-forming units (CFU), with range between 0 and 1.6% . A total of 164 pulmonary-healthy pigs from 6 closed herds were selected . The BALF obtained from these pigs were examined bacteriologically . Bacteria could not be isolated from 10.4% of all BALF; 5.5% of the BALF samples yielded pure cultures; and 84.1% yielded mixed aerobic bacterial growth . In BALF from 29.2% of the pigs, < or = 5 x 10(2) CFU of bacteria/ml were isolated . The total number of bacteria in BALF from 50% of the pigs varied between 5 x 10(2) and 10(3) CFU/ml; 10.4% of BALF samples contained between 10(3) CFU/ml and 5 x 10(3) CFU/ml . More than 1 bacterial species were isolated from a single lung lavage of 84.1% of the pigs . Up to 6 species were isolated from a single BALF sample . A total of 443 bacterial isolates were differentiated into 25 bacterial genera and species . Samples of BALF yielded staphylococci (67.6%: Staphylococcus hyicus from 13.4% of the samples and S aureus from 2.4%), alpha-hemolytic streptococci (49.4%), Escherichia coli (42.1%), non-hemolytic streptococci (26.2%), Klebsiella spp (18.3%), micrococci (12.8%), and Coryneformes (11.0%) . Other bacterial species were found, but less frequently.(ABSTRACT TRUNCATED AT 250 WORDS) Oral Microbiol Immunol, 1994 Dec, 9(6), 364 - 71 Kinetics of lactose-reversible coadhesion of Actinomyces naeslundii WVU 398A and Streptococcus oralis 34 on the surface of hexadecane droplets; Ellen RP et al.; Most investigations of mechanisms accounting for intergeneric coaggregation have emphasized stereospecific rather than nonspecific interactions . The purpose of this investigation was to determine the relative importance of lectin-carbohydrate and nonspecific hydrophobic and ionic interactions, using a model based on strains with one of the most well understood specific coaggregation mechanisms, the lactose-reversible coaggregation of Actinomyces naeslundii and Streptococcus oralis . The kinetics of coadhesion and desorption of coadherent bacteria were studied using S . oralis 34 bound to hexadecane droplets as an affinity support for the adhesion of A . naeslundii WVU 398A . Light, confocal microscopy and transmission electron microscopy confirmed that A . naeslundii cells adhered only to the S . oralis cells, not to exposed hexadecane between the streptococci . Coadhesion was inhibited by lactose concentrations as low as 2.0 mM . The rate of coadhesion was halved at 60 mM lactose . The hydrophobicity inhibitors bovine serum albumin and defatted bovine serum albumin and the salts LiCl and KCl failed to inhibit coadhesion in the hexadecane assay, and bovine serum albumin also failed to inhibit coaggregation in a bacterial aggregation assay on glass slides . High concentrations of the salts achieved a 50% rate decrease in A . naeslundii adhesion to the S . oralis-coated droplets only when they were combined with > 20 mM lactose . Sodium dodecyl sulfate (SDS) and Tween 20 inhibition was tested by the slide coaggregation assay because they tended to emulsify the droplets; SDS was inhibitory . Lactose selectively desorbed A . naeslundii from S . oralis-coated droplets at low concentrations equivalent to those that inhibited coadhesion . Neither LiCl nor KCl desorbed A . naeslundii from the droplets, even at 500 mM . At low concentrations, SDS but not Tween 20 eluted both A . naeslundii and S . oralis from the droplets . Although the SDS results might suggest a degree of cooperative charge interactions, the results support the hypothesis that stereospecific, beta-galactoside-sensitive interactions have a much greater impact than nonspecific interactions on the coadhesion of A . naeslundii and S . oralis. J Nihon Univ Sch Dent, 1994 Dec, 36(4), 276 - 82 Adsorption of salivary proteins to the surface of oral streptococcal cells; Tamura M et al.; Oral tissues, especially tooth surfaces, are covered with a layer of salivary proteins . Oral bacterial cells that adsorb to salivary components accumulated on the tooth surface are, as a rule, covered with the same components, especially proteins . Thus, it is possible that the salivary proteins covering the bacterial cells are related to the adhesion of bacteria to oral tissues . The aim of this study was to clarify the mechanisms of adsorption of salivary proteins to the surface of Streptococcus sanguis, S . mitis and S . salivarius using an adsorption assay with salivary proteins labeled with tritiated formaldehyde . The results showed that salivary proteins adsorbed more to S . salivarius than to S . mitis, and least to S . sanguis . It was evident that hydrophobic bonding was involved in the adsorption of salivary proteins to the bacterial cells tested . The amount of salivary proteins adsorbed to S . mitis and S . salivarius was decreased by the presence of phosphate, that to S . sanguis was increased by the presence of a divalent cation such as Ca2+, and that to all bacteria tested was inhibited in different ways by the presence of sugars . The amount of salivary proteins adsorbed to S . sanguis and S . salivarius was reduced effectively by pretreatment of the cells with trypsin, chymotrypsin and papain . In the case of S . mitis, the amount of adsorbed salivary proteins was decreased by pretreatment of the cells with chymotrypsin only, and was increased by pretreatment with lipase . These results indicate that there are different mechanisms of adsorption of salivary protein to the cell surfaces of oral streptococci. Rev Prat, 1994 Dec 1, 44(19), 2577 - 80 {What is happening to acute rheumatic fever?}; Stephan JL; Rheumatic fever is an inflammatory disease of the heart, joints, central nervous system and subcutaneous tissues that develops after a nasopharyngeal infection by one of the group A beta-haemolytic streptococci . The pathogenesis remains an enigma . As the disease has been less florid and some of the more characteristic manifestations less common in developed countries, it has become more difficult to establish the diagnosis on clinical grounds . Rheumatic fever and its sequellae are still active in developing countries . Carditis is a dominant feature of this social disease . Renewed educational efforts concerning this preventable disorder are needed among both physicians and the public. Am J Obstet Gynecol, 1994 Dec, 171(6), 1668 - 72 Induction of interleukin-1 receptor antagonist in rhesus monkeys after intraamniotic infection with group B streptococci or interleukin-1 infusion; Witkin SS et al.; OBJECTIVE: Interleukin-1 receptor antagonist is a natural inhibitor of interleukin-1, a cytokine implicated in the initiation of preterm labor after intraamniotic infection . The effects of intraamniotic infection and interleukin-1 infusion on the appearance of interleukin-1 receptor antagonist in amniotic fluid and fetal and maternal plasma were assessed with a monkey model . STUDY DESIGN: On day 130 of pregnancy four chronically catheterized rhesus macaques received intraamniotic inoculations of group B streptococci, three monkeys received intraamniotic infusions of recombinant human interleukin-1 beta, and three monkeys received buffered saline solution infusions . At timed intervals samples of amniotic fluid, fetal plasma, and maternal plasma were assayed for interleukin-1 beta and interleukin-1 receptor antagonist by immunoassays . Uterine activity was continuously monitored by intraamniotic pressure catheters and by electromyographic activity . RESULTS: Interleukin-1 receptor antagonist, but not interleukin-1 beta, was present in the amniotic fluids of all monkeys before intervention . Infection induced the appearance of interleukin-1 beta and an increase in interleukin-1 receptor antagonist in the amniotic fluid . Interleukin-1 beta infusion resulted in a similar increase in the intraamniotic concentration of interleukin-1 receptor antagonist . Both infection and interleukin-1 beta infusion were followed by the transient appearance of interleukin-1 receptor antagonist in the plasma of all fetuses . The subsequent decrease in plasma levels was paralleled by increased amniotic fluid levels of interleukin-1 receptor antagonist . Interleukin-1 beta and interleukin-1 receptor antagonist were not detected in maternal plasma . Both infection and interleukin-1 infusion induced preterm labor in all treated animals . CONCLUSIONS: Interleukin-1 receptor antagonist is a normal component of monkey amniotic fluid . Intraamniotic infection or the appearance of interleukin-1 beta in the amniotic fluid results in increased production of interleukin-1 receptor antagonist . Under physiologic conditions interleukin-1 receptor antagonist in amniotic fluid may inhibit interleukin-1-induced preterm labor. Am J Obstet Gynecol, 1994 Dec, 171(6), 1660 - 7 An experimental model for intraamniotic infection and preterm labor in rhesus monkeys; Gravett MG et al.; OBJECTIVE: Our purpose was to describe the temporal and quantitative relationship between intraamniotic infection and preterm labor in a nonhuman primate model . STUDY DESIGN: On day 130 of gestation (term 167 days) four chronically instrumented rhesus monkeys (Macaca mulatta) were infected with an intraamniotic inoculation of 10(6) colony-forming units of group B streptococci . Four additional noninfected monkeys were followed up to spontaneous parturition as controls . Amniotic fluid was serially sampled in all monkeys both before and after inoculation for bacterial growth, tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6, prostaglandin E2, and prostaglandin F2 alpha, and uterine activity was continuously recorded . RESULTS: Increases in uterine contractility occurred 28 hours (range 14 to 40 hours) after inoculation and were preceded by increases in amniotic fluid cytokines and prostaglandins . Intraamniotic concentrations of tumor necrosis