Streptococci

J Infect Dis, 1994 Jan, 169(1), 143 - 9
Analysis of plasmin(ogen) acquisition by clinical isolates of group A streptococci incubated in human plasma; Wang H et al.; Group A streptococci isolated from throat swabs or blood cultures were compared for the expression of plasmin(ogen) receptors . The majority of isolates bound 125I-labeled Lys-plasmin and 125I-labeled Lys-plasminogen while displaying minimal reactivity with 125I-labeled Glu-plasminogen . All streptococcal isolates could acquire surface enzymatic activity when incubated in human plasma but not if the plasma had been depleted of plasminogen . The ability to acquire surface enzymatic activity was limited by the quantity of streptokinase in the reaction mixture . There was no statistically significant difference between group A streptococci isolated from throat swabs and those from blood cultures with respect to their interaction with components of the fibrinolytic system in human plasma . However, these isolates could be divided into two groups based on their ability to acquire surface enzymatic activity when incubated in plasma with exogenous streptokinase . Surprisingly, the acquisition of surface enzymatic activity when incubated in plasma containing streptokinase was not always correlated with the plasmin(ogen) binding capacity determined by direct binding of radiolabeled ligands . Analysis of this phenomenon suggests that group A streptococci can use diverse mechanisms to acquire plasmin(ogen)-dependent enzymatic activity.

Infect Immun, 1994 Jan, 62(1), 184 - 93
Conservation of salivary glycoprotein-interacting and human immunoglobulin G-cross-reactive domains of antigen I/II in oral streptococci; Moisset A et al.; In this study we localized more precisely the salivary glycoprotein-interacting and the human immunoglobulin G (hIgG)-cross-reacting domains on the SR molecule, an antigen I/II-related protein from S . mutans serotype f . Mapping of the SR molecule with polypeptides expressed by subclones covering the entire molecule and with synthetic peptides demonstrates that the salivary glycoprotein-binding domain is located in the N-terminal alanine-rich repeats of the SR molecule . In order to investigate the degree of conservation of both regions in various oral streptococci, we tested the reactivity of 8 representative strains of the mutans group and 11 nonmutans oral Streptococcus strains (S . anginosus, S . milleri, S . constellatus, S . intermedius, S . mitis, S . sanguis, S . gordonii, S . salivarius, and S . mitis strains) with antipeptide antibodies in a whole-cell enzyme linked immunosorbent assay together with colony hybridization analysis using DNA probes designed to map these two regions . All the mutans group strains except S . rattus and the 11 nonmutans streptococcal strains showed a high conservation of the C-terminal part of the SR molecule, especially the hIgG-cross-reacting domain, and less homology for the N-terminal salivary glycoprotein-binding region . Almost all of the sera from patients with rheumatic disease reacted strongly with SR from S . mutans serotype f, P1 from S . mutans serotype c, and four peptides located in the hIgG-cross-reacting region and not with peptides located at the C and N termini and in the proline-rich repeats . These results confirm that epitopes located within this region are immunogenic in humans and could lead to the synthesis of natural anti-IgG antibodies.

Clin Immunol Immunopathol, 1994 Jan, 70(1), 28 - 31
Streptococcal adherence to Langerhans cells: a possible step in the pathogenesis of streptococcal pharyngitis; Reed WP et al.; Group A streptococci are nonmotile and have no structures that would enable them to penetrate submucosally into the pharynx . We have postulated that they adhere to host pharyngeal mucosal cells called Langerhans cells that are motile and could transport them into deeper tissues . We used a microscopic assay to assess the adherence of streptococci to cells from normal pharyngeal scrapings after the cells and bacteria were incubated in vitro . Langerhans cells were identified by immunofluorescent staining for the CD1a antigen . Nonstaining cells were considered to be keratinocytes . Of the 2279 cells examined from 9 subjects, 92.6% were keratinocytes and 7.4% were Langerhans cells . Only 1.8% of the 2111 keratinocytes had > 50 bacteria attached in this assay, while 76.2% of the 168 Langerhans cells had > 50 attached bacteria . Thus, under the conditions of this study, group A streptococci adhere preferentially to Langerhans cells from the pharynx . Adherence to these motile cells may provide a mechanism through which pathogenic streptococci may be transported into submucosal tissues.

Microbios, 1994, 77(313), 253 - 9
Evaluation of the diagnostic accuracy of a kit for the rapid detection of group A streptococci; Savoia D et al.; A rapid immunoassay method using an Event Test Strip Strep A experimental kit (Boehringer Mannheim) was evaluated . Results obtained were compared with culture results to evaluate the accuracy of detection of group A streptococci directly from throat swabs or from artificial swabs containing various bacterial concentrations . A good diagnostic accuracy was obtained with a sensitivity of 96.9% in the assay of throat swabs which provided more than ten group A Streptococcus colonies per plate . Since a low level of micro-organisms may indicate infection, it is recommended that a culture be performed when the rapid test based on antigen detection is negative.

Scand J Infect Dis, 1994, 26(1), 85 - 93
Septic arthritis of the knee: a 10-year review and long-term follow-up using a new scoring system; Studahl M et al.; The case records of 64 patients with 65 episodes of infectious gonarthritis during 1979-88 were reviewed regarding epidemiological, clinical and laboratory data of possible relevance to the course and outcome of the disease . Long-term healing results were evaluated by means of a new scoring system 2-11 years after the acute disease in 46 patients . The infection was acquired by inoculation in 37% and by the hematogenous route in 55% . The major risk factors were trauma to the joint and arthrosis . Staphylococcus aureus was the causative agent in 58% and Streptococci in 15% . Treatment consisted of suction irrigation (86%) or intermittent aspiration (5%) combined with systemic antibiotic treatment . At follow-up, the pain and ache scores of the arthritic joint had decreased by 21% and 16% respectively, compared with the scores of the contralateral control joints . Anatomy and motility were reduced by 9% and 8% respectively . Age < 45 was associated with a greater score loss than in older patients . Treatment delayed by > 5 days was associated with increased loss of motility . We estimate that 79% of the patients had excellent or good long-term results following treatment of infectious arthritis of the knee . Evaluation of healing after infectious gonarthritis by use of a scoring system is quite feasible and allows comparison of different treatment regimes with improved accuracy.

Scand J Infect Dis, 1994, 26(1), 59 - 66
Five versus ten days treatment of streptococcal pharyngotonsillitis: a randomized controlled trial comparing cefpodoxime proxetil and phenoxymethyl penicillin; Portier H et al.; A total of 220 adults and children > 10 years old (mean 29.5 +/- 11.7 years) with pharyngitis/tonsillitis were randomized to receive either cefpodoxime proxetil 100 mg bid for 5 days (n = 113) or phenoxymethyl penicillin, 600 mg tid for 10 days (n = 107) . At the end of treatment of the 166 evaluable patients, a satisfactory clinical response was obtained in 85/88 (96.6%) patients treated with cefpodoxime proxetil and in 75/78 (96.1%) treated with phenoxymethyl penicillin . Group A beta-hemolytic streptococci (GABHS) eradication was similar in both groups: 79/82 (96.3%) patients in the cefpodoxime proxetil group and 64/68 (94.1%) patients in the phenoxymethyl penicillin group . At follow-up (20-30 days after the end of treatment) the GABHS eradication persisted in 67/72 (93.1%) patients treated with cefpodoxime proxetil and in 56/61 (91.8%) patients treated with phenoxymethyl penicillin . Significantly better compliance (p < 0.01) was noticed with the cefpodoxime proxetil regimen compared with the phenoxymethyl penicillin regimen, with only 2/110 (2%) poorly compliant patients in the cefpodoxime proxetil group vs 17/104 (16%) in the phenoxymethyl penicillin group . Thus, the shorter duration of therapy, in conjunction with demonstrated clinical and bacteriological efficacy that is equivalent to standard therapy, makes cefpodoxime proxetil an acceptable alternative for the treatment of GABHS pharyngitis/tonsillitis.

Infection, 1994 Jan-Feb, 22(1), 56 - 7
Endophthalmitis as presenting symptom of group G streptococcal endocarditis; Verweij PE et al.; Group G streptococci can cause serious infections in patients with predisposing factors . Involvement of the eye has rarely been reported in patients without ocular history . Two cases of group G streptococcal endocarditis which presented with an endogenous endophthalmitis are reported . Topical and systemic antimicrobial therapy resulted in recovery, but visual outcome was poor.

Pediatr Infect Dis J, 1994 Jan, 13(1 Suppl 1), S5 - 9; discussion S20-2
Current issues in upper respiratory tract infections in infants and children: rationale for antibacterial therapy; Klein JO; Otitis media is a common infection in preschool-age children, but selected children have recurrent and severe disease . The characteristics of these children include a first episode of infection at an early age, sibling(s) with a history of ear infections, a history of not having been breast-fed, attending group day care and living in a household with exposure to cigarette smoke . The organisms responsible for otitis media are consistently the pneumococcus, H . influenzae and, in some areas, M . catarrhalis . Changes in antimicrobial susceptibility and differences in virulence govern the choice of antimicrobial agents . Although many drugs have clinical efficacy in children with AOM, the choice of optimal agents should be based on knowledge of microbiologic efficacy against the major pathogens, dosage schedules, side effects, palatability and cost . Sinusitis shares with otitis media similar pathogenesis, microbiology and choices of antimicrobial drugs for treatment . Although there are fewer data on epidemiology and microbiologic efficacy available for sinusitis than for otitis media, antibiotics are important for the clinical improvement and eradication of the bacterial pathogen from the infected sinus . Group A streptococcal infections are an increasing cause of concern because of reports of outbreaks of rheumatic fever in some cities in the United States and fatal or severe invasive infections and toxin-associated disease . Although Group A streptococci remain susceptible to penicillins and cephalosporins, higher rates of eradication of the organism from the pharynx by cephalosporins or by macrolides compared with penicillin have raised doubt as to the continued consideration of penicillin as the drug or choice for patients with streptococcal pharyngitis in communities with high incidence of supperative or nonsupperative disease.

Microbios, 1994, 77(310), 19 - 27
A comparison of whole cell protein profiles for sporadic human isolates of Streptococcus equisimilis and beta-haemolytic group G streptococci; Clark S et al.; Whole cell protein profiles were resolved for Streptococcus equisimilis (group C) and large colony human biotype beta-haemolytic group G streptococci by the use of one dimensional sodium dodecyl sulphate-polyacrylamide gel electrophoresis . Strains of S . equisimilis (27 in toto) were distributed among eight patterns designated A to H . Pattern A represented 48.2% of the latter isolates . Strains of group G streptococci (59 in toto) were distributed among sixteen patterns designated 1-16, and there were no predominant patterns which represented more than 20% of all strains . Profiles were reproducible, not susceptible to strain passage, but susceptible to variation in growth media . Considerable homology was observed among bacteria in either Lancefield group.

Caries Res, 1994, 28(2), 99 - 105
Arginine metabolism in the salivary glands of protein-deficient rats and its potential association with the oral microflora; Enwonwu CO et al.; Salivary glands and their secretions play key roles in the prevention of dental diseases . The antibacterial and physicochemical properties of saliva are compromised in chronic malnutrition . The present study has examined the possibility that some malnutrition-induced changes in salivary gland function are potentially capable of promoting growth and metabolic activities of pathogenic oral microorganisms . Compared to well-fed controls, rats fed a 3% protein diet for 18 days showed a significant reduction (p < 0.001) in the submandibular gland arginase (L-arginine amidinohydrolase, EC 3.5.3.1) activity . Associated with the latter finding was a marked increase (+85%) in the glandular level of free arginine, this basic amino acid accounting for 12.2% of the total essential amino acids as compared with a figure of only 4.6% for the controls . The total free amino acid pool in whole saliva was relatively unaffected by malnutrition, but the levels of the basic amino acids arginine and histidine were marginally increased . Many oral bacterial species, some of which are dominant plaque microorganisms, utilize the arginine deiminase (EC 3.5.3.6) pathway . Thus, increased availability of free arginine from salivary glands offers a plausible explanation for the frequently reported observation of differential overgrowth of several potentially pathogenic microorganisms including some mutants streptococci in protein-deficient laboratory animals and may well apply to similar findings in malnourished populations in Third World countries.

Caries Res, 1994, 28(2), 69 - 82
The application of molecular genetics to the microbiology of dental caries; Russell RR; The introduction of techniques for the manipulation of DNA in vitro has had an enormous impact on progress in every area of biological research . In the case of oral microbiology, the first reports on the application of molecular genetics to streptococci started to appear in the early 1980s, and it is now more than 10 years since the first paper describing cloning and expression of a gene from Streptococcus mutans in another bacterium was published . The purpose of this review is not to provide a resume of all the work that has been done on the molecular biology of oral bacteria; indeed, we are approaching the stage when a comprehensive survey of work on all oral bacteria is no longer feasible--for instance, over 40 genes have now been cloned and sequenced from S . mutans alone--but rather to illustrate examples of how the new techniques have been applied to give novel approaches and insights into old problems, or expand into new directions . The great majority of published work so far relates to streptococci, and many aspects have been covered in previous review articles {Curtiss, 1985; Russell, 1991}, the most recent thorough review being that by Kuramitsu {1993} . Discussion of molecular biology is now so all-pervasive that most readers will be familiar with many of the basic terms, but it may be worth clarifying some of the main points during the course of this article . For total novices, the short book by Brown {1990} forms a useful introduction . A number of recent articles have reviewed recent research on plaque formation {Kolenbrander and London, 1993} and the mutans streptococci in particular {Loesche, 1986}, while Freedman et al . {1981} and Tanzer {1992} have summarised the information derived from a genetic approach to oral microbiology before the advent on in vitro manipulation of DNA.

Klin Padiatr, 1994 Jan-Feb, 206(1), 26 - 9
{Effectiveness and tolerance of cefixime in comparison with penicillin V in bacterial pharyngitis and tonsillitis in children . Cefixime Study Group}; Adam D et al.; 154 children aged 2 to 12 years with clinical diagnosis of bacterial pharyngitis and/or tonsillitis and--in most of the patients--a positive enzyme immunoassay for group A beta-hemolytic streptococci before therapy were enrolled in this open controlled randomized and multicenter trial . The children received either 8 mg/kg bodyweight cefixime once daily or 20,000 I.E . pencillin V/kg bodyweight t.i.d . Clinical evaluation and microbiological tests were carried out before treatment and 1-5 days after end of the treatment . 3-4 weeks after end of the treatment the rate of relapses was evaluated . The data of 149 children could be evaluated for clinical efficacy . In the cefixime group 93.3% of the children were cured and 6.7% improved compared to 89.2% and 10.8%, respectively, in the penicillin V group . Complete microbiological data were obtained from 136 patients . The eradication rate was 82.7% in the cefixime group and 77% in the group of patients treated with penicillin V . At follow up relapses were seen in 7 of the cefixime treated patients and in 6 of those receiving penicillin V . Mild side effects were reported by 4 patients in the cefixime group and by 3 children treated with penicillin V (1 drop out each) . These results show that cefixime once daily is at least as effective as penicillin V t.i.d . in pharyngitis and tonsillitis in children . Both compounds are well tolerated.

Arch Pediatr Adolesc Med, 1994 Jan, 148(1), 67 - 71
Decline of erythromycin resistance of group A beta-hemolytic streptococci in Japan . Comparison with worldwide reports; Bass JW et al.; OBJECTIVE: To determine the current prevalence of erythromycin resistance and penicillin tolerance of group A beta-hemolytic streptococci (GABHS) in Japan . RESEARCH DESIGN: One hundred four isolates of GABHS from the civilian community in Tokyo and 101 isolates from the military population at the US Air Force Base in Yokota, Japan, were tested for erythromycin susceptibility and penicillin susceptibility and tolerance . SETTING: US Army Medical Center . RESULTS: Of the Japanese civilian isolates, two were moderately susceptible and none were resistant to erythromycin; of the military isolates, none were moderately susceptible and one was resistant, for an overall resistance rate of 0.49% . All isolates were exquisitely susceptible to penicillin, and no evidence of penicillin tolerance was found . CONCLUSIONS: Comparison with similar studies world-wide shows that erythromycin susceptibility of GABHS in Japan is now among the lowest in the world, while just over a decade ago it was the highest . These observations mandate constant monitoring of erythromycin resistance of GABHS wherever this drug is used to treat patients with infections due to this organism.

Clin Pharmacokinet, 1994 Jan, 26(1), 71 - 81
Cost considerations in therapeutic drug monitoring of aminoglycosides; Bertino JS Jr et al.; Aminoglycoside antibiotics are very important in the treatment of Gram-negative infections and as synergistic agents for the treatment of staphylococcal and streptococcal (group B streptococci and enterococci) infections . However, these agents have a narrow therapeutic index . Thus, a number of new antibiotics have been introduced in an attempt to reduce the number of patients treated with aminoglycosides . Unfortunately, these new antibiotics tend to be costly, and are often associated with development of resistance and treatment failure . Data suggest that a pharmacokinetic/pharmacodynamic relationship exists for some aspects of efficacy and toxicity of aminoglycosides . Serum drug concentrations and/or tissue accumulation are related to the development of nephrotoxicity, and individualised pharmacokinetic monitoring may decrease rates of nephrotoxicity . Peak serum drug concentrations and the ratio of peak serum drug concentration to minimum inhibitory concentration appear to correlate with clinical efficacy in the treatment of patients with bacteraemia or pneumonia . Therapeutic drug monitoring (TDM) has been used to optimise aminoglycoside therapy and reduce toxicity . Cost-effective approaches to drug selection and TDM are important considerations in the proper use of aminoglycosides.

Caries Res, 1994, 28(1), 48 - 54
Effect of xylitol and sorbitol in chewing-gums on mutans streptococci, plaque pH and mineral loss of enamel; Wennerholm K et al.; Seventeen subjects with more than 3 x 10(5) mutans streptococci per millilitre of saliva completed this randomised, cross-over study . Four different chewing-gums, containing: (1) 70% xylitol, (2) 35% xylitol + 35% sorbitol, (3) 17.5% xylitol + 52.5% sorbitol, and (4) 70% sorbitol, were tested . The participants used 12 pieces of each gum per day for 25 days . During the four experimental periods, they wore a removable palatinal plate containing two demineralised enamel samples, and brushed their teeth with a non-fluoridated toothpaste . The results showed that an increased concentration of xylitol in the gum resulted in a lower number of mutans streptococci in both saliva and dental plaque, although the decreases were only significant in the saliva samples (p < 0.01) . The pH drop in plaque, measured in vivo after a 1-min mouthrinse with a 10% sorbitol solution, was least pronounced after the 70% xylitol gum and most pronounced after the 70% sorbitol gum period (p < 0.01) . No significant differences were found after a mouthrinse with a 10% sucrose solution . All demineralised enamel samples lost mineral during the experimental periods . However, the lesion depth as well as the mineral loss values, assessed microradiographically, did not differ significantly between the four chewing-gums.

Ann Hematol, 1994 Jan, 68(1), 49 - 52
Capillary leak syndrome associated with elevated IL-2 serum levels after allogeneic bone marrow transplantation; Funke I et al.; The pathophysiological mechanisms involved in the development of a spontaneous systemic capillary leak syndrome (CLS) are unknown . In contrast, CLS is a well-known side effect of high-dose interleukin-2 (IL-2) therapy in solid tumors . We report on a patient who developed CLS with high serum levels of endogenous IL-2 under immunosuppressive therapy for chronic graft-versus-host disease (GvHD) after allogeneic bone marrow transplantation (BMT) . Generalized edema persisted for 10 weeks . The condition resolved after antibiotic therapy of a septic shock with beta hemolyzing streptococci group A . Thus, a latent infection may alter cytokine homeostasis and may cause CLS in BMT patients.

Schweiz Monatsschr Zahnmed, 1994, 104(8), 946 - 51
Release of preventive agents from pacifiers in vitro . An introduction to a novel preventive measure; Suhonen J et al.; Clinical data show that the later primary teeth are colonized by mutans streptococci (MS), the less caries will develop, if at all . Since up to 90% of teething children develop a sucking habit, pacifiers were designed to release preventive agents into the mouth . Simultaneous use of sodium fluoride and xylitol increases the enamel fluoride content . Xylitol affects specifically growth and metabolism of mutans streptococci . The aim of this study was to determine the release of fluoride, xylitol and sorbitol from pacifiers in vitro . A disintegration apparatus was designed to test the dissolution of tablets containing NaF resp . 0.25 mg F, 160 mg xylitol and 150 mg sorbitol from the pacifiers . Six pacifiers were agitated simultaneously with a standardised pump movement, 30 strokes/min, in 15 ml normal saline at +37 degrees C for 2, 5, 10, 20, 40, 60 and 90 min . The released fluoride was determined in 1 ml samples of saline to which 1 ml Tisab was added using a combined F-ion electrode . Xylitol and sorbitol were analyzed by using an ion chromatograph with a pulsed-amperometric detector . A linear slow release of fluoride, xylitol and sorbitol from the pacifiers could be observed up to 90 min . After 2700 strokes the residual saline in the suction chambers (vol . approximately 0.4 ml) was equally analyzed, where all 3 ingredients could still be detected.

Caries Res, 1994, 28(4), 291 - 6
Delayed effect of wheat starch in foods on the intraoral demineralization of enamel; Kashket S et al.; There is considerable evidence for an association between dental caries and food starches . However, the intraoral utilization of starch may be quite complex, giving rise to conflicting results . Demineralization induced by unsweetened cookies was examined in an intraoral model system that utilized palatal appliances containing blocks of bovine enamel . The enamel surfaces were covered with either a filter paper disc to trap sugars or a layer of Streptococcus mutans to metabolize the sugars and bring about enamel demineralization . Demineralization was determined as an increase in porosity with respect to iodide ions (delta Ip) . Measurements revealed a rapid elevation and maintenance of high levels of maltose in the plaque space after ingestion of the unsweetened or sweet cookies . Entrapped food particles appeared to serve as a reservoir of maltose . Unsweetened cookies brought about enamel demineralization, but the pH of the streptococcal plaque fell slowly, and the initiation of demineralization was delayed . Thus, delta Ip and plaque pH were -0.3 +/- 1.3 U and 6.1 +/- 0.3, respectively, after 15 min . The delay was shown to be related to the need to induce the acidogenic streptococci to metabolize maltose . Once induced, delta Ip rose rapidly and reached a maximum at 45 min . Sweet cookies released sucrose and maltose and brought about a rapid onset of demineralization . In summary, the data demonstrated (1) that maltose was released rapidly from unsweetened cookie particles and diffused into the plaque space of the model system and (2) that maltose-dependent demineralization of enamel required time for the induction of the streptococcal cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Caries Res, 1994, 28(4), 262 - 6
Effect of chlorhexidine varnish on streptococci in dental plaque from occlusal fissures; Schaeken MJ et al.; The treatment of tooth surfaces with chlorhexidine varnish may lead to long-lasting suppression of mutants streptococci in dental plaque . Microbiological observations following varnish treatment suggest that this prolonged suppression might be caused by bacterial interference . To investigate whether physiologically related organisms, such as other Streptococcus species, compete with mutans streptococci in the ecosystem, we have analyzed streptococcal populations on the tooth surface before and after chlorhexidine varnish treatment . Occlusal surfaces with high numbers of mutans streptococci were selected in human volunteers and treated with chlorhexidine varnish . Analyses of sequentially collected plaque samples confirmed that S . oralis-group streptococci returned to baseline levels shortly after the chlorhexidine application, while Actinomyces naeslundii populations reached prestudy or even higher levels only several days after treatment . Mutans streptococci, however, were below the detection level in the 14-day samples, except in 1 individual . The pattern of recolonization by individual Streptococcus species after chlorhexidine application closely resembled that of cleaned enamel surfaces: S . oralis and S . sanguis were primary colonizers while S . gordonii became dominant at a later stage . It is concluded that after intensive chlorhexidine treatment, a normal oral microflora reestablished, characterized by low proportions of mutans streptococci.

