Streptococci

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 end of therapy in 95%, 90%, and 78% of the patients, respectively . The 10- and 5-day cefpodoxime treatment regimens were more efficacious than penicillin V (P = .003 and P = .02, respectively) . The cumulative bacteriologic failure rate among assessable patients by the 32- to 38-day posttreatment visit was 20 (17%) of 121 patients who were treated with cefpodoxime for 10 days, 24 (19%) of 125 patients who were treated with cefpodoxime for 5 days, and 45 (35%) of 130 patients who were treated with penicillin V for 10 days (P = .001 and P = .005, respectively) . Clinical cure or improvement was observed at the end of therapy in 96%, 94%, and 91% of the patients, respectively (P = not significant) . Adverse events were infrequent and similar in all three treatment groups, with minor gastrointestinal side effects predominating . CONCLUSIONS: Five days of treatment with cefpodoxime is as efficacious in bacteriologic eradication and clinical response (cure plus improvement) as 10 days of cefpodoxime therapy, and both cefpodoxime regimens produced superior bacteriologic efficacy compared with a 10-day regimen of penicillin V in the treatment of group A beta-hemolytic streptococcal tonsillopharyngitis in children.

Eur J Clin Microbiol Infect Dis, 1994 Oct, 13(10), 846 - 50
Comparative efficacy and safety of cefprozil versus penicillin, cefaclor and erythromycin in the treatment of streptococcal pharyngitis and tonsillitis; McCarty JM; Cefprozil is a new oral cephalosporin with an enhanced in vitro spectrum of activity that includes group A beta-hemolytic streptococci (GABHS) . Four multicenter randomized clinical trials were conducted to compare the clinical efficacy and safety of cefprozil administered once or twice a day for the treatment of mild to moderate GABHS tonsillitis and pharyngitis . A total of 1597 patients were enrolled in the trials . Patient demographics and severity of infection were similar for all treatment groups . In Study 1, cefprozil administered at 20 mg/kg once daily was clinically, in 68 of 76 patients (89%) and bacteriologically, in 66 of 74 patients (89%) superior to penicillin -51 of 69 (74%) and 46 of 69 (67%)--administered three times a day in patients of two to 12 years of age . In Study 2, the patients enrolled were 13 years of age and older, and cefprozil administered at 20 mg/kg once a day had similar clinical (93% vs . 90%) and bacteriological (95% vs . 94%) response rates as cefaclor administered three times a day . Study 3 demonstrated that cefprozil administered twice daily was similar to penicillin given three times a day, the clinical satisfactory response being 164 of 175 (94%) for cefprozil and 146 of 165 (88%) for penicillin . In Study 4, identical clinical and bacteriologic responses (95%) were observed for cefprozil administered once a day and erythromycin ethylsuccinate administered four times a day in children over two years of age . There were no significant differences in the incidence or severity of drug-related adverse events, which, when reported, were mild and transient.(ABSTRACT TRUNCATED AT 250 WORDS)

Thromb Haemost, 1994 Oct, 72(4), 595 - 603
Characterization of a novel streptokinase produced by Streptococcus equisimilis of non-human origin; Nowicki ST et al.; Streptokinases are proteins with plasminogen activator activity produced by certain hemolytic streptococci . We previously identified equine streptococcal isolates which produced streptokinases (ESKs) that bound both human and equine plasminogen but only readily activated equine plasminogen (14) . This property was exploited to purify a representative ESK produced by Streptococcus equisimilis strain 87-542-W . Affinity chromatography with human plasminogen resulted in the isolation of a M(r) approximately 49,000 molecule with two isoforms . This ESK was subsequently compared to well characterized streptokinases (HSKs) that efficiently activate human plasminogen . Differences in streptokinases were identified in the highly conserved amino-terminal amino acid sequence, peptide maps, and antigenic properties, and these differences were supported by DNA hybridization studies . These results indicate that the family of proteins identified as streptokinases has much greater diversity than previously appreciated.

Diagn Microbiol Infect Dis, 1994 Oct, 20(2), 77 - 80
Rapid detection of hyaluronic acid capsules on group A streptococci by buoyant density centrifugation; DeAngelis PL et al.; One of the virulence factors of group A streptococci is the hyaluronic acid polysaccharide capsule . A rapid method for ascertaining the status of the capsule phenotype in Streptococcus pyogenes is described . Bacteria with a capsule have a lower buoyant density than acapsular or hyaluronidase-treated cells . Early log phase cultures were underlaid with 65% Percoll and centrifuged at 500-1000 g for 5 min . Upon visual examination, encapsulated cells were observed at the interface, whereas acapsular cells appeared in the pellet . Cultures that produced at least 7 micrograms/ml of hyaluronic acid per A600 unit of cells were detected at the interface; this level of polysaccharide is only about 0.5%-4% of that found for most mucoid strains . Therefore, this procedure can detect capsules around strains that do not appear to be encapsulated by light microscopy or do not possess mucoid colony morphology . Furthermore, this method reduces dependence on other expensive assays that use labile radioactive reagents to detect hyaluronic acid.

Pediatr Infect Dis J, 1994 Oct, 13(10), 854 - 9
Surveillance of pharyngeal colonization: detection and control of serious bacterial illness in low birth weight infants; Finelli L et al.; Routine surveillance for bacterial colonization has been used for the past three decades as a tool for the prediction of nosocomial infection in low birth weight infants; however, its usefulness has never been proven . A prospective cohort study was conducted to examine the utility of surveillance for pharyngeal colonization in detection and control of serious bacterial illness in low birth weight infants . One hundred fifty-four infants who weighed less than 1750 g and who were admitted to the Neonatal Intensive Care Unit were enrolled and followed for a total of 5620 infant-days . Pharyngeal cultures were collected at the time of enrollment and then weekly . All infants had bacterial pharyngeal colonization by the third day of life . Coagulase-negative staphylococci were the most common organisms cultured from the pharynx, followed by viridans streptococci and Staphylococcus aureus . More than 90% of the pharyngeal cultures grew multiple isolates . Gram-positive organisms, particularly coagulase-negative staphylococci, were the most prevalent organism recovered from blood and cerebrospinal fluid cultures . Fifty-two episodes of bacteremia and 6 episodes of cerebrospinal fluid infection occurred in 42 infants . Among infants with viridans streptococci in pharyngeal cultures, the subsequent risk of serious bacterial illness was significantly reduced (odds ratio = 0.16) . However, pharyngeal cultures were poor predictors of the causative organism in an episode of serious bacterial illness . Pharyngeal and blood/cerebrospinal fluid cultures were concordant in only 11% of invasive infections . We conclude that pharyngeal surveillance cultures provide little clinically meaningful information and have no apparent utility in the Neonatal Intensive Care Unit setting.

Acta Odontol Scand, 1994 Oct, 52(5), 294 - 302
Site-related streptococcal attachment to buccocervical tooth surfaces . A correlative micromorphologic and microbiologic study; Bevenius J et al.; Scanning electron (SEM) microscopy of epoxy replicas made from dental impressions has shown that in buccal gingival recession the root surfaces are devoid of cementum, leaving the dentin exposed . In this study replication techniques were applied to correlate the micromorphology of the buccocervical region with early streptococcal attachment . The subjects were 27 healthy young adults . The buccocervical surfaces of all the premolars were meticulously cleaned . The subjects fasted for 2 h before impression-taking . Replicas were made from impressions in hydrophilic A-silicone, and streptococcal attachment was visualized by light microscopy of mitis-salivarius agar replicas incubated anaerobically for 48 h . The surface micromorphology was documented by SEM of corresponding epoxy replicas . Colonization only 2 h after cleaning was very sparse . Sites with healthy or inflamed gingivae had markedly different colonization patterns in the sulcular region . In 4 subjects with a total of 12 sites where gingival recession, undetected clinically, was disclosed by SEM, representative colonies were retrieved and identified microbiologically to species level . Two healthy sites per subject were also sampled . Streptococcus mutans and S . sobrinus were identified from eight sites with exposed root dentin . S . oralis predominated on the enamel surfaces . The method offers a valuable complement to in situ and in vitro microbiologic studies of exposed dentin and a novel technique for sampling clinical isolates of streptococci.

Community Dent Oral Epidemiol, 1994 Oct, 22(5 Pt 1), 273 - 6
Early plaque accumulation--a sign for caries risk in young children; Alaluusua S et al.; Four variables which are capable of measurements at the chairside were assessed for their ability to identify young children who would experience caries during the subsequent 1 1/2 yr period . The total of 92 children and their mothers participated the study . The age of the children at baseline was 19 months . The variables studied were: visible plaque on the labial surfaces of the maxillary incisors, the use of a nursing bottle, mother's caries prevalence and mother's salivary level of mutans streptococci . Visible plaque and the use of a nursing bottle were strongly associated with the caries development, while the other two variables had weak or no statistically significant associations . The best indicator of risk was visible plaque . Its sensitivity was 83%, specificity 92%, positive prognostic value 63% and negative prognostic value 97% . Overall, 91% of the children were correctly classified with this variable, while the corresponding percentage of the other variables ranged from 72 to 77 . The results suggest that visible plaque on the labial surfaces of maxillary incisors of a young child is a sign of caries risk.

Oral Microbiol Immunol, 1994 Oct, 9(5), 278 - 83
Immunoglobulin A antibodies to mutans streptococci in human saliva and serum comparing fresh and subcultivated strains and activity in repeated saliva samples; Widerstrom L et al.; The aims of this study were i) to characterize and compare the sodium dodecyl sulfate-polyacrylamide gel electrophoresis protein patterns of reference Streptococcus mutans and Streptococcus sobrinus strains, subcultivated for years, with fresh isolates of the same serotype; ii) to study possible differences between the human salivary immunoglobulin A (IgA) activity to reference strains and to fresh bacterial isolates of the saliva donors; iii) to examine for potential differences in the salivary IgA activity to the streptococcal antigens during 1 week; and iv) to map, in the same individuals, the serum IgA activity against the selected bacteria . S . mutans reference and fresh isolated strains showed a similar protein pattern with few exceptions . The immunoblot also revealed similarity in saliva IgA response, with only one subject's saliva displaying clearly one band's difference . For S . sobrinus a larger discrepancy was seen . The antibody activity during the one week interval was essentially unchanged . When incubated with serum, a different immunoblot profile was seen compared with saliva, although most bands revealed by saliva were also displayed by serum.

N C Med J, 1994 Oct, 55(10), 464 - 6
Necrotizing fasciitis and myositis caused by group A streptococci . Epidemiology, diagnosis, and treatment of "flesh-eating bacteria"; Abolnik IZ et al.; Despite the absence of conclusive proof, the incidence of necrotizing fasciitis and myositis due to GAS may be increasing, possibly related to shifts in the proportion of GAS isolates of M-Types 1 and 3 . These M-types (or the production of exotoxins and proteases associated with them) may lead to severe GAS infections in individuals who lack immunity . Recent television and newspaper reports underscore the potential virulence of GAS even in young and previously well individuals although they do this at the expense of raising fear in the general population . It is unfortunate that these reports often fail to emphasize the rarity with which GAS causes myositis and fasciitis . The overall incidence of these dreadful diseases is very low . In fact, by extrapolating the CDC estimates, we suspect that only 14-40 cases of GAS-induced myositis or fasciitis occur annually in North Carolina . Each of these infections is a true calamity for the affected patients and their physicians, but together they represent only a tiny fraction of all GAS infections that occur in North Carolinians each year . It is relatively easy to separate uncomplicated streptococcal cellulitis from GAS-induced fasciitis and/or myositis by bedside exam and old-fashioned clinical judgment . Prompt and aggressive surgical debridement and antibiotic therapy are needed for all patients with myositis and/or fasciitis due to GAS; others can be treated with simple beta-lactam antibiotics and careful observation.

J Dent Res, 1994 Oct, 73(10), 1627 - 35
Emergence in human dental plaque and host distribution of amylase-binding streptococci; Scannapieco FA et al.; Salivary amylase is known to bind specifically to several species of oral streptococci . To assess the importance of this interaction in bacterial colonization of the oral cavity, we determined the proportion and identity of amylase-binding bacteria (ABB) in dental plaque of humans and various salivary amylase-secreting and non-secreting mammalian species . The numbers of ABB in undisturbed plaque collected over time from tooth surfaces of six human volunteers or from 14 other mammalian species were determined by means of a replicating assay . The mean proportion of ABB cultured aerobically from human teeth at 2 h was 10.5% (SD 10), at 8 h 7.9% (8), at 24 h 13% (11), and at 48 h 12% (9) . The mean proportion of anaerobically cultured ABB found at 2 h was 3% (SD 4), at 8 h 5% (5), at 24 h 12% (9), and at 48 h 16% (12) . Amylase-binding bacteria cultured from these samples resembled Streptococcus mitis, Streptococcus gordonii, Streptococcus salivarius, Streptococcus crista, or unidentified streptococci . In addition, only animals exhibiting salivary amylase activity in their saliva harbored ABB (ranging from 2 to 31% of the total flora), with the exception of the pig, where no ABB were found to colonize, despite considerable amylase activity in saliva . Only strains resembling S . mitis and S . salivarius and unspeciated strains were isolated from these mammals . These results suggest that amylase-binding streptococci are the predominant ABB in human plaque, and their numbers generally increase as plaque develops . Since ABB colonized only the oral cavities of hosts demonstrating salivary amylase activity, the ability to bind amylase may play an important role in oral colonization by these bacteria.

Lancet, 1994 Sep 3, 344(8923), 639 - 42
Towards a vaccine for rheumatic fever: identification of a conserved target epitope on M protein of group A streptococci; Pruksakorn S et al.; Rheumatic fever and rheumatic heart disease remain very common in developing countries, and a vaccine to protect against these disorders would have a great impact on public health . A vaccine must target the M protein of group A streptococci (Streptococcus pyogenes), but until lately immunity was thought to be strain-specific and dependent on antibodies to the variable serotype-specific regions of the protein . Experiments in animals have suggested the conserved region of the M protein as a possible alternative target for protective antibodies . We constructed a 20-aminoacid peptide (peptide 145) within the conserved region of the carboxyl terminus of the protein . In mice the peptide induced serum antibodies that could opsonise reference type 5 streptococci . By enzyme-linked immunosorbent assay, positive responses to peptide 145 were obtained with serum from 77 (90%) of 86 Aboriginal subjects and 135 (81%) of 167 Thai subjects living in areas with high exposure to streptococci . Only 10 (14%) of 71 Caucasian subjects with low exposure to streptococci showed positive responses . There was no difference in the proportion positive between subjects with rheumatic heart disease and control groups (other or no heart disease) . Antibodies to peptide 145 were able to opsonise isolates of streptococci from Aboriginal and Thai subjects with acute rheumatic fever as well as reference strains . This highly conserved part of the M protein may be a suitable target for vaccines to prevent streptococcal infections and their sequelae.

Am J Med, 1994 Sep, 97(3), 256 - 64
Bacteremia due to viridans streptococci in neutropenic patients: a review; Bochud PY et al.; Viridans streptococci have long been considered, with the exception of the ability to cause endocarditis, as minor pathogenic agents . More recently, however, these bacteria have become a major concern in neutropenic patients undergoing a chemotherapeutic treatment . In this high-risk population, they can be responsible for up to 39% of bacteremia cases and are the most frequent cause of this type of infection . The most frequently isolated species in blood cultures are Streptococcus mitis and Streptococcus sanguis II . Viridans streptococcus bacteremia can be accompanied by serious complications, like adult respiratory distress syndrome (ARDS) (3% to 33%), shock (7% to 18%) or endocarditis (7% to 8%) . Mortality rates range from 6% to 30% . Case-control studies have identified the following risk factors: severe neutropenia (< 100 neutrophils/mm3), prophylactic antibiotic treatments with quinolone or co-trimoxazole, absence of intravenous antibiotics at the time of bacteremia, high doses of cytosine arabinoside, oropharyngeal mucositis, and heavy colonization by viridans streptococci . The introduction of penicillin in prophylactic antibiotic treatments has reduced the incidence of these infections, but the long-term use of penicillin could be compromised by the emergence of resistant strains.

J Infect Dis, 1994 Sep, 170(3), 717 - 20
Relation between maternal age and serum concentration of IgG antibody to type III group B streptococci; Anthony BF et al.; Coded serum samples collected from healthy obstetric patients at delivery were examined by ELISA for IgG antibody to the purified type III polysaccharide of group B streptococci . When 217 patients were divided into 4 groups according to age (group I =16-20 years, n = 56; group II = 21-25, n = 53; group III = 26-30, n = 54; group IV = 31-35, n = 54), antibody concentrations were significantly lower in group I than in older patients . Fewer subjects in group I had measurable antibody levels (> or = 0.05 microgram/mL) than in groups II-IV (41% vs . 76%, P < .001) . The geometric mean in group I (0.09 microgram/mL) was significantly lower (P < .001) than in the older groups (0.23, 0.19, and 0.20 microgram/mL, respectively) with little or no overlap of the 95% confidence limits (1.96 SE) about the means . These findings may be relevant to the observation of a significantly greater risk of both early- and late-onset group B streptococcal disease in infants of teenage mothers.

Clin Orthop, 1994 Sep, (306), 128 - 31
Compartment syndrome associated with infection of the upper extremity; Schnall SB et al.; Compartment syndrome is a potentially devastating entity associated with a great variety of injuries, but to the authors' knowledge there are no known reports of infection documented as a cause . A retrospective review of 263 patients with upper extremity infections admitted to the orthopaedic infection ward during 1992 was conducted to identify patients with compartment syndrome directly associated with infection . Four patients' clinical presentations fulfilled the criteria: two presented with infection and compartment syndrome, and two developed compartment syndrome 2-12 hours after admission . All four had beta-hemolytic streptococci on initial culture; three of four grew Group A streptococcus . Fasciotomies and serial debridements were necessary . One patient ultimately underwent amputation through the elbow.

Infect Immun, 1994 Sep, 62(9), 4000 - 4
The gene encoding a new mitogenic factor in a Streptococcus pyogenes strain is distributed only in group A streptococci; Yutsudo T et al.; We recently cloned a gene encoding a new mitogenic factor (MF) from Streptococcus pyogenes NY-5 . In the present study, we determined the distribution of this MF gene (mf) by PCR based upon its sequence . Of 371 streptococcal group A strains isolated from clinical specimens, 370 (99.7%) were positive for mf . The strain that was negative for the MF gene was also negative for the streptolysin O gene (slo) . Some streptococcal strains belonging to groups C and G were negative for mf but positive for slo . Group B strains were negative for both . Furthermore, we examined the presence of mf in 54 strains belonging to 28 families and found mf only in group A streptococci . These results indicate that mf is distributed specifically in group A streptococci and the presence of mf in clinical samples strongly suggests infection with group A streptococci.

Infect Immun, 1994 Sep, 62(9), 3937 - 46
Cloning, sequencing, and expression of a fibronectin/fibrinogen-binding protein from group A streptococci; Courtney HS et al.; Lipoteichoic acid and several streptococcal proteins have been reported to bind fibronectin (Fn) or fibrinogen (Fgn), which may serve as host receptors . We searched for such proteins by screening a library of genes from M type 5 group A streptococci cloned into Escherichia coli . Lysates of clones were probed with biotinylated Fn and biotinylated Fgn . One clone expressed a 54-kDa protein that reacted with Fn and Fgn . The protein, termed FBP54, was purified and used to immunize rabbits . Anti-FBP54 serum reacted with purified, recombinant FBP54 and with a protein of similar electrophoretic mobility in extracts of M type 5, 6, and 24 streptococci . Anti-FBP54 serum also reacted with 5 of 15 strains of intact, live streptococci, suggesting that FBP54 may be a surface antigen . Southern blot analysis confirmed that the gene is found in group A streptococci but not in Staphylococcus aureus or E . coli . The cloned gene was sequenced and contained an open reading frame encoding a protein with a calculated molecular weight of 54,186 . Partial amino acid sequencing of purified FBP54 confirmed that this open reading frame encoded the protein . As determined by utilizing fusion proteins containing truncated forms of FBP54, the primary Fn/Fgn-binding domain appears to be contained in residues 1 to 89 . These data suggest that FBP54 may be a surface protein of streptococci that reacts with both Fn and Fgn and therefore may participate in the adhesion of group A streptococci to host cells.

Vaccine, 1994 Sep, 12(12), 1071 - 7
Human T-helper cell recognition of an immunodominant epitope of HIV-1 gp120 expressed on the surface of Streptococcus gordonii; Pozzi G et al.; Our genetic system for expression of heterologous proteins on the surface of the Gram-positive bacterium Streptococcus gordonii was used to express a human T-helper epitope of HIV-1 envelope glycoprotein gp120 . In previous work on the naive repertoire of human T-helper cells, it was shown that a 15-amino acid synthetic peptide of the HIV-1 gp120 sequence contained an immunodominant T-helper epitope . Synthetic DNA coding for this peptide was cloned in frame within the gene for the streptococcal surface protein M6, and the gene fusion was integrated by transformation into the chromosome of S . gordonii . The expected M6-gp120 fusion protein was found to be expressed on the surface of the recombinant streptococci . To test whether the T epitope could be recognized by T cells when expressed on the bacterial surface within the context of M6, recombinant bacteria were used as antigen in proliferation assays to stimulate the 15-amino acid-specific human T-helper clone, in the presence of autologous antigen-presenting cells . Bacteria expressing the T epitope were efficiently recognized by the T cells in culture . In proliferation assays, 10(6)-10(7) bacteria induced responses comparable to those obtained by standard amounts of synthetic peptide (0.02-0.2 micrograms) . Recombinant S . gordonii, a candidate for a live vaccine vector, appeared suitable for delivering T epitopes to the immune system.

Arch Dis Child, 1994 Sep, 71(2), F75 - 80
Neonatal meningitis in England and Wales: a review of routine national data; Synnott MB et al.; The objective of this study was to describe trends in neonatal meningitis in England and Wales during the years 1975-91 . Laboratory reports and, for the years 1983-91, data on statutory notifications and deaths from neonatal meningitis were reviewed . The mean annual total of laboratory reports of neonatal bacterial meningitis 1975-91 was 109 cases (range 69-133) with a slight upward trend apparent in the latter half of the study period . The mean annual number of reports of neonatal viral meningitis was only 14 cases with no trend apparent . The leading bacteria isolated were group B streptococci, Escherichia coli, and Listeria monocytogenes accounting for 34.1%, 28.5%, and 6.8% of reports, respectively . There was a change in the pattern of causative bacteria from 1981 onwards with the group B streptococcus displacing E coli as the leading cause . With respect to neonatal viral meningitis, echoviruses and coxsackie viruses accounted for 55.4% and 38.6% of cases, respectively . Neonatal meningitis was seriously undernotified; the ratio of laboratory reported cases to cases notified ranged from 12:1 in 1985 to 4:1 in 1989 . The annual numbers of deaths ranged from 18 to 39 . The laboratory reporting system provided the most useful data on secular trends and causative organisms for neonatal meningitis . The slight upward trend in the number of reports of bacterial meningitis merits continued surveillance.

Clin Ther, 1994 Sep-Oct, 16(5), 753 - 66; discussion 752
A retrospective evaluation of imipenem use in bone marrow transplant patients; Leong WA et al.; A retrospective, open, 3-year trend analysis of imipenem use in bone marrow transplant (BMT) patients was conducted at a 1000-bed tertiary care hospital . Broad-spectrum antibacterial drugs are routinely used to treat infections in the febrile neutropenic host . The antibacterial activity and acceptable tolerance profile of imipenem makes this agent a potentially useful addition to the traditional armamentarium which includes aminoglycosides, cephalosporins, and glycopeptides . Some authorities recommend imipenem as monotherapy in the treatment of fever of unknown origin in this select patient population . Eighty-three treatment courses (one treatment course per patient) were evaluated . The major indications for initiating therapy were fever of neutropenia (28%), suspected infection in the absence of fever (55%), and documented infection (17%) . Imipenem was used as a first-line agent in 42% of patients, although imipenem monotherapy was not common . Concurrent antibacterials were usually vancomycin and tobramycin . Seventeen patients required modification of the initial regimen with vancomycin and/or tobramycin for additional coverage after an average of 8 days of imipenem therapy . Forty-eight bacterial isolates were obtained in cultures from 35 patients during the study, with gram-positive organisms predominating (in particular, staphylococci and streptococci) . Pretherapy and superinfecting organisms were primarily gram-positive . Overall clinical success or improvement occurred in 42% of patients . Microbiologic outcome was indeterminate in 89% of patients, microbiologic eradication occurred in 1%, and superinfection occurred in 6% . Imipenem was relatively well tolerated . Rash and nausea/vomiting were reported most often; 29% of those patients who had adverse reactions discontinued therapy.

Pediatr Dent, 1994 Sep-Oct, 16(5), 346 - 9
Growth inhibition of glass ionomer cements on mutans streptococci; Loyola-Rodriguez JP et al.; This study was conducted to identify the factors involved in the antibacterial activity of glass ionomer cement (GIC) on mutans streptococci . The antibacterial effect of GIC was estimated using agar plates infected with strains of S . mutans and S . sobrinus . The effect of pH and fluoride release of GIC on mutans streptococci was studied under acid and neutral pH . Strains of S . sobrinus were more sensitive to GIC antibacterial activity, the difference being statistically significant (P < 0.001) . The GIC Fuji II LC, Fuji II type II, Vitremer, Vitrebond, and Ketac-Cem were the most active materials in this study . The inhibition activity was associated with GIC fluoride release; 140 +/- 25 ppm were required to inhibit S . sobrinus 6715 . Inhibition activity was not associated with changes in pH after setting of these materials.

Nippon Saikingaku Zasshi, 1994 Sep, 49(5-6), 779 - 85
{Identification of group C Streptococcus with Helix pomatia lectin in use for blood grouping}; Nagai T et al.; The lectin anti-AHP (Helix lectin) obtained from the albumen gland of an edible snail, Helix pomatia, was used for the identification of group C streptococci . All 1,045 strains of group C streptococci (S . equisimilis, S . zooepidemicus, and S . dysgalactiae) were agglutinated with the Helix lectin, but none of the 12,264 strains of group A, 1,346 strains of group G, 330 strains of group B, and 121 strains of other streptococcal groups was not . A few strains of S . equisimilis which belongs to group C have on the cell surface specific T antigen of group A streptococci, but it did not affect the agglutination with Helix lectin . Some strains of S . milleri carrying or not carrying group G specific carbohydrate and S . sanguis with group H antigen were agglutinated with the Helix lectin (Anti-AHP) . This suggests that terminal N-acetyl-D-galactsamine of the cell-wall carbohydrate of these bacteria reacts with the Helix lectin (Anti-AHP) . Therefore, the Helix lectin is a very useful tool for identification of group C streptococci.

J Clin Microbiol, 1994 Sep, 32(9), 2318 - 20
Evaluation of E test as a rapid method for determining MICs for nutritionally variant streptococci; Douglas CP et al.; E test was evaluated as an alternative rapid and simple method of MIC estimation for nutritionally variant streptococci . E test with various media was compared with conventional broth and plate dilution techniques supplemented with 0.001% (wt/vol) pyridoxal hydrochloride (vitamin B6) . Of the 14 strains tested with E test, isosensitest agar supplemented with 5% defibrinated horse blood and 0.001% pyridoxal HCl, with and without 0.01% cysteine, gave complete agreement within one twofold-dilution titer of the agar reference method and between 93 and 86% agreement within one twofold-dilution titer of the broth reference method . E test MICs with other media were comparable; however, these were considerably more difficult to interpret . Use of Mueller-Hinton and Columbia-based supplemented agar showed hazy growth and double zoning around the endpoint, respectively . The addition of 0.01% (wt/vol) cysteine to media exhibited no significant effect, and incubation in 5% carbon dioxide (CO2) did not affect MICs.