factor-alpha, interleukin-6, and interleukin-1 beta all rose dramatically 9, 15, and 18 hours after infection and 10 to 20 hours before increases in uterine contractility . In spontaneous parturition only interleukin-6 concentrations rose moderately (from 0.1 to 1.2 ng/ml) . Increases in prostaglandin E2 and prostaglandin F2 alpha paralleled those of the cytokines . Peak prostaglandin concentrations in intraamniotic infection exceeded by severalfold concentrations seen in spontaneous parturition (16,046 pg/ml vs 2765 pg/ml for prostaglandin E2, p < 0.05; and 5547 pg/ml vs 708 pg/ml for prostaglandin F2 alpha, p < 0.05) . In spite of intraamniotic none of the monkeys were febrile or had peripheral leukocytosis at the onset of labor . CONCLUSION: In the rhesus monkey, after intraamniotic infection, there is a predictable and sequential increase in amniotic fluid tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-6, followed by increases in prostaglandin E2 and prostaglandin F2 alpha . These increases all occur before an increase in uterine contractility and before clinical signs of infection . Our data provide evidence for a cause-and-effect relationship between intraamniotic infection and preterm labor and support the utility of measuring interleukin-6 or other cytokines in the diagnosis of intraamniotic infection. Int J Paediatr Dent, 1994 Dec, 4(4), 245 - 50 Use of the strip mutans test in the assessment of caries risk in a group of preschool children; Twetman S et al.; The purpose of this study was to evaluate the use of a chair-side test involving a count of salivary mutans streptococci (the Strip mutans test) in the assessment of caries risk in a group of preschool children living in an area with a low caries prevalence . A group of 528 4-year-old children were randomly allocated to a study or a control group . In the study group, the baseline microbial data, together with clinical findings of past caries experience, were used for caries risk assessment and for planning subsequent preventive treatment . All children were examined at baseline and after 2 years . Caries experience was assessed according to WHO criteria . There was no difference in caries experience between the study group and the control group at baseline . Within the study group, caries increment was positively correlated (P < 0.01) with the number of mutans streptococci in saliva at baseline, and children assessed 'at risk' at baseline (Strip mutans score > or = 2 and/or > or = 1 dmfs) developed more new lesions than those considered as 'low risk' (mean dmfs 2.6 v 0.9; P < 0.05) . The sensitivity and specificity of this combined clinical and microbial caries risk selection were 67% and 75%, respectively, disease being defined as an increment of at least one carious lesion over the 2-year period . In both groups, 50% of the children remained caries inactive during the study . The mean caries increment was, however, lower in the study group than in the control group (mean dmfs 1.7 v 2.1) but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS) Gen Pharmacol, 1994 Dec, 25(8), 1563 - 6 Cephalexin concentrations in radicular granuloma following a single oral administration of 250- or 500-mg cephalexin; Akimoto Y et al.; 1 . Cephalexin concentrations in radicular granuloma and serum following a single oral administration of 250- or 500-mg cephalexin were measured by a paper disk method . 2 . The highest concentration of cephalexin in radicular granuloma following administration of 250-mg cephalexin to nonfasting patients was observed at 2 hr, and was 1.62 micrograms/g . The mean cephalexin concentration ratio of radicular granuloma/serum at 2 hr was 0.35 . 3 . The highest concentrations of cephalexin in radicular granuloma following administration of 500-mg cephalexin to nonfasting and fasting patients occurred at 2 and 1.5 hr, and was 3.35 and 3.42 micrograms/g, respectively . Mean cephalexin concentration ratios of radicular granuloma/serum at 2 and 1.5 hr were 0.32 and 0.30, respectively . 4 . All mean cephalexin concentrations in radicular granuloma following administration of 500-mg cephalexin to both fasting and nonfasting patients exceeded MIC for 90% (2 micrograms/ml) of clinically isolated strains of alpha-hemolytic streptococci . However, those concentrations obtained by 250-mg cephalexin did not exceed it. Arch Oral Biol, 1994 Dec, 39(12), 1057 - 62 Colonization by mutans streptococci in the mouths of 3- and 4-year-old Chinese children with or without enamel hypoplasia; Li Y et al.; This case-control study compared the prevalence and concentration of mutans streptococci (MS) in saliva between children with and without enamel hypoplasia (EHP) . A total of 486 3- or 4-year-old Chinese children were initially screened for EHP, then distributed into two groups: 234 children diagnosed as having EHP were assigned to the case group; 252 who were free of EHP were included in the control group . The concentration of MS in saliva was assayed for each child . Nutritional status was deduced from body height and weight . Birth weight, prematurity, and nursing history were also determined . MS were found in 94.7% of the study population . The differences in MS concentrations were not associated with low birth weight, prematurity, length of breast feeding, or body height and weight . A statistically significant association existed between the presence of EHP and high counts of MS (p < 0.001) . High MS counts were correlated with severity of enamel defects (p < 0.001) . When the caries status of the children was controlled as the confounding factor in statistical analyses, the association between EHP and MS decreased but still remained significant (p = 0.025) . This study shows that high MS counts are correlated with EHP, suggesting that irregularities in enamel surfaces could be a contributing factor that fosters the increased colonization of MS in the mouths of children. Antimicrob Agents Chemother, 1994 Dec, 38(12), 2846 - 9 Simulation of amoxicillin pharmacokinetics in humans for the prevention of streptococcal endocarditis in rats; Fluckiger U et al.; The pharmacokinetic determinants of successful antibiotic prophylaxis of endocarditis are not precisely known . Differences in half-lives of antibiotics between animals and humans preclude extrapolation of animal results to human situations . To overcome this limitation, we have mimicked in rats the amoxicillin kinetics in humans following a 3-g oral dose (as often used for prophylaxis of endocarditis) by delivering the drug through a computerized pump . Rats with catheter-induced vegetations were challenged with either of two strains of antibiotic-tolerant viridans group streptococci . Antibiotics were given either through the pump (to simulate the whole kinetic profile during prophylaxis in humans) or as an intravenous bolus which imitated only the peak level of amoxicillin (18 mg/liter) in human serum . Prophylaxis by intravenous bolus was inoculum dependent and afforded a limited protection only in rats challenged with the minimum inoculum size infecting > or = 90% of untreated controls . In contrast, simulation of kinetics in humans significantly protected animals challenged with 10 to 100 times the inoculum of either of the test organisms infecting > or = 90% of untreated controls . Thus, simulation of the profiles of amoxicillin prophylaxis in human serum was more efficacious than mere imitation of the transient peak level in rats . This confirms previous studies suggesting that the duration for which the serum amoxicillin level remained detectable (not only the magnitude of the peak) was an important parameter in successful prophylaxis of endocarditis . The results also suggest that single-dose prophylaxis with 3 g of amoxicillin in humans might be more effective than predicted by conventional animal models in which only peak levels of antibiotic in human serum were stimulated. Antimicrob Agents Chemother, 1994 Dec, 38(12), 2683 - 8 Parenteral sparfloxacin compared with ceftriaxone in treatment of experimental endocarditis due to penicillin-susceptible and -resistant streptococci; Entenza JM et al.; A new, investigational, parenteral form of sparfloxacin was compared with ceftriaxone in the treatment of experimental endocarditis caused by either of three penicillin-susceptible streptococci or one penicillin-resistant streptococcus . Both drugs have prolonged half-lives in serum, allowing single daily administration to humans . Sparfloxacin had relatively low MICs (0.25 to 0.5 mg/liter) for all four organisms and was also greater than or equal to eight times more effective than the other quinolones against 21 additional streptococcal isolates recovered from patients with bacteremia . Ceftriaxone MICs were 0.032 to 0.064 mg/liter for the penicillin-susceptible strains and 2 mg/liter for the resistant isolate . Both antibiotics resulted in moderate bacterial killing in vitro . Rats with catheter-induced aortic vegetations were inoculated with 10(7) CFU of the test organisms . Antibiotic treatment was started 48 h later and lasted either 3 or 5 days . The drugs were injected at doses which mimicked the kinetics in human serum produced by one intravenous injection of 400 mg of sparfloxacin (i.e., the daily dose expected to be given to human adults) and 2 g of ceftriaxone . Both antibiotics significantly decreased the bacterial densities in the vegetations . However, sparfloxacin was slower than ceftriaxone in its ability to eradicate valvular infection caused by penicillin-susceptible bacteria . While this difference was quite marked after 3 days of therapy, it tended to vanish when treatment was prolonged to 5 days . In contrast, sparfloxacin was very effective against the penicillin-resistant isolate, an organism against