Clin Infect Dis, 1994 Jan, 18(1), 25 - 31
Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors; Bochud PY et al.; Between 1988 and 1991, 26 episodes of bacteremia due to viridans streptococci occurred in 25 neutropenic patients undergoing intensive chemotherapy for hematologic malignancies . Complications related to the bacteremia were observed in 10 episodes: unilateral pulmonary infiltrates (4), acute respiratory distress syndrome (ARDS) (4), hypotension (3), and endocarditis (2) . All patients with ARDS had received high doses of cytosine arabinoside and had bacteremia due to Streptococcus mitis . Death occurred in three patients (12%) but was possibly related to bacteremia in only one case . Case patients who had received prophylaxis with quinolones were compared with matched control patients who received similar prophylaxis but who did not have bacteremia due to viridans streptococci . Multivariate analysis of predisposing factors showed that high doses of cytosine arabinoside (P = .01), the presence of mucositis (P = .02), and the absence of previous therapy with parenteral antibiotics (P = .01) were independent risk factors for the development of viridans streptococcal bacteremia . Of 259 patients who had received quinolone prophylaxis during the study period, 22 (8.5%) developed an episode of viridans streptococcal bacteremia as compared with three episodes (3.7%) in 82 patients who had received a quinolone and penicillin (P = .07) . However, the latter three episodes were caused by strains with decreased susceptibility to penicillin, thus suggesting that resistance to penicillin might limit the use of this antibiotic as a prophylactic agent in the future.

Scand J Infect Dis, 1994, 26(2), 157 - 62
Changing etiology of bacteremia in patients with hematological malignancies in Denmark; Arpi M et al.; To ascertain whether the microbiological etiology of bacteremia among patients with hematological malignancies has changed in Denmark, the species distribution of clinically relevant blood culture isolates from the Hematological Department at Rigshospitalet, Copenhagen in 1990 was compared with 2 previous studies (1970-72; 1981-85) . In addition, time trends of the etiology of bacteremia among hematological patients in Copenhagen (eastern Denmark) and in Arhus (western Denmark) were compared . In contrast to many other studies, a significant increase in the proportion of Gram-negative aerobes was observed in Copenhagen (from 43% in 1981-85 to 55% in 1990; p < 0.05), whereas in Arhus the proportion of Gram-positive aerobes increased steadily during the 1980s (from 34% to 51%; p < 0.05) . In Copenhagen, non-hemolytic streptococci and Xanthomonas maltophilia increased significantly and accounted for 10% (p < 0.01) and 5% (p < 0.05) respectively, of all isolates in 1990, whereas Staphylococcus aureus during the 2 decades studied decreased from 25% to 8% (p < 0.001) . In both regions, a decrease was observed in the proportion of Pseudomonas aeruginosa which accounted for only about 5% of all isolates in 1990 . No changes were observed in the rates of anaerobes and yeasts . Several factors may contribute to the reported differences in the etiology of bacteremia among hematological patients, e.g . criteria used to assign the clinical significance of the isolate, blood culture system used, practice of using indwelling intravenous catheters, different policies with respect to antimicrobial treatment, and the degree of immunosuppression . A local surveillance of blood culture isolates is mandatory if changes in etiology and resistance development are to be detected.

Caries Res, 1994, 28(3), 161 - 8
Mutans streptococci in a Thai population: relation to caries and changes in prevalence after application of fissure sealants; Songpaisan Y et al.; The aims of this study were to evaluate the level of mutans streptococci in two groups of Thai (Bangkok) children; to relate the findings to caries prevalence and to the caries increment over 2 years, and to study whether different sealant and fluoride programmes affected levels of mutans streptococci over a 2-year period . The baseline survey comprised 1,114 children aged 12 years . For the sealant project, a minimum of three caries-free permanent molars was required; 752 children aged 12-13 and 512 children aged 7-8 years were distributed into five groups: control group, Delton fissure sealant group, glass ionomer fissure sealant applied by dentist (GIC-dentist group) or by school teachers given a 3-day course (GIC-teacher group), and an HF group (0.5% HF solution applied 3 times) . The WHO standard criteria were used to record caries . Prevalence of mutans streptococci was estimated using the Strip mutans test . Mean DMFT (n = 1,114) of 12-years-olds was 2.96; 17% had Strip mutans class 0 (low level), 32% class 1, 33% class 2 and 18% class 3 (the corresponding mean DFT +/- SD for each mutans streptococci class was 1.84 +/- 2.33, 2.23 +/- 2.14, 3.18 +/- 2.75, and 3.59 +/- 3.01 respectively) . For the 7- to 8-year-olds (n = 512), mean df teeth at baseline was 5.36 (d = 5.19; f = 0.17); 5% had Strip mutans class 0, 17% class 1, 33% class 2 and 45% class 3 (the corresponding mean df teeth was 3.19 +/- 2.5, 4.13 +/- 2.84, 4.89 +/- 2.94 and 6.39 +/- 3.16 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Caries Res, 1994, 28(3), 146 - 9
Reduction of dental plaque deposition in humans by oolong tea extract; Ooshima T et al.; The inhibitory effect of oolong tea extract (OTE) containing polymerized polyphenols on plaque deposition was examined in 35 human volunteers . Thirty-five human volunteers, aged 18-29 years, who received extensive oral prophylactic procedures were requested to refrain from all oral hygiene procedures for 4 days, and to rinse their mouth with 0.5 mg/ml OTE solution in 0.2% ethanol before and after every intake of food and before sleeping at night . No restriction regarding meals was given during the test period, except to refrain from teas or coffee . Plaque deposition was evaluated after disclosing the teeth with Erythrocin at the termination of this experiment . The study was repeated 1 week after the first trial, but only 0.2% ethanol without OTE was used for mouthrinsing in the second trial . OTE was found to significantly inhibit plaque deposition in volunteers, although mouthrinsing with OTE solution had no significant effect on the number of mutans streptococci in unstimulated whole saliva.

Eur J Cardiothorac Surg, 1994, 8(4), 173 - 6
Homograft aortic valve and root replacement for severe destructive native or prosthetic endocarditis; Pagano D et al.; Ten male patients with a mean age of 57.5 years (range 27-75 years) underwent homograft aortic valve or root replacement for destructive aortic valve endocarditis . Six patients had native valve endocarditis (one with associated native mitral valve endocarditis) and four had prosthetic valve endocarditis (one with associated prosthetic mitral endocarditis) . Causative organisms were Streptococci in six patients, Staphylococci in one, Q fever in one and no organisms were isolated in the remaining two patients . All the patients were operated while on antibiotics (mean lengths of treatment 13 days; range 2-42) . The main indication for surgery was cardiogenic shock in five patients, progressive cardiac failure in four patients and uncontrolled sepsis in one patient . Operative procedures involved homograft aortic root replacement with coronary reimplantation (seven patients; associated prosthetic mitral valve replacement in one patient), infracoronary homograft aortic valve replacement (three patients) and a number of other procedures were performed to reconstruct the disrupted cardiac anatomy . Patients were followed up for a mean of 13.2 months (range 2-21) . One patient died 4 months postoperatively of an unrelated cause; all the others are asymptomatic with no evidence of recurrent endocarditis . We conclude that homograft aortic valve or root replacement is an effective method of managing destructive aortic valve endocarditis.

Gen Pharmacol, 1994 Jan, 25(1), 111 - 3
Amoxicillin concentration in pus from abscess caused by odontogenic infection; Akimoto Y et al.; 1 . Amoxicillin concentration in pus from odontogenic infection was assayed and the concentrations were compared with MIC (minimum inhibitory concentration) of alpha-hemolytic streptococci isolated from odontogenic infection . 2 . Measurable amoxicillin concentrations in serum and pus were found in all instances (n = 16) . 3 . The mean peak concentrations in serum and pus were found at identical times, 1.5 hr after administration, which were 5.92 and 0.90 micrograms/ml, respectively . 4 . The mean concentration ratio of pus/serum at the peak time was 0.15 . 5 . All amoxicillin concentrations in pus at the peak time exceeded the MIC for 90% of alpha-hemolytic streptococci (0.25 micrograms/ml).

Eur J Immunol, 1994 Jan, 24(1), 131 - 8
Assembly of monoclonal antibodies with IgG1 and IgA heavy chain domains in transgenic tobacco plants; Ma JK et al.; The genes encoding the heavy and light chains of a murine monoclonal antibody (mAb Guy's 13) have been cloned and expressed in Nicotiana tabacum . Transgenic plants have been regenerated that secrete full-length Guy's 13 antibody . By manipulation of the heavy chain gene sequence, constant region domains from an immunoglobulin alpha heavy chain have been introduced, and plants secreting Guy's 13 mAb with chimeric gamma/alpha heavy chains have also been produced . For each plant antibody, light and heavy chains have been detected by Western blot analysis and the fidelity of assembly confirmed by demonstrating that the antibody is fully functional, by antigen binding studies . Furthermore, the plant antibodies retained the ability to aggregate streptococci, which confirms that the bivalent antigen-binding capacity of the full length antibodies is intact . The results demonstrate that IgA as well as IgG class antibodies can be assembled correctly in tobacco plants and suggest that transgenic plants may be suitable for high-level expression of more complex genetically engineered immunoglobulin molecules . Since mAb Guy's 13 prevents streptococcal colonization in humans, transgenic plant technology may have therapeutic applications.

Zh Mikrobiol Epidemiol Immunobiol, 1994 Jan-Feb, (2), 57 - 62
{The manifestations of a scarlatina epidemic process in a large city and their interpretation}; Briko NI et al.; The average morbidity level in scarlet fever for the period of 1972-1990 in Moscow was 230.9 cases per 100,000 of the population and the annual economic damage was 2-2.5 million rubles . The highest morbidity rate values were registered among children attending children's institutions, and in this group among children aged 3-6 years . Cohort and disperse analysis revealed that age-dependent fluctuations of morbidity rate had a regular character and significantly differed . An increase in scarlet fever morbidity was registered simultaneously with elevated levels of morbidity in tonsillitis and acute respiratory diseases and occurred several weeks after a rise in tonsillitis morbidity . Contamination with group A streptococci was higher among "organized" children of preschool age than among other groups of the population . T serovars 4/28, 8/29/Imp.19, 3/13/B3254 and 1, constituting 44% of all isolated Streptococcus pyogenes strains, and OF type 2 (44%) and 22 (20%) occurred most frequently . Among the strains isolated from patients T-4 and OF-2 types prevailed.

Caries Res, 1994, 28(5), 335 - 41
Effects of subinhibitory concentrations of chemical agents on hydrophobicity and in vitro adherence of Streptococcus mutans and Streptococcus sanguis; Cai S et al.; The aim of this investigation was to determine whether sublethal concentrations of chlorhexidine (Cx), hexetidine (Hx), cetylpyridinium chloride (Cc), sodium dodecyl sulfate (SDS), sanguinarine (Sg), sodium fluoride (NaF), and ammonium fluoride (NH4F) could affect hydrophobicity and adhesion of Streptococcus sanguis and Streptococcus mutans to saliva-coated hydroxyapatite (S-HA) . Determination of the minimum inhibitory concentrations (MICs) showed that both species were susceptible to all agents tested . Growth in the presence of sub-MIC concentrations of Cx, SDS, Cc, NaF, or NH4F did not change significantly the hydrophobicity of S . sanguis cells when compared to the control which lacked any agent . However, growth in the presence of Hx or Sg resulted in a significant reduction in their hydrophobicity . Sub-MIC levels of SDS or Sg in the growth medium resulted in S . mutans cells with increased affinity for hexadecane compared with the control . The adherence of S . sanguis was changed significantly only by Hx or Sg, resulting in less cells adhering to S-HA . However, S . mutans cells previously incubated with NaF, NH4F, or Sg showed a higher adherence to S-HA than the control . The mechanisms of interference with adherence are at present not completely understood . Thus, antimicrobial agents at sub-MIC concentrations can interfere selectively with hydrophobicity and/or adhesion of oral streptococci.

Adv Perit Dial, 1994, 10, 73 - 6
CAPD for treatment of ESRD patients with ascites secondary to liver cirrhosis; Bajo MA et al.; The treatment of cirrhotic patients with ascites and end-stage renal disease (ESRD) is complex . Continuous ambulatory peritoneal dialysis (CAPD), as a continuous therapy, represents an alternative to hemodialysis-associated hemodynamic intolerance . We report our experience with 5 cirrhotic patients with ascites who were treated by CAPD . Three had been transferred from hemodialysis (HD) for intolerance . The hemodynamic tolerance was excellent in all patients, and solute and water peritoneal transport were increased over the normal range in all cases . Morbidity was principally related to liver disease . Peritoneal protein losses, initially high, decreased over time . Serum albumin was within the low normal range . The incidence of peritonitis was higher than usual in these patients; episodes caused by gram-negative bacteria, streptococci and listeria, were predominant . The cause of death was not CAPD-related . In our experience, CAPD should be the treatment of choice for cirrhotic patients with ascites who require dialysis.

Arch Gynecol Obstet, 1994, 255(3), 147 - 51
Eradication of Viridans streptococci from the amniotic cavity with transplacental antibiotic treatment; Mazor M et al.; We report a case of eradication of Viridans streptococci from the amniotic cavity in a patient with preterm labor and intact membranes by transplacental antibiotic treatment . Following this modality of treatment, preterm labor was arrested and the pregnancy continued uneventfully until normal term delivery . We suggest that transplacental antibiotic treatment should be seriously considered as part of the medical armamentarium for treatment of patients with preterm labor and microbial invasion of the amniotic cavity.

Yao Xue Xue Bao, 1994, 29(5), 340 - 5
{Antimetastatic action of polyactin A and its mechanism}; Qiang WA et al.; Polyactin A (PAA) is a home-made immunomodulator, isolated from submerged culture broths of alpha-hemolytic streptococci . The effect of PAA on the metastasis of B16-F10 melanoma cells in the syngeneic C57BL/6J mice and its antimetastatic mechanism have been studied . The results showed that: PAA inhibited the experimental pulmonary metastasis nodules at a dose of 100 mg.kg-1.d-1 for 18 d . The number of pulmonary metastasis nodules were significantly decreased from 137 to 95 as compared with those in the control; The plasma concentration of TXB2 in B16 bearing mice was higher than that in normal mice . After treatment with PAA, a decreased content of TXB2 and 6-keto-PGF1 alpha was found without change of the ratio TXB2 to 6-keto-PGF1 alpha . The cellular immunities were evidently decreased in the B16 bearing mice . The restoration of lymphocyte proliferation response and augmentation of the NK cell activity of the splenocytes were found in vivo in normal mice and B16 bearing mice after treated with PAA . PAA was also shown to antagonize the suppressing effect of cyclophosphamide on murine NK cells; PAA at the concentration of 10-5000 micrograms.ml-1 was found to inhibit the biosynthesis of DNA, RNA and protein in the B16-F10 melanoma cells to different degrees and the effect was dose-dependent . It is evident that PAA is effective in preventing the pulmonary metastasis of B16-F10 melanoma and the antimetastatic action may be related not only to promoting the effect the antitumor immunities, but also to inhibiting the growth of B16-F10 melanoma cells.

Microbiol Immunol, 1994, 38(6), 457 - 60
Coaggregation between Porphyromonas gingivalis and mutans streptococci; Kamaguchi A et al.; Coaggregation occurred between Porphyromonas gingivalis and mutans streptococci . The coaggregation was completely inhibited by L-arginine, N alpha-p-tosyl-L-lysine chloromethyl ketone (TLCK), and a trypsin inhibitor, and weakly inhibited by L-lysine, N-ethylmaleimide, lysozyme, and human whole saliva . The results of heat and proteinase K treatment suggested that a heat-labile proteinaceous substance of P . gingivalis and a heat-stable substance of mutans streptococci may play a role in the coaggregation . Mutans streptococci also aggregated in the presence of the heat-labile factor in the supernatant of P . gingivalis . The aggregation was also inhibited by L-arginine, TLCK, and a trypsin inhibitor.

Eur Urol, 1994, 26(2), 115 - 9
Urethral syndrome: clinical results with antibiotics alone or combined with estrogen; Parziani S et al.; The urethral syndrome is very frequent in women but the etiology is unknown . In all 77 patients suffering from the syndrome, endoscopy revealed characteristic lesions in the trigonal area . As unidentified bacteria may be responsible, a microbiological investigation was carried out . Wide-spectrum or specific antibiotic therapy was prescribed as required . All patients were also randomized to 2 groups to assess the efficacy of local estrogen therapy . The authors concluded that wide-spectrum antibiotic therapy with macrolide and mepartricin should be the first choice of treatment and that local administration of estrogen does not significantly enhance the benefits achieved through antibiotic therapy . A detailed microbiological investigation is necessary when symptoms persist . Overall a positive result was obtained in 75.32% of the cases (58 patients) . The presence of Streptococci negatively influenced the results of specific antibiotic therapy.

Trop Geogr Med, 1994, 46(3), 154 - 6
Experience with brain abscess in the central province of Saudi Arabia; Jamjoom A et al.; The characteristics of brain abscess in the Central Province of Saudi Arabia are outlined in this report which is a review of 22 consecutive cases that were treated at King Khalid University Hospital between 1985-1991 . The incidence of brain abscess in Saudi Arabia is calculated to be 3.6 cases/500,000 population/year which is twice as high as the incidence reported from the West . There were 17 males and 5 females with an age range of 8 months-80 years (mean 29.9 years) . The parietal lobe was involved in 27%, while the abscess was in the posterior fossa in 14% and multiple in another 14% of cases . The primary source of sepsis was unknown in 50%, post-traumatic in 18% and from a dental and mastoid origin in 14% of cases only . Duration of symptoms ranged between 4-30 days (mean 12 days) . Fever was present in 55% of cases and epilepsy in 23% . Sixteen (73%) cases had burr hole aspiration, while 3 (14%) had craniotomy and excision, and 3 (14%) cases were managed with antimicrobial treatment only . Staphylococci were the pathogens in 27%, while streptococci were cultured in 23% cases and the culture was negative in 23% . Three (14%) cases all of which died had fungal abscesses caused by Fonsecaea pedrosoi . The mortality was 18%, good recovery in 68% and fair recovery in 14% . Follow-up was from 3 months to 5.5 years (mean 1.8 years).

Scand J Infect Dis, 1994, 26(3), 297 - 300
Acute suppurative thyroiditis: a ten-year review in a Taiwanese hospital; Jeng LB et al.; 12 patients with acute suppurative thyroiditis were treated over a 10-year period . Their ages ranged from 2-81 years . Eight of them had a pre-existing thyroid mass . A piriform sinus fistula was demonstrated in one of the 2 patients with a history of recurrent infections . Cultures of the pus taken from the infected glands grew Gram-positive streptococci in 4 patients, Gram-negative bacteria in 4, and anaerobic bacteria in 1; the other 3 were sterile . Both patients who grew Klebsiella pneumonia were diabetic . Most of the patients received drainage in addition to systemic antibiotics . Only 2 patients had recurrence during the follow-up period . We present a review of our experience with this uncommon infection.

Scand J Infect Dis, 1994, 26(3), 283 - 7
Arcanobacterium haemolyticum and streptococcal pharyngitis; Carlson P et al.; Arcanobacterium haemolyticum was recovered from 0.5% of throat cultures of 3,922 patients seeking medical attention because of sore throat . Most of the patients positive for A . haemolyticum were 15-25 years old, and had fever (80%), lymphadenopathy (67%), pharyngeal exudate (69%) or skin rash (23%) . In this age group, 2% of the throat cultures proved positive for A . haemolyticum . All A . haemolyticum strains were susceptible to penicillin, erythromycin, cephalexin and clindamycin, but resistant to trimethoprim/sulphamethoxazole . In half of the patients with A . haemolyticum it was the only bacterial pathogen isolated, while in the remainder, beta-haemolytic streptococci were also detected . As expected, beta-haemolytic streptococci were much more frequent than A . haemolyticum in the throat cultures.

Acta Haematol, 1994, 92(3), 140 - 1
Acute rhabdomyolysis complicating viridans streptococcal shock syndrome; Martino R et al.; A 20-year-old male underwent an allogeneic bone marrow transplantation for acute myelogenous leukemia after conditioning with cyclophosphamide and total body irradiation . On day +6 of the procedure, he developed fever, chills and myalgias . Empiric treatment with ceftazidime and amikacin was begun, and blood cultures grew viridans streptococci . Biochemical changes suggestive of acute rhabdomyolysis were evident . Within 24 h, adult respiratory distress syndrome with multiorgan failure appeared, and he died 7 days later . At autopsy, the presence of rhabdomyolysis was confirmed.

Scand J Infect Dis, 1994, 26(5), 585 - 95
Comparison of imipenem versus cefuroxime plus tobramycin as empirical therapy for febrile granulocytopenic patients and efficacy of vancomycin and aztreonam in case of failure; Erjavec Z et al.; 143 aplastic episodes with fever in 91 haematological patients with granulocytopenia were treated empirically in a randomized prospective study using either imipenem (Imi) or a combination of tobramycin and cefuroxime (T/C) . Response after 72 h was significantly better in patients receiving Imi (44/75 vs 27/68, p < 0.05) . This was seen especially in patients with bacteriologically proven infections where the isolated staphylococci and streptococci were more susceptible to Imi . In both groups, patients who failed to respond to the initial antibiotic therapy were given vancomycin and aztreonam (V/A) . The response rate after another 72 h, measured using the same criteria as after the first 72 h, did not differ statistically between the groups . One patient in each study group died from the bacterial infection, both from Gram-positive bacteraemia . Duration of fever was significantly shorter in the Imi group (4 days vs 7 days, p < 0.04) . Serum peak and trough concentrations of the antibiotics were comparable . Both regimens were well tolerated . Our results show that monotherapy with imipenem is superior to the combination of tobramycin and cefuroxime during the first 72 h of therapy and can be safely administered to neutropenic patients with predominantly Gram-positive infections . A combination of vancomycin and aztreonam, given when initial imipenem treatment has failed, was effective in only a few patients . Adjuvant glycopeptide therapy from the outset in the treatment of febrile granulocytopenic patients did not seem worthwhile.

Scand J Infect Dis, 1994, 26(5), 535 - 41
Clindamycin in persisting streptococcal pharyngotonsillitis after penicillin treatment; Orrling A et al.; 239 patients with streptococcal pharyngotonsillitis completed treatment with phenoxymethyl penicillin 12.5 mg per kg body weight b.i.d . for 10 days . At examination after completing therapy, throat specimens from 53 patients (22%) yielded growth of group A streptococci of the same . T-type as the initial culture (bacterial treatment failure) . 20 of these 53 (38%) had symptoms and signs of tonsillitis (clinical and bacterial treatment failure) . 48 of the patients with bacterial failure were randomly allocated to phenoxymethyl penicillin or clindamycin in an open design; 22 of them received a second course of phenoxymethyl penicillin for 10 days and 26 were given clindamycin, 6.5 mg per kg body weight b.i.d . (children) or 300 mg t.i.d . (adults) for 10 days . After completing their treatment, 14 of 22 patients (64%) given phenoxymethyl penicillin harboured the same T-type as in the previous two cultures, while group A streptococci were not recovered from any of the 26 patients receiving clindamycin . In patients with clinical failure after phenoxymethyl penicillin treatment, a new course with this drug is not motivated . In that situation clindamycin seems to be an efficient choice.