J Clin Microbiol, 1994 Sep, 32(9), 2041 - 5
Demonstration of circulating group B streptococcal immune complexes in neonates with meningitis; Vallejo JG et al.; Group B streptococci are the major cause of sepsis and fatal shock in neonates in the United States . Although a number of clinical features have been associated with enhanced severity of disease, the role of soluble immune complex formation in group B streptococcal infection has not been evaluated . We determined the frequency with which circulating immune complexes occurred in 16 infants with nonfatal type III, group B streptococcal meningitis, using an immunoglobulin-specific C1q enzyme immunoassay . Ten healthy, age-matched infants served as a control group . Elevated levels of immunoglobulin M (IgM)-containing immune complexes were present in the sera of four (25%) patients with group B streptococcal meningitis . Group B antigen was detected in precipitated IgM immune complexes from each of these four infants by competitive enzyme-linked immunosorbent assay . In addition, IgG-containing immune complexes were present in 56% of sick and 60% of control infants . Group B antigen was demonstrated in the serum of a sick neonate containing only IgG immune complexes but not in controls . Our findings indicate that a subset of infants with type III, group B streptococcal meningitis develop IgM immune complexes containing group B-specific antigen, and these may persist for up to 3 months in some patients.

Eur J Vasc Surg, 1994 Sep, 8(5), 611 - 6
An eight year experience of conservative management for aortic graft sepsis; Gordon A et al.; This paper describes the results of conservative management of 15 patients with aortic graft infection . The median time to presentation was 4 months . Six of eight grafts that were sent for culture grew organisms, of which the commonest were streptococci and coagulase negative staphylococci . Four patients did not receive intensive antibiotic treatment and all died of sepsis . Eleven patients received intensive intravenous and oral antibiotic therapy and appropriate surgical management; two of these died, one of a stroke and the other of an unknown cause . Two of the nine surviving patients had no surgery and the remainder had procedures to drain pus and unblock occluded grafts, including minimal graft excision in four patients, although two of these subsequently required total graft excision . The follow-up period for six of these nine patients is more than 4 years . For most patients with aortic graft infection aggressive antibiotic treatment supplemented by minimalist surgery is preferable to primary radical surgery.

Antimicrob Agents Chemother, 1994 Sep, 38(9), 2183 - 6
Antibiotic resistance and penicillin tolerance in clinical isolates of group B streptococci; Betriu C et al.; The aim of this study was to determine the susceptibility patterns of 100 group B streptococcal strains isolated in our hospital and to ascertain tolerance to penicillin by determining quantitative killing curves . We found two strains with intermediate susceptibility to penicillin and eight strains to ampicillin . Seventeen isolates were tolerant to penicillin, with bacterial counts decreasing 2 to 3 log during the first 8 h but still above 10(2) CFU/ml after 24 h . The kinetic study shows that penicillin tolerance is not rare among group B streptococci isolated in our hospital.

Antimicrob Agents Chemother, 1994 Sep, 38(9), 2041 - 6
Effects of teicoplanin and those of vancomycin in initial empirical antibiotic regimen for febrile, neutropenic patients with hematologic malignancies . Gimema Infection Program; Menichetti F et al.; The efficacy and toxicity of teicoplanin and vancomycin in the initial empirical antibiotic regimen in febrile, neutropenic patients with hematologic malignancies were compared in a prospective, randomized, unblinded, multicenter trial in the setting of 29 hematologic units in tertiary-care or university hospitals . A total of 635 consecutive febrile patients with hematologic malignancies and chemotherapy-induced neutropenia were randomly assigned to receive intravenously amikacin plus ceftazidime plus either teicoplanin at 6 mg/kg of body weight once daily or vancomycin at 1 g twice daily . An efficacy analysis was done for 527 evaluable patients: 275 treated with teicoplanin and 252 treated with vancomycin . Overall, successful outcomes were recorded for 78% of patients who received teicoplanin and 75% of those who were randomized to vancomycin (difference, 3%; 95% confidence interval {CI}, -10 to 4%; P = 0.33) . A total of 102 patients presented with primary, single-agent, gram-positive bacteremia . Coagulase-negative staphylococci accounted for 42%, Staphylococcus aureus accounted for 27%, and streptococci accounted for 21% of all gram-positive blood isolates . The overall responses to therapy of gram-positive bacteremias were 92 and 87% for teicoplanin and vancomycin, respectively (difference, 5%; CI, -17 to 6%; P = 0.22) . Side effects, mainly represented by skin rash, occurred in 3.2 and 8% of teicoplanin- and vancomycin-treated patients, respectively (difference, -4.8%; CI, 0.7 to 8%; P = 0.03); the rate of nephrotoxicity was 1.4 and 0.8% for the teicoplanin and vancomycin groups, respectively (difference, 0.6%; CI, -2 to 1%; P = 0.68) . Further infections were caused by gram-positive organisms in two patients (0.7%) treated with teicoplanin and one patient (0.4%) who received vancomycin (difference, 0.3%; CI, -0.9 to 1.0%; P = 0.53) . Overall mortalities were 8.5 and 11% for teicoplanin- and vancomycin-treated patients, respectively (difference, -2.5%; CI, - 2 to 7%; P = 0.43); death was caused by primary gram-positive infections in three patients (1%) in each treatment group . When used for initial empirical antibiotic therapy in febrile, neutropenic patients, teicoplanin was at least as efficacious as vancomycin, but it was associated with fewer side effects.

Spec Care Dentist, 1994 Sep-Oct, 14(5), 203 - 7
Dental health status of mentally retarded adults with various living arrangements; Gabre P et al.; During the last few years in Sweden, there has been a change in the way of living for the mentally retarded . There has been a gradual movement away from institutions toward a more integrated life within society . The aim of the present study was to examine the dental health of mentally retarded adults with different ways of living . Forty-two subjects lived in an institution, 50 lived in integrated units, and 40 stayed in their own apartments or with their parents . All subjects had had regular dental care for at least ten years . The clinical examination was made by one dentist . The use of fluoride and chlorhexidine was recorded in addition to a microbiological examination . The results showed a higher caries prevalence and incidence in subjects with integrated living . Compared with other studies where the mentally retarded had had no regular dental care, the caries incidence and prevalence were lower in this study, and the number of missing teeth was lower . The prevalence of mutans streptococci was related to caries prevalence and incidence . High scores of mutans streptococci could be observed, even among subjects with a frequent use of chlorhexidine gel . The loss of alveolar bone was more pronounced for individuals living in the institution compared with that in individuals with other ways of living.

FEMS Microbiol Lett, 1994 Aug 15, 121(2), 133 - 40
Cell surface protein receptors in oral streptococci; Jenkinson HF; Streptococci have a vast repertoire of adherence properties which include binding to human tissue components, epithelial cells and to other bacterial cells . These interactions are determined by the expression of cell-surface receptors some of which are species-specific . In the oral streptococci, two families of surface protein receptors with highly conserved amino acid sequences have been identified . The antigen I/II family of polypeptides are wall-associated high molecular mass proteins (158-166 kDa) with several binding functions that may be attributed to different domains of the receptor molecules . The LraI family of polypeptides are surface-associated lipoproteins (32-33 kDa) involved in adherence of streptococci to salivary glycoprotein pellicle and to oral Actinomyces . A region of amino acid sequence similarity is evident amongst members of the two protein families in Streptococcus gordonii . Ligand-binding specificities of these receptor polypeptides may account for species-specific adherence and site-directed colonization of streptococci within the human oral cavity.

Biochemistry, 1994 Aug 9, 33(31), 9033 - 9
Immunochemical confirmation of the primary structure of streptococcal hyaluronan synthase and synthesis of high molecular weight product by the recombinant enzyme; DeAngelis PL et al.; We have recently identified and cloned the gene for hyaluronan (HA) synthase, hasA, from group A Streptococci {DeAngelis, P.L., Papaconstantinou, J., & Weigel, P.H . (1993) J . Biol . Chem . 268, 19181-19184} . We have now generated two polyclonal monospecific antibodies against synthetic peptides corresponding to portions of the deduced protein . Both antibodies recognize a protein with an apparent molecular weight of 42,000 either from wild-type Streptococcus pyogenes or from Escherichia coli containing the cloned gene on a plasmid . Immobilized affinity-purified antibody depleted HA synthase activity from functional detergent extracts of streptococcal membranes in a specific fashion . The immobilized protein displayed HA synthase activity, and HasA was the major bound polypeptide . The recombinant HA synthase behaves identically to that from Streptococci, with respect to sugar nucleotide specificity and polysaccharide production . Only the authentic sugar nucleotides UDP-glucuronic acid and UDP-N-acetylglucosamine support HA polymerization . The recombinant enzyme elongates HA in a processive manner and rapidly produces polymers on the order of > or = 5 x 10(6) Da at rates of about 10-30 monosaccharides/s at three times the apparent Km of substrates.

Ugeskr Laeger, 1994 Aug 8, 156(32), 4576 - 9
{Endocarditis--clinical picture of native valve infection}; Nissen H et al.; In a population of 930,000 inhabitants all records of native valve infective endocarditis diagnosed in the decade 1980-89 were reviewed . One hundred and thirty-two cases were found, of whom 23 were not diagnosed until postmortem . Median prehospital duration of symptoms was 20 days (range 0-180) and median in-hospital diagnostic delay five days (range 0-54) . Known cardiac disease was found in 42%, possible portal of entry in 33%, but in 36% no predisposing factors were found . During the clinical course 55% experienced cardiac failure and 17% embolic episodes . Surgery was required in 19 patients . Of 111 culture positive cases, streptococci were found in 61 and staphylococci in 45 cases . Overall mortality was 33% with a mortality of clinically diagnosed cases of 18% . Native valve endocarditis is thus associated with a significant mortality in part due to significant diagnostic delays and a large number of post-mortem diagnosed cases . Only by securing a high level of alertness towards endocarditis can we expect a reduced mortality.

J Can Dent Assoc, 1994 Aug, 60(8), 717 - 20; discussion 721-2, 725
Another update for Canadian dentists regarding chlorhexidine varnish therapy for the prevention of dental caries; Lewis DW; Some of the reasons for my belief that CVT has been marketed prematurely have been described . They include the belief that the only really important outcome from the patients' and dentists' perspectives is proven reductions in dental caries . Associated with this is the need to recognize that, using such a criterion, the numbers of patients who may truly benefit from CVT in Canada are small--much smaller than those who promote the testing for and use of CVT appear to infer . Once proven clinically effective, the cost effectiveness of CVT for different patient groups must be demonstrated . I also think that studies to determine Cariescreen's accuracy in terms of predictive values for the "gold standard" plate counts of mutans streptococci should be undertaken . These results should then be given to dentists to help them in their decisions about using CVT in their practices, and if this decision is affirmative, in their discussions with patients for whom they decide CVT will be beneficial . Similarly, the effectiveness of the single application of CVT must be proven by a properly-designed study, since the current justification is inadequate for so important an issue . Finally, dentists should have been provided with all of this basic information before CVT was marketed in Canada.

J Dent Res, 1994 Aug, 73(8), 1437 - 43
Incorporation of bacterial inhibitor into resin composite; Imazato S et al.; Attempts to produce resin composite with antibacterial properties by incorporation of an antibacterial agent such as chlorhexidine have been reported, but problems can arise due to release of the inhibitory agent from the composite . Such problems may include toxic effects, influence on mechanical properties, and loss of effectiveness . A new monomer, methacryloyloxydodecylpyridinium bromide (MDPB), was synthesized by combining an antibacterial agent and methacryloyl group . The monomer was incorporated into resin composite to develop a non-releasing antibacterial composite . The ability of composite incorporating MDPB to inhibit growth and plaque accumulation by Streptococcus mutans in vitro was assayed, elution of antibacterial components from the material was investigated, and the influence of incorporation of MDPB on the mechanical properties of composite was studied . Uncured MDPB revealed antibacterial activity against S . mutans and six other species of oral streptococci, with the minimum inhibitory concentration for S . mutans being comparable with that of triclosan . After composite incorporating MDPB was cured, no elution of the antibacterial components was observed from the material, even after 90 days' immersion in water or other solvents . Growth of S . mutans on agar under specimens of MDPB-containing composite was inhibited compared with controls . In a bacterial accumulation study, S . mutans accumulated to a lesser degree on the surface of composite incorporating MDPB (p < 0.05) than on control . Incorporation of MDPB had no significant influence on the mechanical properties of the composite.

South Med J, 1994 Aug, 87(8), 857 - 9
Pyogenic arthritis complicating varicella infection; Glass KL et al.; Arthritis has not previously been reported as a complication in adult patients with chickenpox . In pediatric patients, the arthritis that complicates chickenpox is most commonly aseptic but does rarely result from bacterial infection . We report the case of a 21-year-old man who developed acute monoarticular septic arthritis due to Lancefield Group A beta-hemolytic streptococci . Despite the more common viral cause of arthritis in pediatric patients, physicians should not attribute arthritis associated with varicella in adults to a viral cause without diagnostic arthrocentesis.

J Bacteriol, 1994 Aug, 176(16), 4845 - 50
Identification of amino acid residues in Streptococcus mutans glucosyltransferases influencing the structure of the glucan product; Shimamura A et al.; The glucosyltransferases (GTFs) of mutans streptococci are important virulence factors in the sucrose-dependent colonization of tooth surfaces by these organisms . To investigate the structure-function relationship of the GTFs, an approach was initiated to identify amino acid residues of the GTFs which affect the incorporation of glucose residues into the glucan polymer . Conserved amino acid residues were identified in the GTF-S and GTF-I enzymes of the mutans streptococci and were selected for site-directed mutagenesis in the corresponding enzymes from Streptococcus mutans GS5 . Conversion of six amino acid residues of the GTF-I enzyme to those present at the corresponding positions in GTF-S, either singly or in multiple combinations, resulted in enzymes synthesizing increased levels of soluble glucans . The enzyme containing six alterations synthesized 73% water-soluble glucan in the absence of acceptor dextran T10, while parental enzyme GTF-I synthesized no such glucan product . Conversely, when residue 589 of the GTF-S enzyme was converted from Thr to either Asp or Glu, the resulting enzyme synthesized primarily water-insoluble glucan in the absence of the acceptor . Therefore, this approach has identified several amino acid positions which influence the nature of the glucan product synthesized by GTFs.

J Med Microbiol, 1994 Aug, 41(2), 145 - 8
Biochemical differences among human and animal streptococci of Lancefield group C or group G; Efstratiou A et al.; Pyogenic streptococci of Lancefield group C or group G from human or animal sources were examined with a view to increasing the number of diagnostic tests useful for their differentiation . Human strains of group G produced L-prolyl-L-arginine aminopeptidase but isolates of Streptococcus equisimilis (group C) did not . Tests for alpha-L-glutamate aminopeptidase together with fermentation of glycogen or sorbitol distinguished S . dysgalactiae from strains of S . equisimilis isolated from animals . It was confirmed that fermentation tests were helpful in the study of S . equi and S . zooepidemicus and that enzyme reactions helped distinguish between S . canis and the human strains of group G.

Infect Immun, 1994 Aug, 62(8), 3236 - 43
Neonatal mouse protection against infection with multiple group B streptococcal (GBS) serotypes by maternal immunization with a tetravalent GBS polysaccharide-tetanus toxoid conjugate vaccine; Paoletti LC et al.; Most cases of neonatal sepsis and meningitis caused by group B streptococci (GBS) are attributable to one of four major capsular serotypes: Ia, Ib, II, or III . Because resistance to infection with GBS has been correlated with the presence of serum antibodies to the type-specific capsular polysaccharides in both experimental animals and human neonates, efforts have been made to elicit protective immunity with GBS capsular polysaccharide vaccines . However, the GBS capsular polysaccharides alone are not highly immunogenic in either animals or human volunteers . Therefore, we and other investigators have attempted to enhance immunogenicity by coupling individual capsular polysaccharides to a carrier protein . Here we report the synthesis and immunogenicity in rabbits of a GBS type Ib polysaccharide-tetanus toxoid vaccine prepared by the direct, covalent attachment of tetanus toxoid to a selected number of sialic acid residues on the type-specific polysaccharide . In addition, the Ib polysaccharide-tetanus toxoid conjugate vaccine was combined with similar tetanus toxoid conjugates of GBS type Ia, II, and III polysaccharides to form a tetravalent GBS conjugate vaccine . Protective efficacy of the GBS tetravalent conjugate vaccine was demonstrated in a mouse maternal immunization-neonatal challenge model of GBS infection . The results support testing in human subjects of a multivalent GBS conjugate vaccine of this design, with the eventual goal of protecting newborns against GBS infection.

Infect Immun, 1994 Aug, 62(8), 3102 - 7
Group B streptococcus-induced nitric oxide production in murine macrophages is CR3 (CD11b/CD18) dependent; Goodrum KJ et al.; Nitric oxide (NO) is produced by murine macrophages in response to cytokines and/or gram-negative bacterial lipopolysaccharide . NO induction by gram-positive bacteria such as group B streptococci (GBS), the major etiologic agents of neonatal pneumonia and meningitis, has received little study . GBS as well as two other gram-positive bacterial species, Staphylococcus aureus and Staphylococcus epidermidis, were found to stimulate NO production in thioglycolate-elicited murine macrophages and in the mouse macrophage cell line J774A.1 in the presence of gamma interferon . Serotype Ia and III GBS were both stimulatory, as were asialo- and type antigen-deficient mutant strains of type III GBS . NO production was dose dependent, inhibitable by L-arginine analogs, and unaffected by polymyxin B . Since phagocytosis by murine and human phagocytes of GBS is dependent on complement receptor type 3 (CR3), the role of CR3 in the NO response to GBS was tested in the CR3-deficient myelomonocytic cell line WEHI-3 . GBS did not induce NO, whereas S . aureus or lipopolysaccharide did induce NO in WEHI-3 cells . S . epidermidis, whose nonopsonic phagocytosis is also CR3 dependent, failed to induce NO in WEHI-3 cells . Monoclonal anti-CR3 (anti-CD11b or anti-CD18) in the presence of interferon also induced NO production in thioglycolate-elicited macrophages and in J774A.1 cells but not in WEHI-3 cells . This evidence suggests that ligated CR3 and gamma interferon act synergistically to induce NO production and that CR3 mediates the GBS-induced signal for NO production in interferon-treated macrophages.

J Appl Physiol, 1994 Aug, 77(2), 751 - 6
Magnesium attenuates pulmonary hypertension due to hypoxia and group B streptococci; Anderson ME et al.; We investigated whether hypermagnesemia alleviates hypoxic or group B streptococcal (GBS) pulmonary hypertension (PH) . Hypoxic PH was induced and maintained in 14 lambs by continuous ventilation with 12% oxygen . GBS PH was induced and maintained in 16 lambs by the continuous infusion of 5-10 x 10(8) colony-forming units.kg-1.h-1 of GBS . After the onset of PH, lambs were randomized to receive either magnesium sulfate (MgSO4, intermittent boluses of 0.38 mmol/kg, with a continuous infusion of 0.15 mmol.kg-1.h-1) or a similar volume of normal saline . Hypermagnesemia lowered pulmonary arterial pressure (PAP) and delayed the fall in systemic arterial pressure and stroke volume index seen in the control animals (each P < 0.05) . At a serum magnesium concentration ({Mg}) of 2.75 +/- 0.25 mmol/l, PAP was 27 +/- 3 compared with 40 +/- 4 Torr in the control animals ({Mg} = 0.87 +/- 0.06 mmol/l; P < 0.05) . In the GBS PH trial, hypermagnesemia prevented the continued increase in PAP seen in the control animals . At {Mg} = 2.15 +/- 0.07 mmol/l, PAP fell 2 +/- 1 Torr from prerandomization values, whereas it rose 4 +/- 2 Torr in the control animals ({Mg} = 0.59 +/- 0.07 mmol/l; P < 0.05) . However, during the same time the systemic arterial pressure fell further in the magnesium-treated animals (-19 +/- 1 vs . -2 +/- 5 Torr) . MgSO4 attenuates PH in both models but may cause systemic hypotension in sepsis.

J Clin Microbiol, 1994 Aug, 32(8), 1945 - 8
Typing of group A streptococci by random amplified polymorphic DNA analysis; Seppala H et al.; Random amplified polymorphic DNA (RAPD) analysis was evaluated in comparison with restriction endonuclease analysis (REA) of genomic DNA and serotyping in the typing of 160 epidemiologically unrelated group A streptococci (GAS) . Amplification of genomic DNA of GAS was performed with a single primer with an arbitrarily selected nucleotide sequence of 12 nucleotides . In total, 31 RAPD patterns and 15 REA patterns were observed among the isolates studied . The results of RAPD analysis were in accordance with the results of REA for 86% of the isolates, as both methods identified 15 different strains among 138 isolates . However, RAPD analysis differentiated 16 additional strains among 22 isolates . RAPD analysis was somewhat better than REA for differentiation of isolates of the same and different serotypes . However, not all of the serotypes were differentiated by RAPD analysis either . In conclusion, RAPD analysis provides a practical alternative for genomic typing of GAS . It can be recommended for the typing of GAS, especially if used in parallel with serotyping.

Eur J Clin Invest, 1994 Aug, 24(8), 511 - 21
Group A streptococcal antigens and superantigens in the pathogenesis of autoimmune arthritis; Taylor JE et al.; Evidence from repeated clinical observations and from a variety of experimental approaches implicates group A streptococci in the pathogenesis of the autoimmune arthritides . Several streptococcal antigens and superantigens have now been characterized and their properties suggest that they may be involved in the mechanisms which underlie these diseases, although other antigens and superantigens yet to be discovered may also be involved . The association between group A streptococcal infection and autoimmune arthritis offers a useful model for providing a long-elusive understanding of the role of bacterial infection in the pathogenesis of autoimmune disease.

Int Immunol, 1994 Aug, 6(8), 1235 - 44
Identification of T cell autoepitopes that cross-react with the C-terminal segment of the M protein of group A streptococci; Pruksakorn S et al.; Rheumatic fever (RF) follows a throat infection with different M-serotypes of beta-hemolytic group A streptococci (GAS) and can affect different tissues, predominantly the heart . It is thought to be an autoimmune illness . Although histological examination of affected heart shows an infiltrate consisting mainly of T cells, antigens or epitopes that could be putative targets of autoimmune T cells have not been identified . We have examined the T cell response to the conserved C-terminal region of the M protein--a streptococcal surface coiled-coil protein which is the target of opsonic antibodies and antibodies which cross-react with human heart tissue . Australian Aborigine, Caucasian and Thai patients, controls and mice were studied to define regions of the protein immunogenic for T cells, and T cell lines and clones were tested for cross-reactivity to myosin as well as an extract of RF-diseased mitral heart valve . Murine (B10, B10.D2, B10.BR) M peptide-specific T cells were often cross-reactive for other M peptides but did not cross-react with human heart antigens . Patients with RF or other heart diseases, or control subjects exposed more commonly to GAS were more likely to have T cell responses to the M protein, with many regions of the C-terminus being recognized . T cell lines and a clone specific for different M peptides were generated from five donors . Cross-reactivity could be shown between different M peptides, but unlike murine M peptide-specific T cells three of the human T cell lines reacted strongly to peptides representing homologous regions of cardiac and skeletal muscle myosins, and two of these lines also responded to porcine myosin and an extract of human rheumatic mitral valve . However, these last two lines were derived from a normal donor without history of RF or other heart disease . Our data demonstrate that regions of the M protein, including regions that are being considered as subunit vaccines, have the potential to stimulate pre-existing heart cross-reactive T cells, but that the ability of such T cells to cross-react (as measured in vitro) is not in itself sufficient to lead to disease.

J Clin Pathol, 1994 Aug, 47(8), 752 - 5
Assessment of two methods for rapid intrapartum detection of vaginal group B streptococcal colonisation; Simpson AJ et al.; AIMS--To compare two methods for the rapid detection of intrapartum vaginal carriage of group B streptococci (Streptococcus agalactiae) with standard culture techniques and to establish their suitability for routine use . METHODS--Vaginal swabs from 266 patients in labour were incubated in glucose broth in an anaerobic atmosphere for four to six hours . The Wellcogen Strep B latex particle agglutination test kit was subsequently used for antigen detection . In the second part of the study swabs from 117 women were assessed for the presence of group B streptococci using the ICON STREP B immuno-concentration assay (Hybritech) . Both methods were compared with standard semiquantitative culture on Columbia horse blood agar and Islam's medium . RESULTS--In the first study vaginal carriage of group B streptococci was shown in 38 of 266 (14.3%) patients by culture . Latex particle agglutination with the Wellcogen kit detected 30 of these positive results (sensitivity 78.9%, specificity 100%) . In those patients with moderate to heavy colonisation (> 10(4) colony forming units per millilitre) antigen was detected in all (26/26) culture positive patients (sensitivity 100%, specificity 100%) . In the second study 16 (13.7%) patients were culture positive . The ICON test detected 11 positive results (sensitivity 68.8%, specificity 100%) and for heavy colonisation (10(5) cfu/ml) detected nine of nine cases (sensitivity 100%, specificity 100%) . The ICON test took 10 to 15 minutes to perform . CONCLUSION--These tests are potentially useful for the rapid detection of group B streptococci vaginal colonisation in labour, particularly heavy colonisation . Both tests are insufficiently sensitive to replace standard culture methods.

Microbiology, 1994 Aug, 140 ( Pt 8), 1945 - 52
Metabolic and energetic aspects of the growth response of Streptococcus rattus to environmental acidification in anaerobic continuous culture; Miyagi A et al.; Streptococcus rattus, a serotype b strain of mutans streptococci, was grown in an anaerobic glucose-limited chemostat . The molar growth yield of glucose {Yglucose, g dry wt (mol glucose)-1} together with the maximum growth yields (Ymax) and maintenance coefficients for glucose utilization and calculated ATP generation were estimated as a function of pH . When the pH was lowered from 7.0 to 5.0, Yglucose decreased, with a concomitant gradual change in the composition of the end product from a mixture of formate, acetate and ethanol to one mostly of lactate . Whereas the Ymax for glucose decreased without any change in the Ymax for ATP on acidification, both of the maintenance coefficients markedly increased . Kinetic and immunochemical examinations indicated the presence of an F1F0-type proton-translocating ATPase in the membrane fraction prepared from bacterial cells grown under acidic conditions; no detectable level of the enzyme was found in cells grown at neutral pH . However, when incubated with glucose under non-growing conditions, these acid-adapted and unadapted cells showed an insignificant difference in the ability to maintain the intracellular pH alkaline relative to the acidic environments . These results suggest that the organism responds and adapts to environmental acidification by sacrificing some energy cost in terms of both the efficiency of glucose utilization to generate ATP and the extra maintenance required to continue biomass production as efficiently as under neutral pH.

