Streptococcal

Zhonghua Kou Qiang Yi Xue Za Zhi, 1993 May, 28(3), 164 - 6, 191
{The effect of antibody to Streptococcus mutans in saliva on caries activity and S . mutans adhering}; Luo ZL; An indirect enzyme-linked immunosorbent assay (ELISA) was used for measuring IgA antibody to whole cell of Streptococcus mutans (serotype c) in saliva . 36 parotid salivary samples of human were collected from two groups: Caries free (CF) and caries sensitive (CS) . The result shows that the IgA antibody to S . mutans in CF group was higher than those in CS group (P < 0.05) . The saliva antibody was gained from the rabbits by injection with S . mutans (serotype c), and the adhesion of S . mutans--3H on the surface of hydroxylapatite beads treated by rabbit's saliva was measured . The results show that the saliva with immunity could inhibit the S . mutans to adhere on the HA beads (P < 0.05) . It means saliva antibody may prevent caries through inhibition of S . mutans from adhesion.

Eur J Med, 1993 May, 2(5), 275 - 80
Should vancomycin be used empirically in febrile patients with prolonged and profound neutropenia? Results of a randomized trial; Pico JL et al.; OBJECTIVES: We conducted a randomized trial with ceftazidine alone or associated with amikacin or vancomycin to investigate the efficacy of the daily 3 g dosage of ceftazidime and the efficacy of monotherapy with ceftazidime and to determine if vancomycin should be added empirically . METHODS: Patient inclusion criteria were: age over 10 years, therapeutically-induced neutropenia and fever for at least three hours above 38.5 degrees C in absence of a clear non-infectious aetiology . Patients were randomized into three groups: group C, ceftazidime alone 3 g/day; group CA, ceftazidime 3 g/day plus amikacin 15 mg/kg/day; or group C, ceftazidime 3 g/day plus vancomycin 1.5 g/day . RESULTS: Results from one hundred and two episodes of fever were analyzed . The underlying diseases were haematological malignancies (89 patients) and solid tumours (13 patients) . The median duration of neutropenia (< 0.5 x 10(9) PMN/L) was 18 days and the minimum duration of 7 days . The main criterion for the analysis of efficacy was the onset of a major infectious event, i.e . death related to documented or suspected infection and any infectious event considered life-threatening or hindering future treatment of the underlying disease . Eight (22%) patients in group C developed major infectious events compared with four (13%) in group CA and none in group CV (p < 0.01) . Major infectious events were mainly due to Gram-positive organisms, particularly Streptococcus species . CONCLUSION: We conclude that: 1) ceftazidime alone and in association with amikacin is effective in preventing Gram-negative major infectious events; and 2) vancomycin should not be added only when a Gram-positive infection is documented, but used empirically.

Rev Hosp Clin Fac Med Sao Paulo, 1993 May-Jun, 48(3), 130 - 8
Polyvalent pneumococcal polysaccharide vaccines; a review of the literature; Requejo HI; Streptococcus pneumoniae is a leading cause of morbidity and mortality, mainly in children, elders and individuals with AIDS or AIDS-related complex, being a frequent bacterial cause of pneumonia, otitis media, sinusitis, bacteremia and meningitis . Polyvalent pneumococcal capsular polysaccharide vaccines contain the 23 most common pneumococcal serotypes causative of pneumococcal infection in several countries . Public Health Service Advisory Committee on Immunization Practice of the Centers for Disease Control (CDC) does not recommend the polyvalent pneumococcal vaccine for general public . However, several investigators have recommended its employment for special population at high risk, such as for HIV infection, who can be at enhanced risk for systemic pneumococcal disease . The objective of the present literature review is to relate the importance of studied different types of polyvalent pneumococcal vaccines as well as their immunological properties in the vaccinated people.

Res Microbiol, 1993 May, 144(4), 305 - 16
Altered expression of several genes in IIIManL-defective mutants of Streptococcus salivarius demonstrated by two-dimensional gel electrophoresis of cytoplasmic proteins; Lapointe R et al.; Mannose, glucose and fructose are transported in Streptococcus salivarius by a phosphoenolpyruvate:mannose phosphotransferase system (PTS) which consists of a membrane-bound Enzyme II (EII) and two forms of IIIMan having molecular weights of 38,900 (IIIManH) and 35,200 (IIIManL), respectively . We have previously reported the isolation of spontaneous mutants lacking IIIManL and showed that they exhibit higher beta-galactosidase activity than the parental strain after growth on glucose, and that some of them constitutively express a fructose PTS which is induced by fructose in the parental strain . In an attempt to determine whether the expression of other genes is affected by the mutation and what the physiological link is between them, we examined three S . salivarius IIIManL-defective mutants (strains A37, B31 and G29) and the parental strain using two-dimensional gel electrophoresis after growth of the cells on a variety of sugars . After growth on glucose, five new proteins were detected in the cytoplasm of the three mutants . Two of these proteins were induced in the parental strain by galactose or oligosaccharides containing galactose, and one was specifically induced by melibiose . The other two proteins were not detected in the parental strain under any of the growth conditions tested . Two other proteins were only detected in glucose-grown cells of mutant A37, and a protein associated with the metabolism of fructose was constitutively expressed in mutants B31 and G29 . Moreover, we have found that under identical growth conditions the amounts of several other proteins which were detected in the parental strain were either increased or decreased in the mutants . Globally, our results have indicated that (1) the expression of several genes was affected in the spontaneous IIIManL-defective mutants; (2) some of the proteins abnormally produced in the mutants were specifically induced in the parental strain by sugars; (3) the phenotypic modifications observed in the mutants were of two types: most were observed solely after growth of the cells on glucose whereas the others were glucose-independent; and (4) the mutants shared common phenotypic traits, but also exhibited idiosyncratic characteristics.

Clin Infect Dis, 1993 May, 16(5), 714 - 8
Neonatal group B streptococcal infection in Mallorca, Spain; Hervas JA et al.; Early onset infection in neonates caused by group B Streptococcus and the prevalence of colonization by this microorganism in a group of 1,003 pregnant women and their neonates were studied . The capsular serotypes of the colonizing and infecting bacterial isolates and the components of C protein expressed were determined . Except for serotype IV, all the currently recognized capsular serotypes (including serotype V) were found . Among the colonizing strains, serotypes III, Ia, and Ib were almost equally represented and accounted for 82% of the isolates . Serotype III was predominantly found in cases of infection (55%), and serotypes Ia and V were also found in such cases . C protein was not detected in serotype III isolates, but alpha and/or beta components of this protein were found in isolates of all other serotypes . Neonatal infection and colonization due to this microorganism were observed in 1.2 cases per 1,000 live births and in 7.1% of pregnant women . Host factors for infection, such as low birth weight, premature delivery, and prolonged rupture of membranes, were uncommon . The level of specific antibodies to serotype III was also quantitated; lower levels were found in infected children and their mothers than in healthy infants and pregnant women . Further similar studies in Spain are necessary so that preventive measures can be planned.

J Infect Dis, 1993 May, 167(5), 1112 - 7
Molecular epidemiology of group A streptococcus M type 1 infections; Martin DR et al.; Data were reviewed about 665 streptococcus M type 1 isolates received by the Streptococcus Reference Laboratory of the New Zealand Communicable Disease Centre between 1980 and 1991 . Isolates were voluntarily submitted by diagnostic laboratories throughout New Zealand as part of a surveillance system for streptococcal infections . Over the study period, distribution of M type 1 was uneven, and two waves of infections occurred, each with a distinctive disease pattern . Molecular typing using restriction fragment length polymorphism (RFLP) analysis was used to examine phylogenetic relationships among isolates randomly selected from different geographic locations for each of the years studied . Although six distinct RFLP patterns occurred, most isolates (74%), including those of both waves, belonged to type 1a . This type and one other were also identified among additional isolates originating from Australia and the United States . Typed isolates from cases of severe invasive disease occurring both in the United States and in New Zealand in the late 1980s belonged to RFLP type 1a.

Am J Surg, 1993 May, 165(5), 642 - 5
Symmetrical peripheral gangrene (purpura fulminans) complicating pneumococcal sepsis; Johansen K et al.; Bacterial sepsis is only infrequently accompanied by peripheral ischemia . However, we have managed 10 patients with symmetrical peripheral gangrene (purpura fulminans) accompanying pneumococcal sepsis (Streptococcus pneumoniae) during the past 15 years at a single institution . In only two (20%) of these patients could vasoconstrictor administration be implicated as contributory to gangrene . The clinical scenario was characterized by pneumococcal bacteremia, admission to the medical intensive care unit, normal proximal arterial perfusion, and symmetrical full-thickness digital and distal extremity ischemia leading to cutaneous gangrene . Three (30%) of these patients died . The failure of anticoagulant and antiplatelet agents as therapy and the successful reversal of impending digital gangrene in one patient by sympathetic blockade suggest that the initial underlining pathophysiology is vasoconstrictive rather than thrombotic in nature . Effective management includes appropriate antibiotic therapy, avoidance of early operative intervention, conservative local debridement, and secondary skin grafting.

J Appl Bacteriol, 1993 May, 74(5), 526 - 31
Development of gene probes for the specific identification of Streptococcus uberis and Streptococcus parauberis based upon large subunit rRNA gene sequences; Harland NM et al.; 23S ribosomal RNa (rRNA) gene sequences of Streptococcus uberis and Strep . parauberis were determined by direct polymerase chain reaction (PCR) sequencing . Oligonucleotide probes specific for Strep . uberis and Strep . parauberis were designed from variable regions of the 23S rRNA gene sequence data . Molecular hybridizations with PCR-amplified rRNA gene targets provided a precise and reliable means of differentiating Strep . uberis and Strep . parauberis from each other and from other streptococcal species.

Scand J Immunol, 1993 May, 37(5), 605 - 14
Peripheral lymphoid hyperplasia and central lymphoid depletion in mice treated with a bacterial B-cell mitogen (F3'EP-Si/p90); Lima M et al.; In order to further understand the mechanism mediating the mitogenic and immunosuppressor effects of p90, a protein produced by Streptococcus intermedius, flow cytometric studies were performed on peripheral and central lymphoid organs of mice treated with this protein . p90 induced a strong blastogenic B-cell response in the spleen and lymph nodes, followed by a slight but significant polyclonal T-cell activation . B-cell repertoire analysis indicated that polyclonal B-cell responses affected similarly both CD5+ and conventional (CD5-) B cells in the spleen . Repertoire analysis of T cells failed to reveal any preferential stimulation of the V beta T-cell receptor (V beta-TcR) families studied . Peripheral lymphoid hyperplasia was observed concomitantly with central lymphoid depletion . In the bone marrow, pre-B and B cells were profoundly depleted, with a more pronounced effect on small pre-B cells . In the thymus, double-positive (CD4+CD8+) thymocytes were preferentially eliminated, with a relative enrichment of single positive (either CD4+ or CD8+) and double-negative (CD4-CD8-) thymocytes.

J Med Chem, 1993 Apr 30, 36(9), 1239 - 44
Hybrids of antibiotics inhibiting protein synthesis . Synthesis and biological activity; Zemlicka J et al.; Four hybrid antibiotics combining structural features of chloramphenicol (1a), sparsomycin (2b), lincomycin (5c), and puromycin (6d)--lincophenicol (1c), chloramlincomycin (5a), sparsolincomycin (5b), and sparsopuromycin (6b)--were synthesized . They were investigated as inhibitors of several partial reactions of procaryotic and eucaryotic protein synthesis as well as potential antimicrobial agents . Lincophenicol (1c) was active as inhibitor of Escherichia coli ribosomal peptidyltransferase-catalyzed puromycin reaction . Both lincophenicol (1c) and sparsophenicol (1b) inhibited the binding of the iodophenol analogue of sparsomycin to E . coli ribosomes . The results are discussed in terms of a retro-inverso hypothesis advanced earlier for interpretation of biological activity of chloramphenicol (1a) and sparsophenicol (1b) . Chloramlincomycin (5a) suppressed the growth of Streptococcus pyogenes with MIC 6.25 micrograms/mL.

Carbohydr Res, 1993 Apr 23, 243(1), 115 - 30
Molecular size analysis of capsular polysaccharide preparations from Streptococcus pneumoniae; Bednar B et al.; Purified capsular polysaccharide preparations from Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F were analyzed by high performance size exclusion chromatography (HPSEC) with multi-angle laser light scattering (MALLS), specific viscosity (SV), and refractive index (RI) detection to determine the molecular size and molar mass of each of the pneumococcal (Pn) polysaccharides . The Mw's of the polysaccharides ranged from a low of 606 kg/mol for Pn4 to a high of 1145 kg/mol for Pn9V, and the z-average radii of gyration ranged from 59 nm for Pn14 to 72 nm for Pn18C . Estimations of molar mass of the highly anionic polysaccharides (all but Pn14) by the universal calibration approach were unsuccessful, resulting in a 27-53% overestimate of the Mw's though application of Mark-Houwink-Sakurada coefficients calculated from the HPSEC-MALLS/SV/RI data resulted in estimates of Mw that were in agreement with the MALLS estimates for all but the Pn4 preparation . These results emphasize the need for direct measurement of both molecular size and intrinsic viscosity distributions for definitive characterization of the molar mass, hydrodynamic volume, rigidity, and drainage of complex biological polymers such as the pneumococcal polysaccharides.

Gene, 1993 Apr 15, 126(1), 123 - 8
Identification of several rod loci and cloning of the rodD locus of Streptococcus mutans; Tao L et al.; Previous work has shown that Streptococcus mutans is normally a short rod or a sphere, depending on its environment . This paper describes two distinct genetic approaches used to identify multiple loci and isolate one locus, rodD, controlling S . mutans rod shape . The first method involved isolation of a group of rod- mutants caused by transposon Tn916 insertion, and analysis of the inactivated genes by Southern hybridization . The second method involved mutagenesis via a shotgun insertion-duplication technique, isolation of a rod- mutant, and cloning the intact rod locus, employing an integration shuttle plasmid, pVA891 . These approaches have led to the identification of multiple rod loci involved in determining the rod shape of S . mutans, and also cloning of one rod locus, rodD . The cloning strategy may also be useful for cloning other streptococcal genes which cannot be detected by their expression in Escherichia coli.

Carbohydr Res, 1993 Apr 7, 242, 191 - 201
Formation of alpha-(1-->6), alpha-(1-->3), and alpha-(1-->2) glycosidic linkages by dextransucrase from Streptococcus sanguis in acceptor-dependent reactions; Bhattacharjee MK et al.; Dextransucrase from Streptococcus sanguis 10558 was found to synthesize alpha-(1-->6), alpha-(1-->3), and alpha-(1-->2) linkages during an acceptor-dependent glucosyl transfer reaction . Normally, new glucosyl residues are added at C-6 of monosaccharide acceptors . However, sugars blocked at C-6 also can serve as good acceptors . The disaccharide and trisaccharide products formed when methyl 6-bromo-6-deoxy-alpha-D-glucopyranoside was used as acceptor were isolated and characterized . Both were found to contain only alpha-(1-->3) glycosidic bonds . This supports the hypothesis that when C-6 is blocked the acceptor binds to the enzyme in a flipped orientation, resulting in an approximate exchange in space of the C-3 and C-6, thereby putting C-3 adjacent to the active site . The second alpha-(1-->3) links in the trisaccharide are formed by a single-chain mechanism without release of the intermediate disaccharide . With maltose as acceptor, new glucosyl residues are added at C-6' . However, if that position is blocked with a bromine atom, the resulting compound, 6'-bromo-6'-deoxy-maltose, can still serve as an acceptor . The product in this case was isolated and characterized . The new glycosidic link was found to be alpha-(1-->2).

J Med Chem, 1993 Apr 2, 36(7), 871 - 82
Quinolone antibacterials containing the new 7-{3-(1-aminoethyl)-1- pyrrolidinyl} side chain: the effects of the 1-aminoethyl moiety and its stereochemical configurations on potency and in vivo efficacy; Domagala JM et al.; A series of stereochemically pure 7-{3-(1-aminoethyl)-1-pyrrolidinyl}-1, 4-dihydro-4-oxoquinoline and 1,8-naphthyridine-3-carboxylic acids, with varied substituents at the 1-, 5-, and 8-positions, were synthesized to study the effects of the 7-{3-(1-aminoethyl)-1- pyrrolidinyl} moiety on potency and in vivo efficacy relative to the known 7-{3-(aminomethyl)-1- pyrrolidinyl} derivatives . The antibacterial efficacies of the target compounds and their relevant reference agents were determined in vitro using an assortment of Gram-negative and Gram-positive organisms and in vivo using Escherichia coli and Streptococcus pyogenes mouse infection models . The effects of the 7-{3-(1-aminoethyl)-1-pyrrolidinyl} moiety were also examined at the level of the target enzyme by employing a DNA-gyrase supercoiling inhibition assay . Selected compounds were further evaluated for potential phototoxic and clastogenic liabilities using a phototoxicity mouse model and an in vitro mammalian cell cytotoxicity assay . It was found that the differences in in vitro antibacterial activity between the stereoisomers were significantly greater than previously reported for other optically pure 3-substituted pyrrolidinyl side chains . Relative to their 7-{3-(aminomethyl)-1-pyrrolidinyl} analogs, the (3R,1S)-3-(1-aminoethyl)pyrrolidines generally conferred a 2-4-fold increase in Gram-positive in vitro activity and an average of 10-fold improvement in oral efficacy . The level of phototoxicity and cytotoxicity of the product quinolones was ultimately determined by the combined influence of the 7-{3-(1-aminoethyl)-1-pyrrolidinyl} side chains and the other quinolone substituents . From this study, several compounds were identified with outstanding antibacterial activity and low degrees of phototoxicity and mammalian cell cytotoxicity . One such agent, 34F-R,S (PD 140248), showed the best overall blend of safety and efficacy.

Eur J Clin Microbiol Infect Dis, 1993 Apr, 12(4), 297 - 9
Killing kinetics of cefuroxime against Streptococcus pneumoniae in an in vitro model simulating serum concentration profiles after intramuscular administration; Bingen E et al.; The killing kinetics of cefuroxime against 25 Streptococcus pneumoniae isolates with penicillin MICs of < 0.1, 0.1-1.0 and 2 mg/l were studied in an in vitro model simulating the serum concentration profile in healthy adults following a single intramuscular injection of 500 mg . Cefuroxime was bactericidal against the isolates with exquisite or slightly diminished susceptibility to penicillin (-4 and -3.9 log10 cfu/ml killing, respectively) during the 6 h incubation period . In contrast, there was only a 2.8 log10 cfu/ml reduction in the initial inoculum of six of the eight isolates resistant to penicillin (MIC 2 mg/l) . The two remaining penicillin-resistant isolates (cefuroxime MIC 8 mg/l) only showed a 2 log10 cfu reduction in the initial inoculum.

Mikrobiyol Bul, 1993 Apr, 27(2), 154 - 63
{Antibacterial and cytotoxic effects of N-butyl-2-cyanoacrylate used as a tissue adhesive}; Giray CB et al.; In this study, the antibacterial and cytotoxic effects of a synthetic tissue adhesive called n-butyl-2-cyanoacrylate (Histoacryl) which provide rapid healing in incision in oral surgical procedures were investigated . The antibacterial effects of Histoacryl were tested by using standard reference strains of Streptococcus pyogenes, Streptococcus mitis, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus grown in Mueller-Hinton media (sheep blood supplemented Mueller-Hinton for streptococcus strains) by diffusion technique . The cytotoxic effects were also researched on continuous Vero and primary gingival fibroblast cell cultures by using agar overlay method . In these methods, the inhibition zones produced by Histoacryl were evaluated . As a result, Histoacryl was found to have antibacterial effect on the tested bacteria and produce cytotoxic and cytopathic effects on the tested cell cultures.

Acta Odontol Scand, 1993 Apr, 51(2), 109 - 14
Xylitol and the bactericidal effect of chlorhexidine and fluoride on Streptococcus mutans and Streptococcus sanguis; Nuuja T et al.; The present study was made to investigate the effect of xylitol on the bactericidal and bacteriostatic action of chlorohexidine diacetate (CHX) and sodium fluoride (F) in ATCC strains of Streptococcus mutans and S . sanguis . Standardized bacterial cell suspensions were used in tests for bactericidal effect and for inhibition of growth and sucrose fermentation . The results showed no interference of xylitol with the antibacterial effect of CHX and F combinations . Xylitol did not show any additive effect either but appeared inert in the combinations used.

Mol Microbiol, 1993 Apr, 8(1), 133 - 42
Sucrose-derived exopolysaccharides of Streptococcus mutans V403 contribute to infectivity in endocarditis; Munro CL et al.; We used an isogenic mutant of Streptococcus mutans V403, which differs from the wild-type V403 in genes involved in glucan and fructan production, to examine the importance of these exopolysaccharides as factors affecting infectivity in endocarditis . Rats inoculated with V403 developed endocarditis more frequently than animals inoculated with the mutant strain which produced neither glucan nor fructan (58% versus 12%, P < 0.01) . In phagocytosis assays, both strains were found to be associated with the human granulocytes but a greater number of live V403 than of mutant organisms could be recovered . Colony counts recovered from fibrin plates incubated with the mutant were lower than those incubated with V403 . These experiments indicate that exopolysaccharides produced by Streptococcus mutans contribute to its infectivity in endocarditis.

Antimicrob Agents Chemother, 1993 Apr, 37(4), 896 - 900
In vitro activities of ramoplanin, selected glycopeptides, fluoroquinolones, and other antibiotics against clinical bloodstream isolates of gram-positive cocci; Lawrence T et al.; The susceptibilities of 316 gram-positive bacteremic isolates to ramoplanin, vancomycin, and teicoplanin and seven other antibiotics were tested . Ramoplanin demonstrated MICs of < or = 0.25 microgram/ml for at least 99% of Staphylococcus aureus isolates and 100% of coagulase-negative staphylococci tested . For both oxacillin-susceptible and oxacillin-resistant S . aureus and coagulase-negative staphylococci, the activity of ramoplanin surpassed those of both vancomycin and teicoplanin . Ramoplanin and teicoplanin had comparable activities against enterococci and Streptococcus pneumoniae and were superior to vancomycin.

Am J Hematol, 1993 Apr, 42(4), 354 - 8
Viridans streptococcal shock in bone marrow transplantation patients; Steiner M et al.; We have recognized a rapidly progressive, often fatal shock syndrome associated with viridans streptococcal sepsis following bone marrow transplantation (BMT) . Of 832 patients receiving a marrow transplant at the University of Minnesota between 1976 and 1988, including 123 with viridans streptococcal bacteremia, 10 patients (8%) developed clinical shock within an average of 2 days (range 0-4 days) of their first positive blood culture . Viridans streptococcal shock occurred in patients early in the transplantation course, between 1 and 28 (median 6) days following BMT when all 10 patients were neutropenic . Six of the 10 patients died as a consequence of their shock or from subsequent complications . The most frequent (6 of 10 patients) viridans streptococcal species isolated in the shock patients was Streptococcus mitis . Of multiple factors analyzed for increased risk of developing viridans streptococcal shock, only younger patient age was significantly associated with the development of shock . Although 58% of BMT recipients with viridans streptococcal bacteremia were younger than 15 years, all 10 patients comprising the shock population were < 15 years of age (P < 0.02) . We speculate that certain streptococcal strains may trigger fulminant shock in the immunocompromised BMT patient.

Trends Biochem Sci, 1993 Apr, 18(4), 136 - 40
Molecular evolution of bacterial cell-surface proteins; Goward CR et al.; The cell-surface proteins of the infective bacteria Streptococcus and Staphylococcus are probably involved in the process of infection . These proteins share many features including secretion signal peptides, cell-wall spanning regions, membrane anchor domains and repeated domains of various functions . These common features may have evolved by gene duplication and swapping of gene fragments.

FEMS Microbiol Lett, 1993 Apr 1, 108(2), 163 - 7
Local and systemic immunity against Streptococcus pneumoniae: humoral responses against a non-capsulated temperature-sensitive mutant; Garcia VE et al.; Temperature-sensitive mutants of Streptococcus pneumoniae were isolated after chemical mutagenesis . Intranasal immunization with temperature-sensitive mutant J/3 induced higher levels of circulating antibody than those obtained after immunization with the heat-killed parental wild type . Moreover, local immunization with mutant J/3 induced high levels of anti-S . pneumoniae IgG and IgA in the lower respiratory tract, whereas only moderate IgG (and no IgA) antibodies were detected in lung lavage fluids from mice immunized intranasally with the heat-killed strain.

Am J Vet Res, 1993 Apr, 54(4), 570 - 2
Correlations between histologic endometrial lesions in mares and clinical response to intrauterine exposure with Streptococcus zooepidemicus; Troedsson MH et al.; The relationship between histologic lesions in endometrial biopsy specimens and susceptibility to chronic uterine infection (CUI) in mares was investigated . Mares were allotted to 4 groups on the basis of degree of endometrial lesions . Mares in group 1 (n = 6) had no pathologic changes, mares in group 2 (n = 5) had only mild pathologic changes, group-3 mares (n = 7) had moderate changes, and group-4 mares (n = 7) had severe inflammatory and fibrotic endometrial changes . Susceptibility to CUI was determined by the inflammatory response to intrauterine inoculation of 5 x 10(6) Streptococcus zooepidemicus . The inoculum was given on the third day of behavioral estrus and in the presence of a follicle > 30 mm . Mares with > 1 neutrophil/5 high-magnification (400 x) microscopic fields and > 20 colonies of S zooepidemicus at 96 hours after inoculation were considered to be susceptible to CUI . There was a significant association between biopsy grade and susceptibility to CUI among the groups . Histologically normal endometrium was associated with resistance to CUI, and severe histopathologic changes in the endometrium were associated with susceptibility to CUI . Mild to moderate endometrial lesions did not correlate consistently with susceptibility or resistance to CUI.

Pediatr Res, 1993 Apr, 33(4 Pt 1), 373 - 9
Three different strains of heat-killed group B beta-hemolytic streptococcus cause different pulmonary and systemic hemodynamic responses in conscious neonatal lambs; Covert RF et al.; Although group B beta-hemolytic streptococcus (GBS) causes pathologic hemodynamic alterations in both human neonates and neonatal animal models of sepsis, little is known about strain-dependent differences in hemodynamic responses to GBS . This study compared pulmonary and systemic hemodynamic dose-response profiles in conscious neonatal lambs with three different strains of heat-killed GBS originally isolated from infected human neonates (group 1: serotype Ib, early-onset sepsis; group 2: serotype Ib, necrotizing enterocolitis; and group 3: serotype III, meningitis) . Regression models of hemodynamic responses were characterized after lambs were injected with heat-killed GBS (dose range 0.1-6.0 x 10(9) colony-forming units, i.v.) . All three GBS strains caused dose-dependent increases in mean pulmonary arterial pressure and pulmonary and systemic vascular resistances and decreases in cardiac output and heart rate . The GBS strain used in group 1 caused a greater effect on mean pulmonary arterial pressure and systemic vascular resistance than those used in groups 2 and 3 and was the only strain to cause an increase in mean systemic arterial pressure . The GBS strains used in groups 1 and 2 had a greater effect on pulmonary vascular resistance than that used in group 3 . No group differences were observed in cardiac output and heart rate responses, which were, however, influenced by age, gender, and duration of postoperative recovery of the lambs . No attenuation or augmentation of hemodynamic effect was observed after sequential doses of 10(9) colony-forming units of GBS given in a single day . This study demonstrates strain-dependent quantitative differences in pulmonary vascular response and qualitative differences in systemic vascular response to heat-killed GBS.

Am J Pathol, 1993 Apr, 142(4), 1227 - 37
Suppression of local and systemic responses in streptococcal cell wall-induced acute inflammation of the air pouch by cyclosporine A . Comparison with the effects of two anti-inflammatory bis-benzimidazoles; Dieter Geratz J et al.; Injection of streptococcus group A cell wall-derived peptidoglycan polysaccharide into a subcutaneous air pouch causes local outpouring of neutrophils and macrophages and distant hemopoietic proliferation in spleen and bone marrow . Cyclosporine A (CyA) suppressed neutrophil accumulation and all cell lines of hemopoiesis . trans-1,2-Bis(5-amidino-2-benzimidazolyl)ethene (BBE) also interfered with neutrophil exudation, yet reduced only the erythroid component of the hemopoietic process . The ethane analogue of BBE, on the other hand, did not prevent neutrophil emigration, but held down splenic erythropoiesis and myelopoiesis . All three compounds stimulated streptococcus group A cell wall-derived peptidoglycan polysaccharide uptake by pouch macrophages . CyA being the least active, BBE and its ethane analogue also produced a shift of wear-and-tear pigment from large numbers of small splenic macro-phages into small numbers of large macrophages . The pouch model is very useful in the study of anti-inflammatory compounds and has furnished the first evidence of CyA interference with massive neutrophilic infiltration and with hemopoietic signals.

Anal Chem, 1993 Apr 1, 65(7), 913 - 21
Determination by heteronuclear NMR spectroscopy of the complete structure of the cell wall polysaccharide of Streptococcus sanguis strain K103; Reddy GP et al.; Although complete structures of complex polysaccharides have traditionally been determined by chemical degradative methods, a number of recent developments in instrumentation have greatly facilitated this task . We illustrate the application of several of these methods in a determination of the complete covalent structure of the polysaccharide from Streptococcus sanguis K103, which is composed of an octasaccharide repeating subunit linked by phosphodiester bonds . Carbohydrate analysis by HPAE-PAD and by reverse-phase chromatography of benzoylated derivatives of the hydrolysis products of the polysaccharide gave glucose (3 mol), galactose (1 mol), rhamnose (2 mol), N-acetylglucosamine (1 mol), and galactose 6-phosphate (1 mol) . Circular dichroism of the O-benzoylated monosaccharides showed the absolute configurations to be D for all residues except for rhamnose, which is L . The 1H NMR spectrum was completely assigned by two-dimensional homonuclear methods (DQF-COSY, NOESY, HOHAHA) . The stereochemistry of pyranosides was assigned from 3JHH coupling constant values determined from these experiments . The 13C spectrum was assigned by 1H-detected heteronuclear multiple-quantum correlation (1H{13C} HMQC) and by the hybrid method of HMQC-COSY . The glycosidic linkage positions of the polymer were determined by 1H-detected multiple-bond correlation (1H{13C} HMBC) and by 2D-NOESY spectra . The position of the phosphodiester linkage was determined by splitting observed in the 13C resonances due to 31P couplings leading to the overall structure given in Chart I.

Infect Immun, 1993 Apr, 61(4), 1563 - 6
Analysis of a DNA polymorphic region in the gtfB and gtfC genes of Streptococcus mutans; Chia JS et al.; We have previously demonstrated the existence of DNA polymorphisms at the 5' coding regions of the gtfB and gtfC genes specifying the streptococcal glucosyltransferases (J.S . Chia, T.Y . Hsu, L.J . Teng, J.Y . Chen, L.J . Hahn, and C.S . Yang, Infect . Immun . 59:1656-1660, 1991) . DNA sequence analysis by polymerase chain reaction and direct sequencing revealed that while several nucleotide changes were identified, accounting for the polymorphisms, the amino acids which they code for remain unchanged . The polymorphic region is located in a highly conserved amino terminus of the glucosyltransferases . A peptide of 19 amino acids from this region reversed the inhibiting activity of an antiserum raised against the proteins coded for by the gtfB and gtfC genes . The results suggest that the polymorphic region, varying in DNA but not in amino acid sequences, might specify some biological function.

Infect Immun, 1993 Apr, 61(4), 1547 - 52
Identification of a salivary agglutinin-binding domain within cell surface adhesin P1 of Streptococcus mutans; Crowley PJ et al.; DNA encoding the alanine-rich region (A-region) of the cell surface adhesin, P1, from Streptococcus mutans was subcloned and expressed as a fusion protein with the maltose-binding protein (MBP) of Escherichia coli . The A-region fusion protein was shown to competitively inhibit both adherence of S . mutans to salivary agglutinin-coated hydroxyapatite and fluid-phase agglutinin-mediated aggregation of this organism . MBP alone or an MBP-paramyosin fusion protein was not inhibitory . Proteolytic cleavage of the fusion protein into its component moieties, MBP and A-region, resulted in breakdown of the A-region into three main fragments . Western immunoblot analysis of calcium-dependent agglutinin binding to this preparation revealed binding specificity for a 28-kDa fragment . Thus, the A-region of P1 is an important domain which interacts directly with salivary agglutinin, and this interaction interferes with both the aggregation and the adherence mechanisms in vitro.

Infect Immun, 1993 Apr, 61(4), 1538 - 43
The cell wall mediates pneumococcal attachment to and cytopathology in human endothelial cells; Geelen S et al.; Streptococcus pneumoniae interacts with vascular endothelial cells during the course of bacteremia . In this study, we characterized the initial attachment of pneumococci to human endothelial cells (EC) and the response of the endothelium to this interaction . Pneumococci adhered to EC in a dose-dependent fashion . Attachment was rapid, with the majority of bacteria attached by 30 min . No difference was found between the attachment of unencapsulated (R6) and encapsulated (SIII) strains . Purified pneumococcal cell wall components competitively inhibited attachment of R6 by a maximum of 60% in a dose-dependent manner . Following attachment of pneumococci or exposure of EC to pneumococcal cell wall, pronounced changes in EC morphology ensued, resulting in striking separation of the cells of the monolayer and, eventually, destruction of the cells . The cytopathic effects of the cell wall were inhibited by antibodies to interleukin-1 but not to tumor necrosis factor . Both antibodies were required to neutralize the cytopathology caused by intact pneumococci . We conclude that pneumococci attach rapidly to human EC and that the cell wall is important in this interaction . Intact pneumococci and pneumococcal cell wall induce profound morphologic changes in human EC, leading to loss of barrier integrity . These cytopathic effects are likely to be cytokine mediated.

Infect Immun, 1993 Apr, 61(4), 1352 - 8
Toxicity of pneumolysin to pulmonary alveolar epithelial cells; Rubins JB et al.; Mortality during the first several days of pneumococcal pneumonia has not decreased appreciably over the past 30 years, despite the widespread use of antibiotics . Disruption of the alveolar epithelial barrier is likely an initial step in the pathogenesis of pneumococcal pneumonia . We report that soluble factors from Streptococcus pneumoniae can directly injure isolated rat alveolar epithelial cells . Using biochemical and immunological techniques, we identified pneumolysin as a major soluble S . pneumoniae toxin for alveolar epithelial cells . Alveolar epithelial cells at 24 or 72 h after isolation were equally sensitive to injury by purified pneumolysin . Purified pneumolysin substantially increased alveolar permeability in an isolated perfused rat lung model . Electron microscopy revealed that instilled pneumolysin caused widespread lung injury, primarily to type I alveolar epithelial cells . Pneumolysin toxicity to alveolar epithelial cells may be important in the pathogenesis of acute lung injury during pneumococcal pneumonia and may facilitate pneumococcal bacteremia.

Infect Immun, 1993 Apr, 61(4), 1259 - 67
Streptococcus mutans fructosyltransferase (ftf) and glucosyltransferase (gtfBC) operon fusion strains in continuous culture; Wexler DL et al.; Three glucosyltransferases (GTFs), which catalyze the formation of water-insoluble adherent glucans, and fructosyltransferase (FTF), which synthesizes fructans, are believed to contribute to the pathogenic potential of Streptococcus mutans . Study of the regulation of expression of GTF and FTF has been difficult because of the complexity and number of exoenzymes produced by this bacterium . By using continuous chemostat culture to control environmental conditions, chloramphenicol acetyltransferase (CAT) operon fusions were utilized to measure transcriptional activity of the ftf and gtfBC gene promoters . Expression of these operon fusions was differentially regulated in response to culture pH and growth rate and during transition states between growth domains . Furthermore, the addition of sucrose to steady-state cultures resulted in significant increases in CAT specific activities for both fusions . In a few cases, GTF and FTF enzyme specific activities did not parallel those of the corresponding CAT fusion activities; this lack of correspondence was likely due to posttranscriptional events controlling enzyme secretion and enzyme activity, as well as to the differential expression of dextranase(s) and fructan hydrolase by S . mutans . These results clearly demonstrate that the extracellular polymer synthesis machinery of S . mutans is regulated in a complex manner . The use of operon fusions in combination with chemostat culture is a viable approach to analyzing gene expression in S . mutans and will be helpful in defining the molecular mechanisms underlying regulation of expression of virulence attributes under conditions that may more closely mimic those in dental plaque.