Caries Res, 1994, 28(6), 435 - 40
Effect of chlorhexidine treatment followed by stannous fluoride gel application on mutans streptococci in margins of restorations; Wallman C et al.; The effect of antimicrobial treatment on the numbers of mutans streptococci (MS) in plaque from margins of restorations and in saliva was studied . Nineteen persons with well-restored dentitions and > 0.5 x 10(6) MS per ml saliva were treated with 1% chlorhexidine (CHX) gel in individually designed applicators 5 min/day for 9 days . Ten of the subjects continued the treatment with 0.4% stannous fluoride (SnF2) gel and the remaining 9 with a placebo gel for another 14 days . Plaque samples from margins of selected restorations and stimulated saliva were collected at baseline, after the completion of each gel treatment and then again at regular intervals up to 24 weeks . The CHX gel treatment suppressed MS in the margins of restorations as well as in saliva . Additional treatment with the SnF2 gel prolonged this suppression compared with CHX treatment alone . In the CHX-SnF2 group, the number of MS in margins of amalgam and composite restorations was still significantly lower at the end of the study compared with the baseline . In the CHX placebo group, the margins of amalgam restorations, mainly placed in premolars and molars, were recolonized somewhat faster than the margins of composite restorations in the front teeth.

Caries Res, 1994, 28(6), 421 - 8
Lysozyme and lactoperoxidase inhibit the adherence of Streptococcus mutans NCTC 10449 (serotype c) to saliva-treated hydroxyapatite in vitro; Roger V et al.; Lysozyme, lactoperoxidase and salivary peroxidase inhibit the metabolism and growth of mutans streptococci, but any possible effects on the adherence of these bacteria are unknown . In this study the effects of lysozyme and lactoperoxidase on the adhesion of 3H-labelled Streptococcus mutans (NCTC 10449, serotype c strain) to saliva-coated hydroxyapatite were studied at pH 5.0 and 7.0 . Human whole saliva was either lysozyme-depleted and centrifuged, or sterilized and dialysed to achieve no detectable lysozyme and peroxidase activities; this modified saliva was used to form experimental pellicles . The incorporation of lysozyme (50-200 micrograms/ml) to the pellicle caused a significant (p < 0.01) reduction in the adherence of S . mutans without any loss of bacterial viability . Pretreatment of either saliva-coated apatite or S . mutans cells with lysozyme did not change the results but lysozyme bound more readily to bacteria than to the experimental pellicles . Also, lactoperoxidase (10-200 micrograms/ml) reduced significantly (p < 0.001) the adherence of S . mutans but, in contrast to lysozyme, in a dose-dependent way . The strongest inhibition of adhesion was found when both saliva-coated apatite and bacteria were pretreated with lactoperoxidase . This enzyme bound to experimental pellicles in preference to streptococci . A non-specific protein control, albumin, did not block the inhibition by lysozyme or lactoperoxidase . The inhibition of adherence of a serotype c strain of S . mutans to saliva-coated hydroxyapatite is a novel antibacterial mechanism for both lysozyme and lactoperoxidase.

Caries Res, 1994, 28(6), 416 - 20
Mucin-sulphatase activity of some oral streptococci; Smalley JW et al.; Mucin-sulphatase activity, measured using a 35S-{SO4(2-)}-labelled colonic mucin substrate, was detected in whole cells of Streptococci isolated from the human oral cavity . The highest levels of sulphatase activity were found in all strains of Streptococcus salivarius, Streptococcus mitis and in half of the strains of Streptococcus mutans tested . Little or no activity was detected in 9 of the 11 Streptococcus oralis strains examined, in the 4 Streptococcus constellatus strains, and in the 3 Streptococcus anginosus isolates tested . The highest enzyme levels were obtained from the two fresh Streptococcus gordonii isolates . This is the first report of such activity in oral microorganisms . Streptococcal mucin-sulphatase may contribute to the destruction of salivary mucins and mitigate their protective functions in the oral cavity, and be a determinant in the development of dental caries.

Rev Med Interne, 1994, 15(11), 715 - 9
{Parenchymatous abscess in Streptococcus anginosus (Streptococcus milleri) septicemia . Value of their systematic search, apropos of 4 cases}; Colnot F et al.; Streptococcus anginosus, the term suggested to cover a set of streptococci previously known under various names (milleri, MG, anginosus, intermedius, constellatus), is characterized by a propensity to create parenchymatous abscesses, essentially cerebral or hepatic, particularly within the terms of septicemia . These abscesses are sometimes difficult to detect due to a difficult or non-existent symptomatology . The authors report on four cases illustrating the necessity to search for them systematically by cerebral CT scan and abdominal echography or CT scan in all cases of septicemia caused by Streptococcus anginosus.

DNA Seq, 1994, 4(5), 325 - 8
Cloning and sequencing the streptolysin O genes of group C and group G streptococci; Okumura K et al.; On the basis of the known streptolysin O (SLO) genomic sequence of Streptococcus pyogenes group A, we identified the SLO genes in some strains of group C and group G streptococci by the polymerase chain reaction procedure (PCR) . The entire open reading frame region of these genes was cloned and analyzed . Their nucleotide sequence data showed that the defined SLO genes in group C and group G are almost identical to that of group A.

Arch Tierernahr, 1994, 46(4), 357 - 65
The adherence of three Streptococcus bovis strains to cells of rumen epithelium primoculture under various conditions; Styriak I et al.; Three Streptococcus bovis strains were tested in biotype assay and examined for the adherence to cells of rumen epithelium primoculture . The adherence pattern of ruminal streptococci in phosphate buffered saline at pH values ranging from 4.1 to 8.5 was determined . Our isolates of Streptococcus bovis strains adhered best at pH 7.0-7.3 . To characterize the adhesive determinants, the bacterial cells were exposed to various treatments . Protease treatment dramatically decreased the adherence of all Streptococcus bovis strains, thus suggesting that the determinants responsible for the adherence are largely proteinaceous . Carbohydrates could be also significantly involved in the active sites of bacterial surface because metaperiodate-treated cells adhered much more poorly than control, sodium iodate-treated cells . Addition of carbohydrates (lactose, maltose and saccharose) had no significant effect on the adherence of Streptococcus bovis strains although a slight decrease in the adhesion was detected.

Ann Fr Anesth Reanim, 1994, 13(5 Suppl), S135 - 7
{Antibiotic prophylaxis in gastroduodenal surgery}; Ballay JL et al.; The incidence of postoperative wound infections is increased up to 35% after gastroduodenal surgery, when gastric motility and acidity are decreased, as in case of gastric ulcer or cancer, obstruction, bleeding, antacid therapy . The endogenous flora contaminating the operative-site consists of organisms of the oropharynx and the jejunum and includes anaerobes like bacteroides, aerobes like streptococci, staphylococci, E . coli . Antimicrobial prophylaxis is therefore indicated in these high risk patients . All groups of antibiotics have been used, however 1st and 2nd generation cephalosporins are the most effective . A single dose given intravenously just before anaesthesia is recommended, a second dose is advisable intraoperatively when surgery is prolonged or massive blood loss occurs . Antibiotic prophylaxis is also recommended in gastric bypass surgery for obesity, but remains controversial for percutaneous endoscopic gastrotomy.

Scand J Infect Dis, 1994, 26(6), 753 - 4
Group F beta-hemolytic streptococcus, tonsillitis and myocarditis; Maki-Ikola O et al.; A case of tonsillitis and myocarditis is reported, where the only positive microbiological finding was a throat swab growing group F beta-hemolytic streptococci . The patient made an uneventful recovery after treatment with benzylpenicillin and clindamycin.

Crit Rev Oral Biol Med, 1994, 5(3-4), 203 - 48
Saliva-bacterium interactions in oral microbial ecology; Scannapieco FA; Saliva is thought to have a significant impact on the colonization of microorganisms in the oral cavity . Salivary components may participate in this process by one of four general mechanisms: binding to microorganisms to facilitate their clearance from the oral cavity, serving as receptors in oral pellicles for microbial adhesion to host surfaces, inhibiting microbial growth or mediating microbial killing, and serving as microbial nutritional substrates . This article reviews information pertinent to the molecular interaction of salivary components with bacteria (primarily the oral streptococci and Actinomyces) and explores the implications of these interactions for oral bacterial colonization and dental plaque formation . Knowledge of the molecular mechanisms controlling bacterial colonization of the oral cavity may suggest methods to prevent not only dental plaque formation but also serious medical infections that may follow microbial colonization of the oral cavity.

Acta Vet Scand, 1994, 35(4), 363 - 9
Association af changes in the bacterial ecology of bovine mastitis with changes in the use of milking machines and antibacterial drugs; Myllys V et al.; The results of mastitis bacteriology made by the National Veterinary and Food Research Institute in Finland during the past 50 years (1.15 million samples) are viewed in relation to simultaneous changes in dairy cow management . Although intensive preventive measures have been applied for decades, the prevalence of bovine mastitis has not decreased . Instead, pathogenic bacteria are becoming progressively less susceptible to the available therapy . In part this must be due to the emergence of antibiotic resistant strains of bacteria, but it seems that the bacterial spectrum has also changed . The incidence of Streptococcus agalactiae (group B streptococci) has decreased, while in contrast, the incidence of staphylococci, initially Staphylococcus aureus and later coagulase-negative staphylococci, has increased . Results suggest that external pressure, like changes in animal husbandry, including antimicrobial treatments and introduction of modern milking machines, act as selective forces on the bacterial species which cause bovine mastitis.

Ann Trop Paediatr, 1994, 14(2), 145 - 8
Streptococcal toxic shock-like syndrome: case report and review of the literature; al Mazrou AM; Streptococcal toxic shock-like syndrome is a newly recognized complication of infections by group A beta-haemolytic streptococci (GABHS) . Previous reports of this syndrome have originated from developed countries, predominantly North American and Europe . This report describes a 5-year-old Saudi child who developed this syndrome in association with streptococcal pharyngitis . It indicates that the recent resurgence of severe GABHS diseases is a global phenomenon.

Caries Res, 1994, 28(4), 257 - 61
The use of lectins in monitoring degradation of oligosaccharide chains in mucin by oral streptococci; van der Hoeven JS et al.; The ability of utilize mucin oligosaccharides as sources of carbohydrate and energy is believed to be an important mechanism in the ecology of oral streptococci . In this study we have used digoxigenin-labelled lectins of various specificities to monitor changes in the nonreducing end groups of oligosaccharide chains following their degradation by Streptococcus oralis Ny 586 and Streptococcus sanguis Ny 584 . The reaction of degraded mucin with peanut lectin, that recognizes the core disaccharide Gal (1,3)GalNAc in O-glycans, revealed a more extensive degradation of oligosaccharide by S . oralis than by S . sanguis . This corresponds to better growth of S . oralis on the mucin . Analyses with Datura stramonium lectin showed that terminal Gal (1,4)GlcNAc, or GlcNAc (1,4)GlcNAc moieties, in the oligosaccharides are attacked by both strains . Reaction patterns with alpha-L-fucose-specific lectins indicated that terminal fucose was released by S . oralis but not by S . sanguis . This was in accordance with sugar analyses which showed that approximately 40% of the fucose units were released . The results extend previously observed losses of sugars from oligosaccharide chains during growth of these organisms on mucin.

Drugs, 1994, 47 Suppl 3, 27 - 33; discussion 34
Cefetamet pivoxil in the treatment of pharyngitis/tonsillitis in children and adults; Guggenbichler JP; Between 15 and 35% of pharyngeal infections are attributable to Group A beta-haemolytic streptococci . Streptococcal pharyngitis is one of the most common infections in adolescents and children . A specific diagnosis of pharyngitis can be obtained only by isolating organisms in culture . The current treatment of choice for streptococcal pharyngitis/tonsillitis is a 10-day course of phenoxymethylpenicillin (penicillin V); however, unresolved problems concerning the use of penicillin include the timing of therapy, appropriate therapy for treatment failures, chronic carriers and those with frequent recurrences . In addition, failure rates of 10 to 35% have been reported with oral phenoxymethylpenicillin . Effective treatment alternatives in this indication include oral cephalosporin agents or penicillin/beta-lactamase inhibitor combinations . The oral cephalosporins offer the advantage of an improved pharmacokinetic profile, once- or twice-daily administration, a shorter (7-day) regimen, and a low incidence of adverse effects, although these advantages must be balanced against the broad spectrum of these agents (broader than is necessary) and their cost . Clinical trials conducted with cefetamet pivoxil, a new oral third generation cephalosporin, in both adults and children with pharyngitis/tonsillitis indicate that this agent offers an effective alternative for phenoxymethylpenicillin in this indication.

J Biol Chem, 1993 Dec 5, 268(34), 25417 - 24
PAM, a novel plasminogen-binding protein from Streptococcus pyogenes; Berge A et al.; The ability of group A streptococci to bind human plasminogen and plasmin has attracted interest, because it could provide the bacteria with a mechanism for invasion . M or M-like proteins account for the binding of several plasma proteins to group A streptococci . To investigate whether M or M-like proteins were responsible for the binding of plasminogen to group A streptococci, acid-extracted material from a type M53 streptococcal isolate was tested for its ability to bind plasminogen . Indeed, a 42-kDa plasminogen-binding protein was solubilized . Two oligonucleotides homologous with conserved sequences in known M protein genes were used as primers in the polymerase chain reaction, with chromosomal DNA from the M53 isolate . When cloned and expressed in Escherichia coli, a resulting fragment encoded a 43-kDa plasminogen-binding protein . Nucleotide sequence determination of the gene fragment revealed an open reading frame encoding a polypeptide of 43,580 Da, which matched the amino-terminal amino acid sequence of the plasminogen-binding protein extracted from M53 streptococci . The DNA sequence data also proved the relationship of the encoded protein, named PAM, to the M proteins . The plasminogen-binding domain was mapped to the amino-terminal third of PAM . Plasminogen absorbed by M53 streptococci or by immobilized PAM could be activated by streptokinase . The results provide further evidence of the diversity of the M protein family and suggest a new mechanism whereby these proteins contribute to the virulence of group A streptococci.

Lancet, 1993 Dec 4, 342(8884), 1385 - 8
Toxic shock syndrome toxin-secreting Staphylococcus aureus in Kawasaki syndrome; Leung DY et al.; Kawasaki syndrome (KS), the main cause of acquired heart disease in children, is associated with the selective expansion of V beta 2+ T cells in peripheral blood . Our study suggests that KS may be caused by a superantigen--a staphylococcal or streptococcal toxin . Bacteria were cultured without knowledge of their origin, from the throat, rectum, axilla, and groin of 16 patients with untreated acute KS and 15 controls . Bacteria producing toxins were isolated from 13 of 16 KS patients but from only 1 of 15 controls (p < 0.0001) . Toxic shock syndrome toxin (TSST) secreting Staphylococcus aureus was isolated from 11 of the 13 toxin-positive cultures, and streptococcal pyogenic exotoxin (SPE) B and C were found in the other 2 . These toxins are known to stimulate V beta 2+ T cells . All TSST-producing KS isolates were tryptophan auxotrophs indicating they were clonally related . S aureus isolates from acute KS patients were unusual because they produced less lipase, haemolysin, and protease compared to other isolates (p < 0.01) . S aureus colonies from KS patients were white, and could be easily mistaken for coagulase-negative staphylococci, whereas colonies of non-KS isolates were gold . These observations suggest that the expansion of V beta 2+ T cells in most patients with KS may be caused by a new clone of TSST-producing S aureus, and, in a minority of patients, SPEB-producing or SPEC-producing streptococci.

J Clin Microbiol, 1993 Dec, 31(12), 3223 - 6
Effects of media, atmosphere, and incubation time on colonial morphology of Arcanobacterium haemolyticum; Cummings LA et al.; Arcanobacterium haemolyticum causes pharyngitis as well as skin and other wound infections . Although it is a beta-hemolytic organism, the hemolysis is less well defined than that of beta-hemolytic streptococci and may be overlooked in cultures with heavy growth of commensal throat flora . To determine whether routine throat culture conditions are sufficient to produce recognizable colonies of A . haemolyticum, the morphology of six distinct strains was studied after various combinations of incubation time, medium, and atmosphere . The agar media, containing 5% sheep blood, were Trypticase soy agar, Columbia agar, and heart infusion agar . Cultures were incubated in ambient air, 6 to 8% CO2, or an anaerobic atmosphere . Cultures were compared after 24, 48, and 72 h of incubation for colony size, clarity and size of hemolytic zone, and macroscopic evidence of agar pitting . A minimum of 48 h was needed for expression of beta-hemolysis and pitting . Trypticase soy agar was the superior medium and CO2 was the superior atmosphere for beta-hemolysis . Agar pitting was not significantly affected by variations in medium or atmosphere . Strains differed in their expression of hemolysis and production of pits at 48 h . After 72 h of incubation, beta-hemolysis and pitting were visible in over 96% of culture observations.

Immunology, 1993 Dec, 80(4), 640 - 4
Binding ability of complement receptor CR1 to C3 bound on the surface of M+ group A streptococci; Hong K et al.; A previous study demonstrated that although M+ bacteria bound C3, mainly C3b and iC3b, via the classical pathway of complement activation, they were not phagocytosed by polymorphonuclear leucocytes (PMN) . To elucidate this mechanism, we attempted to distinguish between the possibilities that M+ bacteria are effectively adhering to PMN but are not being endocytosed, or that the C3 deposited on M+ bacteria is not able to interact with the complement receptors on PMN . In the present study, we studied the interaction of C3-coated M+ bacteria with complement receptor CR1, which was isolated from the stroma of human erythrocytes . We show that the isolated complement receptor CR1 can associate with C3-coated M+ bacteria as well as with C3-coated M- bacteria, and the C3 deposited on M+ bacteria is cleaved and releases a C3 fragment in the presence of factor I and liquid-phase CR1 . These results suggest that the C3 bound on the surface of M+ bacteria is able to promote adherence to the complement receptor CR1 on PMN . We also studied the distribution of C3 deposited on M+ bacteria in normal human serum (NHS) or normal human plasma (NHP) . By immunofluorescence, we show that the C3 bound to M+ bacteria in NHS was deposited uniformly over the surface of the bacteria . On the other hand, the C3 bound to M+ bacteria in NHP was deposited at both ends between adjacent daughter cocci . The results suggest that an additional factor contained in NHP is related to the enhancement of anti-phagocytic activity of M+ bacteria.

Community Dent Oral Epidemiol, 1993 Dec, 21(6), 365 - 9
Prediction of caries incidence in schoolchildren living in a high and a low fluoride area; Mattiasson-Robertson A et al.; A salivary mutans streptococci test and past caries experience were used as predictors for caries increment in a 3-yr study comprising 655 12-yr-old schoolchildren from two areas with contrasting levels of fluoride in the drinking water . The mean caries (DMFS) increment was similar in both groups during the study period, but a significantly (P < 0.05) higher incidence of approximal enamel lesions was registered in children from the high fluoride area . In both groups, a statistically significant (P < 0.05-0.001) positive relationship between salivary mutans streptococci score and/or past caries experience at baseline on one hand and caries increment during the study period on the other was established . The past caries experience was the most powerful predictor of caries risk in both the low fluoride and the high fluoride area . The sum of the sensitivity and specificity was somewhat higher in the low fluoride area (138%) compared to the high fluoride area (123%) . The salivary bacterial enumeration used alone or in combination with past caries experience as well as past approximal caries experience were less useful as predictors in both groups . The present findings indicate that the natural fluoride exposure has a limited influence on caries risk assessment and the caries predictive ability of the salivary bacterial test and past caries in populations with a low level of disease.

Crit Care Med, 1993 Dec, 21(12), 1929 - 34
Acute asphyxia affects neutrophil number and function in the rat; Beachy JC et al.; OBJECTIVES: Previous studies in adults suggest that various types of physiologic stress appear to decrease phagocytic cell function . Adherence and chemotaxis of, and phagocytosis and bacterial killing by, neonatal neutrophils are altered compared with adult neutrophil function . Stresses encountered by the fetus and neonate, such as asphyxia, were hypothesized to further alter neonatal neutrophil function . To investigate the impact of asphyxia on systemic immunity, we developed a rat model of acute asphyxia and evaluated the effect of asphyxia on neutrophil number and function . DESIGN: Prospective, laboratory study . SETTING: Research laboratory . SUBJECTS: Adult female Wistar rats . INTERVENTIONS: Exposure to CO2 and cold stress . MEASUREMENTS AND MAIN RESULTS: Arterial blood gas, blood glucose, neutrophil number, neutrophil-mediated, complement-dependent bacterial phagocytosis and killing were determined . After a 20-sec exposure to CO2 and cold stress (dry ice vapors), adult rats developed acute respiratory acidosis (pH 6.89 +/- 0.26, PaCO2 220 +/- 183 torr {29.3 +/- 24.3 kPa}), and mild hypoxia (60 +/- 20 torr {8.0 +/- 2.7 kPa}) followed by significant metabolic acidosis (base deficit = -12.0 +/- 1.5) . Neutrophil number slowly increased and reached statistical significance by 72 hrs (5.0 +/- 1.5 x 10(3)/mm3) compared to controls (2.9 +/- 1.6 x 10(3)/mm3) (p = .03) . Phagocytosis and killing of group B streptococci by neutrophils isolated immediately after asphyxia were significantly impaired (p = .03), and this decrease in function lasted for 24 hrs after asphyxia (p = .04), as measured by two different in vitro complement and antibody-mediated functional assays . CONCLUSIONS: After brief exposure to CO2 and cold stress, rats developed an acute respiratory acidosis and subsequent metabolic acidosis similar to acute asphyxia . Neutrophil number did not increase until 72 hrs after asphyxia . However, neutrophil-mediated phagocytosis and killing of bacteria were immediately impaired . We speculate that asphyxia may increase the risk for sepsis secondary to altered neutrophil function.

Toxicol Appl Pharmacol, 1993 Dec, 123(2), 211 - 8
A comparison of the pulmonary defenses against streptococcal infection in rats and mice following O3 exposure: differences in disease susceptibility and neutrophil recruitment; Gilmour MI et al.; Ozone (O3) exposure reduces alveolar macrophage (AM) phagocytosis in mice and increases their susceptibility to Streptococcus zooepidemicus . O3 exposure also decreases AM phagocytosis in rats but does not result in mortality to infection . To investigate the mechanism of disease protection in rats, antibacterial defenses of two strains of mice and F344 rats were compared . O3 exposure (3 hr, 0.4 or 0.8 ppm) and infection with S . zooepidemicus resulted in a dose-dependent proliferation of bacteria in the lungs of mice and high mortality . Polymorphonuclear leukocytes (PMNs) were observed in severely affected individuals 2 or more days postinfection and did not alter the fatal infection . In contrast, microbial inactivation was only impaired in O3-exposed rat lungs during the first 48 hr after infection . In these animals PMNs could be isolated from bronchoalveolar lavage fluid between 6 and 48 hr postinfection with the peak response occurring at 24 hr . Pretreatment with anti-PMN serum eliminated the neutrophil influx and impaired further the bactericidal activity in ozone-exposed rats . The results suggest that inhaled streptococci are cleared normally from the mouse lung by AMs . Following exposure to O3, AM phagocytosis is reduced and the mice develop a fatal infection . The persistence of bacteria in the lungs of O3-exposed rats triggers a transient influx of PMNs whose appearance corresponds with elimination of the bacteria . Differences in antimicrobial defenses between various experimental species and humans need to be better understood in order to predict effects of air pollutants on susceptibility to infection in man.

J Med Microbiol, 1993 Dec, 39(6), 440 - 5
The agglutination of beta-haemolytic streptococci by lectins; Kellens JT et al.; The ability of 25 lectins, isolated from different plants and fungi, to agglutinate 95 clinical isolates of beta-haemolytic streptococci was examined . Cell suspensions were untreated, trypsin-treated or boiled at pH 2.0 . None of the 95 untreated cell suspensions gave a visible reaction with any of the lectins . When the cells were trypsinised, 42 strains were agglutinated with one or more lectin and after boiling at pH 2, all the strains were agglutinated . After treatment with trypsin, 20 different agglutination patterns were observed, and after boiling, 19 patterns, four of which were similar . A correlation was found between Lancefield group C and some of these patterns . Some lectins reacted specifically with group C streptococci; DBA and WFA, both specific for D-GalNAc, DSA, a GlcNAc-specific lectin, and RPA, which showed a complex specificity, reacted only with group C strains . Furthermore, the lectin of Maackia amurensis reacted with 50% of group B streptococci only . Agglutination assays with lectins were reproducible, easy to perform, relatively inexpensive and, therefore, applicable to studies of cell-wall structure and epidemiology of beta-haemolytic streptococci.