Microb Pathog, 1994 Aug, 17(2), 111 - 20
The fibronectin binding domain of the Sfb protein adhesin of Streptococcus pyogenes occurs in many group A streptococci and does not cross-react with heart myosin; Valentin-Weigand P et al.; Sfb protein, a fibronectin binding adhesin of Streptococcus pyogenes (Lancefield group A streptococcus), mediates streptococcal adherence to human epithelial cells via its fibronectin binding domain coded by a repetitive gene region named fnbr . In the present study, Southern blot analysis using the fnbr gene region as a probe to screen genomic DNA from 51 epidemiologically unrelated clinical isolates of S . pyogenes revealed that 70% carried a sequence homologous to the fnbr probe . Among ten other streptococcal strains belonging to serological groups B, C, and G, DNA from only two human S . equisimilis (group C) strains reacted with the probe . Further analysis by PCR-mediated amplification of the binding repeat coding sequences revealed that repeats of different S . pyogenes isolates were identical in size but varied in number, ranging from one to five . Most of the isolates were shown to carry multiple repeats . Presence of the probe-positive sequence correlated strongly with streptococcal binding to purified fibronectin and adherence to HEp2 human epithelial cells; of the 36 probe-positive isolates, 95% bound fibronectin and 89% adhered strongly to epithelial cells, whereas among the 15 probe-negative isolates only 27% had binding activities for fibronectin and 27% showed strong adherence to HEp2 cells . Antibodies raised against the fibronectin binding domain of Sfb protein recognized streptococcal fibronectin binding surface proteins in most of the clinical isolates but did not react with heart or skeletal muscle myosin in an enzyme immunoassay, as is the case with antibodies directed to M protein, another major surface protein of group A streptococci . The results of the present study suggest that Sfb protein could be a potential candidate for a streptococcal vaccine.

Zentralbl Bakteriol, 1994 Aug, 281(2), 158 - 73
Kinetics of growth and product formation in cultures from streptococci of groups A and C; Muller PJ et al.; During growth of streptococci of Lancefield groups A and C in a culture medium containing glucose, yeast extract and peptone, two main growth phases occur: growth phase I and growth phase II (diauxic growth) . They are separated by a short stationary phase (1st stationary phase) . The diauxic growth is caused by transient limitations as well as the availability of new sources of the amino acids L-serine and L-arginine . Growth phase I consists of an exponential and a nearly linear part . These growth kinetics are reflected by the kinetics of gas metabolism as well as by product formation . Hyaluronic acid is formed during the nearly linear phase whereas the enzyme alkaline phosphatase, is exclusively excreted in the 1st stationary phase . Also carbon dioxide and L-lactate are mainly produced in a growth phase-dependent mode . In the late stationary phase (2nd stationary phase) more oxygen is consumed whereas the demand for oxygen in the 1st stationary phase is nearly zero.

Eur J Clin Microbiol Infect Dis, 1994 Aug, 13(8), 645 - 50
Prevalence of penicillin-resistant viridans streptococci in healthy children and in patients with malignant haematological disorders; Guiot HF et al.; The prevalence of penicillin-resistant viridans streptococci was studied in healthy children and in paediatric and adult patients with leukaemia to determine whether the frequent presence of penicillin-resistant streptococci in the oral cavity of children with leukaemia is the result of antibiotic therapy . Twenty of the oral swabs from 50 healthy children who had not received antibiotics in the three months prior to sampling yielded viridans streptococci that could be cultured on blood agar containing 2 micrograms/ml benzyl-penicillin . In 11 of the 20 cases the streptococci were resistant to penicillin (MIC > or = 4 micrograms/ml) . This prevalence is significantly higher than that found in adult leukaemia patients (40% vs . < or = 5%) but is about the same as that found in paediatric patients with leukaemia . The high prevalence of penicillin-resistant streptococci in the paediatric age group should be considered when selecting therapy and prophylaxis, especially when the risk of infection with one of these cocci is enhanced.

Oral Microbiol Immunol, 1994 Aug, 9(4), 209 - 17
Biochemical change exhibited by oral streptococci resulting from laboratory subculturing; Cvitkovitch DG et al.; The intent of this study was to assess the effects of continued laboratory subculturing on selected biochemical properties of oral streptococci freshly isolated from dental plaque . Six fresh isolates (3 Streptococcus mutans and 3 non-mutans) and 2 laboratory strains were subcultured daily for a total of 225 transfers, and cells were harvested every 75 transfers from duplicate batch cultures grown with glucose at a constant pH . Eleven biochemical properties were assayed with cells, membranes and cell-free extracts and the results subjected to statistical analysis for differences between the duplicate cultures and the various subcultures . In addition, the activity of 19 hydrolytic enzymes was assayed with the semiquantitative apiZYM system (Analytab products) . The activity of zero-time samples varied by as much as 241-fold for a single property with particularly low activity for EIIglc of the phosphoenolpyruvate phosphotransferase system and cell-associated extracellular polysaccharide synthesis . The 3 S . mutans fresh isolates had higher activity in 8 of the 11 assays compared with the 3 non-mutans strains, with extracellular polysaccharide synthesis the most significant trait . Statistical analysis of the 2816 assays of the 11 traits for the 8 test strains at the 4 selected time intervals revealed considerable change in the activity of the test parameters . The most notable changes in the S . mutans strains over the 225 subcultures were significant increases in glycolytic activity and decreases in hydrophobicity and extracellular polysaccharide synthesis activity . Of the measured properties, lactate dehydrogenase and cell-associated extracellular polysaccharide synthesis activity were the most stable and H+/ATPase activity was the most variable.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral Microbiol Immunol, 1994 Aug, 9(4), 193 - 201
In vitro modulation of oral bacterial adhesion to saliva-coated hydroxyapatite beads by milk casein derivatives; Neeser JR et al.; Bovine caseinate, derivatives of its glycosylated moiety {caseinoglycomacropeptide (CGP)}, and caseinophosphopeptides were evaluated as inhibitors of adhesion of oral bacteria to saliva-coated hydroxyapatite beads (S-HA) . All milk casein-derived components behaved as potent inhibitors of Streptococcus sanguis OMZ 9 and Streptococcus sobrinus OMZ 176 adhesion to S-HA, whereas neither bovine serum albumin nor polyethyleneglycol were able to interfere with the adhesion of these strains . By contrast, none of the molecular species tested was able to inhibit the attachment of Actinomyces viscosus Ny 1 to S-HA . On the other hand, casein derivatives were shown to displace human serum albumin from S-HA beads . They were also able to bind to the bacterial cell surface of all strains examined . Collectively, these findings suggest that interactions between acidic casein-derived milk components and the biological surfaces involved in bacterial adhesion to S-HA result in an inhibitory effect that is selective for the oral streptococci examined.

Ned Tijdschr Geneeskd, 1994 Jul 23, 138(30), 1529 - 31
{Bacteremia caused by Streptococcus salivarius and S . Milleri, and colonic carcinoma}; Smit EF et al.; There is a well-known association between colon carcinoma and bacteraemia with Streptococcus bovis biotype I . There are also associations, less well known, with other streptococci of the viridans group . In three patients, a man of 44, a woman of 53 and one of 52 years old, colorectal carcinomas were diagnosed in association with bacteraemia with S . salivarius, S . milleri, and S . salivarius respectively.

Kansenshogaku Zasshi, 1994 Jul, 68(7), 830 - 6
{Microbiological and clinical studies of infective endocarditis due to nutritionally variant streptococci}; Kikuchi K et al.; We report four cases of infective endocarditis due to nutritionally variant streptococci (NVS) that occurred between 1981 and 1991 . Three female and one male patients had underlying heart diseases . Causative organisms showed satellitism to staphylococci . Two strains were identified as S . adjacens and the other two were identified as S . defectivus by DNA-DNA hybridization . All strains had tolerance and one strain had resistance to benzylpenicillin (MIC 4 micrograms/ml) . This penicillin-resistant strain also had tolerance to gentamicin . There was no synergism of benzylpenicillin and gentamicin against this strain by a killing curve in vitro . A 11-year-old female patient with infective endocarditis due to this strain, who had a transposition of great arteries, had large vegetations in external conduits by the Rastelli's operation . Some intensive antimicrobial chemotherapies were unsuccessful and a surgical replacement of the conduits must be done in this case . Since infective endocarditis due to NVS is not rare in Japan, NVS should be considered for the causative organisms in culture negative endocarditis.

Oral Surg Oral Med Oral Pathol, 1994 Jul, 78(1), 47 - 50
Dens in dente associated with infective endocarditis; Whyman RA et al.; This article describes an 11-year-old patient in whom infective endocarditis developed after the occurrence of a dental abscess associated with a dens in dente affecting the maxillary left lateral incisor . Dens in dente has not been reported in the literature previously as a source of infection associated with infective endocarditis . A prolonged period of hospitalization was required to control the infective endocarditis, which was caused by a strain of nutritionally deficient streptococci.

J Bacteriol, 1994 Jul, 176(14), 4316 - 20
Isolation and biochemical characterization of a novel lantibiotic mutacin from Streptococcus mutans; Novak J et al.; Certain members of the indigenous biota of humans produce antimicrobial substances called bacteriocins, which inhibit other bacteria, including members of their own species . One of these substances, mutacin, is made by Streptococcus mutans, a member of the oral biota . Mutacin inhibits other mutans streptococci as well as many gram-positive exogenous pathogens . Here, we report for the first time the purification and partial biochemical characterization of a lanthionine-containing mutacin peptide from S . mutants T8 . The biologically active peptide was isolated from the broth cultures by ultrafiltration and differential precipitation . The final mutacin preparation was homogeneous as shown by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and N-terminal amino acid sequencing . A molecular mass of the peptide was estimated by electrospray ionization mass spectroscopy to be 3,244.64 +/- 1.15 Da . Its amino acid composition indicates the presence of lanthionine and likely beta-methyllanthionine in a total of about 25 amino acids . Because alpha,beta-unsaturated amino acids, the precursors of lanthionine residues, are often found in lantibiotics, we carried out the addition reaction of the mutacin with N-(methyl)mercaptoacetamide . The subsequent electrospray ionization mass spectroscopy analysis indicated the presence of two reaction products with M(r)s of 3,350.45 and 3,456.0 . These are interpreted as the mutacin molecule with the addition of one and two molecules of reagent to the unsaturated amino acids, respectively . Sequencing of the peptide revealed an N-terminal amino acid sequence of Asn-Arg-Trp-Trp-Gln-Gly-Val-Val.

Clin Immunol Immunopathol, 1994 Jul, 72(1), 35 - 43
Tissue distribution of antigen(s) defined by monoclonal antibody D8/17 reacting with B lymphocytes of patients with rheumatic heart disease; Kemeny E et al.; Monoclonal antibody D8/17 originally prepared by immunization of mice with B cells from a patient with rheumatic heart disease (RHD) reacts with epitopes expressed on significantly elevated proportions of B cells (10-35%) from all patients with acute rheumatic fever or rheumatic heart disease . This B cell marker does not segregate with any known HLA or DR phenotype . We have examined the reactivity of D8/17 with a broad assortment of human tissues, using indirect immunofluorescence . Strong positive reactivity of D8/17 was observed with cardiac muscle, skeletal muscle, and smooth muscle of blood vessels . Positive fluorescent staining was also noted in cell membranes of hepatocytes and cells lining bile canaliculi as well as in epithelial cells of skin, esophagus, and cervix . D8/17 mAb binding to cardiac muscle was markedly diminished by preincubation of mAb with KH B cell line originally established from an RHD patient . D8/17 mAb binding to human heart was also inhibited by preincubation with myosin and tropomyosin but not by actin . Using the D8/17 mAb in immunoblots, positive binding was noted by the antibody to recombinant type M6 protein, vimentin, and myosin . Our findings indicate that the B cell antigen reacting with mAb D8/17 may be related to contractile proteins present in heart, skeletal and smooth muscle, and may also share epitopes with some components of group A streptococci.

J Infect Dis, 1994 Jul, 170(1), 88 - 93
Complement and antibody in neutrophil-mediated killing of type V group B streptococcus; Hall MA et al.; Serious infections caused by type V group B streptococci (GBS) are increasing . The requirements for antibody, complement, and neutrophil receptors in the killing of 12 clinical type V GBS isolates were investigated . When tested at concentrations of 33%, 5% and 1%, a human serum pool promoted neutrophil-mediated killing of the 12 isolates at a mean of 83% +/- 9%, 77% +/- 17%, and 14% +/- 28%, respectively . Addition of heated immune rabbit serum to the 5% or 1% pool increased killing significantly (97% +/- 2% or 80% +/- 15%, respectively, P < .01) . With hypogammaglobulinemic serum, complement-mediated killing ranged from 74% +/- 2% for a strain designated resistant to 98% +/- 1% for a strain designated sensitive . Neutrophil-mediated killing was not altered by use of human sera deficient in C4 or C7 but was reduced significantly with C3-deficient serum (P < .05) . Maximal inhibition of neutrophil-mediated killing was observed by monoclonal antibody blockade of complement receptor (CR) 3 alone or in combination with CR1 or Fc receptor III . Thus, C3 is required and specific antibody promotes neutrophil-mediated killing of type V GBS . Neutrophil CR3 and either CR1 or Fc receptor III optimize phagocytosis . A number of host responses function in concert to effect optimal neutrophil-mediated killing of clinical isolates of type V GBS.

J Med Microbiol, 1994 Jul, 41(1), 14 - 9
Agglutination of "Streptococcus milleri" by lectins; Kellens JT et al.; The agglutination of 218 clinical isolates and three ATCC type strains of "Streptococcus milleri" was tested with 25 different lectins from plants and fungi . An agglutination reaction with one or more lectins was observed with 42 isolates when the cells were untreated . After trypsinisation of the bacteria, 109 strains yielded a positive reaction and after boiling the bacterial cells at pH2, 218 isolates were agglutinated . As an overall result of our experiments with untreated, trypsinised and boiled cells, 17, 37 and 45 different agglutination patterns, respectively, were obtained . The lectins from Datura stramonium, Robinia pseudoacacia and Dolichos biflorus agglutinated isolates belonging only to Lancefield group C, being non-reactive with other isolates . These lectins were also found to be specific for "large colony type" streptococci of group C . The use of lectin agglutination in epidemiological and ecological studies of "S . milleri" is discussed.

Acta Derm Venereol, 1994 Jul, 74(4), 276 - 8
Decreased T cell reactivity to trypsinized group A, type M22 streptococci in psoriasis; Baker BS et al.; The proliferative responses of peripheral blood mononuclear cells from patients with guttate and chronic plaque psoriasis to streptococcal M protein were investigated using whole and trypsinized group A M22-positive streptococci . Peripheral blood mononuclear cell responses to whole type M22 group A streptococci were significantly increased in guttate, but not chronic plaque, psoriasis patients compared to 17 non-psoriatic controls (p < 0.05; n = 17) . A significant reduction of this response was observed in both guttate (p < 0.001; n = 17) and chronic plaque (p < 0.01; n = 27) psoriatic patients, but not in the control group, after repeated trypsinization to remove M protein from the streptococci . Furthermore, the difference between the peripheral blood mononuclear cell response to untrypsinized and trypsinized streptococci was significantly greater in the guttate patients than in the controls (p < 0.02) . This preliminary study has shown an increased reactivity of T lymphocytes with specificity for trypsin-sensitive protein expressed by type M22 streptococci in the peripheral blood of patients with psoriasis.

Pediatr Infect Dis J, 1994 Jul, 13(7), 630 - 5
In vitro susceptibility of recent North American group A streptococcal isolates to eleven oral antibiotics; Coonan KM et al.; Because of the recent resurgence of Group A streptococcal infections and their sequelae and to concerns about Group A streptococcal antimicrobial resistance, 282 isolates from acute pharyngitis and 43 additional isolates from severe, invasive infections were examined for susceptibility to 11 oral antibiotics . M serotypes 1, 2, 3, 4 and 12 accounted for more than one-half of the pharyngeal isolates; M serotypes 1 and 3 accounted for most isolates from severe infections . All 325 isolates were exquisitely susceptible to penicillin (Concentration of antibiotic required to inhibit 90% of isolates, 0.012 micrograms/ml) . Only approximately 4% of the tested strains demonstrated an erythromycin minimum inhibitory concentration of 0.5 microgram/ml or greater; the new macrolides, azithromycin and clarithromycin, were similar . The cephalosporins varied somewhat in their ability to inhibit Group A streptococci, but all were effective in vitro . No major differences in minimum inhibitory concentrate were observed between strains associated with severe infections and those from uncomplicated upper respiratory tract infections . On the basis of the 325 isolates examined, we conclude that antimicrobial resistance has not been a factor in the recent resurgence of Group A infections.

J Infect, 1994 Jul, 29(1), 77 - 81
Severe community acquired pneumonia associated with a desquamating rash due to group A beta-haemolytic streptococcus; Hamour A et al.; In recent years frequent and severe infections due to group A beta-haemolytic streptococci have been recognised with increasing frequency . Group A streptococcal pneumonia remains a rare disease occurring sporadically in contrast to epidemics in the past . The association between group A streptococcal pneumonia and a desquamating skin rash typical of scarlet fever has rarely been reported.

Pediatr Dent, 1994 Jul-Aug, 16(4), 272 - 5
IgA antibodies to Streptococcus mutans in caries-resistant and -susceptible children; Rose PT et al.; Previous studies have shown a positive correlation between salivary IgA antibody levels to Streptococcus mutans and caries resistance in adults . In this study, enzyme-linked immunosorbent assay (ELISA) was used to compare IgA antibody levels with S . mutans in whole and parotid saliva from 20 caries-susceptible (CS; DMFS > 5) and 20 caries-resistant (CR; DMFS < or = 1) children (aged 7-11 years) . Whole salivary S . mutans numbers were significantly greater (P < or = 0.05) in the CS group (mean of 31.2% of total oral streptococci) than in the CR group (mean of 1.6% of total oral streptococci) . Whole saliva, but not parotid saliva, from CR children had significantly higher (P < or = 0.05) levels of IgA antibodies to S . mutans than saliva from CS children . These results suggest that salivary IgA antibodies to S . mutans may play a role in natural protection from dental caries in children and that the source of increased salivary IgA antibody in CR children may be either the minor, submandibular, or sublingual salivary glands.

J Clin Microbiol, 1994 Jul, 32(7), 1721 - 4
Detection of Streptococcus pneumoniae DNA in blood cultures by PCR; Hassan-King M et al.; We have developed a PCR assay, with primers derived from the autolysin (lyt) gene, for the detection of Streptococcus pneumoniae DNA in blood cultures . The predicted fragment of 247 bp was detected in all strains of pneumococci, embracing 12 different serotypes that were tested . Although DNA extracted from four viridans streptococci spp . Streptococcus oralis, Streptococcus mitis, Streptococcus sanguis, and Streptococcus parasanguis) gave amplification products, these were quite different from the predicted fragment for S . pneumoniae . Application of the assay for diagnosis of septicemia caused by S . pneumoniae showed concordance between PCR and culture results . However, on four occasions PCR was positive in supernatants from both paired culture bottles while pneumococci were cultured from only one . Performing PCR on negative cultures in controlled studies such as vaccine trials may provide a sensitive tool for increasing case detection.

Microsc Res Tech, 1994 Jul 1, 28(4), 263 - 76
High voltage immunoelectron microscopy of complement receptor type 3-mediated capping and internalization of group A streptococcal cell walls by human neutrophils; Pryzwansky KB; The mechanism of human neutrophil clearance of peptidoglycan group A-specific polysaccharide polymers derived from streptococcal cell walls (PG-APS) was investigated by high voltage immunoelectron microscopy (HVEM) in order to determine how neutrophils process this highly inflammatory bacterial debris . Neutrophil monolayers were incubated from 5-30 min with serum-opsonized PG-APS . Cells were lightly fixed with 0.5% glutaraldehyde, and the PG-APS was localized on the neutrophil surface by immunogold using antibodies to N-acetyl-glucosamine and 15 nm colloidal gold coupled to goat anti-rabbit IgG . Neutrophils were viewed unsectioned by stereo HVEM . Patches of PG-APS were distributed randomly on the plasmalemma of well-spread neutrophils within 5 min . In polarized cells, PG-APS was densely localized on the uropod and retraction fibers . Within 15 min, PG-APS was predominantly concentrated into a large aggregate, measuring approximately 1 micron in diameter, near the cell margin or nucleus . The aggregate of PG-APS was engulfed in the vicinity of the indentation of the nucleus (hof) . Intact microfilaments were required for aggregation and internalization of PG-APS . Binding of PG-APS was dependent upon complement fixation . Furthermore, PG-APS elicited an increase in density of complement receptor type 3 (CR3, C3bi receptor) on the neutrophil surface as determined by morphometry of immunogold labeled anti-CR3 . When cells were stained for both PG-APS and CR3, co-localization was observed, and stereomicroscopy revealed clusters of CR3 in areas associated with phagocytosis . These data suggest that neutrophils use an efficient mechanism for removal of bacterial debris . Unlike whole streptococci which are phagocytosed at multiple sites, these bacterial cell walls are first collected into a large aggregate, or cap, which is then internalized at one site.

Adv Dent Res, 1994 Jul, 8(2), 254 - 62
Bacterial-protein interactions in the oral cavity; Douglas CW; Bacteria in the oral cavity must interact with salivary proteins if they are to survive . Such interactions can take several forms, either providing nutrients, a means of adhesion to surfaces, or resulting in aggregation or killing and, therefore, clearance of organisms . Recent work has provided an insight into the mechanisms of some of these bacterial-protein interactions, revealing complexity and diversity . For example, the interaction between a putative Streptococcus mutans adhesin, P1 (B, I/II, etc.), and a parotid glycoprotein results in adhesion when it occurs at a surface or aggregation when in solution, and different domains of P1 appear to be involved in the two processes . An alternative strategy is employed by Actinomyces viscosus, which interacts, via its type-1 fimbriae, with a proline-rich salivary protein; however, this interaction occurs only when the PRP is adsorbed to a surface . A . viscosus takes advantage of a conformational change in the PRP when it becomes surface-bound, which exposes a cryptic part of the molecule . A third, and intriguing, type of interaction is seen between various streptococci and salivary amylase . This does not result in either adherence or aggregation but provides organisms with the ability to utilize starch breakdown products for metabolism . An understanding of the mechanisms involved in bacterial-protein interactions could conceivably lead to novel methods for controlling specific pathogens, but the systems operating in the mouth are numerous, complex, and diverse.

J Clin Invest, 1994 Jul, 94(1), 286 - 92
Maternal immunization of mice with group B streptococcal type III polysaccharide-beta C protein conjugate elicits protective antibody to multiple serotypes; Madoff LC et al.; Group B streptococcal infection is a major cause of neonatal mortality . Antibody to the capsular polysaccharide protects against invasive neonatal disease, but immunization with capsular polysaccharides fails to elicit protective antibody in many recipients . Conjugation of the polysaccharide to tetanus toxoid has been shown to increase immune response to the polysaccharide . In animal models, C proteins of group B streptococci are also protective determinants . We examined the ability of the beta C protein to serve in the dual role of carrier for the polysaccharide and protective immunogen . Type III polysaccharide was covalently coupled to beta C protein by reductive amination . Immunization of rabbits with the polysaccharide-protein conjugate elicited high titers of antibody to both components, and the serum induced opsonophagocytic killing of type III, Ia/C, and Ib/C strains of group B streptococci . Female mice were immunized with the conjugate vaccine and then bred; 93% of neonatal pups born to these dams vaccinated with conjugate survived type III group B streptococcal challenge and 76% survived type Ia/C challenge, compared with 3% and 8% survival, respectively, in controls (P < 0.001) . The beta C protein acted as an effective carrier for the type III polysaccharide while simultaneously induced protective immunity against beta C protein--containing strains of group B streptococci.

Gene, 1994 Jun 24, 144(1), 25 - 30
Antigenic diversity within a family of M proteins from group A streptococci: evidence for the role of frameshift and compensatory mutations; Relf WA et al.; The genes (emm) encoding M proteins, from isolates of group-A streptococci (GAS) serotyped as M52, M53, M80 and M nontypeable (MNT; serologically related to M53 and M80), were examined . Characterization of emm from these GAS revealed some discrepancies with serotyping, illustrating the difficulty in serotype determination when cross-reactions occur . DNA sequences corresponding to the N-terminal region of M proteins from the isolates showed considerable similarity both in the hypervariable region and the repeat regions . We propose that these serotypes form a family of closely related M types . Frameshift mutations in the hypervariable region followed by a corrective (compensatory) frameshift were observed . This may be an effective mechanism for generating antigenic diversity in the M protein.

Mol Gen Genet, 1994 Jun 15, 243(6), 691 - 8
Genetic variability of the emm-related gene of the large vir regulon of group A streptococci: potential intra- and intergenomic recombination events; Podbielski A et al.; One of the most prevalent genetic lineages of group A streptococci (GAS) harbors a genomic locus termed the large vir regulon, which contains an emm gene encoding the antiphagocytic M protein, and structurally related fcrA and enn (emm-related) genes encoding immunoglobulin-binding proteins . In the present study more than 100 large vir regulons from 42 different GAS serotypes were analyzed by PCR and partial DNA sequencing . On comparing these data to published sequences, sites of mutational and putative recombinational events were identified and ordered with respect to their intra/intergenic or intra/intergenomic nature . The emm-related genes were found to display small intragenic deletions or insertions, were completely deleted from, or newly inserted into the genome, or were fused to adjacent genes . Intergenomic exchanges of complete emm-related genes, or segments thereof, between different vir regulons were detected . Most of these processes seem to involve short flanking direct repeats . Occasionally, the structural changes could be correlated with changes in the functions of the encoded proteins.

Proc Natl Acad Sci U S A, 1994 Jun 7, 91(12), 5543 - 7
Alterations in major histocompatibility complex association of myocarditis induced by coxsackievirus B3 mutants selected with monoclonal antibodies to group A streptococci; Huber SA et al.; Three monoclonal antibodies (mAbs), 49.8.9, 36.2.2, and 54.2.8, made to the group A streptococcus M5 serotype identify crossreactive epitopes in cardiac tissues and also neutralize a highly myocarditic variant of coxsackievirus B3 (H3) . Mutants of H3 were selected with these mAbs and evaluated for pathogenicity compared with the wild-type virus . H3 and the mutant variants selected with mAbs 36.2.2 (H3-36) and 54.2.8 (H3-54) induced severe myocarditis in DBA/2 (H-2d) and A/J (H-2a) male mice, whereas CBA (H-2k) mice were disease resistant . The virus variant isolated with mAb 49.8.9 (H3-49) was strikingly different and caused disease in CBA and A/J mice but not in DBA/2 animals, suggesting that the major histocompatibility complex association of the disease had been altered . This hypothesis was confirmed by using B10 congenic mice . In addition, T lymphocytes from the H3 and H3-49 virus-infected mice responded to distinctly different peptides in the streptococcal M protein, suggesting that certain epitopes of infectious agents which are shared with host tissues may be critical in determining disease susceptibility in genetically distinct individuals.