Infect Immun, 1993 Apr, 61(4), 1246 - 50
Expression of gtfS is essential for normal insoluble glucan synthesis by Streptococcus downei; Gilmore KS et al.; The gtfI and gtfS genes of Streptococcus downei were investigated to determine the contribution of the respective enzymes to glucan production in the presence and absence of other glucosyltransferases . Extracts of Escherichia coli expressing cloned gtfS produced a short linear dextran from sucrose which could act as a primer for insoluble glucan synthesis when mixed with extracts of a strain expressing recombinant gtfI . To elucidate the contribution of gtfS to glucan production by S . downei, a mutant was constructed by insertionally inactivating gtfS . S . downei (gtfS mutant) colonies exhibited a marked phenotypic change on sucrose-containing media and a decreased ability to adhere to glass and produced no detectable water-insoluble glucan . These experiments confirm that expression of gtfS is essential for normal insoluble glucan synthesis by S . downei.

J Neurosurg, 1993 Apr, 78(4), 661 - 5
Selective endovascular techniques in the treatment of cerebral mycotic aneurysms . Report of three cases; Khayata MH et al.; The aim of this study was to evaluate the role of endovascular treatment for intracranial mycotic aneurysms . The clinical and angiographic features of three patients with endocarditic vegetation (two with Streptococcus viridans and one with Staphylococcus) were reviewed retrospectively . Patients were selected for this treatment according to the clinical setting and aneurysm location . In two cases, selective catheterization of a distal middle cerebral and posterior cerebral artery branch with a microcatheter followed by superselective amobarbital testing of the parent vessel was preliminary to the occlusion of that vessel with autologous clot or glue . The third patient was treated by selective occlusion of the aneurysm by intra-aneurysmal placement of platinum minicoils . Two patients presented with intracranial hemorrhage and in one the lesion was found on computerized tomography . All three aneurysms had been excluded from the circulation at the 6-month follow-up review . The only complication from the procedure, despite the septic nature and distal localization, was balloon deflation in one patient, who was successfully retreated with coils . Endovascular embolization is indicated in patients who are at risk of hemorrhage and cannot undergo the standard procedure . The superselective amobarbital test allows selection of patients who will tolerate distal vessel occlusion . This endovascular procedure represents a safe and effective treatment for these lesions.

J Infect Dis, 1993 Apr, 167(4), 850 - 6
Penicillin-resistant Streptococcus pneumoniae strains recovered in Houston: identification and molecular characterization of multiple clones; Versalovic J et al.; A sample of 48 penicillin-resistant Streptococcus pneumoniae (PRSP) strains recovered between January 1989 and May 1991, primarily from infected children in Houston, was characterized by multilocus enzyme electrophoresis and repetitive extragenic palindromic-polymerase chain reaction genomic profiling . A heterogeneous array of 22 clonal genotypes was identified, but 64% of the PRSP strains in the sample were assigned to five clones that are closely similar in overall chromosomal character and express serotype 6 capsule . A close genetic association between these five clones and penicillin-resistant 6B clones recovered in Alaska, Iceland, and Spain was identified by multilocus enzyme electrophoresis . Taken together, the results suggest either that the common resistant 6B clones in Alaska, Iceland, Spain, and Houston have a recent ancestor or that isolates of a certain pneumococcal phylogenetic lineage are more likely to develop penicillin resistance.

Thorax, 1993 Apr, 48(4), 364 - 9
Interference with the oxidative response of neutrophils by Streptococcus pneumoniae; Perry FE et al.; BACKGROUND--Pneumococcal infections are still a major clinical problem . Polymorphonuclear leucocytes (neutrophils) are considered to have a key role in the host's defence against Streptococcus pneumoniae but the mechanisms by which they kill the pneumococcus remain unclear . As reactive oxygen species are regarded as a major antimicrobial defence of phagocytes an attempt has been made to establish their role in the response of neutrophils to S pneumoniae . METHODS--S pneumoniae isolated from patients with bacteraemic pneumococcal pneumonia were incubated with neutrophils in suspension and superoxide production was measured by reduction of ferricytochrome c . RESULTS--S pneumoniae did not stimulate superoxide production alone or in the presence of normal human serum . Spontaneous superoxide production by neutrophils was actually abrogated by S pneumoniae, as was the powerful respiratory burst stimulated by phorbol myristate acetate . This phenomenon depended on both the dose and the viability of the bacteria . With S pneumoniae in the logarithmic phase of growth inhibitory activity was confined to the organisms themselves but with organisms undergoing autolysis it was also present in filtered supernatants, suggesting that the inhibitory activity can be attributed to a factor released during autolysis . CONCLUSIONS--S pneumoniae can interfere with the respiratory burst of neutrophils . This property may help to explain the pathogenicity of the organism.

Antimicrob Agents Chemother, 1993 Apr, 37(4), 793 - 800
Antibacterial activity of NM394, the active form of prodrug NM441, a new quinolone; Yoshida T et al.; The in vitro antibacterial activity of NM394 was compared with those of other new quinolones . NM394 showed potent and broad-spectrum antibacterial activity against 2,606 recent clinical isolates . The activity of NM394 against gram-positive bacteria was 2- to 16-fold less than that of tosulfoxacin and sparfloxacin but was comparable to that of ofloxacin . Only against Streptococcus pyogenes was the activity of NM394 equal to that of sparfloxacin . Against gram-negative bacteria, NM394 showed antibacterial activity equal to that of ciprofloxacin . Against quinolone-resistant Pseudomonas aeruginosa (norfloxacin MIC, > 6.25 micrograms/ml), the activity of NM394 was greater than those of the other agents tested . NM394 was rapidly bactericidal at concentrations near the MIC . NM394 inhibited supercoiling activities of DNA gyrase purified from Staphylococcus aureus, Escherichia coli, and P . aeruginosa; the 50% inhibitory concentrations were 18.0, 0.41, and 2.05 micrograms/ml, respectively.

Pediatr Infect Dis J, 1993 Apr, 12(4), 280 - 4
Pharyngitis associated with herpes simplex virus in college students; McMillan JA et al.; During a 16-month period patients who presented to the Syracuse University Health Center with upper respiratory complaints had throat swabs obtained for viral, streptococcal and Mycoplasma pneumoniae cultures . Thirty-five of 613 patients (5.7%) had herpes simplex virus (HSV) isolated . All but 2 of the HSV isolates were found to be type 1 by immunofluorescent staining . Two HSV-positive patients also grew Group A Streptococcus, one grew M . pneumoniae and three had serum heterophile antibody tests that were positive . On physical examination 25 of the 35 HSV-positive patients had pharyngeal erythema and 14 had pharyngeal exudate . Twelve of these patients had vesicular lesions of the lips, throat or gums associated with their other symptoms . For 29 of the 35 HSV-positive students the primary diagnosis assigned was pharyngitis, for 2 the diagnosis was stomatitis and the remainder were assigned a primary diagnosis of upper respiratory infection, pneumonia, bronchitis or dental infection . Thirty-two of the 35 HSV-positive patients were treated with oral antibiotics and 7 were treated with oral or topical acyclovir . During the same 16-month period 89 (6.9%) of 1297 students presenting with sore throat were culture-positive for influenza A or B, 30 (2.3%) of 1283 were culture-positive for M . pneumoniae and 169 (2.8%) of the 6016 cultured for Group A Streptococcus were positive . Serum was tested for heterophile antibody in 2438 students, and 257 (10.5%) were positive . Herpes simplex virus is associated with pharyngeal symptoms in college students, and herpes simplex pharyngitis cannot easily be distinguished clinically from other causes of acute pharyngitis in this age group.

J Bacteriol, 1993 Apr, 175(8), 2214 - 20
A bifunctional protein in the folate biosynthetic pathway of Streptococcus pneumoniae with dihydroneopterin aldolase and hydroxymethyldihydropterin pyrophosphokinase activities; Lopez P et al.; A protein encoded by sulD, one of four genes in a previously cloned folate biosynthetic operon of Streptococcus pneumoniae, had been shown to harbor 6-hydroxymethyl-7,8-dihydropterin pyrophosphokinase activity . This SulD protein was purified and shown now to harbor also dihydroneopterin aldolase activity . The bifunctional protein therefore catalyzes two successive steps in folate biosynthesis . The aldolase activity can be ascribed to the N-terminal domain of the SulD polypeptide, and the pyrophosphokinase activity can be ascribed to the C-terminal domain . Homologs of the dihydroneopterin aldolase domain were identified in other species, in one of which the domain was encoded as a separate polypeptide . The native SulD protein is a trimer or tetramer of a 31-kDa subunit, and it dissociated reversibly after purification . Dihydroneopterin aldolase activity required the multimeric protein, whereas pyrophosphokinase was expressed by the monomeric form . With purified SulD, the amount of 6-hydroxymethyl-7,8-dihydropterin product formed by the aldolase was proportional to the fourth power of the enzyme concentration, as expected for a reversibly dissociating tetramer . By identifying the gene encoding dihydroneopterin aldolase, this work extends our understanding of the molecular basis of the folate biosynthetic system common to many organisms.

Intern Med, 1993 Apr, 32(4), 278 - 84
Lung abscess: analysis of 66 cases from 1979 to 1991; Mori T et al.; Sixty-six patients with bacterial lung abscess were treated between 1979 and 1991 in our hospital . Among these patients, death occurred in one of the 42 cases of community-acquired infection (mortality rate: 2.4%) and in 16 of the 24 cases of nosocomial infection (mortality rate: 66.7%) . Of all 66 cases, 55 were culture-positive, and the etiologic agents isolated from 24 of the culture-positive cases were found to be anaerobic bacteria . The most common aerobes isolated from the foci were identified as Staphylococcus aureus, Klebsiella spp . and Pseudomonas aeruginosa, while the most common anaerobes were Bacteroides spp., Peptostreptococcus, Fusobacterium spp., microaerophilic Streptococcus and Veillonella . The mortality was higher in the cases with P . aeruginosa, Klebsiella spp . and Candida spp . than in those with other bacteria . The prognosis of lung abscess patients proved to depend on the presence of underlying diseases and on superinfection with aerobes.

Microb Pathog, 1993 Apr, 14(4), 299 - 305
Antibodies against pneumococcal C-polysaccharide are not protective; Nielsen SV et al.; The ability of antibodies against C-polysaccharide (C-Ps) to protect against experimental pneumococcal infection was examined in a mouse model . No protection against types 6A and 14 pneumococcal infection could be demonstrated neither with mouse monoclonal antibodies against C-Ps, specific for phosphorylcholine (PC) or for C-Ps backbone, nor for polyclonal rabbit immunsera against C-Ps . The monoclonal antibody with PC-specificity was protective against infection with type 27 pneumococcus, that has PC as part of its capsular polysaccharide . Type-specific mono- and polyclonal antibodies were highly protective against infection with the homologous type . We conclude that no species-specific protection can be achieved against intraperitoneal Streptococcus pneumoniae infection with optimally capsulated bacteria in outbred mice by passive immunization with antibodies to C-Ps.

J Virol Methods, 1993 Apr, 42(1), 13 - 22
Radioimmunoprecipitation of avian reovirus polypeptides using virus-specific IgM and IgG murine monoclonal and chicken polyclonal antibodies; Reddy SK et al.; A simple and improved procedure for radioimmunoprecipitation (RIPA) for the identification of major immunogenic proteins of avian reovirus using murine monoclonal and chicken polyclonal antibodies is described . Bacterial proteins (Staphylococcus aureus-Protein A or Streptococcus species-Protein G) commonly used in RIPA procedures lack reactivities with low avidity monoclonals belonging to immunoglobulin (Ig)G or IgM subtypes, as well as avian Ig . Hence we used an indirect approach utilizing species-specific anti-IgM, IgG or chicken Ig antibodies followed by the precipitation of the immune complexes using Protein A . This improved the sensitivity of the RIPA enabling the antigenic analysis of the major antigenic proteins of avian reovirus . The results indicated that the virus is highly immunogenic in the natural host, chicken than in mice . Furthermore, there exists a direct correlation between a strong neutralizing antibody response and an increased precipitation of the sigma (sigma) proteins of the virus . The results also demonstrate a strong association between the conformational viral epitopes of the three classes of proteins, large (lambda), medium (mu) and small (sigma).

Nippon Ganka Gakkai Zasshi, 1993 Apr, 97(4), 448 - 54
{Study on safety of sodium hyaluronate (SL-1010) by injection in the anterior chamber}; Sawa M et al.; We investigated effects of a newly developed sodium hyaluronate (SL-1010) on the anterior segment of the eye . The tested sodium hyaluronate was biosynthesized using Streptococcus zoo-epidemicus . Under an operating microscope, we replaced the aqueous humor of Macaca fascicularis (n = 3) with 150 microliters of 1% sodium hyaluronate solution without loss of the anterior chamber . The opposite eye was treated as a control and its aqueous was replaced with the same volume of the vehicle, isotonic phosphate buffer solution . We performed follow-up clinical examination with slit-lamp microscopy, pachymetry, pneumotonometery, and specular microscopy . On the 7th day, we performed histological study by light microscopy, transmission and scanning electron microscopy . Although the sodium hyaluronate group showed a significant increase of intraocular pressure at 9 hours after the treatment over the control, there were no significant differences in clinical findings between the sodium hyaluronate and the control groups . Histological studies demonstrated nothing particular except for slight swelling of mitochondria of corneal endothelial cells in both groups . It was concluded that the newly developed sodium hyaluronate is a biologically inactive and safe biomaterial.

Ryumachi, 1993 Apr, 33(2), 169 - 74
{Two cases of pneumococcal septic arthritis complicating rheumatoid arthritis}; Yoshio T et al.; It is reported that most of the causative organisms of suppurative arthritis complicating rheumatoid arthritis (RA) is Staphylococcus aureus and that Streptococcus pneumoniae is rare, representing less than 5% of cases of suppurative arthritis complicating RA . We here report two cases of pneumococcal septic arthritis complicating RA . Both were female, and 68 and 64 years old, respectively . They had active, long-standing RA with destructed changes . Infected joints included both knees (case 1) and right knee (case 2) . Pain and loss of motion in the septic joints were prominent . On admission, the physical examination showed severe redness, swelling and tenderness of the septic joints and the range of motion of those was markedly decreased . The radiograph of affected joints showed stage III . Laboratory data showed markedly elevated ESR of 127 mm/hr (case 1) and 142 mm/hr (case 2) and C-reactive protein of 49.91 mg/dl (case 1) and 30.36 mg/dl (case 2) . Aspirate of the left knee of case 1 showed numerous neutrophils . Cultures of the joint fluid grew S . pneumoniae . Grossly purulent material was aspirated from the right knee of case 2 and cultures also grew S . pneumoniae . They were started on intravenous antibiotics with a good response and the function of involved joints returned to preseptic condition . The source of infection on case 1 was presumed to be otitis media because she had discharge from left ear concurrently with the exacerbation of joint symptoms . Case 2 had productive cough and cultures of sputum also disclosed S . pneumoniae when pain of right knee joint developed . The suggested source of infection was upper respiratory tract.(ABSTRACT TRUNCATED AT 250 WORDS)

Kansenshogaku Zasshi, 1993 Apr, 67(4), 355 - 60
{A case of Kartagener's syndrome with S . pneumoniae lung abscess}; Masaki H et al.; A 38-year-old male with Kartagener's syndrome (KS) was admitted to our department for evaluation of recurrent pneumonia . Before admission the patient was diagnosed as having pneumonia in another hospital and received ofloxacin (300 mg/day) . Fever and production of purulent sputum decreased initially but again increased in the middle of April . On admission the films of both X-ray and CT scan of the chest revealed several air-fluid levels and infiltrative shadows on the left lower lung field . The patient was diagnosed as lung abscess using bronchofiberscopy . Gram staining of the intrabronchial specimens revealed many Gram-positive cocci and neutrophils including phagocytosed bacteria . A new carbapenem (L-627, 600 mg/day), was started intravenously . After the therapy Streptococcus pneumoniae were eradicated soon from the sputum . At the same time the above symptoms including dyspnea on exertion subsided, and the findings of the chest X-ray and CT scan were also improved . Regarding KS the electron micrograph of the cilia showed the absence of the outer-dynein arms . While by both the saccharin test and the sputum cytology impaired mucociliary clearance was found . Lung abscess infrequently accompany KS . There are reports of respiratory infections in KS, but to our knowledge no report of lung abscess was found in KS . We present this case report describing lung abscess in KS.

Kansenshogaku Zasshi, 1993 Apr, 67(4), 349 - 54
{Case report: suppurative arthritis due to group B Streptococcus in a patient with rheumatoid arthritis}; Obana M et al.; A 62-year-old woman, who had been diagnosed as having rheumatoid arthritis (RA) with systemic amyloidosis and diabetes mellitus, was admitted to our hospital because of polyarthralgia on October 1, 1987 . She had some subcutaneous nodules and rheumatic pleural effusion . Therefore she was treated with 20 milligrams of prednisolone (PSL) daily . On the ninth day after the beginning of steroid therapy, she complained of severe pain and a new swelling in her right knee joint . The knee joint aspirate on arthrocentesis yielded a pure growth of group B Streptococcus (GBS) . Blood culture was also positive for GBS . Her suppurative arthritis gradually improved by treatment with penicillin G . However, after the discontinuance of PSL, her pleural effusion deteriorated and she died on January 10, 1988 . To our knowledge, there have been no prior reports of group B streptococcal suppurative arthritis complicating RA in Japan.

J Postgrad Med, 1993 Apr-Jun, 39(2), 60 - 2
Bacterial pneumonias--evaluation of various sputum culture methods; Verenkar MP et al.; With an objective of improving diagnostic value of sputum in bacterial pneumonias, 50 uncomplicated 'community' acquired cases were studied using Gram staining of sputum along with bedside inoculation with/without dilution of the specimen . Gram staining of sputum samples collected before treatment revealed pneumococcal infection in 46% cases . The results were however inconclusive on samples sent by routine procedure involving logistic delay . Cultural analysis of sputum processed by three different techniques showed that bedside inoculation of sputum after dilution to be the most efficient technique yielding Streptococcus pneumoniae in 34% cases, Gram positive cocci in lesser number (20%), Gram negative rods (GNR) in 18% cases . Sputum samples processed bedside without dilution yielded a lower number of pneumococci and other Gram positive cocci (24% & 16% cases respectively) . Routine processing of sputum, involving logistic delay yielded a high number of Gram negative rods (62%), indicating their overgrowth . Thus bedside inoculation of sputum after dilution coupled with direct Gram staining serves as a simple and yet valuable laboratory aid in the diagnosis of uncomplicated 'community' acquired bacterial pneumonias.

Chest, 1993 Apr, 103(4), 1283 - 4
Left ventricular outflow tract obstruction following repair of pneumococcal mitral annular abscess; Charney R et al.; An unusual case of a mitral annular abscess caused by Streptococcus pneumoniae was diagnosed by transesophageal echocardiography . The patient underwent surgical resection of the abscess and developed outflow tract obstruction . This is an unusual complication of the surgical procedure . The outflow tract obstruction may have been due to anterior displacement of the mitral valve by the abscess.

Infect Immun, 1993 Apr, 61(4), 1301 - 6
Identification of antigenic epitopes in an alanine-rich repeating region of a surface protein antigen of Streptococcus mutants; Okahashi N et al.; A surface protein antigen (PAc) of Streptococcus mutans with a molecular mass of 190 kDa is considered to play an important role in the initial attachment of this streptococcus to the tooth surface . Two internal repeating amino acid sequences are present in the PAc molecule . One repeating region located in the N-terminal region is rich in alanine (A-region), and the other, located in the central region, is rich in proline (P-region) . To identify antigenic epitopes on the A-region of the PAc protein, 82 sequential overlapping synthetic decapeptides covering one of the repetitive units of the A-region were synthesized . In the epitope scanning analyses using murine antisera raised against recombinant PAc (rPAc), multiple antigenic epitopes were found in the repetitive unit of the A-region, and some of them reacted with antisera to rPAc from BALB/c, B10, B10.D2, and B10.BR mice . In particular, a peptide YEAALKQY (residues 366 to 373) was recognized by anti-rPAc sera from all four strains of mice . The reactivities of anti-rPAc sera in the epitope scanning were confirmed by using a purified synthetic peptide, NAKATYEAALKQYEADLAA (corresponding to residues 361 to 379) . Furthermore, antisera against a surface protein antigen PAg (SpaA) of Streptococcus sobrinus from BALB/c mice reacted strongly to residues 330 to 337, 362 to 369, and 366 to 373 of the PAc protein by the epitope scanning analysis . An AKATYEAALKQY (residues 362 to 373 of the PAc protein)-like sequence, AKANYEAKLAQY, was found within the A-region of S . sobrinus PAg, suggesting that the amino acid sequences AKA-YEA and YEA-L-QY may be major cross-reactive epitopes of the S . mutans PAc protein and the S . sobrinus PAg protein.

Ned Tijdschr Geneeskd, 1993 Mar 20, 137(12), 604 - 7
{The return of severe infections caused by Streptococcus pyogenes}; Verhoef-Verhage EA et al.; Two patients with severe group A streptococcal infection associated with a toxic shock-like syndrome are described . Both isolates produced the pyrogenic exotoxin B . Since 1987 there have been many reports of these severe streptococcal infections . In order to know the incidence in the Netherlands, isolates from patients with severe streptococcal infection have to be serotyped (types of M-protein) and tested for streptococcal toxin production, and serum antibody levels have to be determined.

FEMS Microbiol Lett, 1993 Mar 15, 108(1), 87 - 92
Lytic action of cloned pneumococcal phage lysis genes in Streptococcus pneumoniae; Romero A et al.; The genes hbl3, cpl1 and cpl7 coding for the pneumococcal phage lytic enzymes HBL3, CPL1 and CPL7, respectively, have been cloned into shuttle plasmids that can replicate in Streptococcus pneumoniae and Escherichia coli . All these genes were expressed in E . coli under the control of either the lytP promoter of the lytA gene, which codes for the major pneumococcal autolysin, or the promoter of the tetracycline-resistance gene (tetP) . In contrast, cpl1 and cpl7 genes that code for lysozymes were expressed in pneumococcus only under the control of tetP, whereas the hbl3 gene that codes for an amidase can be expressed using either promoter . The phage lysozymes or amidase expressed in S . pneumoniae M31, a mutant deleted in the lytA gene coding for short chains, were placed under physiological control since these transformed bacteria grew as normal 'diplo' cells during the exponential phase and underwent autolysis only after long incubation at 37 degrees C . The lysis genes appear to be expressed constitutively in the transformed pneumococci, since sharply defined lysis of these cultures could be induced prematurely during the exponential phase of growth by addition of sodium deoxycholate.

J Immunol, 1993 Mar 15, 150(6), 2457 - 66
Stimulation of human T cells by streptococcal "superantigen" erythrogenic toxins (scarlet fever toxins); Braun MA et al.; The pyrogenic (erythrogenic) exotoxins A and C (SPEA and SPEC) of Streptococcus pyogenes belong to the family of mitogenic toxins of which the staphylococcal enterotoxins are the prototypes . The erythrogenic toxin B (SPEB) is a proteinase precursor . All SPE have been reported to be superantigens . Here we have analyzed the human T cell response to these toxins . We used highly purified preparations of SPEA, SPEB, and SPEC from different S . pyogenes strains . These toxins were apparently homogenous in SDS-PAGE, IEF, and HPLC . In addition, recombinant SPEA and SPEC were produced in Escherichia coli . In cultures of PBMC, all three toxins expanded preferentially a fraction of T cells . Using mAb against V beta 2, -5, -6, -8, and -12, we investigated the phenotype of the stimulated cells . Natural SPEA, SPEB, and SPEC strongly stimulated V beta 8+ T cells, whereas recombinant SPEA and SPEC did not . Both natural and recombinant SPEA stimulated V beta 12+ cells and both natural and recombinant SPEC stimulated V beta 2+ cells . In accordance with these findings, a human V beta 8+ line responded to all three toxins derived from S . pyogenes but not to the recombinant proteins . An antiserum against natural SPEC neutralized specifically the V beta 2-stimulating activity of SPEC and the V beta 8-stimulating activity of all three toxins, but had no effect on the response to other superantigens . This shows that trace amounts of a potent novel V beta 8-stimulating activity not identical to SPEA and SPEC are responsible for the stimulation of V beta 8+ T cells by natural SPEA and SPEC reported previously . In a preliminary screening of S . pyogenes strains from patients, we found that this novel superantigen appears to be more widely distributed than SPEA and SPEC . Furthermore, we present evidence that also the superantigenic properties of SPEB are due to contaminations with this V beta 8 stimulator . The response to SPEB usually required 1000 times higher concentrations than to SPEA or SPEC . Antisera to SPEC but not to SPEB inhibited the response of PBMC and V beta 8+ Jurkat cells to SPEB . Furthermore, more stringent purification of SPEB yielded SPEB preparations devoid of mitogenic activity . These results indicate that the mitogenicity that is commonly attributed to SPEB is due to minute contaminations of the V beta 8 stimulator . These results raise two important caveats for the work with these highly potent T cell mitogens.(ABSTRACT TRUNCATED AT 400 WORDS)

J Biol Chem, 1993 Mar 15, 268(8), 5594 - 9
DNA processing during entry in transformation of Streptococcus pneumoniae; Mejean V et al.; The current model for processing DNA during entry in the transformation of Streptococcus pneumoniae is that following double-strand cleavage of DNA bound at the cell surface, uptake of one strand proceeds linearly from a newly formed 3'-end with simultaneous degradation of the opposite strand . Two important predictions of this model have been tested in the work reported here: first that the polarity of DNA degradation is the opposite of that for entry, and second that the rate of DNA degradation is (at least) equal to the rate of entry . The processing of DNA during entry was investigated using donor molecules constructed in vitro and labeled in one strand only . With uniformly labeled donor molecules, an amount of label equivalent to that taken up by the cells was recovered in acid-soluble form in the transformation medium . Experiments with 3'- or 5'-end-labeled molecules revealed that whereas essentially all of the 3'-end label was susceptible to degradation, most 5'-end label was resistant . Kinetic analysis of both entry and degradation revealed very similar rates for these processes, about 100 nucleotides s-1 at 31 degrees C, suggesting that they occur concomitantly . Entry and degradation appear to proceed with opposite polarity, 3'-->5' for entry and 5'-->3' for degradation . A prediction of the entry model, that a single-strand interruption would inhibit the uptake of DNA sequences located 5' to the nick, was confirmed experimentally . Therefore, we suggest that an intact sugar phosphate backbone is required by the entry machinery for continuous uptake.

J Immunol, 1993 Mar 15, 150(6), 2332 - 40
Type M12 protein from Streptococcus pyogenes is a receptor for IgG3; Retnoningrum DS et al.; Streptococcus pyogenes, serotype M12, was discovered to express a human IgG3 binding protein . Western blot analysis of partially purified M12 protein, exposed to IgG3 myeloma protein, showed that both M12 Ag and the receptor protein were the same apparent size . A lambda clone (lambda 4.1) containing the emm12 open reading frame expressed both the M12 Ag and the IgG3 binding protein . The emm12 open reading frame was amplified by the polymerase chain reaction and subcloned into the expression vector pJLA602 . Based on Western blot analysis, one recombinant Escherichia coli (pD3) expressed M12 protein with IgG3 binding activity . This result confirmed that the M12 protein from strain CS24 is also an IgG3 receptor . Deletion analyses showed that a truncated M12 protein encoded by an internal PvuII fragment was sufficient for IgG3 binding activity . Further deletion studies suggested that the IgG3 binding domain was located in a 200 amino acid internal fragment containing two directly repeated sequences . Other experiments suggest that the receptor did not bind to the same IgG3 domain as that recognized by protein G . The M12 protein did not bind human IgG1, IgG2, IgG4, or Ig from several other animal species.

Presse Med, 1993 Mar 13, 22(9), 413 - 6
{Infectious complications during treatments with interleukin-2}; Morere JF et al.; Between January 1989 and May 1991, 97 patients were treated with interleukin 2 in the Oncology Department of the Avicenne Hospital (Bobigny, France) . IL 2 was given over 5 days by continuous infusion through an implantable port . Ten patients (4 males, 6 females), mean age 46 years (36-67) with various cancers (breast 3, kidney 1, melanoma 1, colorectal 5), developed infection: 4 local infections around the port, 1 phlebitis, 4 septicemias, 1 bacteremia were observed . In 9 cases blood cultures were positive: Staphylococcus aureus 5, Staphylococcus epidermidis 3, Streptococcus G 1 . In 5 cases the same pathogen was isolated from the port and from the blood . The mean leucocyte count was 10,627/mm3 at the time of infection . The delay between the beginning of interleukin 2 treatment and the infection was 3 months . The mean dose of IL 2 administered before infection was 456 million IU . In all cases infection was controlled without lethal complication by antibiotics and catheter removal . This high incidence (8 percent) of staphylococcal infection is partly due to the skin toxicity of IL 2 and to depressed neutrophil chemotactic response . Prophylactic antibiotics are warranted during IL 2 intravenous therapy.

Med Clin (Barc), 1993 Mar 6, 100(9), 325 - 8
{Endocarditis due to penicillin-sensitive and -resistant pneumococci: the current perspectives on the disease}; Aguado JM et al.; BACKGROUND: To evaluate the clinic characteristics and therapeutic aspects of endocarditis by Streptococcus pneumoniae sensitive and resistant to penicillin . METHODS: Twelve cases of pneumococcal endocarditis evaluated in 4 Spanish hospitals over the last 10 years were studied, analyzing their clinical characteristics and the existence of resistance to penicillin . The features were compared with a series of 98 cases found in a review of the literature . RESULTS: All the patients were males, most being alcoholics . The course of the disease was acute (2 weeks) in all the cases and evolved with great aggressivity: cardiac failure (9 patients), myocardial abscess (7 patients), multiple arterial embolisms (5 patients), septic arthritis (4 patients) . Three patients had simultaneous pneumococcal meningitis but only one had pneumonia . The valve most affected was the aortic (9 cases) . Three cases were due to strains of Streptococcus pneumoniae with moderate resistance to penicillin (CMI 0.5-1 micrograms/ml) . Global mortality was 42% . All the patients receiving inadequate antibiotic treatment died . Vancomycin and cefotaxime appear to be effective in the treatment of cases produced by strains of pneumococcus with intermediate sensitivity to penicillin . There were no apparent differences in mortality between the cases of endocarditis by pneumococcus sensitive or moderately resistant to penicillin . CONCLUSIONS: Pneumococcal endocarditis continues to condition a high mortality similar to that produced in previously made series . The classic relation with meningitis and pneumonia is infrequent today . The appearance of strains resistant to penicillin may increase the incidence of this infection and further worsen prognosis.

Quintessence Int, 1993 Mar, 24(3), 171 - 5
Prevention of infective endocarditis: an update for clinicians . American Heart Association; Wahl MJ et al.; Infective endocarditis is a rare, serious, and sometimes fatal heart disease that can be caused by bacteremia from the mouth, especially by Streptococcus viridans . As a result, dental procedures have often been blamed for cases of infective endocarditis but poor oral health and hygiene may actually cause more cases of infective endocarditis than do dental procedures . The American Heart Association and other groups have published recommendations for the prevention of infective endocarditis in dental patients and advise specific antibiotic regimens for certain dental procedures in cardiac-abnormal patients . The most recent (1990) American Heart Association recommendations are the most conservative yet, reflecting concern about the prevention of not only infective endocarditis, but also problems resulting from the antibiotics themselves . Clinicians should carefully consider not only the patient's medical history, but also the types of dental procedures planned.

Eur J Clin Microbiol Infect Dis, 1993 Mar, 12(3), 217 - 20
Antigen detection in oropharyngeal secretions for rapid diagnosis of pneumococcal pneumonia; Boersma WG et al.; To determine the value of detection of antigen in the oropharynx in the diagnosis of pneumococcal pneumonia, oropharyngeal secretions were cultured for the presence of Streptococcus pneumoniae and tested for the presence of pneumococcal antigen . Sputum (if available) collected on the same day was also investigated for the presence of antigen . Detection of pneumococcal antigen was found to be directly related to the severity of pneumococcal carriership or infection (p < 0.0001) and was not related to culture results . Patients with pneumococcal pneumonia had the highest antigen detection rate (38%), followed by patients with pneumonia of unknown etiology (32%) and patients with an acute lower respiratory tract infection due to Streptococcus pneumoniae (20%) . Pneumococcal carriers had a detection rate of only 9% . Antigen could be detected in only one patient of the control groups . Although antigen detection in sputum was superior to that in oropharyngeal secretions, concordant results were obtained in 8 (40%) and 6 (36%) patients with pneumococcal pneumonia and pneumonia of unknown etiology respectively . The results strongly suggest that pneumococcal carriage seldom leads to a detectable level of antigen, and that antigen detection in the oropharynx appears to be of additive value in the diagnosis of pneumococcal pneumonia.

Am J Vet Res, 1993 Mar, 54(3), 387 - 91
Prevalence of mycoplasmal and ureaplasmal recovery from tracheobronchial lavages and prevalence of mycoplasmal recovery from pharyngeal swab specimens in dogs with or without pulmonary disease; Randolph JF et al.; The prevalence of mycoplasmal and ureaplasmal recovery from tracheobronchial lavage specimens and the prevalence of mycoplasmal recovery from pharyngeal swab specimens from dogs with (n = 38) or without (n = 26) pulmonary disease were determined . Similar mycoplasmal recovery rates were found for tracheobronchial lavage specimens from dogs > or = 1 year old with (21%) or without (25%) pulmonary disease . Prevalence of mycoplasmal recovery from tracheobronchial lavages was significantly associated with pulmonary disease among dogs < 1 year old (P = 0.04), and with dogs that had concurrent Bordetella (P = 0.006) and Streptococcus (P = 0.05) isolations . Among dogs with pulmonary disease, mycoplasmas were significantly (P = 0.02) more prevalent in dogs with septic inflammation than in dogs with nonseptic inflammation of the tracheobronchial tree . Ureaplasmas were only isolated from a tracheobronchial lavage specimen of 1 dog with pulmonary disease and from none of the dogs without pulmonary disease . Most dogs with (84%) and all dogs without pulmonary disease had mycoplasmas isolated from the pharynx . Seemingly, mycoplasmas are part of the normal pharyngeal flora of most dogs and normal inhabitants of the lower airway in about a fifth to a fourth of the canine population > or = 1 year old . Dogs < 1 year old with pulmonary disease and dogs with concurrent Bordetella or tracheobronchial streptococcal isolations may be more susceptible to mycoplasmal colonization of the lower airways . Seemingly, ureaplasmas are rarely associated with pulmonary disease, and are not normal inhabitants of the trachea and bronchi of dogs.

Prikl Biokhim Mikrobiol, 1993 Mar-Apr, 29(2), 266 - 70
{The characteristics of the regulation of lysine biosynthesis in Streptococcus bovis}; Kal'cheva EO et al.; The effect of threonine and methionine on the growth of and lysine synthesis in Streptococcus bovis st . A024/85 was studied . The character and the degree of manifestation of growth and regulation effects of these amino acids depend on their contents in the fermentation medium . The target in the regulation of lysine biosynthesis is aspartate kinase, whose synthesis is controlled by threonine and methionine . Lysine excretion was stimulated by the addition of a low concentration of dimethylsulfoxide in the medium during fermentation.

Kansenshogaku Zasshi, 1993 Mar, 67(3), 236 - 9
{Case report of toxic shock-like syndrome due to group A streptococcal infection}; Shimizu Y et al.; A case of streptococcal toxic shock like syndrome occurring in a 44-year-old previously healthy Japanese male is reported . He initially had a sore throat, low grade fever, diarrhea and mild pains in a lower extremities . Shortly thereafter, he rapidly developed a high fever, profound hypotension, multifocal epidermal necrosis, and sever purulent fasciitis and myositis in both lower extremities, which required above knee amputation of both legs . He later developed disseminated intravascular coagulopathy, adult respiratory distress syndrome, acute renal failure, coma and necrotizing inflammation of both arms and external genitalia despite treatment . He died on the 13th hospital day . Streptococcus pyogenes was isolated from the necrotic muscles and right knee joint . The organism was typed as M3, T3, was sensitive to penicillins, and was found to be producing streptococcal pyogenic exotoxin A in vitro . This is the first case report of streptococcal toxic shock like syndrome in Japan.