J Med Microbiol, 1993 Dec, 39(6), 434 - 9
Evaluation of the capacity of oral streptococci to produce hydrogen peroxide; Garcia-Mendoza A et al.; The capacity of 11 strains of oral streptococcal species (Streptococcus sanguis, S . oralis, S . mitis and S . sobrinus) to produce hydrogen peroxide (H2O2) was studied in vitro . Detection of this property in solid media, particularly with trypticase soy agar-benzidine-peroxidase, was more sensitive than in liquid media . The addition of carbohydrates (arabinose, xylose, mannose, sorbose and lactose), sorbitol and saccharine to buffered trypticase soy broth increased H2O2 production in S . oralis NCTC 11427, although the concentrations obtained with some substrates (glucose, galactose, mannitol and xylitol) were lower than those obtained in controls . In S . sanguis NCTC 7863, H2O2 production was detected only with galactose, sorbitol, lactose and saccharin.

CMAJ, 1993 Dec 1, 149(11), 1659 - 65
Effectiveness of intrapartum penicillin prophylaxis in preventing early-onset group B streptococcal infection: results of a meta-analysis; Allen UD et al.; OBJECTIVE: To determine the effectiveness of intrapartum penicillin prophylaxis in preventing early-onset group B streptococcal (GBS) infection in neonates of women whose birth canals are colonized by group B streptococci . DATA SOURCES: Articles published between 1966 and 1992 identified from MEDLINE, EMBASE, the Science Citation Index and the Oxford Perinatal Database; the bibliographies of primary studies, textbooks and review articles and published abstracts from major conferences and symposia . DATA SELECTION: Studies were selected if four criteria were met: (a) the target population was intrapartum women and neonates, (b) the intervention was penicillin prophylaxis, (c) invasive early-onset GBS infection was an outcome measure, and (d) the studies were controlled trials or cohort studies . Seven primary studies were identified, four of which were randomized controlled trials . DATA EXTRACTION: Explicit methodologic criteria were used by two of the authors to assess independently the study quality; one of the reviewers was blind as to author, institution and journal . The baseline characteristics of the population, intervention and outcome were summarized twice and checked for accuracy by two of the authors . DATA SYNTHESIS: Five of the studies showed a trend toward a beneficial effect of penicillin prophylaxis, and two showed a statistically significant effect . The pooled odds ratio indicated a 30-fold reduction (95% confidence interval 0.0013 to 0.17) in the incidence of early-onset GBS infection with intrapartum penicillin prophylaxis . Subgroup analyses did not change these results . The magnitude of improvement observed did not differ between women with prenatal risk factors (premature rupture of the membranes and premature labour) and those without these risk factors . CONCLUSIONS: There is accumulative evidence that intrapartum penicillin prophylaxis is effective in preventing early-onset GBS infection . Such therapy is beneficial to women whose birth canals are colonized with group B streptococci . Further studies are needed to determine the optimum timing and method of detecting vaginal colonization during pregnancy.

Infect Immun, 1993 Dec, 61(12), 5413 - 6
Circulating tumor necrosis factor alpha (TNF), soluble TNF receptors, and interleukin-6 in human subacute bacterial endocarditis; Kern WV et al.; Cell surface components of viridans streptococci and enterococci have been shown to stimulate the release of tumor necrosis factor alpha (TNF) and interleukin-6 from monocytes/macrophages . In the sera from 10 patients with subacute enterococcal or streptococcal endocarditis, however, the levels of both cytokines were low or undetectable, with elevated TNF levels on admission in 3 patients with complicated disease . Soluble TNF receptor levels were significantly elevated compared with those of healthy controls . When patients with malaria were used as a control group of acute intravascular infection with high circulating TNF values, the ratio between soluble TNF receptors and TNF on admission was significantly greater in the patients with subacute bacterial endocarditis . Besides different amounts of circulating TNF, enhanced TNF receptor shedding may have an important role in the pathogenesis of subacute versus acute clinical disease following human intravascular infection.

Infect Immun, 1993 Dec, 61(12), 5252 - 60
Cytokine induction by extracellular products of oral viridans group streptococci; Takada H et al.; During an etiological study of Kawasaki disease (mucocutaneous lymph node syndrome {MCLS}), we found that dominant viridans streptococcal strains on tooth surfaces and in the throat of both MCLS patients and non-MCLS control children formed erythrogenic and biologically active, extracellular products . In this study, we demonstrated that erythrogenic culture supernatant concentrates of representative strains (two Streptococcus mitis and two Streptococcus oralis), when injected intravenously, induced serum tumor necrosis factor alpha, interleukin-6 (IL-6), and gamma interferon in muramyldipeptide- or Propionibacterium acnes-primed C3H/HeN mice . The concentrates also induced tumor necrosis factor alpha, IL-6, and thymocyte-activating factor (essentially IL-1) in murine peritoneal macrophage, human monocyte, and human whole-blood cultures . An erythrogenic, heat-labile extracellular protein fraction (F-1) that was concentrated from the culture supernatants of a representative S . mitis strain exhibited the above-mentioned cytokine-inducing activity . This partially purified F-1 fraction also induced thymocyte-activating factor and IL-6 in human umbilical vascular endothelial cell and gingival fibroblast cultures.

J Korean Med Sci, 1993 Dec, 8(6), 453 - 7
Optimal site of throat swab for the isolation of beta-hemolytic streptococci; Kim SJ; The optimal site for the isolation of beta-hemolytic streptococci (BHS) from throat cultures was investigated in 164 healthy elementary school children . All throat cultures were streaked onto duplicate blood agar plates (BAP), one of which was taken from the tonsillar fossae and the other from the posterior pharynx . BHS were isolated in cultures from 56 (34.2%) of the children . BHS were more frequently recovered from the tonsillar fossae than from the posterior pharynx (54 vs . 47; both sites, 45; tonsillar fossae only, 9; posterior pharynx only, 2; P < 0.0001) . There were significantly more numerous colonies in the tonsillar fossae than in the posterior pharynx (p < 0.01) . To conclude, the tonsillar fossae are more optimal sites of throat cultures to isolate BHS than the posterior pharynx.

J Nihon Univ Sch Dent, 1993 Dec, 35(4), 267 - 75
Concentrations of lomefloxacin in radicular cyst and oral tissues following single or multiple oral administration; Akimoto Y et al.; Concentrations of lomefloxacin in serum, the wall and fluid of radicular cyst, gingiva, and jawbone following single or multiple oral administration were measured . The highest concentrations of lomefloxacin in serum, cyst wall, cyst fluid, gingiva, and jawbone occurred at 3 h after multiple administration, and were 2.31 micrograms/ml, 4.06 micrograms/g, 1.54 micrograms/ml, 4.72 micrograms/g and 2.79 micrograms/g, respectively . The mean concentration ratios of wall/serum, fluid/serum, fluid/wall, gingiva/serum, and jawbone/serum at the highest concentrations were 1.74, 0.73, 0.47, 2.52 and 1.20, respectively . Although most lomefloxacin concentrations in cyst and oral tissues following single oral administration did not exceed the MICs for 80% of clinically isolated strains of alpha-hemolytic streptococci, Staphylococcus aureus and Niesseria spp., most of those obtained after multiple oral administration exceeded the MICs except in the case of fluid.

Oral Microbiol Immunol, 1993 Dec, 8(6), 370 - 4
Survival in transport media of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in human subgingival samples; van Steenbergen TJ et al.; The purpose of this study was to evaluate the survival in 3 transport media of 3 suspected periodontal pathogens, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia . Subgingival samples were taken from 10 patients with severe periodontitis, all harboring at least two of the above-mentioned species . The material was dispersed and aliquots were added to vials containing reduced transport fluid, reduced transport fluid containing 10% Fildes extract, or viability-maintaining microbiostatic medium, anaerobically prepared (VMGA III) . Viable counts were determined after 1, 2, 4, 24 and 48 h of storage at 4 degrees C or at room temperature . The results showed that, for up to 4 h of storage, no significant differences existed for all parameters tested . A large increase of the total viable counts was found in VMGA III at room temperature after 24 and 48 h . This was due to an outgrowth of mainly streptococci . Incubation at 4 degrees C yielded often a significantly higher recovery compared to room temperature . After storage at room temperature, the tested bacteria were below detection level in some samples.

Oral Microbiol Immunol, 1993 Dec, 8(6), 349 - 54
Transmission of oral bacterial species between spouses; Saarela M et al.; The transmission of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and mutans streptococci was studied between 4 married couples who suffered from advanced periodontitis . Of the 20 couples investigated, the 4 in which both spouses harbored A . actinomycetemcomitans and P . gingivalis were chosen for the transmission study . Three of these couples also harbored mutans streptococci . A . actinomycetemcomitans isolates (8-24 per subject) and mutans streptococcal isolates (5-23 per subject) were serotyped by immunodiffusion technique . For ribotyping, chromosomal DNA from A . actinomycetemcomitans isolates (4-5 per subject) and mutans streptococcal isolates (4-11 per subject) was digested with restriction endonucleases ClaI or BglI and HindIII or SmaI, respectively . P . gingivalis isolates (2-15 per subject) were ribotyped by using ClaI, BglI and SmaI . The blotted restriction fragments were hybridized to the plasmid pKK3535, which contains the rRNA operon of the E . coli chromosome . The spouses in 2 couples shared the same sero- and ribotypes of A . actinomycetemcomitans and S . mutans . P . gingivalis ribotypes were identical in 2 couples . The result suggests transmission of oral bacteria between spouses.

Kinderarztl Prax, 1993 Dec, 61(10), 355 - 8
{The pathogen spectrum of blood cultures of premature and newborn infants in a neonatal intensive care unit}; Ludwig S et al.; The bacterial spectrum of blood cultures in a neonatal intensive-care unit was retrospectively assessed in a two-year study . Analysis of positive blood cultures showed a dominance of gram-positive bacteria, especially of coagulase-negative staphylococci . The resistance of these germs points to vancomycin as the most effective antibiotic . B-streptococci, germs that are dreaded especially in neonatology, were not found in any of the cases . Positive blood cultures were mostly in correlation with clinical symptoms, less so to the leukocyte count and/or C-reactive protein levels . There was no case of death directly caused by sepsis.

Eur Heart J, 1993 Dec, 14 Suppl K, 43 - 50
Bacteriology of dental infections; Asikainen S et al.; The most common dental diseases, periodontal disease and dental caries, are chronic infections caused by bacteria of normal oral flora . When these bacteria increase in number and irritation exceeds the host defence threshold, disease arises . The human oral flora comprises more than 300 different bacteria . During the last decade approximately 10 species, mainly Gram-negative anaerobes, have been noted as putative pathogens in periodontal disease . The Gram-positive and facultatively anaerobic mutans streptococci are aetiologically the most important bacteria in dental caries . Data have rapidly increased on the association of these bacteria with certain periodontal diseases or caries, on phenotypic and genotypic characteristics, pathogenic mechanisms, antibiotic susceptibility patterns and transmission among family members . Chronic dental infections have been the focus of renewed interest because of recent advances in oral microbiology as well as in medicine . We now know that in addition to oral streptococci, recently classified, fastidious periodontal anaerobes can be detected from various extra-oral infections . Oral bacteria may spread into the blood stream through ulcerated epithelium in diseased periodontal pockets and cause transient bacteraemias, which are regarded as increased risk, especially for immunocompromised patients or persons with endoprotheses . In these patients, routine antibiotic prophylaxis is recommended for invasive dental care procedures . Also the new association between dental infections and myocardial/cerebral infarction have offered new challenges for cooperation between dental and medical researchers.

Zentralbl Veterinarmed B, 1993 Dec, 40(9-10), 597 - 602
Encapsulation of streptococci isolated from bovine milk; Matthews KR et al.; Capsule expression was assessed by India ink staining in 95 streptococcal and enterococcal isolates representing 8 species . Organisms were evaluated after primary culture on blood agar and after storage in 10% skim milk at -80 degrees C . Seventeen of 95 primary culture samples were positive for an unstained halo (capsule) by India ink . Only 3 isolates were positive for capsule after being maintained for an extended period of time . To confirm results of India ink tests, an unencapsulated and encapsulated strain of each species was observed by electron microscopy . Cells of encapsulated strains were surrounded by thread-like fibers indicative of capsule, whereas cells of unencapsulated strains had a smooth surface . The importance of capsule in the pathogenesis of streptococcal mastitis is unknown . Studies on capsule expression by streptococci may facilitate investigations on the pathogenesis of streptococcal mastitis.

J Gen Microbiol, 1993 Dec, 139 ( Pt 12), 2953 - 8
Detection of immunoglobulin-G-binding proteins in Streptococcus suis; Serhir B et al.; This study was undertaken to search for the presence of immunoglobulin G (IgG)-binding proteins in Streptococcus suis, an important swine pathogen . Whole bacterial cells were incubated with human or pig IgG conjugated to gold particles and examined by transmission electron microscopy . Cells of some S . suis strains were labelled as were cells of the positive control strain, Staphylococcus aureus Cowan I . Binding of pig and human IgG to five different bacterial species of group D streptococci, to reference strains representing the 29 capsular types of S . suis, and to 12 S . suis capsular type 2 strains was then examined using Western blotting . All strains interacted with pig and human IgG, although the binding profiles were slightly different . A 52 kDa protein was observed in all capsular types of S . suis . This protein, absent in other group D streptococcal species, was observed in all capsular type 2 isolates originating from diseased or clinically healthy pigs, and was shown to bind human IgG-Fc fragments . The IgG-binding activity was also observed in the culture supernatant and was sensitive to proteolysis.

J Gen Intern Med, 1993 Dec, 8(12), 667 - 73
Adult bacterial nasopharyngitis: a clinical entity?
Heald A, Auckenthaler R, Borst F, Delaspre O, Germann D, Matter L, Kaiser L, Stalder H.
OBJECTIVE: To investigate bacterial nasopharyngitis as a cause of adult upper respiratory infection . DESIGN: Prospective case series . SETTING: Walk-in medical clinic of a university hospital . PATIENTS: 507 patients with cold or flu symptoms, sore throat, or recent cough; 21 control subjects without symptoms of upper respiratory infection . MEASUREMENTS AND MAIN RESULTS: After thorough history and physical examination, the patients underwent nasopharyngeal aspiration and throat culture . Nasopharyngeal specimens were cultured for both bacteria and viruses; antigens for influenza, parainfluenza, and respiratory syncytial virus were sought by enzyme-linked immunosorbent assay (ELISA); serum antibodies to viral respiratory pathogens were determined . Group A beta-hemolytic streptococci grew from the throat specimens of 39 of the 507 patients (8%) or 38 of 334 patients (11%) who had clinical diagnoses of pharyngitis . Thirty-three cases of influenza A, 20 cases of influenza B, and seven cases of parainfluenza infections were diagnosed . Bacteria were cultured from the nasopharyngeal secretions of 284 patients (56%) . In contrast to pharyngeal culture, commensal mixed flora were rarely found in nasopharyngeal culture . Nasopharyngeal culture of bacteria usually considered to be respiratory pathogens was significantly associated with the presence of leukocytes . Streptococcus pneumoniae (odds ratio 6.0, 95% confidence interval 2.6-14.2), Moraxella catarrhalis (odds ratio 12.9, 95% confidence interval 3.1-79.5), and Hemophilus influenzae (odds ratio 3.0, 95% confidence interval 1.2-7.4) were all associated with the presence of leukocytes . In contrast, nasopharyngeal culture of coagulase-negative staphylococci, mixed flora, and the documentation of a viral infection were not associated with the presence of leukocytes . For none of 21 control subjects were "pathogenic" bacteria found . CONCLUSIONS: These data suggest that potentially pathogenic bacteria may have a causal role in adult nasopharyngitis, although further data are needed to confirm this hypothesis.

Antimicrob Agents Chemother, 1993 Dec, 37(12), 2593 - 8
Study of heterogeneity of chloramphenicol acetyltransferase (CAT) genes in streptococci and enterococci by polymerase chain reaction: characterization of a new CAT determinant; Trieu-Cuot P et al.; An assay based on the utilization of degenerate primers that enable enzymatic amplification of an internal fragment of cat genes known to be present in gram-positive cocci was developed to identify the genes encoding chloramphenicol resistance in streptococci and enterococci . The functionality of this system was illustrated by the detection of cat genes belonging to four different hydridization classes represented by the staphylococcal genes catpC221, catpC194, catpSCS7, and the clostridial gene catP, and by the characterization of a new streptococcal cat gene designated catS . A sequence related to the clostridial catQ gene, which was present in one streptococcal strain, was not detected by this assay . These results reveal that these six cat genes account for chromosomal-borne chloramphenicol resistance in 12 group A, B, and G streptococci tested . By contrast, only three of these six cat genes (catpC221, catpC194, and catpSCS7) were detected on the 10 enterococcal plasmids studied here that encode resistance to chloramphenicol.

Arch Mal Coeur Vaiss, 1993 Dec, 86(12 Suppl), 1857 - 61
{Bacterial endocarditis occurring on native valves: identification of risk patients}; Selton-Suty C et al.; Analysis of the large series of infective endocarditis reported in the medical literature allows identification of the principal poor prognostic factors . Of the clinical factors, the worst prognosis is observed in the most elderly patients, in those with persistence of the infections syndrome despite antibiotic therapy, those with cardiac failure or complications, principally arterial embolism (cerebral or peripheral) . From the anatomical viewpoint, aortic valve endocarditis seems to carry a slightly worse prognosis than mitral valve endocarditis, but the extension of infection to the paravalvular region is the complication most likely to aggravate the condition . The infecting organism is also an important factor: non-streptococci, especially staphylococcal endocarditis, have a much worse prognosis . Finally, echocardiographic analysis of the vegetations allows identification of the cases with the highest risk of embolism: those with vegetations over 10 mm in size which appear very mobile . The appearance of signs of poor haemodynamic tolerance, the persistence of an infectious syndrome despite appropriate medical therapy and the detection of large, mobile vegetations by echocardiography should lead to early surgical referral: this attitude now provides good immediate and long-term results.

Arch Mal Coeur Vaiss, 1993 Dec, 86(12 Suppl), 1847 - 56
{Bacterial endocarditis in children}; Normand J et al.; The authors undertook a retrospective study of 69 cases of infective endocarditis (IE) in 68 children treated from 1971 to 1992 . The comparison between two groups (Group I comprising 34 patients treated between 1971 and 1981; Group II comprising 34 patients treated between 1982 and 1992) based on a review of the literature showed that the natural history of paediatric IE has changed during these two decades: a slight increase in the incidence in young children . The sequellae of rheumatic heart disease play no role in determining IE in France . Congenital heart disease plays a major role (72% of cases) with increasing numbers having undergone surgical treatment for more complex lesions . Mitral valve prolapse has become a more common cause with multiple portals of entry, predominantly buccal and oto-rhino-laryngeal . Blood cultures are positive in 75% of cases, the commonest organisms being Streptococci and Staphylococci, but the frequency of uncommon pathogens is increasing . Echocardiography plays a major role in the diagnosis and inventory of IE (vegetations demonstrated in 64% of cases in Group II) . Although mortality is progressively decreasing (3% in Group II) because of more frequent surgical indications (32% in Group II) and more severe sequellae: only 27% of children in Group II were cured without sequellae or aggravation of their previous cardiac lesion.

Arch Mal Coeur Vaiss, 1993 Dec, 86(12 Suppl), 1837 - 43
{Prosthetic valve endocarditis: current problems}; Maroni JP et al.; Prosthetic valve endocarditis is a rare complication of valve replacement surgery but carries a grim prognosis . The physiopathology of this condition allows identification of two clinically distinct forms based on their bacteriological profiles and outcome: early endocarditis, diagnosed in the first year following valve replacement is observed in 0.7 to 3% of cases: staphylococci are the predominant organism as contamination usually occurs at operation . The prognosis is poor due to the high incidence of complications and the mortality rate is about 60 to 70%; late endocarditis: diagnosed after the second year, it is observed in 0.5 to 1% of cases per year . Contamination is due to bacteraemia and the commonest organisms are the streptococci . The mortality rate is over 20% . The diagnosis is particularly difficult in chronic forms and those with negative blood cultures . Cardiac imaging in prosthetic valve endocarditis is mainly dependent on Doppler echocardiography especially using the transoesophageal approach which allows evaluation of lesion such as abscesses, vegetations and perivalvular leaks, and enables planning of treatment . Management is medico-surgical . Apart from symptomatic treatment of complications, antibiotic therapy using synergistic drugs at bactericidal dosages intravenously is essential as soon as bacteriological specimens have been sent for culture . Surgery is essential in early forms but may be avoided in uncomplicated late forms . The timing of surgery (the objectives of which are to excise the infected material, to repair destructive lesions and to implant a new valve) is a decisive factor in reducing the morbidity and mortality of this condition . Prophylactic measures have a particularly important role to play: they are based on pre- per- and postoperative guide lines.

Gerodontology, 1993 Dec, 10(2), 98 - 104
Relationships between mutans streptococci and perceived treatment need of primary root-caries lesions; Lynch E et al.; A total of 447 primary root-caries lesions from 169 dental patients was studied to determine the relationships between mutans streptococci and the perceived treatment need of primary root-caries lesions . Samples of this altered dentine for microbiological culture were obtained . Lesions were classified into 5 treatment categories: soft and restore, leathery and restore, leathery and debride of caries, leathery and treat chemotherapeutically, and hard, to receive no treatment . The total numbers of mutans streptococci decreased significantly with decreased treatment need . The percentage of mutans streptococci from lesions requiring no treatment was significantly less than from lesions requiring treatment . The frequency of isolation of mutans streptococci was significantly greater from lesions requiring more treatment . Significantly more lesions containing > 10(2) mutans streptococci were distributed in the groups with a greater perceived treatment need or with larger dimensions occluso-gingivally and/or mesio-distally or bucco-lingually or with a closer proximity to the gingival margin.

Mol Gen Genet, 1993 Dec, 241(5-6), 685 - 93
VirR and Mry are homologous trans-acting regulators of M protein and C5a peptidase expression in group A streptococci; Chen C et al.; Transcription of the group A streptococcal M12 protein gene (emm12) and the C5a peptidase gene (scpA), which encodes an inhibitor of complement-mediated chemotaxis, was previously shown to depend on a third genetic locus, designated virR . A 1.6 kb region of DNA which is 200 bp upstream of emm12 and is thought to contain the virR locus, was sequenced . An open reading frame which overlaps deletion mutations that define virR was identified . The sequence of the encoded VirR protein, which was deduced to contain 499 amino acids, is characteristic of cytoplasmic proteins . Comparison of the VirR protein to a variety of DNA binding proteins, such as lambda Cro, revealed a DNA binding motif . VirR was also compared to the M6 positive regulator, mry, and found to be 98% homologous . The predicted virR promoter is preceded by two sets of inverted repeats, in contrast to mry which is preceded by one repeat . Introduction of virR on the shuttle vector pAM401 into a strain of group A Streptococcus with a deletion in the chromosomal virR gene demonstrated that the VirR protein activated transcription of both emm12 and scpA genes in trans . Analysis of RNA by Northern blot using virR-specific probes identified two virR transcripts, a 1.6 kb transcript which corresponds to the predicted size of the gene, and a second transcript, 3.5 kb, which also overlaps virR . These results demonstrate that virR and mry are structurally and functionally very similar and show that the former is a trans activator of both M protein and C5a peptidase synthesis.