which ceftriaxone therapy failed in vivo . No sparfloxacin-resistant mutant was selected during therapy . Thus, in the present experimental setting, this new, investigational, parenteral form of sparfloxacin was effective against severe infections caused by both penicillin-susceptible and penicillin-resistant streptococci. Med Microbiol Immunol (Berl), 1994 Dec, 183(6), 299 - 306 Protective immunity to the group A Streptococcus may be only strain specific; de Malmanche SA et al.; M protein enables Group A streptococci to resist phagocytosis . Protective immunity is considered to be mediated by opsonic antibodies directed against this M protein . In recent studies we have shown that genetically distinct populations exist within an M-type . The question asked in this study was whether human and rabbit type specific M1 antibody was opsonic for all strains of M-type 1, irrespective of their restriction fragment length polymorphism type . When locating a blood donor from among our staff for use in the indirect bactericidal test, selective variation in opsonic ability was demonstrated by one person . Subsequent testing of 44 randomly selected human sera revealed that 11 (25%) had opsonic antibody . Of these 11, 6 opsonised all seven strains and 5 demonstrated selective opsonisation . We conclude that opsonic antibody is not necessarily type specific but may be strain specific. Tokai J Exp Clin Med, 1994 Dec, 19(3-6), 121 - 4 Surgical treatment of infective endocarditis; Kanabuchi K et al.; From February, 1975 through October, 1990, 26 patients underwent surgical treatment for infective endocarditis at Tokai University Hospital . The overall operative mortality rate was 11.5% (3/26) . The three patients who died were suffering from aortic prosthetic valve endocarditis (PVE) in the active stage . Among 16 patients in the active stage, the mortality rate was 18.7% (3/16) Among 10 patients with native valve endocarditis (NVE) in the healed stage, all survived . Among the total of 21 patients with NVE, the mortality rate was zero and among those with PVE, the rate was 60% (3/5) . Various species of streptococci were the most common organisms encountered, followed by Staphylococcus epidermides . The two PVE patients with S . epidermides died . Nine of the 11 NVE cases in the active stage were of the localized type . Only one case of the localized type of PVE suffered from an infected mitral bioprosthetic valve . The 6 extensive-type cases had aortic valve endocarditis (2NVE, 4PVE) . Three patients with the extensive type of PVE died . We conclude that patients with infective endocarditis who develop progressive congestive heart failure, recurrent embolization, or progressive sepsis despite antimicrobial treatments, should undergo prompt valve replacement within 7 days after institution of therapy. Ugeskr Laeger, 1994 Nov 14, 156(46), 6869 - 73 {Diagnosis of sore throat . A multipractice study of 3 different ways of antigenic determination for detection of group A streptococci in throat swabs}; Andersen JS et al.; During five months in the winter of 1992/1993, 34 general practitioners (GPs) from 18 offices participated in a clinical testing of three group A streptococcal antigen detection test (ADT) kits (Abbott TestPack Strep A Plus (Abbott), Concise Strep A, Hybritech (Concise) and Kodak SureCell Strep A (Kodak)) . The GPs obtained duplicate throat swabs, one for processing with the ADT kit, the other for culture reference at The Streptococcus Laboratory (Bacteriological Department, Statens Seruminstitut, Copenhagen) . A total of 1389 patients were enrolled in the study, thirty percent of whom were infected by group A streptococci . The following results were obtained: Abbott: Sensitivity: 76%, specificity: 99%, positive predictive value: 97%, negative predictive value: 91% . Concise: Sensitivity: 82%, specificity: 95%, positive predictive value: 86%, negative predictive value: 92% . Kodak: Sensitivity: 84%, specificity: 87%, positive predictive value: 73%, negative predictive value: 93% . As a follow-up to the main study, each GP filled in a questionnaire, stating his opinion about the investigated ADT kit . Considering the practical handiness, Concise scored higher than Abbott, which in turn scored higher than Kodak . In conclusion, Abbott and Concise are recommended for the diagnosis of group A streptococcal pharyngotonsillitis in general practice. Presse Med, 1994 Nov 12, 23(35), 1616 - 20 {Fluoroquinolones in respiratory infections}; Mouton Y et al.; Given orally, currently marketed fluoroquinolones, ciprofloxacin, ofloxacin and pefloxacin are absorbed rapidly, have an excellent diffusion coefficient . They are wide-spectrum first intention antibiotics effective against Gram negative bacilli, staphylococci and intracellular germs such as Legionella, Chlamydiae and mycoplasms . The spectrum does however not include streptococci, and in particular pneumococci, and anaerobic germs . The development of resistant strains, particularly in hospital settings, have been observed and despite their fundamental properties, the use of fluoroquinolones has been restrained for infections of the respiratory tract . Actually, the insensitivity of pneumococci or anaerobic germs means that fluoroquinolones cannot be used empirically for isolated cases of pneumonia or sinusitis . They can however be used successfully, either empirically, in a combination regimen or after identification of the bacteria, for treating infections due to Gram negative bacilli (superinfection of chronic bronchitis or cystic fibrosis, otitis) or intracellular germs (pneumonia) . In the near future, when new fluoroquinolones active against pneumococci or anaerobic germs are introduced, therapeutic options will be modified. Appl Environ Microbiol, 1994 Nov, 60(11), 4207 - 9 Duplication of the lantibiotic structural gene in M-type 49 group A streptococcus strains producing streptococcin A-M49; Hynes WL et al.; Streptococcin A-M49 is produced by certain strains of M-type 49 group A streptococci . The structural gene for streptococcin A-M49 was cloned after hybridization with a probe containing the scnA lantibiotic structural gene . Sequence analysis revealed a duplication of the scnA gene; each gene (scnA' and scnA") encoded a 51-amino-acid prepeptide. J Dent Res, 1994 Nov, 73(11), 1742 - 7 A quantitative study of calcium binding by isolated streptococcal cell walls and lipoteichoic acid: comparison with whole cells; Rose RK et al.; Calcium-binding by surface components of oral bacteria may have important effects on remineralization/demineralization phenomena and plaque cohesion . Additionally, some species export large quantities of lipoteichoic acid, possibly as a protective measure . Measurement of calcium-binding can facilitate prediction of how this will effectively buffer plaque fluid calcium concentration and affect these processes . Using equilibrium dialysis, we measured calcium-binding capacities and affinities at pH 7.0 in isolated cell walls of Streptococcus downei, S . sanguis, and purified lipoteichoic acid (LTA) of S . sanguis . Mean binding capacities were: 56.5 mumol Ca/g wet weight for S . downei cell walls and 47.2 mumol Ca/g wet weight for S . sanguis cell walls, and 1.11 mol Ca/mol LTA phosphate were found . Mean dissociation constants (mmol/L) for cell wall calcium binding were 2.16 mmol/L (S . downei) and 2.69 mmol/L (S . sanguis) . These constants were not significantly different from those for whole cells of the same species (Rose et al., 1993), but the dissociation constant for LTA (7.82 mmol/L) was significantly higher and suggested a different mode of binding . At neutral pH, at the known calcium concentration of plaque fluid, whole cells and cell walls are likely to be completely saturated with calcium, whereas free LTA is only 30% saturated . The large amounts of LTA exported by some sucrose-grown streptococci may therefore act as a calcium buffer and so protect the organisms against high local concentrations of calcium produced during demineralization. J Med Microbiol, 1994 Nov, 41(5), 324 - 8 Lectin typing of beta-haemolytic streptococci of groups A and B; Munoz A et al.; Patterns of agglutination of 124 clinical isolates of beta-haemolytic streptococci (30 group A and 94 group B isolates) by 21 commercial lectins are reported . Cell suspensions were untreated . Nine (30%) of the group A isolates, and 23 (24%) of the group B isolates, were agglutinated by at least one of the lectins . Ten different patterns of agglutination were observed with group A and 15 with group B streptococci . No pattern, except that of non-agglutination by any lectin, was common to group A and group B isolates . In view of the growing interest in the use of lectin typing there is a need for standardisation of assay procedures to enable meaningful comparison of the results of different research groups. J Infect Dis, 1994 Nov, 170(5), 1316 - 9 Carriage of group B Streptococci in pregnant Gambian mothers and their infants; Suara RO et al.; The prevalence of group B streptococcal (GBS) colonization was studied in 136 pregnant women and their newborn infants by collecting vaginal and rectal swabs from the mothers and throat, rectal, and umbilical swabs from their infants . Maternal and infant colonization rates were 22% and 23%, respectively . One-third of infants born to colonized mothers and 15% of infants born to noncolonized mothers had GBS isolated . Of GBS-colonized infants, 50% remained colonized at the mean age of 2 months . Type V was the commonest serotype among GBS isolates from mothers and infants; type III strains were uncommon . The rarity of GBS disease in Gambian infants may be due to low rates of maternal carriage with the more virulent GBS serotypes. Obstet Gynecol, 1994 Nov, 84(5), 