An Med Interna, 1993 Mar, 10(3), 116 - 8
{The indications for the antipneumococcal vaccine in Spain}; Garcia-Arenzana JM et al.; The anti-pneumococcal vaccine, with 23 capsular polysaccharides, is an effective vaccine used in most of the developed countries, although still not commercially available in Spain . Between January 1981 and June 1992, we isolated 784 Streptococcus pneumoniae from clinical samples (excluding asymptomatic carriers), 728 of which could be serotyped (300 isolated in hemoculture and/or LCR) . 91.5% of the total and 93.3% of the most invasive strains, as well as 98.1% of the penicillin-resistant strains or 98.8% of the isolated multiresistant strains, presented a serotype covered by the current vaccine . The high resistance to antibiotics of the pneumococcus in Spain makes more urgent the indication of the vaccine in our community.

Mol Microbiol, 1993 Mar, 7(6), 893 - 903
Positive transcriptional control of mry regulates virulence in the group A streptococcus; Okada N et al.; Transcription of the antiphagocytic M protein in the group A streptococcus (Streptococcus pyogenes) is environmentally regulated in response to CO2 and requires Mry, a trans-acting positive regulatory protein . We have examined the role of Mry in environmental regulation by analysing the factors that regulate expression of the gene that encodes Mry (mry) . By employing a strategy that utilizes integrational plasmids, it was found that expression of mry requires the participation of DNA sequences that extend 473 base pairs upstream of the Mry coding region . Transcription of mry, as analysed in S1 nuclease protection assays, is initiated from two separate promoters located within this extended regulatory region . Construction and analysis of transcriptional fusions between the mry promoters and a promoterless chloramphenicol acetyltransferase gene demonstrated that mry is autoregulated and environmentally regulated in response to the level of CO2 . These data suggest a model for the regulation of virulence in S . pyogenes where positive transcriptional control of mry in response to environmental stimuli regulates the expression of the M protein.

J Rheumatol, 1993 Mar, 20(3), 521 - 4
Pyomyositis: early detection and treatment; Fam AG et al.; We describe a patient with Crohn's disease and pyomyositis due to Streptococcus anginosus ("milleri") . Early recognition of pyomyositis during its presuppurative phase allowed for prompt antibiotic treatment and rapid resolution of the muscle infection without surgical drainage.

J Antimicrob Chemother, 1993 Mar, 31 Suppl C, 111 - 20
The problems of treating atypical pneumonia; Schlick W; Atypical pneumonia has been recognized for at least four decades as a clinical syndrome characterized by a less severe clinical course than typical bacterial pneumonia . It is caused by a variety of different organisms including Mycoplasma pneumoniae, chlamydiae, rickettsiae, viruses and Legionella pneumophila . Of the chlamydiae, TWAR-strain (Chlamydia pneumonia) is now considered the most important pathogen . Its prevalence in community-acquired pneumonia varies considerably depending on the cyclical nature of the disease, but also on the diagnostic methods applied . The first line therapy in community-acquired pneumonia is usually empirical administration of a penicillin or cephalosporin to cover the bacterial pathogens which usually cause 'typical' pneumonia, most importantly Streptococcus pneumoniae . If, however, atypical pneumonia is diagnosed by bacteriological or serological testing, or is suspected clinically or on the basis of treatment failure, the treatment of choice would be erythromycin 2-4 g or tetracyclines (doxycycline 200 mg) daily for M . pneumoniae pneumonia and C . pneumoniae (TWAR-strain) infection . For coxiella pneumonia tetracycline is preferred . Psittacosis (ornithosis) has a high mortality and must be treated with tetracyclines immediately . Legionella pneumonia is preferably treated with erythromycin 2-4 g for at least three weeks; as an alternative, tetracyclines or quinolones may be given . Quinolones are less effective in mycoplasma and chlamydial infection . The new macrolide antibiotics are promising agents in pneumonia due to M . pneumoniae, L . pneumophila and C . pneumoniae . Compared to erythromycin they have improved pharmacological properties . They have long half-lives allowing once-daily dosing and achieve high tissue and intracellular concentrations.

Acta Otolaryngol, 1993 Mar, 113(2), 152 - 9
Cytotoxic effects on hair cells of guinea pig cochlea produced by pneumolysin, the thiol activated toxin of Streptococcus pneumoniae; Comis SD et al.; The cytolytic toxin, pneumolysin, from the gram positive bacterium, Streptococcus pneumoniae, when perfused through the scala tympani of the guinea pig cochlea reduced the amplitude of both the compound action potential and the cochlear microphonic potential . When the surface of the organ of Corti was examined by scanning electron microscopy, both inner and outer hair cells and supporting cells were found to be damaged . Inner hair cells and outer hair cells of row 3 were the most susceptible to damage by pneumolysin, followed by row 2 and then by row 1 of the outer hair cells . Damage to hair cells included disruption and splaying of stereocilia, loss of stereocilia and complete dissolution of hair bundles . Apical surfaces of hair cells and supporting cells were torn, pitted and cratered with shrinkage and tearing of cell boundaries . Within the dose range perfused (0.05-1 micrograms/microliters in a 10 microliters aliquot), the magnitude of the physiological and anatomical lesions was concentration dependent . The cytotoxic effects of pneumolysin reported here may be clinically significant factors in deafness caused by meningitis and otitis media in humans.

Med J Aust, 1993 Mar 1, 158(5), 340 - 2
An outbreak of serotype 1 Streptococcus pneumoniae infection in central Australia; Gratten M et al.; An outbreak of serotype 1 Streptococcus pneumoniae infection involving both adults and children occurred in central Australia during the winter months of 1991 . Eighteen patients, mainly Aboriginal men, presented with culture-positive serotype 1 bacteraemic pneumonia . In this group, 11 of 12 adults for whom medical records were available were alcohol dependent . Thirteen children who were separately studied were hospitalised with acute lower respiratory tract infection: none had bacteraemia but all had upper airway colonisation by type 1 pneumococci . Antibiotics taken by 8 of the 13 children before admission to hospital may have compromised the isolation of type 1 pneumococci from blood cultures . Since the availability of antibiotics, epidemic pneumococcal infection is infrequent and has not been reported in Australia . In three outbreaks of type 1 disease recorded elsewhere crowding and alcoholism were identified as contributory factors . In the 16 month period before this outbreak none of 162 strains of pneumococci isolated from blood (32 strains) and nasopharyngeal secretions (130 strains) from Aborigines with acute lower respiratory tract infection and meningitis in the Alice Springs region were serotype 1 organisms.

J Gen Microbiol, 1993 Mar, 139 ( Pt 3), 433 - 9
Characterization of a calcium porter of Streptococcus pneumoniae involved in calcium regulation of growth and competence; Trombe MC; It is shown that Streptococcus pneumoniae possesses a Ca2+ transporter, sensitive to the amiloride derivative 2',4'-dimethylbenzamil (DMB), which is essential for grown at high Ca(2+)-concentrations, and which mediates the triggering by Ca2+ of competence for genetic transformation in the exponential phase and autolysis in the late exponential phase . DMB inhibited both Ca2+ transport and the Ca2+ response . Kinetic analysis of 45Ca2+ transport in ATP-depleted S . pneumoniae revealed an electrogenic influx sensitive to DMB . This transport was cooperative with respect to Ca2+ concentration, and exhibited a Hill coefficient (nH) of 2 . In bacteria pre-loaded with 45Ca2+, a DMB-sensitive efflux could be triggered by an imposed Na+ gradient . The efflux kinetics showed the same cooperativity profile as Ca2+ concentration and a similar nH value to that of influx, suggesting a possible Na+/Ca2+ antiport . Cooperativity of transport was lowered (nH = 1) by a mutation that confers resistance to DMB and abolishes the Ca2+ response . These results demonstrate that DMB-sensitive Ca2+ transport is essential for growth and competence regulation . The role of the DMB-sensitive porter involved in Ca2+ circulation and in Ca2+ homeostasis and its possible regulation by competence factor are discussed.

Oral Surg Oral Med Oral Pathol, 1993 Mar, 75(3), 312 - 7
Effect of radioactive iodine therapy on salivary flow rates and oral Streptococcus mutans prevalence in patients with thyroid cancer; Laupa MS et al.; Unstimulated and stimulated salivary flow rates, Streptococcus mutans samples, and dental caries data were obtained from 50 patients with thyroid cancer who had received radioactive iodine, I131, from 0.3 to 20 years earlier . The salivary flow rates were compared with a healthy control group, and the S . mutans counts were compared to a group of patients with head and neck cancer who were sampled before radiotherapy . Flow rates were found to be significantly lower in the patients with thyroid cancer, and S . mutans levels were slightly but not significantly higher than the controls . Longitudinal flow rate data taken on four patients, who served as their own controls before and after I131 therapy, indicated a trend in saliva reduction.

Exp Lung Res, 1993 Mar-Apr, 19(2), 221 - 35
Role of protein synthesis and CD11/CD18 adhesion complex in neutrophil emigration into the lung; Winn RK et al.; The mechanism of neutrophil (PMN) emigration into the lung may be stimulus-dependent . This study examined PMN emigration in the lung induced by intratracheal instillation of lipopolysaccharide (LPS), Streptococcus pneumoniae (S . pneu) organisms, supernatant from S . pneu incubated with alveolar macrophages (AM phi), Escherichia coli (E . coli) organisms, or phorbol myristate acetate (PMA) . Rabbits were pretreated with either the CD18 monoclonal antibody (MAb) 60.3, the protein synthesis inhibitor cycloheximide (Cx), or, in one case, both . Animals were then given one of the above stimuli to elicit PMN emigration . Four hours after the stimulus was instilled, animals were killed and total and differential cell counts were performed on bronchoalveolar lavage (BAL) fluid . PMN emigration in response to PMA was virtually abolished by MAb 60.3, but was not significantly inhibited by Cx . Emigration induced by LPS was inhibited by 80% by either MAb 60.3 or Cx, and greater than 94% when MAb 60.3 and Cx were given simultaneously . Emigration in response to E . coli organisms was 80% inhibited by MAb 60.3 . Emigration induced by S . pneu was approximately 50% inhibited by MAb 60.3, but was greater than 90% blocked by Cx . The MAb 60.3 had approximately the same effect on PMN emigration toward the supernatant from co-incubation of AM phi with S . pneu as it did toward live S . pneu . It is concluded that the mechanism of PMN emigration into the lung is stimulus-dependent . The CD18-dependent mechanism is responsible for the majority of the emigration in response to PMA, E . coli LPS, and E . coli organisms . S . pneu and supernatant from S . pneu + AM phi produce a CD18-independent pathway . These data suggest the requirement for de novo protein synthesis for PMN emigration in response to LPS and S . pneu, but not for PMA-induced emigration.

Res Vet Sci, 1993 Mar, 54(2), 256 - 8
Eosinophilic synovitis following the intra-articular injection of bacterial antigen in horses; Madison JB et al.; Purified streptococcal M protein was injected into one intercarpal joint in three horses hyperimmunised with Streptococcus equi M protein vaccine . The contralateral joints were injected with pH adjusted polyionic solution . All antigen-injected joints developed a severe suppurative synovitis (mean synovial fluid nucleated cell count = 102,200 x 10(6) cells litre-1) . Eosinophils were found in the synovial fluid and in synovial membrane biopsy specimens of two of the horses . Immune complexes were not demonstrated in the synovial membrane . Two horses are described that developed synovial fluid eosinophilia after the intra-articular injection of streptococcal antigen.

Ann Otol Rhinol Laryngol, 1993 Mar, 102(3 Pt 1), 209 - 14
Erythromycin in acute laryngitis in adults; Schalen L et al.; Moraxella catarrhalis and Hemophilus influenzae are isolated from the nasopharynx in 50% to 55% and 8% to 15%, respectively, of cases of acute laryngitis in adults . This finding indicates that these organisms, M catarrhalis in particular, are in some way involved in the pathogenesis of the disorder . In the present double-blind, placebo-controlled trial, the effect of erythromycin ethylsuccinate (0.5 g twice a day for 5 days) on the elimination of nasopharyngeal pathogens and reduction of clinical signs of upper respiratory tract infection, as well as on subjective complaints, was evaluated in 106 adults with acute laryngitis . The bacterial isolation rates at presentation were M catarrhalis 50%, H influenzae 18%, and Streptococcus pneumoniae 4% . In the 99 patients who completed the study, the elimination of M catarrhalis after 1 week was better in the erythromycin group (25 of 30 cases) than in the placebo group (6 of 19 cases; p < or = .00038) . The elimination of H influenzae was unaffected by erythromycin . Otolaryngologic examination did not reveal any significant group differences regarding laryngitis, pharyngitis, or rhinitis . Voice quality was improved after 1 week, irrespective of treatment . However, as compared to the placebo group, the erythromycin group reported fewer voice complaints after 1 week and fewer coughing complaints after 2 weeks . As acute laryngitis in adults is self-limiting, and subjective symptoms are spontaneously reduced after 1 week in most cases, antibiotic treatment does not seem warranted as a general policy . However, erythromycin may be justified in patients who are professionally dependent on voice function.

J Fam Pract, 1993 Mar, 36(3), 336 - 8
Mycobacterium marinum skin infections: two case reports; Paul D et al.; Most infections of soft tissue injury sites are caused by Staphylococcus or Streptococcus and respond to beta-lactam antibiotics . Occasionally, a patient does not respond to routine antibiotics, and other possibilities must be considered . A detailed history of the event that caused the soft tissue injury can be important in the diagnosis . Two cases of Mycobacterium marinum soft tissue infection (ie, fish tank granuloma) are presented.

J Can Dent Assoc, 1993 Mar, 59(3), 292 - 4, 297-300
A review of commonly prescribed oral antibiotics in general dentistry; Karlowsky J et al.; The microflora associated with odontogenic infections are typically mixed and of indigenous origin . Streptococcus, peptostreptococcus, peptococcus, fusobacterium, bacteroides, and actinomyces species are the principle microflora isolated from these infections . Penicillin V (phenoxymethyl penicillin) remains the antimicrobial of choice for the initial empirical treatment of odontogenic infections . This agent is safe, highly effective and inexpensive . Amoxicillin has little indication for the routine treatment of odontogenic infections . However, it is the agent of choice for endocarditis prophylaxis, as it produces higher serum levels than penicillin V . Erythromycin may be used for mild, acute odontogenic infections in penicillin-allergic patients . The high incidence of gastrointestinal disturbances and superinfection commonly associated with the ingestion of tetracycline limits its role in general dental practice . Tetracycline may be considered as an alternative therapy for penicillin-allergic patients over the age of 13 who cannot tolerate erythromycin . Clindamycin is very effective against all odontogenic pathogens, but its potential gastrointestinal toxicity relegates it to third- or even fourth-line therapy in general dentistry . Although metronidazole displays excellent activity against anaerobic gram-negative bacilli, it is only moderately effective against facultative and anaerobic gram-positive cocci, and should not be used alone in the treatment of acute odontogenic infections.

Pediatr Infect Dis J, 1993 Mar, 12(3), 196 - 200
Dilemmas in diagnosis and management of cephalosporin-resistant Streptococcus pneumoniae meningitis; Friedland IR et al.; We recently managed an infant with meningitis caused by Streptococcus pneumoniae in whom ceftriaxone failed to sterilize the cerebrospinal fluid after 6 days of therapy . This strain, which had a penicillin minimal inhibitory concentration (MIC) of 2 micrograms/ml, appeared susceptible to ceftriaxone (MIC < 0.5 micrograms/ml) when evaluated by a commercial MIC panel (Microtech Medical Systems, Inc., Aurora, CO) but was found to have a ceftriaxone MIC of 4 micrograms/ml when evaluated by conventional microtiter broth dilution technique . Furthermore ceftriaxone therapy of meningitis induced with this strain in a rabbit model was ineffective . Thirteen of 112 pneumococcal strains (11.6%) isolated recently at Children's Medical Center of Dallas were penicillin-resistant, and 3 of these were highly penicillin-resistant (MIC > or = 2 micrograms/ml) . The incidence of pneumococcal strains with cefotaxime MICs > or = 1.0 micrograms/ml has increased from 0 of 258 from 1981 to 1983 to 5 of 112 (4.5%) from 1991 to 1992 . The definition of cephalosporin resistance for pneumococci requires modification and further studies of the antibiotic management of meningitis caused by such strains are needed because resistance to cephalosporins is increasing and the extended spectrum cephalosporins may be ineffective as sole therapy.

J Clin Periodontol, 1993 Mar, 20(3), 186 - 92
Effects of a streptococcal lipoteichoic acid on complement activation in vitro; Monefeldt K et al.; This study describes activation of serum complement by lipoteichoic acid (LTA) from Streptococcus mutans OMZ 176, while in solution . Serum from 16 healthy students was taken . Test samples were incubated with increasing doses (1-5,000 micrograms/ml) of LTA or lipopolysaccharide (LPS) from Escherichia coli 0111:B4 for 1 h at 37 degrees C; then assayed for degradation of C3, C4 or factor B by crossed immunoelectrophoresis . Each preparation caused a significant (p < 0.05) dose-dependent conversion of C3 . The response curves obtained were not statistically different . LPS was a stronger activator of the alternative pathway than LTA, as judged from analysis of C3 degradation in the presence of Mg2+/EGTA, and from their effects on factor B cleavage . LTA caused, however, pronounced alterations in the shape of C4 precipitation in the gels . Functional (hemolytic) assays showed that, when tested at 200 micrograms/ml, LTA and LPS triggered significant (p < 0.05) consumptions of both classical and alternative pathway proteins . LPS was a significantly (p < 0.05) stronger activator than LTA . Apparently, the C3 degradation found for this LTA involved the alternative pathway to a small extent; thus some other mechanism of fluid-phase C3 cleavage seemed also to be operative.

J Bacteriol, 1993 Mar, 175(6), 1853 - 5
MsmE, a lipoprotein involved in sugar transport in Streptococcus mutans; Sutcliffe IC et al.; Metabolic labelling by {14C}palmitic acid showed that growth of Streptococcus mutans LT11 in raffinose, an inducer of the msm operon, resulted in increased production of a 45-kDa lipoprotein corresponding to MsmE, which is believed to be a sugar-binding protein . MsmE was also labelled when an msmE clone was expressed in Escherichia coli . The presence of a lipid anchor on MsmE provides a likely explanation of how the sugar-binding protein component of the msm binding protein-dependent multiple sugar transport system is retained at the cell surface.

J Bacteriol, 1993 Mar, 175(6), 1717 - 22
Possible role of a choline-containing teichoic acid in the maintenance of normal cell shape and physiology in Streptococcus oralis; Horne DS et al.; Streptococcus oralis ATCC 35037 took up radioactively labeled choline from growth medium . Most of the choline (80 to 90%) was incorporated into the cell wall teichoic acid, and about 10% was localized in the plasma membrane . While cells grew in choline-free medium, they did so at slow rates and produced cell walls with greatly reduced amounts of phosphate and no detectable choline . Cells grown in choline-free medium had grossly abnormal shape and size . Both biochemical and morphological abnormalities were reversible by addition of choline to the medium.

J Thorac Cardiovasc Surg, 1993 Mar, 105(3), 428 - 34
Prosthetic valve endocarditis . Experience with porcine bioprostheses; Sett SS et al.; Prosthetic valve endocarditis remains an infrequent but serious complication of cardiac valvular replacement . Prosthetic valve endocarditis was diagnosed in 56 (1.8%) of 3200 patients in whom one or more porcine bioprostheses were implanted between 1975 and 1988 . Of the 56 patients with prosthetic valve endocarditis, there were 40 men and 16 women, with a mean age at initial implantation of 57 years (27 to 81 years) . Of the 56 patients, 6 were initially treated for native valve endocarditis . There were 8 cases of early prosthetic valve endocarditis (defined as occurring less than 60 days after initial surgical intervention) and 48 cases of late prosthetic valve endocarditis (occurring after 60 days) . The overall mortality rate of the 56 patients was 32% (18 patients) . Of the 8 patients with early prosthetic valve endocarditis, 6 (75%) died . Of the 48 patients with late prosthetic valve endocarditis, 12 (25%) died . The predominant organisms were Staphylococcus epidermidis (12 cases), Streptococcus viridans (8 cases) and Staphylococcus aureus (7 cases) . The presence of hemodynamic compromise, including congestive heart failure, septic embolism, persistent sepsis, and echocardiographic evidence of vegetations, dictated the mode and timing of the addition of surgical intervention to medical therapy . The survival rate for medically and surgically treated patients with late prosthetic valve endocarditis was 91% (20 patients); none of the patients with early prosthetic valve endocarditis survived (all had severe hemodynamic compromise) . We analyzed 18 factors for the prediction of early and late death . The predictors of death by univariate analysis for both early and late prosthetic valve endocarditis were age, diagnosis time, renal status, sepsis, management mode, fever, dental procedures, and dental prophylaxis . The predictors by multivariate analysis were age, diagnosis time, renal status, and management mode for early prosthetic valve endocarditis, and only diagnosis time for late prosthetic valve endocarditis . Annular abscess formation occurred in 27% of the patients . There were no complex aortic or mitral reconstructions . There was one reoperation for recurrent and residual endocarditis . There was one late death as a result of recurrent prosthetic valve endocarditis . We advocate early diagnosis and aggressive combined medical and surgical treatment before the development of hemodynamic compromise and other characteristic signs when the culprit organisms are Staphylococcus aureus, gram-negative organisms, and Candida albicans.

J Oral Maxillofac Surg, 1993 Mar, 51(3), 226 - 31
Contemporary management of deep infections of the neck; Peterson LJ; Odontogenic infections rarely lead to involvement of the lateral and retropharyngeal spaces . When this does occur, the microbiology of the infection is similar to the typical odontogenic infection, ie, Streptococcus and oral anaerobes including Peptostreptococcus, Bacteroides, and Fusobacterium . There is an increased incidence of Fusobacterium seen in the more severe infections, as well as a higher incidence of Streptococcus milleri . Many patients who have deep cervical infections also have some compromise in their host defense mechanism, such as diabetes . The signs and symptoms of deep cervical space infections are similar to those of the severe submandibular space infection, but also includes sialorrhea, respiratory distress, odynophagia, and dysphagia . Lateral soft-tissue radiographs of the neck are useful in assisting with the diagnosis of retropharyngeal infections, and CT scans can provide definitive information regarding lateral pharyngeal space involvement . Treatment includes the use of high-dose intravenous bacteriocidal antibiotics . The recommended antibiotics are penicillin-metronidazole, ampicillin-sulbactam, or clindamycin . Certain cephalosporins may also be useful in selected patients . Early surgical intervention is also indicated . Aggressive incision and drainage of all of the involved spaces is necessary to assure early resolution of the infection . Continual airway monitoring and the establishment of surgical airways is the final portion of the treatment triad.

J Infect Dis, 1993 Mar, 167(3), 759 - 62
Temporal variation in bacterial disease frequency: molecular population genetic analysis of scarlet fever epidemics in Ottawa and in eastern Germany; Musser JM et al.; In an effort to understand the molecular genetic basis of temporal variation in frequency and severity of bacterial disease, genetic relationships among strains of Streptococcus pyogenes that caused scarlet fever epidemics in Canada in the early 1940s and in eastern Germany in the 1960s to 1980s were studied . Application of multilocus enzyme electrophoresis and comparative sequencing of the gene (speA) encoding streptococcal pyrogenic exotoxin A (scarlet fever toxin) revealed that new waves of scarlet fever are associated with an increase in frequency of S . pyogenes clones carrying variant speA alleles . This finding suggests that the occurrence of new scarlet fever epidemics can be predicted by comprehensive monitoring of the frequency of S . pyogenes clones with variant toxin alleles.

Arch Otolaryngol Head Neck Surg, 1993 Mar, 119(3), 288 - 91
Clinical scoring system in the evaluation of adult pharyngitis; Seppala H et al.; OBJECTIVE--To compare results of a clinical scoring system for diagnosis of group A streptococcal pharyngitis with microbiologic results, when several different pharyngeal pathogens were tested simultaneously . DESIGN--Evaluation of clinical manifestations of 106 adult patients with pharyngitis of different microbial origin . SETTING--General private practice; Health Center Pulssi, Turku, Finland . PATIENTS--Adult patients whose chief complaints were sore throats . MAIN OUTCOME MEASURE--A symptom score that was assigned to each patient according to the total number of certain signs and symptoms that are postulated to increase the probability of group A streptococcal pharyngitis and blood measurements for infection . RESULTS--The highest symptom scores, 3 and 4, were found in 21 patients . These patients had pharyngitis due to group A streptococcus (four patients), group C streptococcus (four patients), group G streptococcus (two patients), group F streptococcus, Mycoplasma pneumoniae, Chlamydia pneumoniae, influenza A virus, influenza B virus, herpes simplex type 1 virus (two patients), and coxsackie B4 virus . No pathogen could be identified from three of the 21 patients . The C-reactive protein values and the leukocyte counts were raised significantly more often in streptococcal infections than in infections of other origin; the P values were .00016 and .028, respectively . CONCLUSION--Use of a clinical scoring system alone for diagnosis of pharyngitis may lead to improper use of anti-microbial agents . There is a need for accurate microbiologic diagnostic procedures in general practice to determine proper treatment of pharyngitis as well as to test the effect of antibacterial and, in the future, antiviral treatment in respiratory tract infections.

Infect Immun, 1993 Mar, 61(3), 1121 - 5
Cloning and expression of the multiple sugar metabolism (msm) operon of Streptococcus mutans in heterologous streptococcal hosts; Tao L et al.; The multiple sugar metabolism (msm) operon of Streptococcus mutans is responsible for the uptake and metabolism of a variety of sugars . In order to further characterize the substrate specificities of the transport system, a 12-kb region of DNA containing the entire msm operon was cloned, via a novel two-step integration strategy, into the chromosomes of two heterologous streptococcal strains, Streptococcus gordonii Challis and Streptococcus anginosus Is57, as well as the chromosome of a natural isolate of S . mutans with a deletion of the msm region . These strains are unable to transport or ferment melibiose, raffinose, or isomaltosaccharides, but the newly constructed recombinants gained the ability to ferment all of these sugars . The S . gordonii Challis construct containing msm was shown to transport radiolabelled melibiose, raffinose, isomaltotriose, and isomaltotetraose, and the transport function was also subjected to induction by raffinose, an inducer of the msm operon in S . mutans . The results confirm the role of the msm operon in the transport and metabolism of melibiose, raffinose, and isomaltosaccharides.

Arch Oral Biol, 1993 Mar, 38(3), 227 - 32
Agglutination of Streptococcus mutans serotype C cells but inhibition of Porphyromonas gingivalis autoaggregation by human lactoferrin; Soukka T et al.; The ability of various forms of human lactoferrin (LF) to agglutinate oral Streptococcus mutans, Strep . sobrinus, Strep . rattus, Strep . sanguis, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans cells was studied spectrophotometrically . Fe3+ saturated LF was unable to agglutinate these bacteria, whereas iron-free LF (apo LF) effectively agglutinated Strep . mutans cells but not the other bacteria . The efficiency and rate of agglutination of Strep . mutans were somewhat lower with apo LF than with human whole saliva . However, secretory IgA, phosphate and whole saliva almost totally abolished the apo LF-mediated agglutination of Strep . mutans, suggesting binding to the same target sites on bacterial cell surfaces, or to each other . The presence of exogenous iron (Fe2+, Fe3+), lactoperoxidase or serum albumin did not affect the agglutination by apo LF . Low Ca2+ (50-100 microns) slightly enhanced the agglutination by apo LF but higher concentrations (0.5-1.0 mM) totally blocked the apo LF-mediated agglutination of Strep . mutans . Both saliva and apo LF significantly delayed the rapid autoaggregation of P . gingivalis cells . Aggregation of P . gingivalis is considered a potential virulence factor and a protective mechanism against the host's cellular defences in the gingival crevice . These findings show a novel, strain-specific antibacterial mechanism for LF against Strep . mutans and P . gingivalis and adds a new compound to the group of agglutinating proteins in human saliva.

Plasmid, 1993 Mar, 29(2), 147 - 53
Diversity of chromosomal genetic elements and gene identification in antibiotic-resistant strains of Streptococcus pneumoniae and Streptococcus bovis; David F et al.; Antibiotic-resistant Streptococcus pneumoniae (26 strains) and Streptococcus bovis (28 strains), devoid of R plasmids, were examined for DNA-DNA homology to Tn916 and Tn3701 . Tn916-like structures were found in 17 S . pneumoniae and 21 S . bovis strains . Tn916-modified structures were present in 6 S . pneumoniae and 2 S . bovis strains . Two strains of each species carried elements having a Tn3701-like composite structure . All these elements were chromosome-borne . No chromosomal elements were detected in 1 S . pneumoniae and 3 S . bovis strains.

Infect Immun, 1993 Mar, 61(3), 1055 - 61
Staphylococcus aureus toxic shock syndrome toxin 1 and Streptococcus pyogenes erythrogenic toxin A modulate inflammatory mediator release from human neutrophils; Hensler T et al.; We studied the influence of staphylococcal toxic shock syndrome toxin 1 and streptococcal erythrogenic (pyrogenic) toxin A (ETA) on intact and digitonin-permeabilized human polymorphonuclear granulocytes (PMNs) . As was shown by reversed-phase high-performance liquid chromatography analysis, toxic shock syndrome toxin 1 or ETA alone, in the absence of any additional stimulus, did not induce the generation of the chemoattractant leukotriene B4 (LTB4) from PMNs in a wide range of concentrations . In addition, pretreatment of intact PMNs with either toxin potentiated formyl-methionyl-leucyl-phenylalanine (fMLP)- and washed Staphylococcus aureus cell-induced generation of LTB4 in a time- and dose-dependent manner . This increase included LTB4 as well as its inactive omega-oxidated compounds . Further studies revealed evidence that toxin exposure was accompanied by enhanced cellular receptor expression for fMLP as well as for LTB4 . The intrinsic GTPase activity of membrane fractions was modulated by both toxins . Short-term incubation with ETA increased the GTPase activity of PMNs up to 141% . Inhibitory effects were obtained when GTP-binding protein functions were stimulated with sodium fluoride (NaF) . In addition, specific binding of Gpp(NH)p to GTP-binding protein was inhibited by both toxins during the first 10 min of incubation and was restored at later times of incubation . Our data therefore suggest that both toxins significantly affect the signal transduction pathways of human PMNs, which results in immunomodulatory functions.

Int Endod J, 1993 Mar, 26(2), 106 - 11
In vitro antimicrobial activity of calcium hydroxide cements on Streptococcus sanguis NCTC 7864; Milosevic A; Several studies have questioned the antimicrobial role of calcium hydroxide cements . This study assessed the antimicrobial activity of four commercially available calcium hydroxide cements on Streptococcus sanguis NCTC 7864 using inoculated Mueller-Hinton growth medium . Growth curves from optical density analysis, pH measurements, and viability counts were compared over a 24 h period . Significant differences occurred (P < 0.05) between pH measurements but not the growth curves or the viability counts . All cements exerted a cidal effect although this cannot be attributed to an increase in alkalinity alone.

Intern Med, 1993 Mar, 32(3), 221 - 4
Streptococcus mitis septicemia in leukemia patients; clinical features and outcome; Tasaka T et al.; The frequency of streptococcal infections has been reported to be increasing . To determine the significance of such infections complicating treatment of leukemia, we studied the incidence and clinical features of Streptococcus mitis septicemia among 51 leukemia patients in our department . During 166 consecutive treatment courses for leukemia, eight episodes of Streptococcus mitis septicemia were observed in 35 septicemic patients . In seven out of eight episodes (88%), severe mucositis developed after aggressive chemotherapy, suggesting that oral mucosa might be the site of entry for Streptococcus mitis . The isolates were sensitive to imipenam/cilastatin and cefuzonam, and were relatively resistant to amikacin . Although none of the patients died of Streptococcus mitis septicemia, life-threatening adult respiratory distress syndrome (ARDS) developed in two independent treatment courses . We should thus be aware of the risk of ARDS in patients with Streptococcus mitis septicemia.

Microb Pathog, 1993 Mar, 14(3), 239 - 48
Binding of bovine fibronectin to mastitis-causing Streptococcus agalactiae induces adherence to solid substrate but not phagocytosis by polymorphonuclear cells; Rainard P; Streptococcus agalactiae is frequently associated with mastitis in cattle, and fibronectin is a host protein which interferes with infection, particularly at mucosal sites . The binding of bovine fibronectin to S . agalactiae was investigated by enzyme-linked immunosorbent assay (ELISA) . Binding was time-dependent and dose-dependent . Most of the strains tested showed low ELISA activity, but some strains (six out of 17) had much higher activity . The highest-binding strains of S . agalactiae were able to adhere to bovine fibronectin-coated polystyrene . Adherence was inhibited by arginine or gelatin, but was slightly favored by soluble fibronectin . Fibronectin did not contribute to the opsonization (deposition of complement C3) and phagocytosis of the strain which bound the highest amount of fibronectin, even when polymorphonuclear cells were activated with serum-derived chemotaxin (C5a) . These data suggest that fibronectin might promote tissue adherence but not phagocytosis of S . agalactiae in the mastitis process.

Aust N Z J Surg, 1993 Mar, 63(3), 237 - 40
Streptococcus milleri liver abscess presenting as fulminant pneumonia; Henderson A et al.; A case of a young man who developed a Streptococcus milleri liver abscess secondary to an occult colonic foreign body, which presented as fulminant community acquired pneumonia, is reported . The isolation of Streptococcus milleri, a normal member of the gastrointestinal flora, from an abscess, blood or sputum should prompt a search for pathology, foreign bodies or silent perforation in the gastrointestinal tract.

Arch Mal Coeur Vaiss, 1993 Mar, 86(3), 291 - 5
{Comparison of hospital prevalence of rheumatic heart diseases and acute rheumatic arthritis in France and Africa}; Bertrand E et al.; This study reports the results of a multicentre enquiry performed in France in 1990 which included 41,242 adults hospitalised in Cardiology Units, 33,907 children hospitalised in Pediatric departments and 8,868 soldiers . A comparative enquiry was also carried out in North Africa (Tunis) and West Africa (Abidjan, Ouagadougou) . The results of the French arm of the enquiry showed that rheumatic heart disease (RHD) has become very rare in adults (3.1% of all cardiac disease) and that it tends to occur in older subjects (average 54.4 years of age) . There is practically no RHD in young adults . This decreased prevalence of RHD is confirmed in children in whom this diagnosis represents only 0.04% of cases of all cardiac disease--of which 87.5% are of extra-European origin . In contrast, there is a high frequency of RHD in Tunisia (29.3%) and West Africa (13.2% in Abidjan and 13% in Ouagadougou) . The disease remains active as is shown by the age of affected adults in Africa (average 21 and 27 years of age) . The results also show a reduction to a very low prevalence of acute rheumatic fever in French pediatric departments (0.005%) . The authors discuss the reasons for the persistence of endemic infection in Africa: virulence of the streptococcus, predisposing factors (HLA group?), geographic factors and, above all, socioeconomic factors and difficulties in obtaining treatment and prophylaxis . A movement of international cooperation is suggested in order to combat RHD in Africa, especially with regards to its prevention in childhood.(ABSTRACT TRUNCATED AT 250 WORDS)

Int J Gynaecol Obstet, 1993 Mar, 40(3), 245 - 8
A severe puerperal group A streptococcal infection causing a toxic shock-like syndrome; Snabes MC et al.; Toxic shock syndrome (TSS) is classically associated with vaginal recovery of Staphylococcus aureus during menses . In this case a patient presented with fever, rash, abdominal pain and signs of shock, 6 days postpartum . Blood cultures were negative but endometrial cultures were positive for Group A beta-hemolytic streptococcus . This case presents a toxic shock-like syndrome due to streptococcus, (toxic streptococcus syndrome) and points out the importance of culturing these patients for organisms other than Staphylococcus aureus.

J Infect Dis, 1993 Mar, 167(3), 684 - 90
Triggering of pneumococcal autolysis by lysozyme; Cottagnoud P et al.; Lysozyme had no effect on the rate of multiplication of growing cultures of Streptococcus pneumoniae, but it greatly reduced the lag period that precedes autolysis of these bacteria in stationary phase . Several experiments were done to understand the mechanism of this effect . Lysozyme had no hydrolytic activity on intact cell walls, and cell walls of pneumococci grown with or without lysozyme had identical composition and susceptibility to the pneumococcal autolysin . The acceleration of stationary-phase autolysis by lysozyme involved triggering of the pneumococcal autolytic enzyme since lysozyme had no detectable effect on nonautolysing (LytA-) mutants and heat-inactivated lysozyme completely lacking enzymatic activity was as effective as the nondenatured enzyme in facilitating stationary-phase autolysis . The role of lysozyme in host defense against pneumococcal infection remains elusive.