J Am Coll Cardiol, 1993 Nov 15, 22(6), 1661 - 5
Purulent pericarditis: review of a 20-year experience in a general hospital; Sagrista-Sauleda J et al.; OBJECTIVES . The purpose of this study was to review the features of purulent pericarditis in patients from a general hospital during a recent 20-year period . BACKGROUND . Although studies published from 1974 to 1977 suggested a changing spectrum for purulent pericarditis, this view has not been proved . METHODS . We retrospectively evaluated the records of 33 patients from one general hospital who had a diagnosis of purulent pericarditis during the period 1972 to 1991 . All autopsy protocols from the same period were also reviewed . In 19 patients (group I), the condition was diagnosed during life; in 14 (group II), it was identified at autopsy . RESULTS . In group I, the possible sources of pericardial infection were identified in 17 patients; pneumonia (6 patients) was the most common source . Empyema was present in 10 patients; 15 had cardiac tamponade . The most common microorganisms were streptococci, pneumococci and staphylococci . Six patients developed constrictive pericarditis and required pericardiectomy . Three patients died, 1 patient was lost to follow up and 15 patients had a favorable outcome at a mean follow-up interval of 35 months . In group II, the clinical diagnoses included pneumonia (five patients) among other infections, with empyema in six patients . Purulent pericarditis was probably the direct cause of death in two patients . CONCLUSIONS . In our experience, the spectrum of purulent pericarditis has not changed in recent years . Many patients do not have the classical findings of pericarditis, and diagnosis is made only at autopsy or after tamponade has developed . Empyema remains a common predisposing condition . Purulent pericarditis is still a severe disease, but its prognosis is excellent in patients who can be discharged from the hospital.

Infect Immun, 1993 Nov, 61(11), 4814 - 7
Antibodies against active-site peptides common to glucosyltransferases of mutans streptococci; Cope PA et al.; Polyclonal antibodies were raised against peptides derived from an active-site sequence common to the family of mutans streptococcal glucosyltransferases (GTFs) . The sequence contains an aspartic acid residue that functions in formation of the enzyme transition state in catalysis . Two GTFs were targeted with similar but not identical sequences in this region: one that synthesizes an alpha-1,3-linked water-insoluble glucan and a homologous GTF that synthesizes an alpha-1,6-linked water-soluble glucan . For each enzyme, an 8-mer and 22-mer peptide were prepared . The two peptide lengths were chosen in order to increase the likelihood of the peptides folding in a conformation similar to that of the native enzyme . Each peptide immunogen produced high titers of antibody in rabbits, and all antisera cross-reacted with all peptides, albeit to various degrees . Native enzyme showed weak interaction with antisera, which, on the basis of enzyme denaturation experiments, likely reflects binding to a small but finite population of denatured enzyme in the sample . GTF was assayed for inhibition in the presence of protein A-purified immunoglobulin G from each antiserum . Given the mass of the antibody and catalytic importance of the peptide, any enzyme-antibody complex formation would result in enzyme inhibition . No significant inhibition was observed, which demonstrates that either polyclonal antibodies raised against each of the four peptides cannot access this active-site region, or antibodies do not recognize the native enzyme conformation . The advantages and challenges of generating antibodies against enzyme active-site peptides are discussed in the context of the crystal structure of Aspergillus oryzae alpha-amylase, which has a homologous peptide segment which serves the same catalytic function.

Infect Immun, 1993 Nov, 61(11), 4760 - 6
Stimulation of protective antibodies against type Ia and Ib group B streptococci by a type Ia polysaccharide-tetanus toxoid conjugate vaccine; Wessels MR et al.; Antisera elicited by type Ia group B streptococci (GBS) contain antibodies that react with both type Ia and type Ib strains . Previous studies suggested that antibodies elicited by type Ia organisms recognized a carbohydrate antigen or epitope common to Ia and Ib strains . We now report the synthesis and immunogenicity testing of a type Ia polysaccharide-tetanus toxoid (Ia-TT) conjugate vaccine . Ia-TT elicited type Ia polysaccharide-specific immunoglobulin G antibodies in all three of the rabbits inoculated . In competitive enzyme-linked immunosorbent assay, these antibodies reacted with high affinity to type Ia polysaccharide and with lower affinity to the structurally related GBS type Ib polysaccharide . Despite the lower binding affinity of the Ia-TT-induced antibodies for the type Ib polysaccharide, Ia-TT antiserum opsonized not only type Ia GBS but also type Ib GBS for killing by human blood leukocytes . Ia-TT antiserum was also evaluated in a mouse model designed to test the efficacy of maternal antibodies in protecting neonates against GBS infection . Pups born to dams that had received Ia-TT antiserum were protected against lethal challenge with either type Ia or Ib GBS . These studies using a polysaccharide-protein conjugate as an immunogen support the view that the carbohydrate immunodeterminant recognized on Ib strains by Ia antisera is a common epitope contained within the structurally related Ia and Ib capsular polysaccharides . Although antibodies elicited by Ia-TT had protective activity against both Ia and Ib strains, these antibodies reacted with lower affinity to Ib than to Ia polysaccharide.

Infect Immun, 1993 Nov, 61(11), 4689 - 95
Inhibition of glucosyltransferase activities of Streptococcus mutans by a monoclonal antibody to a subsequence peptide; Chia JS et al.; Preliminary analysis indicated that a 19-amino-acid peptide sequence (435 to 453 of GtfC) within a highly conserved region of the glucosyltransferases of the cariogenic streptococci might be functionally important (J.-S . Chia, S.-W . Lin, T.-Y . Hsu, J.-Y . Chen, H.-W . Kwan, and C.-S . Yang, Infect . Immun . 61:1563-1566, 1993) . To obtain antipeptide monoclonal antibodies (MAbs), the 19-amino-acid peptide was conjugated to bovine serum albumin and used as an antigen in BALB/c mice . Six immunoglobulin G-secreting hybridoma clones, CJSm18-S1 to -S6, specifically reacted with this peptide and with purified GtfC and GtfD but not with bovine serum albumin in an enzyme-linked immunosorbent assay . The concentrated hybridoma supernatant of all six MAbs inhibited GtfC enzymatic activity but failed to inhibit GtfD, although GtfD contains the same peptide sequence . Further analysis of a purified immunoglobulin G2b MAb from one of the clones, CJSm18-S3, confirmed that this MAb specifically inhibited GtfC enzymatic activity for insoluble-glucan synthesis in a dose-dependent manner . CJSm18-S3, even at high concentrations, had no effect on GtfD, which synthesizes water-soluble glucan exclusively . Furthermore, the in vitro sucrose-dependent adherence of Streptococcus mutans was also inhibited by CJSm18-S3 in a dose-dependent manner . Our results indicate that the peptide containing the N-terminal conserved region of glucosyltransferases is functionally important for both enzymatic activity and bacterial adherence.

Infect Immun, 1993 Nov, 61(11), 4645 - 53
Bacterial cell wall polymers (peptidoglycan-polysaccharide) cause reactivation of arthritis; Lichtman SN et al.; Intraperitoneal (i.p.) injection of peptidoglycan-polysaccharide derived from group A streptococci (PG-APS) causes chronic arthritis with spontaneous remissions and exacerbations . We hypothesized that, following i.p . injection, PG-APS released from hepatic stores mediated spontaneous recurrences of arthritis . We tested whether transplanted livers with large amounts of PG-APS were able to reactivate quiescent arthritis . Saline-loaded (group 1) or PG-APS-loaded (group 2) livers were transplanted into rats which had been injected intra-articularly 10 days earlier with PG-APS in one joint and saline in the other . A comparison was made with the arthritis that occurred in rats injected i.p . with PG-APS which did not receive transplants (group 3) . Arthritis was monitored by serial measurement of joint diameters . Transplantation of saline-loaded livers (group 1) caused no reactivation of arthritis . However, transplantation of PG-APS-loaded livers (group 2) reactivated arthritis (P < 0.0001) . Injection of PG-APS i.p . (group 3) induced the most-severe arthritis . PG-APS levels in plasma decreased with time, and PG-APS accumulated in the spleen in groups 2 and 3 . Plasma and hepatic levels of PG-APS in rats injected i.p . with PG-APS were greater than levels in rats transplanted with PG-APS-loaded livers, which in turn were greater than levels in rats with saline-loaded livers . Plasma tumor necrosis factor did not correlate with recurrence of arthritis . Transplantation with PG-APS-loaded livers induced reactivation of arthritis in preinjured joints . The extent of arthritis was proportional to hepatic PG-APS content . Reactivation of arthritis may be mediated by slow release of liver-sequestered PG-APS or cytokines (not tumor necrosis factor) released by the liver.

Infect Immun, 1993 Nov, 61(11), 4535 - 9
Phlogistic properties of peptidoglycan-polysaccharide polymers from cell walls of pathogenic and normal-flora bacteria which colonize humans; Schwab JH; PG-PS polymers which can induce experimental chronic inflammation in joints and other tissues can be isolated from the cell walls of human pathogens, such as group A streptococci, as well as from certain indigenous bacterial species which colonize the human intestinal tract . The structural and biological properties that are required for cell wall fragments to express this remarkable activity are still not well defined, but polymer size, resistance to tissue enzymes, and capacity to sustain activation of complement, macrophages, neutrophils, and T cells are properties associated with the most active preparations . There is increasing evidence that PG-PS structures with arthropathogenic activity occur in the human intestinal lumen and that these polymers can be translocated systemically . These observations support the concept that PG-PS, derived from a variety of bacterial species, can be part of the etiology of rheumatoid arthritis and other chronic inflammatory diseases . Since the PG component provides a common element to which all individuals are exposed, it follows that susceptibility is related to efficiency of disposal of bacterial cell wall debris, as well as to cytokine networks and immune cell function (51).

Zentralbl Bakteriol, 1993 Nov, 279(4), 472 - 83
Studies on binding of glycosaminoglycans to Streptococcus pyogenes by using 125I-heparan sulphate as a probe; Schmidt KH et al.; Binding of 125I-heparan sulphate to the cell surface of Streptococcus pyogenes is mediated by proteins, that could be released from the streptococcal cell wall by using alkaline buffer . SDS-electrophoresis revealed two bands with molecular weights of 63 and 58 kDa . Binding of the 125I-labelled heparan sulphate probe to streptococci seems to be due to charge interactions, as the same probe was displaced by unlabelled heparan sulphate, other negatively charged molecules such as heparin, dextran sulphate, dermatan sulphate or by high ionic strength . The interaction was also strongly influenced by pH . The binding constant at pH 7.2 was estimated to be 9.8 x 10(6) mol/l, suggesting a moderate affinity . The presence of collagen of different types enhanced binding of 125I-labelled heparan sulphate to streptococci, whereas fibronectin and vitronectin had an inhibitory effect . The cooperation between heparan sulphate and collagen could be important for the adhesion of streptococci to connective tissue.

Arch Oral Biol, 1993 Nov, 38(11), 1013 - 9
Grouping of oral streptococcal species using Fourier-transform infrared spectroscopy in comparison with classical microbiological identification; van der Mei HC et al.; The grouping and identification made by Fourier-transform infrared spectroscopy (FT-IR) of 40 oral streptococcal strains was compared with their known taxonomic positions . Grouping was obtained by cluster analysis on the spectral distances between the first derivative spectra of the strains . Spectra were divided into five spectral 'windows' and cluster analysis was either on either a combination of all five windows or on a selected window . The oral streptococci were divided into two main clusters, mutans streptococci and other streptococci . This division was based mainly on the spectral information contained in the window between 1300-900 cm-1, indicative of polysaccharide and phosphate-carrying compounds . In the grouping based on the entire spectrum, species clusters could be observed for Streptococcus crista, Strep . salivarius and Strep . rattus . A few strains were placed in wrong clusters because of intra-strain variance . It is concluded that the grouping of these oral streptococcal species was good and similar to the classical taxonomy and that FT-IR might develop into a new identification method for oral streptococci.

Antimicrob Agents Chemother, 1993 Nov, 37(11), 2493 - 5
Activities of potential therapeutic and prophylactic antibiotics against blood culture isolates of viridans group streptococci from neutropenic patients receiving ciprofloxacin; McWhinney PH et al.; All 47 sequential blood culture isolates of viridans group streptococci obtained from febrile neutropenic patients receiving quinolone prophylaxis were susceptible to vancomycin, teicoplanin, and imipenem . Resistance to benzylpenicillin (MIC for 50% of isolates {MIC50}, 0.125 microgram/ml) and ceftazidime (MIC50, 4 micrograms/ml) was common . Most isolates were susceptible to amoxicillin, co-amoxiclav (amoxicillin-clavulanic acid at a 2:1 ratio by weight), azlocillin, clarithromycin, and erythromycin, with azithromycin showing comparable activity . The MIC90 of sparfloxacin was 1 microgram/ml; those for ciprofloxacin and ofloxacin were > 16 and 16 micrograms/ml, respectively.

J Dairy Sci, 1993 Nov, 76(11), 3437 - 44
Efficacy of intramammary antibiotic therapy for treatment of clinical mastitis caused by environmental pathogens; Guterbock WM et al.; For three California dairy herds with bulk tank SCC < 200,000/ml, twice daily milking, and no mastitis vaccine, 254 quarters with mild clinical mastitis were randomly assigned to three groups . Group A (n = 74) was treated with 62.5 mg of intramammary amoxicillin every 12 h for three milkings . Group C (n = 75) was treated with 200 mg of intramammary cephapirin every 12 h for two milkings . Group O (n = 105) was treated with 100 units of intramuscular oxytocin every 12 h for two or three milkings . Aseptic pretreatment quarter samples revealed 94 (37%) coliforms, 65 (26%) environmental streptococci, 34 (13%) other bacteria, and 61 (24%) with no isolate on bovine blood agar plates . Contagious pathogens were not isolated . Clinical cure (return of quarter and milk to normal) and bacterial cure (absence of primary pathogen isolated pretreatment) were assessed at milking 8 and d 20 after initial treatment . No difference existed in clinical (67.6, 67.7, or 66.7%) or bacterial (43.9, 55.0 or 49.1%) cure rate among groups . Clinical cure rates did not differ when quarters were grouped by etiology, but clinical cure rates for quarters with pathogens other than streptococci or coliforms were lower in group O.

J Clin Microbiol, 1993 Nov, 31(11), 2996 - 3000
Rapid detection of Streptococcus pyogenes in pediatric patient specimens by DNA probe; Steed LL et al.; A chemiluminescent DNA probe test (Group A Streptococcus Direct Test; Gen-Probe, Inc., San Diego, Calif.) for rapid, direct detection of cRNA of Streptococcus pyogenes in throat swabs was compared with conventional culture and identification techniques . Throat swabs from 277 patients suspected of having streptococcal pharyngitis were examined . By DNA probe alone, 10 specimens were positive, 51 were positive by both assays, and 8 were positive by culture alone . Thus, DNA probe sensitivity, specificity, and positive and negative predictive values were 86, 95, 84, and 96%, respectively . Including an indeterminate category, sensitivity, specificity, and positive and negative predictive values were 89, 96, 86, and 97%, respectively . After discrepancy testing, these values for the raw data improved to 90, 98, 93, and 97%, respectively . None of the 24 specimens that grew non-S . pyogenes beta-hemolytic streptococci in culture were positive by the DNA probe . Because mucoid S . pyogenes strains are more virulent than nonmucoid strains, 24 isolates were retrospectively tested with the DNA probe to ensure that both types would be detected equally well . Isolates were examined in pure cultures as well as mixed with representative normal oral flora . There was no statistical difference in detection of any of the four groups . Group A Streptococcus Direct Test is a rapid, sensitive, and specific test for S . pyogenes.

J Med Microbiol, 1993 Nov, 39(5), 352 - 62
Biologically active extracellular products of oral viridans streptococci and the aetiology of Kawasaki disease; Ohkuni H et al.; A bacteriological study of isolates from the oral cavity of patients with Kawasaki disease (KD), age-matched non-KD patients and healthy children, showed that over half the KD and control isolates had gram-positive, catalase-negative cocci . About 50% of these organisms were identified as viridans streptococci by means of an API Strep 20 kit . Further identification by fluorometric DNA-DNA hybridisation demonstrated that the predominant species were S . oralis and S . mitis, each of which accounted for 25% of the isolates of viridans streptococci; 40% of viridans strains were unidentifiable; and S . sanguis and S . parasanguis were minor components . Studies in vivo showed that insertion of culture supernates of most of the viridans streptococci increased capillary permeability and induced redness with swelling and occasional bleeding in rabbit skin . One-third of S . mitis strains and one-fifth of the unidentified strains caused aggregation of human blood platelets, whereas S . oralis and other strains had no such effect . The distribution of extracellular lipoteichoic acids and glucan produced in the presence of sucrose was also examined . There were no significant differences in the recovery rate of viridans streptococci forming these biologically active extracellular products between KD and control groups.

Am J Obstet Gynecol, 1993 Nov, 169(5), 1139 - 43
The effect of colonization with group B streptococci on the latency phase of patients with preterm premature rupture of membranes; Towers CV et al.; OBJECTIVE: Our purpose was to determine whether colonization of pregnant women with group B streptococci shortens the latency time from rupture of membranes to delivery in patients with preterm premature rupture of membranes . STUDY DESIGN: All patients transferred to Long Beach Memorial Women's Hospital with the diagnosis of preterm premature rupture of the membranes were prospectively recorded . The patients included in the study were transferred between Jan . 1, 1986, and June 30, 1991 . Data were collected in regard to various obstetric characteristics, the presence or absence of a digital vaginal examination, tocolytic usage, antibiotic usage, and results of the culture for group B streptococci . The latency period was defined as days from membrane rupture to delivery . Patients with multiple gestations, cerclage in place, advanced labor on admission, or an indicated delivery on admission were excluded from data analysis . Patients with a positive culture for group B streptococci were then compared with those having a negative culture in regard to latency time after membrane rupture . RESULTS: The study population was made up of 332 patients . Forty-three (13%) were positive for group B streptococci; they were compared with 289 that were culture negative . There was no difference in the latency period from membrane rupture to delivery when we controlled for digital vaginal examinations and antibiotic usage . In addition, all other comparisons between the two groups were not significant . CONCLUSION: When the presence of a digital vaginal examination, antibiotic usage, and tocolytic usage are controlled for, colonization with group B streptococci by itself does not appear to affect the latency time from premature rupture of membranes to delivery.

Postgrad Med, 1993 Nov 1, 94(6), 107 - 8, 111-3, 117-8
Toxic shock syndrome . Are you recognizing its changing presentations?
Strausbaugh LJ.
Nonmenstrual cases of toxic shock syndrome now occur at least as often as the classic menstrual cases . The syndrome has been reported in every conceivable clinical setting involving colonization or infection with Staphylococcus aureus and as a complication of surgical procedures, traumatic injuries, and local infections . Unusual clinical manifestations have been observed in patients with AIDS . Cases of toxic shock syndrome also have been linked to infection with toxin-producing strains of coagulase-negative staphylococci and group A streptococci . Knowledge of the expanding spectrum of toxic shock syndrome and early consideration of the disease in patients with fever, hypotension, rash, and/or multisystem disease are essential for timely diagnosis and optimum management.

Infection, 1993 Nov-Dec, 21(6), 358 - 61
Bacteraemia due to different groups of beta-haemolytic streptococci: a two-year survey and presentation of a case of recurring infection due to Streptococcus "equisimilis"; Nielsen SV et al.; We present a 2-year survey of bacteraemic episodes due to beta-haemolytic streptococci and a case of recurring infection due to group C streptococcus, Streptococcus "equisimilis" . We found 53 episodes of bacteraemia with beta-haemolytic streptococci . Group A was the most common, followed by groups B, G and C . The proportion of nosocomial cases was the same in all four groups i.e . 24% (neonatal cases excluded) . The clinical picture presented by groups C and G streptococcal cases was indistinguishable from that caused by group A streptococci, but patients with group G bacteraemia were older than patients with group A bacteraemia . Obvious clinical foci were more common in group A than group G cases . Disregarding neonatal cases, most patients had predisposing conditions . There was no difference in foci of bacteraemia, predisposing factors, treatment and outcome of disease . The overall mortality was 25%.

Vet Microbiol, 1993 Nov, 37(3-4), 389 - 95
The protective M proteins of the equine group C streptococci; Timoney JF et al.; The group C streptococci are the most commonly isolated bacteria from disease states in the horse . Important virulence factors of S . equi and S . zooepidemicus are the hyaluronic acid capsule and the antiphagocytic fibrillar M protein located on the surface of the cell wall and extending into and through the capsule . The hyaluronic acid capsule is non-antigenic and so is not involved in protective immunity . The M protein, a superantigen, elicits very strong B and T cell responses that may result in protective immunity mediated by opsonic antibodies in plasma and by locally synthesized IgG and IgA on the pharyngeal mucosa . However, vaccines based on acid or mutanolysin extracted M protein do not confer a high level of protection against field exposure . Protective antibodies to S . equi or S . zooepidemicus can in part be assayed by the bactericidal test that measures opsonization for equine neutrophils . A mouse-challenge model has also been used to test immunizing potency of streptococcal extracts and in a passive protection test for protective antibody . There is as yet no means of distinguishing protective opsonic or mucosal antibodies from other antibodies produced against the many epitopes on the M molecule.

Diagn Microbiol Infect Dis, 1993 Nov-Dec, 17(4), 259 - 64
Reactivity of the glycocalyx of endocarditis-producing viridans group streptococci; Dall LH et al.; We correlated quantity of streptococcal polysaccharides and endocarditis production by those bacterial strains . To investigate this finding further, we studied the composition of the glycocalyx using a spectrophotometric assay and lectin analysis of exopolysaccharides from endocarditis- and non-endocarditis-producing strains of viridans streptococci . Identical weights of glycocalyx from the clinical endocarditis isolates produced significantly different absorbances as compared with the nonendocarditis isolates (P < 0.0012, Wilcoxon rank test) . Lectin-binding experiments showed that endocarditis-producing streptococci contained increased amounts of glucose, galactose, sialic acid, and mannose . These data suggest that the glycocalyx of endocarditis-producing viridans streptococci is both qualitatively and quantitatively different from non-endocarditis-producing isolates . These differences can be measured in vitro.

Lakartidningen, 1993 Oct 27, 90(43), 3771 - 2
{Chlorhexidine prophylaxis at labor . Prevention of sudden infant death?}; Elfast RA; In a study of nearly 5,000 births it was reported that decontamination of the birth canal at labour with chlorhexidine prevents excess neonatal morbidity associated with group B streptococci . Toxigenic E coli or chlamydia, most likely transmitted from vagina to infant at labour, has been uncovered in victims of the sudden infant death syndrome (SIDS) . Assuming an etiological connection, vaginal decontamination at labour might also reduce mortality in SIDS . In a study of co-twins of SIDS victims, 13/23 survivors were reported to have long-term respiratory disorders . Recent reports link chlamydia with asthma and other respiratory dysfunction . This suggests an etiological connection between chlamydia, SIDS and respiratory dysfunction including asthma . It would be interesting if these hypothesized connections could be tested in an extension of the chlorhexidine study beyond infancy.