Med J Aust, 1994 Jun 6, 160(11), 709 - 13, 716-8
Hospital practices influence the pattern of infective endocarditis; Dwyer DE et al.; OBJECTIVE: To identify factors contributing to infective endocarditis at a major teaching hospital . METHODS: Retrospective review of clinical records of patients diagnosed with endocarditis by standard case definitions with respect to causative organisms, clinical features and outcome . RESULTS: One hundred and ninety-three episodes of endocarditis seen between 1979 and 1992 at Westmead Hospital, Sydney, were reviewed . In the 174 cases where the causative organism was isolated, 75 (43%) were Staphylococcus aureus and 50 (29%) were viridans streptococci . Nosocomial acquisition and/or inter-hospital transfer accounted for 83 episodes; 48 (58%) S . aureus (P < 0.001) and nine (11%) viridans streptococci (P < 0.001) . In cases from the local community, viridans streptococci were more common than S . aureus (37% versus 25%); these included 18 episodes (14 S . aureus) in intravenous drug users . CONCLUSION: We conclude that, compared with community-acquired infections, the aetiology of endocarditis in a large teaching hospital is influenced strongly by the prevalence of nosocomial endocarditis and the need for interhospital transfer of complicated cases.

J Infect Dis, 1994 Jun, 169(6), 1397 - 400
Role of amoxicillin serum levels for successful prophylaxis of experimental endocarditis due to tolerant streptococci; Fluckiger U et al.; The importance of amoxicillin serum profiles for successful prophylaxis of experimental endocarditis in rats was assessed . Animals with catheter-induced vegetations were challenged intravenously with large inocula of Streptococcus sanguis and received one of the following amoxicillin dosages: single or multiple bolus injection of 40 mg/kg; 40 mg/kg administered as a continuous infusion over 12 h; or either 9 or 18 mg/kg administered over 12 or 24 h, respectively . The regimen producing a single transient high peak serum level failed to prevent experimental endocarditis; in contrast, a second injection 6 h after the first resulted in successful prophylaxis . Likewise, the three regimens of continuous, relatively low-dose regimens prevented infections . Thus, the most important parameter for successful prophylaxis was the duration of inhibitory concentration of the drug in the serum . The total dose of antibiotic, the peak serum levels, or the area-under-the-curve values were not predictive of successful prophylaxis.

Infect Immun, 1994 Jun, 62(6), 2450 - 8
Adherence of group B streptococci to cultured epithelial cells: roles of environmental factors and bacterial surface components; Tamura GS et al.; Group B streptococci (GBS) are the major cause of neonatal pneumonia, sepsis, and meningitis . Steps considered to be important in the pathogenesis of this infection include colonization of the rectum and vagina of the mother, aspiration of GBS into the fetal lung during or just prior to delivery, and invasion of GBS into pulmonary epithelial cells . We have previously demonstrated that GBS can invade pulmonary epithelial cells both in vivo and in vitro . Adherence of GBS to epithelial cells may play an important role in colonization of the rectum and vagina and constitute a first step in invasion of pulmonary epithelial cells . Because GBS can both adhere to and invade epithelial cells, we have developed two assays for GBS adherence which measure cell surface and not intracellular bacteria . Using these assays, we were able to demonstrate specific adherence of GBS to pulmonary epithelial cells . Adherence levels were similar at 4 and 37 degrees C and for log- and stationary-phase bacteria . Physiologic conditions vary considerably between the rectum, vagina, and lung, and a range of conditions was therefore tested . Adherence was enhanced in hypotonic solutions, while magnesium and calcium had no effect on adherence at physiologic concentrations . In comparison with adherence at neutral pH, adherence was increased 6- to 20-fold at pH 4, which is the normal vaginal pH . Neither capsular polysaccharide nor lipoteichoic acid was important for adherence in these assays . Treatment of GBS with trypsin decreased their adherence by more than 75%, indicating that surface proteins play an important role.

Infect Immun, 1994 Jun, 62(6), 2440 - 9
Cloning and sequence analysis of a gene encoding a 67-kilodalton myosin-cross-reactive antigen of Streptococcus pyogenes reveals its similarity with class II major histocompatibility antigens; Kil KS et al.; The group A streptococcal sequela acute rheumatic fever (ARF) has been associated with immunological cross-reactivity between streptococcal and heart proteins . To identify Streptococcus pyogenes genes that encode a myosin cross-reactive antigen(s) recognized by ARF sera, a genomic library from an emm deletion strain (T28/51/4) was screened with a single ARF serum . A positively identified lambda EMBL3 clone (T.2.18) produced a protein which reacted with myosin-specific antibodies affinity purified from individual ARF sera . The recombinant protein was initially estimated to be 60 kDa in size by sodium dodecyl sulfate-polyacrylamide gel electrophoresis; however, upon sequence analysis it had a molecular mass equivalent to 67 kDa . Sera from patients with streptococcal infections, acute glomerulonephritis, and ARF were reactive with the recombinant 67-kDa protein . However, individual sera from healthy persons were negative or demonstrated low levels of reactivity with the 67-kDa antigen . The gene encoding the 67-kDa myosin-cross-reactive antigen was subcloned, and its nucleotide sequence was determined by using a combined strategy of DNA sequencing of the cloned gene and N-terminal amino acid sequencing of the protein expressed in Escherichia coli . The amino-terminal sequence deduced from the nucleotide sequence of an open reading frame was identical to that determined from the 67-kDa protein expressed in E . coli . The gene encoded 590 amino acids with a calculated molecular weight of 67,381 . No cleavable signal peptide was detected with the 67-kDa protein expressed in E . coli . The deduced amino acid sequence of the 67-kDa protein did not exhibit significant similarity to any known streptococcal proteins . However, it was found to be 19% identical and 62% similar over 151 amino acid residues to the beta chain of mouse major histocompatibility complex class II antigen (I-Au) . Similar degrees of homology to the beta chains of other murine and human class II haplotypes were found . Mouse anti-IA sera reacted with the recombinant 67-kDa protein about five times more strongly than normal mouse sera in the enzyme-linked immunosorbent assay . Southern hybridization experiments using a probe for the gene encoding the 67-kDa protein showed that the gene was present and conserved among pathogenic groups A, C, and G of streptococci . These data suggest that the streptococcal protein, which is distinct from the M protein, may have structural features in common with the beta chain of the class II antigens, as well as myosin, and may play an important role in the pathogenesis of streptococcal infections.

Infect Immun, 1994 Jun, 62(6), 2387 - 94
M12 protein from Streptococcus pyogenes is a receptor for immunoglobulin G3 and human albumin; Retnoningrum DS et al.; We previously showed that M12 protein from opacity factor-negative Streptococcus pyogenes (group A streptococci) CS24 is responsible for immunoglobulin G3 (IgG3) binding activity . Here, we report that this M protein binds human serum albumin (HSA) . Deletion analysis showed that the C repeats are sufficient for binding HSA, although upstream regions may be required for optimal binding . Like protein G, IgG3 and HSA bind to independent domains in the M protein . Experiments showed that bound IgG3 did not inhibit HSA binding to the M protein . The interaction between M12 protein and HSA is specific . M12 protein does not bind chicken egg and bovine serum albumins . Alignments of C1 and C2 repeats of M12 protein to sequences at the carboxy termini of other M proteins and Ig receptors revealed highly homologous sequences in the FcRV, M5, M6, ML2.1, and M57 proteins, suggesting that all could bind HSA . As predicted from the alignment, M5 protein and M6+ streptococci bound HSA, whereas an isogenic M6- mutant did not bind HSA . Furthermore, M2 protein from an opacity factor-positive strain also bound HSA.

Infect Immun, 1994 Jun, 62(6), 2187 - 94
Glucosyltransferase mediates adhesion of Streptococcus gordonii to human endothelial cells in vitro; Vacca-Smith AM et al.; Human umbilical vein endothelial cells (HUVEC) were used as an experimental host model to investigate the mechanism(s) of streptococcal adhesion in infective endocarditis . Adhesion activity of Streptococcus gordonii was maximal during the logarithmic phase of growth and was greatly reduced or eliminated by pretreatment of bacteria with heat, formaldehyde, or trypsin . At saturating numbers of streptococci, an average of 81 bacteria were bound per HUVEC . Streptococcal adhesion was inhibited by low-molecular-weight dextran and heparin but not by sucrose, fibronectin, or laminin . Adhesion was also prevented by pretreatment of HUVEC with proteins dissociated from the surface of S . gordonii with 10 mM EDTA or isolated from spent culture medium . Western blot (immunoblot) assays detected a single adhesion protein of 153 kDa (AP153) on HUVEC after incubation with unfractionated extracts of streptococci . The adhesin exhibited glucosyltransferase (GTF) activity when incubated with sucrose and Triton X-100 after sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The AP153 was purified by affinity chromatography on dextran beads and show to have binding activity for HUVEC, GTF activity, an amino acid composition similar to that reported for GTF of S . gordonii, and the ability to inhibit S . gordonii adhesion . Incubation of the streptococci with antibodies to the adhesin inhibited bacterial attachment to HUVEC monolayers . These results indicate that surface-localized GTF mediates adhesion of S . gordonii to HUVEC in vitro and may serve as a mechanism for colonization of the endocardium in infective endocarditis.

Infect Immun, 1994 Jun, 62(6), 2165 - 8
Pioneer oral streptococci produce immunoglobulin A1 protease; Cole MF et al.; As part of a longitudinal study of the relationship between bacterial colonization and the secretory immune response, 367 isolates of pioneer viridans streptococci collected from 40 breast- and bottle-fed neonates within the first month postpartum were tested for the production of immunoglobulin A1 (IgA1) protease and glycosidases . Fifty percent of the streptococci isolated produced IgA1 protease, including all isolates of Streptococcus oralis and S . sanguis, 60.7% of S . mitis biovar 1 isolates, and some isolates that could not be identified . Three cleavage patterns of alpha 1 heavy chains were observed . Six isolates of S . mitis biovar 1 that did not produce IgA1 protease attacked the alpha 1 chain . Incubation of IgA1 protease-negative S . mitis biovar 1 isolates with IgA1, either prior to or together with S . sanguis, rendered the IgA1 paraprotein resistant to cleavage by the IgA1 protease of S . sanguis . The ability of some pioneer streptococci in the human oral cavity to produce IgA1 protease and of others to modify the susceptibility of IgA1 to cleavage by IgA1 protease perhaps enhances their ability to survive in this habitat.

JAMA, 1994 Jun 1, 271(21), 1707 - 8
Psychiatry; Goodwin FK; Eleven percent of the population seek mental health services during a given year, with a majority seeking some care from nonpsychiatrist physicians or hospital emergency departments . Some behavioral and neuropsychiatric problems of childhood may be mediated through antineuronal antibodies that arise in response to infection by group A beta-hemolytic streptococci.

Minerva Pediatr, 1994 Jun, 46(6), 303 - 6
{Perianal streptococcal dermatitis}; Paradisi M et al.; Perianal streptococcal dermatitis is a childhood disorder caused by group A beta-hemolytic streptococci which was first described by Amren in 1966 . The incidence of this dermatosis, characterized by well defined erythema in the perianal area, has certainly been underestimated and to the authors' knowledge there have still been no reports of this pathology in Italy . Perianal streptococcal dermatitis merits attention given that affected subjects do not always receive appropriate treatment and on average there is a 6-month lapse between the appearance of symptoms and diagnosis . The authors present two cases which were recently referred to their attention and discuss the methods of contagion, the difficulties of clinical diagnosis, associations with other streptococcal disorders and the treatment of this morbid condition.

Trends Microbiol, 1994 Jun, 2(6), 209 - 12
Adherence and accumulation of oral streptococci; Jenkinson HF; Oral streptococci adhere to human salivary components and coadhere with specific partner oral bacteria . These interactions may favour the ordered development of plaque communities . The primary sequences of several streptococcal polypeptide adhesins are conserved, indicating that similar colonization mechanisms may have evolved . Critical amino acid changes within binding domains of adhesins might account for species- and site-specific adherence and accumulation.

Enferm Infecc Microbiol Clin, 1994 Jun-Jul, 12(6), 285 - 8
{Carrier state of groups A, B, C, and D beta-hemolytic streptococci}; Betriu C et al.; BACKGROUND: Streptococci group A is the most frequently isolated pathogen in the cases of acute pharyngotonsilitis in school-aged children . Hemolytic streptococci B, which are not of group A, have recently been described as a cause of pharyngotonsilitis . A study was carried out in school children in primary school with the aim of knowing the frequency of the state of pharyngeal carriers of streptococci in groups A, B, C and G . METHODS: A total of 347 children with ages ranging from 4 to 14 years of age were included in the study in which a pharyngeal exudate was obtained to investigate the presence of hemolytic streptococci B . RESULTS: The prevalence of streptococci group A in all the age groups studied was of 11.52% being significantly greater (40.47%) among children of preschool age (4-6 years) . The prevalence of streptococci group C was 2.3% with no carriers of groups B or G being observed . CONCLUSIONS: The results of this study are in agreement with the literature reviewed in which asymptomatic carriers of streptococci group A were found to be principally school aged children who are those who most frequently have acute pharyngotonsilitis . Neither the pathogenicity of hemolytic streptococci B, which are not of group A, nor their epidemiologic implications are totally clear.

Planta Med, 1994 Jun, 60(3), 222 - 7
Electron microscopic and microcalorimetric investigations of the possible mechanism of the antibacterial action of a defined propolis provenance; Takaisi-Kikuni NB et al.; Microcalorimetric and electron microscopic studies on the mode of the antibacterial action of propolis were performed on Streptococcus agalactiae . It was shown that propolis inhibits bacterial growth by preventing cell division, thus resulting in the formation of pseudo-multicellular streptococci . In addition, propolis disorganized the cytoplasm, the cytoplasmic membrane, and the cell wall, caused a partial bacteriolysis, and inhibited protein synthesis . It was evident that the mechanism of action of propolis on bacterial cells is complex and a simple analogy cannot be made to the mode of action of any classic antibiotics.

Int J Pediatr Otorhinolaryngol, 1994 Jun, 29(3), 169 - 78
Acute upper respiratory tract infections and indications for tonsillectomy in children . I . Immunoglobulin synthesis in the palatine tonsil tissue; Katic V et al.; Current viewpoints and practice concerning indications for tonsillectomy are presented . The annual specific risk for upper respiratory infection in children aged up to 15 is 1.1 . The risk is higher in the youngest age group, in whom it rises to 1.8, decreasing with age and being lowest among children aged 12-15 years (0.5) . The proportion of tonsillitis among acute upper respiratory tract infections is highest in the age group up to 3 years (36.9%); at the age of 4-5 years it is 37.1%, and is lowest among children aged 12-15 years (21.9%) . The risk of tonsillitis caused by streptococci is highest among children aged up to 5 years . Statistical significance of differences in the synthesis of immunoglobulins (G, M, A and sA) and lysozymes in the palatine tonsil tissue of tonsillectomized children and healthy volunteers was tested by non-parametric tests for independent samples . Significant differences of the above mentioned syntheses were found in all entities studied . Any contribution to the documentation on the nature and cause of each tonsillitis in childhood is of great clinical value, because it is the only basis for rational consideration of indications for tonsillectomy.

Pediatr Dermatol, 1994 Jun, 11(2), 168 - 71
Perianal streptococcal dermatitis associated with guttate psoriasis and/or balanoposthitis: a study of five cases; Patrizi A et al.; Perianal streptococcal dermatitis (PSD) is a recently described cutaneous entity caused by group A beta-hemolytic streptococci . It is characterized by perianal erythema, sometimes associated with functional disturbances . We describe four children (2 boys, 2 girls) who had acute guttate psoriasis and also PSD . One of these patients also had balanoposthitis . A fifth patient experienced an association of PSD and balanoposthitis without psoriasis . To our knowledge, the association between guttate psoriasis and PSD has only been reported in five children, and the one with balanitis has not been previously reported.

FEMS Microbiol Lett, 1994 Jun 1, 119(1-2), 19 - 25
Rapid typing of group A streptococci by the use of DNA amplification and non-radioactive allele-specific oligonucleotide probes; Kaufhold A et al.; Because of the allelic variations within the M protein gene (emm gene) of group A streptococci, reliable typing of this important human pathogen can be accomplished by the use of emm gene-specific oligonucleotide probes . Two technical modifications (a reverse dot blot and a reverse line blot hybridization assay) of a novel approach for the type-specific identification of emm genes have been developed . Both procedures involved amplification of an emm gene by polymerase chain reaction . The non-radioactively labeled amplicon was subsequently hybridized to a membrane carrying an array of immobilized emm gene-specific oligonucleotide probes, thus allowing the simultaneous analysis of the gene polymorphism in a single hybridization reaction . The feasibility of these rapid and easy to perform methods was shown for the unequivocal identification of reference strains and clinical isolates belonging to 16 different M serotypes.

Eur J Biochem, 1994 Jun 1, 222(2), 267 - 76
Streptokinase activates plasminogen bound to human group C and G streptococci through M-like proteins; Ben Nasr A et al.; An ability to interact with plasminogen or plasmin could provide micro-organisms with a mechanism for invasion . Thus, group A, C and G streptococci secrete streptokinase which binds and activates plasminogen . Some streptococci also express surface structures which bind plasminogen without causing its activation . Plasminogen-binding surface proteins were extracted from one group C and one group G streptococcal isolate . Both proteins were found to bind plasmin, fibrinogen and serum albumin in addition to plasminogen . Gene fragments encoding the streptococcal proteins were amplified by PCR and were subsequently cloned and expressed in Escherichia coli . DNA sequence determination revealed for both genes open reading frames encoding proteins which contained repetitive domains and a carboxyl-terminal unrepeated region that were typical of M and M-like proteins . Though the amino-terminal regions of the group C and G streptococcal proteins demonstrated a rather high overall similarity between themselves, they were not similar to the variable regions of other M-like proteins with one exception: there was a 46% identity between the first 22 amino acids of the group G streptococcal protein and the corresponding sequence of PAM, the plasminogen-binding M-like protein of type M53 group A streptococci . Like the proteins extracted from the streptococci, the recombinant proteins bound plasminogen, fibrinogen and albumin . The three plasma proteins bound to separate sites on the streptococcal M-like proteins . Plasminogen bound by the group C and G streptococcal proteins was readily activated by streptokinase, providing evidence for a functional link between the secreted plasminogen-activator and proteins exposed on the bacterial surface.

Am J Respir Crit Care Med, 1994 Jun, 149(6), 1648 - 53
The bacteriology of obstructive pneumonitis . A prospective study using ultrasound-guided transthoracic needle aspiration; Liaw YS et al.; Obstructive pneumonitis, the opacity that develops distal to an obstructing endobronchial lesion or external compression, is actually a combination of atelectasis, bronchiectasis with mucus plugging, and true parenchymal inflammation . In the majority of cases, it is usually not possible to determine whether infection is present or not from the radiographic findings alone . The aim of this study was to evaluate the bacteriology of obstructive pneumonitis and the influence of this result on the treatment of patients . From March 1992 to February 1993, 26 consecutive patients (20 men and six women) with obstructive pneumonitis were investigated . The obstructive pneumonitis had been caused by malignant tumors in 24 and benign lesions in two . Chest ultrasound (US) and US-guided percutaneous transthoracic aspirations were undergone to obtain specimens for microbiologic examination . Microorganisms were isolated from seven of nine febrile patients and two of 17 nonfebrile patients . A total of 16 bacterial strains are detected in obstructive pneumonitis (Pseudomonas aeruginosa, Klebsiella pneumoniae, viridant streptococci, Bacteroides fragilis, two Peptostreptococcus species, Mycobacterium tuberculosis, Pseudomonas maltophilia, Streptococcus sanguis, Staphylococcus aureus, Bacteroides thetaiotamomicrons, Bacteroides intermedius, Bacteroides species, Veillonella species, aerobic gram-positive bacilli, and Escherichia coli) . In five cases the isolates were monobacteriae, and in the remaining four cases, cultures yielded more than one bacteria . The results of aspirate cultures led to changes in the initial antibiotic trial in seven of nine patients, and fever subsided thereafter . Pneumothorax occurred in one cases as the sole complication . The pathogen causing obstructive pneumonitis is very heterogeneous, and polymicrobial infection is common.(ABSTRACT TRUNCATED AT 250 WORDS)

Scand J Prim Health Care, 1994 Jun, 12(2), 70 - 6
Does near-to-patient testing contribute to the diagnosis of streptococcal pharyngitis in adults?
Hjortdahl P, Melbye H.
OBJECTIVE--To asses the efficacy of near-to-patient laboratory testing in diagnosing group A beta haemolytic streptococci throat infection in adults, alone and in conjunction with the doctor's clinical judgement . SETTING AND SUBJECTS--174 primary care patients with a sore throat, of which 59 (34%) were identified as having group A streptococci . MAIN OUTCOME MEASURES--The erythrocyte sedimentation rate, leucocyte count, and C-reactive protein, and a specific streptococcal immunological assay were evaluated separately and in conjunction with the doctor's clinical diagnosis . The presence of GAS throat infection, the reference standard, was defined as those patients presenting with a chief complaint of sore throat and having a positive GAS culture or a four-fold or more increase or fall of AST or ADNase B serum levels during a four-week observation period . RESULTS--The discriminatory ability of the sedimentation rate was not satisfactory and added little useful clinical information . Leucocytes and C-reactive protein both yielded clinically significant information and had similar test characteristics . The immunological test had the best characteristics of the tests evaluated . CONCLUSION--Near-to-patient testing, except the erythrocyte sedimentation rate, may, in addition to the clinical evaluation, contribute to the differential diagnosis of streptococcal pharyngitis in adults.

Vet Microbiol, 1994 Jun, 40(3-4), 253 - 61
Macrolide-lincosamide resistance determinants in streptococcal species isolated from the bovine mammary gland; Roberts MC et al.; Seventy one streptococci isolated from dairy cows with clinical mastitis were tested for erythromycin and lincomycin susceptibility . Ten isolates (7.1%) were resistant to erythromycin and/or lincomycin and seven were constitutive and three were inducibly resistant . Nine of the isolates hybridized with one or more of the Erm probes tested and eight isolates gave PCR products with rRNA methylase primers . The Erm determinants were transferable at frequency of 10(-5) to 10(-6) per recipient.

Sangre (Barc), 1994 Jun, 39(3), 191 - 6
{Early bacterial infections in 103 patients treated with bone marrow transplantation}; Tomas JF et al.; PURPOSE: To analyse bacterial infections in the period immediately following bone-marrow transplantation . PATIENTS AND METHODS: A retrospective study of 174 febrile episodes appearing on 103 patients treated with bone-marrow transplantation in 1990 and 1991 was carried out, special attention being paid to the bacterial infections . RESULTS: Virtually all patients (100/103) had at least one febrile episode, and its infectious character was documented in 54% of the instances . Gram-positive germs were most commonly present, 85% of the bacteria isolated, and coagulase-negative staphylococci, especially St epidermidis, predominated (60%) . Different species of streptococci, mostly of the viridans group, were isolated in 22% of the blood cultures attained in the first febrile episodes . The mortality due to infection in the series as a whole was 4.8% . CONCLUSIONS: Infections by gram-positive germs, especially coagulase-negative staphylococci, are commonly found among the patients subjected to bone-marrow transplantation . Increased streptococci infections, mostly of the viridans group, are also appreciated . These facts, along with decreased number of gram-negative infections, must be born in mind when designing initial antimicrobial coverage for these patients.

Semin Arthritis Rheum, 1994 Jun, 23(6), 396 - 405
Nontropical pyomyositis in adults; Gomez-Reino JJ et al.; Pyomyositis (PMS) is a primary infection of striated muscle . Recent scanty reports suggest that non-tropical PMS may differ from classical tropical PMS . To address this question, 12 cases of nontropical PMS seen at two hospitals between 1976 and 1992 were reviewed and an English-literature search of similar cases was conducted . Both the series and reported cases are pooled together and herein reported . The age distribution of the 97 patients showed 30-50 and 60-70-year peaks, with a 3:1 (male-female) ratio . Fever, high erythrocyte sedimentation rate, and muscle stiffness or inflammation were present in more than 75% of patients . Muscles of the thigh (54%), back (13%), buttock (11%), arm (9%), or chest wall (4%) were involved . Staphylococci (61%), gram-negative bacilli (16%), streptococci (12%), and fungi (2%) were isolated from muscle specimens . Human immunodeficiency virus infection, diabetes mellitus, hemopoietic disorders, and other conditions with defective neutrophil function were present in 64 patients (66%) . Drainage of pus and antibiotic therapy were the standard treatments . The mortality rate reached 10% . Analysis of patients classified by the comorbid condition showed differences in age, causative microorganisms, clinical features, and death rate . It is concluded that several clinical presentations of nontropical PMS are at variance with that of tropical PMS.

Oral Microbiol Immunol, 1994 Jun, 9(3), 180 - 5
Evidence for an ecto-ATPase on the cell wall of Streptococcus sanguis; MacFarlane GD et al.; Certain strains of viridans streptococci bind platelets, which release ATP from dense granules and then aggregate . By hydrolyzing the released ATP to the platelet agonist, ADP, cell wall-associated ATPase activity of Streptococcus sanguis may amplify the aggregation of platelets . To identify and characterize this ecto-ATPase activity, whole cells were incubated with {14C}-ATP . The cell-free nucleotides were separated by thin-layer chromatography and quantified by liquid scintillation counting . Whole-cell activity showed temperature and pH optima in the physiological range . To isolate a soluble fraction with ATPase activity from the cell wall, whole cells were digested under osmotically stable conditions to produce protoplasts . Protoplasts and cells were separated from soluble cell wall materials by centrifugation . ATPase activity in cell fractions was identified by zymograms of native 8% polyacrylamide gels after electrophoresis . The ecto-ATPase preparation, membrane and cytoplasmic ATPase in lysed protoplasts showed different zymograms and sensitivity to inhibition by DCCD, ouabain vanadate, azide and NEM . In electron micrographs of ultrathin sections of cells of S . sanguis, ATPase activity was localized to the cell wall . Since the pattern of localization to the wall changed with the phase of growth, the ecto-ATPase of S . sanguis may be associated with the development and maintenance of the cell wall.

Minerva Stomatol, 1994 Jun, 43(6), 263 - 72
{Microbiological contamination in the dental office and its possible decrease}; Signoretto C et al.; A microbiological analysis of the environment after dental work is presented in this paper . Detection of oral streptococci in the air is used as an index of the presence of salivary aerosol in consequence of the use of dental tools at high spin . This salivary aerosol may be considered a very important cause for the transmission of infectious diseases in the dental surgery . The real efficacy of a tool for the production of a dry aerosol of phenols or clorexidine with the purpose of environmental disinfection, is evaluated . Among possible parameters has been considered both the spray ability of the tool and the bactericidal activity of the aerosol at variable length from the source . Data here presented demonstrate the real utility of such an instrument for the disinfection of the dental surgery to be applied daily at the end of the work, not only in reducing environment microbial counts but also in totally eliminating salivary microorganisms.

Indian J Ophthalmol, 1994 Jun, 42(2), 71 - 4
Donor corneoscleral rim contamination by gentamicin-resistant organisms; Gopinathan U et al.; Gentamicin is the most widely used antibiotic in the decontamination of donor cornea for penetrating keratoplasty . However, the incidence of resistance to gentamicin is on the rise . Bacterial isolates from 178 donor corneal rims were studied for gentamicin sensitivity . The overall rate of gentamicin resistance was 63.4% . At 86.2% the Pseudomonas . species had the highest rate of resistance, followed by Streptococci at 84.6% . The high rate of gentamicin resistance encountered by us and others suggest that either addition of a second antibiotic to corneal storage media or replacement of gentamicin by an antibiotic with a broader spectrum of activity may help reduce the risk of endophthalmitis following penetrating keratoplasty.