Biull Eksp Biol Med, 1993 Mar, 115(3), 274 - 6
{Lymphocytes with receptors to streptococcal polysaccharide group A in the thymus of rheumatism patients . Change in the response of normal thymocytes to adenosine, theophylline and decantate}; Gnezditskaia EV et al.; With the help of immunomodulators (adenosine, theophylline, levamisole) and decantat of 3-hour culture of normal thymocytes, the features of thymocytes with the receptor for polysaccharide of streptococcus group A(A-PSC) (R = PSC+cells) in patients with rheumatism . It has been established that in patients' thymus the quantity of lymphocytes, able to express R-PSC (predecessors of R = PSC + cells) decreased under the influence of theophylline and adenosine . The predecessors of R = PSC+thymocytes in the majority of patients with rheumatism are areactive to decantat action . Moreover R = PSC+cells in comparison with normal ones lose this receptors under it's influence.

Vet Rec, 1993 Feb 27, 132(9), 208 - 10
Detection of bacterial antigens in milk samples from clinical cases of bovine mastitis in which culture is negative; Zorah KT et al.; ELISAs to detect antigens against Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae, Streptococcus dysgalactiae and Streptococcus uberis were developed and used on whey samples from quarter milk samples from cases of clinical mastitis in which no bacterial pathogen had been isolated by standard culture techniques . Antigens against one or other of the bacteria listed above were detected in 68 per cent of 84 samples . Fifty-one per cent of the 84 samples contained antigens to E coli . Antigens against one or other of these bacteria were also detected in 51 per cent of 53 quarter milk samples which were negative on culture but had somatic cell counts of more than 500,000 cells/ml . It is suggested that ELISAs for the detection of antigens in quarter milk samples could be a useful adjunct to culture, to determine the infection status of a quarter.

J Biol Chem, 1993 Feb 25, 268(6), 4311 - 7
Characterization of a novel bacterial adhesion specificity of Streptococcus suis recognizing blood group P receptor oligosaccharides; Haataja S et al.; Streptococcus suis causes sepsis, meningitis, and other serious infections in piglets, and meningitis in humans . Hemagglutination inhibition experiments with mono- and oligosaccharides and glycoproteins indicated that galactose-binding strains of S . suis recognized the Gal alpha 1-4Gal sequence present in the P1 and Pk blood group antigen structures . In thin-layer chromatography overlay assays the bacteria bound to trihexosylceramide (GbO3) but not to globoside (GbO4) or Forssman glycolipid (GbO5), in contrast to P-fimbriated Escherichia coli, which bound only to the latter two . The S . suis adhesin also differed from that of E . coli in that some of the hydrogen bonds formed with the receptor, as determined with chemically modified receptor analogues, were different . In agreement with the binding specificity, the S . suis bacteria agglutinated best among P blood group erythrocytes those of the P1k and P2k type, and from different animal erythrocytes those from rabbit, which express GbO3 as the predominant glycolipid . Binding to frozen sections of pig pharyngeal tissue was decreased by the free GbO3 oligosaccharide and its protein conjugate, which indicated that the corresponding glycolipid may function as receptor for galactose-binding strains of S . suis in pig pharyngeal epithelium.

Biochim Biophys Acta, 1993 Feb 24, 1166(2-3), 222 - 8
Biosynthesis and characterization of phosphatidylglycerophosphoglycerol, a possible intermediate in lipoteichoic acid biosynthesis in Streptococcus sanguis; Chiu TH et al.; A membrane enzyme preparation from Streptococcus sanguis was shown to convert sn-{14C}glycerol 3-phosphate and CDP-diacylglycerol (or deoxyCDP-diacylglycerol) into a series of progressively higher-molecular-weight {14C}oligophosphoglycerophospholipids in vitro . The first oligophosphoglycerophospholipid to accumulate (termed lipid-1) was purified to homogeneity; chemical analysis, gas-liquid chromatography and chemical degradation studies indicated the most likely structure to be phosphatidylglycerophosphoglycerol (PGpG) . PGpG is formed directly from two molecules of phosphatidylglycerol (PG), one molecule of PG serving as a sn-glycerol 1-phosphate (pG) donor and the second serving as the pG acceptor, with co-production of diacylglycerol . These oligophosphoglycerophospholipids may be intermediates in the biosynthesis of lipoteichoic acids.

FEMS Microbiol Lett, 1993 Feb 15, 107(1), 67 - 70
Identification of Streptococcus mutans antigen D as the HPr component of the sugar-phosphotransferase transport system; Sutcliffe IC et al.; Extraction of Streptococcus mutans with the detergents HECAMEG and lauroyl sarcosinate preferentially extracted antigen D, previously identified as a low molecular mass wall-associated protein . Western blotting with specific antisera was used to demonstrate that this antigen is the HPr component of the sugar-phosphotransferase transport system . Non-denaturing electrophoresis indicated that HECAMEG selectively extracted only one of the two forms of HPr . It is suggested that this form of HPr may have a specific cell surface location.

Blood, 1993 Feb 15, 81(4), 923 - 7
Maternal administration of granulocyte colony-stimulating factor improves neonatal rat survival after a lethal group B streptococcal infection; Novales JS et al.; Maternally administered recombinant human granulocyte colony-stimulating factor (rhG-CSF) has been shown to cross the placenta and induce a peripheral neutrophilia and increases in the marrow and spleen neutrophil storage pools in fetal and newborn rats . In the present study, we have used this model system to investigate the efficacy of prenatally administered rhG-CSF on neonatal defense to a lethal challenge with Group B-beta hemolytic Streptococcus (GBS) . Pregnant rats were injected with rhG-CSF twice daily beginning 6 days before parturition . At birth, all pups were infected with a dose of GBS that is lethal for 90% of infected pups (LD90) . Survival was monitored daily for 5 days . Survival of infected pups from saline-treated mothers beyond 60 hours after infection was 10% . No difference in survival was observed among pups from mothers treated 2 and 4 days before parturition . In contrast, we determined that survival was 82.5% among infected pups from mothers treated for 6 days before parturition with rhG-CSF . Our results demonstrate that maternal administration of rhG-CSF augments neonatal defenses against a lethal bacterial challenge.

Nucleic Acids Res, 1993 Feb 11, 21(3), 615 - 20
Molecular cloning, sequence, structural analysis and expression of the histidyl-tRNA synthetase gene from Streptococcus equisimilis; Menguito CA et al.; The histidyl-tRNA synthetase gene (hisS) from Streptococcus equisimilis was cloned and sequenced . The gene for this aminoacyl-tRNA synthetase has an open reading frame of 1278 nucleotides . The deduced amino acid sequence encodes a protein of 426 amino acids with MW = 47,932 . The protein is predicted to be soluble with a pl = 5.27 . The protein sequence has extensive overall identity/similarity with the Escherichia coli and the yeast histidyl-tRNA synthetases (approximately 58% and approximately 20%, respectively) . A putative promoter for gene transcription lies within two hundred nucleotides of the polypeptide start codon . The enzyme was overexpressed, to a level of about 18% of total cellular protein, as a fusion protein (containing an additional 15 amino acids) in E . coli using the pT7 expression system containing the T7 RNA polymerase/promoter (Tabor and Richardson, Proc . Natl . Acad . Sci . U.S.A . 82:1074-1078, 1985) . The predicted MW for the hisS gene product is in good agreement with the size of the fusion protein determined by SDS-PAGE (M(r) = 53,700) . Amino acid sequencing of the intact fusion protein and proteolytic fragments confirmed the deduced sequence of the synthetase at many positions throughout the protein . The expressed protein catalyzed the specific aminoacylation of tRNA(His) in vitro.

Oral Microbiol Immunol, 1993 Feb, 8(1), 62 - 4
Effects of fluoxetine on the oral environment of bulimics; Bretz WA et al.; The purpose of this study was to evaluate in a double-blind placebo-based study the effects of fluoxetine over a period of 16 weeks on the frequency of binging and purging and on fluctuations in the levels of cariogenic organisms and saliva secretion rate of patients (n = 30) with bulima nervosa . Profile analysis suggested that, over the course of the study, binging and purging frequency and Streptococcus sobrinus salivary levels decreased significantly in the fluoxetine group as compared with the placebo group . Our finding that S . sobrinus levels decreased 16 weeks after subjects were on medication suggests that the salivary levels of these organisms could serve as an objectively measured indicator of patient compliance with antibulimic therapy.

Oral Microbiol Immunol, 1993 Feb, 8(1), 16 - 23
Dental plaque development on defined streptococcal surfaces; Skopek RJ et al.; Coaggregations between bacterial species have been widely studied in vitro but not in the mouth . A new in vivo assay was used to measure the rate and composition of indigenous plaque formation onto bovine enamel chips covered with a continuous layer of bacteria . Chips were covered with Streptococcus oralis ATCC 10557, which coaggregated with many oral species, or Streptococcus gordonii S7, which did not coaggregate with these oral species, and placed in the mouth for 4 and 24 h . There were no differences in the number of most indigenous bacterial species isolated from the two streptococcal surfaces . However, the number of Actinomyces viscosus as a proportion of total Actinomyces spp . was significantly different on the two surfaces at 24 h . With the exception of Actinomyces naeslundii and A . viscosus removed from the S7 surface, all indigenous species increased significantly in number from 4 to 24 h, irrespective of the streptococcal surface . This study demonstrated that interbacterial coaggregation had only a limited effect on in vivo plaque development . Thus suggesting that environmental factors, growth or other adherence phenomena are dominant in in vivo plaque formation.

Pediatr Emerg Care, 1993 Feb, 9(1), 26 - 8
Magnetic resonance imaging for early diagnosis of necrotizing fasciitis; Zittergruen M et al.; One of the most serious complications of chickenpox is varicella gangrenosa, a form of necrotizing fasciitis . A confounding factor is the frequency of more superficial skin infections during chickenpox, often caused by group A beta-hemolytic streptococcus . Because the progression from cellulitis to fasciitis is so insidious, severe tissue necrosis often has occurred before the correct diagnosis is made on the basis of clinical examination . Even today, limb amputation is occasionally required for treatment of gangrenous varicella . In this report, we demonstrate that magnetic resonance imaging can delineate the degree and depth of inflammation within an extremity and, thereby, indicate when the infection is progressing despite antibiotic therapy . Thus, the earlier use of magnetic resonance imaging may facilitate the diagnosis of necrotizing fasciitis.

Pediatr Emerg Care, 1993 Feb, 9(1), 19 - 22
Bacterial peritonitis and sepsis presenting as acute gastrointestinal bleeding in patients with portal hypertension; Glassman MS et al.; Four children with portal hypertension and ascites developed hematemesis, abdominal pain, and fever as the acute manifestations of bacterial peritonitis . Initial management in the emergency department was directed toward controlling the upper gastrointestinal hemorrhage, and antibiotic therapy was delayed in four of six episodes until ascitic fluid cultures grew Streptococcus pneumoniae . Gastrointestinal bleeding has not been previously reported as a presenting symptom of peritoneal infection . Our clinical experience emphasizes the need for antibiotic therapy during the initial management of children with ascites and hematemesis.

Arch Oral Biol, 1993 Feb, 38(2), 107 - 12
The effect of different strontium concentrations on the efficacy of chlorhexidine-fluoride-strontium gel in preventing enamel softening in vitro; Spets-Happonen S et al.; The effects were compared of strontium concentrations of 0, 15, 50 and 250 parts/10(6) in chlorhexidine(0.20%)-fluoride(0.16%) gel in preventing the softening of bovine enamel during bacterial fermentation . Fresh Streptococcus sobrinus cells were suspended in a buffer solution (pH 6.0) with 3.3% sucrose and centrifuged as a plaque-like layer on the top of enamel slabs covered with 10 microliters gel . AFter 24 h incubation, the pH fall of the fluid was significantly smaller in all test groups than in the placebo group . Strontium seemed to have an inhibitory effect on the pH fall . All test gels significantly prevented softening and dissolution of enamel during bacterial fermentation, which was directly related to strontium concentration . The amounts of calcium and phosphorus in the cells and fluid after incubation were the smallest in the group with 250 parts/10(6) strontium . In a second experiment without bacteria, new enamel slabs were covered with 10 microliters gel containing chlorhexidine and NaF with 0 and 250 parts/10(6) strontium to study the protective effect of strontium . After 24 h gel treatment, each enamel slab was dissolved in 1 ml 0.1 M lactic acid, pH 5.0, for 2 h . Significantly less calcium and phosphorus were dissolved from the enamel in both test groups than in the control and placebo groups . However, the placebo gel also prevented calcium and phosphorus dissolution significantly . These results suggest that the addition of strontium to chlorhexidine-fluoride gel improves the ability of this combination to prevent caries-like enamel softening . The inhibition of bacterial acid production by the strontium-containing gel may explain this enhanced protection of enamel.

Diagn Microbiol Infect Dis, 1993 Feb, 16(2), 131 - 4
Endovascular infection and septic arthritis caused by Gemella morbillorum; Omran Y et al.; Streptococcus morbillorum was transferred to the genus Gemella in 1988 . Infections caused by G . morbillorum are unusual . We report a case of endovascular infection and presumptive septic arthritis caused by G . morbillorum . Previous cases of infection caused by G . morbillorum and G . haemolysans are reviewed.

J Antimicrob Chemother, 1993 Feb, 31(2), 273 - 80
Susceptibility of 170 penicillin-susceptible and penicillin-resistant pneumococci to six oral cephalosporins, four quinolones, desacetylcefotaxime, Ro 23-9424 and RP 67829; Spangler SK et al.; MICs of six oral cephalosporins (cefdinir, cefpodoxime, cefaclor, cefuroxime, cefixime and Ro 40-6890), four quinolones (ciprofloxacin, ofloxacin, OPC-17116 and fleroxacin), desacetylcefotaxime, Ro 23-9424 (a fused combination of fleroxacin + desacetylcefotaxime) and RP 67829 (a benzonaphthyridine) were determined for 49 penicillin-susceptible (S), 38 penicillin-intermediate (I), and 83 penicillin-resistant (R) strains of Streptococcus pneumoniae . All MICs were determined by a standardized agar dilution method utilizing Mueller-Hinton agar supplemented with sheep blood . MIC90s of OPC-17116 and RP 67829 were < or = mg/L, and were unaffected by penicillin-susceptibility . MICs of all beta-lactams increased with increasing penicillin-MICs, with cefdinir, cefpodoxime, cefuroxime and Ro 40-6890 being the most active compounds, followed by cefaclor and cefixime . MIC90s of ciprofloxacin and ofloxacin were 2 mg/L . MIC90s of Ro 23-9424 were lower than those of either parent compound (fleroxacin 8 mg/mL for all three groups; desacetylcefotaxime 0.5 mg/mL {S}, 0.5 mg/mL {I}, 4 mg/mL {R}; Ro 23-9424 0.125 mg/L {S}, 0.25 mg/L {I}, 0.5 mg/L {R}) . The results indicated that several newly introduced and experimental antimicrobials have potential for the treatment of infections caused by resistant strains of S . pneumoniae.

Mol Gen Genet, 1993 Feb, 237(1-2), 65 - 72
In vivo definition of the functional origin of replication (ori(+)) of the promiscuous plasmid pLS1; del Solar G et al.; We have defined the minimal origin of replication of the plasmid pLS1 leading strand, as comprised within a 247 bp region, by in vivo deletion analyses . Cloning of pLS1 DNA regions containing its oriV(+) into a compatible replicon resulted in weak incompatibility towards pLS1, but only when the cloned fragment included the entire pLS1 oriV(+) . Plasmids lacking a functional repB gene (which encodes the pLS1 initiator of replication RepB protein) could be established in Streptococcus pneumoniae only when RepB was supplied in trans . We conclude that all the pLS1-encoded gene products involved in its replication and control are efficient trans-complementing plasmid elements.

Antimicrob Agents Chemother, 1993 Feb, 37(2), 234 - 9
Evaluation of the efficacy of ciprofloxacin against Streptococcus pneumoniae by using a mouse protection model; Sullivan MC et al.; A mouse protection model was used to investigate the association of the pharmacokinetics and pharmacodynamics with the in vivo efficacy of ciprofloxacin compared with that of penicillin G in the treatment of mice infected with Streptococcus pneumoniae ATCC 6303 . Mice were inoculated intraperitoneally with 10 times the minimum lethal dose of S . pneumoniae . For determination of the 50% protective dose, subcutaneous antibiotics were begun 1 h after infection and were continued for 24 h . The 50% protective doses of ciprofloxacin and penicillin G were 25.52 +/- 1.95 and 0.307 +/- 0.006 mg/kg of body weight, respectively, an 83-fold difference in efficacy . For 100% protection with penicillin G, the time that the drug concentration needed to remain above the MIC was 51 min, a value easily achieved in most clinical situations . For 100% protection with ciprofloxacin, the peak concentration/MIC ratio must reach a value of 10.6 . This ratio is rarely achieved with this drug against S . pneumoniae in clinical practice . These pharmacodynamic differences probably contribute to the reported differences in clinical success between these agents.

Antimicrob Agents Chemother, 1993 Feb, 37(2), 207 - 12
Synergistic activity of ceftriaxone combined with netilmicin administered once daily for treatment of experimental streptococcal endocarditis; Francioli PB et al.; We have conducted experiments to determine if one daily injection of netilmicin (NET) would be synergistic with the broad-spectrum cephalosporin ceftriaxone (CRO) in the treatment of experimentally induced endocarditis . Rats with catheter-induced aortic vegetations were infected intravenously with 3 x 10(7) CFU of a beta-lactam-sensitive strain of Streptococcus sanguis or a beta-lactam-resistant strain of Streptococcus mitis . Treatment with the antibiotics alone (CRO, 10 mg/kg of body weight every 8 h; NET, 18 mg/kg every 24 h) or in combinations which had proved synergistic in in vitro time-kill curves was commenced 48 h postinfection and continued for 72 h . The results show that the combination was markedly effective against S . sanguis and moderately effective against S . mitis, while, with the protocol used here, the agents alone were not . The results suggest that CRO-NET should be an effective combination for treating streptococcal endocarditis in humans and may permit a shorter duration of treatment and once-a-day dosing to be used.

J Antimicrob Chemother, 1993 Feb, 31 Suppl B, 119 - 28
Prophylaxis for HIV-associated infections in the developing world; Gilks CF; Prophylaxis for specific HIV-associated infections has made a major difference in the industrialized world to patient survival and the quality of life . However, the HIV epidemic is spreading most rapidly in the poor developing world, where prophylaxis is neither currently used nor recommended . Streptococcus pneumoniae . Mycobacterium tuberculosis and non-typhi salmonellae are the pathogens responsible for much of the morbidity and mortality associated with HIV infection in the tropics . Because these problems often present relatively early in the course of the HIV disease, prophylaxis may be cost-effective and increase the years of productive life . Prevention of pneumococcal disease has not been considered a priority in the developing world . Penicillin chemoprophylaxis may be efficacious; immunization which is recommended for all HIV seropositive adults in the USA, has not been used . The importance of studies to test both efficacy and cost compared to benefit is discussed . The problem of HIV-associated tuberculosis is of major importance and several intervention studies are now in progress . The efficacy of chemoprophylaxis may be limited if the problem is largely acute infection rather than reactivated disease and if shown to be effective compliance will present a major operational difficulty . Systemic salmonellosis is greatly underdiagnosed but may be the leading cause of death . Recurrent infection can be prevented by chemoprophylaxis but this will be costly . The use of novel or currently unlicensed vaccines may eventually prove to be the most effective means of controlling the burden of disease and death caused by salmonellosis.

Ann Rheum Dis, 1993 Feb, 52(2), 127 - 32
Responses of synovial fluid and peripheral blood mononuclear cells to bacterial antigens and autologous antigen presenting cells; Klasen IS et al.; The specificity of T cells in the inflamed joints of patients with rheumatoid arthritis (RA) has been the subject of much study . Bacterial antigens are suspect in the aetiology of rheumatic diseases . The responsiveness of the mononuclear cell fraction of peripheral blood and synovial fluid of patients with RA and of patients with rheumatic diseases other than RA to bacterial antigens such as cell wall fragments of the anaerobic intestinal flora, cell wall fragments of Streptococcus pyogenes, intestinal flora derived peptidoglycan polysaccharide complexes, the 65 kilodalton protein of Mycobacterium tuberculosis, and muramyldipeptide was investigated . No significant difference in response was found to all these bacterial antigens in the synovial fluid of patients with RA compared with the responses in patients with other rheumatic diseases . The highest responsiveness in the synovial fluid of the patients with RA was to the streptococcal cell wall fragments and to the 65 kilodalton protein . Higher responses to several bacterial antigens in the synovial fluid of patients with RA were found compared with peripheral blood from the same patient group . The antigen presenting cell population of the synovial fluid in patients with RA and the patients with other rheumatic diseases was found to be stimulatory for autologous peripheral blood T cells even in the absence of antigen . This suggests an important role for the synovial antigen presenting cell in the aetiology of inflammatory joint diseases.

Clin Infect Dis, 1993 Feb, 16(2), 286 - 7
Inhibition of the scarlet fever exanthem in concurrent varicella and group A streptococcus infection; Friedman MA et al.; An atypical scarlet fever exanthem was noted in a 5-year-old child with varicella complicated by secondary group A beta-hemolytic streptococcus pneumonia and empyema . The rash consisted of symmetrical, concentric, circular exanthem-free zones surrounding individual varicella vesicles . The possible role of virus-induced interferon in locally modifying the effect of streptococcal pyrogenic exotoxin is explored.

Ophthalmology, 1993 Feb, 100(2), 159 - 63
Scleral flap necrosis and infectious endophthalmitis after cataract surgery with a scleral tunnel incision; Ormerod LD et al.; BACKGROUND: Long scleral tunnel dissection techniques have been developed for cataract surgery incisions . These incisions reduce postoperative astigmatism and keratorefractive instability . If fashioned correctly, the internal lip of the incision produces a tight seal to the anterior chamber, permissible of sutureless surgery . The behavior of such a wound during intraocular infection is unknown . METHODS: The authors describe two elderly patients in whom postoperative bacterial endophthalmitis was accompanied by infectious scleritis, infectious sclerokeratitis or keratitis, and rapid scleral flap necrosis . One of the patients had a painless disease process . RESULTS: Intraocular isolates of Staphylococcus aureus and Streptococcus equinus were recovered from the two patients, respectively . Management was complicated by loss of tectonic integrity that followed scleral flap necrosis, by impaired vitreoretinal visualization associated with rapidly progressive sclerokeratitis or keratitis, and by bacterial scleritis in the base of the scleral flap . No light perception was retained in either eye . CONCLUSION: Scleral tunnel incisions create a potential abscess cavity . Although a rare occurrence, postoperative endophthalmitis in such an eye may present major surgical and therapeutic problems intrinsic to the wound design.

Epidemiol Infect, 1993 Feb, 110(1), 71 - 8
The carriage of Streptococcus suis type 2 by pigs in Papua New Guinea; Paterson RA et al.; An indirect fluorescent antibody test was used to detect the presence of Streptococcus suis type 2 in nasal and pharyngeal swabs taken from pigs in Papua New Guinea . The rate of carriage for the two sites in domesticated indigenous village pigs was 0.5 and 2.5% respectively, compared to 39 and 43% for intensively reared pigs . These findings were supported by the results of a serological survey, using an enzyme linked immunosorbent assay, in which 87% of intensively reared pigs but only 8% of village pigs were seropositive to S . suis type 2 . It is proposed that in intensive piggeries S . suis type 2 is continually cycled between pigs . In village pigs, the low population density and harsh environmental conditions prevents this cycle of infection.

Biotechniques, 1993 Feb, 14(2), 209 - 12
Biotin-containing protein as a cause of false positive clones in gene probing with streptavidin/biotin; Wang D et al.; Using a streptavidin/biotin labeling technique, we unintentionally cloned a gene encoding a biotin carboxyl carrier protein, a subunit of biotin-dependent enzymes, from a genomic library of Streptococcus mutans strain UT-041 . In colony lifts, the clone reacted positively to the streptavidin-containing detection system but could not be detected in Southern blot analysis . The amino acid sequence of the gene product, deduced from its nucleotide sequence, demonstrated all the features common to biotin carboxyl carrier proteins from other bacteria, indicating that the biotin carboxyl carrier protein in the clone had produced a "false-positive" (DNA probe-independent) reaction by binding to the streptovidin . To circumvent this problem with the detection system in gene probing in the future, we recommend that all positive clones be screened by direct incubation with streptavidin-alkaline phosphatase (SA-AP) in the absence of biotin-labeled probe DNA . Clones binding to SA-AP would be considered false positives.

Am J Med, 1993 Feb, 94(2), 149 - 52
Underutilization of pneumococcal vaccine in nursing home in Washington State: report of a serotype-specific outbreak and a survey; Quick RE et al.; PURPOSE: To describe an outbreak of pneumococcal disease in a Washington state nursing home and to report a survey of pneumococcal vaccine utilization in Washington nursing homes . PATIENTS AND METHODS: Outbreak . Data were collected from nursing home residents' records . Nasopharyngeal cultures were obtained from residents and staff . Survey . Fifty-four randomly selected Washington nursing homes were surveyed about pneumococcal vaccine utilization and policies . RESULTS: Outbreak . Three confirmed and 4 possible cases of pneumococcal disease occurred over 9 days among 94 residents; 5 patients (71%) died . Cases were identified among 6 of 42 residents on 1 wing, compared with 1 of 52 on the other 2 wings (relative risk 7.4, 95% confidence interval 1.0, 398.5) . Streptococcus pneumoniae serotype 9V was cultured from the blood of 3 confirmed case-patients and the nasopharynx of 2 of 73 residents . Only 7% of residents had received pneumococcal vaccine, including one case-patient who had received 14-valent vaccine without serotype 9V . Survey . Only 22% of residents were reported to have received pneumococcal vaccine; vaccination status was unknown for 66% . Physician discretion determined pneumococcal vaccination in 49 (91%) nursing homes; 9 (17%) had a written policy . Two major barriers to pneumococcal vaccination were cited: low priority among physicians (43%) and difficulty in determining residents' vaccine history (37%) . CONCLUSIONS: A pneumococcal disease outbreak among undervaccinated nursing home residents probably resulted from person-to-person transmission . Pneumococcal vaccine appears to be underutilized in Washington state nursing homes.

J Med Microbiol, 1993 Feb, 38(2), 151 - 4
Phagocytosis of bacterial strains isolated from acute dentoalveolar abscess; Lewis MA et al.; The phagocytosis by human polymorphonuclear leucocytes of 37 bacterial strains identified as Streptococcus milleri (10 strains), strictly anaerobic gram-positive cocci (10) Prevotella intermedia (6), Pr . oralis (5) and Fusobacterium nucleatum (6) was investigated in vitro . The ingestion of S . milleri and strictly anaerobic gram-positive cocci was significantly greater (p < 0.001) than that of strains of Prevotella spp . and F . nucleatum . The degree of uptake of capsulate and non-capsulate strains did not differ.

J Dent Res, 1993 Feb, 72(2), 524 - 8
Synergistic, growth-inhibitory effects of chlorhexidine and copper combinations on Streptococcus mutans, Actinomyces viscosus, and Actinomyces naeslundii; Drake DR et al.; The purpose of this investigation was to determine whether chlorhexidine combined with copper would exert a synergistic, growth-inhibitory effect against selected oral bacteria . Actinomyces viscosus, Actinomyces naeslundii, and Streptococcus mutans were all susceptible to chlorhexidine individually, with S . mutans displaying the highest sensitivity . Much higher concentrations of copper were needed to achieve growth inhibition of the micro-organisms tested . Determination of minimum inhibitory concentrations (MICs) of chlorhexidine and Cu2+ combinations suggested synergistic activity . Bactericidal kinetics assays confirmed synergism of chlorhexidine and Cu2+ combinations with 1 to 2 log greater decreases in viable cell numbers compared with chlorhexidine alone . Under the constraints of the conditions employed, these data demonstrate the efficacy of chlorhexidine and Cu2+ combinations against the oral bacteria tested . These studies suggest that a chlorhexidine and copper formulation could be useful as a mouthrinse in helping control cariogenic micro-organisms and/or in the treatment of gingivitis.

Appl Environ Microbiol, 1993 Feb, 59(2), 519 - 22
Identification and characterization of the proBA operon of Streptococcus bovis; Campanile C et al.; A genomic DNA library of the rumen bacterium Streptococcus bovis was constructed in Escherichia coli, and recombinant plasmids able to complement proA and proB mutations of the host were found . Southern hybridization and restriction analysis showed that a 3.5-kb fragment of S . bovis DNA contained two genes, organized in an operon and coding for enzymes functionally similar to the glutamyl phosphate reductase-glutamyl kinase enzyme complex that in E . coli catalyzes the first step of proline biosynthesis . Complementation of the E . coli mutations was observed with the fragment inserted in both orientations, which suggested that the S . bovis proBA operon was transcribed from its own promoter . Genetic and biochemical data suggested that the proline biosynthetic pathway of S . bovis is similar to the one previously characterized for E . coli.

Arch Mal Coeur Vaiss, 1993 Feb, 86(2), 197 - 201
{Mitral valvuloplasty during the acute phase of endocarditis}; Fuzellier JF et al.; Thirty-five patients were operated in the acute phase of mitral valve endocarditis between 1986 and 1991 . The surgical indications were hemodynamic (22), echocardiographic (9), embolic (2) and infectious (2) . There were pre-existing valve lesions in 45% of cases . The causal organism was identified in 90% of cases: streptococcus (19), staphylococcus (9) and Gram negative bacilli (4) . Preoperative antibiotic therapy was prescribed for an average of 18 days . The aortic valve was infected in 9 patients and tricuspid valve in 1 patient . The mitral lesions were: abscess (11), vegetations (11), perforations (16), and ruptured chordae tendinae (22) . All patients underwent Carpentier's mitral valvuloplasty . The operative mortality was 5.7% (2 patients) . Early reoperation was required in 1 case . Follow-up was possible in 96% of cases for an average of 23 months . No recurrences of endocarditis were observed . One patient was reoperated and 3 died . All the others were in Classes I and II of the NYHA . None had significant mitral regurgitation or stenosis . These results show that mitral valvuloplasty is possible in the acute phase of endocarditis in 90% of cases . The mortality and morbidity are low and long-term results are stable.

Arch Fr Pediatr, 1993 Feb, 50(2), 131 - 3
{Neonatal septicemia due to Pneumococcus resistant to beta-lactam antibiotics}; Devaux AM et al.; BACKGROUND . Neonatal sepsis due to Streptococcus pneumoniae is relatively rare . The increasing risk that this bacterium is resistant to betalactam antibiotics worsens its prognosis . CASE REPORT . A newborn was delivered by cesarean section because of an abnormal fetal heart rate pattern . Despite intubation, respiratory support and correction of acidosis, the baby remained cyanotic and displayed signs of shock . Neutropenia, increased percentage of immature neutrophils, high C-reactive protein levels and an X-ray pattern of pneumonia also indicated an infection . The child was given symptomatic therapy, and amoxicillin, cefotaxime and amikacin . Pneumococci type 9 were isolated from peripheral secretions and from the blood . Deterioration of the respiratory condition required higher doses of amoxicillin and cefotaxime on day 2 pending the results of antibiotic sensitivity testing . This test showed that the strains were resistant to beta-lactam antibiotics . On day 3, the treatment was replaced by a combination of vancomycin, rifampicin, amikacin and cefotaxime . This treatment was pursued for 2 weeks, except for rifampicin which was stopped after 2 days . The follow-up was uneventful . A search for pneumococci in the mother was negative . CONCLUSIONS . Streptococcus pneumoniae should always be considered as a cause of neonatal sepsis . Poor therapeutic control indicates resistance to beta-lactam antibiotics . This patient may be the first reported case of maternal-fetal infection with this resistant strain.

Immun Infekt, 1993 Feb, 21(1), 9 - 12
{Sensitivity of penicillin-resistance pneumococci}; Cullmann W et al.; Fifty-three clinical Streptococcus pneumoniae isolates from Hungary and Spain which were either moderately susceptible to penicillin G (MIC 0.25-1 mg/l) or highly resistant (MIC > or = 2 mg/l) were studied for their antibacterial susceptibility to the following 14 agents: penicillin G, amoxicillin, mezlocillin, cefotaxime, ceftriaxone, amikacin, cotrimoxazole, erythromycin, rifampicin, vancomycin, fosfomycin, doxycycline, ciprofloxacin, and the dual-action compound Ro 23-9424 . Rifampicin was the most active compound (MIC90 < or = 0.015 mg/l) followed by imipenem (MIC90 0.25 mg/l), vancomycin (MIC90 1 mg/l), cefotaxime and ceftriaxone (MIC90 1 mg/l), the dual-action compound Ro 23-9424 and amoxicillin (MIC90 2 mg/l) . Most of the isolates were less sensitive to ciprofloxacin (MIC90 4 mg/l), doxycycline and erythromycin (MIC90 16 mg/l) and resistant to cotrimoxazole (MIC90 640 mg/l) . Furthermore, synergism between penicillin G or ceftriaxone on the one hand, amikacin or rifampicin on the other hand was studied in all 53 isolates . A combination of a beta-lactam with amikacin resulted mostly in an additive effect, as was the case for the rifampicin combinations . The selection of rifampicin-resistant clones can be repressed by the addition of a beta-lactam thus suggesting such a combination of rifampicin with a beta-lactam as a possible therapeutic approach.

J Dairy Sci, 1993 Feb, 76(2), 468 - 74
Genomic deoxyribonucleic acid restriction fragment length polymorphism of Streptococcus uberis: evidence of clonal diversity; Jayarao BM et al.; Fifty plasmid-free strains of Streptococcus uberis, including 40 strains isolated from cows in two dairy herds in Tennessee with subclinical and clinical mastitis, 9 strains isolated from cows in the US, and 1 strain from Great Britain were examined for genomic DNA restriction fragment length polymorphisms . The 50 strains belonged to 35 DNA fingerprint patterns . Within a herd, fingerprint patterns from isolates obtained from cows with subclinical mastitis at different periods of the lactation cycle and from episodes of clinical mastitis were similar . Restriction fragment length polymorphism analysis revealed the presence of DNA fragments > or = 21 kb in all 12 strains of S . uberis isolated from episodes of clinical mastitis and in only 8 of the 38 (21%) remaining strains . Cluster analysis placed the 50 strains into eight distinct clusters . Most strains from the northeastern US were confined to one cluster, whereas most of the isolates from episodes of clinical mastitis belonged to two different clusters . These data suggest that clonal diversity exists among strains of S . uberis isolated from bovine mammary secretions.

J Infect Dis, 1993 Feb, 167(2), 337 - 46
Geographic and temporal distribution and molecular characterization of two highly pathogenic clones of Streptococcus pyogenes expressing allelic variants of pyrogenic exotoxin A (Scarlet fever toxin); Musser JM et al.; The molecular population genetics and pathogenic potential of North American and European invasive strains of Streptococcus pyogenes were assessed . Isolates from recent invasive infections and from infections in the 1920s and 1930s were characterized for multilocus enzyme genotype and allelic variation in the gene (speA) that encodes streptococcal pyrogenic exotoxin (SPE) A (scarlet fever toxin) . A subset of strains was studied for allelic variation in genes that encode SPE B and streptokinase . All contemporary strains assigned to electrophoretic types (ETs) 1 and 2 that synthesize SPE A have the speA2 and speA3 allelic variants, respectively, and their relative virulence in two mouse models is similar to that of strains of the same ET and M protein types recovered earlier . In contrast, ET 1 and 2 isolates from disease episodes in the 1920s and 1930s contain the speA1 allele . The data suggest there may be temporal and geographic variation in the occurrence of clone--virulence factor allele combinations, an observation that may in part explain fluctuations in disease frequency, severity, and character.

Biochem Biophys Res Commun, 1993 Jan 29, 190(2), 648 - 53
Cloning and expression of the major allergen from yellow mustard seeds, Sin a I; Gonzalez de la Pena MA et al.; The cloning and bacterial expression of the major allergen from yellow mustard (Sin a I) is reported . Cloning has been carried out by means of the polymerase chain reaction using non-degenerate oligo primers encoding the N- and C-terminal regions of the mature protein . Two nucleotide sequences (SA2S1 and SA2S2) have been found and analysed . The observed polymorphism suggests the existence of multiple isoforms for Sin a I allergen . SA2S2 has been expressed as a fusion protein, linked to the choline-binding domain of the Streptococcus pneumoniae murein hydrolase . The resulted fusion protein is recognized by Sin-a-I-specific antibodies.