Rev Prat, 1993 Oct 15, 43(16), 2112 - 7
{Acquired data on the antibiotic treatment of bacterial endocarditis on native or prosthetic valves}; Hoen B et al.; Antimicrobial therapy of infective endocarditis is based on periodically updated expert recommendations that derive from both clinical and experimental data . Streptococcal and enterococcal endocarditis should be treated intravenously with a combination of penicillin+aminoglycoside in the absence of allergy to penicillin . The choice of either penicillin or ampicillin, the dose and the length of treatment plainly depend on susceptibility of streptococcal strain to penicillin . In patients allergic to penicillin, vancomycin is the optimal choice . The treatment of native valve meticillin-susceptible staphylococcal endocarditis is based on a combination of oxacillin or cefamandole+aminoglycoside . Vancomycin is recommended in case of allergy to penicillin and in meticillin resistant staphylococcal endocarditis . Prosthetic valve staphylococcal endocarditis are often due to meticillin-resistant coagulase negative staphylococci . Therefore they should be treated with vancomycin in combination with rifampicin and an aminoglycoside unless the strain is resistant to either of these 2 antibiotics . For the treatment of culture-negative endocarditis, different situations should be considered: in native valve endocarditis, the possible responsibility of deficient streptococci justifies an ampicillin+aminoglycoside combination; in recently implanted (< 1 year) prosthetic valve endocarditis a combination of vancomycin+rifampicin+aminoglycoside should be used because of the high probability of meticillinresistant staphylococci: if prosthetic valve is implanted for more than a year endocarditis may be due to streptococci, staphylococci and fastidious gram-negative bacilli; a combination of vancomycin+aminoglycoside +/- third generation cephalosporin is therefore recommended.

J Infect Dis, 1993 Oct, 168(4), 910 - 4
Effect of thrombocytopenia on the early course of streptococcal endocarditis; Sullam PM et al.; Although platelets are a major factor in the pathogenesis of endocarditis, it is unclear if these cells promote or limit disease progression . To address this issue, the effects of thrombocytopenia on the early course of endovascular infection were examined . Aortic valve endocarditis was produced in rabbits by using Streptococcus sanguis M99 . Thrombocytopenia was induced by intravenous administration of antiplatelet serum . Compared with controls (infected rabbits given nonimmune serum), thrombocytopenic rabbits had higher densities of streptococci within vegetations (mean log10 cfu/g, 9.78 vs . 8.11, P < .002) and a higher total number of bacteria per valve (mean log10 total cfu/valve, 8.96 vs . 7.43, P < .004) . When tested for its interactions with platelets in vitro, strain M99 bound, activated, and aggregated rabbit platelets extensively and was rapidly killed by platelet microbicidal protein . These results indicate that platelets can limit disease progression in endocarditis . The host defense properties of platelets may in part be mediated by platelet microbicidal protein.

J Infect Dis, 1993 Oct, 168(4), 904 - 9
Clonal analysis of Streptococcus agalactiae isolated from infants with neonatal sepsis or meningitis and their mothers and from healthy pregnant women; Helmig R et al.; The purpose of this study was to evaluate if group B streptococci (GBS) isolated from infants with neonatal sepsis or meningitis and their mothers differ from GBS isolated from healthy pregnant women who gave birth to healthy infants . Danish clinical isolates of GBS (n = 118) were characterized by multilocus enzyme electrophoresis, a method recently used to identify virulent clones of GBS type III from North American infants . By analysis of allelic profiles of 11 metabolic enzyme loci, 43 different electrophoretic types were found . Clustering analysis revealed two primary phylogenetic divisions at a distance of > 0.8, both containing serotype III isolates . One division, comprising virtually all disease isolates, showed a population structure like that of traditional pathogens . The other division, containing the majority of carrier isolates, had a structure reminiscent of that of mucosal commensals, with each isolate being different.

Microb Pathog, 1993 Oct, 15(4), 303 - 11
Streptokinase gene polymorphism in group A streptococci isolated from Ethiopian children with various disease manifestations; Tewodros W et al.; Certain variants of streptokinase from group A streptococci have been associated with acute post-streptococcal glomerulonephritis (APSGN) . The streptokinase gene (ska) has previously been grouped into nine different polymorphic genotypes of which ska1, ska2, ska6, and ska9 were identified in group A streptococci associated with clinical and experimental APSGN . A total of 53 group A streptococci isolated from Ethiopian children: five from acute rheumatic fever, 18 from APSGN, ten each from tonsillitis, impetigo and healthy carriers, were analyzed for ska gene polymorphism using polymerase chain reaction (PCR) and restriction enzyme analysis . The frequency of the nephritis-associated streptokinase genotypes was 83% among the APSGN isolates and 74% in the non-ASPGN isolates . ska2 was the most commonly found genotype with a frequency of 64% among all isolates, 66% among the APSGN isolates, and 63% among the non-APSGN isolates . ska1 was identified in 13% among all isolates and 17% among the APSGN isolates . Seventeen non-APSGN isolates from Scandinavian countries were studied for comparison and all carried either ska1 or ska2 . The other nephritis-associated ska6 and ska9 were not detected among the 53 Ethiopian isolates . ska1 was exclusively associated with serum opacity reaction (SOR) producers . ska2 was evenly distributed among SOR-positive and SOR-negative isolates . The other genotypes were detected only among SOR-negative strains . The findings of the present study showed an even distribution of the nephritis-associated streptokinase gene among group A streptococcal isolates with no correlation to disease pattern . Thus additional factors must also be operative in the pathogenesis of APSGN.

Eur J Clin Microbiol Infect Dis, 1993 Oct, 12(10), 750 - 5
Evaluation of penicillin G in the prevention of streptococcal septicaemia in patients with acute myeloid leukaemia undergoing cytotoxic chemotherapy; de Jong P et al.; The efficacy of penicillin G was evaluated in the prevention of infections caused by streptococci in patients receiving remission induction or intensive consolidation treatment for acute myeloid leukaemia . Between 1980 and 1988, 29 episodes of streptococcal septicaemia occurred in 139 treatment events . All patients received as prophylaxis regimen ciprofloxacin (n = 38) or a combination of polymyxin B with nalidixic acid (n = 42) or neomycin (n = 59) . Six patients died of streptococcal septicaemia despite adequate antibiotic treatment . The high incidence of streptococcal septicaemia lead to the administration of penicillin G in addition to ciprofloxacin as prophylaxis regimen during the 14 days immediately following cytotoxic chemotherapy . Only two episodes of streptococcal septicaemia were documented after addition of penicillin G to the prophylaxis regimen (n = 76, p < 0.001) . Both patients had an uneventful recovery after treatment with vancomycin . Patients receiving penicillin G prophylaxis experienced fever during 17% of the time and received antimicrobial therapy during 20% of the time per treatment event compared with 27% and 32% respectively of this time in patients receiving no streptococcal prophylaxis (p < 0.001) . Penicillin G prophylaxis was associated with an increased incidence of fever of unknown origin and more frequent isolation of aerobic gram-negative bacteria in surveillance cultures . Penicillin G in combination with ciprofloxacin proved to be highly successful in preventing infections caused by streptococci and in reducing infection-related mortality and morbidity.

Semin Hematol, 1993 Oct, 30(4 Suppl 4), 35 - 43; discussion 44
Vaccinia virus: a novel approach for molecular engineering of peptide vaccines; Hruby DE; One of the more promising new approaches for producing prophylactic vaccines involves the genetic engineering of vaccinia virus (VV) strains to express a single protein, a portion of a protein, or a single epitope from a heterologous pathogen . As an example, the application of this approach to the prevention of streptococcal-related diseases is considered . Experiments are described in which several generations of VV-based recombinant vaccines were constructed that expressed various derivatives of the M protein gene from Streptococcus pyogenes (serotype 6) . These recombinants were used to demonstrate the high-level expression, stability, and antigen authenticity of the bacterial proteins expressed in infected tissue culture cells . When tested in a mouse model system, immunization with the VV recombinants expressing specific subdomains of the M protein conferred protection to challenge from both homologous and heterologous serotypes of pathogenic streptococci.

Aust Fam Physician, 1993 Oct, 22(10), 1763 - 8
Streptococcal update . A microbiology perspective; Asche V; The streptococci remain important human pathogens despite it being nearly 60 years since sulphonamides were introduced . Rheumatic fever and post glomerulonephritis are common diseases in the Aboriginal community, and a new invasive disease, toxic shock-like syndrome, is also caused by Group A Streptococcus . Group B, first described over 50 years ago in obstetric wards remains the primary neonatal pathogen despite attempts to eliminate this organism from the genital tract of the carrier mother . A major concern in paediatrics is the relatively poor response to the current pneumococcal vaccines . Australian researchers are playing a major role in developing a new vaccine with high antigenicity against all of the 100 odd serotypes of S pneumoniae . The oral streptococci are now recognised as important opportunistic pathogens and the pathogenesis is well defined . Disturbing reports from different geographical regions alert us to the antibiotic resistance in some of the streptococci once thought of as sensitive bacteria, for example, Group A has shown resistance to erythromycin, the pneumococcus to penicillin and beta-lactam antibiotics and the aminoglycosides have been ineffective against the enterococci due to plasmid-borne genes.

FEMS Immunol Med Microbiol, 1993 Oct, 7(3), 231 - 40
Susceptibility of chicken embryos to group A streptococci: correlation with fibrinogen binding; Schmidt KH et al.; One problem in investigating group A streptococcal infections and virulence is the lack of appropriate in vivo models . In this study we introduce the chicken embryo model for determining virulence of Streptococcus pyogenes . We found that M protein positive strains, if administered intravenously, were highly virulent for 12-day-old chicken embryos . The LD50 of the strains tested could be correlated directly with the amount of cell wall exposed M protein, which has been determined by the capacity of streptococci to bind fibrinogen and by the ability of streptococci to survive in fresh normal human blood . The number of colony forming units (cfu) of M+ strains necessary to kill 50% of embryonated eggs was significantly lower (< 10(2) cfu) than for M-variants (> 10(4) cfu) . Albumin and/or IgG binding streptococcal cells, which can also take place in proteins of the M protein family which do not bind to fibrinogen, did not show that clear correlation to the virulence in chicken embryos that did fibrinogen binding . Application of anti-streptococcal M protein antisera from chicken and rabbit reduced the lethality of the chicken embryos . In contrast, no correlation was found between lethality of chicken embryos and the in vitro production of erythrogenic toxins by the administered strains . Thus the results indicate that the presence of M-protein with its fibrinogen binding activity on the streptococcal cell surface is necessary for virulence of group A streptococci in the chicken embryo model.

Can J Vet Res, 1993 Oct, 57(4), 293 - 9
Leukotriene B4 in cows with normal calving, and in cows with retained fetal membranes and/or uterine subinvolution; Slama H et al.; Two experiments were performed to study the relationship between leukotriene B4 (LTB4) synthesis and placental separation and uterine involution in the cow . In experiment I, the concentration and synthesis of LTB4 by caruncular tissue was lower in cows with retained fetal membranes (RFM cows, n = 11) than in cows that expelled the fetal membranes normally (NFM cows, n = 19) . The presence of bacterial cell wall, especially of alpha-hemolytic streptococci and coagulase positive staphylococci enhanced LTB4 synthesis by allantochorion only in NFM cows . In the RFM group, Escherichia coli lipopolysaccharide decreased allantochorionic LTB4 synthesis . With caruncle, only epidermal growth factor increased LTB4 production in NFM cows . In experiment II, the caruncular and endometrial secretion of LTB4 was lower in cows with subuterine involution (SUI cows, n = 5) or cows with SUI and RFM (SUI+RFM cows, n = 4) than in cows with normal uterine involution (NUI cows, n = 8) . This decrease was especially noticeable in the previously gravid horn . In the three uterine involution groups, there were no differences in LTB4 synthesis by caruncular tissue taken from the previously gravid horn . However, progesterone and a bacterial suspension of E . coli reduced the synthesis of LTB4 . Estradiol had no effect on LTB4 synthesis at the end of the postpartum period . These results suggest that LTB4 may play an important role in both placental separation and uterine involution in cattle and LTB4 synthesis may be modulated by endocrine and bacterial factors.

APMIS, 1993 Oct, 101(10), 746 - 52
Crossed immunoelectrophoresis used for bacteriological diagnosis in patients with endocarditis; Kjerulf A et al.; Sera from 151 patients suspected of having endocarditis were obtained during a period of 3 1/2 years at Rigshospitalet, Copenhagen . The sera were examined by crossed immunoelectrophoresis for antibodies to bacteria causing endocarditis . The patients were divided into four groups: 1 . Patients with definite endocarditis, 2 . Patients with culture-negative endocarditis, 3 . Patients with uncertain endocarditis, and 4 . Patients without endocarditis . In sera from patients suffering from endocarditis caused by viridans streptococci, precipitating antibodies were demonstrated by crossed immunoelectrophoresis (diagnostic specificity = 86%; diagnostic sensitivity = 100%) while other bacterial etiologies of endocarditis were less reliably demonstrated by this method.

Oral Microbiol Immunol, 1993 Oct, 8(5), 322 - 4
Mutans streptococci in caries-active and caries-free infants in Tanzania; Matee MI et al.; The occurrence of mutans streptococci species was investigated in Tanzanian infants aged between 1.0 and 3.5 years with rampant caries and without caries using biochemical and immunological techniques . These infants came from Turiani and Singida, where the caries prevalence for this age group was 12.8% and 1.6% respectively . Streptococcus mutans was found to be the only mutans streptococcal species . The other species, including the previously reported Streptococcus rattus, were not found . Consequently, the differences in caries experience observed between and within the two populations could not be explained by differences in mutans streptococcal species.

Oral Microbiol Immunol, 1993 Oct, 8(5), 295 - 7
Beta-hemolytic streptococci in advanced periodontitis; Flynn MJ et al.; The distribution of serotypes of beta-hemolytic streptococci was examined in 718 periodontitis patients . Subgingival samples were obtained with paper points from the 3 deepest lesions in each patient, transported in VMGA III, plated onto brucella agar with 5% sheep blood and incubated anaerobically for 7 days . Serotyping and speciation were performed with Meritec-Strep Beta-Hemolytic Streptococcus Grouping Set and the Analytab 20S Streptococcus System . Beta-hemolytic streptococci were recovered from 33.7% of patients and averaged 10.5% of the total viable counts in culture-positive subjects . The organisms occurred with higher prevalence in patients 35 years or older than in younger patients . The predominant serotypes were F (62.9%), non-typeable (18.1%), B (6.9%), C (6.9%) and G (5.2%) . 100% of beta-hemolytic streptococci were sensitive to penicillin, but less than 5% were sensitive to tetracycline, metronidazole or ciprofloxacin . Beta-hemolytic streptococci may contribute to inflammatory periodontal disease and may interfere with healing after therapy.

Antimicrob Agents Chemother, 1993 Oct, 37(10), 2200 - 5
A new method to determine postantibiotic effect and effects of subinhibitory antibiotic concentrations; Lowdin E et al.; It has been shown that bacteria in a postantibiotic (PA) phase exposed to subinhibitory concentrations (sub-MICs) of antibiotics show a long delay before regrowth . This effect has been named the PA sub-MIC effect (PA SME) . In the present study, we have used a new method to demonstrate this phenomenon . A computerized incubator for bacteria, Bioscreen C (Lab Systems, Helsinki, Finland), which incubates the bacteria, measures growth continuously by vertical photometry, processes the data, and provides a printout of the results was used . With this method, one may easily test several antibiotics against different bacteria for PA effects (PAEs), PA SMEs, and SMEs . In this study, the effects of benzylpenicillin against beta-hemolytic streptococci and pneumococci were examined . The bacteria were exposed to 2, 10, or 50x MIC for 2 h, washed and diluted, incubated in the Bioscreen C incubator, and then exposed to 0.1 to 0.9x MIC . The regrowth was monitored for 20 h . The PAE was calculated as the difference in the time required for the exposed and unexposed bacteria to grow to a defined point (A50) on the absorbance curve . A50 was defined as 50% of the maximum absorbance for the control cultures . The PA SMEs were calculated as the difference in the time required for the reexposed cultures and the unexposed controls to reach A50 . The PAEs ranged between 0.6 and 3.2 h and varied little with the concentration used for the induction of the PAEs . At 0.2x MIC, the PA SMEs were 2 to 3 h longer than the PAEs . Higher sub-MICs increased this delay before regrowth . Most cultures exposed to sub-MICs alone were only slightly affected compared with the controls.

Z Gesamte Inn Med, 1993 Oct, 48(10), 497 - 501
{The effect of timing of surgical intervention on fatality of acute endocarditis}; Fritzsche D et al.; Between 1/1986 and 5/1992 a total of 5283 surgical procedures involving extracorporal circulation were performed at our clinic, including 44 patients who underwent a total of 54 operations for acute endocarditis . On the basis of a retrospective study, this paper presents the pre-operative findings and the results of surgery in relation to the duration of the case history . Pathogenic microorganisms were successfully grown from the blood cultures of 63.6% (n = 31) of the patients . Among these microorganisms were viridans streptococci (n = 12), coagulase-negative staphylococci (n = 5), staph . aureus (n = 5), beta-haemolytic streptococci (n = 2) as well as combined infections (n = 2) and miscellanea . Preoperatively, 38 patients were in NYHA stage III or IV . Surgery resulted in an average improvement of 1.6 NYHA classes from NYHA 3.3 to NYHA 1.7 . The total-mortality rate was n = 13; early mortality was n = 3 . The mean follow-up period was 3.9 years (minimum 5 weeks, maximum 6.4 years) . The time elapsed between initial clinical manifestation of the disease and operation had a significant influence on mortality and on the prevalence of complications . Patients who died of endocarditis had a significantly longer case history (p < 0.05) . The prognosis was poorer, according to our data, if the case history extended over more than 80 days . Our results demonstrate clearly the necessity for such patients to be referred to a heart surgeon without delay.

J Gen Microbiol, 1993 Oct, 139 ( Pt 10), 2451 - 8
Albumin-binding proteins on the surface of the Streptococcus milleri group and characterization of the albumin receptor of Streptococcus intermedius C5; Willcox MD et al.; Members of the Streptococcus milleri group (SMG) that react with Lancefield group C antisera were shown to bind large amounts of albumin although there was no direct relation between these two properties as polyclonal antisera to Lancefield group C antigen did not prevent the binding of albumin . There was a specificity for albumin binding, with albumin from man, monkeys, cat, dog and mouse being bound to a greater degree than albumin from cow, horse, goat or rabbit . Gold-labelled albumin was shown to be located close to the surface of strains by transmission electron microscopy . A cell-surface protein of M(r) 24,000, which was liberated by lysozyme treatment of cells, was shown to be the cell-surface receptor on Streptococcus intermedius C5 . The receptor was physically dissimilar from protein G, an albumin- and IgG-binding protein of 'large-colony' Lancefield group C and G streptococci.

J Clin Microbiol, 1993 Oct, 31(10), 2616 - 20
Molecular analysis of multiple isolates of the major serotypes of group B streptococci; Fasola E et al.; Serotyping of clinical isolates is a widely used technique for epidemiologic study of group B streptococcal infections . However, serotyping cannot definitively determine epidemiologically related or unrelated isolates . We investigated the use of restriction endonuclease analysis (REA) with both conventional agarose gel electrophoresis (AGE) and pulsed-field gel electrophoresis (PFGE) in 50 isolates of the major serotypes of group B streptococci . Single digestion with HindIII and HaeIII and double digestion with HindIII and then EcoRI were used for conventional AGE, and digestion with SmaI was used for PFGE . The molecular profile of one strain was compared with those of the strains within the same serotype as well as with the profiles from strains of different serotypes . Among 10 type Ia, Ia/alpha, Ia/alpha+beta, and Ia/R1 isolates and depending on the restriction enzyme used, we found between five and six REA patterns by conventional AGE and seven by PFGE; among 4 type Ib/alpha+beta isolates we found 2 to 4 REA patterns by conventional AGE and 4 by PFGE; among 21 type II, II/alpha, II/beta, II/alpha+beta, and II/R4 isolates, we found 11 REA patterns by both AGE and PFGE; and among 14 type III, III/R1, and III/R4 isolates, we found from 7 to 12 different REA patterns by AGE and 10 by PFGE . In total, among 13 serotypes and one nontypeable strain, we found 29 to 31 REA patterns by conventional AGE and 33 by PFGE . A particular REA pattern within a serotype was different from the patterns found in the other serotypes, suggesting that REA analysis by using conventional AGE or PFGE is a sensitive method for analyzing genetic relatedness and diversity in group B streptococci and has potential value in molecular epidemiologic studies.

Ann Plast Surg, 1993 Oct, 31(4), 369 - 71
Necrotizing periorbital cellulitis; Placik OJ et al.; We report traumatic necrotizing periorbital cellulitis attributed to group A beta-hemolytic streptococci in a 4-year-old child . The infection was successfully treated via surgical cleansing, drainage, and grafting . The virulence of this organism requires an aggressive approach to the patient with periorbital cellulitis, which is refractory to intravenous antibiotics . Early treatment may limit extensive eyelid necrosis, the resultant secondary deformity, and the need for multiple reconstructive procedures.

J Clin Pathol, 1993 Oct, 46(10), 965 - 7
Fatal infection associated with group C streptococci; Bateman AC et al.; Serious infection caused by Lancefield group C streptococci is unusual in man . Two unrelated deaths associated with these organisms in a 55 year old woman who died after three days of diarrhoea and vomiting, and in a 65 old man who died after a week of non-specific symptoms, are presented . Post mortem examination showed septicaemia in the former and severe aortic stenosis with widespread septic emboli and probable meningitis in the latter . Lancefield group C streptococci were isolated from both cases . These organisms may be carried asymptomatically and usually cause disease in animals but cases of serious human infection have recently been described, mainly in elderly patients or those with other predisposing factors.

Community Dent Oral Epidemiol, 1993 Oct, 21(5), 288 - 91
Mutans streptococci and caries prevalence in preschool children; Thibodeau EA et al.; Numerous studies have reported a correlation between mutants streptococci levels and dental caries . The aim of this study was to assess the relationship between salivary mutans streptococci levels and caries in preschool children of low socioeconomic status . A total of 462 Head Start children, mean age 3.8 yr (range 2.0-5.3 yr), were examined by the modified method of Radike . Saliva samples from 458 of these children were collected with tongue blades and impressed onto mutants streptococci selective agar . Children's mutants streptococci levels were categorized as low (0 CFU), moderate (1-50 CFU) or high (> 50 CFU), and the mean dmfs was 0.40, 1.92 and 4.88, respectively . All study groups (Black, Hispanic and White) had infection rates of approximately 83%; however, 39.1% of Black children had high mutans streptococci levels compared with 28.4% of White children . Pit/fissure caries was the most prevalent disease type in children with moderate or high mutants streptococci levels, although White children in the high group had significantly less of this pattern than Blacks and Hispanics . Sensitivity, specificity, and positive and negative predictive values for the high mutants streptococci group were 91.3%, 57.5%, 69.3% and 86.3% . Results from this study indicate that differences between Black, Hispanic and White preschool children may influence caries activity within populations that have similar mutants streptococci infection levels and socioeconomic backgrounds.

Diagn Microbiol Infect Dis, 1993 Oct, 17(3), 209 - 11
Effect of protein on ramoplanin broth microdilution minimum inhibitory concentrations; Scotti R et al.; Ramoplanin is a glycolipodepsipeptide antibiotic active against Gram-positive bacteria . We observed that microdilution minimum inhibitory concentrations (MICs) were higher than those obtained in glass tubes or by agar dilution . Initial studies showed that these differences disappeared when 30% bovine serum was added to the broth . Further studies showed that addition of 0.01% bovine serum albumin (BSA) to the broth lowered the microdilution MICs for staphylococci, streptococci, and enterococci by four- to 32-fold . This phenomenon occurred in several commonly used growth media and in different types of commercially available microtiter trays . Precoating of the microtiter wells with a dilute solution of BSA (0.02%) had the same effect . It seems likely that ramoplanin adsorbs to plastic surfaces and is lost from solution, and that protein masks the sites of adsorption . Ramoplanin MICs may be reliably determined by broth microdilution if a small amount of protein is added to the diluent.