Microb Pathog, 1994 Jun, 16(6), 443 - 50
Vaccination with streptococcal extracellular cysteine protease (interleukin-1 beta convertase) protects mice against challenge with heterologous group A streptococci; Kapur V et al.; Virtually all clinical isolates of group A streptococci secrete a highly conserved extracellular cysteine protease that cleaves human fibronectin and vitronectin, and converts IL-1 beta precursor to biologically active IL-1 beta . Based on the high degree of gene conservation within the species and its role in host pathogenicity, it was postulated that antibodies to the cysteine protease would confer protective immunity against S . pyogenes infection . To test this hypothesis, Swiss CD1 mice were intraperitoneally administered either saline, rabbit IgG, or IgG from rabbits immunized with the protease, and challenged with a highly virulent (minimum lethal dose approximately 10 cfu) clinical isolate of S . pyogenes expressing a heterologous cysteine protease . The results indicate that mice administered IgG from rabbits immunized with purified cysteine protease had significantly enhanced survival when compared with mice given either non-specific rabbit IgG (log rank test; chi 2; p = 0.0195) or saline (log rank test; chi 2; p = 0.0002) . Moreover, mice actively immunized with the cysteine protease had a significantly longer time to death than the control group (log rank test; chi 2; p = 0.0418) . The results show that the cysteine protease elicits non-type-specific immunity to challenge with heterologous S . pyogenes.

Diagn Microbiol Infect Dis, 1994 Jun, 19(2), 69 - 73
Bacteriologic characteristics and antimicrobial susceptibility of 70 clinically significant isolates of Streptococcus milleri group; Gomez-Garces JL et al.; The phenotypical characteristics of 70 clinical isolates of Streptococcus milleri group were analyzed . Association of the three species with particular sites of isolation could not be demonstrated in all cases, but S . anginosus strains predominated in abdominal area, while S . intermedius was isolated mainly in hepatic abscesses . Penicillin G and other beta-lactams showed good in vitro activity against these streptococci, whereas > 10% exhibited resistance to erythromycin and clindamycin . Resistance to tetracycline reached almost 40% . All of the isolates were uniformly susceptible to vancomycin, chloramphenicol, and trimethoprim.

Kansenshogaku Zasshi, 1994 May, 68(5), 686 - 90
{Human fibrinogen binding activities in culture supernates of group A streptococci . Streptococcal Diseases Study Group}; Arai H et al.; Fibrinogen binding activities in culture supernates of group A streptococci were detected by dot blot assay using horseradish peroxidase conjugated human fibrinogen . Various intensities in colored dots were seen in 63 of 70 strains isolated from pharyngitis patients in 1992 . Strong binding activities in all of 16 strains were partially sensitive to trypsin digestion . The binding activities in the concentrated culture supernate of M-type 4 strain SS91 were analysed by SDS-PAGE and Western blotting . Intense colored bands and faint ones were seen in the position corresponding to 89K, 66K, 59K, 49K, 42KDa and 77K, 53K, 51K, 44KDa, respectively . Only one band at 42KDa remained after trypsin digestion.

Kansenshogaku Zasshi, 1994 May, 68(5), 680 - 5
{Long term observation on beta-hemolytic streptococci in institutions for handicapped preschool children . Streptococcal Diseases Study Group}; Takizawa Y et al.; Studies on beta-hemolytic streptococci have been carried out in 2 institutions for handicapped preschool children during the last nine-year period from 1985 to 1993 . These studies were based on continuous throat cultures, 4 to 12 times a year, from 244 children including Down's syndrome and mentally retarded children in K-institution (K), and from 134 including cerebral palsy and other cerebrospinal disorders in H-institution (H) . A significant difference (p < 0.05) was demonstrated in the isolation rates between K (11.1%) and H (6.4%) . In K, isolation rates of beta-hemolytic streptococci ranged from 0 to 43.5%, showing a higher rate in winter (16.5%) than in summer (6.6%), and elevated-isolation rates of homologous types were demonstrate four times during the study period; i.e., type T12 in '87, type T28 in '88, type T1 in '90 and '92 . In H, on the other hand, no higher rates (as to group A) were observed in winter or summer . In relation to disorders of children, the rates were 12.6% in Down's syndrome (mean age 2.7y), 10.0% in mentally retarded children (3.9y) and 6.4% in cerebral palsy or others with cerebrospinal disorders (3.3y) . Down's syndrome, the youngest group, revealed the highest isolation rate of beta-hemolytic streptococci . In only two cases isolated hemologous types detected were over two times continuously.

Kansenshogaku Zasshi, 1994 May, 68(5), 665 - 79
{An epidemiological study of group A, B, C and G hemolytic streptococci isolated from elementary school children in the recent 12 years . Part II . Susceptibility to antibiotics . Streptococcal Diseases Study Group}; Okuyama M et al.; During a 12-years period between 1980 and 1992, 5,023 strains of hemolytic streptococci were detected from throats of school children, and described in part I . Among them, the following strains their susceptibility were tested to 14 kinds of antibiotics; 1,511 strains of group A, 1,038 of group B, 125 of group C, 553 of group G . 1 . No resistant strains against both penicillins (PCG, AMPC, ABPC, ACPC) and cephems (CER, CET, CCL, CEX) could be found . Strains of group B were less susceptible than the others to penicillins and cephems . 2 . Some resistant strains were found against macrolides (EM, OL & JM), 5.9-8.6% . These resistant strains belonged many to group A and a few to group B & G . Since 1983, the gradual decrease of the resistant strains was noted though few were found after 1986 . 3 . To TC a number of resistant strains were detected in group A, B, C & G through this study, (12.5-48.4%) . 4 . To CP some resistant strains were found from 1980 to 1985 among group A, B & G, 3.0-5.1% . Since 1986, the sharp decrease of the resistant strains was noted . 5 . Multiresistant strains to TC, CP and macrolides were found since 1980 to 1982 . They were found in many of group A and a few of group B and G, but after 1986 decreased sharply . 6 . Most of the multiresistant strains of group A belonged to serotype T-12 and group B to serotype Ia . Ia/c, III and III/R . 7 . Among the strains of group A type T-13, there were many resistant strains to TC . The rate of resistant occupied over 60% from 1980 to 1986, but decreased slightly thereafter.

Kansenshogaku Zasshi, 1994 May, 68(5), 656 - 64
{An epidemiological study of group A, B, C, and G hemolytic streptococci isolated from elementary school children in the recent 12 years . Part I . Isolation trends . Streptococcal Diseases Study Group}; Okuyama M et al.; During a 12-years period between September, 1980 and November, 1992, hemolytic streptococci (group A, B, C, & G) in throats of healthy school children in Osaka were examined every other month . The results were summarized as follows . 1 . 5,023 strains of hemolytic streptococci were detected from 11,647 specimens, 43.1% . Among them, 2,395 strains (20.6%) belonged to group A, 1,647 (14.4%) to group B, 767 (6.6%) to group G and 187 (1.6%) to group C . 2 . In the first half of the research, group A streptococci were detected predominantly and the last half, group B generally . Both this lower rate of group A to the total strains (47.7%) and this higher rate of group B (33.3%) were due to the small number of lower school grade children from whom group A streptococci are often detected and also due to application of the selective enrichment medium . 3 . Group A streptococci were classified T-type . The most common serotype was T-1, and 638 strains (26.6%) were detected, followed by T-12, 377 (15.7%), T-6, 210 (8.8%) and T-13, 203 (8.5%) . The dominant serotype was exchanged annually, but only T-1 was the most common serotype for 4 years (1983-1986) . 4 . In group B, the most common serotype was Ia, and 524 strains (31.3%) were detected, followed by III, 417 (24.9%), Ib, 164 (9.8%), III/R, 130 (7.8%) and Ia/c 122 (7.3%) . Annual changes of serotype were as follows; Ia was dominant from 1980 to 1988, III from 1989 to 1990 and NT6 in 1991-1992 generally.

J Med Microbiol, 1994 May, 40(5), 330 - 7
Cloning and sequencing the endocarditis immunodominant antigen of Streptococcus sobrinus strain MUCOB 263; Brooks W et al.; Immunoblotting sera from cases of Streptococcus mutans or S . sobrinus endocarditis against an extract from S . sobrinus strain MUCOB 263 had identified three immunodominant antigenic bands at 190, 200 and 220 kDa . A lambda ZAPII DNA library was produced from the sheared genomic DNA of S . sobrinus MUCOB 263 and six identical positive clones were identified when this library was screened with serum from a patient with endocarditis caused by a bacterium from the mutans group of streptococci . On subcloning and sequencing, a protein containing 1548 amino acids was identified with a 99.2% homology to the SpaA antigen of S . sobrinus and 68.4% homology to the PAc antigen of S . mutans.

J Med Microbiol, 1994 May, 40(5), 323 - 9
Immunodominant antigens of Streptococcus equisimilis shared by other beta-haemolytic streptococci; Cimolai N et al.; Three immunodominant antigens of Streptococcus equisimilis (Lancefield group C) with approximate mol . wts of 46, 66 and 105 kDa were recognised by human serum IgG and IgA immunoblotting . These antigens were identified consistently by various human sera but immunoblots with IgA (heavy chain) and secretory IgA (J chain) from human respiratory secretions gave more variable results . Antigens with similar migration rates were demonstrated in S.pyogenes, large colony human biotype group G streptococci, and streptococci of groups C and G from the "S . anginosus-milleri group" . Polyclonal antibody which was eluted from immunoblot substrates that contained the S . equisimilis 66-kDa antigen reacted with the 60-kDa antigen of S . pyogenes . Both polyclonal and monoclonal anti-vimentin antibodies identified the 46-kDa and 66-kDa antigens of S . equisimilis . The homology of these antigens among beta-haemolytic streptococci has the potential to complicate both a strategy for the utilisation of immunoblotting for diagnostic purposes and the understanding of how such antigens may be involved in the pathogenesis of post-infectious sequelae.

Infect Immun, 1994 May, 62(5), 2104 - 7
Identification of two functional forms of immunoglobulin G3-binding protein expressed by group A streptococci; Pack TD et al.; Analysis of group A streptococcal immunoglobulin G (IgG)-binding protein reactivity with different human IgG3-myeloma proteins provided evidence for at least two functional forms of these molecules . Representative IgG3-binding molecules were isolated, biotinylated, and used as tracers in competitive binding assays . Cross-inhibition studies demonstrated the existence of two distinct patterns of IgG3-binding activity . Proteins of one form could be inhibited from binding to an IgG3-myeloma protein by streptococcal protein G while binding of the second form was not inhibited . These studies further underscore the extent of heterogeneity among immunoglobulin-binding proteins expressed by group A streptococci.

Infect Immun, 1994 May, 62(5), 1968 - 74
Localization of immunoglobulin A-binding sites within M or M-like proteins of group A streptococci; Bessen DE; Many strains of group A streptococci are capable of binding human immunoglobulin A (IgA) by a nonimmune mechanism . M or M-like proteins constitute a family of structurally diverse molecules which form surface fibrillae, and some of the M or M-like protein forms are responsible for the IgA-binding activity . In this report, the binding site for IgA is localized within two structurally distinct M or M-like proteins, ML2.2 and Arp4 . Apart from those structural domains which are common to all M and M-like proteins, ML2.2 and Arp4 lack significant levels of amino acid sequence homology, with the exception of a short segment (ALXGENXDLR) located at residues 21 to 30 of the mature ML2.2 protein . Recombinant fusion polypeptides containing portions of the ML2.2 and Arp4 proteins were expressed in Escherichia coli and tested for binding of human myeloma IgA . A 58-residue polypeptide containing residues 14 to 71 of ML2.2 bound human IgA . The IgA-binding site of Arp4 could be localized to a 53-residue polypeptide containing residues 43 to 95, which encompasses the ALXGENXDLR consensus sequence of Arp4 positioned at residues 50 to 59 . Site-specific mutagenesis at three codons within the ALXGENXDLR coding sequence of both the ML2.2 and Arp4 recombinant polypeptides leads to a loss in IgA-binding activity . Thus, the ALXGENXDLR consensus sequence is essential for the nonimmune binding of IgA by both ML2.2 and Arp4 . However, the failure to bind IgA by polypeptides which partially overlap the 58- and 53-residue IgA-binding polypeptides of ML2.2 and Arp4, yet contain the ALXGENXDLR consensus sequence, strongly suggests that flanking regions are also critical for IgA binding . In summary, the results indicate that common functional domains bearing significant sequence homology are distributed within regions of M or M-like molecules that are otherwise highly divergent.

Infect Immun, 1994 May, 62(5), 1593 - 9
Functional activity of antibodies to the group B polysaccharide of group B streptococci elicited by a polysaccharide-protein conjugate vaccine; Marques MB et al.; Group B streptococci (GBS) are a major cause of sepsis and meningitis in infants . While antibodies directed to the type-specific GBS capsule have been shown to be protective, it is less clear whether antibodies to the group B polysaccharide, a noncapsular, cell wall-associated antigen, may play a role in immunity . To investigate the functional activity of group B polysaccharide-specific antibodies, we tested sera from rabbits vaccinated with group B polysaccharide coupled to tetanus toxoid (B-TT) . Anti-B-TT was weakly opsonic in vitro for a highly encapsulated type III strain, while antiserum elicited by vaccination with type III capsular polysaccharide linked to tetanus toxoid (III-TT) was a very effective opsonin . In contrast to anti-III-TT, anti-B-TT given before or after bacterial challenge was only marginally effective in protecting newborn mice against lethal infection with type III GBS . The number of C3 molecules bound to type III GBS was augmented by anti-III-TT but not by high antibody concentrations of anti-B-TT . These results suggest that the difference in opsonic activity between anti-B-TT and anti-III-TT may be due to a difference in their ability to deposit C3 . In addition, the maximum number of antibody molecules bound to the bacterial surface was greater for anti-III-TT than for anti-B-TT . That anti-B-TT binds to fewer sites than anti-III-TT may explain the differences in complement activation and in opsonic and protective efficacy of antibodies to group B polysaccharide compared with antibodies to the type-specific capsular polysaccharide.

J Infect, 1994 May, 28(3), 241 - 9
Microaerophilic streptococcal infection in children; Brook I; A total of 148 isolates of microaerophilic streptococci (MS) (47 Streptococcus constellatus, 43 Streptococcus intermedius and five Gemella morbillorum) were cultured from 123 children . There were predisposing conditions in 47 (38%) patients of which most common were previous surgery (14), trauma (11), malignancy (9) diabetes (6) and immunodeficiency (5) . MS were the only bacteria isolated from 12 (10%) patients and mixed infections were encountered in 111, when the number of isolates varied between two and seven (average 3.0) isolates per specimen . The bacteria most commonly isolated with MS were anaerobic cocci (70 isolates), Bacteroides fragilis group (54), pigmented Prevotella and Porphyromonas (34) and Escherichia coli (26) . Most B . fragilis and E . coli were recovered from intra-abdominal infections, and those of skin and soft tissue adjacent to the rectum . Most pigmented Prevotella and Fusobacteria were isolated from oropharyngeal, pulmonary, head and neck sites . Most MS were recovered from abscesses (43%), the abdominal cavity (17%), sinuses (10%) and chest infections (9%) . Antimicrobial therapy was administered to all patients, in 61 this was combined with surgical drainage or correction . Three patients died . These data illustrate that MS can occasionally be associated with infection in children.

Antimicrob Agents Chemother, 1994 May, 38(5), 953 - 8
Dextranase enhances antibiotic efficacy in experimental viridans streptococcal endocarditis; Mghir AS et al.; In endocarditis, exopolysaccharide production by viridans streptococci has been associated with delayed antimicrobial efficacy in cardiac vegetations . We compared the efficacies of temafloxacin alone and in combination with dextranase, an enzyme capable of hydrolyzing 20 to 90% of the bacterial glycocalyx, in a rabbit model of endocarditis . In in vivo experiments, rabbits were infected intravenously with 10(8) Streptococcus sanguis organisms and were treated 6 days later with temafloxacin (50 mg/kg of body weight intramuscularly twice a day) alone or combined with dextranase (1,000 U per rabbit per day intravenously) . After 4 days of treatment (day 11), the animals were sacrificed and vegetations were quantitatively cultured . For ex vivo experiments, rabbits were infected as stated above and, on day 11, vegetations were excised aseptically and incubated in vitro in rabbit serum alone (control) or with temafloxacin or temafloxacin plus dextranase at concentrations similar to peak levels in plasma . In vitro, dextranase alone had no antimicrobial effect . In vivo and ex vivo, temafloxacin combined with dextranase was more effective than temafloxacin alone (P < 0.05) . Our results suggest that dextranase is able to increase the effects of temafloxacin by reducing the amount of bacterial glycocalyx in infected vegetations, as confirmed in vitro by electron microscopy showing a markedly reduced amount of glycocalyx and a more clearly visible fibrin matrix.

Am J Vet Res, 1994 May, 55(5), 650 - 3
Treatment of group E streptococci-induced lymphadenitis in swine by feeding various concentrations of chlortetracycline: relation of antibody with prevalence of abscesses; Olson LD et al.; Consumption of chlortetracycline (CTC) at concentration of 220 mg/kg of feed for 4 weeks in experiment 1 and at concentrations of 110 and 220 mg/kg for 3 weeks and 440 mg/kg for 2 weeks in experiment 2 failed to eliminate streptococci-induced lymphadenitis from swine referred to as principals . Abscesses, mostly in the head and neck, developed in at least a third of all swine in the various groups fed these CTC concentrations . Feeding of 220 mg of CTC/kg of feed in experiment 1 began 12 weeks after exposure of principals to an untypeable group E streptococci (GES; isolate 3X29A) . In experiment 2, feeding of 110 and 220 mg of CTC/kg of feed began 5 weeks after exposure of principals to GES and feeding of 440 mg of CTC/kg of feed began 6 weeks after exposure . One or more cohabitating sentinel swine of experiment 1 and one or more sentinels in all groups of principals of experiment 2, except group 2, developed abscesses that were mostly in the head and neck . In experiment 2, correlation between serum GES antibody titer and development of one or more abscesses in the principals was highly significant (P < 0.01); however, correlation between antibody titer and abscesses in the sentinels only approached significance (P < 0.10).

J Perinatol, 1994 May-Jun, 14(3), 198 - 200
Value of a rapid enzyme-linked immunosorbent assay for maternal vaginal group B Streptococcus colonization; Schimmel MS et al.; Because group B streptococci maternal colonization is a risk factor for the development of neonatal sepsis, a commercially available rapid test was evaluated for its ability to detect intrapartum maternal colonization . A total of 180 paired vaginal swabs were cultured for group B streptococci and assayed by the Equate test . Of the 15 positive cultures, only 1 was detected by the Equate test, resulting in a sensitivity of 7% and a false-negative rate of 93% . The Equate test detected group B streptococci colonization only at a concentration of > or = 10(7) colony-forming units . These results indicate that the Equate test is not adequately sensitive for screening intrapartum populations for group B streptococci colonization.

Rev Med Interne, 1994 May, 15(6), 399 - 405
{Kidney and vasculitis}; Noel LH; The kidney is affected in a variety of vasculitic syndrome . Vasculitis represent an heterogeneous group of inflammatory disease concerning vessels . They can be considered as secondary in systemic lupus erythematosus, cryoglobulinemia, rheumatoid polyarthritis but also in infectious diseases (Streptococci, hepatitis B) in malignant disease and after drugs . However, in many circumstances, no causes are found . The discovery of autoantibodies directed against components of neutrophil cytoplasm (ANCA) represent a great progress in the understanding of vasculitis . ANCA are autoantibodies directed against neutrophil lysosomial enzymes, preferentially myeloperoxidase and proteinase 3 . They are frequently found in patients with idiopathic necrotizing vasculitis, systemic or localized to the kidney (Wegener granulomatosis, microscopic periarteritis, pauci-immune necrotizing glomerulonephritis, Churg and Strauss syndrome and polyarteritis nodosa) . Diagnostic and prognostic values are sure, although their presence is unconstant with variable percentage in relation with the type of vasculitis . The increase of ANCA level is not always related with disease relapse . Conversely, a permanent low level means a quiescent disease . At the present time, it is not known if ANCA play a pathogenetic role or if they constitute a marker of the disease.

Pediatr Cardiol, 1994 May-Jun, 15(3), 127 - 31
Spectrum of infective endocarditis during infancy and childhood: 20-year review; Fukushige J et al.; The medical records of the 29 patients under 18 years of age with infective endocarditis (IE) seen over a 20-year period by our department were reviewed to provide an overview of the spectrum of IE during infancy and childhood . None of the 29 patients had had previous cardiovascular surgery . The mean age at onset of IE was 7 years 2 months; 3 patients (10%) were under 2 years of age at onset . One patient during the early years died following 4 months of treatment with various antibiotics . Three patients underwent urgent surgery, and 17 patients with healed IE had elective surgery . All of the 20 patients who were operated on survived . The remaining 8 were followed with medical treatment alone . Positive blood cultures were obtained from 24 (83%) patients, and streptococci were still commonly found (38%) . Ventricular septal defect (VSD) accounted for 66% of underlying heart diseases and rheumatic heart diseases for 14% . Vegetations were detected in 12 (67%) of 18 patients observed by echocardiography . Among these 12 patients, 1 with VSD underwent urgent tricuspid valve replacement and VSD closure because of worsening congestive heart failure due to progressive tricuspid regurgitation . Echocardiography identifies patients at high risk with IE, though the presence of a vegetation on echocardiography does not necessarily of itself dictate surgical intervention.

Br Vet J, 1994 May-Jun, 150(3), 263 - 9
Antimicrobial susceptibility of Streptococcus suis isolates; Turgeon PL et al.; The antimicrobial activities of penicillin (PEN), ampicillin (AMP), cephalothin (CT), trimethoprim-sulphamethoxazole (TMP-SMX), streptomycin (STM), and gentamicin (GM) against 122 representative strains of Streptococcus suis, were compared by the agar dilution procedure . The current US National Committee for Clinical Laboratory Standards (NCCLS) breakpoints for non-enterococcal streptococci were used for PEN, AMP, CT, and TMP-SMX . Overall, 50% of strains were not fully susceptible to PEN, whereas these percentages for AMP and CT were 9% and 6% respectively . One strain was resistant to TMP-SMX . High-level GM resistance could not be detected, but more than 46% of strains were highly resistant to STM (MIC > 2000 mg l-1) . This high percentage of resistance to STM precludes the use of this aminoglycoside-penicillin combination as empiric therapy in severe S . suis infections . These results should prompt microbiology laboratories to carry out antimicrobial susceptibility tests on a routine basis on S . suis isolates.

Cesk Patol, 1994 May, 30(2), 43 - 6
{Infectious endocarditis--a study of 153 cases}; Steiner I et al.; The study describes 153 necropsy cases of infective endocarditis (IE) encountered in a university hospital over a period of 23 years (1970-1992), with necropsy incidence of 0.63% . The average age of patients at the time of death was 51.7 years . Both the incidence and the average age tended to increase during the period studied . The location of infective vegetations was mostly in the left heart and univalvular (mitral in 41%, aortic in 33%) . The mitral valves involved by IE were otherwise normal in 62%; the aortic valves were normal in 33% . The spectrum of microorganisms yielded by postmortem cultivations is compared with that obtained by blood cultures during life . Staphylococcus aureus comprised 60% of all positive clinical blood cultures and 40% of all organisms grown postmortally . Gram-negative bacilli, streptococci and mycoses appeared as further important etiologic agents . Discussed in more detail are the subgroups of tricuspid valve IE (5% of all cases), IE in patients on chronic hemodialysis (17%), and IE involving prosthetic valves (9%).

Diagn Microbiol Infect Dis, 1994 May, 19(1), 1 - 4
Improved detection of spontaneous bacterial peritonitis with Bactec as compared with conventional culture methods . A prospective study; Singh N et al.; Bacteriologic diagnosis of spontaneous bacterial peritonitis is difficult due to the low yield of isolating the bacteria from the ascitic fluid . We prospectively compared the conventional culture method with the nonradiometric Bactec culture system for the detection of bacteria in 20 episodes of spontaneous bacterial peritonitis . The ascitic fluid culture was positive by the conventional culture method in 25% and by Bactec in 79% of the episodes of spontaneous bacterial peritonitis (P = 0.004) . Of culture-positive episodes, Gram-negative bacteria were detected by conventional cultures in 20% and by Bactec in 47% . Bactec culture system was significantly better than the conventional cultures for the detection of streptococci (viridans streptococci and Enterococcus fecalis), 33% versus 0 (P < 0.05) . Conventional cultures did not detect bacteria that were not also detected by Bactec cultures . In conclusion, the Bactec nonradiometric culture method is superior to conventional cultures for the diagnosis of spontaneous bacterial peritonitis.

J Dairy Res, 1994 May, 61(2), 263 - 70
Thermal inactivation of gamma-glutamyltranspeptidase and Enterococcus faecium in milk-based systems; Patel SS et al.; Untreated whole milk, skim milk, sweetened milks, sweetened and unsweetened creams and ice-cream mixes were preincubated with a culture of Enterococcus faecium, then subjected to heat treatment in a pilot-scale plate heat exchanger using a hold of 15 s at 76 degrees C . The liquids were examined for gamma-glutamyltranspeptidase (GGTP) activity and total streptococcal count before and after heat treatment and the results plotted against water activity (aW) . There was a good correlation between reduction in GGTP activity, destruction of streptococci and aW, demonstrating the potential of the enzymic assay for assessing the severity of HTST heat treatments above the minimum for pasteurization.

J Clin Microbiol, 1994 May, 32(5), 1312 - 7
Restricted association between biotypes and serotypes within group A streptococci; Bouvet A et al.; Investigating individual variations between different isolates of group A streptococci, we observed a close correlation between biotypes and serotypes in 46 strains from pharyngitis patients . Biotyping, carried out with a commercially available rapid identification gallery, delineated 10 different associations of characteristics, designated biotypes 1 to 10, observed both in the manufacturer's (127 strains) and our personal (98 strains) collections of group A strains . Only the most frequent biotypes (biotypes 1 to 6) were observed in the pharyngitis cohort, but the overall frequencies of the biotypes did not display striking differences compared with the control collections . Serotyping of the pharyngitis strains showed that each M type was restricted to a sole biotype . For example, M types 1, 4, and 28 were found only in biotype 1 and M type 6 was found only in biotype 6 strains . This association was not due to an epidemiologic bias, since it was also observed in a control series consisting of reference strains and isolates from distant countries (the United States and Czech Republic versus France) . An exception was for M type 78, which exhibited biotype 3 or biotype 4 . Investigation of the heterogeneity of the strains at the DNA level showed no significant variations of the ribotype patterns between strains of different biotypes, confirming that group A streptococci belong to a unique and homogeneous species . This previously undescribed association between serotypes and biotypes is of interest for a rapid and preliminary characterization of strains isolated in individual patients or during an outbreak . A possible pathogenic association of some biotypic characteristics with specific M proteins is envisaged.