J Biol Chem, 1993 Jan 25, 268(3), 1646 - 9
The Streptococcus sanguis platelet aggregation-associated protein . Identification and characterization of the minimal platelet-interactive domain; Erickson PR et al.; Streptococcus sanguis expresses a cell wall-bound protein that induces the activation and aggregation of platelets . This platelet aggregation-associated protein (PAAP) contains a collagen-like, platelet-interactive domain within a 23-kDa protein fragment . To isolate the minimal platelet-interactive domain, p23 PAAP was digested with collagenase, and the digest chromatographed to isolate fractions with activity inhibitory to S . sanguis-induced platelet aggregation . The active fraction was then digested with cyanogen bromide, the product chromatographed, and a smaller inhibitory peptide isolated . Finally, this fraction was digested with endoproteinase Lys-C, and the digest fractionated . After each step, inhibitory activity resolved into single chromatographic peaks of 13 kDa (p13 PAAP), 2.7 kDa (p2.7 PAAP), and a minimal 7-mer peptide, respectively . These PAAP fragments showed similar ID50 (19-28 nM), suggesting that each contained a single copy of the platelet-interactive domain . The minimal 7-mer peptide was purified by immunoaffinity chromatography and reverse phase high pressure liquid chromatography . The primary structure was determined to be Pro-Gly-Glu-Gln-Gly-Pro-Lys . This sequence conforms to the predicted structural motif of the platelet-interactive domains of types I and III collagen . This 7-mer peptide is therefore the platelet-interactive domain of the PAAP from S . sanguis . Its structure explains the molecular basis for immunological cross-reactivity and functional similarity to the platelet-interactive domains of collagens.

JAMA, 1993 Jan 20, 269(3), 384 - 9
The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome . A retrospective population-based study; Hoge CW et al.; OBJECTIVE . To determine disease incidence and changes in the epidemiology of invasive group A streptococcal infections in a community in Arizona . DESIGN AND SETTING . We retrospectively surveyed microbiology records from all 10 hospitals in Pima County, Arizona, to identify patients who had Streptococcus pyogenes isolated from blood, sterile body fluid, or tissue biopsy specimens between April 1985 and March 1990 . Demographic and clinical information was abstracted from the medical records of these patients . PATIENTS . A total of 128 patients with a median age of 53.5 years (range, 6 months to 96 years) . OUTCOME MEASURES . Racial/ethnic differences in disease incidence; mortality and changes in the clinical spectrum of disease over the study period . RESULTS . The annual age-adjusted incidence was 4.3 per 100,000 but was 46.0 per 100,000 among Native Americans . Advanced age, age less than 5 years, hypotension, and multi-organ system involvement were significantly associated with increased mortality . From 1985 to 1990, the proportion of infections with hypotension, rash, desquamation, renal impairment, and gastrointestinal involvement increased significantly (chi 2 for trend P < or = .02 for each feature) . A toxic shock-like syndrome occurred in 8% of infections since 1988, compared with none of the infections between 1985 and 1987 (P = .04) . Patients with the syndrome were younger than patients with other invasive infections (median age 15 vs 54 years, P = .02), and were less likely to have underlying medical conditions (P = .008) . CONCLUSIONS . Significant changes occurred in the spectrum of invasive group A streptococcal infections in Pima County, Arizona, between 1985 and 1990 . Native Americans were at increased risk of acquiring these infections . Patients with the streptococcal toxic shock-like syndrome had epidemiologic features that distinguished them from patients with other invasive infections, including younger age and less underlying illness.

FEMS Microbiol Lett, 1993 Jan 15, 106(2), 171 - 5
Deletion analysis of the essentiality of penicillin-binding proteins 1A, 2B and 2X of Streptococcus pneumoniae; Kell CM et al.; An internal fragment from each of the penicillin-binding protein (PBP) 1A, 2B and 2X genes of Streptococcus pneumoniae, which included the region encoding the active-site serine residue, was replaced by a fragment encoding spectinomycin resistance . The resulting constructs were tested for their ability to transform S . pneumoniae strain R6 to spectinomycin resistance . Spectinomycin-resistant transformants could not be obtained using either the inactivated PBP 2X or 2B genes, suggesting that deletion of either of these genes was a lethal event, but they were readily obtained using the inactivated PBP 1A gene . Analysis using the polymerase chain reaction confirmed that the latter transformants had replaced their chromosomal copy of the PBP 1A gene with the inactivated copy of the gene . Deletion of the PBP 1A gene was therefore tolerated under laboratory conditions and appeared to have little effect on growth or susceptibility to benzylpenicillin.

J Immunol, 1993 Jan 15, 150(2), 543 - 9
Repertoire diversity of antibody response to bacterial antigens in aged mice . III . Phosphorylcholine antibody from young and aged mice differ in structure and protective activity against infection with Streptococcus pneumoniae; Nicoletti C et al.; Aging in mice is accompanied by qualitative changes in the antibody repertoire to phosphorylcholine (PC), a natural epitope of certain pneumococci . The PC-specific mAb from young/adult (2-4 mo) BALB/c mice are uniformly encoded by the canonical IgV genes of T15 family, whereas the antibody from aged mice (> or = 20 mo) are molecularly heterogeneous, being encoded by various VH and VL genes of non-T15 families . Interestingly the young/adult and aged BALB/c mice produce comparable amounts of antibodies to PC regardless of the molecular shift in the antibody repertoire . This finding prompted our study on the relative ability of PC antibodies from young and aged donors to protect mice against virulent infection with type 3 pneumococci . Passive administration (i.p.) of pooled, PC-specific mAb generated from young donors (all from the T15 Ig gene family) protected the recipients against subsequent i.p . challenge with a lethal dose of Streptococcus pneumoniae strain WU2, in a dose-dependent manner . In contrast, a mixture of PC mAb from aged donors (all from non-T15 families) failed to protect the mice against the infection, even at the highest amount of administered (100 micrograms of mAb/recipient) . Average affinity of the aged mAb for the free hapten (PC-chloride) as well as their binding to the bacteria was lower than that of the young mAb . Similarly, affinity-purified serum PC antibody from S . pneumoniae vaccine-immunized young mice afforded a measurable degree of passive protection against the pneumococcal infection whereas a similar dose of serum PC antibody from aged mice did not . Further experiments showed that PC mAb from young donors were equally protective in either young or aged recipients challenged with the bacteria . These results demonstrate that the aged immune system may, in some instances, produce high levels of antibody that are structurally different and less protective against microbial infection.

J Biol Chem, 1993 Jan 15, 268(2), 1391 - 6
Disproportionating enzyme (4-alpha-glucanotransferase; EC 2.4.1.25) of potato . Purification, molecular cloning, and potential role in starch metabolism; Takaha T et al.; Disproportionating enzyme (D-enzyme, 4-alpha-glucanotransferase; EC 2.4.1.25) has been purified to homogeneity from potato tubers and its activity characterized . The enzyme catalyzes the transfer of maltooligosaccharides from one 1,4-alpha-D-glucan molecule to another, or to glucose . Maltooligosaccharides are effective donor molecules, but short chain amylose and amylopectin may also function as donors . Enzyme activity is not affected by inorganic phosphate, 3-phosphoglycerate, or hexose phosphates . A cDNA clone encoding the enzyme was isolated using oligonucleotide probes derived from partial peptide sequences of the purified enzyme . The identity of the cDNA clone was confirmed by expression in Escherichia coli resulting in D-enzyme activity . The amino acid sequence deduced from the cDNA shows significant homology with a 4-alpha-glucanotransferase from Streptococcus . The deduced sequence indicates the presence of an amino-terminal plastid transit peptide of 52 amino acid residues and a mature polypeptide of 524 residues . D-enzyme mRNA is present in leaves, stems, roots, and stolons but is most abundant in developing and mature tubers . The amount of mRNA in leaves increases in response to light and to sucrose added to the medium . These results are discussed in terms of the function of D-enzyme in potato starch metabolism.

Int J Legal Med, 1993, 105(6), 333 - 8
The potential role of bacterial toxins in sudden infant death syndrome (SIDS); Blackwell CC et al.; Toxigenic bacteria have been implicated in some cases of Sudden Infant Death Syndrome (SIDS) . Although there is not much evidence that Clostridia spp . are associated with SIDS in Britain, strains of Staphylococcus aureus producing pyrogenic toxins have been isolated from significant numbers of these infants at autopsy The pyrogenic toxins, produced by some strains of group A Streptococcus pyogenes as well as staphylococci, are powerful "superantigens" that have significant physiological effects including induction of fever > 38 degrees C . In this article, interactions between genetic and environmental factors that might enhance colonization of epithelial surfaces by toxigenic staphylococci are analyzed: infant's expression of Lewis(a) antigen which acts as a receptor for some microorganisms; viral infections; the effect of mother's smoking on susceptibility to respiratory infection . Based on epidemiological findings and laboratory investigations, a hypothesis is proposed to explain how bacteria producing pyrogenic toxins might contribute to some cot deaths.

Acta Microbiol Bulg, 1993, 29, 73 - 8
Radiometric study on the invasion capability of Streptococcus pyogenes A49 L-forms in tissue cultures; Ivanova E et al.; By a radiometric method using C14 labelled amino acid mixture it was established that the Streptococcus pyogenes A49 L-forms cells invade tissue cultures MK and F in a similar degree as parent bacterium cells . The L-form cells are not able to enter the HeLa and Pulmo tissue culture cells but the parent bacterium cells produce well expressed peak of isotope take-up at the 8th hour of the observation.

Trop Geogr Med, 1993, 45(2), 70 - 2
Endocarditis in Ethiopia . Analysis of 51 cases from Addis Ababa; Hodes RM; Fifty-one cases of infective endocarditis in 47 Ethiopians over several years are analyzed . There were 32 males and 19 females, average age was 20.5, with 34 < or = 20 . Only 2 patients had a known source of infection . Forty-four cases had underlying rheumatic heart disease, 7 had congenital heart disease of which 5 had patent ductus arteriosus . Staphylococcus aureus and S . epidermidis were the most commonly cultured organisms (10 each), only 1 streptococcus was isolated; 28/47 cultured cases had negative cultures . Eight patients (16%) died . In comparison with western studies, this group was much younger and had a higher prevalence of rheumatic heart disease . Mitral valve prolapse and degenerative valvular disease common in the West were not seen in this population . The rate of negative cultures was much higher than the 5-10% reported in the west, most likely due to previous use of antibiotics and problems with culture techniques.

Scand J Infect Dis, 1993, 25(2), 165 - 70
Capsular types and susceptibility to penicillin of pneumococci isolated from cerebrospinal fluid or blood in Denmark, 1983-1988; Nielsen SV et al.; By means of the capsular reaction test, we typed 2,294 pneumococcal strains isolated from blood or cerebrospinal fluid (CSF) in Denmark during 1983-88.91% of the strains belonged to types included in the 23-valent vaccine . Among 254 pneumococcal isolates from blood and CSF from Danish children, types 6A + 6B, 18C, 14, 7F, 1 and 19F, in that order of frequency, were the most common ones, accounting for 68% . Among 2,031 pneumococcal strains from adults, the most common isolates were types 1, 3, 14, 7F, 4, and 6A + 6B, accounting for 50% of all pneumococcal strains isolated from patients with invasive disease . Penicillin-resistant invasive strains of Streptococcus pneumoniae are rare in Denmark (< 1%).

Med Trop (Mars), 1993 Jan-Mar, 53(1), 13 - 7
{Study of antibiotic sensitivity of Streptococcus pyogenes isolated in the hospital milieu (Charles Nicolle hospital of Tunis)}; el Bour M et al.; The purpose of the present work was to investigate the susceptibility of S . pyogenes to antimicrobial agents . The strains have been taken from the bacteriological Service of Charles Nicolle's hospital at Tunis, and that during the period from January 1988- to December 1990 . The antibiogram results as well as the minimal inhibitrice concentration determined by the agar diffusion technique, reveal that S . pyogenes continues to be very susceptible to the beta-lactamins (M.I.C . of penicillin G is "0.15 for 50% of strains tested . Resistance are noted for chloramphenicol; tetracycline and novobiocine (13%, 93%, 80%) not considered as good antibiotics anti-streptococcies . The macrolids are effective against S . pyogenes (100% of susceptibility) that's they are considered as the best alternating antimicrobiologents to the beta-lactamins (M.I.C . of erythromycin is 0.015.

Bull Soc Pathol Exot, 1993, 86(1), 29 - 34
{Clinical and biological aspects of a collective alimentary toxi- infection by group A streptococcus in a military unit stationed in Djibouti}; Bercion R et al.; An outbreak of streptococcal pharyngitis due to a group A beta-hemolytic streptococcus has occurred in a French Army unit based in Djibouti during the month of september 1991 . Out of 304 sick soldiers, 73% were seen by a physician in the initial 48 hours of the outbreak . All the patients showed a sore throat, associated with myalgia and rachialgia (85%), headache (26%) and digestive signs (24%) . They were given a systematic antibiotic therapy by a penicillin or a macrolide, so no post-streptococcal complication was observed . From 23 throat swabs, 10 Streptococcus pyogenes strains were recovered with identical chimiotype, antibiotype and serotype (T:11, M non typable) . Five serological assays were performed on 33 paired (early and 15 days later) samples of serum: ASLO (latex agglutination and microtitration), ASH, ASD and ASK . ASLO microtitration with ASD appear to be the most profitable association . The cost of such an outbreak is very heavy . More, the operational capacity of this unit was seriously compromised as long as 6 days . Measures to be applied are those used for the prevention of foodborne diseases, including medical surveillance of the cooking staff and strict observance of cool conservation of cooked meals and foods.

Sci China B, 1993 Jan, 36(1), 75 - 80
Structure analysis of streptococcal protein G Fc binding domain; Cai SY et al.; The gene fragment (191 bp) encoding protein G IgG Fc binding domain was isolated by PCR from group G streptococcus (CMCC32138), and a clone containing this gene fragment was found to give fine reactivity to human IgG when expressed in Escherichia coli . The complete nucleotide sequence of the gene fragment was determined . One base pair differs from previously reported protein G nucleotide sequences, and results in an amino acid change (Ala-Thr), but this variation makes no difference in binding to the IgG Fc part by ELISA . The secondary structure of the protein G IgG Fc binding domain has been estimated by circular dichroism and assigned by computer algorithm . It shows a typical alpha-helix region in this domain . By breaking this alpha-helix region with recombinant DNA techniques, a 44 peptide, which contained the N-terminal 27 amino acid residues of this domain, was expressed in E . coli and showed no reactivity to IgG . The hydropathicity of this domain was also analyzed and compared with that of protein A relevant domain . Some similarity was found . These results suggest that the binding mechanism of protein G to the IgG Fc part depends on hydrophobic action which comes from the alpha-helix in protein G molecule, just as protein A binding to IgG Fc part.

Microbios, 1993, 73(297), 269 - 80
Deoxyribonucleic acid relatedness and phenotypic characteristics of oral Streptococcus milleri strains; Taketoshi M et al.; Strains of oral Streptococcus milleri group were compared with the type strains of Streptococcus anginosus, S . intermedius, and S . constellatus by DNA-DNA hybridization at 60 degrees C . Of the 29 strains tested, twelve, twelve, and two strains were closely related to S . anginosus ATCC 33397T, S . intermedius ATCC 27335T, and S . constellatus ATCC 27823T, respectively . Generally, the strains classified in the S . anginosus group in DNA homology were non-beta-haemolytic and belonged to API S . milleri II and biotype I (lactose fermenting), whereas the strains of S . constellatus group were beta-haemolytic and belonged to API S . milleri I and biotype II (lactose non-fermenting) . The strains of the S . intermedius group were all non-beta-haemolytic and belonged to API S . milleri II and mostly biotype II (lactose fermenting) . Furthermore, all except one strain of the S . anginosus group were Lancefield group A/serotype a (A/a), ungroupable/serotype b (-/b), C/c, -/d, -/e, F/f or G/k, whereas those of the S . constellatus group were F/- . The strains of the S . intermedius group were -/g, -/h, -/i, -/j, or -/-.

Eur J Clin Microbiol Infect Dis, 1993 Jan, 12(1), 51 - 4
Evaluation of a rapid latex test for direct detection of Streptococcus agalactiae in various obstetrical and gynaecological disorders; Quentin R et al.; Cervical samples collected during speculum examination in 413 women were tested for the presence of Streptococcus agalactiae by Gram staining, a new latex agglutination test and standard cultures . The results of each method are reported in correlation with the clinical circumstances of isolation . Gram stain and the latex agglutination test had a sensitivity of 30% and 78%, and a specificity of 89% and 98% respectively compared with culture . The sensitivity of the latex agglutination test was higher in cases of premature rupture of membranes (90%), presumed chorioamnionitis (86%), presumed post-partum endometritis (86%) and presumed salpingitis (87%) . This latex agglutination test appears to be useful for identifying patients who are heavily colonized with Streptococcus agalactiae and are at a high risk of infection.

Microbios, 1993, 73(295), 135 - 44
Flow chamber study of the adhesion of Prevotella intermedia to glass after preconditioning with mutans streptococcal species: kinetics and spatial arrangement; Cowan M et al.; The adhesion kinetics and spatial arrangement of a clinical isolate of Prevotella intermedia on bare glass and on glass which had been previously exposed to Streptococcus rattus or Streptococcus cricetus were studied using a parallel plate flow system and image analysis . When S . cricetus was the preconditioning organism the initial deposition rate and efficiency of P . intermedia were reduced even though very few S . cricetus adhered during flow with P . intermedia . Preconditioning with S . rattus had less effect on the adhesion behaviour of P . intermedia despite the fact that more S . rattus cells adhered than S . cricetus cells . Small differences in both the stationary state adhesion and in the final spatial arrangements were evident under the three experimental conditions . S . cricetus negatively influences initial deposition of subsequent P . intermedia adhesion possibly by the production of a biosurfactant or by leaving 'microbial footprints' . This interference is eventually overcome resulting in a similar stationary state adhesion of P . intermedia as found without S . cricetus preconditioning . Furthermore, the flow chamber system employed here proved uniquely suited for studying cell-cell interactions in initial adhesion.

Clin Ther, 1993 Jan-Feb, 15(1), 46 - 56
Comparative evaluation of cefadroxil and cephalexin in children and adolescents with pyodermas . Cefadroxil Once Daily Pyoderma Study Group; Linder CW et al.; This randomized, multicenter study compared the safety and efficacy of cefadroxil with that of cephalexin for the treatment of pyodermas in children and adolescents (1-18 years of age) . Cefadroxil was given as a single oral daily dose of 30 mg/kg, and cephalexin 30 mg/kg/day was given in two divided doses . The maximum daily dose for both drugs was 1 gm, and treatment was administered for 10 days . Clinical and bacteriologic evaluations were made on days 4 or 5 during therapy and 2 to 4 days after therapy was completed . Of the 462 patients enrolled in the study, 156 patients in the cefadroxil group and 133 patients in the cephalexin group were evaluable . Staphylococcus aureus (56% of isolates) and Streptococcus pyogenes (39% of isolates) were isolated most frequently . The bacteriologic response was statistically greater in the patients treated with cefadroxil than in those treated with cephalexin (96% versus 89%; P = 0.042) . A satisfactory clinical response was reported in 147 (94%) cefadroxil-treated patients and 122 (92%) cephalexin-treated patients (P = 0.476) . The overall effective response to treatment was significantly higher with cefadroxil than with cephalexin (94% versus 86%; P = 0.024) . Compliance with 9 or 10 days of therapy was similar in both treatment groups, although there was a difference between the two treatment groups with respect to completion of medication regimen: 95% of patients taking cefadroxil once daily--versus 65% of patients taking cephalexin twice daily--took 100% of their medication (P < 0.0001) . Adverse events were infrequent and mild . The results of this study demonstrate that once-daily cefadroxil offers greater bacteriologic eradication and a better overall effective response than twice-daily cephalexin for the treatment of pyodermas caused by gram-positive pathogens in children and adolescents.

J Gen Microbiol, 1993 Jan, 139 ( Pt 1), 67 - 77
Chromosome organization of Streptococcus mutans GS-5; Hantman MJ et al.; Twenty-eight genetic loci have been physically mapped to specific large restriction fragments of the Streptococcus mutans GS-5 chromosome by hybridization with probes of cloned genes or, for transposon-generated amino acid auxotrophs, with probes for Tn916 . In addition, restriction fragments generated by one low-frequency-cleavage enzyme were used as probes to identify overlapping fragments generated by other restriction enzymes . The approach allowed construction of a low resolution physical map of the S . mutans GS-5 genome using restriction enzymes ApaI (5'-GGGCC/C), SmaI (5'-CCC/GGG), and NotI (5'-GC/GGCCGC).

Int Orthop, 1993, 17(1), 51 - 3
Osteomyelitis of the pubic symphysis due to Streptococcus anginosus . A case report; Gil-Garay E et al.; An unusual case of osteomyelitis of the pubic symphysis in an insulin-dependent diabetic is reported . The infection occurred after the insertion of a penile prosthesis and the organism was streptococcus anginosus . Healing took place after wide excision and drainage, with penicillin given systemically.

Caries Res, 1993, 27(1), 43 - 50
pH changes in human dental plaque from lactose and milk before and after adaptation; Birkhed D et al.; pH changes in human dental plaque in vivo from lactose and milk have been studied in four separate mouthrinse experiments . (1) pH was measured in plaque samples of 12 subjects before and after 6 weeks of frequent daily mouthrinsing with 10% lactose . The pH decreases were significantly more pronounced after the adaptation period than before (p < 0.001), 4 of the 12 subjects showing about the same low plaque pH from lactose as from glucose . (2) Similar to the previous experiment, frequent daily mouthrinsing with low-fat bovine milk in 10 subjects resulted in more pronounced pH decreases in plaque after an adaptation period of 4 weeks (p < 0.001) . (3) Single mouthrinses, without any prior adaptation, with bovine standard milk, human breast milk, lactose-hydrolysed bovine standard milk, 5% lactose and 5% sucrose were compared regarding the effect on plaque pH in 7 subjects . All solutions resulted in pH falls . The most pronounced were found with sucrose, followed by the lactose-hydrolysed milk . (4) Bovine standard milk, 5% lactose and 10% sucrose were compared after a single mouthrinse in 5 subjects using interdental plaque pH wire telemetry . Lactose and milk were fermented more slowly than sucrose . In a separate study, acid production from lactose was also measured in two oral strains each of Streptococcus mutans, Streptococcus salivarius and Streptococcus sanguis . The results from these experiments indicated that at least part of the lactose transport and catabolism in all studied streptococcus strains seems to be regulated by inducible enzymes.

Caries Res, 1993, 27(1), 26 - 30
Mixed continuous cultures of Streptococcus mutans with Streptococcus sanguis or with Streptococcus oralis as a model to study the ecological effects of the lactoperoxidase system; van der Hoeven JS et al.; Mixed continuous cultures of Streptococcus species were obtained, using complex carbohydrate (mucin) as a source of nutrients, to study the ecological effects of oxygen and the lactoperoxidase system . S . mutans NCTC 10449 was unable to grow as a pure culture on mucin, but attained a significant population size in the presence of S . oralis and S . sanguis strains . The cell densities of the anaerobic mixed cultures decreased when oxygen was supplied, and S . mutans was more suppressed by oxygen than were S . sanguis and S . oralis . However, the concentrations of hydrogen peroxide (30 mumol/l in the mixed culture of S . mutans with S . sanguis and 640 mumol/l in the culture with S . oralis) indicated a certain resistance of the organisms to hydrogen peroxide . Addition of lactoperoxidase and thiocyanate to the oxygen-supplied cultures had a differential effect on the streptococcal populations . While S . mutans was inhibited, and even disappeared in the culture with S . oralis, the growth of S . sanguis and S . oralis was unaffected . This latter observation was in accordance with the OSCN- reductase activities of these organisms . When hydrogen peroxide was also added together with lactoperoxidase and thiocyanate, a further inhibition of S . mutans in the culture with S . sanguis was observed . Under these conditions, S . oralis was also inhibited, perhaps by the strong accumulation of OSCN-, exceeding the capacity of the OSCN- reductase . The effects of lactoperoxidase on mixed cultures may reflect the situation in the mouth.(ABSTRACT TRUNCATED AT 250 WORDS)

Biol Neonate, 1993, 63(2), 86 - 95
Comparative disposition kinetics of 111In-labeled group B streptococcus and neutrophils during onset of sepsis-induced pulmonary hypertension; Aziz SM et al.; Little is known of the time course by which intravascular group B streptococcus (GBS) distributes into the infant lung, though the prompt onset of pulmonary hypertension in GBS-infected animals suggests that bacteria interact initially with a resident lung cell or that they promote rapid pulmonary influx of circulating effector cells . Using external gamma scintigraphy to monitor the organ-specific disposition kinetics of 111In-oxine-labeled GBS in anesthetized piglets, we found that 80% of the infused bacteria rapidly distributed into the lung and that pulmonary bacterial uptake exhibited a close temporal relationship with the onset of pulmonary hypertension . Companion studies demonstrated that the extent of pulmonary 111In-neutrophil sequestration was unaffected by GBS, although a neutrophil secretagogue, phorbol myristate acetate, caused rapid pulmonary neutrophil uptake . These observations support the hypothesis that the onset of pulmonary hypertension in GBS sepsis can be attributed to interactions between the bacteria and resident lung cells.

Schweiz Monatsschr Zahnmed, 1993, 103(2), 150 - 5
{Does the application of a fluoride lacquer modify the de- and remineralization of initial carious lesions in vitro?}; Hellwig E et al.; Bovine enamel specimens with artificial initial lesions were fluoridated with a fluoride lacquer (Duraphat) for 6 hours . Subsequently artificial plaque (Streptococcus mutans, FA1) was grown on the enamel blocks in an artificial mouth . During the experimental period (23 days) the specimens were continuously rinsed with synthetic saliva and with sucrose twice daily . Nonfluoridated specimens served as controls . At the end of the experiment microhardness was evaluated in three levels parallel to the enamel surface . In addition, the concentration of KOH-soluble and structurally bound fluoride was determined . In the fluoridated specimens microhardness increased in levels near the surface of the lesion, but decreased in the next two lower levels . However, in the nonfluoridated enamel specimens microhardness decreased in all three levels and was more pronounced compared to the fluoridated specimens . At the end of the experiment no KOH-soluble fluoride could be determined on the surfaces of the artificial lesion . In contrast, structurally bound fluoride was significantly increased in the fluoridated specimens . A single application of the fluoride lacquer on initial enamel lesions resulted in remineralization of the outer enamel layers even under persisting cariogenic conditions . However, lesion progression could not be inhibited totally.

Postgrad Med J, 1993 Jan, 69(807), 64 - 5
Pyomyositis complicating pneumococcal meningitis; Robertson-Mackay F et al.; A young male with a previous splenectomy presented with Streptococcus pneumoniae meningitis complicated by pyomyositis . Pneumococcal meningitis in asplenic patients is well recognized, but the association of pyomyositis as a complication has not to our knowledge been previously reported.

Chemotherapy, 1993, 39(1), 22 - 31
Contributions of post-antibiotic lag and repair-recovery to the post-antibiotic effects of ciprofloxacin on Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pyogenes; Howard BM et al.; A viable counting technique was used to determine the post-antibiotic effect (PAE) of ciprofloxacin against four bacterial species, treated with either one or four times the minimum inhibitory concentration for 1 or 3 h . PAE were demonstrated with Escherichia coli, Staphylococcus aureus or Streptococcus pyogenes after exposure to either concentration for both times . No clear PAE was demonstrated for Klebsiella pneumoniae after any treatment . In some cases, PAE was due to an increased post-treatment lag phase, which was followed by nearly normal multiplication, whereas in other cases a long lag was followed by abnormally rapid cell division, with the generation times of treated cultures being much less than those of the corresponding drug-free controls . This is evidence of recovery of cells that have completed DNA repair . S . aureus, E . coli and K . pneumoniae all exhibited evidence of this type of repair even though K . pneumoniae gave no significant PAE . However, the post-treatment generation times of S . pyogenes, which produced the greatest PAE, gave no evidence of such repair . It is concluded that PAEs may result from a variety of factors.

Am J Perinatol, 1993 Jan, 10(1), 1 - 4
Perinatal infections with Streptococcus pneumoniae; Kaplan M et al.; Perinatal infections with Streptococcus pneumoniae although rare, have caused morbidity and mortality in both neonatal and puerperal patients . To determine the incidence of proven pneumococcal sepsis in these patient groups, blood culture records from 1977 to 1989 were reviewed . Of 89 parturient patients with true positive blood cultures, two (2.2%) were positive for the pneumococcus, whereas of 240 infants with positive blood cultures, three (1.25%) grew pneumococcus . The incidence of maternal pneumococcal sepsis was 0.04/1000 live births, and that of the neonates, 0.06/1000, and the overall rate for sepsis in these two groups was 1.7 and 4.7/1000 live births, respectively . In three mother-infant pairs, the identical pneumococcal serotypes, 7, 18, and 23, were isolated from both mother and infant . Birthweights and gestational ages of the infants ranged from 2330 to 3730 gm and 34 to 40 weeks, respectively . Respiratory distress and poor peripheral perfusion were the predominant clinical signs in the infants with sepsis and became apparent from shortly after birth until 5 days of life . Pyrexia, poor general condition, and leukocytosis characterized the mothers with sepsis . All patients survived following antibiotic and supportive care . Our epidemiologic survey confirms the rareness of perinatal pneumococcal infection and the ability of these organisms to cause morbidity in both mothers and infants.

Microbios, 1993, 73(294), 23 - 35
Four different types of glucans synthesised by glucosyltransferases from Streptococcus sobrinus; Hanada N et al.; Four different kinds of glucosyltransferases (GTFs) were purified from the cariogenic bacterium Streptococcus sobrinus AHT . One of them (GTFP3) produced water-insoluble glucan with the alpha-1,3 linkage, exclusively . The others (GTFP1, P2 and P4) produced water-soluble glucans . GTFP2 produced oligosaccharides with linear 1,6-alpha-D-glucan structure . Since GTFP1 and P4 produce similar molecular weight glucans, the structural differences between these glucans remain unclear . To clarify the difference between GTFP1 and P4 products, the glucan structures were investigated by methylation analysis with gas liquid chromatography and gas liquid chromatography-mass spectrometry . The glucan synthesised by GTFP1 was 1,6-alpha-D-glucan with a high percentage (25.9 mol%) of 1,3-alpha-D-linked units . The other glucan synthesised by GTFP4 contained 1,6-alpha-D-glucan with 1,3,6-alpha-D-glucose (18.5 mol%).

Intensive Care Med, 1993, 19(1), 53 - 6
Group A beta-haemolytic streptococcus septicaemia: the toxic strep syndrome . Report of our cases developing septic shock and multiple organ failure; Soravia C et al.; During the last two decades, severe group A beta-haemolytic streptococcal infections have been defined as the "toxic strep syndrome", and have been reported not only in immunocompromised or elderly people, but also occasionally in previously healthy patients . We describe 4 patients presenting with the toxic strep syndrome, requiring surgery and intensive care, and briefly review the related literature . Fatigue, localized pain and other nonspecific symptoms were associated with the onset of the disease, followed by septic shock with multiple organ failure . Early diagnosis and surgical intervention, if necessary, are mandatory . Subsequently, appropriate supportive treatment of vital organ dysfunction and penicillin as the antibiotic of choice represent the cornerstones of the management of this syndrome.

Pediatr Res, 1993 Jan, 33(1), 10 - 4
Effect of group B streptococcal sepsis on diaphragmatic function in young piglets; Murphy TD et al.; Recent studies indicate that diaphragmatic pressure generation (Pdi) is impaired by bacterial infection . However, group B streptococcus (GBS) had no effect on Pdi when infused into 4-wk-old piglets . As responsiveness to GBS is age-dependent, we therefore studied the acute effect of GBS infusion on Pdi, using a younger, 2-wk-old piglet model . Using trans-Pdi with phrenic nerve stimulation, we studied the effect of continuous GBS infusion in seven anesthetized, spontaneously breathing 2-wk-old piglets . Pdi was measured under baseline conditions (50% O2/50% N2) and at 1, 2, and 4 h of GBS infusion . GBS was infused at a rate which caused a doubling of the pulmonary artery pressure but which avoided hypotension or acidosis--both of which can decrease Pdi . In addition, the piglets were kept hyperoxic {PaO2 > 13.3 kPa (100 torr)}, and no piglet with hypercapnia {PaCO2 > 8.7 kPa (65 torr)} was included, as hypoxia and hypercapnia can also cause respiratory muscle dysfunction . For the GBS group, diaphragmatic contractility declined significantly by 1 h at 30-, 50-, and 100-Hz stimulation frequency and, by 2 h, was significantly decreased at all frequencies . We conclude that 2-wk-old piglets, in contrast to 4-wk-old piglets, demonstrate a decline in Pdi during GBS infusion . These data demonstrate an age-related response to GBS in the piglet.(ABSTRACT TRUNCATED AT 250 WORDS)

Can J Vet Res, 1993 Jan, 57(1), 49 - 52
Production of capsular material by Streptococcus suis serotype 2 under different growth conditions; Gottschalk M et al.; The procedure currently used for the production of Streptococcus suis antigen is very long and includes several subcultures . The aim of the present work was to study the in vitro production of capsular material by S . suis serotype 2 after each of these subcultures . The amount of capsular material produced was evaluated by electron microscopy using bacterial cells grown on blood-agar plates and in Todd-Hewitt broth (THB) or THB supplemented with serum . In addition, the production of antibodies in rabbits with antigens produced using different growth conditions was compared . Antigens produced after only three subcultures possessed as much capsular material as cells obtained after the complete procedure and induced a similar antibody response . The use of serum as a supplement to the broth did not assure a higher production of capsule; in addition, antibody titers obtained with antigens produced in THB were as high as those obtained with antigens produced in THB supplemented with serum . We recommend the use of three subcultures in nonsupplemented broth for the production of immunogens . This revised protocol offers two main advantages: it is less time-consuming because of the limited number of subcultures and is also less expensive since nonsupplemented broths are used.

Can J Vet Res, 1993 Jan, 57(1), 19 - 24
A sandwich enzyme-linked immunosorbent assay for the detection of Streptococcus suis; Serhir B et al.; A double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) was developed for the detection and the identification of Streptococcus suis capsular types 1, 2, 1/2, 3 and 22 . The specificity of this test was first evaluated using reference strains of S . suis capsular types 1 to 28 and 1/2 as well as 15 different bacterial species susceptible to be isolated from swine . The ELISA developed was very specific for capsular types 1, 3 and 22 but it could not discriminate between capsular types 2 and 1/2 . In a second study, S . suis isolates from 328, 493, 368 and 76 diseased pigs were used to detect capsular types 1, 2 or 1/2, 3 and 22 respectively . The relative specificity and sensitivity varied between 98% and 100% . The ELISA results were in excellent agreement with the standard techniques (biochemical tests, coagglutination and capsular reaction tests) in detecting both positive and negative strains . Kappa values were 0.80, 0.99, 0.97 and 1.00 for detecting S . suis capsular types 1, 2 or 1/2, 3, and 22 respectively . To evaluate the relative-sensitivity of the test, primary cultures from 73 diseased pigs and tissue samples from 67 diseased pigs were used directly for detecting these capsular types . With primary cultures, the relative specificity and sensitivity (95.9% and 91.6% respectively) remained high and the test was very suitable (Kappa = 0.87) . The ELISA using tissue samples gave a good specificity (97.6%), a moderate sensitivity (62.5%) and a low agreement with standard tests (Kappa = 0.64).(ABSTRACT TRUNCATED AT 250 WORDS)

J Bacteriol, 1993 Jan, 175(2), 572 - 4
Saliva-binding protein (SsaB) from Streptococcus sanguis 12 is a lipoprotein; Ganeshkumar N et al.; Two lipoprotein consensus sequences (Leu-X-X-Cys) are found in the presumptive signal peptide region (positions 12 to 15 and 17 to 20) of saliva-binding protein (SsaB) from Streptococcus sanguis 12 . Three analogs of SsaB containing Cys-->Gly mutations were constructed by site-directed mutagenesis of pSA2, the recombinant plasmid expressing SsaB . {3H}palmitate was incorporated into SsaB only when the native Cys-20 residue was present . These data show that SsaB is a lipoprotein and that Cys-20 is the critical site for acylation.