816 - 9 Peripartum infection associated with vaginal group B streptococcal colonization; Yancey MK et al.; OBJECTIVE: To determine the frequency of peripartum infection in parturients colonized with group B streptococci . METHODS: We screened 915 obstetric patients for group B streptococcal colonization using selective broth media; 823 had vaginal cultures performed within 2 weeks preceding delivery and received complete follow-up . Vaginal group B streptococcal colonization and other risk factors for peripartum maternal infection were assessed using univariate and multivariate logistic modeling . RESULTS: Two hundred sixteen women (26%, 95% confidence interval {CI} 23-29) were colonized with group B streptococci . Chorioamnionitis or endometritis occurred in 45 of 216 colonized women (21%, 95% CI 15.6-26.4) and 72 of 607 women who were not colonized (12%, 95% CI 9-15; P < .01) . When confounding variables were controlled in a multivariate analysis, the association between group B streptococcal colonization and chorioamnionitis, but not endometritis, was confirmed (odds ratio 3.6, 95% CI 2.1-6.2) . The risk of chorioamnionitis increased in a stepwise fashion with light (odds ratio 1.9, 95% CI 1.0-3.7), moderate (odds ratio 2.6, 95% CI 1.3-5.2), and heavy (odds ratio 3.2, 95% CI 1.5-6.6) colonization . CONCLUSION: Intrapartum vaginal colonization with group B streptococci is an important independent risk factor for chorioamnionitis. Infect Immun, 1994 Nov, 62(11), 4997 - 5002 Beneficial effects of interleukin-6 in neonatal mouse models of group B streptococcal disease; Mancuso G et al.; Previous studies have shown that tumor necrosis factor alpha (TNF-alpha) plays a pathophysiologic role in sepsis induced in rat pups by group B streptococci (GBS) . In this model, TNF-alpha is also partially responsible for the induction of interleukin-6 (IL-6) . The present study was undertaken to investigate the role of IL-6 in neonatal BALB/c mice infected with type III GBS . The effect of anti-IL-6 monoclonal antibodies and recombinant IL-6 on lethality and TNF-alpha production was investigated . In mouse pups infected with GBS strain COH1, plasma IL-6 reached levels of 3,067 +/- 955 and 1,923 +/- 891 U/ml when measured at 22 and 48 h, respectively (P < 0.05 compared with uninfected controls) . Pretreatment with 25 micrograms of anti-IL-6 antibodies totally prevented the increase in circulating IL-6 bioactivity at both 22 and 48 h after infection (P < 0.05) . Treatment with anti-IL-6 also induced a moderate decrease in survival time of mice infected with lethal doses of strains COH1 and COH31, as evidenced by increased lethality (P < 0.05) at 24 to 48 h but not at 96 h . Mouse recombinant IL-6 (12,500 U) given 6 h before challenge with strains COH1 and COH31 consistently increased survival time, as evidenced by decreased (P < 0.05) lethality at 48 to 72 h but not at 96 h . The effects of IL-6 pretreatment were dose dependent, since no protection was observed with doses lower than 12,500 U . In addition, no effects on lethality were noted when IL-6 was given at the time of challenge or at later times . TNF-alpha elevations (P < 0.05 compared with uninfected controls) were measured at 12, 22, and 48 h after challenge with strain COH1 (68 +/- 28, 233 +/- 98, and 98 +/- 34 U, respectively) . Pretreatment with IL-6 significantly (P < 0.05) decreased plasma TNF-alpha levels at 12 and 22 h, with 55 and 69% inhibitions, respectively . Anti-IL-6 had an opposite effect, as evidenced by a 145% increase (P < 0.05) in TNF-alpha levels at 48 h after challenge . Collectively, our data are compatible with the hypothesis that IL-6 is involved in negative feedback regulation of plasma TNF-alpha levels in experimental GBS sepsis . In this model, IL-6 pretreatment can increase survival time . Future studies will be needed to investigate the mechanisms underlying this effect. Infect Immun, 1994 Nov, 62(11), 4868 - 73 Analysis of the role of M24 protein in group A streptococcal adhesion and colonization by use of omega-interposon mutagenesis; Courtney HS et al.; We recently concluded that M protein mediates adherence of group A streptococci to HEp-2 tissue culture cells, because the N-terminal half of M protein blocked adherence and M+ strains attached in greater numbers than M- streptococci . To further assess the role of M protein in adhesion, an M-, isogenic mutant of M type M-, isogenic mutant of M type 24 group A streptococci was constructed by insertional inactivation of the emm24 gene with the omega-interposon flanked by emm24 gene sequences . Southern blot analysis confirmed that the omega-element inserted only into emm24 . The M- isogenic mutant M24-omega 3 did not react with antiserum to M24 protein, not did it survive in whole human blood . Electron micrographs of M24-omega 3 showed a diminution of surface fibrillae and reduced binding of plasma components compared with the parent strain . The adhesion of the M+ parent to HEp-2 cells and to mouse oral epithelial cells was dramatically greater than the adhesion of the M24-omega 3 mutant, although there was no difference between the two in adhesion to human buccal cells . In addition, the parent strain was dramatically more effective than the M24-omega 3 mutant in colonizing the oral cavity of mice . These results indicate that the M24 protein can serve as an adhesin in streptococcal attachment to human cells in tissue culture and is important in the colonization of mouse mucosal surfaces. Mol Microbiol, 1994 Nov, 14(4), 743 - 54 Cell-surface-associated polypeptides CshA and CshB of high molecular mass are colonization determinants in the oral bacterium Streptococcus gordonii; McNab R et al.; The human oral bacterium Streptococcus gordonii expresses, on the cell surface, two antigenically related high-molecular-mass polypeptides denoted CshA and CshB, encoded by genes at separate chromosomal loci . The precursor form of CshA is composed of four distinct segments: (i) a 41-amino-acid residue leader peptide, (ii) N-terminal 42-878 residues, (iii) residues 879-2417 comprising 13 repeat blocks of 101 amino acid residues and three shorter blocks, and (iv) a C-terminal anchor domain similar to those present in some other Gram-positive bacterial cell-wall polypeptides . Insertional mutations within cshA reduced both cell-surface hydrophobicity and ability to adhere to oral Actinomyces naeslundii . Insertional mutations in cshB had less effect on hydrophobicity and coadherence . However, expression of both polypeptides was found to be necessary for streptococci to colonize the murine oral cavity. Mol Microbiol, 1994 Nov, 14(4), 619 - 31 Non-congruent relationships between variation in emm gene sequences and the population genetic structure of group A streptococci; Whatmore AM et al.; To examine the molecular population genetics of the M protein family of Streptococcus pyogenes (group A Streptococcus), the 5' regions of polymerase chain reaction-amplified emm products from 79 M serotypes were sequenced and the phylogeny was compared to estimates of overall genetic relationships among strains determined by multilocus enzyme electrophoresis . Although the 5' emm sequences from several strains designated as distinct M types were identical or almost identical, the overall pattern is characterized by very extensive variation . The composition of distinct emm sequence clusters generally parallels the ability of strains to express serum opacity factor and in some cases historical associations of certain M types with acute rheumatic fever, but not with M types classified as nephritogenic . For many strains there is a lack of congruency between variation in 5' emm sequences and estimates of overall chromosomal relationships, which is undoubtedly due to horizontal transfer and recombination of emm sequences . The results of these studies provide insights into the nature and extent of emm sequence variation and describe how this variation 'maps' onto the population genetic structure of extant S . pyogenes lineages . The complexity of emm sequence and streptococcal cell lineage relationships revealed by this analysis has significant implications for understanding evolutionary events generating strain diversity and the epidemiology of S . pyogenes diseases. FEMS Immunol Med Microbiol, 1994 Nov, 10(1), 75 - 80 Streptokinase alleles and disease association in group A streptococci; Haase A et al.; Allele-specific oligonucleotides were used for PCR-based typing of the streptokinase locus of group A streptococcal strains, including well characterized type strains, isolates from patients with acute poststreptococcal glomerulonephritis and strains from Aboriginal communities in the Northern Territory of Australia . The streptokinase SKN allele, previously thought to be associated with glomerulonephritis, was no more frequent in nephritogenic than in non-nephritogenic streptococcal strains in this collection. Res Vet Sci, 1994 Nov, 57(3), 292 - 9 Genetic structure of populations of beta-haemolytic Lancefield group C streptococci from horses and their association with disease; Jorm LR et al.; The genetic structure of beta-haemolytic Lancefield group C streptococci isolated from horses in Australia was examined by multilocus enzyme electrophoresis . The 249 isolates comprised 70 classified phenotypically as Streptococcus equi subspecies equi, 177 classified as S equi subspecies zooepidemicus and two which were unclassifiable . Forty-one electrophoretic types were identified which could be classified into three major clusters, A, B and C . Of the isolates, 178 fell into cluster B (types 4 to 22) and lay within a genetic distance of 0.36 . Sixty-nine of the 70 S equi subspecies equi isolates fell into type 12, which suggests that they were members of a single