Pathol Biol (Paris), 1994 May, 42(5), 471 - 4
Antibiotic susceptibility of streptococci isolated from blood from neutropenic patients; Pierard D et al.; MICs were performed on 62 streptococci isolated from the blood of neutropenic patients from 1986 to 1992 using the NCCLS broth microdilution procedure . Species isolated were 43 S . mitis, 6 S.pneumoniae, 5 S.sanguis, 1 S.pyogenes, 1 beta-hemolytic streptococcus of the group G, 1 S.adjacens, 1 S.intermedius, 4 not identified isolates (2 alpha-hemolytic, 1 non-hemolytic and 1 nutritionally variant strains) . 26% of all strains were resistant or intermediate to penicillin (MIC 90: 2 mg/l) and 89% to norfloxacine (MIC 90: 32 mg/l) . All were susceptible to vancomycin . Among cephalosporins, all strains were susceptible to cefotaxime (MIC 90: 1 mg/l), ceftriaxone (MIC 90: 1 mg/l) and cefepime (MIC 90: 2 mg/l) while 19% were R or I to ceftazidime (MIC 90: 16 mg/l) . All were susceptible to imipenem (MIC 90: 0.5 mg/l) and meropenem (MIC 90: 1 mg/l) . Among the third generation cephalosporins, ceftazidime--the agent of this class of antibiotics that is most often used for the empirical therapy of febrile episodes in neutropenic patients (in combination but also in monotherapy)--has a high resistance rate as compared to the other compounds.

Pathol Biol (Paris), 1994 May, 42(5), 445 - 7
{Rapid detection of tolerance of streptococci and enterococci to beta-lactam antibiotics by measurement of bacterial TPA}; Laland C et al.; The authors developed a rapid method for determination of tolerance of streptococci and enterococci to ampicillin by measuring the bacterial TPA . Of thirty three strains from blood cultures, 11 were tolerant with a MBC/MIC ratio > 32 . For these strains, the free TPA/total TPA ratio measuring the bacterial lysis after a 2hrs incubation with 2 MIC of ampicillin, had an average of 38% (SD = 21) versus 88.6% (SD = 17.9) for the non-tolerant strains . There is a good correlation between the values of MBC/MIC ratios and the free TPA/total TPA ratios . The authors concluded that TPA assessment after 2hrs incubation with antibiotic can predict the antibiotic tolerance of streptococci or enterococci.

Microb Pathog, 1994 May, 16(5), 359 - 72
Phenotypic variability of X-protein expression by mastitis-causing Streptococcus agalactiae of serotype NT/X and opsonic activities of specific antibodies; Rainard P et al.; This study examined the role of antibodies against the X-protein, a surface-localized antigen frequently associated with streptococci causing mastitis in cattle, in the opsonization and phagocytosis of unencapsulated Streptococcus agalactiae . The analysis of various strains of serotype NT/X by flow cytometry, after labeling with a monoclonal antibody to X-protein, revealed that they consisted of a mixture of unstained and stained bacteria . Cloning of mother strains yielded clones of unstained bacteria but not homogeneous clones of stained bacteria . Analysis by ELISA of an unstained clone (4.1) derived from the reference NT/X strain 24/60 indicated that it expressed low amount of X-protein at its surface, about 25 times less than the stained clone 24/60 5.6 . Colloidal gold immunolabeling showed the X-protein at the periphery of bacteria (of clone 5.6 and in lower amount of clone 4.1), at a distance from the cell wall . Bovine antibodies (essentially IgG) to X-protein behaved like the monoclonal antibody in the cytometric assay . They activated the classical pathway of complement as shown by the deposition of C1q and C4 on bacteria . Deposition of C4 also occurred on the low-surface-producing clone 4.1 in the presence of antibodies to X-protein, although less efficiently than on the high-surface-producing clone 5.6 . When used alone, antibodies promoted the ingestion of bacteria and heat-inactivated immune serum promoted the chemiluminescence activity and the killing by polymorphonuclear cells . In conclusion, antibodies to X-protein induced the deposition of C3 by the classical pathway and were also able to stimulate opsonophagocytic killing of X-bearing S . agalactiae in the absence of deposited C3.

J Exp Med, 1994 May 1, 179(5), 1445 - 56
Human rheumatoid factors with restrictive specificity for rabbit immunoglobulin G: auto- and multi-reactivity, diverse VH gene segment usage and preferential usage of V lambda IIIb; Fang Q et al.; To determine the molecular and functional properties of human rheumatoid factors (RF), we established stable hybridomas and Epstein-Barr virus-transformed B cell lines from the synovial fluid or peripheral blood of three patients with rheumatoid arthritis and one patient with systemic lupus erythematosus . 17 cell lines were obtained that produced high-titer immunoglobulin M (IgM) RF that reacted exclusively with rabbit but not human IgG or IgG of other mammalian species . Certain anti-rabbit IgG RF also had specificity for other mammalian antigens (Ag), including cytoskeletal proteins and intracellular proteins found in HeLa cells, as well as for Ag present in an extract prepared from the cell wall of group A streptococci . 13 of the 17 RF contained lambda-type light (L) chains, of which 12 were classified serologically as members of the lambda-L chain variable region (V lambda) subgroup, designated V lambda III . The heavy chain V region (VH) and V lambda sequences of nine of these IgM lambda RF were determined at the cDNA level . Five VH genes in three VH families were used by these antibodies (Ab), including VH1 (dp21/1-4b and dp10 {51p1}/hv1051), VH3 (dp38/3-15 and dp77/13-21), and VH4 (dp70/4-4b) . The deduced V gene-encoded amino acid sequences of the lambda chains of these IgM lambda RF confirmed their serological classification as lambda III, and they were further classified as members of the relatively uncommon V lambda III subgroup, designated V lambda IIIb . Based on cDNA analyses, nine were the product of three different V lambda III b germline genes . Two such genes, designated hsiggll150 and hsiggll295, were cloned and sequenced from genomic DNA . Unique combinations of these VH and V lambda III b genes could be related to distinctive patterns of reactivity among the IgM lambda RF . Although the VH and V lambda regions of these Abs were expressed primarily as germline-encoded sequences, four of nine multireactive Abs had extensive V region mutation, indicative of an Ag-driven process . The finding that lambda IIIb L chains are preferentially found among anti-rabbit IgG RF, and that some of these Ab have specificity for other protein, cellular, and bacterial Ag, provides new insight into the pathogenesis of RA and related diseases.

Eur J Immunol, 1994 May, 24(5), 1244 - 7
Processing of viable group A streptococci leads to major histocompatibility complex class II presentation of T cell epitopes from the major protective antigen; Rossiter BA et al.; We have previously mapped major histocompatibility complex (MHC) class II-restricted T cell epitopes of the surface M protein of type 5 group A streptococci (M5) and show here that two out of four epitopes investigated were efficiently processed during incubation of viable streptococci with spleen cells for presentation to M5-specific murine T cell clones . Viable streptococci were processed more efficiently than heat-killed bacteria suggesting that secreted virulence factors of streptococci do not obstruct processing of streptococcal antigens in the dose range used . Epitopes from different regions of M5 could be ranked according to the efficiency with which they were processed, which may contribute to their relative immunodominance . It was further demonstrated that T cell clones specific for M5 308-319, an epitope from the M type conserved carboxy-terminal half of M5, cross-reacted between M5, M6 and M12, but not M49, streptococci . Helper T cell epitopes which are shared between streptococcal M types and are presented by MHC class II molecules on antigen-presenting cells after processing of viable streptococci could be particularly useful in the design of multivalent streptococcal vaccines.

J Chromatogr A, 1994 Apr 29, 667(1-2), 131 - 9
Hydrophobic interaction chromatography for the purification of cytolytic bacterial toxins; Schoel B et al.; The usefulness of hydrophobic interaction chromatography for the simple purification of cytolytic bacterial toxins was studied . Conditions are described for different hydrophobic interaction chromatographic media for purifying with high yields two different kinds of such haemolysins, the thiol-activated toxin listeriolysin O from Listeria monocytogenes and alpha-toxin from Staphylococcus aureus . For listeriolysin O, purification on butyl-Sepharose was followed by gel filtration chromatography . From butyl-Sepharose the recovery of 22% . Alpha-toxin was obtained by a single purification step from alkyl-Superose with 80% recovery and a specific activity of 29,000 U/mg . On sodium dodecyl sulphate polyacrylamide gel electrophoresis purified listeriolysin O and alpha-toxin showed a single band . Another thiol-activated toxin, streptolysin O from group A streptococci, showed a recovery of 38% from butyl-Sepharose . The results suggest the feasibility of using hydrophobic interaction chromatography, particularly with columns of weak hydrophobicity, for the purification of bacterial haemolysins in high yield.

J Biol Chem, 1994 Apr 22, 269(16), 12147 - 51
Protein PAB, a mosaic albumin-binding bacterial protein representing the first contemporary example of module shuffling; de Chateau M et al.; Some strains of the anaerobic human commensal and pathogen Peptostreptococcus magnus bind human serum albumin (HSA), whereas other strains of this species express protein L, an immunoglobulin light chain-binding surface protein . A novel HSA-binding protein called protein PAB was purified in one step from the culture supernatant of an HSA-binding strain of P . magnus by affinity chromatography on HSA-Sepharose . The apparent size of the molecular was 47 kDa on SDS-polyacrylamide gel electrophoresis . Amino acid sequence analysis of protein PAB demonstrated that the 4 NH2-terminal residues were identical to the corresponding sequence in protein L . In a polymerase chain reaction, oligonucleotides based on extragenic 5'- and 3'-end sequences of the protein L gene generated a product of the expected size: 1.3 kilobase pairs . A recombinant protein with retained albumin binding capacity was expressed in Escherichia coli, and the nucleotide sequence of the protein PAB gene was determined . The structural gene is 1161 nucleotides long, corresponding to a preprotein of 387 amino acids and a molecular mass of 43,043 Da . Unlike most other Gram-positive bacterial surface proteins described, protein PAB contains no internal homologies . However, substantial homologies were found to both proteins L and G (the IgG- and HSA-binding surface protein of group C and G streptococci) . The derived amino acid sequence of the 135-base pair-long region homologous to protein G corresponds to the HSA-binding domain of that protein, and in protein PAB, this region is inserted between sequences showing extensive homology to COOH-terminal regions of peptostreptococcal protein L . This mosaic organization of protein PAB demonstrates that the molecule is a product of intergenic interspecies recombination of a functional domain into a common framework for peptostreptococcal surface proteins . Such an interspecies exchange of a functional protein module has previously not been described in prokaryotic cells.

Proc Natl Acad Sci U S A, 1994 Apr 12, 91(8), 3280 - 4
Allelic polymorphism of emm loci provides evidence for horizontal gene spread in group A streptococci; Bessen DE et al.; Group A streptococci have a virulence regulon containing a single emm locus or two or three distinct and adjacent loci of structurally related emm family genes . The products of the emm gene cluster consist of fibrillar surface proteins, at least some of which are known to contain determinants of type specificity located in their NH2-terminal regions, lying distal to the cell surface . The emm genes can be categorized into four major subfamilies (SFs), based on structural differences within their 3' regions encoding the peptidoglycan-spanning domain . In this study, we investigate the polymorphism within the 5' region of SF-4 and SF-3 emm genes (which occupy the first and last emm positions of the gene cluster, respectively) in 22 strains representing different serotypes . Our findings indicate that unlike the centrally positioned SF-1 or SF-2 genes, SF-3 and SF-4 genes each display only limited polymorphism in their 5' regions, suggesting that their gene products may not be major contributors to type specificity . Two forms of the SF-3 gene (SF3a, SF3b) and two forms of the SF-4 gene (SF4a, SF4b) are found to exist in all four possible combinations (SF3aSF4a, SF3aSF4b, SF3bSF4a, SF3bSF4b), strongly suggesting that horizontal gene spread has contributed to the evolution of emm genes and to the generation of emm gene diversity in group A streptococci.

J Med Microbiol, 1994 Apr, 40(4), 256 - 60
Small-fragment restriction endonuclease analysis in epidemiological mapping of group A streptococci; Mylvaganam H et al.; The usefulness of small-fragment restriction endonuclease digest analysis (SF-REA) of group A streptococcal DNA with EcoRI, as a supplement to the more conventional T serotyping, was assessed for epidemiological characterisation . One hundred and thirty-five clinical isolates from 1988-1990 were examined . SF-REA provided characteristic fingerprints of all isolates, whereas eight isolates were non-typable by T serotyping . Generally, there was a striking correlation between the results obtained with the two techniques . Furthermore, SF-REA reliably classified the eight T-non-typable isolates and occasionally revealed subgroups within the T serotypes . In addition, SF-REA was useful for the clarification of discrepancies between serotyping results from two different reference laboratories . No obvious correlation was observed between the DNA fingerprints and the clinical manifestations of infection or the geographical origin of the group A streptococcal isolates . SF-REA is a valuable supplement to T typing in epidemiological studies and frequently appears to be a more efficient tool for strain differentiation.

J Oral Maxillofac Surg, 1994 Apr, 52(4), 397 - 400; discussion 400-1
Cefadroxil concentrations in human serum, gingiva, and mandibular bone following a single oral administration; Akimoto Y et al.; Cefadroxil concentrations in human serum, gingiva, and mandibular bone were measured by a paper disk method following a single 500-mg oral dose . The mean peak concentrations in serum, gingiva, and mandibular bone occurred at the identical time, 3 hours, and were 12.92 micrograms/mL, 6.50 micrograms/g, and 2.67 micrograms/g, respectively . Mean cefadroxil concentration ratios of gingiva/serum and mandibular bone/serum at the peak time were 0.54 and 0.21, respectively . Mean concentrations in gingiva and mandibular bone at the peak time exceeded the minimum inhibitory concentrations for 90% of clinically isolated strains of a alpha-hemolytic streptococci.

Infect Immun, 1994 Apr, 62(4), 1268 - 74
Streptococcal M6 protein binds to fucose-containing glycoproteins on cultured human epithelial cells; Wang JR et al.; M6 protein of Streptococcus pyogenes binds directly to HEp-2 cell surfaces and helps to mediate bacterial adhesion . Two epithelial cell receptors for M protein were identified as 97- and 205-kDa glycoproteins . Purified recombinant M6 protein (rM6) showed a dose-dependent and saturable binding to isolated HEp-2 membranes in an enzyme immunoassay . The HEp-2 cell receptors were selectively denatured by pretreatment of isolated membranes at 80 degrees C or with chymotrypsin; binding activity for rM6 was reduced 83 and 80%, respectively . Pretreatment of the HEp-2 membranes with neuraminidase-N-glycosidase, neuraminidase-O-glycosidase, alpha-L-fucosidase, or Ulex lectin caused 33, 42, 73, and 80% reduction of rM6 binding, respectively . Quantitative analysis of HEp-2 cells pretreated with alpha-L-fucosidase showed that the 97- and 205-kDa glycoproteins lost 70 and 62% of their abilities to bind M6 protein and that 33% of the HEp-2 cell's ability to bind whole streptococci was also lost . These results indicated that binding of M6 protein to HEp-2 cell surfaces is highly selective for certain fucose-containing oligosaccharides on these glycoproteins.

Infect Immun, 1994 Apr, 62(4), 1228 - 35
Role of human major histocompatibility complex DQ molecules in superantigenicity of streptococcus-derived protein; Esaki Y et al.; Antigenicity of peptic extract from type 12 group A streptococci (PEAST12) for T cells was examined in major histocompatibility complex (MHC) class II transgenic mice . PEAST12 was mitogenic for murine T cells when antigen-presenting cells were obtained from human MHC (HLA)-DQ4 alpha beta transgenic mice or from DQ6 alpha beta transgenic mice but was not mitogenic in DR alpha transgenic, DR51 alpha beta transgenic, E alpha transgenic, or nontransgenic mice . In addition, PEAST12 showed mitogenicity for murine T cells in DQ4 alpha singly transgenic mice but not in DQ4 beta singly transgenic mice . T-cell stimulation by PEAST12 was unrestricted by but dependent on the expression of HLA-DQ molecules on antigen-presenting cells, and PEAST12 selectively activated T-cell receptor V beta 11-, V beta 15-, and V beta 18-positive T cells in mice . We propose that PEAST12 contains a superantigen which binds preferentially to the alpha-chain of HLA-DQ molecules . The well-known phenomenon that peptic extracts from group A streptococci are mitogenic in humans but not in mice is likely due to structural differences in MHC class II molecules between these two species of mammals.

Int Dent J, 1994 Apr, 44(2), 174 - 80
Associations of dental caries with salivary mutans streptococci and acid producing bacteria in 5-year-old children from KwaZulu and Namibia; Boardman M et al.; Two hundred and eighty-five, 5-year-old children from rural and urban KwaZulu and Namibia were examined for dental caries, salivary mutans streptococci and salivary acid producing bacteria . The findings showed statistically significant correlations between salivary mutans streptococci counts and ds and dmfs scores in all groups of children, the highest values being in Namibian children . Salivary acid forming bacteria had low correlations with few statistically significant groups . While salivary mutans streptococci counts may be a useful caries screening method in children of this age, salivary acid forming bacterial counts appear unsuitable.

Glycobiology, 1994 Apr, 4(2), 183 - 92
The cell wall polysaccharide of Streptococcus gordonii 38: structure and immunochemical comparison with the receptor polysaccharides of Streptococcus oralis 34 and Streptococcus mitis J22; Reddy GP et al.; As part of our ongoing investigations involving lectin-mediated adhesion among oral bacteria, the receptor polysaccharide from Streptococcus gordonii 38 was isolated and characterized . Carbohydrate analysis of the hydrolysed S . gordonii 38 polysaccharide by high-performance anion-exchange chromatography with pulsed amperometric detection (HPAEC-PAD) showed galactose (Gal) (2 mol), N-acetylgalactosamine (GalNAc) (1 mol), rhamnose (Rha) (2 mol), glucose (Glc) (1 mol) and galactosamine-6-phosphate (1 mol) . Mild acid hydrolysis of the polysaccharide yielded a heptasaccharide repeating unit . The structure of the heptasaccharide repeating unit was determined by high-resolution NMR spectroscopy which includes various homonuclear (DQF-COSY, TQF-COSY, NOESY and HOHAHA) and heteronuclear experiments (HMQC), including linkage assignments by 1H-13C long-range correlation (HMBC) . Complete 1H and 13C NMR assignments for the intact polysaccharide yielded the covalent structure of a heptasaccharide repeating unit: {Formula: see text} The structure of the strain 38 polysaccharide is closely related to those of Streptococcus mitis J22 and Streptococcus oralis 34 . Thus, the difference between the strain 38 and J22 heptasaccharides was at their reducing ends, with GaLNAc beta-(1-->3)-Gal in the former and Gal beta-(1-->3)-GalNAc in the latter, while the difference between the 38 heptasaccharide and 34 hexasaccharide was at the non-reducing ends, where a rhamnose branch occurred in the former but not the latter structure . When compared by their quantitative precipitin curves with rabbit antibodies against each streptococcal strain, the strain 38 polysaccharide reacted more like the polysaccharide of strain J22 than that of strain 34 . In contrast, each strain was recognized by the Gal- and GalNAc-reactive lectins of Actinomyces spp., but only strains 38 and 34 were recognized by GalNAc-sensitive lectins of other streptococci . These findings strongly support the hypothesis that the immunogenic features of these polysaccharides are distinct from those detected by lectin binding.

Acta Odontol Scand, 1994 Apr, 52(2), 116 - 27
Cariologic aspects of xylitol and its use in chewing gum: a review; Birkhed D; Several studies indicate that xylitol is not metabolized to acids either in pure cultures of oral microorganisms in vitro or in dental plaque in vivo . Chronic consumption of xylitol-sweetened chewing gum resulted in reduction of dental plaque, suppression of mutans streptococci, and reduced adhesiveness of plaque . So far, four field studies with regimens including chewing gum and other xylitol-containing products and four clinical trials have been carried out . All of the latter studies showed that a daily intake of two to three pieces of xylitol gum resulted in a defined reduction of caries . There are indications that regular and prolonged use of xylitol chewing gum may have a caries-preventive effect.

Paediatr Perinat Epidemiol, 1994 Apr, 8(2), 188 - 92
Maternal carriage and neonatal colonisation of group B streptococci in labour are uncommon in Turkey; Ayata A et al.; Group B streptococcus infection is an important cause of neonatal morbidity and mortality . We studied 114 women and their newborns to determine the relationship between maternal carriage and neonatal group B streptococcal colonisation . Rectal, cervical and vaginal swabs were taken at delivery . Within a few minutes of birth, swab specimens were also taken from throat, ear, umbilicus, conjunctiva and skin of the newborns . Group B streptococcus was isolated in 10 (8.7%) of the 114 pregnant women studied and in five (4.3%) of the 114 newborns . Vertical transmission rate was found to be 50% . Neonatal group B streptococcus colonisation has not reached a high level in Turkey, and consequently does not warrant intrapartum screening at the moment.

Pediatr Infect Dis J, 1994 Apr, 13(4), 264 - 9
Acute rheumatic fever in Auckland, New Zealand: spectrum of associated group A streptococci different from expected; Martin DR et al.; Annual specific rates for acute rheumatic fever (ARF) in Auckland children less than 15 years were 22/100,000 for the years 1980 to 1984 . From 1984 to 1992 the rates remained relatively constant with an average of 45 (range, 30 to 70) children annually admitted with ARF to the Auckland Children's Hospital . This study examined retrospectively Group A streptococci identified from hospitalized pediatric patients during these 9 years . The total of 2410 isolates included 32 isolates from well-documented cases of ARF and an additional 6 from siblings of cases . Results of M typing indicated that streptococci associated with ARF are generally different from those described overseas and involved types which cause more skin than throat infections in the community.

Arch Oral Biol, 1994 Apr, 39(4), 261 - 9
The effects of streptozotocin diabetes on salivary-mediated bacterial aggregation and adherence; Anderson LC et al.; Diabetic rats are known to have an increased susceptibility to dental caries and major alterations in parotid salivary composition . Salivary proteins play an important part in oral health maintenance; thus specific changes in salivary protein composition in diabetic animals might alter the ecological balance in favour of cariogenic bacteria, and toward the initiation and progression of the disease process . The ability of whole, parotid and submandibular salivas from control and streptozotocin-diabetic rats to mediate the aggregation and adherence to hydroxyapatite of mutans streptococci was examined . Salivary-mediated bacterial aggregating activity was significantly reduced in whole and parotid salivas from diabetic rats, but bacterial adherence to hydroxyapatite was unaffected . The aggregating and adherence activities of rat whole saliva were derived mainly from parotid saliva, which contains predominantly low molecular-weight proteins and glycoproteins (< 200 kDa), but rat parotid saliva was capable of interacting with the bacterial receptor for the high molecular-weight aggregating factor in human saliva . SDS-PAGE of parotid saliva revealed that a number of proteins, including the basic and acid proline-rich proteins, were altered in the salivas of diabetic animals . After incubation with either Streptococcus mutans or hydroxyapatite several protein bands were depleted, and thus a variety of proteins and glycoproteins may be responsible for the adherence and aggregating activity of rat parotid saliva.

Chem Pharm Bull (Tokyo), 1994 Apr, 42(4), 922 - 5
An investigation of diterpenes from the leaves of Rabdosia trichocarpa and their antibacterial activity against oral microorganisms; Osawa K et al.; The ethanolic extract of Rabdosia trichocarpa leaves showed antibacterial activity against cariogenic mutans streptococci and periodontopathic Porphyromonas gingivalis . Chromatographic separation and purification of the extract afforded ten diterpenes, including one novel ent-kauren type compound named trichoranin . Some of these compounds possess potent antibacterial activity against these oral micro-organisms, indicating that these diterpenes may be useful natural substances for the maintenance of oral health.

Aust Dent J, 1994 Apr, 39(2), 111 - 4
The glucosyltransferases of Streptococcus salivarius; Jacques NA; This review covers some of the more recent developments in the understanding of the different glucosyltransferases (GTFs) secreted by oral streptococci, particularly those produced by Streptococcus salivarius--a species that has been intensively studied at the Institute of Dental Research in Sydney.

Scand J Dent Res, 1994 Apr, 102(2), 113 - 9
Isolation frequency and serotype distribution of mutans streptococci and Actinobacillus actinomycetemcomitans, and clinical periodontal status in Finnish and Vietnamese children; Holtta P et al.; The isolation frequency and serotype distribution of mutans streptococci and A . actinomycetemcomitans (A.a.) were investigated in a group of Finnish (n = 16) and Vietnamese (n = 16) children, matched by sex, age, and caries status . In the Vietnamese children, the isolation frequencies were higher than in the Finnish children: 100%/62% for mutans streptococci and 78%/13% for A.a . Isolates (n = 3-8) from plaque and saliva were serotyped by immunodiffusion technique using serotype-specific antisera against serotypes c, e, f, d, and g for mutans streptococci and a, b, c, d, and e for A.a . The distribution of mutans streptococci serotypes in Finnish/Vietnamese children was: c 100%/50%; e 10%/31%; d 0%/56%; g 20%/38% . The frequency of plural serotypes was 30%/75%, respectively . In the Vietnamese group the serotype distribution of A.a . was: a 36%, b 27%, and c 63%; 45% of children carried two serotypes . One Finnish child harbored serotype a and one serotype b . The mean percentage of bleeding gingival sites was 7.4 in the Finnish and 15.1 in the Vietnamese group . Calculus and clinically deepened gingival pockets were more frequent findings in the Vietnamese children . The results indicate considerable differences in bacteriologic status and in clinical periodontal status between these Finnish and Vietnamese children.

Scand J Dent Res, 1994 Apr, 102(2), 103 - 8
Dental caries and mutans streptococci in relation to plasma ascorbic acid; Vaananen MK et al.; Ascorbic acid (AA) affects in vitro growth of bacteria and may also act in vivo to decrease caries activity . The aim of this study was to evaluate the possible association of AA level in plasma with number of caries lesions, relative numbers of some species of oral cariogenic flora, and rate of salivary secretion . The caries status and some bacteriologic variables of dentulous adult subjects with a low level of AA in the plasma (< or = 25 mumol/l; n = 75) were compared with those of controls (plasma level > or = 50 mumol/l; n = 75) matched for age, sex, and number of teeth . For each subject, site-specific recordings of the presence or absence of plaque, dental caries, fillings, and erosions were recorded clinically by the same dentist in a double-blind system . The amounts of visible plaque and numbers of decayed tooth surfaces were significantly higher in the low AA group than in the controls . No between-group differences were found in the number of fillings and the amount of oral bacterial growth . The frequencies of consumption of vegetables, berries, and other fruit were significantly lower in the low AA group than in the controls.

Trends Microbiol, 1994 Apr, 2(4), 131 - 6
Group A streptococcal immunoglobulin-binding proteins: adhesins, molecular mimicry or sensory proteins?
Cleary P, Retnoningrum D.
Pathogenic streptococci express multiple immunoglobulin-binding proteins (IGPs) on their surface that are similar in sequence and structure to the antiphagocytic M proteins . Both are evolutionary products of a duplicated ancestral gene and are components of the Vir gene cluster . Except for M proteins, there is little direct experimental evidence to implicate IGPs in pathogenesis . Several functions of IGPs are postulated and discussed.