Clin Exp Immunol, 1993 Jan, 91(1), 54 - 7
Relationship of in vitro phagocytosis of serotype 14 Streptococcus pneumoniae to specific class and IgG subclass antibody levels in healthy adults; Lortan JE et al.; The role of specific IgG2 antibody in the protection against serious infection with Streptococcus pneumoniae is unclear . We therefore decided to investigate the relationship between serum antibody levels and opsonization and phagocytosis of this microorganism . We have measured serum IgM, IgA and IgG subclass antibody specific for pneumococcal capsular polysaccharide and in vitro phagocytosis of serotype 14 pneumococcus by polymorphs, in healthy adults before and after immunization with Pneumovax II . IgM and IgG2 were the predominant anti-pneumococcal antibodies seen, IgA and IgG1 being present at low titre . No significant relationship of phagocytosis with specific IgM and IgA antibodies was found . However, both specific IgG1 and IgG2 antibodies in post-immunization sera correlated significantly with phagocytosis of the pneumococcus in the presence of complement (r = 0.57, P = 0.029 and r = 0.59, P = 0.022 respectively) . After heat-inactivation, the remaining opsonic activity of sera correlated only with levels of specific IgG2 antibody (r = 0.61, P = 0.0006) . Whereas phagocytosis supported by specific IgG1 and IgG2 antibody to serotype 14 pneumococcus after immunization is mediated by complement activation, IgG2-specific antibody in high titre may also be able to function by complement-independent interaction with Fc gamma receptors on polymorphs.

J Infect Dis, 1993 Jan, 167(1), 91 - 7
Comparison of the opsonic activity of human surfactant protein A for Staphylococcus aureus and Streptococcus pneumoniae with rabbit and human macrophages; McNeely TB et al.; Surfactant protein A (SP-A) is a glycosylated apoprotein that may facilitate bacterial phagocytosis and contribute to early bacterial clearance in the lung . The effect of SP-A on attachment (or ingestion) of Staphylococcus aureus and type 25 pneumococci to rabbit alveolar macrophages and human monocyte-derived macrophages was studied . SP-A bound to S . aureus and type 25 pneumococci in a calcium-dependent manner . Bacteria-associated SP-A significantly increased attachment of S . aureus, but not pneumococci, to macrophages . Increased association of SP-A-coated S . aureus with macrophages appeared to consist mainly of attachment without ingestion, as determined by bactericidal tests and release of tritiated bacterial digestion products from macrophages . Preincubation of macrophages with SP-A did not increase attachment or ingestion of S . aureus or type 25 pneumococci, with or without the addition of immune opsonins . SP-A acts as a ligand to facilitate attachment of S . aureus to macrophages but has no effect on S . pneumoniae.

Infect Immun, 1993 Jan, 61(1), 48 - 55
Comparative effectiveness of the cholera toxin B subunit and alkaline phosphatase as carriers for oral vaccines; Dertzbaugh MT et al.; The purpose of this study was to determine whether the B subunit of cholera toxin (CtxB) has adjuvant activity over and above serving as a carrier protein for orally administered vaccines . An oligonucleotide that encodes an antigenic determinant (GtfB.1) from the glucosyltransferase B gene (gtfB) of Streptococcus mutans was genetically fused to the 5' terminus of either the CtxB gene (ctxB) or the Escherichia coli alkaline phosphatase gene (phoA) . The resulting chimeric proteins were expressed in a phoA mutant strain of E . coli and then purified . The antigenicities of the proteins were confirmed by immunoblotting analysis using antisera specific for GtfB, CtxB, or PhoA . An equimolar amount of peptide on each carrier was administered by gastric intubation to mice three times at 10-day intervals . Antibody titers to the peptide, CtxB, and PhoA (in the serum, intestine, vagina, saliva, and bronchus) were determined by enzyme immunoassay . Antibody to the peptide was detected only in the sera of mice immunized with the peptide fused to CtxB . No antipeptide antibody was detected in mice immunized with the peptide fused to PhoA . The lack of detectable levels of antipeptide antibody in intestinal lavage fluid was attributed to dilution of the sample beyond the sensitivity of the assay . This was confirmed by cultivation of Peyer's patch and mesenteric lymph node tissue from mice orally immunized with the GtfB.1::CtxB chimera . Using this method, antipeptide antibody was detected in the culture fluid . We conclude that CtxB possesses unique properties that allow it to act as more than a simple carrier protein.

Infect Immun, 1993 Jan, 61(1), 323 - 8
Production, characterization, and application of monoclonal antibodies which distinguish three glucosyltransferases from Streptococcus mutans; Fukushima K et al.; Thirty-three murine monoclonal antibodies (MAbs) against the three glucosyltransferases (GTFs) (GTF-I, -SI, and -S) from Streptococcus mutans were obtained by the fusion of murine myeloma cells (P3X63-Ag8-U1) with spleen cells of BALB/c mice immunized with pure GTF-S or partially purified GTF-I from serotype c S . mutans PS14 . The immunoreactivities of these MAbs were tested by enzyme-linked immunosorbent assay and Western blotting (immunoblotting) with various GTF preparations . GTF-I and GTF-SI were expressed from two Streptococcus milleri or Escherichia coli transformants harboring gtfB or gtfC, respectively . All of the five MAbs raised against the GTF-S from PS14 reacted only with the homologous enzymes . Of these, 8 MAbs reacted only with the gtfB gene product (GTF-I), 4 MAbs reacted only with the gtfC gene product (GTF-SI), and the remaining 16 MAbs reacted with both gene products . The existence of GTF-SI in the purified GTF-I from PS14 was demonstrated by Western blot analysis using the representative monospecific MAbs . Further, the relative levels of the three GTFs in the extracellular and cellular fractions of S . mutans clinical isolates were examined by immunoblot analysis . The findings indicated that the relative level of GTF-SI, unlike that of GTF-I or GTF-S, differed markedly among isolates although the three GTFs were synthesized extracellularly by all the strains.

Infect Immun, 1993 Jan, 61(1), 314 - 22
Induction of mucosal immunity by intranasal application of a streptococcal surface protein antigen with the cholera toxin B subunit; Wu HY et al.; The level and distribution of isotype-specific antibodies in various secretions and of antibody-secreting cells in corresponding lymphoid organs and tissues were compared in mice immunized with Streptococcus mutans surface protein antigen I/II (AgI/II) conjugated to the cholera toxin B subunit (CTB), given intranasally (i.n.) or intragastrically (i.g.), with or without free cholera toxin (CT) as an adjuvant . Immunization i.n . induced stronger initial antibody responses to AgI/II in both serum and saliva than immunization i.g., but salivary immunoglobulin A (IgA)-specific antibody responses to immunization about 3 months later were not increased relative to total salivary IgA concentrations . Specific antibodies induced by i.n . immunization were as widely distributed in serum, saliva, tracheal wash, gut wash, and vaginal wash as those induced by i.g . immunization . Likewise, specific antibody-secreting cells were generated in the spleen, salivary glands, intestinal lamina propria, and mesenteric and cervical lymph nodes by either route of immunization . The strongest salivary IgA antibody response was induced by AgI/II-CTB conjugate given i.n., but the addition of CT did not further enhance it . However, free CTB could effectively replace CT as an adjuvant in i.n . immunization with unconjugated AgI/II . Booster i.n . immunization with AgI/II plus either free CT or CTB induced stronger recall serum antibody responses than conjugated AgI/II-CTB with or without CT as an adjuvant . Therefore, i.n . immunization with a protein antigen and free or coupled CTB is an effective means of generating IgA antibody responses expressed at several mucosal sites where protective immunity may be beneficial.

Chest, 1993 Jan, 103(1), 232 - 5
A three-year study of severe community-acquired pneumonia with emphasis on outcome; Rello J et al.; Fifty-eight consecutive patients with severe community-acquired pneumonia were studied prospectively during a three-year period . The group included 44 men and 14 women (mean age: 45.0 +/- 15.7 years) . The cause of pneumonia was diagnosed in 35 (60.3 percent) cases, and the most common pathogens were Streptococcus pneumoniae (37.1 percent), Legionella pneumophila (22.8 percent) and Gram-negative bacilli (11.4 percent) . The fact that Mycobacterium tuberculosis was present in four (11.4 percent) patients and Pneumocystis carinii in three (8.5 percent) is worthy of note . The overall death rate was 22.4 percent . More than 50 percent of deaths occurred within the first five days and were caused by septic shock, hemoptysis (tuberculosis) or hypoxia . However, hypoxia remains the main fatal complication and all late-occurring deaths (> 5 days) observed were due to this cause . These data could be important in planning strategies and protocols to improve prognosis.

Cardiovasc Clin, 1993, 23, 3 - 23
Acute rheumatic fever; Burge DJ et al.; During the first half of this century rheumatic fever was a common disease with significant morbidity and mortality in the United States . In the 1980s, when many clinicians were hoping this disease was a disease of the past, anxieties were renewed when outbreaks were reported in several areas around the country . Although the etiology still eludes us, insight has been gained . Environmental and genetic factors are believed to play a role in the epidemiology of this disease . Additionally, the implicated organism, the group A streptococcus, has many strains, and differences in its many proteins may determine their potential for rheumatic fever . The mechanisms leading to disease are not clear, but the streptococcus has been implicated as a source of antigens with cross-reactivity with human tissues and has been shown to modify immune mechanisms . Clinical aspects are briefly reviewed and physicians are reminded to consider rheumatic fever as a diagnostic possibility in the appropriate settings.

Acta Clin Belg, 1993, 48(3), 148 - 55
{Trends in pneumococcal infections in Belgium from 1986 to 1991}; Ducoffre G et al.; Streptococcus pneumoniae is one of the most frequent causes of pneumonia, meningitis, and otitis media . Persons at high risk are young children, elderly, and individuals with immunodeficiency or with an underlying disease . Thanks to a network ot 111 laboratories spread all over Belgium, the evolution of the number of deep isolates of S . pneumoniae has been followed from 1986 to 1991: the recorded frequency increased with a mean number of isolations per laboratory and per year rising from 3.6 in 1986 to 6.2 in 1991 . The objectives of this paper are to study the evolution of age and sex distribution of the patients, and of the origin of the isolates, and to propose solutions for slowing down this evolution.

Antonie Van Leeuwenhoek, 1993 Jan, 63(1), 29 - 34
The wall associated lipoteichoic acid of Streptococcus sanguis; Hogg SD et al.; A competitive ELISA is described for the measurement of lipoteichoic acid . The assay was used to determine the wall associated lipoteichoic acid of Streptococcus sanguis which was found to represent only 2-4% of the phenol extractable content . Extracellular lipoteichoic acid was detected even after exhaustive cell washing . This material was not the result of de novo synthesis because membrane de-polarization had no effect on the amount detected . Since extracellular lipoteichoic acid interfered with the measurement of cell surface antigen, cells were fixed with glutaraldehyde prior to assay . Lipoteichoic acid was demonstrated on the surface of fixed cells which did not leak antigen . The relevance of fixation used in antigen location studies by electron microscopy of immune-labelled cells is discussed.

J Antimicrob Chemother, 1993 Jan, 31 Suppl A, 97 - 104
The efficacy and safety of piperacillin/tazobactam in the therapy of bacteraemia; Wise R; The efficacy of the combination of piperacillin plus tazobactam was studied in 142 patients who had a bacteriologically proven bacteraemia . Seventy-three patients were bacteriologically evaluable and, of these, 55 had a follow-up blood culture; there was no follow-up culture in the other 18 patients, so that any cure could only be presumptive . Of the 55 patients who were fully followed up, 32 received only piperacillin and tazobactam and 23 also received an aminoglycoside . Overall, there were 67 cures and six failures out of 73 evaluable cases (three Staphylococcus aureus, two Staphylococcus epidermidis and one Streptococcus bovis) . There were 11 deaths, eight of which occurred in neutropenic patients . In no case was death drug related . Side-effects were mild; the commonest adverse events noted were mild elevations of liver enzymes . Piperacillin plus tazobactam appeared efficacious and safe in the therapy of bacteraemia.

Chemotherapy, 1993, 39(1), 36 - 9
Induction of resistance of Streptococcus pneumoniae to quinolones in vitro; Lafredo SC et al.; Twelve strains of Streptococcus pneumoniae were serially exposed to increasing concentrations of levofloxacin, temafloxacin, ciprofloxacin and norfloxacin for five passages . Wild-type and passaged strains were tested for susceptibility to quinolones, macrolide and penicillin G . The MIC90 data showed a 2-fold increase for levofloxacin but a 32-fold increase for ciprofloxacin, a 16-fold increase for temafloxacin and an 8-fold increase for norfloxacin . Among 16 ciprofloxacin-induced resistant strains, 14 were susceptible to levofloxacin . No cross-resistance to other antibiotics was observed.

Chemotherapy, 1993, 39(1), 32 - 5
In vitro activity of sparfloxacin compared with ciprofloxacin and ofloxacin against respiratory tract pathogens; Malmborg AS et al.; The in vitro activity of sparfloxacin, a new fluoroquinolone, was compared with ciprofloxacin and ofloxacin against 166 consecutive isolates from the upper respiratory tract of outpatients . The strains were fully susceptible to three quinolones . The antibacterial activity of sparfloxacin was comparable or better than that of ofloxacin and ciprofloxacin against all strains . Sparfloxacin was fourfold more active against Staphylococcus aureus and Streptococcus pneumoniae . The favourable MIC values and a prolonged half-life makes sparfloxacin interesting for treating respiratory tract infections in out-patient care.

Microbios, 1993, 74(301), 233 - 40
Serotype distribution, antimicrobial susceptibility, and clinical character of Streptococcus pneumoniae isolates; Ismaeel NA; Strains of Streptococcus pneumoniae (268 in toto) isolated from different infected sites in patients were serotyped, their susceptibilities to antimicrobial agents were determined, and the laboratory data were correlated with clinical information . The distribution pattern of serogroups and serotypes was different in paediatric patients (< 18 years old) when compared with that of adults . Overall, 91% of the strains were represented in a 23-valent vaccine . Only eight patients received pneumococcal vaccine before infection, and only 18 strains (6.7%) were moderately susceptible or resistant to one or more of the antimicrobial agents tested . Five strains were moderately susceptible to penicillin G, and not one was fully resistant.

Scand J Infect Dis, 1993, 25(3), 317 - 22
Detection of pneumococcal capsular antigen in the presence of penicillin in vitro; Holloway Y et al.; Eight strains of Streptococcus pneumoniae were tested in vitro for their ability to produce capsular antigen in the presence of penicillin . It was found that, provided 10(6) to 10(7) pneumococci/ml were present, capsular antigen could be detected during the 72 h in which the experiment was conducted, irrespective of whether penicillin was added at 0 h or 8 h, and even when no viable pneumococci remained . When fewer pneumococci were present, capsular antigen could not be detected at any time in the presence of penicillin . Control cultures, without penicillin, yielded detectable capsular antigen only when the threshold value of 10(6)-10(7) pneumococci/ml was reached . It is concluded that the presence of penicillin does not influence the detection of pneumococcal capsular antigen, but demonstration of this antigen is totally dependent on the number of pneumococci present.

Rev Med Interne, 1993 Jan, 14(1), 46 - 8
{Alcoholism and severe pneumococcal infection . Apropos of a case of purpura fulminans caused by Streptococcus pneumoniae}; Strobel M et al.; A 43-year old woman presented with lethal purpura fulminans caused by a Streptococcus pneumoniae infection with pneumonia, bacteraemia and meningitis . The only predisposing factor identified was severe chronic alcoholism . The high morbidity and mortality rates of pneumococcal infections in alcoholics are emphasized.

Ann Fr Anesth Reanim, 1993, 12(1), 70 - 1
{Fatal streptococcus A shock after thoracic surgery}; Theissen O et al.; A 23-year-old man with relapsing pneumothorax underwent surgical removal of left apical lung bullae and pleural rubbing down . Forty-eight hours later, he suddenly developed a state of shock together with tachypnoea, oliguria, and a scarlet-like erythema of the face and trunk . Haemodynamic and other investigations led to the diagnosis of septic shock, although no portal of entry could be found . Despite antibiotics (vancomycin, gentamycin and pefloxacine) and symptomatic treatment, the patient's condition continued to worsen . He had a fever (40 degrees C) with abdominal tenderness . Exploratory laparotomy failed to disclose a septic foyer . On aspiration of the left thoracic cavity, a large pyothorax was found and 600 mls of pus were drained . Gram-positive cocci were found on staining and pefloxacine was replaced by mezlocillin . Nevertheless, the patient died within 24 h . Blood and pus cultures confirmed that the infection was due to a pyrogenic penicillin-sensitive group A Streptococcus . Similar cases have been described recently . Group A Streptococcus is suspected to cause severe infections with multiple organ failure, termed "toxic shock-like syndrome" . The clinical similarity between the streptococcal and staphylococcal shocks calls for a precise bacteriological diagnosis, and treatment with antibiotics active on both germs.

Vaccine, 1993, 11(6), 643 - 8
Demonstration of protection in mice from a lethal challenge of three M serotypes of Streptococcus pyogenes using an M-negative vaccine; Chappell JD et al.; Mice were vaccinated with a temperature-sensitive, M-negative mutant (JC3) of Streptococcus pyogenes . This vaccine was found to offer protection from a lethal challenge of homologous M-negative and type 28 M-positive strains of S . pyogenes as well as heterologous M3 and M18 strains . Using an immunoblot method, hyperimmune serum from mice vaccinated with JC3 was found to contain moderate to high titres of antibody to all challenge strains . Additionally, this hyperimmune serum was used to probe Western blots of whole-cell proteins extracted from each of the above streptococcal strains . Three proteins were identified (M(r) = 32, 43 and 46 kDa) as immunogenic and conserved among the three serotypes studied.

Caries Res, 1993, 27(2), 135 - 9
Distribution of Streptococcus mutans and Streptococcus sobrinus at sub-sites in human approximal dental plaque; Ahmady K et al.; The distribution and prevalence of Streptococcus mutans and Streptococcus sobrinus were determined at three sub-sites in human approximal plaque: away from (A), to the side of (S) and below (B) the contact area . Small plaque samples were taken from all three sub-sites on clinically sound approximal surfaces of a single premolar from each of 21 schoolchildren . S . mutans was detected significantly more often and in higher proportions than S . sobrinus from sub-sites A (p = 0.019), S (p = 0.034) and B (p = 0.004) . S . mutans was detected in highest proportions from the B site compared to the A site (p = 0.025); there were no significant differences in the isolation frequency or prevalence of S . sobrinus from any of the sub-sites . S . mutans and S . sobrinus were never isolated together from the A sub-sites and were recovered together most commonly from the B sub-sites (p < 0.01) . It is concluded that S . mutans and S . sobrinus preferentially colonise the most caries-prone site apical to the contact area.

Pathology, 1993 Jan, 25(1), 68 - 70
Evaluation of Pharmacia Chlamydia EIA for diagnosis of genital infections caused by Chlamydia trachomatis; Chan SW; A new enzyme-immunoassay test (EIA), Pharmacia Chlamydia EIA, was evaluated in comparison with isolation in cell culture for the diagnosis of genital infections caused by Chlamydia trachomatis . Endocervical and endourethral specimens were collected from 913 patients (875 female and 38 male patients respectively) . Sensitivity, specificity, positive predictive and negative predictive values for this test were 89.4%, 99.2%, 85.8% and 99.4% respectively . Where discrepancies between the 2 techniques occurred, the remainder of the EIA buffer was stained for chlamydial antigen by direct immunofluorescence using the Syva Microtrak Chlamydia trachomatis Direct Specimen Test . Laboratory strains of various micro-organisms that may be present in genital specimens did not cross react with the EIA test except for Staphylococcus aureus and Group B Streptococcus at very high concentrations . The Pharmacia Chlamydia EIA is suitable for a laboratory which handles a large number of chlamydial specimens daily . However, when interpreting EIA results, the prevalence of chlamydial infection in the patient population should be established . At present, EIA tests are unsuitable as the only test for chlamydial diagnosis in low risk populations.

Infection, 1993, 21 Suppl 1, S17 - 20
{Possibilities for the use of 2nd generation cephalosporins in perioperative antibiotic prophylaxis}; Engemann R; Perioperative antibiotic prophylaxis has proven to prevent infections in a variety of surgical interventions such as colorectal, biliary and vascular surgery . The antimicrobial spectrum of an antibiotic used for perioperative prophylaxis should include Staphylococcus spp., Streptococcus spp . and Escherichia coli which are among the most frequent pathogens isolated from surgical infections . Second generation cephalosporins provide appropriate activity against these microorganisms . In colorectal surgery, combination with an anti-anaerobic agent is mandatory . During the past few years no major resistance development has been observed against second generation cephalosporins which are used at a dosage of 1.5 to 2 g . A single dose may provide sufficient serum levels for approximately three hours . Prolonged surgical procedures need an additional dose . Single dose prophylaxis with a second generation cephalosporin appears to be an appropriate strategy for infection prevention in surgery with regard to efficiency, safety and costs.

DNA Seq, 1993, 4(1), 19 - 27
DNA sequence of the glucosyltransferase gene of serotype d Streptococcus sobrinus; Sato S et al.; A glucosyltransferase (GTF) gene was cloned into Escherichia coli from serotype d Streptococcus sobrinus OMZ176 . Transformed E . coli strain MI expressed water-insoluble glucan synthesizing activity . Restriction enzyme map of pGT31 extracted from MI shows that the enzyme gene exists in the 6.4-KB PstI-fragment inserted into pBR322 vector . DNA sequence analysis indicates that a single ORF (530-5,300) is located in the PstI-fragment . The putative amino-acid composition (1,590 residues) resembles those of other GTF-I enzymes obtained from serotype g S . sobrinus and serotype h Streptococcus downei . However, at the same positions of the sequence, 18 and 142 amino-acid residues are different between serotype d and g, and serotype d and h GTF-I enzymes, respectively . The differences between serotype d and h GTF-Is are distributed in N and C-terminal regions.

Nephron, 1993, 65(4), 633 - 5
Spontaneous bacterial peritonitis in a hemodialysis patient with systemic lupus erythematosus; Horina JH et al.; Spontaneous bacterial peritonitis (SBP) is defined as infection of preexisting ascites without evidence for any intraabdominal source for secondary infection . SBP is now recognized with rising frequency and has mainly been reported in patients with alcohol-induced cirrhosis of the liver . We report SBP in a female dialysis patient whose ascites was not due to liver disease, but was possibly due to lupus erythematosus or represented 'nephrogenic ascites' . The patient had severe abdominal pain and a positive rebound phenomenon, fever and an elevated peripheral white cell count of 21,000 cells/microliters . Ascitic fluid analysis revealed an exudate with a protein concentration of 5.2 g/dl, 13,000 white cells/microliters with 94% neutrophils and positive cultures for Streptococcus morbillorum . Because of the dramatic clinical features the patient underwent laparotomy which did not reveal a source for secondary infection and in retrospect was unnecessary . The patient responded well to antibiotic therapy . This case report draws attention to SBP as a cause of acute abdomen in patients on chronic hemodialysis.

Microbios, 1993, 76(307), 115 - 29
Enzymatic differentiation and biochemical and serological characteristics of the clinical isolates of Streptococcus angiosus, S . intermedius and S . constellatus; Taketoshi M et al.; Of the 29 'Streptococcus milleri' strains tested, all thirteen Streptococcus intermedius (DNA homology group 2) strains but none of the thirteen Streptococcus anginosus (group 1) strains produced beta-N-acetylglucosaminidase, beta-N-acetylgalactosaminidase, alpha-N-acetylneuraminidase, beta-galactosidase, alpha-glucosidase, and hyaluronidase . The three Streptococcus constellatus (group 3) strains produced only the latter two . Glycosidase production divided 274 clinical isolates into 103 S . anginosus, 101 S . intermedius, and 70 S . constellatus strains . Generally, strains of S . anginosus and S . intermedius were non-beta-haemolytic . API II and biotype Ia (lactose positive), but the former contained almost all API III strains and belonged to Lancefield group A/serotype a (A/a), -/b, C/c, -/d, -/e, F/f or G/k, and the latter included most of biotype IId (lactose negative) and serovar -/g, -/h, -/i or -/j . S constellatus strains were beta-, alpha- or gamma-haemolytic, of API I or II but mostly biotype Ib (lactose negative), and of F/- or -/b . S . intermedius was a major member of the oral isolates . Non-oral isolates were virtually all S . anginosus (mainly urogenital isolates) or S . constellatus (the other systemic isolates).

Biotherapy, 1993, 6(3), 175 - 82
Locoregional immunotherapy of head and neck cancers utilizing allogeneic spleen cells--a report of 2 cases; Kubota E et al.; Frozen-stored human spleen cells (SC) cultured with streptococcus preparation OK-432 acquired direct cytotoxicity to autologous as well as allogeneic tumor cells . The activated cells started to produce cytocidal cytokine TGIF, which is distinct from previously known cytokines . We examined the possibility of allogeneic adoptive immunotherapy (AIT) using these OK-432-stimulated spleen cells (OK-SC) in two cancer patients . Rapid necrosis of cancer tissue and remarkable decreases of tumor markers in tumor effusion were observed . There were no severe side effects.

Scand J Infect Dis Suppl, 1993, 91, 51 - 9
Efficacy of cefpirome in the treatment of septicaemia; Norrby SR et al.; From a total of 4180 patients entered in 15 phase II-III clinical trials involving cefpirome, an analysis was carried out on 378 patients with bacteriologically confirmed or suspected septicaemia who were treated with cefpirome (n = 282) or comparator drugs (ceftazidime, n = 80; ceftriaxone, n = 15; imipenem/cilastatin, n = 1) . Gram-negative organisms were the causative pathogens in over half of the patients, with Escherichia coli being the most common species found . The most frequently isolated Gram-positive bacterium was Streptococcus pneumoniae . Causative organisms were eradicated in over 90% of patients receiving cefpirome or comparators . Only 4/230 pathogens tested were resistant to cefpirome in vitro . Among patients with bacteriologically confirmed septicaemia, a satisfactory clinical response was documented in 131/176 (74%) cefpirome vs 34/50 (68%) ceftazidime vs 5/10 (50%) ceftriaxone recipients, improvement in 39/176 (22%) vs 11/50 (22%) vs 5/10 (50%), and failure in 6/176 (4%) vs 5/50 (10%) vs 0/10 (0%), respectively . Similar results were achieved in patients with 'suspected' septicaemia . Cefpirome 1 or 2 g twice daily offers an effective treatment option for patients with septicaemia . The higher dosage regimen produced superior bacteriological clearance rates and is therefore preferable in patients with severe septicaemia.

Postgrad Med J, 1993, 69 Suppl 3, S18 - 22
Study of the antiseptic efficacy of a quick drying rubbing type povidone-iodine alcoholic disinfectant solution by the glove juice method; Kawana R et al.; The antiseptic efficacy of HAD Hand Wash (83% ethanol containing 0.5% povidone-iodine) was investigated by the glove-juice method in 29 cases amongst staff members of our university . The number of viable bacteria on the hands and fingers was counted three times, and the mean of these counts was used as the baseline value for each subject . The number of viable bacteria on both hands was the same prior to disinfection . After the hands were disinfected by rubbing with 3 ml of HAD Hand Wash until it dried, the subjects put on sterile gloves . The number of viable bacteria was counted on the right hand of all the subjects immediately after disinfection . The number of viable bacteria on the left hand was counted in 8 subjects 30 minutes after disinfection, and in 7 subjects each 1, 2 and 4 hours after disinfection . The bacteria were identified by subculture . The ratio of bacteria sterilized (bacterial reduction rate) was 75.4% immediately after disinfection, and 69.0%, 71.9%, 35.8% and 27.6% at 30 minutes, 1 hour, 2 hours and 4 hours, respectively . All of the bacteria detected were Gram-positive bacteria that were native to the sebaceous glands, sweat glands or skin surface; i.e . Staphylococcus, Micrococcus, Bacillus, and Streptococcus . The frequency of detection of Staphylococcus warneri was the highest before disinfection, followed by Staphylococcus epidermidis and Staphylococcus hominis, in that order . After disinfection, all these species showed a marked decrease in the number of bacteria . Micrococcus remained in half the subjects, while other species remained in less than one third of the subjects.

Postgrad Med J, 1993, 69 Suppl 3, S10 - 4
Bactericidal effects of povidone-iodine solution to oral pathogenic bacteria in vitro; Higashitsutsumi M et al.; Seven species of periodontal pathogenic bacteria (Bacteroides, gingivalis, Bacteroides intermedius, Bacteroides melaninogenicus, Fusobacterium nucleatum, Actinobacillus actinomycetemcomitans, Capnocytophaga spp., Eikenella corrodens) and two control species (Streptococcus intermedius, Pseudomonas aeruginosa) were selected in order to study the bactericidal effects of 10% povidone-iodine (PVP-I) aqueous solution in vitro . The PVP-I solution was diluted to 10, 20, 50, 100, 200, 400, 800, 1600, 3200, 6400 and 12800 x and contact times were 15, 30 and 60 seconds . The strongest bactericidal effects on the seven periodontal pathogenic bacteria and two control bacteria were seen at a dilution of 400 x and a contact time of 15 seconds . Based on these findings, we advocate a 0.25% solution of 10% aqueous PVP-I for oral mucosa and periodontal pocket irrigation.

J Endod, 1993 Jan, 19(1), 17 - 21
Chelate root filling cements: biological properties; Nielsen TH et al.; The purpose of this study was to test in vivo and in vitro the toxicity and the antibacterial activity of an experimental chelate cement (HN cement) using zinc oxide-eugenol cement as a reference . After subcutaneous injection of the spatulated HN cement paste in rats, it induced markedly less tissue injuries than did the zinc oxide-eugenol cement . In toxicity tests using cultures of human fibroblasts, the HN cement was found to be less toxic than the reference cement . Bacteriologically, blood agar plates inoculated with Streptococcus sanguis, Staphylococcus aureus, and the anaerobic Prevotella intermedia developed inhibition zones between 3 and 12 mm upon application of both cements . Both demonstrated marked bacteriostatic and bactericidal properties.

Caries Res, 1993, 27(6), 461 - 6
Effect of milk on cariogenesis; Bowen WH et al.; Sprague-Dawley rats fed diet 2000, infected by Streptococcus sobrinus, and offered milk or lactose-reduced milk as drinking fluids developed essentially similar caries scores as controls given distilled water . In contrast, animals given fructose or sucrose solutions developed enhanced levels of caries . Significant differences were not detected in the S . sobrinus populations among the groups . In further experiments, the addition of sucrose to milk enhanced the severity of caries scores . However, sucrose-milk solutions were significantly less cariogenic than sucrose-water solutions . Animals fed sucrose (2-5%) milk solutions harbored enhanced populations of S . sobrinus . The results, overall, suggest that milk may have modest cariostatic properties when ingested at the same time as a cariogenic challenge.

Cardiology, 1993, 83(4), 250 - 7
Infective endocarditis in the transesophageal echocardiographic era; Hwang JJ et al.; During a 45-month period, 50 consecutive patients with infective endocarditis were evaluated at the National Taiwan University Hospital with emphasis on the role of transesophageal echocardiography (TEE) in the management of these patients . Among them, rheumatic heart disease was still the most common underlying cardiac disorder (10/50, 20%), while mitral valve prolapse (8/50, 16%) and congenital heart disease (8/50, 16%) were also frequently encountered . More than one third (19/50, 38%) had no underlying heart disease . Four intravenous drug abusers, quite rare previously in Taiwan, were found during the study period . Native valves involved were mostly mitral valve (n = 18), aortic valve (n = 15), and both mitral and aortic valves (n = 3) . Tricuspid valve and pulmonic valve were involved in 3 and 2 patients, respectively . Streptococcus viridans was the leading microorganism isolated (21/50, 42%) . Staphylococci and enterococci were found in 9 (18%) and 5 (10%) patients, respectively . Twelve patients (24%) were culture-negative in this series . Embolic complications occurred in 13 patients (26%), with a total of 17 episodes . No significant correlation was found between the occurrence of embolization and the vegetation size or the location of the vegetation, if patients with right-sided valvular vegetation and no identifiable vegetation were excluded . Surgery was needed by 25 patients (50%), and mortality occurred in 6 (12%) . TEE was superior to transthoracic echocardiography in the detection of vegetations at the mitral or prosthetic valves . Concerning the associated complications with infective endocarditis, TEE was also superior in estimating the severity of mitral regurgitation, recognizing ruptured chordae tendineae and detecting subaortic complications such as valve ring abscess and mitral valve perforation.(ABSTRACT TRUNCATED AT 250 WORDS)

Ann Dermatol Venereol, 1993, 120(6-7), 441 - 3
{Streptococcus beta hemolytic necrotizing fasciitis . 5 cases in the Brussels area}; Simonart T et al.; In the Brussels area five cases of necrotizing fasciitis occurred during the past two years in patients devoid of any pathology likely to lower the immune defence mechanisms . Alcoholism and the use of non-steroidal anti-inflammatory drugs seem to act as contributory factors . Necrotizing fasciitis develops alone or as complication of a pre-existent dermo-hypodermic infection . A massive use of antibiotics and a wide surgical slitting up failed to prevent a fatal issue in all five patients . Extremely early massive surgery remains vital in this disease.

Antonie Van Leeuwenhoek, 1993, 64(1), 39 - 45
Adherence of Streptococcus gordonii HG 222 in the presence of saliva; Ligtenberg AJ et al.; The influence of the presence of saliva from different salivary glands on the adherence of Streptococcus gordonii strain HG 222 to saliva-coated polystyrene surfaces was tested . In the presence of undiluted parotid saliva or diluted whole, submandibular and sublingual saliva the adherence of HG 222 was enhanced by the formation of small aggregates on the attachment surface . In the presence of undiluted whole, submandibular and sublingual saliva large aggregates were formed and the adherence to saliva-coated polystyrene surfaces was inhibited . Adherence in the presence of whole saliva compared to adherence in buffer was decreased when lower densities of bacterial suspension were used, although in this case in the presence of whole saliva smaller bacterial aggregates were formed . In conclusion, these results suggest that the presence of saliva in solution may both enhance and decrease the adherence of S . gordonii HG 222 to saliva-coated polystyrene surfaces, partly depending on the size of bacterial aggregates that are formed in the presence of saliva.

Microbiol Immunol, 1993, 37(9), 737 - 42
Production of monoclonal anti-idiotype antibodies which mimic an M-like protein of Streptococcus equi; Jean-Francois MJ et al.; Rat monoclonal anti-idiotype antibodies (mAb2) were raised against two mouse monoclonal antibodies (mAb1), 1D10 and 2A6, with specificity for the M-like protein of Streptococcus equi . The capacity of the mAb2 to inhibit the binding between the corresponding mouse mAb1 against which the mAb2 were raised and the M-like protein was investigated in an inhibition EIA . One of the ten mAb2 examined, namely 5D1 (anti-mAb1 1D10), was able to inhibit this binding . The mAb2 5D1 bound to the mAb1 1D10 in such a way as to completely inhibit the subsequent binding of the M-like protein antigen to the paratope of the mAb1 1D10 . The mAb2 5D1 is likely to represent a true image of the M-like protein antigen and may thus be described as an Ab2 beta anti-idiotype antibody.

J Cancer Res Clin Oncol, 1993, 120(1-2), 63 - 70
Antitumor effects of GBS toxin: a polysaccharide exotoxin from group B beta-hemolytic streptococcus; Hellerqvist CG et al.; A group B streptococcus (GBS) isolated from human neonates diagnosed with sepsis and respiratory distress ("early-onset disease") produces a polysaccharide exotoxin (GBS toxin) that, when infused in sheep, causes lung pathophysiology similar to that seen in humans . Histological studies have demonstrated that GBS toxin induces a strong inflammatory response in the lung, with pulmonary sequestration of granulocytes and extensive capillary endothelial damage . The susceptibility of humans to GBS toxin is age-dependent and limited to about 4 days after birth . It is rarely evident thereafter . This suggests that the binding of GBS toxin to the target endothelium occurs via specific components in the developing lung endothelial cells of the newborn that are later lost . We report here that GBS toxin can also bind to developing endothelium associated with neoplasia and induce an inflammatory response . GBS toxin was shown by immunohistochemistry to bind to capillary endothelium of human large-cell carcinomas . In nude mice bearing human tumor xenografts, intravenously administered GBS toxin caused tumor necrosis and hemorrhagic lesions, and substantially inhibited the rate of growth of the tumors . In BALB/c mice bearing Madison lung tumors, GBS toxin induced an inflammatory response resulting in marked changes in tumor morphology, including vasodilation, endothelial and tumor cell necrosis, invasion of lymphocytes and macrophages, and capillary thrombosis . In these tumor models, no evidence of toxicity to the vasculature of other tissues was observed . The reported pathophysiology of GBS in human neonates, the lack of disease in non-neonates colonized with GBS, and these results suggest that GBS toxin may have potential as a well tolerated agent in cancer therapy of some human tumors.