Antibiot Khimioter, 1993 Oct-Nov, 38(10-11), 3 - 7
{The development of a nutrient medium for nisin-producing streptococci utilizing the waste products from a number of biotechnology plants}; Baranova IP et al.; The possibility of using some waste products of the dairy and agricultural industries as nutrient substrates for the cultivation of nisin-producing streptococci was studied . Yeast production wastes as well as potato liquor, whey and dried whey as waste products were shown suitable for the growth of Streptococcus lactis and the biosynthesis of nisin . The level of the nisin production increased when corn steep liquor and glucose were added to whey and dried whey respectively.

J Immunol, 1993 Oct 1, 151(7), 3902 - 13
A subset of mouse monoclonal antibodies cross-reactive with cytoskeletal proteins and group A streptococcal M proteins recognizes N-acetyl-beta-D-glucosamine; Shikhman AR et al.; It is well known that antibodies to N-acetyl-beta-D-glucosamine (GlcNAc) cross-react with cardiac valves, skin, and other host tissues . However, molecular targets of these antibodies have not been identified . For this reason, anti-streptococcal mAb cross-reactive with group A streptococci and heart proteins were studied for their reactivity with GlcNAc, the immunodominant epitope of group A streptococcal carbohydrate . Characterization of the mAb that recognized GlcNAc revealed that each mAb had its own unique antigen-binding profile and pattern of immunofluorescence on rat heart cells . In the ELISA and Western blot these mAb reacted with cytoskeletal and heart proteins such as actin, keratin, myosin, and vimentin, as well as with streptococcal recombinant M5 and M6 proteins . Binding of the mAb to cytoskeletal proteins was inhibited by GlcNAc conjugated with BSA in a dose-dependent manner, and the mAb preferentially reacted with high-density GlcNAc-BSA conjugates . Antigenic determinants on the proteins recognized by the mAb were resistant to sodium periodate and N-acetylglucosaminidase treatment, suggesting reactivity with peptide and not carbohydrate structures . On reaction of the mAb with a panel of synthetic streptococcal, viral, and myosin peptides, one of the mAb, 49.8.9, was found to react most strongly with a synthetic peptide sequence synthesized from the coxsackievirus B3 capsid protein VP1, which shows homology with and cross-reacts with sequences in the streptococcal M6 protein and human cardiac myosin . This most interesting mAb, previously shown to neutralize coxsackie viruses, recognized the amino acid sequence RRKLEFF, which may mimic the GlcNAc epitope . The data collected show that we have identified a new group of multireactive autoantibodies that recognize GlcNAc and cytoskeletal proteins, as well as defined peptide epitopes.

N Z Med J, 1993 Sep 8, 106(963), 375 - 6
Maternal mortality in New Zealand; Aickin DR; New Zealand's maternal mortality rate in the triennium 1986-8 was reviewed in comparison with the rates from Australia and the United Kingdom during 1985-7 . The New Zealand rate of 9.6 obstetric deaths/100,000 total births was higher than that for the United Kingdom (6.2) and Australia (4.4) . Six of 16 deaths in New Zealand during the triennium were caused by sepsis, including five cases of puerperal infection with group A beta-haemolytic streptococci . Careful analysis of maternal deaths in New Zealand remains an important priority to provide audit of the performance of maternity services.

Medicine (Baltimore), 1993 Sep, 72(5), 296 - 310
Polyarticular septic arthritis; Dubost JJ et al.; Twenty-five cases of polyarticular septic arthritis (PASA) were observed in our department over a 13-year period . They accounted for 16.6% of all septic arthritis (15% on average in the literature) . A male predominance was noted in our patients, as well as in the literature . The knee was the most frequent location followed by the elbow, shoulder, and hip, in varying order depending on the series . An average of 4 joints was involved . The causative microorganism was Staphylococcus aureus in 20/25 of our patients and in about 50% of published cases . Other frequently causative organisms were streptococci and gram-negative bacteria . Blood cultures and joint aspirations were positive in 19/22 and 23/25 of our cases, respectively . Other septic lesions were noted in 10/25 of our cases . Fever and severe leukocytosis were absent at admission in 5/25 (literature, 37%) and 10/25 of our 25 patients, respectively . The underlying disease was rheumatoid arthritis in 13/25, while 9 of the other patients had immunodepression caused by drugs or by concurrent illness . Typically, rheumatoid arthritis was long-standing and erosive, patients having ulcerated calluses on the feet . This skin source was also noted in 23/36 published cases of PASA in rheumatoid arthritis . Systemic lupus erythematosus was an uncommon disease in PASA, but its presence promoted gram-negative infection . Despite effective therapy with 2 antibiotics, 8/25 patients died, a prognosis that is equally severe in cases reported in the literature (30%) and one that has remained surprisingly stable over the last 40 years . For comparison, the death rate was only 4% in our patients with MASA . Factors contributing to a poor prognosis were age greater than 50 years, rheumatoid arthritis as an underlying disease, and disease of staphylococcal origin . Septic polyarthritis should be considered even when the clinical picture is not florid--when patients have low fever and normal white blood cell counts . Nor should the simultaneous involvement of distant joints rule out infection . Indeed, the frequency of underlying rheumatic disease and its treatment may further confuse the clinical presentation . Joints suspected of harboring infection should be aspirated, including those previously affected by the concurrent rheumatism.

J Bacteriol, 1993 Sep, 175(18), 5953 - 61
A ring-shaped structure with a crown formed by streptolysin O on the erythrocyte membrane; Sekiya K et al.; Streptolysin O (SLO) is a membrane-damaging toxin produced by most strains of group A beta-hemolytic streptococci . We performed ultrastructural analysis of SLO-derived lesions on erythrocyte membranes by examining electron micrographs of negatively stained preparations . SLO formed numerous arc- and ring-shaped structures with or without holes on membranes . Rings formed on intact cell membranes had an inner diameter of ca . 24 nm and had distinct borders of ca . 4.9 nm in width, but the diameter of rings varied from 24 to 30 nm on membranes of erythrocyte ghosts . Image analysis of electron micrographs demonstrated that each ring was composed of an inner and an outer layer . Each layer contained an array of 22 to 24 SLO molecules . On the top of the ring, we found a characteristic crown that projected from the cell membrane . The crown was separated by an electron-dense layer from the basal part of the ring that was embedded in the lipid bilayer of the erythrocyte membrane . Heights of the three parts, namely, the crown (head), the space (neck), and the basal portion (base), were ca . 3.2, 1.6, and 5.0 nm, respectively, and we postulated that these parts are the constituents of a single SLO molecule . The volumes of SLO molecules in the inner and outer layers were calculated to be 77 and 88 nm3 . On the basis of a model of the structure of SLO, we propose some new details of the mechanisms of hemolysis by SLO toxin.

Am J Obstet Gynecol, 1993 Sep, 169(3), 571 - 2
The return of life-threatening puerperal sepsis caused by group A streptococci; Nathan L et al.; A dramatic decline in the prevalence of serious puerperal infection caused by group A beta-hemolytic streptococci has been observed throughout most of the twentieth century, and it is currently a very uncommon cause of maternal morbidity and mortality . We report on two term pregnancies complicated by profound multisystem organ failure caused by group A streptococcal puerperal sepsis . This report serves to highlight the apparent return of serious group A streptococcal puerperal sepsis and to emphasize the clinical implications and sequelae attributable to an old yet virulent enemy.

Proc Natl Acad Sci U S A, 1993 Sep 1, 90(17), 8154 - 8
Glyceraldehyde-3-phosphate dehydrogenase on the surface of group A streptococci is also an ADP-ribosylating enzyme; Pancholi V et al.; We recently identified an enzymatically active glyceraldehyde-3-phosphate dehydrogenase (EC 1.2.1.12; GAPDH) as a major protein on the surface of group A streptococci (SDH), which exhibits multiple binding activity to various mammalian proteins . We now report that the SDH molecule also functions as an ADP-ribosylating enzyme, which, in the presence of NAD, is auto-ADP-ribosylated . In a crude cell wall extract of group A streptococci, SDH is the only protein that is ADP-ribosylated . SDH found in the streptococcal cytoplasmic fraction could not be ADP-ribosylated in the presence of NAD . Treatment of ADP-ribosylated SDH with the cytoplasmic fraction removed the ADP-ribose from SDH, suggesting the presence of an ADP-ribosyl hydrolase in the cytoplasmic compartment . The covalent linkage of ADP-ribose to SDH was stable to neutral hydroxylamine, sensitive to HgCl2, and inhibitable by free cysteine, indicating that the modification was at a cysteine residue of SDH . In addition to its auto-ADP-ribosylation activity, purified SDH or streptococcal cell wall extracts were able to transfer the ADP-ribose moiety of NAD specifically to free cysteine, resulting in a true thioglycosidic linkage . Treatment of purified SDH or the crude cell wall extract with sodium nitroprusside, which spontaneously generates nitric oxide, was found to stimulate the ADP-ribosylation of SDH in a time-dependent manner . ADP-ribosylation and nitric oxide treatment inhibited the GAPDH activity of SDH . Since ADP-ribosylation and nitric oxide are involved in signal transduction events, the ADP-ribosylating activity of SDH may enable communication between host and parasite during infection by group A streptococci.

J Med Microbiol, 1993 Sep, 39(3), 179 - 82
Identity of viridans streptococci isolated from cases of infective endocarditis; Douglas CW et al.; The oral streptococci have undergone considerable taxonomic revision in recent years but there is still little information concerning associations between the newly defined species and disease . This study examined the identities of 47 strains of oral streptococci collected from 42 confirmed cases of infective endocarditis . By means of recently described physiological schemes, the most common species identified were Streptococcus sanguis sensu stricto (31.9%), S . oralis (29.8%) and S . gordonii (12.7%) . Other related species including S . mitis and "S . parasanguis" were less common . This indicates that attention should be focused on S . sanguis sensu stricto and S . oralis when considering possible pathogenic mechanisms involved in viridans streptococcal endocarditis.

Laryngoscope, 1993 Sep, 103(9), 1020 - 6
Effect of specific bacteria on lymphocyte proliferation in diseased and nondiseased tonsils; Koch RJ et al.; Tonsillar tissue lymphocyte (TTL) function as measured by lymphocyte proliferation was assessed in vitro in 38 tonsils--30 diseased and 8 normal controls . TTLs from diseased and control tonsils were challenged with intact, heat-inactivated bacteria which may be found in the core of diseased tonsils; these bacteria were Streptococcus pyogenes and Hemophilus influenzae type B (HIB), as well as the dominant bacterium (DB) grown from that particular tonsillar core . The phytomitogen leukoagglutinin (LA) was used as a nonspecific activator . Lymphocyte proliferation was quantified and reported using a stimulation index (SI) which was based upon viable cell counts at 2, 4, and 6 days following inoculation . Overall, the greatest degree of lymphocyte proliferation in diseased TTLs (SI = .91) was produced by HIB . However, both SP and HIB produced more lymphocyte proliferation in the nondiseased TTLs than in the diseased TTLs (P < .01) . H influenzae (non-B) and group A beta-hemolytic streptococci were the pathogens most frequently cultured as the dominant bacteria from the core of diseased tonsils; Streptococcus viridans was most frequently cultured in nondiseased tonsils . The DB caused greater TTL proliferation in diseased (SI = .89) versus control (SI = .63) TTLs (P < .001) . These findings suggest a differential proliferative response in vitro for diseased and nondiseased TTLs in response to specific bacteria . The role of possibly pathogenic bacteria and commensals, as well as the implications for clinical disease, are discussed.

Infect Immun, 1993 Sep, 61(9), 3998 - 4000
Similar proportions of immunoglobulin A1 (IgA1) protease-producing streptococci in initial dental plaque of selectively IgA-deficient and normal individuals; Reinholdt J et al.; By comparing the initial colonization of cleaned teeth in immunoglobulin A (IgA)-deficient, IgM-compensating individuals with that in normal individuals, no significant difference in the proportion of IgA1 protease-producing streptococci was found . Thus, as one of several bacterial means of immune evasion, the ability to cleave secretory IgA1 does not appear essential to the successful adherence of oral streptococci.

Infect Immun, 1993 Sep, 61(9), 3761 - 8
Interaction of group B streptococcal opacity variants with the host defense system; Pincus SH et al.; Group B streptococci (GBS) demonstrate high-frequency phase variation of colony opacity . Colony opacity is a function of chain length, with opaque colonies consisting of GBS that form longer chains . Because opaque variants do not grow on standard streptococcal media, the role of opacity variation in GBS infection has not been studied . We have isolated stable variants from type III GBS that are either transparent (variants 1.2 and 1.3) or opaque (variants 1.1 and 1.5) . In this study, we evaluated the interactions of these variants with different components of the host immune system both in vitro and in vivo . Opaque GBS were less immunogenic than transparent GBS . Opaque GBS were more susceptible to killing by polymorphonuclear neutrophils (PMNs) and could induce a chemiluminescent response of PMNs in the absence of antibody (Ab) or complement . Transparent GBS did not induce neutrophil chemiluminescence in the absence of Ab and complement . However, in the presence of Ab and complement, transparent GBS induced a stronger chemiluminescent response than did opaque GBS . Scanning electron micrographs of PMNs and GBS demonstrated differences in the attachment and engulfment of the different variants by the PMNs as well as different effects of the GBS on the PMNs themselves . Interactions with complement were affected by GBS opacity as well, with opaque variant 1.1 initiating complement activation in the absence of any Ab . The virulence of the GBS opacity variants was studied in vivo by inoculation of graded numbers of GBS into newborn mice . Transparent variants 1.2 and 1.3 were most virulent, with variant 1.1 intermediate and variant 1.5 minimally virulent . However, in mixed infections, variant 1.5 greatly enhanced the virulence of small numbers of transparent GBS . These results indicate that the opacity status of GBS can influence the interaction between the GBS and the host immune system.

Infect Immun, 1993 Sep, 61(9), 3696 - 702
Association of type II immunoglobulin G-binding protein expression and survival of group A streptococci in human blood; Raeder R et al.; Expression of immunoglobulin G (IgG)-binding proteins on group A streptococcus strain 64 was monitored on bacteria subjected to sequential passage in human blood . After approximately 10 cycles through human blood, strain 64 demonstrated enhanced levels of IgG-binding protein, including the expression of a type IIa binding molecule with an M(r) of approximately 47,000 present only at very low levels on the parent isolate . Changes in the expression of IgG-binding proteins after passage in human blood were similar to those observed when the same organism was passaged sequentially intraperitoneally in mice . Strain 64, passaged in human blood 23 times, was found to be more virulent than the parent isolate when used to infect mice either intraperitoneally or in a skin air sac . These findings suggest that the expression of IgG-binding proteins may be a common response of group A organisms to pressures exerted by distinct host defense mechanisms.

Eur J Epidemiol, 1993 Sep, 9(5), 483 - 8
First characterization in Italy of clinical isolates of mutans streptococci by using specific monoclonal antibodies; Batoni G et al.; The aim of this investigation was to gain further insight into the prevalence of different serotypes of mutans streptococci in the Italian population by using specific monoclonal antibodies in an enzyme immunoassay . Isolates from dental plaque samples, collected from an adult population living in Pisa (Italy), were identified as mutans streptococci on the basis of their morphological and biochemical properties, and were then serotyped . The results show that 77.5% of the strains isolated belonged to serotype c or f (i.e., S . mutans), 15.9% were serotype e (i.e., S . mutans) and only two strains (1.4%) belonged to serotype g (i.e., S . sobrinus) . These data are partially in agreement with other studies in Europe and in the U.S.A . The distribution pattern of the various serotypes turned out to be substantially similar among the different groups of patients, subdivided on the basis of their caries status, indicating that none of the serotypes was particularly associated with dental caries.

J Gen Microbiol, 1993 Sep, 139 ( Pt 9), 2173 - 8
A haemagglutinating adhesin of group B streptococci isolated from cases of bovine mastitis mediates adherence to HeLa cells; Wibawan IW et al.; Rabbit erythrocytes were agglutinated by 43.4% of group B streptococci isolated from bovines but by none isolated from humans . Haemagglutination was enhanced by cultivation of the bacteria under microaerophilic conditions . Most of the haemagglutinating strains had protein type antigen X, either alone, or in combination with polysaccharide antigens . Heat and proteolytic treatment of the bacteria destroyed the haemagglutination activity . The haemagglutinin could be solubilized from the bacterial surface by mutanolysin treatment and isolated from culture supernatant fluid by ammonium sulphate precipitation . The isolated haemagglutinin did not cause direct agglutination of erythrocytes . However, binding of the haemagglutinin to rabbit erythrocytes could be visualized by agglutination of haemagglutinin-treated erythrocytes by specific antiserum obtained by absorption . Western blotting showed that the haemagglutinin obtained from erythrocyte lysates contained an antibody-reactive band with a molecular mass of 43 kDa . Haemagglutination-positive strains adhered to HeLa cells in higher numbers than did haemagglutination-negative strains . The HeLa cell adherence of Group B streptococci was inhibited in the presence of isolated haemagglutinin or of specific antiserum against the haemagglutinin . These observations suggest that the haemagglutinating adhesins of bovine group B streptococcal isolates are directly involved in the adherence mechanisms of these organisms.

Br J Biomed Sci, 1993 Sep, 50(3), 249 - 57
Laboratory aspects of infective endocarditis; James PA; The clinical laboratory has a major role in both the diagnosis and treatment of cases of infective endocarditis . Patients often present with vague non-specific symptoms, which complicates the initial diagnosis . Blood cultures are by far the most important specimens . Laboratories should be aware of isolation problems associated with certain organisms . If initial blood cultures are negative then serological tests for non-bacterial causes should be considered . Staphylococci and streptococci account for > 90% of cases, and appropriate antimicrobial chemotherapy for the majority of strains is well established . The laboratory role is to identify the infecting organism, to establish the in-vitro activity of the proposed antibiotic therapy by determining minimum inhibitory concentrations and minimum bactericidal concentrations of antibiotics, singly and in combination against the patient's own organism, and to measure the bactericidal activity of antibiotics in the patient's serum to assess potential clinical efficacy . Laboratory aspects of diagnosis, treatment and therapeutic monitoring are discussed.

Antimicrob Agents Chemother, 1993 Sep, 37(9), 1971 - 6
Simulated human serum profiles of one daily dose of ceftriaxone plus netilmicin in treatment of experimental streptococcal endocarditis; Blatter M et al.; We performed experiments in rats aimed at determining whether a combination of ceftriaxone (CRO) and netilmicin (NET), by using once-daily administration in rats, which simulated profiles of drug in human serum, was more effective than either agent alone in the treatment of endocarditis caused by viridans group streptococci . A programmable infusion pump system enabled the production of profiles of CRO in serum that simulate those found in humans after the intravenous administration of 2 g . The subcutaneous administration of 18 mg of NET per kg of body weight produced levels in the sera of rats comparable to those after the intravenous administration of a dose of 5 mg of NET per kg in humans . Rats with catheter-induced aortic vegetations were infected intravenously with two test strains, a CRO-susceptible Streptococcus sanguis strain (MICs of CRO and NET, 0.064 and 8 mg/liter, respectively) and a relatively CRO-resistant Streptococcus mitis strain (MICs of CRO and NET, 2 and 8 mg/liter, respectively) . Against both strains, the combination of CRO and NET was synergistic in vitro as determined by time-kill curves . Treatment of rats was started 48 h postinfection and lasted for 3 days . CRO alone was effective against the susceptible strain (P < 0.001 compared with control animals) but was not effective against the resistant organism . A significantly enhanced antibacterial activity of the CRO-NET combination in reducing the valvular bacterial counts was observed with both test strains (P < 0.001) . The synergistic effect was obtained with a single daily injection of NET which provided detectable levels in serum for only 8 h, suggesting that in vivo synergism in the treatment of infections caused by viridans group streptococci can be obtained without 24 h of aminoglycoside coverage . These experimental data might provide a rationale for clinical trials of a once-a-day dosing regimen in the treatment of streptococcal but nonenterococcal endocarditis.

Am J Otolaryngol, 1993 Sep-Oct, 14(5), 343 - 9
Head and neck cellulitis in hospitalized adults; Kimura AC et al.; INTRODUCTION: Our purpose was to review the clinical features of head and neck cellulitis in hospitalized patients . MATERIAL AND METHODS: A retrospective review was undertaken of 147 cases of head and neck cellulitis seen over a 15-year period at a community Hawaiian hospital . RESULTS: Otologic cellulitis was mainly related to otitis externa, caused by Pseudomonas aeruginosa, although some cases had infected pierced ears or ear cysts . Cervical cellulitis was associated with malignancy, dental infection, or lymphadenitis; these patients often had positive blood cultures . Facial cellulitis was almost always caused by Staphylococci and Streptococci, usually preceded by dental infections, traumatic abscesses, or sinusitis . All study patients recovered completely, except for one patient who developed cavernous vein thrombosis and oculomotor palsy . Seventy-five percent of the patients recovered with parenteral antibiotics alone; the other patients required abscess drainage and/or other surgical procedures, especially if neck infection was present . CONCLUSION: Although head and neck cellulitis cases have grave potential consequences, most patients do very well with proper antibiotics and appropriate surgical drainage.

Ear Nose Throat J, 1993 Sep, 72(9), 620 - 2, 624-6, 631
Fatal mediastinal abscess from upper respiratory infection; Isaacs LM et al.; Suppurative mediastinitis following neck infection is an uncommon entity that carries a 40% mortality . It is most commonly associated with esophageal perforation or odontogenic abscess . The rapidity of spread has been attributed to dependent drainage from the neck into the mediastinum, negative intrathoracic pressure, and synergistic necrotizing bacterial growth . Cultures obtained usually grow streptococci and/or Bacteroides . We report the case of a 34-year-old woman with an upper respiratory infection who subsequently was found to have a para-/retropharyngeal and mediastinal abscess . Septic shock, respiratory failure, and death ensued, despite aggressive treatment with broad-spectrum antibiotics (for both aerobes and anaerobes), surgical drainage of the neck and mediastinum, and cardiorespiratory support . The danger of a rapid downhill clinical course with mortality due to suppurative mediastinitis makes early diagnosis of critical importance . All clinicians evaluating a "sore throat" should consider neck edema or gas on neck radiograms as evidence of cervical abscess, and subsequent widening of the mediastinum on chest x-ray as an ominous sign suggesting mediastinal abscess.

Lijec Vjesn, 1993 Sep-Oct, 115(9-10), 280 - 3
{Evaluation of phenotype characteristics of streptococci in the identification of the Streptococcus anginosus (Streptococcus milleri) group}; Bejuk D et al.; Microorganisms referred to as Streptococcus anginosus (Streptococcus milleri) group which consist of S . anginosus, S . intermedius and S . constellatus is very difficult to identify to the species level, because of their diversity of biochemical, hemolytic and serological characteristics and because of confusion surrounding their taxonomy . Identification procedures on three isolates from primary sterile sites of three different patients, using API 20A system are described . Streptococcus intermedius was established in two and Streptococcus anginosus in one case . The importance of these organisms as human pathogens should enhance efforts of clinical microbiologist towards their accurate identification.

Zh Mikrobiol Epidemiol Immunobiol, 1993 Sep-Oct, (5), 74 - 8
{Human sera as a source of anti-OF antibodies for the typing of group-A streptococci}; Beliakova IV et al.; For typing group A streptococci anti-OF rabbit or guinea-pig sera are usually used in the Al-apoproteinase neutralization test . Still in view of the fact that the technology of the preparation of anti-OF sera with the use of laboratory animals is labor consuming and demands great expense, the use of human donor sera is expedient . A good basis for it is created by a wide spread of streptococcal diseases . At the same time it is impossible to provide a full set of anti-OF sera by the efforts of one laboratory in a single geographical region due to the absence of some types in a given population; for this reason the international bank of sera from donors having antibodies to OF(+) of group A streptococci has been created.