Oral Microbiol Immunol, 1994 Apr, 9(2), 77 - 80
Bactericidal action of tachyplesin I against oral streptococci; Masuda K et al.; Tachyplesin I, a polycationic antimicrobial peptide isolated from hemocytes of horseshoe crabs, kills bacteria by disrupting the membrane potential of the cytoplasmic membrane . The present study shows that, among 36 oral streptococcal strains, 12 of 21 Streptococcus sanguis, 3 Streptococcus mutans, 9 Streptococcus salivarius and 3 Streptococcus milleri strains were susceptible to tachyplesin I, whereas 9 S . sanguis strains were resistant . Interestingly, these resistant strains include the clinical isolates from both Kawasaki disease and Behcet patients . According to the time-kill study, tachyplesin I inhibited irreversibly the growth of S . sanguis, S . mutans and S . salivarius strains within 20 min and an S . milleri strain within 80 min . Although it has been suggested that Escherichia coli cultured in rich media were more susceptible to tachyplesin I, the present results show that only 3 S . milleri strains were more sensitized to tachyplesin I in a glucose-supplemented medium, and other tested strains were not . Similarly, only 4 strains were more resistant to tachyplesin I in saline than these were in a rich medium.

Oral Microbiol Immunol, 1994 Apr, 9(2), 65 - 9
Effect of antibody in gingival crevicular fluid on early colonization of exposed root surfaces by mutans streptococci; Smith DJ et al.; The effect of antibody to Streptococcus mutans in gingival crevicular fluid (GCF) on the recolonization of cleaned buccal root surface sites by indigenous mutans streptococci was studied . Seven subjects (mean age = 64 years) were selected from a population of 28 on the basis of the presence of appropriate sites with and without detectable immunoglobulin G (IgG) antibody in GCF to formalin-killed S . mutans and adequate levels of mutans streptococci in saliva available for root surface recolonization . Root surfaces exposed to GCF that did or did not contain antibody were then cleaned and sampled for residual plaque organisms (total cultivable flora and mutans streptococci) directly after cleaning (time 0) as well as 24 h later . One subject failed to recolonize at 24 h at any (antibody-positive or antibody-negative) experimental site . For each of the remaining 6 subjects, the mean levels of mutans streptococci (mean percentage of total flora) were lower at sites with IgG antibody to S . mutans in GCF than at antibody-negative sites in the same subject . In each of the 6 subjects, the site with the highest recolonization level was antibody-negative . Comparison based on intrasubject randomization of sites suggested diminished recolonization of mutans streptococci at sites with antibody 24 h after cleaning . The results support the idea that antibody in GCF can modify the early colonization of gingival root surface areas by potentially cariogenic plaque bacteria such as mutans streptococci.

Indian J Pathol Microbiol, 1994 Apr, 37(2), 185 - 90
Presumptive identification & antibiotic susceptibility of group B Streptococci; Arora S et al.; Three presumptive identification tests were conducted on 60 strains of beta haemolytic group B streptococci (GBS) & evaluated for their sensitivity as compared to the standard serological grouping . The GBS were further subjected to serotyping and antibiotic sensitivity testing . Hippurate was hydrolysed by 96.6%, the CAMP test was positive in 83.3% & pigment was produced by 95% . The commonest serotype was la (33.3%) followed by lb (30%) . Hundred percent strains were sensitive to Penicillin, Ampicillin, Erythromycin & Cephlexin . 76.7% showed MIC of 50 ug/ml or more for Tetracycline & 66.7% were inhibited by 3.2 ug/ml or less of Gentamicin.

J Formos Med Assoc, 1994 Apr, 93(4), 349 - 51
Streptococcus suis meningitis complicated with permanent perceptive deafness: report of a case; Yen MY et al.; A 61-year-old pig farmer was found to be suffering from meningitis caused by Streptococcus suis type II . He was successfully treated with intravenous penicillin G but was left with permanent deafness . B-cell lymphoma was also diagnosed one year later . S . suis is a zoonotic pathogen which causes meningitis, septicemia and endocarditis in pigs . Human infection is rare and often presents as meningitis with the sequela of permanent deafness . It has previously been reported in pig rearing countries such as Holland or Hong Kong . This is the second documented case of human meningitis caused by S . suis in Taiwan, which is also a major pig rearing country in Asia . Infections caused by viridans streptococci or other beta-hemolytic streptococci in Taiwan may therefore actually be due to S . suis . Further investigation of the possibility of the underlying deficiency of humoral immunity is warranted.

Ugeskr Laeger, 1994 Mar 28, 156(13), 1931 - 4
{Streptococcal tonsillitis: failure of penicillin therapy}; Schonheyder HC; Group A beta-haemolytic streptococci (GAS) have remained sensitive to penicillin, but penicillin V therapy does not eradicate GAS in 5-30% of cases of GAS tonsillitis . Multiple factors contribute to treatment failure, the foremost among these being lack of compliance with the prescribed therapy, tolerance of GAS towards the killing effect of penicillin, inactivation of penicillin by bacterial beta-lactamases, and absence of bacteriocin-producing non-haemolytic streptococci from the oral flora . The effect of local immunity should be further assessed . It is unlikely that environmental sources of GAS play any significant role . Throat cultures should not routinely be repeated after penicillin treatment . If, in special cases, a new course of treatment is indicated, penicillin V should still be preferred . In the light of modern pharmacological insights, multiple dosing schedules may be desirable in the therapy of GAS tonsillitis.

Tidsskr Nor Laegeforen, 1994 Mar 10, 114(7), 818 - 9
{Group B streptococci in pregnancy--guidelines for routine examinations and treatment . American Academy of Pediatrics}; Hordnes K; Group B streptococci are a major cause of serious infections in the newborn, and also cause chorioamnionitis, late abortions, puerperal infections and sepsis . Group B streptococci are harboured in the genital tract of 5-40% of pregnant women, and 50-70% of their infants are colonized . Severe perinatal infections caused by group B streptococci affect 1-5 infants per 1,000 live births . American Academy of Pediatrics (AAP) have issued guidelines for preventing group B streptococcal infections . These are described, and it is suggested that these should be adopted in Norway.

Antimicrob Agents Chemother, 1994 Mar, 38(3), 576 - 9
Randomized trial of the addition of gram-positive prophylaxis to standard antimicrobial prophylaxis for patients undergoing autologous bone marrow transplantation; Broun ER et al.; The purpose of the study reported here was to investigate the impact of prophylaxis against gram-positive infections in patients undergoing high-dose chemotherapy and autologous bone marrow transplantation in a randomized trial . Forty-three patients undergoing high-dose chemotherapy with autologous bone marrow transplant were enrolled in a nonblinded randomized trial to receive or not to receive prophylaxis for gram-positive infections with 10(6) U of penicillin intravenously (i.v.) every 6 h (q6h) (if penicillin allergic, 750 mg of vancomycin i.v . q12h) in addition to standard antimicrobial prophylaxis with 400 mg of norfloxacin orally three times a day, 200 mg of fluconazole orally once a day, and 5 mg of acyclovir per kg of body weight i.v . q12h . The patients were being treated for germ cell cancer (n = 15), breast cancer (n = 16), Hodgkin's disease (n = 3), non-Hodgkin's lymphoma (n = 4), acute myeloid leukemia (n = 1), acute lymphoblastic leukemia (n = 1), and ovarian cancer (n = 3) . The trial was stopped because of excess morbidity in the form of streptococcal septic shock in the group not receiving gram-positive prophylaxis . There were significantly fewer overall infections (10 versus 3; P = 0.016) and streptococcal infections (9 versus 1; P = 0.0078) in the group receiving gram-positive prophylaxis . There were no significant differences in the numbers of deaths, duration of broad-spectrum antibiotics, or incidence of neutropenic fever between the two groups . Prophylaxis for gram-positive infections with penicillin or vancomycin is effective in reducing the incidence of streptococcal infections in patients undergoing high-dose chemotherapy and autologous bone marrow transplant . However, this approach may carry a risk of fostering resistance among streptococci to penicillin or vancomycin.

Antimicrob Agents Chemother, 1994 Mar, 38(3), 465 - 72
A randomized trial of roxithromycin in patients with acute leukemia and bone marrow transplant recipients receiving fluoroquinolone prophylaxis; Kern WV et al.; Fluoroquinolone prophylaxis in patients with profound neutropenia may be useful for preventing gram-negative bacterial infection, but it is ineffective against gram-positive bacterial infections in the bloodstream, particularly those caused by streptococci and coagulase-negative staphylococci, which appear to have emerged as significant causes of morbidity, decreased treatment efficacy, and the increased costs of empiric antimicrobial therapy . In a prospective, randomized, open trial, we evaluated the efficacy and safety of oral roxithromycin (150 mg twice daily) as additional antibacterial prophylaxis in 131 adult patients with acute leukemia and bone marrow transplant recipients receiving oral ofloxacin . In comparison with patients given ofloxacin alone, fewer patients receiving ofloxacin plus roxithromycin developed bacteremia caused by viridans group streptococci (incidence, 9 versus 0%; P = 0.03), while the incidence of bacteremia caused by other organisms, the incidence of febrile episodes from any cause, the risk of infection-associated complications (including prolonged or secondary fever, pneumonia, septic shock, need for mechanical ventilation, and/or infection-related death), and antimicrobial usage for therapy were comparable between both groups . Adverse events possibly related to the study drugs were slightly more common among the patients receiving the combination treatment (P = 0.05) . Although effective for the prevention of streptococcal bacteremia, the addition of roxithromycin to a fluoroquinolone should not be used routinely as a prophylactic regimen in patients with profound neutropenia, but it might be considered and may be useful for cancer patients with a particularly high risk of streptococcal infection and related complications.

J Clin Microbiol, 1994 Mar, 32(3), 705 - 9
Detection and nucleotide sequence analysis of the speC gene in Swedish clinical group A streptococcal isolates; Norrby-Teglund A et al.; The production of pyrogenic exotoxins SpeA, SpeB, and SpeC by group A streptococci has been associated with streptococcal toxic shock syndrome . Several epidemiological studies using DNA hybridization and PCR analysis have been performed in attempts to correlate one or several of the toxins with streptococcal toxic shock syndrome . The results reveal great variation in the occurrence of the speA and speC genes among clinical isolates . In this study, we show that the speC gene could be detected by nested PCR in five Swedish T1M1 strains isolated from patients infected with group A streptococci as well as in three Norwegian T1M1 isolates, previously reported to lack speC as determined by dot blot hybridization . To verify the identities of the amplified products, the nucleotide sequences of the PCR fragments from one Swedish T1M1 strain and from the toxin reference strain NY5 were determined . The nucleotide sequences showed that the amplified products were speC and of allele type C2, on the basis of the nucleotides in positions 438 and 456 . However, one additional base pair substitution was found in NY5 at position 147 and in the Swedish isolate at position 157, which resulted in nonsynonymous amino acid changes . Thus, these speC genes represent two new allelic variants.

Mol Biol Evol, 1994 Mar, 11(2), 208 - 19
Molecular evolution of a multigene family in group A streptococci; Hollingshead SK et al.; The emm genes are members of a gene family in group A streptococci (GAS) that encode for antiphagocytic cell-surface proteins and/or immunoglobulin-binding proteins . Previously sequenced genes in this family have been named "emm," "fcrA," "enn," "arp," "protH," and "mrp"; herein they will be referred to as the "emm gene family." The genes in the emm family are located in a cluster occupying 3-6 kb between the genes mry and scpA on the chromosome of Streptococcus pyogenes . Most GAS strains contain one to three tandemly arranged copies of emm-family genes in the cluster, but the alleles within the cluster vary among different strains . Phylogenetic analysis of the conserved sequences at the 3' end of these genes differentiates all known members of this family into four evolutionarily distinct emm subfamilies . As a starting point to analyze how the different subfamilies are related evolutionarily, the structure of the emm chromosomal region was mapped in a number of diverse GAS strains by using subfamily-specific primers in the polymerase chain reaction . Nine distinct chromosomal patterns of the genes in the emm gene cluster were found . These nine chromosomal patterns support a model for the evolution of the emm gene family in which gene duplication followed by sequence divergence resulted in the generation of four major-gene subfamilies in this locus.

J Dairy Sci, 1994 Mar, 77(3), 748 - 58
Winter evaluation of a postmilking powdered teat dip; Goldberg JJ et al.; A powdered teat dip designed for winter usage was evaluated for bacteriological efficacy and teat conditioning qualities . A positive control, natural exposure field trial was conducted for 3 mo on 509 lactating cows . Two sets of cows, primiparous and multiparous, were used . The trial compared efficacy of a powdered teat dip with a teat dip of 1% iodine plus 10% glycerin . Bacteriological efficacy among primiparous cows was equivalent for all major mastitis pathogens, environmental pathogens, and streptococci other than Streptococcus agalactiae . Efficacy was not equivalent against coagulase-negative staphylococci and all mastitis pathogens . Results suggested that the positive control product was more efficacious . Among multiparous cows, efficacy was equivalent against environmental mastitis pathogens and bacteriologically negative, clinical mastitis . The products were not equivalent against Staphylococcus aureus, coagulase-negative staphylococci, or all major mastitis pathogens, once again suggesting that the positive control product was more efficacious . Data indicated that germicidal activity of the powdered dip was not sufficient to reduce the incidence of new IMI caused by contagious or minor pathogens normally associated with teat skin . Application of a powdered postmilking teat dip during 3 winter mo in Idaho resulted in improved teat end condition among primiparous and multiparous dairy cows . Teat skin condition improved among primiparous but not among multiparous cows.

J Dent Res, 1994 Mar, 73(3), 682 - 91
Potential efficacy of chlorhexidine against mutans streptococci and human dental caries; Emilson CG; Chemotherapeutic agents have been considered as having potential for the prevention of dental caries . Several substances have been evaluated as possible candidates, but no antimicrobial agent, with the exception of fluoride, has received as much experimental attention as the bisbiguanide chlorhexidine . This substance represents, so far, the most effective and best-documented agent . To be effective against caries, therapeutic dosages of the antimicrobial agent have to be given for a sufficient but finite time period to sites with established cariogenic plaque . In studies where this principle has been used, the aim has been to eliminate or strongly suppress the population of mutans streptococci . Of various antimicrobial agents and methods tested, the most persistent reduction of mutants streptococci has been achieved by chlorhexidine varnishes, followed by gels and mouthwashes . The best clinical effect resulting in a considerable caries reduction has been obtained when persons highly colonized with mutans streptococci have been treated with gels and when the results of the antimicrobial measures have been verified by microbiological examination.

Tijdschr Diergeneeskd, 1994 Mar 1, 119(5), 123 - 8
{Streptococcal infections as cause of death in pigs brought in for necropsy}; Akkermans JP et al.; Research was carried out into the prevalence of streptococcal types isolated from pigs that died of septicaemia, meningo-encephalitis, endocarditis, and pneumonia and which were brought in for investigation from 1 january 1988 to 31 December 1991 . Cultures were prepared from the liver, spleen, kidneys, and brains of all animals and from the heart valves, joints, bronchi, and lungs of animals with pathological changes . The results are presented in six tables . As a group, streptococci were a major source of bacterial infection in septicaemia (38%), meningo-encephalitis (21%), and endocarditis (74%) . Of the streptococcus types . Streptococcus suis type 2 was isolated the most often in sepsis (36%), meningo-encephalitis (52%), and endocarditis (36%) . Streptococcus suis type 1 was found not only in piglets up to the age of weaning but also in older pigs and was a common pathogen in pigs with endocarditis . The discussion takes into consideration data from the literature . It is concluded that the significance of streptococcus infections, and those involving Streptococcus suis types 1 and 2 in particular, has increased under the influence of environmental and management factors (scaling-up of production, import of pigs from abroad, extermination and control of other pig diseases).

Ophthalmology, 1994 Mar, 101(3), 490 - 8
Concurrent endophthalmitis and retinal detachment; Foster RE et al.; PURPOSE: Eyes with concurrent endophthalmitis and retinal detachment usually have a poor anatomic and visual outcome after treatment . The purpose of this study is to define the relation among the causative organism, the results of retinal detachment repair, and the final visual acuity . METHODS: Data were retrieved by a retrospective, computer-assisted review of the coded inpatient diagnoses from April 1987 through March 1992 . RESULTS: This study included 16 patients (9 males, 7 females) ranging in age from 5 to 88 years (average, 58.7 years) . Endophthalmitis was classified as exogenous in 13 (81%) patients and endogenous in 3 (19%) . Two groups were identified: a virulent group that included eight (50%) patients (Staphylococcus aureus, streptococci, gram-negative, Bacillus), and a less-virulent group that included eight (50%) patients (Staphylococcus epidermidis, Propionibacterium acnes, fungal) . The initial surgical procedure consisted of diagnostic vitreous fluid collection by pars plana vitrectomy (11 cases), anterior vitrectomy (1 case), or vitreous aspiration (4 cases) . Additional initial adjunctive surgical procedures included pars plana lensectomy (2 cases), scleral buckling (6 cases), fluid-gas exchange (7 cases), and intraocular antibiotic injections (9 cases) . In six (75%) of eight patients with endophthalmitis in the virulent group, the retina remained detached . However, in seven (88%) of eight patients with endophthalmitis in the less-virulent group, the retina remained reattached postoperatively, and the remaining patient had a stable, nonprogressive peripheral tractional retinal detachment . None of the eight patients with endophthalmitis in the virulent group retained a postoperative visual acuity of better than 3/200, and four (50%) lost all light perception . Five (62%) of the eight patients with endophthalmitis in the less-virulent group retained a postoperative visual acuity of 5/200 or better, and none lost all light perception . CONCLUSIONS: Concurrent endophthalmitis and retinal detachment patients with virulent organisms have a poor prognosis . Visual and anatomic outcomes were better in the less-virulent group.

J Med Microbiol, 1994 Mar, 40(3), 202 - 4
Identification of viridans streptococci associated with bacteraemia in neutropenic cancer patients; Beighton D et al.; Twenty-three viridans streptococcal isolates from pyrexial neutropenic patients with various malignant diseases were studied in a comprehensive identification scheme . Fourteen isolates were identified as Streptococcus oralis, five as S . mitis and two as S . salivarius but the remaining two could not be identified reliably . The virulence mechanisms associated with the ability of these species to survive and grow in vivo require further investigation but may involve the production of specific glycosidase and proteolytic enzyme activities.

Zentralbl Bakteriol, 1994 Mar, 280(4), 507 - 14
Separation of mitogenic and pyrogenic activities from so-called erythrogenic toxin type B (Streptococcal proteinase); Gerlach D et al.; It is well-established that three types of erythrogenic toxins (ETA, ETB, ETC) are produced by Streptococcus pyogenes (group A streptococci) strains . Culture filtrate concentrates from Streptococcus pyogenes strains T19P (T19, ETA+, ETB+, ETC-), 27337 (T12, B3264, ETA-, ETB+, ETC+), 27252 (T4, ETA-, ETB+, ETC+) and 27195 (T8, ETA-, ETB+, ETC-) were analyzed by preparative isoelectric focusing . These concentrates and the purified erythrogenic toxin type B (ETB) isolated by ion exchange chromatography had mitogenic and pyrogenic activity . Now, it has been found that the mitogenic activity and the pyrogenic activity of this ETB can be separated by preparative isoelectric focusing in Sephadex gels . This means that ETB is not a superantigen as described in literature . The mitogenic and biological activity is caused by traces of ETA (strain T19P), ETC (strains 27252 and 27337) and/or by unknown mitogen(s) (MX, strain 27195) which preferentially stimulate V beta 8+ T cells . The differentiation between ETA (stimulating V beta 12+ but not V beta 8+ or V beta 2+), ETC (stimulating V beta 2+ but not V beta 8+), and MX (stimulating V beta 8+) was done using established leukemic cell lines.

Zentralbl Bakteriol, 1994 Mar, 280(4), 488 - 96
JM9 strains, a new type of group B streptococci from Japan; Wagner M et al.; JM9 strains isolated from human carriers and patients in several districts of Japan, represent a new serotype of group B streptococci (GBS, Streptococcus agalactiae) . They were first detected in 1983 but are meanwhile prevailing among all other GBS serotypes in Japan . Outside of Japan, strains of this type have not been reported until now . In the present work, N-acetylneuraminic acid was detected in all strains investigated, by chemical analysis as well as by interaction with a sialic acid-binding lectin . This component is characteristic of all analyzed GBS type polysaccharides . In a chicken embryo model, all strains exhibited a very strong virulence . Examination of the antibiotic sensitivity revealed that all strains were susceptible to penicillin, cephalothin, clindamycin, mezlocillin, azlocillin, erythromycin, methicillin, chloramphenicol, tetracyclin, oxacillin and sulfamethoxazole/trimethoprim, whereas all strains were resistant against gentamicin, kanamycin and neomycin . Electron microscopic studies revealed for these strains relatively small capsules but unusually thick cell walls . By immunogold labelling, the type polysaccharide, the group polysaccharide, the lipoteichoic acid and in some strains, the protein R were localized.

J Antimicrob Chemother, 1994 Mar, 33(3), 403 - 17
The fluoroquinolones as treatment for infections caused by gram-positive bacteria; Cruciani M et al.; The fluoroquinolones have become attractive options as treatment for a broad range of infections caused by Gram-negative bacteria . However, the value of these antibiotics to patients with infections caused by Gram-positive pathogens remains controversial . Experience with quinolones as therapy for skin and skin structure infections, osteomyelitis and peritonitis in patients receiving continuous ambulatory peritoneal dialysis suggests that the concerns which have been expressed about the use of these agents against methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis and streptococci are justified; indeed, the frequent emergence of quinolone-resistant strains of MRSA and coagulase-negative staphylococci either during or following treatment is now well documented . The fluoroquinolones should be prescribed with caution to patients with community-acquired pneumonia or whenever severe infection of pneumococcal aetiology is proven or suspected . As prophylaxis for the granulocytopenic patient, quinolones such as norfloxacin and ciprofloxacin have been shown to be effective in reducing the incidence of morbidity attributable to Gram-negative bacteria, but they have not significantly affected the incidence of infection caused by Gram-positive bacteria . In the treatment of febrile episodes in the neutropenic patient, ciprofloxacin, the quinolone investigated most extensively in this clinical setting, produced high cure rates only when it was combined with an antibiotic which was predictably active against Gram-positive organisms . We review here the role of currently-available fluoroquinolones (norfloxacin, enoxacin, pefloxacin, ofloxacin and ciprofloxacin) as treatment for these and other infections.

FEMS Immunol Med Microbiol, 1994 Mar, 8(3), 213 - 7
Immunochemical study of polysaccharide antigen in Streptococcus sobrinus and Streptococcus downei with a cross-reactive monoclonal antibody; Ota F et al.; A monoclonal antibody (mAb h-448) was prepared after cell fusion of mouse myeloma cells (SP2/0-Ag-14) to the spleen cells of mice immunised with serotype h strain (MF25) of Streptococcus downei . The antibody (IgM class) reacted in enzyme immunoassay only with whole cells as well as purified polysaccharide (PS) antigen of Streptococcus sobrinus (types d and g) and Streptococcus downei (serotype h), but not with cells or purified PS antigen from any other serotypes of the mutans group of streptococci . mAb h-448 also quantitatively precipitated in solution with the purified antigens . Competitive hapten inhibition tests demonstrated that beta-methylgalactopyranoside inhibited the reaction most strongly . Although rhamnose also showed a substantial inhibitory effect, the results of this study indicate that the antigenic determinant of the PS antigen has a structure similar to the beta-methylgalactopyranoside molecule.

Microbiologia, 1994 Mar-Jun, 10(1-2), 181 - 6
{Culture media for the detection and the identification of Streptococcus agalactiae}; de la Rosa M et al.; Streptococcus agalactiae, a Group B streptococcus, is the main cause of bacterial perinatal infection and is also an important opportunistic pathogen . Detection and identification of S . agalactiae are straight forward with special culture media, where Group B streptococci show a specific, typical pink or red pigment . To quickly and easily detect the pigment, culture media should contain: (i) starch; (ii) an inhibitor of the folate pathway; (iii) animal serum; (iv) a pepsic proteic hydrolysate; and (v) glucose, together with a high-capacity buffer . When selective antibiotics are added to culture media designed in this way, it is possible to detect S . agalactiae directly from clinical samples by observation of its pigment after less than 12 hours of aerobic incubation.

J Infect Dis, 1994 Mar, 169(3), 519 - 25
Evaluation of methods for epidemiologic typing of group A streptococci; Seppala H et al.; Serotyping is widely used for epidemiologic investigation of group A streptococci (GAS) . To evaluate molecular typing methods of GAS, restriction endonuclease analysis (REA) of genomic DNA and analysis of DNA restriction fragment length polymorphism of rRNA genes (ribotyping) were used in parallel with serotyping . The genomic DNA of 239 epidemiologically unrelated GAS isolates from human invasive infections was digested with HindIII restriction enzyme . Both REA and ribotyping differentiated subclasses within serotypes . However, they did not consistently differentiate between isolates of different serotypes . Ribotyping was less discriminatory than REA . Within the T1M1 serotype, often associated with invasive GAS infections, 92% of the REA patterns were identical, suggesting a common origin for these isolates . Most other serotypes studied were more heterogenic . Among 32 isolates nontypeable by serotyping, 11 distinct REA patterns and 5 ribotypes were identified . REA and ribotyping are useful supplementary tools for classification of GAS and can add to the discriminatory power of serotyping.

Br J Biomed Sci, 1994 Mar, 51(1), 1 - 4
Rapid differentiation of Streptococcus milleri from other beta-haemolytic group A, C, and G streptococci by simple screening tests; O'Neill WA et al.; Eighty five beta-haemolytic Lancefield group A(23), C(22), and G(40) streptococci were tested for sulphonamide sensitivity, ability to degrade beta-D glucuronide (groups C and G) and bacitracin sensitivity (group A) . Identification of isolates was initially confirmed by the API 20 STREP system . Zones of beta-haemolysis were too variable for correct Streptococcus milleri identification in 10% of cases . However, only group C and G S . milleri were both sulphonamide-resistant and beta-D glucuronide-negative . Two group A S . milleri strains could have been mis-identified as Streptococcus pyogenes if combined sulphonamide and bacitracin resistance had not been noted . In a busy diagnostic laboratory, screening of beta-haemolytic group A, C, and G streptococci for sulphonamide sensitivity is recommended . Sulphonamide-resistant group A S . pyogenes can be distinguished from S . milleri by bacitracin sensitivity . S . milleri can be rapidly and cheaply differentiated from other sulphonamide-resistant group C and G streptococci by a simple 4 h commercial beta-D glucuronide assay.

Infect Immun, 1994 Mar, 62(3), 785 - 92
Immunogenicity of polysaccharides conjugated to peptides containing T- and B-cell epitopes; Lett E et al.; To develop a general model of polysaccharide-peptide vaccine, we have investigated the efficiency of linear peptides derived from protein SR, and adhesin of the I/II protein antigen family of oral streptococci, to act as carriers for two T cell-independent polysaccharides: serogroup f polysaccharide from Streptococcus mutans OMZ 175 (poly f) and Saccharomyces cerevisiae mannan . Peptide 3 (YEKEPTPPTRTPDQ) and peptide 6 (TPEDPTDPTDPQDPSS), accessible on the native SR protein as demonstrated by their reactivity in enzyme-linked immunosorbent assays with rat antisera raised against protein SR, correspond to immunodominant regions of SR . Peptide 3 contains at least one B- and one T-cell epitope, as demonstrated by its ability to induce peptide- and SR-specific antibody responses without any carrier and to stimulate the proliferation of rat lymph node cells primed either with free peptide or native SR, whereas peptide 6 contains only B-cell epitope(s) . Peptide 3 was then covalently coupled though reductive amination to either poly f or mannan, and peptide 6 was coupled to poly f . Subcutaneous immunizations of rats with poly f-peptide 3 or mannan-peptide 3 conjugates produced a systemic immunoglobulin M (IgM) and IgG antibody response, and the elicited antibodies reacted with free poly f or mannan, peptide 3, protein SR, and S . mutans or S . cerevisiae whole cells . Rats immunized with poly f-peptide 6 did not develop any antipeptide or anti-SR response . Furthermore, a booster immunization of animals with poly f-peptide 3 or mannan-peptide 3 conjugates induced high titers of anti-peptide 3, anti-poly f, and antimannan antibodies, which occurred quickly . The response is anamnestic for the peptide and the polysaccharides and is characterized by an Ig switch from IgM to IgG . The data presented here confirm that the presence of B- and T-cell epitopes is necessary to induce an anamnestic antipeptide response and that a peptide containing relevant B- and T-cell epitopes can act as a good carrier in improving an antipolysaccharide anamnestic immune response.