Microbios, 1993, 76(306), 41 - 5
Comparative effect of salinomycin and monensin on Streptococcus bovis strain ATCC 9809; Leblanc D et al.; The effect of salinomycin (2.5 mg/l) on the in vitro growth of Streptococcus bovis strain ATCC 9809, on its catabolism of glucose and on its anabolism of lactic acid was compared with that of monensin (5.0 mg/l) . In control cultures containing no ionophore, glucose consumption and lactic acid production were completed concomitantly with maximal growth which was reached after 2 h of incubation at 37 degrees C . No further growth of S . bovis was observed within 2 h after the addition of one or the other ionophore to exponentially growing cultures . Glucose consumption and lactic acid production continued for 6 h after the addition of monensin and for 8 h after the addition of salinomycin . As observed in cultures without ionophore, glucose was totally consumed and lactic acid was stoichiometrically produced in cultures grown in the presence of one or the other ionophore . Thus, salinomycin and monensin inhibited bacterial growth but not fermentation of glucose by S . bovis.

Cancer Chemother Pharmacol, 1993, 33(2), 171 - 5
Postoperative PSK and OK-432 immunochemotherapy for patients with gastric cancer; Maehara Y et al.; We evaluated the effects of chemotherapy given postoperatively with and without immunomodulators on the survival of patients who had undergone resection for gastric cancer . We conducted a retrospective survey of data on 963 Japanese patients treated at our department of surgery between 1965 and 1987 . Data related to the duration of postoperative survival were calculated for those who received chemotherapy, i.e . an individualized combination of various agents given with or without the immunomodulators PSK, a protein extract of the fungus Coriolus versicolor, and/or OK-432, a preparation of an attenuated strain of Streptococcus (immunochemotherapy) . Postoperative immunochemotherapy was more often prescribed for patients with advanced disease . The survival of patients who received immunochemotherapy was shorter than that of patients who received only chemotherapy . In a subgroup of patients adjusted for disease stage, the survival of those on chemotherapy versus immunochemotherapy did not differ significantly at any stage . For optimal results, a protocol for postoperative immunochemotherapy needs to be designed and investigated prospectively and according to the stage of gastric cancer . The stage III gastric cancers seem amenable to a favorable response.

Microbios, 1993, 75(305), 249 - 59
Haemagglutinating activities of oral strains of Streptococcus milleri group; Yamaguchi T et al.; Of a total 148 strains of Streptococcus milleri group, 66 agglutinated sheep erythrocytes . The haemagglutinating strains were confined to serotypes g, h, i, j or were untypeable, and had no Lancefield group antigens (A to G and K), all of which have been shown to belong to Streptococcus intermedius . Cell surface hydrophobicity did not significantly differ even between the agglutinating and non-agglutinating S . intermedius strains . The haemagglutinating activity of strain 0813-1 (serotype i) was partially sensitive to heat (100 degrees C, 30 min) or trypsin (1 mg/ml, 30 min) treatment, but completely lost after the heat and subsequent trypsin treatments . Only L-arginine, L-lysine (100 mM), mucin, and fetuin (1 mg/ml) partially inhibited the haemagglutination with native bacterial cells but completely inhibited that with heated cells, whereas none was inhibitory in the reaction with trypsin-treated cells . The results suggest that at least two haemagglutinins are involved in the agglutination of the S . intermedius strain and that the heat-stable but trypsin-sensitive haemagglutinin recognizes the receptors on the erythrocyte surface which contain L-arginine and L-lysine at the reactive site.

Scand J Infect Dis, 1993, 25(4), 403 - 8
Alpha-hemolytic streptococcal bacteremia: a review of 203 episodes during 1980-1991; Watanakunakorn C et al.; This is a review of 203 episodes of alpha-hemolytic streptococcal bacteremia during a 12-year period (1980-91) in a large community teaching hospital in the USA . There were 87 male and 116 female patients, with ages ranging from newborn infants to a 96-year-old; 118 patients (58.1%) were 60 years or older . 31 patients had endocarditis, 93 had bacteremia, and 79 had polymicrobial bacteremia . Streptococcus sanguis, S . mitis, S . salivarius and S . intermedius accounted for 80% of the strains . Some strains were resistant to tetracycline, nafcillin, erythromycin or clindamycin . The overall mortality was 29.6% (60 of 203 patients) . There was no significant difference in the mortality among patients with endocarditis, bacteremia, and polymicrobial bacteremia . Factors that adversely influenced the mortality rate were old age (60 years and older) and rapidly fatal or ultimately fatal underlying conditions.

Arq Bras Cardiol, 1993 Jan, 60(1), 25 - 30
{Infectious endocarditis in a drug addict}; Jorge Sdo C et al.; PURPOSE--To compare two groups of patients with infective endocarditis, the drug addicts and non-drug addicts . We attempted to set particularities among the various aspects that involve the patient with endocarditis, due to the concurrent chronic use of cocaine intravenously . METHODS--Twenty nine patients, group B, whose clinical diagnose was compatible with infective endocarditis, with risk factor of parenteral toxicomania by cocaine were treated at Institute "Dante Pazzanese de Cardiologia" and Hospital "Emilio Ribas" in Sao Paulo, from 1984 to 1990 . The data obtained for etiological agents, previous cardiac pathology, affected heart structures, affected heart side and clinical-surgical evolutions of group B were compared to group A (193 patients), which was also composed of patients with endocarditis, without chronic endovenous use of cocaine antecedent . The data obtained were analysed comparatively according to the chi square with Yates correction . RESULTS--Male gender (89.7%) was predominate in group B towards group A (57.0%); (p < 0.01) . Previous cardiopathy, either congenital or acquired, as antecedent proning to endocarditis, was found in 89.1% of patients in group A, significantly higher than 17.2% of patients group B (p < 0.001) . Staphylococcus aureus was the most frequent agent, which accounted for endocarditis of group B in 86.4% of the cases, significantly higher when compared to 23.9% of cases of group A (p < 0.01) . Streptococcus viridans was the most frequent etiological agent for endocarditis of group A (44.8%), significantly higher than group B (4.5%), (p < 0.01) . In concern to the affected structures, the tricuspid valve was most affected in group B (65.5%), significantly higher than group A (4.7%) p < 0.001 . The mitral valve was significantly more affected in group A (45.1%) in comparison to group B (6.9%), (p < 0.05) . In group A 82 patients (42.5%) required surgical treatment and this occurred in 3 patients of group b (10.3%), (p < 0.05) . No significant statistical difference was found as for the general mortality (clinical and surgical) in both groups . CONCLUSION--a) presence of previous cardiac disease was lower suggesting permanent contamination blood flow by pathologic agents, mainly of those found in the skin as S . aureus; b) right side of the heart is most frequently affected, specially the tricuspid valve even without previous damage.

Arch Immunol Ther Exp (Warsz), 1993, 41(2), 105 - 9
Quantitation of human haptoglobin by ELISA system based on streptococcal haptoglobin receptors; Katnik I et al.; Streptococcus pyogenes cells with binding properties for human haptoglobin were used for quantitative determination of the acute phase protein, haptoglobin in various biological fluids . The S . pyogenes cells with protein surface antigen T4 served as solid phase in a microtitre ELISA system . After binding to the bacteria the amount of haptoglobin could be quantified by polyclonal or monoclonal antibodies . The constructed ELISA proved to be sensitive and correlated well with a conventional peroxidase method and with an immunoassay based on hemoglobin binding to haptoglobin.

Arch Tierernahr, 1993, 44(1), 1 - 10
Probiotics and manipulation of rumen development and function; Kmet V et al.; There is good evidence that the bacterial and fungal probiotics are effective in the manipulation of rumen development and function . The effects of adherent Streptococcus bovis preparations were manifested by significant increase of adherent S . bovis bacteria and alpha amylase activity in the rumen wall of young ruminants . Fungal probiotics based on Saccharomyces cerevisiae and Aspergillus oryzae are rapidly gaining acceptance as a means of improving productivity in adult ruminants . However, fungal probiotics may also have a complementary role to bacterial probiotics in young animals . Dietary yeast improved performance of calves and lambs in terms of feed intake and live weight gain and Aspergillus foetidus was effective in altering rumen fermentation in newly weaned lambs.

Am J Nephrol, 1993, 13(3), 218 - 22
Rapidly progressive glomerulonephritis associated with bacterial endocarditis: efficacy of antibiotic therapy alone; Orfila C et al.; A 65-year-old woman presented rapidly progressive glomerulonephritis with purpura and mitral insufficiency . Blood cultures grew Streptococcus mitis . By light microscopy, the renal biopsy revealed necrotizing glomerulonephritis 56% associated with cellular crescents and tubulointerstitial changes . By immunofluorescence, deposits of IgM and C3 were found to be present in the mesangium . Electron-microscopic study showed subendothelial and intramembranous deposits . Treatment with antibiotics alone resulted in renal recovery with disappearance of proteinuria, circulating immune complexes and cryoglobulinemia . A 2nd renal biopsy, performed after 3 months, showed segmental sclerosis and tubulointerstitial lesions . Eight months after the first hospitalization, cardiac insufficiency occurred . Four years later, a valve replacement was performed . No abnormal serum creatinine, serum creatinine clearance or urinalysis levels were present . These data suggest that rapidly progressive glomerulonephritis associated with bacterial endocarditis may be treated by antibiotics alone and result in normal and stable renal function.

Medicina (B Aires), 1993, 53(5), 401 - 7
{Prophylaxis with fluoroquinolones in patients with neutropenia}; Brodsky AL et al.; In order to evaluate whether the prophylactic use of fluoroquinolones diminishes the incidence of infections and/or mortality during neutropenia, we undertook a prospective, aleatory and controlled study in non-hospitalized adult patients with acute leukemia and chemotherapy-induced neutropenia including twenty five episodes of neutropenia including twenty five episodes of neutropenia which had occurred in 14 patients who were randomly selected either to receive or not quinolones (norfloxacin 800 mg daily or ciprofloxacin 1000 mg daily) . Both groups were similar in terms of sex, age, underlying disease, chemotherapy for hematologic malignancy, duration and severity of neutropenia . The use of quinolones was associated with a delay in the fever onset during neutropenia (p = 0.0448), a decrease in the proportion of neutropenic febrile days (p = 0.0456), a decrease of infections caused by gram-negative bacilli (p = 0.037) and an increase of Streptococcus infections (p = 0.0857) . There was no significant decrease in mortality, incidence of severe infections, proportion of neutropenic episodes without fever, empiric use of amphotericin B or fungal infections between both groups . The results of this study demonstrate that the prophylactic use of fluoroquinolones does not diminish the infectious morbidity and/or mortality in these patients.

Nat Toxins, 1993, 1(5), 263 - 70
Cytolysins increase intracellular calcium and induce eicosanoids release by pheochromocytoma PC12 cell cultures; Raya SA et al.; Cytolysins are the most commonly occurring toxins among bacteria, plants, and animals . By distributing cell membrane, they impair ionic permeability, leading to cell death . In an attempt to investigate cytolysin action on catecholaminergic neurons, we have treated pheochromocytoma cell cultures with Streptolysin S, Staphylococcus aureus alpha and delta, Stoichatus, Parcelsin, and cobra direct lytic factor . To measure neurotoxicity, PC12 cultures were loaded with 51Cr and exposed for 1 hr at 37 degrees C to different concentrations of cytolysins . Cytotoxic dose-response curves have been generated resulting in CD50 (cytotoxic dose 50%) in the range of 1-50 micrograms toxin/culture . Using subcytotoxic concentrations of cytolysins (which are of clinical relevance), changes on intracellular calcium were measured by Fura-2 fluorescence technique . Addition of either Stoichatus toxin and tetanolysin or streptococcus and staphylococcus cytolysins to PC12 cells caused rapidly or gradually a progressive increase in {Ca2+}i, respectively . Under similar conditions, samples of PC12 culture medium were assayed for 3H-arachidonic acid released and by radioimmunoassay for the content of PGE2 (prostaglandin), TXB2 (stable metabolite of thromboxane), and 5-HETE (hydroxy acid lipoxygenase product) . PLA2 was activated 4.5-6.0-fold and the levels of all three eicosanoids were increased by 2.5-9-fold (PGE2), 4-6-fold (TXB2), and over 100-fold (5-HETE) by Stoichatus and Parcelsin cytolysins . Upon treatment with Streptolysin S and staphylococcus delta toxins PLA2 (phospholipase A2) was slightly activated (1.5-fold) and the levels of PGE2 and TXB2 increased 1.3-2.0-fold and that of 5-HETE up to 30-fold.(ABSTRACT TRUNCATED AT 250 WORDS)

J Infect Dis, 1993 Jan, 167(1), 49 - 56
Streptococcus pneumoniae colonization, bacteremia, and immune response among persons with human immunodeficiency virus infection; Janoff EN et al.; Although invasive pneumococcal infections are common among men infected with human immunodeficiency virus (HIV), the prevalence of pharyngeal colonization with Streptococcus pneumoniae was not significantly different among HIV-infected patients (8 {14%} of 56) and HIV-seronegative men (9 {9%} of 99) attending a sexually transmitted disease clinic . Sixteen HIV-infected men (mean CD4+ T cell count, 132 +/- 37/microL) developed pneumococcal bacteremia, accounting for 13.6% of 117 total cases and 42% of 38 cases in men 16-55 years old . Serum killing activity, a measure of functional humoral response to S . pneumoniae, was lower in 4 (67%) of 6 acute sera and 6 (54%) of 11 convalescent sera from bacteremic HIV-infected patients when compared with baseline sera of 7 HIV-seronegative healthy subjects . These findings suggest that the high rates of pneumococcal bacteremia among HIV-infected patients may be associated with low numbers of CD4+ T cells and impaired humoral responses to S . pneumoniae rather than to increased exposure to the organism.

Biotherapy, 1993, 7(1), 47 - 54
The effect of local immunotherapy for breast cancer using a mixture of OK-432 and fibrinogen supplemented with activated macrophages; Takeda T et al.; OK-432 is an immunomodulatory agent prepared from a strain of Streptococcus pyogenes . We have previously reported that intratumoral injection of a mixture of OK-432 and fibrinogen (hereinafter referred to as OK/fbg) is very effective in the local immunotherapy for colorectal cancer . However, we found that the intratumoral injection of OK/fbg into tumor tissues of breast cancers did not always induce a strong antitumor effect . With conventional OK/fbg treatment, tumor necrosis observed in breast cancer tumors was significantly less than that in colorectal cancer tumors; the formation of fibrin meshwork and macrophage infiltration, in particular, were poor . In this study, the OK/fbg mixture was supplemented with activated macrophages for local immunotherapy of breast cancers . Macrophages were prepared from peripheral blood of breast cancer patients and activated with 0.05 mg/ml of OK-432 . Between 2-7 days before operation, a single intratumoral injection of the above mixtures was done . The addition of activated macrophages to the OK/fbg mixture resulted in marked degrees of fibrin meshwork formation, macrophage infiltration and cancer cell necrosis . These findings suggest that the recruitment of macrophages in tumor stroma and their activation are necessary for sufficient induction of antitumor immunity, and supplementation of activated macrophages at the site of immune reaction may be an alternative method for reinforcement of the antitumor effect of local immunotherapy.

J Med Liban, 1993, 41(2), 86 - 9
Bacterial meningitis with normal cerebrospinal fluid findings . Report of a case and review of the literature; Araj GF et al.; Bacterial meningitis presenting with normal initial CSF findings is rare and could be confusing to the physicians . Such an entity was observed in this first case report from Lebanon on an 8-month-old female febrile infant whose initial CSF studies were normal despite the culture yielding Streptococcus pneumoniae . Thus, this case emphasizes the need that physicians should start antimicrobial therapy, pending culture results, whenever bacterial meningitis is clinically suspected, even if initial CSF investigation of cellular, protein, sugar and gram-strain results do not reveal abnormal findings . In addition, repeat lumbar puncture should be considered in all febrile patients having clinical features suggestive of this diagnosis.

Akush Ginekol (Sofiia), 1993, 32(2), 3 - 5
{Puerperal streptococcal sepsis}; Georgiev P et al.; A series of 8 cases of puerperal sepsis caused by beta-haemolytic Streptococcus from group A is analysed, including two cases of death--of a mother and her newborn . Among the women in seven cases serotype 2 of beta-haemolytic Streptococcus from group A has been identified . The cases have been observed in the Delivery department as a result of the existing favorable conditions for the transmission of the infection . Most probably among these conditions are the negligence of the sterility of the obstetric service from the moment of admission in the ward as well as the possibility for personal contacts among the patients after delivery . The late diagnosis (after two cases of death--of a newborn and a mother) can be attributed to the atypical clinical course of the disease as well as to the negligence of the existing relatively simple methods for early diagnosis . Among the mothers in two of the cases after radical surgical treatment combined with antibiotics and in all the others--after the application of high doses of antibiotics alone, the septic conditions has been overcome . The authors stress on the existing possibilities for the development of streptococcal sepsis in the era of the effective treatment of infections caused by this agent with antibiotics and once more underline the role of the penicillins in cases of septic streptococcal infections.

Med Pregl, 1993, 46(7-8), 243 - 5
{Occurrence of group (genus) specific Chlamydia antibodies in the blood of patients with tonsillo-pharyngitis}; Milosevic V et al.; A prospective study of 108 persons form Novi Sad population aged from 1 to over 40 years with tonsylopharingitis, showed that in 21.3% of the throat smears pyogenic streptococcus was present . In the blood serum, both in streptococcus positive and streptococcus negative subjects we confirmed the presence of antistreptosolin-0-antibodies . The occurrence of these antibodies was higher (p < 0.05) in streptococcus positive patients, especially in those aged from 1 to 14 years . On the basis of simultaneously proved presence of group (genus) specific antibodies to Chlamydia organisms in 26.8% of the patients, in titre value > or = 1/64, the authors point to the necessity of further systematic studies on etiologic role of Chlamydia pneumoniae in the development of acute tonsylopharingitis.

Annu Rev Microbiol, 1993, 47, 89 - 115
Molecular analysis of the pathogenicity of Streptococcus pneumoniae: the role of pneumococcal proteins; Paton JC et al.; For many years the virulence of Streptococcus pneumoniae has largely been attributed to its antiphagocytic polysaccharide capsule . Recent evidence, however, indicates that certain pneumococcal proteins play an important part in the pathogenesis of disease, either as mediators of inflammation or by directly attacking host tissues . Pneumococci carrying defined mutations in the genes encoding any one of at least three pneumococcal proteins (the toxin pneumolysin, the major pneumococcal autolysin, and pneumococcal surface protein A) have significantly reduced virulence . Pneumococcal hydrolytic enzymes, such as neuraminidase, hyaluronidase, and IgA1 protease may also contribute to colonization and/or invasion of the host . Several of these proteins (or their detoxified derivatives) are protective immunogens in animal models and therefore warrant consideration for inclusion in human antipneumococcal vaccine formulations.

Southeast Asian J Trop Med Public Health, 1993, 24 Suppl 1, 204 - 5
Experimental research on immunological activity of Polyactin A; Zeng XY; Polyactin A is a polysaccharide extracted from cultured alpha-Streptococcus No . 33 in the mouth . It is also known as alpha-glucomannan . According to clinical reports, Polyactin A is considered to be an immunological adjuvant with significant curative effect in chemotherapy of tumors . Immunological activities of Polyactin A were studied . When injected into mice at the dosage of 100 mg/kg for 4-5 consecutive days, Polyactin A can cause a marked increase in spleen weight and RFC in spleen, and it can antagonize the immunosuppressive actions of cyclophosphamide . Polyactin A can also increase phagocytosis of macrophages in the peritoneal cavity of mice . Phagocytotic ratio and phagocytotic index in the experimental group were greater than those in the control group . Phagocytotic ratio and phagocytotic index were respectively 63.5 +/- 8.3% and 1.02 +/- 0.05% in the Polyactin A treated group but were respectively 21.0 +/- 5.7% and 0.3 +/- 0.03% in the control group . The differences were significant (p < 0.05, < 0.01) . Polyactin A had definite influence on the transformation test of lymphocytes and increased the transformation ratio of lymphocytes in vitro . The ability of Polyactin A to induce the transformation of lymphocytes into lymphoblasts was almost the same as that of PHA . These results suggest that polyactin A has a marked immunological activity, which is not entirely due to the role of large molecular weight polysaccharide . They provide direct evidence for the assumption that Polyactin A may be an immunological adjuvant, and it is experimentally confirmed that Polyactin A can protect the immunity of the organism.

Rev Fac Cien Med Univ Nac Cordoba, 1993, 51(1), 7 - 11
{Bacterial infections of the skin . Impetigo: etiology and clinical aspects}; Jalil M et al.; One hundred children with a clinical diagnosis of Impetigo are presented . Seventy of them were bacteriologically studied . The sign-symptomatology is that usually described in this type of affection . Streptococcus was the principal bacterium involved and predominated in the youngest patients . Males were more frequently affected . There were no complications which could be attributed to this pathology either by local extension or by immunological involvement.

Curr Microbiol, 1993 Jan, 26(1), 11 - 6
Molecular cloning of a chromosomal DNA region encompassing the dihydrofolate reductase gene of Streptococcus pneumoniae; Perez-Urena MT et al.; Natural competence of Streptococcus pneumoniae was used to locate and enrich DNA restriction fragments, biologically active for transformation of thymidine-deficient to thymidine-proficient cells . Mutations in the dihydrofolate reductase gene are accompanied by resistance to the drug trimethoprim (Tp) . A 6.5-kb region of the pneumococcal chromosome encompassing the dihydrofolate reductase gene has been cloned in plasmid pLS1 . Escherichia coli mutants, resistant to Tp, became fully sensitive to the drug when they harbored the recombinant plasmid . The pneumococcal dfrA mutation has been mapped within a 500-bp DNA region.

J Clin Lab Immunol, 1993, 40(4), 149 - 61
Elevated levels of IgG specific antimyosin antibodies in acute rheumatic fever (ARF): differential profiles of antibodies to myosin and soluble myocardial antigens in ARF, acute glomerulonephritis and group A streptococcal pharyngitis; Jambotkar SM et al.; Group A streptococcus is the common etiologic agent associated with group A streptococcal pharyngitis (SAP) and its sequelae: acute rheumatic fever (ARF) and acute glomerulonephritis (AGN) . However, hyperresponsiveness to cardiac antigens stemming from the shared antigenic determinants with streptococcal antigens is believed to play a role only in the pathogenesis of ARF . A Profile of IgM and IgG immune responses to soluble myocardial antigen (SMA) and myosin was evaluated in ARF, AGN and SAP . A modified ELISA measuring the area under curve (AUC) for quantitation of antibodies to SMA and rabbit muscle myosin was employed . Proteins in the SMA were resolved by SDS-PAGE . Immune responses to a major protein band of congruent to 205 kD, corresponding to the molecular weight of the heavy chain of cardiac myosin was also evaluated . In the ARF group while a significant elevation of both IgM and IgG anti-SMA antibody levels was observed, only antibodies of IgG isotype were elevated against rabbit muscle myosin and 205 kD protein of human cardiac tissue in comparison with normal controls, AGN and SAP groups . There was a significant positive correlation of antibodies against skeletal muscle myosin with antibodies against 205 kD protein of human cardiac tissue for both IgM and IgG specificities in ARF alone . The incidence of positive sera (values greater than mean + 2SD of control values) for IgM and IgG anti-SMA and antimyosin antibodies was higher in ARF than in AGN and SAP . None of the AGN and SAP sera had elevated levels of antibodies against SMA whereas low incidence of positive sera for antimyosin antibodies was observed in these groups . Although group A streptococcus etiology is associated with ARF, AGN and SAP, differential profiles of immune responses to cardiac antigens is observed in these diseases . Elevated IgG specific response to myosin and 205 kD cardiac protein was demonstrated in ARF and not in other groups with a similar etiology . It may be worthwhile, therefore to explore the possibility of using this as an additional parameter in diagnosis of ARF.

Drugs, 1993, 45 Suppl 3, 91 - 7
Quinolones in the treatment of lower respiratory tract infections in adult patients; Carbon C; The potential role of quinolones is discussed on the basis of data obtained during the past 2 years from epidemiological studies, in vitro investigations, animal experiments and clinical trials . Although the newest compounds exhibit good activity against Streptococcus pneumoniae and intracellular pathogens in animal models, the role of quinolones as first line therapy in community-acquired pneumonia is still debatable and may be modified according to clinical presentation and the rate of resistance of pneumococci to beta-lactams and macrolides . Cost-utility and cost-benefit studies are required to delineate precisely the role of quinolones in the treatment of acute exacerbations of chronic bronchitis . In addition, promising results indicating a possible future for the clinical use of quinolones in the therapy of mycobacterial infections have been obtained.

Ann Trop Paediatr, 1993, 13(2), 189 - 94
Infective endocarditis in children: profile in a developing country; Dhawan A et al.; With the object of studying the profile of infective endocarditis in Indian children younger than 16 years of age, a retrospective study of 37 patients with infective endocarditis admitted to this hospital between January 1984 and December 1990 was carried out . There were 26 boys and 11 girls (aged 2-16 years (mean (SD) 10.3 (3.8)) . Eighteen (48.6%) patients had underlying congenital heart disease, 13 (35.1%) had associated rheumatic heart disease whilst the remaining six had no pre-existing heart disease . All six patients with a normal heart and infective endocarditis had preceding extra-cardiac bacterial illnesses (epididymitis and orchitis in one, pneumonia in five) . Blood cultures were positive in only 16 (43.2%): Staphylococcus aureus was grown in nine, Streptococcus viridans in six and Candida albicans in one . Sixteen (43.2%) of the 37 patients died owing to worsening cardiovascular haemodynamics, uncontrolled septicaemia and our inability to offer emergency surgery . The profile of infective endocarditis in developing countries is different from that in Europe and the United States of America, and the disease carries a very high mortality.

Scand J Infect Dis Suppl, 1993, 88, 67 - 78
T lymphocyte responses in CVB3-induced murine myocarditis; Huber S et al.; Three monoclonal antibodies (mAB) to group A streptococcus M5 serotype (mAB 36.2.2, 49.8.9 and 54.2.8) cross-reactivity bind to various heart antigens (including myosin, tropomyosin and vimentin) and neutralize a myocarditic variant of coxsackievirus B-3 (Nancy) (CVB3) . The existence of shared antigenic epitopes between the two distinct infectious agents and the heart implies that antigenic mimicry may form the foundation of the autoimmune response . Plaque purified variants of CVB3 were isolated with these streptococcal mAB . The wild-type virus (H3) and the virus variants made with mABs 36.2.2 (H3-36) and 54.2.8 (H3-54) caused significant myocarditis in Balb/c (H-2d) mice, but not in CBA (H-2k) animals . The virus variant made with mAB 49.8.9 (H3-49) caused myocarditis in CBA, but not in Balb/c mice . No significant differences in virus concentrations in the heart were detected with any of the virus variants . Cytolytic activity of mesenteric lymph node cells generally correlated to the severity of myocarditis in the infected animals . Using overlapping synthetic peptides of the CVB3 VP1 protein, mAB 49.8.9 was shown to bind preferentially peptides 6, 8, 11, and 12 . T lymphocytes from H3 infected mice proliferated to VP1 peptides 1, 3, 9, 13, 14, and 21 . To determine whether immunity to specific peptides could affect CVB3 pathogenicity, Balb/c mice were immunized with VP1 peptides 1, 3, 6, 13, 14 and 21 in complete Freund's adjuvant (CFA) then infected with 5 x 10(4) PFU CVB3 14 days later . Pre-immunization of animals with (a) peptide 1 resulted in a significant decrease in virus titers in the heart, (b) peptides 3, 13 and 21 increased animal mortality and lymphocyte mediated cytotoxicity to uninfected cardiocyte targets, and (c) peptides 3 and 21 resulted in significant increases in myocarditis compared to animals given virus without pre-immunization.

Arzneimittelforschung, 1993 Jan, 43(1), 80 - 3
Role of interferon in the protective effect of an immunomodulator derived from the Su strain of Streptococcus pyogenes A3 against viral myocarditis in mice; Kanda T et al.; OK432 (preparation derived from the Su strain of Streptococcus pyogenes A3; Picibanil, CAS 39325-01-4) is an immunomodulator . The treatment of mice with OK432 enhances their resistance to encephalomyocarditis virus (EMCV) along with a concomitant increase of interferon (IFN) titer and natural killer (NK) cell activity . To ascertain whether IFN or NK cell activity may play a crucial role in the mechanism of resistance, we compared these strains: EMCV resistant C57BL mice, C3H mice with myocarditis and DBA/2 mice with both myocarditis and diabetes mellitus . Although IFN production in all three kinds of mice was significantly increased on day 3 after inoculation, NK cell activity in EMCV resistant C57BL mice was significantly lower than that in C3H and DBA/2 mice . The lower antiviral resistance of mice treated with both OK432 and anti-interferon antibody (aIFN) was accompanied by a reduction of serum IFN titer, irrespective of the reduction in NK cell activity . Decreased activation of NK cells by anti-asialo GM1 monoclonal antibody (aNK) of OK432-treated mice also resulted in higher viral titers . However, these titers of both OK432 and aNK-treated mice were significantly lower than those of both OK432 and aIFN-treated mice . The degree of elevation of viral titer showed the following trend: OK432 and a IFN-treated mice > OK432 and aNK-treated mice >> OK432-treated mice . Moreover, histological changes of the heart in OK432 and aIFN-treated mice were significantly (p < 0.05) more severe than that in OK432 and aNK-treated and that in OK432-treated infected mice 7 days after inoculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Appl Environ Microbiol, 1993 Jan, 59(1), 189 - 96
Regulation and cloning of the gene encoding amylase activity of the ruminal bacterium Streptococcus bovis; Cotta MA et al.; Streptococcus bovis is an important starch-degrading ruminal bacterium that has been implicated as being important in the etiology of a number of ruminal pathologies associated with diets high in grains . Previous studies with S . bovis have shown that amylase production was influenced by the growth substrate, but the nature of this regulation was not determined . The current study was conducted to better describe the regulatory phenomena and gain a better understanding of the molecular characteristics of this activity . Nutritional experiments demonstrated that the presence of starch or the starch-derived disaccharide maltose was required for maximum amylase production . Subsequent time-course experiments showed that amylase synthesis was induced by maltose and repressed by glucose, cellobiose, and fructose, while inulin and lactose had little effect on enzyme accumulation . The effects of the added antibiotics rifampin and tetracycline were consistent with transcriptional control of amylase synthesis . Analysis of S . bovis cells grown on glucose or maltose showed that they contained similar low levels of cyclic AMP, indicating that it was unlikely that regulation of amylase synthesis was mediated through a mechanism involving this nucleotide . The amylase gene from S . bovis JB1 was cloned and expressed in Escherichia coli . The amylase produced in E . coli was of lower molecular weight than that synthesized by S . bovis and had catalytic characteristics different from those of S . bovis amylase . When the gene was introduced back into S . bovis JB1, only one form of amylase activity was detected, indicating that the entire gene was present on this insert . The use of the amylase gene as a genetic probe for identification of S . bovis strains is discussed.

Biotherapy, 1993, 7(1), 39 - 45
The presence of a common antigen between human gastric cancer cells and OK-432; Ogawa K et al.; Twenty two surgical specimens of gastric cancer resected after administration of OK-432 for the skin reaction test were examined to determine whether the cancer cells had the same antigens as OK-432, a product of hemolytic streptococcus cells . When the tissues were stained by the PAP method with anti-Su streptococcus antibody used as the primary antibodies, the common antigens were demonstrated in 10 (45.5%) of the 22 . The presence or absence of the common antigens was independent of the degree of skin reaction to OK-432, and the relations of the common antigens to other host responses were not clear in this study . This is the first report for the presence of such common antigens between human gastric cancer and OK-432.

Eur J Obstet Gynecol Reprod Biol, 1992 Dec 28, 47(3), 255 - 7
Postpartum periarticular hip abscess with later coxitis caused by group B streptococcus; Brandenberger AW et al.; Intrapartum haematogenous spread of vaginal group B Streptococcus is rare, but it can lead to severe complications like abscesses, endocarditis and meningitis postpartum . We report a postpartum periarticular hip abscess caused by group B Streptococcus . Clinically it caused pain in the hip and a compression of the femoral nerve with motor and sensory component . Diagnosis was made by aspiration under computed tomography control . The only sign of infection was an increased sedimentation rate . After antibiotic treatment the symptoms disappeared and the abscess vanished, but it was reactivated 4 months after delivery, leading to arthritis of the hip joint . Another antibiotic treatment was administered for 8 weeks . 17 months postpartum the patient is well, but a development of a secondary coxarthrosis can not be excluded.

J Mol Biol, 1992 Dec 20, 228(4), 1219 - 34
Determination of the solution structures of domains II and III of protein G from Streptococcus by 1H nuclear magnetic resonance; Lian LY et al.; We have used 1H nuclear magnetic resonance spectroscopy to determine the solution structures of two small (61 and 64 residue) immunoglobulin G (IgG)-binding domains from protein G, a cell-surface protein from Streptococcus strain G148 . The two domains differ in sequence by four amino acid substitutions, and differ in their affinity for some subclasses of IgG . The structure of domain II was determined using a total of 478 distance restraints, 31 phi and 9 chi 1 dihedral angle restraints; that of domain III was determined using a total of 445 distance restraints, 31 phi and 9 chi 1 dihedral angle restraints . A protocol which involved distance geometry, simulated annealing and restrained molecular dynamics was used to determine ensembles of 40 structures consistent with these restraints . The structures are found to consist of an alpha-helix packed against a four-stranded antiparallel-parallel-antiparallel beta-sheet . The structures of the two domains are compared to each other and to the reported structure of a similar domain from a protein G from a different strain of Streptococcus . We conclude that the difference in affinity of domains II and III for IgG is due to local changes in amino acid side-chains, rather than a more extensive change in conformation, suggesting that one or more of the residues which differ between them are directly involved in interaction with IgG.

JAMA, 1992 Dec 16, 268(23), 3323 - 7
Epidemiology of invasive pneumococcal infections in children in Finland; Eskola J et al.; OBJECTIVE--To study the epidemiologic characteristics of invasive infections in children caused by Streptococcus pneumoniae to provide background data for vaccination programs . DESIGN--A nationwide laboratory-based prospective surveillance of all invasive pneumococcal infections in children during 1985 through 1989 . SETTING--A network of all microbiologic laboratories and pediatric wards in Finland . PATIENTS--Children aged 0 to 15 years who were admitted to a hospital with S pneumoniae isolated from blood, cerebrospinal fluid, or deep aspirate sample . RESULTS--Four hundred fifty-two invasive pneumococcal infections were diagnosed in 1985 through 1989 . The annual incidence rate was 8.9 per 100,000 children less than 16 years of age (24.2 per 100,000 among children less than 5 years of age and 45.3 per 100,000 among those less than 2 years of age) . The most common clinical entities were bacteremia without focus (310 cases), pneumonia (66 cases), and meningitis (51 cases), with other focal infections seen in 25 cases . The pneumococcal groups/types 14, 6, 19, 7, 18, and 23 comprised 78% of all invasive infections . CONCLUSIONS--Streptococcus pneumoniae is a common cause of invasive infections in children in Finland . A pneumococcal conjugate vaccine containing the six most common groups/types could prevent up to 70% of invasive pneumococcal infections of children in Finland if fully protective in infancy.

JAMA, 1992 Dec 16, 268(23), 3328 - 32
Epidemiology of invasive childhood pneumococcal infections in Israel . The Israeli Pediatric Bacteremia and Meningitis Group; Dagan R et al.; OBJECTIVE--To study the epidemiology of childhood pneumococcal invasive infections in Israel as a background for immunization programs . DESIGN--A 2-year (October 1988 through September 1990) prospective, nationwide surveillance of all invasive pediatric pneumococcal infections . SETTING--All 25 medical centers hospitalizing children in Israel, including all laboratories performing blood cultures from pediatric patients . PATIENTS--Infants and children aged 0 to 12 years visiting the pediatric emergency department or hospitalized in pediatric departments were included if Streptococcus pneumoniae was isolated from blood or cerebrospinal fluid . RESULTS--Four hundred sixty-nine invasive infections were diagnosed . Pneumonia, bacteremia without apparent focus, meningitis, and cellulitis were found in 39%, 37%, 17%, and 3%, respectively . The annual incidence was 42 per 100,000 for children younger than 5 years of age (104 per 100,000 for those < 12 months old) . The two most common serotypes were 1 and 5, which are rare in Western Europe and North America . Eight groups comprised 82% of all invasive infections . Extrapolated to a population in which 100,000 live births occur yearly, the total annual hospitalizations for pneumococci infections was calculated to be 1928 days . The overall case-fatality rate was 2.2%, but it was 30% during the first month of life . CONCLUSIONS--Pneumococcal invasive infections are common in children in Israel and carry considerable morbidity.