clone, and the isolates from abscesses were significantly more likely to belong to type 12 than those from horses with no clinical signs (P < 0.001) . There were no other significant associations between electrophoretic types or clusters and the isolation of the organism from particular sites . These data suggested that S zooepidemicus may be the archetypal species from which the clone designated subspecies equi has been derived . If isolates of the subspecies equi from other geographical regions also prove to be members of electrophoretic type 12, this hypothesis would be strengthened. Allerg Immunol (Paris), 1994 Nov, 26(9), 345 - 8 {Choice of antibiotic therapy for acute streptococcus A sore throat: new bacteriologic data}; Philippon A; The choice of antibiotic therapy for sore throat of bacterial origin must be directed against the beta-haemolytic streptococcus A, or more rarely C and G . Recent bacteriological data confirm the raised and constant antibacterial activity in vitro of penicillins V and G, with minimal inhibitory concentrations (CMI) as low as 0.01 mg/ml . Until now, there have been no resistant or reduced sensitivity strains reported . Those strains reported as "tolerant" to penicillin are not correlated with therapeutic checks . As for strains of "intermediate sensitivity" to penicillin, these should be attributed to effects of the diffusion techniques . In contrast, in France now, 8% of strains of streptococcus A are resistant to macrolides and 60% to tetracyclines . Finally, new data show that the different selective powers of beta-lactamines, especially cephalosporins, introduce risks of modification of the oro-pharingeal ecology, linked in part with transfer of genetic material between commensal streptococci of reduced sensitivity to beta-lactamines to sensitive pneumococci . All these data emphasize the importance of an antibiotic therapy that is directed to streptococcus A, with a strong and constant bactericidal activity, without risk of selection or appearance of strains of resistant streptococcus A, and that will not disturb the long term bacterial ecology of the oro-pharynx . Now, in 1994 phenoxymethylpenicillin, Oracilline, penicillin V has the place of reference in the treatment of bacterial acute sore throat. Allerg Immunol (Paris), 1994 Nov, 26(9), 337 - 40 {Targetted antibiotic therapy . Acute sore throat: streptococcus A update}; Reinert P; Acute sore throat is a very common pathology, but should not because of this be considered as banal . In effect, the beta-haemolytic streptococcus A, which is responsible for most of the bacteriological etiologies is not only responsible for distant inflammatory complications, acute articular rheumatism (RAA) and glomerulonephritis, which are re-appearing in the United States, but also a fulminating septicemia and a syndrome of visceral failure that makes a grave prognosis for life . Moreover, today, streptococcus A is one of the factors involved in a series of fatal fasciites and necrosing myosites seen in several European countries . Understanding of these complications gives better definition of the causative immunological mechanisms and particularly the adverse role of the "superantigens" of streptococci in the start of an increase in the responses of immunocompetent cells and pro-inflammatory and prothrombic mediators . Finally, availability now of rapid diagnostic tests with monoclonal antibody techniques confirms the presence of streptococci A in acute sore throat and should help the physician to make an etiological diagnosis that takes into account the clinical signs . Unfortunately, these tests are not widely available in France and are not subject to reimbursement . All these factors justify the introduction of an antibiotherapy targetted at streptococcus A in the context of bacterial sore throat . Oral penicillin V (phenoxymethyl penicillin, Oracilline) is always the reference, with an excellent anti-bacterial and clinical activity and without risk of production of strains of streptococcus that are of reduced sensitivity or resistant.(ABSTRACT TRUNCATED AT 250 WORDS) J Clin Microbiol, 1994 Nov, 32(11), 2698 - 701 Evaluation of two rapid antigen assays, BioStar Strep A OIA and Pacific Biotech CARDS O.S., and culture for detection of group A streptococci in throat swabs; Dale JC et al.; Two rapid methods, BioStar Strep A OIA (OIA; BioStar, Inc., Boulder, Colo.), an optical immunoassay, and CARDS O.S . (O.S.; Pacific Biotech, Inc., San Diego, Calif.), a color immunochromographic assay, and two culture methods, one with 5% sheep blood agar (SBA) and one with Todd-Hewitt broth (TH; Remel, Lenexa, Kans.), were evaluated for use in the detection of Streptococcus pyogenes from pharnygeal swabs . Seven hundred forty-six double swabs (Culturette II) were processed, with OIA and SBA culture performed on one swab and O.S . and SBA culture performed on the other swab . The pledget from the Culturette II was incubated overnight in TH and was subcultured onto SBA for an additional 48 h in ambient air . All beta-hemolytic streptococci from culture were tested by a direct fluorescent-antibody test (Difco Laboratories, Detroit, Mich.) . Specimens with discordant fluorescent-antibody test and rapid test results were also tested by using the Streptex latex agglutination reagent (Murex Diagnostics Limited, Dartford, England) . The results obtained by all testing methods were compared with a combined test result ("gold standard"), which was defined as any positive culture detected by the SBA or TH culture methods and confirmed by Streptex latex agglutination or, in the case of negative results by both culture methods, a concomitant positive result by OIA and O.S . antigen testing . Sensitivity and specificity results for each of the methods were as follows, respectively: OIA, 81.0 and 97.5%; O.S., 74.4 and 99.0%; SBA culture, 92.3 and 98.3%; and TH culture, 86.4 and 100% . Both OIA and O.S . are suitable screening methods for detecting S . pyogenes directly from throat swabs but are of insufficient sensitivity to eliminate the need for backup cultures for specimens with negative OIA and O.S . results. Natl Med J India, 1994 Nov-Dec, 7(6), 263 - 6 Humoral immune response to mutans streptococci associated with dental caries; Parkash H et al.; BACKGROUND . Mutans streptococci are important aetiological agents in dental caries and their prolonged contact with oral tissues evokes a variety of immune responses through local secretory and systemic antibodies . Patterns of such humoral responses in Indian children have not been reported and we undertook the present study to examine these . METHODS . One hundred and twenty-six children with dental caries and 55 matched controls were studied and saliva and sera collected from them . The tests on these specimens included total salivary and systemic immunoglobulins of different classes using radial immunodiffusion and Streptococcus mutans specific IgA, IgG and IgM using specifically standardized enzyme immunoassays . RESULTS . Children with caries had higher levels of IgG (1350 +/- 9.9 mg/dl; controls 1110 +/- 6.7 mg/dl) and IgA (260 +/- 1.8 mg/dl; controls 190 +/- 1 mg/dl) in the serum but their saliva had lower levels of total IgG (160 +/- 0.7 mg/dl; controls 340 +/- 2.9 mg/dl) and IgA (130 +/- 0.5 mg/dl; controls 410 +/- 3 mg/dl) . IgM levels in caries children and controls were not significantly different . Higher levels of Streptococcus mutans specific IgA were detected in the saliva of 95 out of 126 (75%) children with caries compared to 13 out of 55 (22%) controls . Specific serum IgG and IgA levels were also increased in 105 and 114 children with caries, although the levels were not as high as those in saliva . Total and specific salivary and serum IgM antibodies were similar in children with caries and control subjects . CONCLUSION . The nature of the humoral immune response in Indian children with dental caries suggests that Streptococcus mutans specific salivary and serum antibodies may play a major role in pathogenesis . Our findings may have importance when devising methods for follow up and prognosis as well as for vaccination strategies. APMIS, 1994 Nov, 102(11), 810 - 6 Bacterial interference in vitro . Comparison between a quantitative kinetic and a cocultivation blood agar test method; Johansson A et al.; The aim of the present study was to compare two methods for estimation of bacterial growth interference between various bacteria using a Bioscreen robot analyzer, allowing kinetic documentation, and a cocultivation test on blood agar plates . Six laboratory strains with different virulence and growth requirements were used: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum, Streptococcus mitis, Staphylococcus aureus, and Staphylococcus epidermidis . The interference activity was correlated with a reference system of Streptococcus sanguis (strain alpha 89) and Streptococcus pyogenes (group A streptococci, GAS serotypes T 9 and T 22) . The methods used and results obtained were as follows: 1 . Estimation of synergistic and antagonistic bacterial interferences using a Bioscreen robot analyzer . Suspensions of viable bacteria were added to microtiter plates with different concentrations of UV light-killed bacteria in liquid media . The Bioscreen analyzer monitored bacterial growth every 10 min for 24 h giving kinetic data during the growth period . Synergisms as well as antagonisms were demonstrated between the tested bacterial strains which have not earlier been reported in the literature . However, the antagonistic effect observed between the six strains was less than that induced by the S . sanguis strain on the two strains of S . pyogenes . 