J Immunol, 1994 Feb 15, 152(4), 2066 - 73
Characterization of unique human TCR V beta specificities for a family of streptococcal superantigens represented by rheumatogenic serotypes of M protein; Watanabe-Ohnishi R et al.; The M protein of Streptococcus pyogenes plays a major role in the virulence of these bacteria . Members of the M protein superfamily are characterized by the presence of tandem segments of repeated amino acid sequences . The NH2-terminal end of the M proteins is a hypervariable region that harbors the type-specific epitopes of the molecule . Pepsin cleaves the molecule into a highly conserved carboxyl terminal half and a variable amino terminal portion referred to as pep M . In some individuals, infection with certain serotypes of group A streptococci is followed by autoimmune disorders such as rheumatic fever and acute glomerulonephritis . The serotypes of M protein that show a high degree of association with acute rheumatic fever are referred to as rheumatogenic serotypes . We have reported that one such serotype, type 5, is a superantigen to human T cells, specifically stimulating T cells bearing V beta 2, V beta 4, and V beta 8 elements . Here we extend our studies by examining other rheumatogenic serotypes for superantigenic properties . Studies with types 6, 18, 19, and 24 M proteins revealed that they are all superantigens to human T cells . The specificity to V beta 4 was shared by the rheumatogenic M proteins tested; however, each pep M serotype has its unique characteristic set of V beta specificity and these are distinct from those reported for the streptococcal pyrogenic exotoxins . The non-rheumatogenic serotype, pep M2, only stimulated V beta 2-bearing T cells . This study establishes that the structurally related M proteins represent a family of streptococcal superantigens analogous to the structurally related family of staphylococcal enterotoxin superantigens.

Infect Immun, 1994 Feb, 62(2), 529 - 35
Antibacterial activity of hydrogen peroxide and the lactoperoxidase-hydrogen peroxide-thiocyanate system against oral streptococci; Thomas EL et al.; In secreted fluids, the enzyme lactoperoxidase (LP) catalyzes the oxidation of thiocyanate ion (SCN-) by hydrogen peroxide (H2O2), producing the weak oxidizing agent hypothiocyanite (OSCN-), which has bacteriostatic activity . However, H2O2 has antibacterial activity in the absence of LP and thiocyanate (SCN-) . Therefore, LP may increase antibacterial activity by using H2O2 to produce a more effective inhibitor of bacterial metabolism and growth, or LP may protect bacteria against the toxicity of H2O2 by converting H2O2 to a less-potent oxidizing agent . To clarify the role of LP, the antibacterial activities of H2O2 and the LP-H2O2-SCN- system were compared by measuring loss of viability and inhibition of bacterial metabolism and growth . The relative toxicity of H2O2 and the LP system to oral streptococci was found to depend on the length of time that the bacteria were exposed to the agents . During incubations of up to 4 h, the LP system was from 10 to 500 times more effective than H2O2 as an inhibitor of glucose metabolism, lactic acid production, and growth . However, if no more H2O2 was added, the concentration of the inhibitor OSCN- fell because of slow decomposition of OSCN-, and when OSCN- fell below 0.01 mM, the bacteria resumed metabolism and growth . In contrast, the activity of H2O2 increased with time . H2O2 persisted in the medium for long periods of time because H2O2 reacted slowly with the bacteria and streptococci lack the enzyme catalase, which converts H2O2 to oxygen and water . After 24 h of exposure, H2O2 was as effective as the LP system as an inhibitor of metabolism . H2O2 also caused a time-dependent loss of viability, whereas the LP system had little bactericidal activity . The concentration of H2O2 required to kill half the bacteria within 15 s was 1.8 M (6%) but fell to 0.3 M (1%) at 2 min, to 10 mM (0.03%) at 1 h, and to 0.2 mM (0.0007%) with a 24-h exposure . The results indicate that if high levels of H2O2 can be sustained for long periods of time, H2O2 is an effective bactericidal agent, and the presence of LP and SCN- protects streptococci against killing by H2O2 . Nevertheless, the combination of LP, H2O2, and SCN- is much more effective than H2O2 alone as an inhibitor of bacterial metabolism and growth.

Infect Immun, 1994 Feb, 62(2), 433 - 41
Effects on virulence of mutations in a locus essential for hyaluronic acid capsule expression in group A streptococci; Wessels MR et al.; Mucoid or highly encapsulated strains of group A streptococci have been associated both with unusually severe infections and with acute rheumatic fever . Previously, we described an acapsular mutant, TX4, derived from a mucoid M-type 18 strain of a group A streptococcus by transposon mutagenesis (M . R . Wessels, A . E . Moses, J . B . Goldberg, and T . J . DiCesare, Proc . Natl . Acad . Sci . USA 88:8317-8321, 1991) . We now report studies further characterizing strain TX4 as well as an additional acapsular mutant, TX72 . Strain TX4 was found to contain a 9.5-kb deletion of chromosomal DNA adjacent to the site of transposon Tn916 insertion . Cloned chromosomal DNA from TX4 flanking the transposon insertion site was used as a probe to demonstrate the presence of homologous regions in 11 of 11 wild-type group A streptococcal strains of various M protein types . A second acapsular mutant, TX72, had a single transposon insertion and had no apparent deletion of chromosomal DNA . The Tn916 insertion in TX72 was mapped to the hasA locus (encoding hyaluronate synthase), which lies within the chromosomal region deleted in TX4 . Strain TX72 was avirulent in mice and sensitive to phagocytic killing in vitro . Transduction of either the insertion-deletion mutation from TX4 or the simple insertion mutation from TX72 to a type 24 group A streptococcus strain also resulted in loss of capsule expression, demonstrating that a homologous region of the chromosome controls capsule expression in another serotype of group A streptococci . We conclude that the hyaluronic acid capsule plays an important role in virulence and that a region of the chromosome essential for capsular polysaccharide expression is conserved among diverse group A streptococcal strains.

Med Microbiol Immunol (Berl), 1994 Feb, 183(1), 33 - 42
Immunoglobulin-binding FcrA and Enn proteins and M proteins of group A streptococci evolved independently from a common ancestral protein; Podbielski A et al.; Significant sequence homology between M proteins and immunoglobulin (Ig)-binding proteins of group A streptococci suggests that these proteins arose by gene duplication followed by the development of functional diversity due to mutations and intragenic recombinations . The deduced sequence of multiple Ig-binding proteins and M proteins were compared to distinguish between two evolutionary models . Did these functionally distinct genes originate in the distant past from duplication of a common ancestral gene and then functionally evolve independently or did they evolve more recently, one from the other by duplication of a fixed gene? Multiple alignments of conserved sequences of these proteins are consistent with the former hypothesis . Comparison of N termini of Ig-binding proteins revealed less diversity than that of the M proteins' N termini, suggesting that these proteins are under less selective pressure to change.

Mol Microbiol, 1994 Feb, 11(4), 671 - 84
The identification of rofA, a positive-acting regulatory component of prtF expression: use of an m gamma delta-based shuttle mutagenesis strategy in Streptococcus pyogenes; Fogg GC et al.; Binding of the Gram-positive pathogenic bacterium Streptococcus pyogenes (group A streptococcus) to respiratory epithelium is mediated by the fibronectin-binding adhesin, protein F . Most strains of streptococci regulate the expression of protein F in response to oxygen levels and redox potential; however, JRS4 constitutively binds high levels of fibronectin under all environmental conditions . In this study, we have examined the regulation of protein F expression in JRS4 using a shuttle mutagenesis strategy novel to S . pyogenes . Cloned DNA representing the chromosomal loci adjacent to the gene which encodes protein F (prtF) was subjected to transposon mutagenesis in Escherichia coli using a derivative of transposon m gamma delta that was modified to contain a streptococcal antibiotic-resistance gene . mutagenized DNA was then returned to the streptococcal chromosome by allelic replacement . Analysis of the resulting fibronectin-binding phenotypes revealed that insertions in a region upstream of prtF abolished the constitutive phenotype . However, these mutants now demonstrated regulation in response to both oxygen levels and redox potential . Because these insertions define a locus responsible for the constitutive phenotype, it has been designated rofA (regulator of F) . Chromosomal interruption studies using integrational plasmids together with complementation data from a previous study (VanHeyningen et al., 1993) suggested that rofA acts as a positive trans-acting regulator of prtF . Construction of prtF-lacZ fusions indicated that transcription of prtF is constitutive in JRS4 but is regulated in rofA mutants . Analysis of the DNA sequence defined by the rofA insertions revealed a 1495 bp open reading frame, whose predicted product (RofA) possessed both a putative helix-turn-helix motif and limited homology to two other transcriptional activators (Mry, PrgR) of Gram-positive surface proteins . Sequences homologous to rofA were found in regulated strains of S . pyogenes, which suggests that rofA may act as an activator of prtF in response to an unidentified environmental signal . We speculate that the allele reported here contains a mutation that renders it constitutively active.

Pneumologie, 1994 Feb, 48(2), 121 - 5
{Pneumonia after cytostatic drug therapy}; Bohme A et al.; On account of its high mortality, pneumonia is a particularly feared infectious complication in granulocytopenic patients . One of the main reasons for the fatal outcome is the increasing rate of pulmonary mycoses . Fungal infections offer considerable problems concerning diagnostics and therapy . To improve the prognosis of pulmonary mycoses undelayed diagnostics--even by more invasive methods like bronchoalveolar lavage--and immediate start of antifungal treatment (Amphotericin B/5-Flucytosine are still considered as standard therapy) is necessary . A further problem are gram positive organisms, insufficiently prevented by the standard prophylactic regimens . Particularly pneumonia by Staphylococcus aureus and Viridans-Streptococci may show lethal outcome . The initial treatment with glycopeptides is discussed . Treatment of infections by gram negative organisms however, is less controversial . Finally pneumonias in granulocytopenic patients present serious problems in diagnostics and therapy requiring interdisciplinary co-operation of hematology, radiology, pneumology and microbiology.

Acta Paediatr Jpn, 1994 Feb, 36(1), 25 - 9
Dose-related protective efficacy of immunoglobulins in experimentally induced group B streptococcal infection; Iguchi K et al.; This study investigates the dose-dependent effect of administration of commercially available intravenous immunoglobulins (IVIG) on the survival of newborn rats experimentally infected with group B streptococci (GBS) . The opsonic activity of various concentrations of IVIG in vitro was determined by examination of opsonophagocytosis of GBS by peritoneal macrophages and bacterial killing by blood neutrophils . The best survival was observed in newborn rats who received immunoglobulins at doses of 250, 500 and 1,000 mg/kg of bodyweight . The survival of animals that received either 125 mg/kg or 2.5 g/kg of immunoglobulins was no better than that of animals who received no immunoglobulins . The maximal phagocytosis and bacterial killing were observed at in vitro immunoglobulin concentrations ranging from 32 to 250 mg/dL (these in vitro concentrations may correspond roughly to in vivo administration doses ranging from 150 to 1200 mg/kg) . These doses are comparable to the doses of IVIG currently administered to neonates . However use of very high doses may be harmful to babies since the high concentration of non-specific immunoglobulins inhibited in vitro phagocytosis and bacterial killing by phagocytes.

Clin Infect Dis, 1994 Feb, 18(2), 157 - 60
Oral amoxicillin as prophylaxis for endocarditis: what is the optimal dose?
Dajani AS, Bawdon RE, Berry MC.
We compared serum levels and tolerability of oral amoxicillin in 30 healthy adults who each received 2.0 g of amoxicillin and, 1 week later, 3.0 g of the same preparation . Serum levels of amoxicillin were determined at 1, 2, 4, and 6 hours following its ingestion . Mean serum levels of amoxicillin were significantly higher after 3.0-g doses than after 2.0-g doses . Levels in females were higher than in males; this was a reflection of differences in body weights . Food intake had no effect on serum levels . The 2.0-g doses resulted in adequate serum levels; 6 hours after dosing levels were still substantially higher than the MICs for oral streptococci . Three individuals (10%) experienced mild gastrointestinal side effects after they received the 3.0-g doses; no side effects were noted after the 2.0-g doses . We propose that to prevent bacterial endocarditis in adults who are at risk, a single 2.0-g dose of oral amoxicillin may be adequate prophylaxis for dental, oral, or upper respiratory tract procedures.

Pathologe, 1994 Feb, 15(1), 40 - 3
{Granulomatous endocarditis caused by streptococcus}; Gassel AM et al.; Two cases of granulomatous endocarditis are reported . The patients developed aortal endocarditis refractory to antibiotics . Therefore, aortal valve replacement was performed . In both cases, Streptococcus viridans was demonstrated in culture and bacterioscopically to be the cause of infection . Histological examination of the valves showed characteristic endocarditis with fibrinoid necrosis and histiocytic granulomas . Streptococci were found in the cytoplasm of macrophages . The possible causes of this special form of infectious endocarditis are discussed.

Jpn J Antibiot, 1994 Feb, 47(2), 129 - 42
{Antimicrobial activities of cefteram against recently clinically detected and isolated strains from patients with dental infections}; Deguchi K et al.; To investigate the antibiotic activity of cefteram (CFTM), the minimum inhibitory concentrations (MICs) of CFTM and of the control drugs were determined against clinically isolated strains received from November 1991 to April 1993 from 19 dental facilities throughout the country, as well as against clinically isolated strains from samples obtained at this center from patients with dental infectious diseases, and the following results were obtained . 1 . 430 strains were detected in 198 cases but identified strains amounted to 425 . They are comprised of 204 strains of oral streptococci (48.0%), 81 strains of Peptostreptococcus spp . (19.1%), 10 strains of Bacteroides spp . (2.4%), 23 strains of Prevotella spp . (5.4%), and 9 strains of Porphyromonas spp . (2.1%) . The ratios of Gram-positive bacteria v.s . Gram-negative bacteria were 78.4% and 21.6%, respectively, and the Gram-positive bacteria were isolated at higher frequency than Gram-negative bacteria . 2 . The MIC90's of CFTM against oral streptococci and Peptostreptococcus spp . were 0.10 microgram/ml and 0.05 microgram/ml, and year to year increases of incidences of resistance against CFTM were not observed . Some strains, however, appeared to have obtained resistance to CFTM . 3 . Among Bacteroides spp., Prevotella spp., Porphyromonas spp . which used to belong to genus Bacteroides, there were some strains resistant to CFTM . As a whole, however, no year to year increases in the incidence of CFTM resistance among these strains also . 4 . Two strains of 6 Staphylococcus aureus subsp . aureus were methicillin-resistant . 5 . The above observations indicate that CFTM still shows strong antimicrobial activity against clinically isolated strains that may be involved in dental infections.

Nippon Rinsho, 1994 Feb, 52(2), 502 - 6
{Recent intractable bacterial infections in otolaryngology}; Harada T et al.; Antibiotic treatment has resulted in a significant change in the etiology and character of bacterial infections in otolaryngology as well as in another fields . Classic signs and symptoms may be masked . Administration of penicillin can be still effective in the treatment of usual bacterial infections, as it is effective against group A beta-hemolytic streptococci and most anaerobes except those that produce beta-lactamase . Administration of antibiotics, such as penicillin with clindamycin or chloramphenicol to combat both aerobic and anaerobic bacteria, coupled with surgical drainage is essential in management of deep neck infections . In this communication, several important bacterial diseases are described . Care should be taken to prevent airway obstruction, especially in deep neck infections and acute epiglottitis.

Am J Obstet Gynecol, 1994 Feb, 170(2), 521 - 6
Group B streptococci: results of a protocol of antepartum screening and intrapartum treatment; Katz VL et al.; OBJECTIVE: Our purpose was to evaluate and report the results of a protocol for the identification and treatment of all group B streptococcal carriers . STUDY DESIGN: In 1991 we instituted a protocol of antepartum cultures for group B streptococci on all pregnant women who attended clinics at the University of North Carolina Hospitals . Cultures were obtained from the lower third of the vagina and rectum at 24 to 28 weeks' gestation . Women with positive cultures were treated with intravenous antibiotics in labor . Women with signs of chorioamnionitis (through intrapartum assessment) were also treated in labor, regardless of carrier status . RESULTS: During the first 2 years of this protocol 1681 women were delivered . Forty percent of the women were from the private practice, 32% were black, and 62% were married . The group B streptococcal carriage rate was 14% . During the period of evaluation there were no infants infected with group B streptococci and no adverse reactions or complications among women who were treated with antibiotics . CONCLUSION: We found antepartum screening and intrapartum chemoprophylaxis of all group B streptococcal carriers to be an acceptable and effective protocol for reducing perinatal group B streptococcal infections.

J Infect Dis, 1994 Feb, 169(2), 319 - 23
Passive protection of mice against group A streptococcal pharyngeal infection by lipoteichoic acid; Dale JB et al.; Previous studies have shown that lipoteichoic acid (LTA) of group A streptococci plays a central role in the adherence of these organisms to epithelial cells . In this study, intranasal instillation of purified LTA but not deacylated LTA in mice blocked colonization and prevented death after intranasal challenge infection with group A streptococci . Bacteria pretreated with rabbit antisera against LTA also failed to colonize or infect mice after intranasal challenge . In vitro studies showed that LTA and M protein inhibited adherence of type 24 streptococci to mouse pharyngeal cells . Passive intranasal administration of purified type 24 M protein protected mice from death after challenge infection with type 24 streptococci but had no significant effect on pharyngeal colonization . Surface LTA and M protein may mediate adherence of streptococci to mouse pharyngeal cells, and blocking adherence with LTA prevents colonization and infection in this animal model.

J Cell Physiol, 1994 Feb, 158(2), 347 - 53
Effects of fibronectin on actin organization and respiratory burst activity in neutrophils, monocytes, and macrophages; Yang KD et al.; Previous studies have shown that fibronectin (Fn) enhances phagocytosis and killing of antibody-coated bacteria by neutrophils and macrophages . In an attempt to understand the mechanism of this enhancement, we have investigated the effects of Fn on phagocytosis-related actin organization as well as respiratory burst activity in neutrophils, monocytes and culture-derived macrophages . Employing an NBD-phallacidin flow cytometric analysis of filamentous actin formation, we found that Fn promotes rapid actin polymerization within 30 seconds in neutrophils, monocytes, and macrophages, but not lymphocytes . Enhancement of actin polymerization by Fn was concentration-dependent and mediated by a pertussis toxin- but not cholera toxin-sensitive G protein . Inhibition of protein kinase C by sphingosine (20 microM), calcium influx by verapamil (0.1 mM), or intracellular calcium mobilization by 8-(N,N-diethyl-amino) octyl-3,4,5-trimethoxybenzoate HCl (TMB-8; 0.1 mM) did not block Fn-enhanced actin polymerization in phagocytes . Incubation of neutrophils and macrophages on microtiter plates precoated with Fn suppressed superoxide (O2-) production induced by IgG- and IgA- opsonized group B streptococci . In contrast, Fn significantly enhanced IgA- and IgG-mediated O2- production by freshly isolated monocytes . These data suggest that Fn enhances phagocytosis, presumably through G protein-coupled cytoskeleton reorganization and augments O2- production by circulating monocytes . In contrast, it appears to suppress O2- production by the active phagocytic cells, neutrophils and macrophages . This may result in enhanced phagocytosis and intracellular killing of microorganisms without damaging interstitial tissues.

Mol Cell Probes, 1994 Feb, 8(1), 73 - 80
Oligonucleotide probes for mutans streptococci; Cangelosi GA et al.; Oligodeoxyribonucleotide probes complementary to hypervariable regions of the 16S ribosomal RNA were designed for specificity toward Streptococcus mutans and Streptococcus sobrinus . The probes were tested for specificity and sensitivity by hybridization with nucleic acid from over 100 mutans and non-mutans oral streptococci and other common oropharyngeal bacteria . Probes designated SM002 and SM010 were 100% sensitive and > 99% specific for S . mutans . Probe SSP001, designed to detect both S . mutans and S . sobrinus, was 88% sensitive and > 99% specific . The probes were able to detect nucleic acid extracted from 3 x 10(4)-1 x 10(5) homologous bacteria . Sensitivity did not vary significantly with the growth state of the cells, except for diminished signals when using nucleic acid extracted from very old cultures . The probes correctly identified 72 S . mutans colonies isolated from 10 volunteer saliva samples, using sugar utilization patterns as a reference standard . Ten isolates resembling S . mutans by colony morphology but not by sugar utilization patterns were correctly distinguished from mutans streptococci by the probes . These results demonstrate that oligonucleotide probes can accurately identify S . mutans in saliva samples.

Can J Microbiol, 1994 Feb, 40(2), 99 - 105
Growth of group B streptococci in human serum leads to increased cell surface sialic acid and decreased activation of the alternative complement pathway; Platt MW et al.; Group B streptococcus type III is a major cause of neonatal death . The terminal sialic acid moiety of the group B streptococcus type specific capsule has been shown to be an important virulence factor . We demonstrate here that bacteria grown in human serum have increased cell surface sialic acid content compared with cells grown in common laboratory media . This sialic acid was removed by incubation with neuraminidase, showing that it was on the bacterial surface . Serum-dependent sialylation was dependent on metabolic activity, as the addition of chloramphenicol reduced the amount of added sialic acid by more than 90% . Probing the cell surface with an antibody specific for group B streptococcus type III capsular sialic acid showed an increase in antibody binding after growth in human serum . This effect could be lowered by incubating serum-grown cells in neuraminidase prior to antibody exposure . A group B streptococcus mutant that when grown in laboratory media lacks cell surface sialic acid showed significant cell surface sialic acid when grown in human serum . This increase was associated with a significantly decreased ability to bind C3 and hence activate the alternative complement pathway.

J Clin Microbiol, 1994 Feb, 32(2), 437 - 43
Use of restriction fragment polymorphism analysis of rRNA genes to assign species to unknown clinical isolates of oral viridans streptococci; Rudney JD et al.; This study evaluated restriction fragment length polymorphisms of rRNA genes (ribotyping) for genotypic identification of 53 oral isolates classified as "Streptococcus sanguis" by colony morphology . Isolates were from 8-h buccal plaque on lower first permanent molars of 20 subjects . DNA was digested with AatII and hybridized with digoxygenin-labeled cDNA of Escherichia coli 16S and 23S rRNA . Strains were ribotyped again with AlwNI or PvuII on the basis of the presence or absence of a 2,290-bp AatII band . Band patterns were compared with reference ribotypes for Streptococcus gordonii, Streptococcus sanguis, Streptococcus crista, Streptococcus oralis, Streptococcus mitis, and Streptococcus parasanguis strains . Forty-eight isolates could be assigned to a species (22 S . sanguis, 14 S . oralis, 12 S . gordonii) . Multiple species were seen in 14 subjects; multiple strains of the same species occurred in 11 subjects . Our findings suggest that ribotyping can be used for genotypic identification of S . sanguis, S . oralis, and S . gordonii isolates.

JAMA, 1994 Jan 19, 271(3), 234 - 8
Pediatricians' diagnostic approach to pharyngitis and impact of CLIA 1988 on office diagnostic tests; Schwartz B et al.; OBJECTIVE--To determine the factors associated with an optimal diagnostic approach to a child with pharyngitis, characterize office laboratory methods for throat swab culture and group A streptococcal rapid antigen testing, and assess the potential impact of the Clinical Laboratory Improvement Amendments (CLIA) of 1988 on the performance of these tests . DESIGN AND SETTING--Mailed survey to all board-certified primary care pediatricians from seven western states with telephone follow-up for nonrespondents . OUTCOME MEASURES--Differences in practice characteristics and use of office laboratory tests for physicians who usually (> 80%) diagnose pharyngitis using a recommended approach vs those who follow this approach less often (< 50%); characteristics of physicians who indicate that they intend to discontinue office throat culture because of CLIA and those who will continue to perform this test also are compared . RESULTS--Responses from 531 pediatricians were analyzed . Forty-four percent diagnosed pharyngitis appropriately for more than 80% of patients, and 17% did so for fewer than 50% . Optimal diagnosis was significantly more common among physicians who cultured throat swabs in their office (relative risk, 1.40; 95% confidence interval, 1.19 to 1.66) and less common among solo practitioners (relative risk, 0.71; 95% confidence interval, 0.56 to 0.88) . Factors that may decrease the sensitivity of office throat culture include short duration of incubation (59%), lack of quality control (51%), and limited education of the persons reading results (6%) . With implementation of CLIA, 24% of pediatricians reported that they already have discontinued or will discontinue office throat culture, and 23% have discontinued or will discontinue antigen detection testing for group A streptococci . Those most likely to stop office culture include solo practitioners and practitioners who do not currently perform quality control of culture methods . CONCLUSIONS--Office culture for group A streptococci is strongly associated with an optimal diagnostic approach . Implementation of CLIA regulations may substantially decrease the number of physicians who perform this test . The balance between potential improvements in the quality of office culture with CLIA implementation and the decreased availability of this test needs to be assessed.

J Biol Chem, 1994 Jan 7, 269(1), 169 - 75
Molecular characterization of hasA from an operon required for hyaluronic acid synthesis in group A streptococci; Dougherty BA et al.; The mechanism by which group A streptococci produce the antiphagocytic hyaluronate (hyaluronic acid) capsule is incompletely understood . Enzymes known to be essential for synthesis of this polysaccharide include the membrane-associated hyaluronate synthase as well as those required for production of the substrate sugars UDP-N-acetylglucosamine and UDP-glucuronic acid . In this study, a Tn916 insertion that inactivates hyaluronate synthetic activity was localized to a gene designated hasA in the hyaluronic acid synthesis operon . This gene has recently been preliminarily identified as the group A streptococcal hyaluronate synthase . The DNA sequence and transcription start site of hasA were determined, and the predicted HasA protein was shown to have characteristics of a membrane protein . Amino acid sequence homology suggests that HasA is related to a family of proteins involved in polysaccharide production and cell differentiation . Finally, in addition to the loss of hyaluronate synthase activity, the hasA::Tn916 insertion was demonstrated to correlate with a loss of UDP-glucuronic acid dehydrogenase activity . These results suggest that the genes required for hyaluronate synthase activity and production of the UDP-glucuronic acid substrate are transcribed as a unit in group A streptococci.

South Med J, 1994 Jan, 87(1), 95 - 6
Streptococcus milleri as a cause of antecubital abscess and bacteremia in intravenous drug abusers; Stocker E et al.; S milleri should be added to the list of organisms producing wound infections in parenteral drug addicts . Recovery of "viridans streptococci" from an antecubital aspirate should prompt the clinician to request speciation, examine closely for abscess formation, and anticipate prolonged antibiotic therapy.

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