FEMS Microbiol Lett, 1992 Dec 15, 79(1-3), 67 - 70
Enzyme-linked immunosorbent assay for the detection of antibodies to exocellular proteins of Staphylococcus aureus in bone infection; Lambert PA et al.; An enzyme-linked immunosorbent assay (ELISA) was developed for measurement of the antibody response to exocellular protein antigens of Staphylococcus aureus . The wells of a microtitre plate were coated with the exocellular proteins present in the tryptic soya broth growth medium from a stationary phase culture of a bone infection strain of S . aureus . The wells were then reacted sequentially with patient sera, protein A-peroxidase conjugate and chromogenic substrate . Serum from patients with S . aureus bone infection gave a significantly higher IgG titre than sera from patients with Staphylococcus epidermidis or Streptococcus sanguis bone infection or healthy uninfected individuals . The assay therefore appears to have potential in the serodiagnosis of S . aureus bone infection.

Biochem Biophys Res Commun, 1992 Dec 15, 189(2), 1184 - 8
Molecular genetic analysis of the catalytic site of Streptococcus mutans glucosyltransferases; Kato C et al.; In the present communication molecular genetic approaches have been utilized to confirm the nature of the catalytic site of Streptococcus mutans glucosyltransferases (GTF)s . Site-directed mutagenesis was used to convert the putative sucrose binding Asp-451 of the GTF-I enzyme from S . mutans GS5 to Glu, Asn, and Thr . All three of the resulting mutated enzymes displayed no detectable sucrase or GTF activities . By contrast, mutation of nearby Asp residues did not markedly reduce enzymatic activity . The inactive enzymes also appear to bind acceptor dextrans as well as the parental enzyme . These results confirm the essential role of Asp-451 of the GTF-I from strain GS5 and analogous Asp residues in other related GTFs in enzymatic activity.

FEMS Microbiol Lett, 1992 Dec 15, 79(1-3), 439 - 47
Structural analysis and biological significance of the cell wall lytic enzymes of Streptococcus pneumoniae and its bacteriophage; Lopez R et al.; The development of an appropriate technique for the identification of autolysin-defective mutants of pneumococcus has been a fundamental step to carry out studies on the molecular characteristics of the lytic enzymes of Streptococcus pneumoniae and its bacteriophage . Our results show that the principal pneumococcal autolysin (an amidase) is responsible for the separation of the daughter cells at the end of the cell division . On the other hand, this system provides a reliable experimental model to support the extended idea concerning the modular organization of most proteins . The comparative analyses of the deduced amino acid sequences of these enzymes, as well as the construction of functional chimeric phage-bacterial enzymes, demonstrate that the C-terminal domain, which contains a large number of repeated amino acid motifs, is the substrate-binding domain, whereas the N-terminal domain provides enzymatic specificity . We propose that the pneumococcal lytic enzymes have evolved by modular exchange providing examples of the types of novel genes that the bacteria or the phage might create to allow them to become adapted to new environmental situations.

Pediatrics, 1992 Dec, 90(6), 928 - 33
Systemic infections due to Streptococcus pneumoniae relatively resistant to penicillin in a children's hospital: clinical management and outcome; Tan TQ et al.; Streptococcus pneumoniae isolates relatively (0.1 microgram/mL < minimum inhibitory concentration < or = 1.0 microgram/mL) resistant to penicillin (RRP) have been recovered worldwide, but reports of therapy and outcome of systemic infections due to these strains are limited . This retrospective study of prospectively identified patients reviews the clinical features, management, and outcome of 19 children with systemic infections due to S pneumoniae . From January 1, 1989 to December 31, 1991, 13 of 244 blood (5.3%) and 4 of 32 cerebrospinal fluid (12.5%) pneumococcal isolates were relatively resistant to penicillin . The serotypes were as follows: 14 (12 isolates), 6 (4 isolates), 19 (2 isolates), 23 (1 isolates) . One peritoneal fluid isolate and one joint fluid isolate were also relatively resistant to penicillin . The mean age of the 19 patients was 30 months (range 5 to 104 months), and five children had underlying disorders . Eleven children (nine inpatients) were treated initially with a parenteral cephalosporin . Six patients were treated as outpatients, and all had (occult) bacteremia . Three of these patients received ceftriaxone intramuscularly in the emergency department; five were treated with amoxicillin/clavulanic acid, and one received amoxicillin . Seven of 13 children treated in the hospital became afebrile in 48 hours . Three others were afebrile from the time of admission . Repeat blood cultures obtained within 24 to 48 hours after therapy was initiated were sterile in 10 children . All but one child responded to initial therapy . The recovery of S pneumoniae isolates relatively resistant to penicillin has increased in our hospital during the last 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)

J Chromatogr, 1992 Dec 11, 584(1), 101 - 7
Purification and characterization of recombinant pyrrolidone carboxyl peptidase of Bacillus subtilis; Gonzales T et al.; Bacillus subtilis pyrrolidone carboxyl peptidase (Pcp) overexpressed in Escherichia coli was purified to homogeneity in less than 12 h using ammonium sulphate precipitation and hydrophobic interaction chromatography . The enzyme, which removes amino-terminal L-pyroglutamic acid from peptides, appears to be a tetramer of 25,200 molecular mass subunits . The protein cross-reacted with polyclonal antibodies raised against Pcp from Streptococcus pyogenes . The overexpressed enzyme exhibits an absolute substrate specificity towards N-terminal pyroglutamyl residues with a Michaelis constant of 1.04 mM for L-pyroglutamyl-beta-naphthylamide . The enzyme could be used for the removal of pyroglutamyl residues that block amino termini of proteins and peptides before performing Edman sequential degradation.

Biochemistry, 1992 Dec 8, 31(48), 12198 - 203
Structure of the N- and O-glycans of the A-chain of human plasma alpha 2HS-glycoprotein as deduced from the chemical compositions of the derivatives prepared by stepwise degradation with exoglycosidases; Watzlawick H et al.; The structure of the glycans of the A-chain of human plasma alpha 2HS-glycoprotein was established from the chemical compositions of its derivatives prepared by sequential enzymatic degradation of the carbohydrate moiety, from the determination of the kind and amount of the monosaccharides liberated after each step of the enzymatic digestion, and from the distinct specificity of the highly purified exoglycosidases . The exoglycosidases were three sialidases (Vibrio cholerae, fowl plague virus, and Arthrobacter ureafaciens), two beta-galactosidases (Streptococcus pneumoniae and bovine testis), one alpha-N-acetylgalactosaminidase, one beta-N-acetylglucosaminidase, and one alpha-mannosidase . Utilizing sialidases with different cleavage specificities, the number of alpha 2-3- and alpha 2-6-linked sialic acid residues could be separately determined . As to the beta-galactosidases, the enzyme isolated from S . pneumoniae cleaves only beta 1-4-linked galactose residues, whereas the bovine testes enzyme acts on both the beta 1-4- and beta 1-3-linked galactose residues . Jack bean beta-N-acetylglucosaminidase cleaves beta 1-2, beta 1-4, and beta 1-6 GlcNAc with higher activity for the beta 1-2 . Jack bean alpha-mannosidase cleaves alpha 1-2, alpha 1-6, and alpha 1-3 Man with greater activity for alpha 1-2 and alpha 1-6 . Bovine liver alpha-N-acetylgalactosaminidase cleaves O-linked GalNAc . On the basis of these results, the A-chain of alpha 2 HS-glycoprotein was found to possess two biantennary N-glycans and two O-linked trisaccharides.

Bol Med Hosp Infant Mex, 1992 Dec, 49(12), 856 - 60
{Systemic neonatal infection by Streptococcus pneumoniae . A case report}; Ortiz-Ibarra FJ et al.; The neonatal sepsis by Streptococcus pneumoniae is a clinical manifestation well know, but very often reported . It's role as an etiologic agent is limited to sporadic references in the medical literature, since 1972 only about fifty cases of septicaemia and/or meningitis have been reported . In the Instituto Nacional de Perinatologia, from a whole of 560 confirmed cases of septicaemia in the newborn within the last 6 years, only one has been documented as systemic infections by S . pneumoniae . This was a 32.2 gestational aged male patient, with antecedent of maternal chorioamnionitis . This patient presented early-onset sepsis and died during the first 12 hours of life . Presence of S . pneumoniae was found in the blood culture . The type of clinical presentation and its correlation to the perinatal infection is discussed.

Nippon Kyobu Geka Gakkai Zasshi, 1992 Dec, 40(12), 2236 - 40
{Surgical treatment of infected left atrial myxoma--a case report}; Shimizu K et al.; A 22-year-old man had undergone dental therapy following an intermittent fever, and the bacteriological examination by blood culture identified Streptococcus viridans . A left atrial myxoma was echocardiographically found out and the tumor was surgically resected with uneventful postoperative course . Multiple foci and Gram-positive cocci within the typical myxoma were revealed histopathologically . Reviewing previous reports on infected cardiac myxoma, the coexistence of cardiac myxoma and a confirmed positive blood culture has been considered diagnostic criteria for "infected cardiac myxoma" . But, from the surgical viewpoint, the demonstration of infecting organisms within the tumor is essential for accurate diagnosis . Infected atrial myxoma has an extremely high incidence of systemic embolization, and its bacterial foci could be the source of persistent bacteremia . Therefore, in clinical situations suggesting infected cardiac myxoma, we recommend performing open heart surgery to prevent both the embolization and the infective progression into other cardiac valves, as soon as possible.

Immun Infekt, 1992 Dec, 20(6), 192 - 9
{Infections by Streptococcus pyogenes: new aspects of diagnosis, epidemiology, clinical practice, and therapy}; Kaufhold A et al.; Essential procedures for the cultural and serological laboratory diagnosis of Streptococcus pyogenes are described . A reliable and rapid species identification is achieved by serologic or biochemical tests . Direct antigen detection tests from throat swabs have broadened the diagnostic possibilities; however, they are often not satisfactory in terms of sensitivity . Typing of strains (either by classic serologic techniques or by molecular methods) is of high value for the study of clinical and therapeutic questions . In recent years, the epidemiology of the prevalent group A streptococcal strains has changed in Europe as well as in the U.S.: an increase of those M protein serotypes that are associated with higher virulence is being recognized . There is good evidence that the unexpected resurgence of rheumatic fever in the U.S . and the emerging number of life-threatening invasive and toxic manifestations of disease (including the toxic shock syndrome) in the U.S . and in Europe are related to the changing epidemiology . The existence of strains with rheumatogenic and nephritogenic potency has been established, but genetic host factors are a prerequisite for the sequelae as well . Although, based on experimental data, there are a lot of hypotheses concerning the nonsuppurative sequelae and the toxic shock syndrome, the exact pathogenesis of these diseases remains to be clarified . A thorough knowledge of the various clinical manifestations of group A streptococcal infections is necessary in order to apply the therapeutic and preventive measures in a rational and sophisticated manner . For most infections penicillins are considered the drug of choice, although no final conclusions regarding optimal dosages or the reasons for treatment failures can be made.(ABSTRACT TRUNCATED AT 250 WORDS)

FEMS Microbiol Lett, 1992 Dec 1, 78(2-3), 111 - 6
Studies on a murine model for evaluation of virulence of Streptococcus suis capsular type 2 isolates; Beaudoin M et al.; Five different parameters, time of incubation of the culture, type of culture medium, inoculum, strain of inbred mice, and age of mice, were tested using the LD50 technique to standardize a murine model for the evaluation of the virulence of Streptococcus suis capsular type 2 isolates . A model using 28 day-old mice belonging to CF1 strain appeared to give the best results . The inoculum size was the parameter most influencing the 50% lethal dose obtained with mice . Inoculation with 1-ml volume of a bacterial suspension instead of 0.1 or 0.5 ml decreased the LD50 . The standardized model was used to evaluate the virulence of some isolates of known pathogenicity for pigs . The minimum lethal dose was used in the model and it appeared that the virulence of Streptococcus suis capsular type 2 isolates can be measured from highly virulent to totally avirulent.

Curr Eye Res, 1992 Dec, 11(12), 1221 - 5
Confirmation of the role of pneumolysin in ocular infections with Streptococcus pneumoniae; Johnson MK et al.; In earlier experiments on the role of the cytolytic toxin pneumolysin in ocular infections with pneumococcus, we found that a strain carrying a deletion in the gene encoding pneumolysin was considerably less virulent than wild type when tested in an intracorneal model of keratitis in the rabbit . To confirm this result, we have constructed a strain in which pneumolysin activity was restored by transformation of the deleted strain with a plasmid bearing the complete pneumolysin gene . Hemolytic titers of pneumolysin indicated that only one copy of the plasmid per bacterium expresses the pneumolysin gene in this strain . The virulence of this strain was compared with that of wild type and deleted strains transformed with the vector lacking the pneumolysin gene . Slit lamp examination (SLE) scores for eyes infected with the restored strain were similar to those for eyes infected with wild type and significantly greater than those for the pneumolysin-deleted strain . Molecular analysis of bacteria recovered from infected corneas showed that the vector plasmid was retained; however, in most isolates of the restored strain, the plasmid underwent an excision and lost the pneumolysin gene . The cloned gene apparently persisted long enough to induce the pathologic changes, and the results confirm the importance of pneumolysin as a virulence factor in ocular infections.

Immunol Lett, 1992 Dec, 34(3), 207 - 11
Low number of antibody producing cells in patients with sickle cell anemia; Rautonen N et al.; B cell function is impaired in patients with sickle cell anemia . Although the number of surface IgM positive cells was similar in sickle cell patients and controls, in vitro spontaneous IgM, and PWM stimulated IgA, IgM, and IgG synthesis was significantly lower in the patients than in controls . The number of PWM induced and antigen specific immunoglobulin producing cells after immunization with Pneumovax, containing 21 serotypes of Streptococcus pneumoniae, was about 100-fold lower in the patients as compared with controls . Finally, the ability of the patients' peripheral blood mononuclear cells to proliferate in response to mitogens (PWM, SAC, PHA) was diminished . Because of the observed impairments in both nonspecific and antigen specific immunoglobulin synthesis and cell proliferation assays in the patients, we determined serum concentrations of IL-4 and IL-6, two cytokines associated with antibody production . IL-4 concentrations appeared low in sickle cell patients, and correlated with that of serum IgM . We hypothesize that B cell maturation in sickle cell patients is arrested at an IL-4 dependent stage.

An Esp Pediatr, 1992 Dec, 37(6), 481 - 3
{Neonatal septicemia: incidence and risk factors}; Clemente Yago F et al.; The cases of 131 newborns with positive blood cultures have been reviewed . These children were born in our hospital between 1985 and 1990 . We found that the incidence of sepsis was 4.3/1000 newborns . Early neonatal sepsis was the most frequent, representing 58% of the cases . Late sepsis in hospitalized infants represented 1.34% of the cases . Streptococcus B was the microorganism most frequently isolated (26.7%), followed by S . epidermidis (19.8%), E . coli (13.7%) and S . aureus (10.68%) . In over 50% of the cases of early sepsis, maternal-fetal risk factors were present . Mortality was 7.6%, with half of these cases due to Streptococcus B.

J Am Acad Dermatol, 1992 Dec, 27(6 Pt 1), 959 - 61
Sterility of refrigerated injectable collagen syringes after injection of patient; Davis K et al.; BACKGROUND: Injectable collagen has been used for more than 15 years to correct soft tissue cosmetic defects . After injection, the collagen remaining in the syringe is often refrigerated for later use in the same patient, despite manufacturer and Food and Drug Administration recommendations to discard the unused collagen . OBJECTIVE: This study examined the incidence of bacterial contamination of stored collagen . METHODS: Syringe needle tips and collagen from 50 previously used syringes containing either Zyderm I, Zyderm II, or Zyplast were cultured separately under aerobic and anaerobic conditions . Bacterial isolates were identified . RESULTS: Propionibacterium acnes was cultured from 7 of 50 needle tips . One positive needle tip culture grew both P . acnes and Staphylococcus aureus . Bacteria were isolated from only one collagen sample that grew a nonhemolytic streptococcus that may have represented a laboratory contaminant . CONCLUSION: Syringes of collagen stored for repeated use rarely become contaminated with bacteria despite frequent contamination of their needle tips . Skin abscesses after collagen injection should be cultured under anaerobic, as well as aerobic, conditions so that infections caused by P . acnes will not be missed.

Acta Odontol Scand, 1992 Dec, 50(6), 345 - 50
The effect of phenytoin medication on dentin apposition, root length, and caries progression in rat molars; Larmas M et al.; To determine the effect of phenytoin (PHT) on dentin apposition and the rate of caries progression in dentin, 40 Wistar rats were treated daily for 35 days with intraperitoneal injections of 5,5-diphenylhydantoin . Twenty-eight controls received saline with pH adjusted to that of PHT . One PHT and one control group were fed a 43% sucrose diet, and the others a non-cariogenic pellet diet . Streptococcus sobrinus was inoculated to induce caries . Schiff staining was used to determine caries . The areas of dentin apposition and dentinal caries lesions were quantified after tetracycline staining . The root lengths were measured . PHT reduced slightly the dentin apposition and activated significantly the progression of the dentinal carious lesions . No difference in caries initiation was found . The high-sucrose diet reduced dentin apposition and increased the rate of progression of existing caries greatly . Our study suggests that both the high-sucrose diet and PHT have an effect on secreting odontoblasts, which can be seen as an alteration in dentin apposition and caries progression rates in dentin.

Acta Odontol Scand, 1992 Dec, 50(6), 337 - 43
The effect of ovariectomy on dentin formation and caries in adult rats; Hietala EL et al.; Since acute osteoporosis is known to enhance bone remodeling and osteoid formation, it may also affect dentin apposition . We induced osteoporosis in 15-week-old Wistar rats by ovariectomy and dental caries by Streptococcus sobrinus infection in the presence of either a high sucrose (cariogenic) diet or a non-cariogenic diet . Intact animals with the same diets served as controls . After 99 days of cariogenic challenge the rats were killed, and the success of ovariectomy was confirmed by failure to detect ovarian tissue and observation of marked atrophy of the uterine horns . Areas of dentinal apposition during the experiment and carious lesions were quantified with a tetracycline method . Ovariectomy activated dentin formation significantly in rats fed either a high-sucrose or a non-cariogenic diet, indicating enhanced odontoblast function . The rate of dentinal apposition in adult rats was smaller than reported in young animals . The effect of ovariectomy on caries remained negligible.

Eur J Pediatr, 1992 Dec, 151(12), 874 - 5
Streptococcal pharyngitis and epiglottitis in a newborn infant; Bos AP et al.; We describe a newborn infant with Streptococcus sanguis septicaemia and concomitant upper airway obstruction due to epiglottitis and pharyngitis . This rare infection of the supraglottic region was treated with endotracheal intubation and antibiotics . Full recovery occurred within 4 days.

Tijdschr Diergeneeskd, 1992 Dec 1, 117(23), 691 - 3
{Acute mortality in pigs caused by Streptococcus suis type 1}; van der Giessen J et al.; In early 1991 many young pigs died without clinical signs on a farm in the Province of Utrecht . This article describes the isolation of Streptococcus suis type 1 after postmortem examination of the piglets.

Pediatr Infect Dis J, 1992 Dec, 11(12), 1030 - 6
Coagulase-negative staphylococcal bacteremia in severely malnourished Jamaican children; Christie CD et al.; Immunosuppression increases the susceptibility to infection and changes the inflammatory response in children with severe protein-energy malnutrition . In this 5-year prospective study bacteremia was documented in 16% of 336 severely malnourished children, 2 to 34 months of age, who were hospitalized consecutively in the Tropical Metabolism Research Unit, Kingston, Jamaica . The 53 children had 60 episodes of nosocomial and community-acquired bacteremia with 69 blood isolates . Community-acquired bacteremia accounted for 72% (43 of 60) of bacteremic episodes . Thirty-five percent (24 of 69) of the strains were coagulase-negative staphylococci, 19% (13 of 69) were Staphylococcus aureus and 11% (8 of 69) were Streptococcus Group D . Seventeen episodes of coagulase-negative staphylococcal bacteremia were acquired in the community and 7 were nosocomial . These patients were more likely to have pneumonic consolidation than children with all other bacteremias combined (P < 0.02, Fisher's exact test) . The bacteremia-related case fatality rate was 8% (5 of 60) . Polymicrobial and Gram-negative septicemia were independent positive predictive factors for mortality when compared with single-agent and Gram-positive sepsis (P < 0.02) . This 71% (49 of 69) prevalence of Gram-positive organisms suggests a change in the epidemiology from the predominant Gram-negative etiologies (76%) described in previous reports.

J Bacteriol, 1992 Dec, 174(24), 8081 - 93
Cloning and characterization of the Bacillus subtilis hemEHY gene cluster, which encodes protoheme IX biosynthetic enzymes; Hansson M et al.; Mutations that cause a block in a late step of the protoheme IX biosynthetic pathway, i.e., in a step after uroporphyrinogen III, map at 94 degrees on the Bacillus subtilis chromosomal genetic map . We have cloned and sequenced the hem genes at this location . The sequenced region contains six open reading frames: ponA, hemE, hemH, hemY, ORFA, and ORFB . The ponA gene product shows over 30% sequence identity to penicillin-binding proteins 1A of Escherichia coli, Streptococcus pneumoniae, and Streptococcus oralis and probably has a role in cell wall metabolism . The hemE gene was identified from amino acid sequence comparisons as encoding uroporphyrinogen III decarboxylase . The hemH gene was identified by enzyme activity analysis of the HemH protein expressed in E . coli . It encodes a water-soluble ferrochelatase which catalyzes the final step in protoheme IX synthesis, the insertion of ferrous iron into protoporphyrin IX . The function of the hemY gene product was not elucidated, but mutation analysis shows that it is required for a late step in protoheme IX synthesis . The hemY gene probably encodes an enzyme with coproporphyrinogen III oxidase or protoporphyrinogen IX oxidase activity or both of these activities . Inactivation of the ORFA and ORFB genes did not block protoheme IX synthesis . Preliminary evidence for a hemEHY mRNA was obtained, and a promoter region located in front of hemE was identified . From these combined results we conclude that the hemEHY gene cluster encodes enzymes for the synthesis of protoheme IX from uroporphyrinogen III and probably constitutes an operon.

Infect Immun, 1992 Dec, 60(12), 5291 - 3
An 87-kilodalton glucan-binding protein of Streptococcus sobrinus B13; Wu-Yuan CD et al.; An 87-kDa glucan-binding protein (GBP) of Streptococcus sobrinus B13 (serotype d) was isolated and purified from extracellular culture supernatant by using affinity chromatography on Sephadex G-50 and elution with a guanidine HCl gradient . Western blot (immunoblot) analysis showed it to be antigenically related, but not completely identical, to the 74-kDa GBP of Streptococcus mutans Ingbritt . The 87-kDa GBP has no glucosyltransferase activity . A possible role for this GBP in the cariogenicity of S . sobrinus B13 is suggested.

Infect Immun, 1992 Dec, 60(12), 5042 - 7
eNAP-2, a novel cysteine-rich bactericidal peptide from equine leukocytes; Couto MA et al.; We purified a novel cysteine-rich antibiotic peptide, eNAP-2 (M(r), approximately 6,500), from acid extracts of equine neutrophils by sequential gel filtration and reversed-phase high-performance liquid chromatography and determined its partial N-terminal amino acid sequence . Although its cysteine motif distinguished eNAP-2 from all other currently known endogenous antibiotic peptides, including defensins and granulins, it showed substantial sequence similarity to WDNM1, a putative member of the four-disulfide-core protein family that also includes animal and human antiproteases, snake venom neurotoxins, and rat and mouse whey proteins . The antibacterial properties of eNAP-2 were tested against several equine uterine pathogens, namely, Streptococcus zooepidemicus, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae . Killing of S . zooepidemicus was very efficient, as evidenced by a 94% decrease in numbers of CFU per milliliter after exposure to 100 micrograms of eNAP-2 per ml (approximately 15 microM) for 2 h . Exposure of E . coli and P . aeruginosa to 200 micrograms of eNAP-2 per ml for 2 h resulted in 90.2 and 77.6% reduction, respectively, in the numbers of CFU per milliliter . Bacteriostasis, without bactericidal activity, occurred after K . pneumoniae was incubated with 200 micrograms of eNAP-2 per ml . Additional studies will be required in other species and cell types to determine whether eNAP-2 is restricted to equine neutrophils or is the index member of a larger family of endogenous antibiotics.

J Infect Dis, 1992 Dec, 166(6), 1346 - 53
The spread of multiply resistant Streptococcus pneumoniae at a day care center in Ohio; Reichler MR et al.; Streptococcus pneumoniae, type 23F, resistant to penicillin (MIC, 2 micrograms/mL) and multiple other antimicrobic agents, was isolated from middle ear fluid of a child with otitis media attending a day care center in Ohio . To determine the extent of spread of this strain, nasopharyngeal culture surveys were done, and 52 carriers were identified among 250 children attending the index day care center . No carriers were found among 121 children at two other day care centers in the same urban area . Use of prophylactic doses of antibiotics (P < .001) and frequent use of antibiotics (P < 0.001) were risk factors for nasopharyngeal carriage . Carriers were more likely to have had frequent otitis media episodes (P < .02) and otitis media not responsive to antimicrobial therapy (P < .001) . Strategies to limit the spread of highly resistant pneumococcal strains should include encouraging judicious use of antimicrobic agents and reevaluating indications for prophylactic use of antimicrobic agents.

Rev Med Brux, 1992 Dec, 13(10), 367 - 70
{Fulminant erysipelas}; Devaster JM et al.; An apparent resurgence of invasive and life-threatening group A streptococcal infections in young and previously healthy hosts is reported in several countries . We report a case of fatal necrotizing fasciitis and review the spectrum of these clinical syndromes, including the invasive soft tissue infections . This changing pattern of infection could be explained by an increased incidence of some serotypes of group A Streptococcus carrying specific virulence factors, such as pyrogenic exotoxins.

Arch Dis Child, 1992 Dec, 67(12), 1478 - 80
Sinusitis-induced subdural empyema; Skelton R et al.; Over a 17 year period, 1975-91, 10 children were managed who had sinusitis-induced subdural or extradural empyema . Their ages ranged from 6 to 14 years, with a mean of 11 years . All presented with worsening headaches, fever, vomiting, all had neurological abnormalities, and all had symptoms or signs suggestive of sinusitis . Initial computed tomography gave normal results in five cases and the empyema was diagnosed on the second or third scan . All patients had symptoms for at least one to two weeks before the diagnosis was made . Streptococcus milleri was the organism most frequently implicated . Medical treatment was started in all cases on admission, but all required surgical intervention before resolution.

J Gen Microbiol, 1992 Dec, 138 ( Pt 12), 2639 - 45
Molecular analysis of isolates of Streptococcus suis capsular type 2 by restriction-endonuclease-digested DNA separated on SDS-PAGE and by hybridization with an rDNA probe; Beaudoin M et al.; This study was undertaken to assess the discriminatory value of restriction endonuclease (RE) digestion patterns of Streptococcus suis chromosomal DNA using polyacrylamide gel electrophoresis (SDS-PAGE) and DNA-rDNA hybridization . For the RE digestion patterns, DNAs were digested separately with the enzymes BamHI and BglII and the resultant fragments were separated by SDS-PAGE . An Escherichia coli rDNA probe derived from pKK3535 was used for the hybridization . Twenty-three S . suis capsular type 2 isolates recovered from diseased and clinically healthy pigs, from a human case, and from a cow were compared in this study . The majority of isolates associated with septicaemia belonged to one restriction endonuclease analysis (REA) profile group . Isolates associated with pneumonia belonged either to the REA profile group of isolates associated with septicaemia or to a second REA profile group . The REA profiles of isolates from clinically healthy animals were more heterogeneous . The REA profile of the type 2 reference strain, S735, which was originally isolated from a pig, was very different from those of the porcine and bovine isolates but similar to the profile of the human isolate . The profiles obtained after rDNA hybridization were more homogeneous . Although different patterns were detected in the 23 isolates, there was no correlation between the source of the isolate and the patterns observed with this technique.

J Nihon Univ Sch Dent, 1992 Dec, 34(4), 233 - 6
Antibacterial efficacy of root canal medicaments; Gencoglu N et al.; The antibacterial efficacy of four endodontic medicaments was studied in vitro . Calcium hydroxide (CALACEPT), camphorated parachlorophenol (CPCP), Cresophene, and 2% iodine-potassium iodide (IKI) were tested against four anaerobic microorganisms, Streptococcus mutans, Peptostreptococcus anaerobius, Porphyromonus gingivalis and Fusobacterium nucleatum, for 10 or 15 min . IKI was effective only against F . nucleatum and P . gingivalis, and the others were effective against all four microorganisms.

Antimicrob Agents Chemother, 1992 Dec, 36(12), 2584 - 8
In vitro demonstration of transport and delivery of antibiotics by polymorphonuclear leukocytes; Frank MO et al.; Several antibiotics are concentrated inside polymorphonuclear leukocytes (PMN) . To investigate whether PMN could act as vehicles for delivery of antibiotics, we combined an assay measuring PMN chemotaxis under agarose with a bioassay measuring levels of antibiotic in agar . Double-layer plates were made by pouring a layer of chemotaxis agarose into tissue culture plates and then adding a thin layer of Trypticase soy agar . Neutrophils were incubated with antibiotic for 1 h and then were washed and placed in wells made in the plates . After allowing PMN to migrate under the agar toward a chemoattractant well containing formyl-methionine-leucine-phenylalanine for 3 h, Streptococcus pyogenes was streaked on top of the agar and grown overnight . PMN migration and zones of inhibition of bacterial growth were measured . Neutrophils migrated 2.51 +/- 0.16 mm toward the chemoattractant well and 1.48 +/- 0.12 mm toward the medium well; migration was not significantly affected by any of the antibiotics used . Plates with PMN incubated without antibiotic showed insignificant inhibition of bacterial growth toward chemoattractant and medium wells (0.38 +/- 0.18 and 0.14 +/- 0.12 mm, respectively; for both, P > 0.05 for difference from 0) . PMN incubated with oxacillin (3 micrograms/ml), a drug not concentrated in PMN, caused a similar lack of inhibition (0.28 +/- 0.09 mm toward chemoattractant; 0.14 +/- 0.03 mm toward medium) . Incubation with 30 microns of ciprofloxacin per ml resulted in inhibition that was similar in both directions (1.40 +/- 0.16 versus 1.18 +/- 0.13 mm) . However, for PMN incubated with azithromycin (3 micrograms/ml), an agent highly concentrated inside phagocytes, there was a large degree of inhibition which was significantly greater in the direction of chemoattractant than in the direction of medium (3.47 +/- 0.30 versus 1.89 +/- 0.25 mm; P < 0.001), indicating that release of bioactive azithromycin by neutrophils occurred after migration . Likewise, after incubation with rifampin (10 micrograms/ml), which is also concentrated by PMN, inhibition was significantly greater in the direction of chemoattractant than in the direction of medium (1.54 +/- 0.24 versus 0.81 +/- 0.28 mm; P = 0.001) . We conclude that for certain antibiotics, PMN may act as vehicles for transport and delivery of active drug to sites of infection.

Genetics, 1992 Dec, 132(4), 975 - 85
Characterization of insertion mutations in the Saccharomyces cerevisiae MSH1 and MSH2 genes: evidence for separate mitochondrial and nuclear functions; Reenan RA et al.; The MSH1 and MSH2 genes of Saccharomyces cerevisiae are predicted to encode proteins that are homologous to the Escherichia coli MutS and Streptococcus pneumoniae HexA proteins and their homologs . Disruption of the MSH1 gene caused a petite phenotype which was established rapidly . A functional MSH1 gene present on a single-copy centromere plasmid was incapable of rescuing the established msh1 petite phenotype . Analysis of msh1 strains demonstrated that mutagenesis and large-scale rearrangement of mitochondrial DNA had occurred . 4',6-Diamidino-2-phenylindole (DAPI) staining of msh1 yeast revealed an aberrant distribution of mtDNA . Haploid msh2 mutants displayed an increase of 85-fold in the rate of spontaneous mutation to canavanine resistance . Sporulation of homozygous msh2/msh2 diploids gave rise to a high level of lethality which was compounded during increased vegetative growth prior to sporulation . msh2 mutations also affected gene conversion of two HIS4 alleles . The his4x mutation, lying near the 5' end of the gene, was converted with equal frequency in both wild-type and msh2 strains . However, many of the events in the msh2 background were post-meiotic segregation (PMS) events (46.4%) while none (< 0.25%) of the aberrant segregations in wild type were PMS events . The his4b allele, lying 1.6 kb downstream of his4x, was converted at a 10-fold higher frequency in the msh2 background than in the corresponding wild-type strain . Like the his4x allele, his4b showed a high level of PMS (30%) in the msh2 background compared to the corresponding wild-type strain where no (< 0.26%) PMS events were observed . These results indicate that MSH1 plays a role in repair or stability of mtDNA and MSH2 plays a role in repair of 4-bp insertion/deletion mispairs in the nucleus.

Infect Immun, 1992 Dec, 60(12), 5057 - 64
Inhibition of Streptococcus mutans adherence to saliva-coated hydroxyapatite by human secretory immunoglobulin A (S-IgA) antibodies to cell surface protein antigen I/II: reversal by IgA1 protease cleavage; Hajishengallis G et al.; The effect of human secretory immunoglobulin A (S-IgA) and serum antibodies to surface protein antigen (Ag) I/II on the adherence of Ag I/II-bearing Streptococcus mutans and of free Ag I/II to saliva-coated hydroxyapatite (SHA) was investigated . The inhibition by S-IgA of binding of both S . mutans and free Ag I/II to SHA was dependent on antibody to Ag I/II . Essentially no difference was found between S-IgA1 and S-IgA2 with respect to antibody-dependent inhibition of Ag I/II binding to SHA, but S-IgA1 inhibited S . mutans adherence more effectively than did either serum immunoglobulin A1 (IgA1) or IgG antibodies . The antiadherence effect of S-IgA was abrogated after cleavage by IgA1 protease . Purified Fab alpha fragments containing Ag I/II-binding activity enhanced the binding of free Ag I/II to SHA and showed greater binding to SHA than did intact S-IgA1 . Despite its relative inability to interact with precoated SHA, S-IgA1 containing antibody to Ag I/II was readily incorporated into the salivary pellicle during coating, but this did not promote Ag I/II binding . These data suggest that S-IgA antibodies can inhibit the initial adherence of S . mutans to salivary pellicle-coated tooth surfaces in an adhesin-specific fashion, but the presence in the oral cavity of bacterial IgA1 proteases would potentially interfere with this antiadherence mechanism.

Zhongguo Zhong Xi Yi Jie He Za Zhi, 1992 Dec, 12(12), 719 - 21, 737, 708
{Clinical and experimental study of xiao er ke cuan ling oral liquid in the treatment of infantile bronchopneumonia}; Li YQ et al.; Xiao Er Ke Chuan Ling Oral Liquid (KCL) is a Chinese herbal preparation consisted of 10 herbs such as Prunus armeniacae, Scutelaria baicalensis, Lonicera japonica etc . 30 children suffering from bronchopneumonia and/or acute bronchitis were treated with KCL (treated group) and another 30 cases were treated with penicillin and aminophylline (control group) . Results: cure rate and effective rate in treated group was 26.6%, and 93.3% respectively . While in control group was 30% and 96.6% respectively . No significant differences were seen between them(P > 0.05) . The pharmacodynamic experiment showed KCL had potent pharmacological action . The experiment on tracheal fragment of Guinea pig in vitro showed it caused moderately strong smooth muscle relaxation, through inhibition the effect of histamine and acetylcholine . Asthma induction experiment of Guinea pig in vivo showed KCL could significantly prolong the latent period of asthma and alleviate asthmatic symptom . Ammonium water cough induction experiment in mice showed it may apparently prolong cough latent period and reduce times of cough relapse and alleviate cough symptom . KCL had potent antipyretic effect on fever model induced by triple vaccine in rabbits . Bacteriostatic and antiviral experiment in vitro showed the drug had quite strong inhibitory effects for Streptococcus hemolyticus, Staphylococcus aureus, Flexners Dysentery bacillus, Diplococcus pneumoniae and Pseudomonas aeruginosa, and it could potently inhibit the respiratory syncytial virus . KCL is an effective drug in treating bronchopneumonia and acute bronchitis.

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