2 . Cocultivation of bacterial strains on blood agar surface with precultivated or simultaneously stamped interfering bacteria indicated no detectable interference between the six tested bacterial strains, while the S . sanguis strain inhibited the growth of S . pyogenes strains as well as the hemolysis around the colonies . The Bioscreen method was found more sensitive for testing bacterial interference compared to the commonly used blood agar test. J Pak Med Assoc, 1994 Nov, 44(11), 256 - 7 Carriage of beta haemolytic streptococci (BHS) in pregnant women and acquisition by neonates; Kirmani N et al.; Beta Haemolytic Streptococci(BHS) carriage rate in pregnant women during labour and its acquisition by their newborns just after birth was investigated in 60 mother baby pairs . The carriage rate of group B Streptococci (GBS) was 11.6%, acquisition rate by newborns of carrier and non-carrier mothers was 85.7% and 1.8% respectively . A total of 28.5% newborns were carrying GBS on all the skin sites and were heavily colonized and therefore, at higher risk of developing early onset of Streptococcal infections . Penicillin G and Ampicillin were most effective antibiotics against GBS. Enferm Infecc Microbiol Clin, 1994 Nov, 12(9), 426 - 32 {Clinical significance of bacteremia caused by streptococci of the viridans group}; Ruiz MP et al.; BACKGROUND: The viridans group Streptococcus (SVG) include species which may have different pathogenic capacity . This study was aimed at evaluating the clinical significance of bacteremia by different species of SVG . PATIENTS AND METHODS: One hundred ninety-four clinical records of patients with blood culture(s) isolation (Hemoline/BioMerieux) of SVG (Api 20 STREP/BioMerieux) over 9 years were reviewed with criteria of clinical significance being established and the results analyzed by the chi square test . RESULTS: The most frequent species of SVG isolated were: S . sanguis II (29.4%), S . mitis (27.3%) and S . anginosus (12.9%) . With regard to the criteria established, 36% of the isolates were clinically significant, associating S . anginosus with significant bacteremia (p = 0.001) and S . mitis with non significant bacteremia (p = 0.04) . More than half of the isolations of S . anginosus, S . bovis, S . mutans and S . adjacens were clinically significant with this rate being lower in the remaining species (S . sanguis I, S . sanguis II, S . mitis, S . salivarius and S . acidominimus) . The significant isolations correspond with endocarditis (S . sanguis II being responsible for 44%; p = 0.05) . In 54.3% of the cases followed by abscesses or other localized infections and severe sepsis in patients with a solid or hematologic tumor with a mortality of 20% . The endocarditis/other disease relation was: greater for the existence of endocarditis for S . sanguis II, S . sanguis I, S . mutans, S . bovis and S . adjacens; similar in both diseases for S . mitis, and greater for the existence of a non endocardic disease for S . anginosus . CONCLUSIONS: In this series the isolation of SVG group was clinically significant in 36% of cases with a probability of clinical significance and disease association related to the species isolated of SVG. Zentralbl Bakteriol, 1994 Nov, 281(4), 526 - 33 Distribution of genes conferring combined resistance to tetracycline and minocycline among group B streptococcal isolates from humans and various animals; Schwarz S et al.; Forty-nine tetracycline and minocycline resistant streptococci of serological group B isolated from humans, cattle, pigs and nutrias were investigated for the presence of genes conferring this combined resistance . Southern blot hybridization of EcoRI-digested chromosomal DNA of the bacteria revealed for 39 of the cultures a hybridization signal with tet(M), for four of the cultures a hybridization signal with tet(O) and for none of the cultures a hybridization signal with the tet(Q) gene probe . The restriction endonuclease digested and blotted DNA of six tetracycline and minocycline resistant group B streptococci did not hybridize with any of the available gene probes . The tet(M) gene probes recognized complementary sequences of EcoRI fragments of approximately 10.5 kb and 21.5 kb, the tet(O) gene probe hybridized with fragments of approximately 19 kb . The hybridization of the tet(M) gene probe in two different patterns appeared to be related to the origin of the cultures. Med Microbiol Immunol (Berl), 1994 Nov, 183(5), 257 - 64 Major histocompatibility complex class II binding site for streptococcal pyrogenic (erythrogenic) toxin A; Hartwig UF et al.; Streptococcal pyrogenic exotoxin A (SPEA) is an important pathogenicity factor of group A streptococci . It is a member of the family of "superantigens" produced by Staphylococcus aureus and Streptococcus pyogenes and its T lymphocyte stimulating activity is involved into the pathogenesis of certain diseases caused by pyogenic streptococci . In this study we have produced and characterized recombinant SPEA molecules in Escherichia coli . These molecules are indistinguishable from natural SPEA in both T cell stimulatory and HLA class II binding activities . Human class II molecules are more efficient than mouse class II molecules in presenting SPEA to T cells . In binding tests to major histocompatibility complex class II-positive cells SPEA competes with staphylococcal enterotoxin B and A but not with toxic shock syndrome toxin-1. Pediatr Nurs, 1994 Nov-Dec, 20(6), 578 - 80 Group B streptococcus revisited; Lumb TM; Though the incidence of early-onset neonatal group B streptococci (GBS) infection is relatively low, it remains a significant diagnosis because of its pernicious consequences . Treatment measures have been directed at antepartum, intrapartum, and neonatal patients in an effort to reduce GBS infections . Neonatal nurses must monitor infants at risk closely and be prepared to act to minimize impact of GBS. J Antimicrob Chemother, 1994 Nov, 34(5), 687 - 96 Postantibiotic effects and postantibiotic sub-MIC effects of benzylpenicillin on viridans streptococci isolated from patients with infective endocarditis; Kikuchi K et al.; We investigated the postantibiotic effects (PAEs) and the postantibiotic sub-MIC effects of benzylpenicillin on three strains of viridans streptococci isolated from infective endocarditis patients . The PAEs of benzylpenicillin on penicillin tolerant Streptococcus sanguis TW-70 (0.4-3.9 h), penicillin tolerant S . sanguis TW-80 (0.3-6.3 h) and nontolerant Streptococcus oralis TW-186 (0.5-3.1 h) were dependent on exposure time . The PAEs were not concentration dependent for S . sanguis TW-70 and S . sanguis TW-80 above the MIC, and for S . oralis TW-186 above 16 x MIC . The antimicrobial effects of benzylpenicillin at sub-MIC concentrations were examined in bacteria pretreated with benzylpenicillin (8 x MIC) for 2 h and compared with untreated bacteria . At the sub-MICs tested, the regrowth of pretreated S . oralis TW-186 cells was more prolonged than that of untreated cells and bactericidal action was seen only in pretreated cells . These effects (so-called 'postantibiotic' sub-MIC effects') were not observed in penicillin tolerant S . sanguis TW-70 . The presence of the postantibiotic sub-MIC effect may be an important factor in determining the dosing regimen for infective endocarditis. Acta Derm Venereol, 1994 Nov, 74(6), 460 - 2 Hydrogen peroxide cream: an alternative to topical antibiotics in the treatment of impetigo contagiosa; Christensen OB et al.; In total, 256 patients with bacteriologically verified impetigo contagiosa were included in three double-blind, parallel group, randomized, multi-centre trials, where the efficacy of hydrogen peroxide cream (Microcid) was compared with that of fusidic acid cream/gel (Fucidin) . The trials were performed at 47 centres in three countries, Sweden, Germany and UK, and the results are compiled in the present report . During the course of the 3-week treatment period, 92 patients out of 128 (72%) in the Microcid group were classified as healed, compared to 105 patients out of 128 (82%) in the Fucidin group . This difference was not statistically significant . The reduction in composite sign severity score (the sum of the score for erythema, vesiculation/bullae, weeping and crusting divided by four) in each separate study was 73%, 78% and 84% in the Microcid group and 85%, 85% and 84% in the Fucidin group . No statistically significant differences were found in the separate studies or when compiling the studies in a meta-analysis . When the patients had been classified as healed, beta-haemolytic streptococci were eliminated in all patients treated with Microcid cream . Since treatment started before the result of the bacteriology was known, another 135 patients with negative skin culture were enrolled in the trials, i.e . 391 patients were included in the safety analysis . Out of these, 23 patients reported the occurrence of adverse events, mainly classified as mild . In conclusion, Microcid cream has been documented as a topical alternative to fusidic acid in the treatment of impetigo. Lancet, 1994 Oct 22, 344(8930), 1111 - 5 Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features; Chelsom J et al.; During November, 1992, to May, 1994, 13 patients were treated at Haukeland University Hospital, Norway, for necrotising fasciitis due to group A beta-haemolytic streptococci . 3 patients died, 1 before admission . Mucoid group A streptococci were isolated from affected tissue (12 patients) and/or blood (5) . Strains from 11 patients were serotype M-1 (5 patients), M-3 (2), M-6 (2), M-28 (1), and M-untypable (T-1, opacity factor negative) (1) . For the 12 patients admitted alive, the following preoperative events were recorded: 8 had clinical signs of shock with systolic blood pressure of 90 mm Hg or less, 8 had impaired renal function, and 7 had biochemical markers of disseminated intravascular coagulation . At least 6 patients fulfilled the criteria for streptococcal toxic shock syndrome . Preoperative C-reactive protein was substantially raised ( > 200 mg/L) in 10 patients . The 12 patients were given high doses of antibiotics and were operated on with aggressive debridement of necrotic skin and fascia, 7 of them within 24 h of admission . The increasing incidence of necrotising fasciitis in western Norway reflects the resurgence of invasive group A streptococcal infections documented in Scandinavia since 1987 . The high case-fatality rate can be reduced by early diagnosis and aggressive surgery combined with adequate antibiotic therapy. Mol Gen Genet, 1994 Oct 17, 245(1), 78 - 85 Sequencing of genes within the vir regulon of Streptococcus pyogenes type M15--an opacity factor-positive serotype with low opacity factor expression; Katerov V et al.; Major virulence determinants of group A streptococci, such as M-protein, immunoglobulin Fc-receptors (FcRA, EmmL) and C5a peptidase, appear to be genetically co-regulated, their genes being located within a vir regulon . We studied the organization of these genes in a group A, type M15 strain of Streptococcus pyogenes, previously defined as OF-, by hybridization analysis of chromosomal DNA and of an S . pyogenes gene library in Escherichia coli, and by gene sequencing . Within the vir regulon, in addition to the virR and scpA genes, three so-called emm-related genes were found: fcrA, emmL and enn . Whereas IgG Fc-binding proteins were encoded by fcrA and emmL, the product of enn was not identified . The presence of three emm-related genes in this region is reminescent of vir regulon organization in OF+ rather than OF- strains as earlier defined by others . Furthermore, analysis of the deduced product of the emmL gene showed deletions and amino acid substitutions within the PGTS-rich domain and membrane anchor, which thus resembles corresponding products of OF+ rather than OF- strains . In view of these findings, the opacity factor (OF) activity of the strain was tested using growth supernatant, with negative outcome . However, a concentrated SDS cell extract revealed definite OF activity . One of two other type M15 reference strains also showed definite OF activity in SDS extracts . We therefore propose that type M15 strains belong to the OF+ category but often show low levels of expression of OF. J Immunol, 1994 Oct 15, 153(8), 3557 - 64 Identification of the IgA-binding region in streptococcal protein Arp; Johnsson E et al.; Cell surface proteins that bind to the Fc part of human IgA are expressed by different species of pathogenic streptococci . The most extensively characterized streptococcal IgA-binding protein is the Streptococcus pyogenes protein Arp4, a member of the M protein family . Here we describe work that identifies the IgA-binding region in this streptococcal protein . A comparison of the amino acid sequences of protein Arp4 and four other IgA-binding proteins of S . pyogenes first made possible the identification of a putative IgA-binding region . Site-specific mutagenesis and generation of deletions were then used to show that Arp4 derivatives lacking different parts of the putative IgA-binding region had lost the ability to bind IgA . Conclusive evidence for the localization of the IgA-binding region was obtained through the characterization of a chimeric protein, in which the putative IgA-binding region of Arp4 had been introduced into another S . pyogenes cell surface protein that does not bind IgA . Our data show that a region comprising 29-amino acid residues in the N-terminal part of Arp4 is necessary and sufficient for IgA-binding capacity . Competitive inhibition experiments with synthetic peptides indicated that the C-terminal half of this 29 residue region may be most important for the IgA-binding property of Arp4 . These results identify, for the first time, the ligand-binding region in an Fc alpha binding protein. Tidsskr Nor Laegeforen, 1994 Oct 10, 114(24), 2854 - 6 {Rheumatic fever--does it exist in Norway today?}; Joakimsen RM et al.; During the last 30 years, acute rheumatic fever has been a curiosity in Norway, and only five cases have been reported to MSIS (National Notification System for Infectious Diseases, Norway) in the 1990s . Even so, during the period 1990 to 1992 99 patients were discharged from Norwegian hospitals with the diagnosis acute rheumatic fever . Could the increase in the number of group A-streptococci in the last years have led to a corresponding increase in the incidence of acute rheumatic fever? If so, could such an increase have escaped our attention? We present an updated review of acute rheumatic fever and the case of a young soldier. Obstet Gynecol, 1994 Oct, 84(4), 496 - 500 Neonatal group B streptococcal sepsis during 2 years of a universal screening program; Gibbs RS et al.; OBJECTIVE: To assess the feasibility and efficacy of a protocol for universal screening for group B streptococci combined with selective intrapartum prophylaxis at a teaching hospital . METHODS: This is a descriptive study of experience with a standardized protocol in which patients were screened at 26-28 weeks with a rectal and genital culture placed directly in selective media . As risk factors, we used clinical chorioamnionitis, preterm birth, and rupture of the membranes greater than 12 hours . Participants were all women receiving prenatal care at our hospital . Major outcomes were compliance and neonatal sepsis due to group B streptococci . RESULTS: The prevalence of rectal and genital group B streptococci was 18.5% of 3721 screened women . Of culture-positive women, 35% developed risk factors (9% chorioamnionitis, 13% preterm birth, and 13% membrane rupture greater than 12 hours at term) . With strict application of criteria, the compliance rate in administering indicated prophylaxis was 80.3% . Of women receiving prophylaxis, 42% had the first dose for 4 hours or less before delivery . There were five cases of group B streptococcal neonatal sepsis, resulting from either protocol violations, protocol failures, or both . Compared to the historic rate of group B streptococcal sepsis of 1.5 per 1000 births at our hospital, the rate in these 2 years was 1.0 per 1000 (1.6 per 1000 in the first year and 0.5 per 1000 in the second) . CONCLUSIONS: It is feasible to conduct such a protocol, but compliance is only moderately good because the algorithm is complex . The protocol is not foolproof in preventing neonatal group B streptococcal sepsis, as there are protocol failures and violations. Burns, 1994 Oct, 20(5), 422 - 5 Beta-haemolytic streptococcal infections in burned patients; Lesseva M et al.; Colonization of burn wounds by beta-haemolytic streptococci can lead to the loss of autografts . The present study investigated the beta-haemolytic streptococcal infections in burned patients treated in the Burns Centre of the Emergency Medical Institute 'N . I . Pirogov' . Sofia during a 12-month period (March 1991-March 1992) . As many as 117 beta-haemolytic streptococcal strains were isolated in 114 burned patients (52 children and 62 adults) . The distribution of the streptococcal strains according to their serogroup was 64 strains (54.7 per cent) group A; 34 strains (29.1 per cent) group B; nine strains (7.7 per cent) group G; five strains (4.25 per cent) group C and five other strains (4.25 per cent) group F . Antibiotic sensitivity tests demonstrated the presence of some differences among the serogroups, especially between groups A and B . The sources of the streptococcal infections were found in 26 (29.2 per cent) of the patients . Epidemiological relationships were established between the strains from one source and the wound swab . For the successful treatment of beta-haemolytic streptococcal infections in burns it is essential to bear in mind the role of non-group A beta-haemolytic streptococci (45.3 per cent according to our study). J Appl Bacteriol, 1994 Oct, 77(4), 408 - 11 Biochemical properties and whole-cell protein profiles of group G streptococci isolated from dogs; Vieira VV et al.; Whole-cell protein profiles obtained by SDS-PAGE were used in conjunction with physiological tests to differentiate strains of Streptococcus canis isolated from dogs . Fermentation of trehalose and lactose, aesculin hydrolysis together with production of beta-D-glucuronidase and alpha-D-galactosidase allowed the demonstration of nine different biotypes . However, visual analysis of the protein patterns and comparison by the coefficient of Dice showed minor differences in band patterns among strains . Only two different profiles were observed . Although a correlation between biotyping and protein profile has been found, this kind of analysis did not provide the basis for a typing method. Immun Infekt, 1994 Oct, 22(5), 189 - 91 {Streptococcal myositis in children: four case histories}; Schemken-Birk EM et al.; We report about four children, who suffered from myositis caused by beta-hemolytic group A streptococci (GAS) . The cases were observed during the last 12 months, and differed much in severity . Soft tissue infections caused by GAS are reported with increasing frequency from the USA, Australia and Europe . They occur in hitherto healthy children and young adults, mostly without a predisposing trauma . In children, a preceding varicella infection is often found . Some patients develop a streptococcal toxic shock syndrome with a letality of 20-50% . The bacteria, which can be isolated from normally sterile body sites, are morphologically inconspicuous, and are mostly of the serological type M1 or M3. Int J Syst Bacteriol, 1994 Oct, 44(4), 646 - 50 Streptococcus phocae sp . nov., a new species isolated from clinical specimens from seals; Skaar I et al.; A new beta-hemolytic streptococcal species, Streptococcus phocae, was isolated from organ specimens obtained from seals . This taxon is described on the basis of the results of a study of 22 strains . S . phocae was serologically somewhat heterogeneous (group antigen -/F/C) . Strains belonging to this species exhibited high levels of DNA-DNA homology to each other, as determined by DNA-DNA hybridization, but low levels of DNA-DNA homology to the type strains of other streptococcal species . A simple scheme for the differentiation of S . phocae from other beta-hemolytic streptococci is presented . Strain 8399 H1 (= NCTC 12719) is the type strain of S . phocae. Ned Tijdschr Geneeskd, 1994 Oct 1, 138(40), 2001 - 4 {Toxic shock syndrome in 8 children}; Hazelzet JA et al.; OBJECTIVE . Evaluation of patients with toxic shock syndrome (TSS) in a paediatric hospital . DESIGN . Retrospective analysis . SETTING . Paediatric Intensive Care Unit, University Hospital, Rotterdam, the Netherlands . METHOD . Analysis of the medical records on 155 patients admitted between January 1982 and January 1992 suffering from shock, 8 of whom had TSS . RESULTS . Five out of 8 TSS patients were under 5 years of age . All the patients needed mechanical ventilation . All patients survived . In 7 patients a probably causative focus of infection was found . The cultures of 6 patients showed growth of Staphylococcus aureus, those of 2 patients showed Lancefield group A beta-haemolytic streptococci (bacterial culture in one, increased antibody titer in the other) . Systematic phage typing was not performed . CONCLUSION . Although TSS is a relatively rare disease in young children, it is a potentially lethal one, early recognition of which is very important. J Dent Res, 1994 Oct, 73(10), 1641 - 5 Influence of incorporation of antibacterial monomer on curing behavior of a dental composite; Imazato S et al.; A newly developed monomer, methacryloyloxdodecylpyridinium bromide (MDPB), has an antibacterial activity against oral streptococci, and this monomer can be active even after being immobilized as one component of a cured composite . The purpose of this study was to investigate the influence of incorporation of MDPB on the curing behavior of Bis-GMA-based composites . Depth of cure, degree of cure, light-attenuating effect, and surface hardness of composites incorporating 0.4 or 0.5% MDPB were measured and compared with those of a control material without MDPB . Depth of cure of composites with MDPB, measured by means of a penetrometer, was greater than for the control (p < 0.05) . Differential thermal analysis showed that composites with MDPB had a significantly greater degree of cure than the control (p < 0.05) . The light-attenuating effect of MDPB composites was less than for the control (p < 0.05) . No significant difference between experimental and control was obtained with respect to Vickers hardness after both one day's and seven days' storage in water . These results indicate that the incorporation of small quantities of MDPB into Bis-GMA-based composites did not adversely affect the cure performance . On the contrary, a significant, though small, improvement was observed. J Bone Joint Surg Am, 1994 Oct, 76(10), 1526 - 30 Abscesses secondary to parenteral abuse of drugs . A study of demographic and bacteriological characteristics; Schnall SB et al.; Seventy-seven patients (eighty-six lesions) who had been seen over a fifteen-month period because of an abscess at the site of injection due to parenteral abuse of drugs were identified in a retrospective review . Forty-one patients (forty-five abscesses) had had cultures before antibiotic therapy . Thirty (73 per cent) of the forty-one patients had isolation of a streptococcal species on culture, with microaerophilic streptococci identified in sixteen . Twenty (49 per cent) of the forty-one patients had isolation of a staphylococcal species . Four of the staphylococcal organisms were identified as oxacillin-resistant Staphylococcus aureus . Two patients who had three abscesses each had different organisms in each abscess . Gram-negative bacilli were identified in the cultures of ten (24 per cent) of the forty-one patients; patients who were forty years old or more had a sixfold greater risk of having gram-negative bacilli . Specimens of the abscess had been obtained from thirty-six patients for culture from twelve to seventy-two hours after the first dose of antibiotics had been given . The microbiological findings in these cultures were similar to those in the cultures of specimens obtained from patients before antibiotics had been given . Five (14 per cent) of thirty-five patients who had been tested for the human immunodeficiency virus had a positive result . This finding emphasizes the importance of surveillance for and precautions against the human immunodeficiency virus in people who abuse drugs parenterally. Infect Immun, 1994 Oct, 62(10), 4469 - 80 Nucleotide sequence of the Streptococcus gordonii PK488 coaggregation adhesin gene, scaA, and ATP-binding cassette; Kolenbrander PE et al.; Human oral viridans group streptococci that coaggregate with Actinomyces naeslundii PK606 express surface proteins related to ScaA, the coaggregation-mediating adhesin of Streptococcus gordonii PK488 (R . N . Andersen, N . Ganeshkumar, and P . E . Kolenbrander, Infect . Immun . 61:981-987, 1993) . The nucleotide sequence of the 6,125-bp EcoRI insert of pRA1, containing scaA, the gene encoding ScaA, was determined . Six open reading frames (ORFs) were identified . The orientation of four ORFs, two upstream (ORF 1 and ORF 2) and one downstream (ORF 4) of scaA (ORF 3), indicated transcription in one direction, whereas ORF 5 and ORF 6 were transcribed divergently . Computer analysis of the deduced amino acid sequences identified a consensus binding site for ATP (GxxGxGKS) in the putative 28,054-Da protein encoded by ORF 1 . ORF 2 potentially encoded a hydrophobic protein of 29,705 Da with six potential membrane-spanning regions . ScaA was 310 amino acids, 34,787 Da, and contained the lipoprotein consensus sequence LxxC, also reported for the ScaA-related proteins SsaB, FimA, and PsaA from Streptococcus sanguis 12, Streptococcus parasanguis FW213, and Streptococcus pneumoniae R36A, respectively . ORF 4 potentially encoded a 163-amino-acid protein of 17,912 Da, which was nearly identical to the downstream adjacent gene products of ssaB, fimA, and psaA . No significant homology with other proteins was found with the putative ORF 5 gene product, a 229-amino-acid protein of 25,107 Da . ORF 6 was incomplete and encoded a protein larger than 564 amino acids . This putative protein had a consensus Zn2+ binding motif, HExxH, found among bacterial thermolysins and mammalian neutral endopeptidases and was 40% identical to a homologous 210-amino-acid region of human enkephalinase . The genetic organization of ORFs 1, 2, and 3 was similar to those of the bacterial periplasmic-binding protein-dependent transport systems of gram-negative bacteria and binding-lipoprotein-dependent transport systems of gram-positive bacteria, and these genes appeared to encode ABC (ATP-binding cassette) proteins . This report describes a cell-to-cell adherence function associated with an ATP-binding cassette. Clin Exp Immunol, 1994 Oct, 98(1), 140 - 4 Streptococcal toxic shock-like syndrome: evidence of superantigen activity and its effects on T lymphocyte subsets in vivo; Michie C et al.; Toxic shock-like syndrome is a serious complication of invasive streptococcal disease . The syndrome is believed to be the consequence of exposure to exotoxins produced by the infecting organisms which behave as superantigens . We describe two patients who fulfilled clinical criteria for this syndrome, one of whom died . Streptococci isolated from both patients were found to produce a mitogen specific for the V beta 2+ T lymphocyte subset in vitro, which had the characteristics of a superantigen . The phenotype and function of lymphocytes collected from both patients during the acute phase of their illness demonstrated a marked reduction in circulating CD4+ ('helper') and CD45RA+ ('naive') T lymphocytes expressing the V beta 2 chain, and an increase of those expressing CD8, CD45RO and the V beta 2 chain . This effect resolved within 4 weeks in the patient who survived . Proliferation assays demonstrated no T cell anergy in either patient . Stimulation of lymphocytes by superantigen in these clinical situations does not appear to cause permanent deletion of T cell subsets, as has been observed in animal models. Arch Pediatr Adolesc Med, 1994 Oct, 148(10), 1053 - 60 Effective short-course treatment of acute group A beta-hemolytic streptococcal tonsillopharyngitis . Ten days of penicillin V vs 5 days or 10 days of cefpodoxime therapy in children; Pichichero ME et al.; OBJECTIVE: To compare bacteriologic and clinical efficacy and safety of 10 vs 5 days of cefpodoxime proxetil vs 10 days of penicillin V potassium for the treatment of acute group A beta-hemolytic streptococcal tonsillopharyngitis in children . DESIGN: Prospective, randomized, observer-blind, multicenter study . PATIENTS/INTERVENTIONS: Four hundred eighty-four children (age range, 2 to 17 years) with signs and symptoms of acute tonsillopharyngitis were enrolled; 377 had a positive throat culture for group A beta-hemolytic streptococci and were fully evaluable . One hundred twenty-one patients received cefpodoxime once a day for 10 days, 126 received cefpodoxime twice a day for 5 days, and 130 received penicillin V three times a day for 10 days . RESULTS: Cefpodoxime for 10 days vs cefpodoxime for 5 days vs penicillin V for 10 days produced bacteriologic eradication at the