Zh Mikrobiol Epidemiol Immunobiol, 1993 Sep-Oct, (5), 35 - 40
{An explosive outbreak of strep throat morbidity in an adult organized collective}; Briko NI et al.; Altogether 162 cases of tonsillitis were registered in two military units during the period of May 11-16 . The disease took an acute course with short-time fever, symptoms of acute intoxication, sore throat, pronounced inflammatory changes in tonsils and swelling of regional (submaxillary and anterocervical) lymph nodes . In some of the patients (1.1%) sickness and vomiting and in 0.2% diarrhea were registered . In 6.7% of the patients scarlatiniform eruptions were observed on days 2-3 of the disease . In the course of the bacteriological examination of the patients group A streptococci, serovar T II, were isolated . The dynamic study of paired sera showed a considerable increase in the number of patients with a high level of antibodies to streptolysin 0 and group A polysaccharide . All patients were fed at the same canteen . The factor of the transmission of this infection could be butter, stored without observation of the required temperature conditions and apportioned by the soldiers of the kitchen police . Experimental study revealed that group A streptococci are capable for proliferation and accumulation in butter.

Mol Microbiol, 1993 Sep, 9(6), 1213 - 22
Adherence and fibronectin binding are environmentally regulated in the group A streptococci; VanHeyningen T et al.; The ability of the pathogenic Gram-positive bacterium Streptococcus pyogenes (group A streptococcus) to bind fibronectin and adhere to respiratory epithelial cells is dependent on a surface protein called protein F . In this study, we have examined the regulation of expression of protein F and have shown that it is environmentally regulated in response to alterations in atmosphere . In six recent clinical isolates expression of protein F was repressed during growth under reduced concentrations of O2 . Expression in an anaerobic environment was induced by both superoxide-generating and redox-altering reagents . However, regulation did not involve mry, a gene that controls expression of several streptococcal surface proteins . Protein F was constitutively expressed in one of two laboratory-passaged strains analysed, and in a complementation analysis using an allele of the gene that encodes protein F (prtF) cloned from a regulated strain and expressed in a constitutive strain, the constitutive phenotype was shown to be dominant in trans . Regulation, as monitored by fusion of prtF to a promoterless chloramphenicol acetyltransferase gene, involved transcriptional control . Environmentally induced alterations in protein F expression affected the ability of the bacterium to adhere to epithelial cells, which suggests that the ability to regulate expression of protein F may be important during infection.

J Clin Microbiol, 1993 Sep, 31(9), 2467 - 73
Species identification of oral viridans streptococci by restriction fragment polymorphism analysis of rRNA genes; Rudney JD et al.; Oral streptococci formerly classified as Streptococcus sanguis have been divided into six genetic groups . Methods to identify those species by genotype are needed . This study compared restriction fragment polymorphisms of rRNA genes (ribotypes) for seven S . gordonii, three S . sanguis, four S . oralis, three S . mitis, one S . crista, and seven S . parasanguis strains classified in previous DNA hybridization studies, as well as one clinical isolate . DNA was digested with HindIII, PvuII, HindIII and PvuII combined, EcoRI, BamHI, AatII, AlwNI, and DraII . DNA fragments were hybridized with a digoxigenin-labeled cDNA probe obtained by reverse transcription of Escherichia coli 16S and 23S rRNA . S . oralis, S . mitis, and S . parasanguis all showed an isolated 2,290-bp band in AatII ribotypes that was absent from S . gordonii, S . sanguis, and S . crista . The last three groups showed species-specific bands with AatII and also with PvuII . S . oralis could be distinguished from S . mitis and S . parasanguis in AlwNI and DraII ribotypes . S . mitis and S . parasanguis could not be distinguished, since they shared multiple bands in PvuII, AlwNI, and EcoRI patterns . The clinical isolate in the panel was very similar to S . sanguis by all enzymes used . Our findings suggest that ribotyping may be useful for genotypic identification of oral viridans streptococci . Initial digests of clinical isolates might be made with AatII, followed by PvuII or AlwNI . Isolates then could be identified by comparing ribotype patterns with those of reference strains . This approach could facilitate clinical studies of these newly defined species.

J Immunol, 1993 Sep 1, 151(5), 2820 - 8
Epitopes of streptococcal M proteins that evoke antibodies that cross-react with human brain; Bronze MS et al.; There is evidence suggesting that Sydenham's chorea, which is a major manifestation of acute rheumatic fever, may be mediated by streptococcal antibodies that cross-react with the brain . Our studies were undertaken to determine whether streptococcal M protein, the major virulence factor of group A streptococci, evoked antibodies that cross-react with human brain . Rabbits were immunized with pepsin-extracted M protein from rheumatogenic type 6 streptococci . Immune sera were screened for the presence of antibodies that cross-reacted with human brain by indirect immunofluorescence tests and immunoblot analyses . Type 6 M protein evoked antibodies that cross-reacted with several brain proteins and antibody binding to these proteins was completely inhibited by type 6 M protein and partially inhibited by types 5 and 19 M proteins, suggesting that these heterologous M proteins contain conserved brain-cross-reactive epitopes . Using synthetic peptides from several serotypes of M proteins, the conserved brain-cross-reactive epitopes were localized to a decapeptide contained within the covalent structure of the B repeat region of type 6 M protein . These peptides also inhibited brain-cross-reactive antibodies in the serum of a patient with active Sydenham's chorea . Our data indicate that streptococcal M proteins contain brain-cross-reactive epitopes that could potentially be involved in the pathogenesis of Sydenham's chorea.

J Dent Res, 1993 Sep, 72(9), 1325 - 30
The resistance and adaptation of selected oral bacteria to mercury and its impact on their growth; Lyttle HA et al.; Selected strains of oral Streptococcus and Actinomyces have been tested for their ability to grow in the presence of mercury . Strains were tested for growth on a semi-defined medium with low mercury-binding characteristics . Sensitivities were initially measured on agar plates, and subsequently, selected strains were grown in broth so that the impact of mercury on the growth characteristics could be determined . Streptococci were more resistant to mercury (5 micrograms/mL to 40 micrograms/mL) than Actinomyces (< 5 micrograms/mL to 30 micrograms/mL) . The most resistant streptococci included S . mitis biovar 1, S . salivarius, S . sobrinus, and one strain of S . mutans, all of which grew on agar with 40 micrograms/mL of mercury . Two other S . mutans strains were more sensitive, being inhibited by 10 and 20 micrograms/mL mercury . The most resistant Actinomyces was A . naeslundii genospecies 1 (ATCC12104), which grew on medium with 30 micrograms/mL mercury; two strains of Actinomyces were completely inhibited by 5 micrograms/mL . Mercury caused increased lag times and reduced cell density in broth cultures . Enrichment cultures of samples of human dental plaque showed that streptococci were the most resistant organisms that could be cultured on the medium and that these strains could adapt to relatively high mercury concentrations . S . oralis and S . mitis biovar 1 were the most resistant organisms isolated from enriched cultures, growing in broth media with 65 micrograms/mL mercury . Mercury was bound to cell walls and cell cytoplasm of streptococci grown in the presence of mercury.(ABSTRACT TRUNCATED AT 250 WORDS)

Infect Immun, 1993 Sep, 61(9), 3745 - 55
Construction of a model secretion system for oral streptococci; Shiroza T et al.; A DNA fragment corresponding to the secretory domain from the Streptococcus mutans GS-5 gtfB gene, which encodes the putative 38-amino-acid signal peptide of the glucosyltransferase I (GTF-I) enzyme product, has been constructed . This fragment was fused with the alpha-amylase structural gene from alkalophilic Bacillus sp . strain 707 . This hybrid gene as well as the intact amylase gene were introduced into an Escherichia coli-streptococcus shuttle vector consisting of three components: the E . coli replicon p15Aori from pACYC177, an erythromycin resistance gene from pAM beta-1, and the streptococcal replicon from pVA838 . Transformation of the oral noncariogenic bacterium Streptococcus gordonii with the chimeric plasmid harboring the hybrid amylase gene resulted in strong extracellular amylase production . By contrast, transformants containing the intact amylase gene exhibited only trace amounts of amylase activity in culture fluids . Since the two signal peptide structures of the GTF-I enzyme and the Bacillus amylase are distinct from each other, these differences might result from the inability of S . gordonii to correctly process the Bacillus signal peptide . Furthermore, culture fluids from transformants of S . mutans as well as Streptococcus milleri harboring the hybrid amylase gene showed only weak amylase activity . Deletion of the gtfB, gtfC, or ftf gene from S . mutans GS-5 did not increase amylase secretion following transformation with the hybrid amylase gene . These results suggest that in contrast to S . gordonii, the inability of S . mutans and S . milleri to secrete hybrid amylase molecules could result from incorrect interaction of the secretory components of these organisms with amylase precursor molecules.

Gene, 1993 Aug 16, 130(1), 81 - 90
Characterization of allelic replacement in Streptococcus parasanguis: transformation and homologous recombination in a 'nontransformable' streptococcus; Fenno JC et al.; We have obtained transformants of Streptococcus parasanguis FW213 containing allelic replacements in several chromosomal loci . Transformation occurred following electroporation with nonreplicating plasmids carrying two antibiotic-resistance-encoding genes, one of which is inserted into DNA homologous to the chromosomal target . In contrast with other streptococci, S . parasanguis FW213 is not transformed by linear DNA . Mutations in nonreplicating plasmid DNA preferentially replaced their homologues in the S . parasanguis FW213 chromosome by a double-crossover homologous recombination event, as shown by the fact that over 90% of transformants were sensitive to the vector-coded antibiotic marker . Southern blot analysis of these transformants showed that three of the five target loci had been mutated, and that the wild-type sequence had been replaced by the mutated sequence carried on the transforming plasmid . This bias toward homologous replacement rather than integration of the entire transforming plasmid DNA simplifies site-specific mutagenesis and genetic analysis of the streptococcal chromosome.

J Immunol, 1993 Aug 15, 151(4), 2188 - 94
Recombinant tetravalent group A streptococcal M protein vaccine; Dale JB et al.; Previous studies have shown that the amino-terminal regions of group A streptococcal M proteins contain primarily protective (opsonic) epitopes and not tissue-cross-reactive epitopes . Limited primary structures from multiple serotypes of M protein containing only protective epitopes could potentially be linked together to form a broadly protective vaccine . The present studies were undertaken to determine the protective immunogenicity of a recombinant, multivalent hybrid molecule containing amino-terminal subunits of types 24, 5, 6, and 19 M proteins . Polymerase chain reaction primers were designed to amplify emm gene fragments ranging from 35 to 113 codons . The PCR products were ligated in tandem and inserted into pKK223-3 . The tetravalent M protein that was purified from extracts of Escherichia coli migrated as a single band on SDS-PAGE with an apparent m.w . of 31 kDa . In immunoblot analyses, the hybrid protein reacted with serotype-specific antisera indicating that it contained all four M protein subunits . Rabbits immunized with the purified tetravalent M protein developed significant antibody levels against all four serotypes of native M proteins represented in the hybrid protein . None of the antisera cross-reacted with human tissues . The immune sera also opsonized all four serotypes of group A streptococci . Our data show that a hybrid protein containing subunits from multiple M proteins can evoke broadly protective immune responses without tissue-cross-reactive antibodies.

Mol Microbiol, 1993 Aug, 9(3), 635 - 43
Evolution of penicillin resistance in Streptococcus pneumoniae; the role of Streptococcus mitis in the formation of a low affinity PBP2B in S . pneumoniae; Dowson CG et al.; Penicillin-resistant strains of Streptococcus pneumoniae possess forms of penicillin-binding proteins (PBPs) that have a low affinity for penicillin compared to those from penicillin-sensitive strains . PBP genes from penicillin-resistant isolates are very variable and have a mosaic structure composed of blocks of nucleotides that are similar to those found in PBP genes from penicillin-sensitive isolates and blocks that differ by up to 21% . These chromosomally encoded mosaic genes have presumably arisen following transformation and homologous recombination with PBP genes from a number of closely related species . This study shows that PBP2B genes from many penicillin-resistant isolates of S . pneumoniae contain blocks of nucleotides originating from Streptococcus mitis . In several instances it would appear that this material alone is sufficient to produce a low affinity PBP2B . In other examples PBP2B genes possess blocks of nucleotides from S . mitis and at least one additional unidentified species . Mosaic structure was also found in the PBP2B genes of penicillin-sensitive isolates of S . mitis or S . pneumoniae . These mosaics did not confer penicillin resistance but nevertheless reveal something of the extent to which localized recombination occurs in these naturally transformable streptococci.

FEMS Microbiol Lett, 1993 Aug 1, 111(2-3), 197 - 202
Amino-terminal methionine processing of the protein HPr in Streptococcus salivarius grown in continuous culture; Vadeboncoeur C et al.; HPr is a protein of the phosphoenolpyruvate:sugar phosphotransferase system (PTS) . Streptococci possess two forms of HPr which differ by the presence or the absence of the N-terminal methionine (Met) . These forms are called HPr-1 (without Met) and HPr-2 (with Met) . In order to determine whether the ratio of these two forms varies with growth conditions, we measured the amount of HPr-1 and HPr-2 present in Streptococcus salivarius grown in continuous culture at pH 7.5 . The results indicated that the HPr-1/HPr-2 ratio: 1) was not related to the cellular amount of total HPr; 2) was highest (10.2 +/- 3.5) under glucose (a PTS sugar) limitation (10 mM) and low dilution rate (D = 0.1 h-1; g = 6.9 h); 3) was decreased 2.4- to 5.7-fold when the amount of glucose and/or D was increased; 4) was not influenced by D when cells were cultured on galactose (a non-PTS sugar) but was two-fold higher under conditions of galactose excess (200 mM) . We suggest that the cleavage of the N-terminal HPr Met is not a stochastic phenomenon but is dictated by growth conditions.

Dtsch Tierarztl Wochenschr, 1993 Aug, 100(8), 319 - 22
{The effect of husbandry, management and stall climate on lung changes in swine}; Kofer J et al.; 21 swine fattening units (17 closed and 4 open swine herds), their pigs suffering from chronic respiratory disease since a long time were investigated concerning fattening period, morbidity, mortality, lung lesions by slaughtered swine, microorganisms involved, husbandry and management conditions, stall climate (indoor temperature, relative air humidity, contents of NH3, CO2, H2S, air microorganisms and dust) . We estimated annual fattening periods of 137.4 +/- 6.8 days, morbidity of 49.1 +/- 12.2% and mortality of 6.8 +/- 3.7% . About 55-96% of lungs of slaughtered pigs showed pneumonic lesions in different degrees . Bacteriological examination of such lesions revealed up to 9 and not less than 3 different bacteria species per unit . Continuous producing systems were used by 19 units, only 2 units were managed by all in all out system . Pigs of 70 kg weight have air spaces of 1.7-3.1 m3, indoor temperature were between 21-26 C degrees and relative air humidity between 83.9 +/- 13.7% . Concentration of NH3 was found between 3-35 ppm, of CO2 between 500-3500 ppm, the numerical content of bacteria was within 900-1620 cfu (colony forming units) and of fungi between 2-80 cfu per litre air . There were also E . coli with and without haemolysis, Klebsiella pneumoniae, beta-haemolyzing streptococci and staphylococci in stall air . 2 swine houses gave 3-5, 15 houses 12-50 and 4 houses more than 50 cfu/cm2 blood agar plates exposed for 1 minute to the stable air (sedimentation method to judge stall dust) . Animals of the later mentioned 4 houses showed the highest incidence of respiratory disorders (> 50% of pigs).(ABSTRACT TRUNCATED AT 250 WORDS)

FEMS Immunol Med Microbiol, 1993 Aug, 7(2), 135 - 43
Multiple binding of type 3 streptococcal M protein to human fibrinogen, albumin and fibronectin; Schmidt KH et al.; M proteins are major virulence factors of group A streptococci which enable the bacteria to resist phagocytic attack . Their binding capacity for different plasma proteins seems to be one reason for the antiphagocytic activity of M protein . In the present study we demonstrate that M3 protein, isolated from the streptococcal culture supernatant of strain 4/55, and the recombinant form (rM3), purified from an E . coli lysate after cloning in phage lambda-EMBL3, show a multiple binding to fibrinogen, albumin and fibronectin in Western blot and dot binding assays . Binding of M3 protein to the multifunctional extracellular matrix and plasma protein fibronectin may not only influence phagocytosis but may also contribute to the adherence of these bacteria to endothelial and epithelial cells.

Clin Infect Dis, 1993 Aug, 17(2), 188 - 94
Prophylactic administration of penicillins for endocarditis does not reduce the incidence of postextraction bacteremia; Hall G et al.; Sixty healthy patients were randomized to receive placebo, penicillin V (2 g), or amoxicillin (3 g) 1 hour before dental extraction was performed . Blood samples for microbiological investigation were collected before, during, and 10 minutes after surgery and were processed by lysis filtration under anaerobic conditions . There was no statistical difference among patients in the placebo group, the penicillin-V group, and the amoxicillin group in terms of incidence or magnitude of bacteremia due to viridans streptococci or anaerobic bacteria during extraction or 10 minutes after the procedure . The overall incidence rates of bacteremia after dental extraction were 95%, 90%, and 85%, respectively, for the three groups . For > 90% of 126 strains of viridans streptococci tested, the MICs of penicillin V and ampicillin were < or = 0.125 mg/L . The protective effect of prophylactically administered penicillins must be due to interference with crucial steps in the development of endocarditis (other than the transient bacteremia that occurs initially).

Int Immunol, 1993 Aug, 5(8), 869 - 75
Mutations affecting MHC class II binding of the superantigen streptococcal erythrogenic toxin A; Hartwig UF et al.; Streptococcal pyrogenic exotoxin A (SPEA) is an important pathogenicity factor of group A streptococci . It is a member of the family of 'superantigens' produced by Staphylococcus aureus and Streptococcus pyogenes, and its T lymphocyte stimulating activity is involved in the pathogenesis of certain diseases caused by pyogenic streptococci . In this study we have generated nine mutant SPEA molecules by substituting amino acids in the regions of homology between different streptococcal and staphylococcal superantigens . An additional mutant was created by deletion of the 10 N-terminal amino acids . The mutants were expressed as fusion proteins . Several mutations led to a loss of function due to a loss of class II-binding activity . Such loss mutations did not cluster to a certain region of the SPEA molecule . Rather, even a substitution of neighboring amino acids had opposite effects . None of the loss mutations affected the binding of neutralizing mAb and all loss mutants could be precipitated in Ouchterlony tests by a polyclonal anti-SPEA serum . We conclude that the functional activities of SPEA, and probably of other superantigens as well, cannot be attributed to a defined region of the molecule.

Geburtshilfe Frauenheilkd, 1993 Aug, 53(8), 543 - 6
{Quantitative study of vaginal flora during the menstrual cycle}; Voss A et al.; The aerobic and facultatively anaerobic vaginal flora of 242 healthy women were examined during menstrual cycles . The most frequently isolated microorganisms at the first premenstrual examination were coagulase-negative staphylococci (61%), followed by enterococci (25%), Gardnerella vaginalis (19%), diphtheroids (12%), group B streptococci (6.8%), Escherichia coli (5.4%) and Candida spp . (4%) . The isolation rate of all species, except Candida and Gardnerella vaginalis increased during menstruation . The lowest isolation rate for Staphylococcus aureus was 0.9% prior to menstruation and it increased to 7.6% during menstruation . This may be of relevance with regard to the toxic shock syndrome . Gardnerella vaginalis was isolated in 37% of women at least once during the study, suggesting, that this species belongs to the normal vaginal flora.

J Clin Microbiol, 1993 Aug, 31(8), 2070 - 3
Comparison of the Gen-Probe Group A streptococcus Direct Test with culture and a rapid streptococcal antigen detection assay for diagnosis of streptococcal pharyngitis; Heiter BJ et al.; The Gen-Probe Group A Streptococcus Direct Test (GP-ST) is a new assay which utilizes a nucleic acid probe to detect group A streptococci directly from pharyngeal swabs . In this study, 1,103 specimens were cultured and tested by GP-ST . The sensitivities and specificities were as follows: culture, 98.8 and 100%; GP-ST, 92.4 and 99.6% . Of the 1,103 specimens, 808 were also tested with the TestPack Strep A assay . For the specimens tested by all three methods, the sensitivities and specificities were as follows: culture, 99.5 and 100%; TestPack Strep A assay, 76.3 and 99.7%; GP-ST, 93.5 and 99.7% . The GP-ST is a very user-friendly assay which has the potential to replace culture for the diagnosis of streptococcal pharyngitis.

J Dent Res, 1993 Aug, 72(8), 1191 - 3
The isolation and characterization of milleri group streptococci from dental periapical abscesses; Fisher LE et al.; Reports of the isolation of streptococci from dental abscesses have shown an association of the "S . milleri" group with such lesions . There has been considerable confusion regarding the taxonomy of these organisms, but the milleri group has recently been reclassified into three distinct species: Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius . In this study, 45 samples from dental periapical abscesses were examined . Milleri group streptococci were isolated from 16 patients (37%), 15 being identified as S . anginosus and one as S . intermedius . In one patient, S . anginosus was isolated in pure culture, and it would appear that this is the predominant species of milleri group streptococci associated with periapical abscesses.

J Dent Res, 1993 Aug, 72(8), 1184 - 90
Protective effect of topically applied fluoride in relation to fluoride sensitivity of mutans streptococci; van Loveren C et al.; The aim of the present in vitro experiments was to determine whether the protection of enamel by topically applied fluoride against demineralization by bacterial acids would depend on the fluoride sensitivity of the bacteria . Glucose-agarose gel suspensions of fluoride-sensitive and fluoride-resistant mutans streptococci were placed on bovine enamel specimens with different amounts of fluoride . One group of specimens was untreated, a second group had been pretreated with a F-lacquer, and a third group had been pretreated with the F-lacquer and rinsed subsequently with a KOH-solution, to remove deposited CaF2 . After 22-hour incubations at 37 degrees C, the amounts of calcium and lactate and the pH of the agarose gels were determined . This procedure was repeated on three consecutive days . Two parent S . mutans strains, one parent S . sobrinus strain, and five fluoride-resistant derivatives were tested . Both pretreatments gave a significant protection to the enamel specimens . For the S . mutans strains, the degree of protection did not depend on the fluoride sensitivity of the strains . For the S . sobrinus strains, the results suggested a reduced protection against demineralization by the fluoride-resistant derivatives . Only from the second group of enamel specimens was enough fluoride released for inhibition of bacterial metabolism . Presumably, it was released by the dissolution of CaF2 . It is concluded that a possible adaptation of mutans streptococci in dental plaque to frequent exposures to fluoride will not necessarily decrease the caries-preventive effects caused by topically applied fluoride agents.

J Dent, 1993 Aug, 21(4), 216 - 9
A simple method for monitoring mutans streptococci in margins of restorations; Wallman C et al.; Plaque material collected from margins of restorations using a sharp toothpick was streaked across one and the same plastic strip from a commercially available test kit and inoculated in a liquid medium containing bacitracin . The reproducibility of the method was good . The method is simple, inexpensive and suitable for the chairside demonstration of the colonization of mutans streptococci in localized areas of the mouth, such as margins of restorations.

J Clin Invest, 1993 Aug, 92(2), 710 - 9
A novel superantigen isolated from pathogenic strains of Streptococcus pyogenes with aminoterminal homology to staphylococcal enterotoxins B and C; Mollick JA et al.; Streptococcus pyogenes (group A Streptococcus) has re-emerged in recent years as a cause of severe human disease . Because extracellular products are involved in streptococcal pathogenesis, we explored the possibility that a disease isolate expresses an uncharacterized superantigen . We screened culture supernatants for superantigen activity with a major histocompatibility complex class II-dependent T cell proliferation assay . Initial fractionation with red dye A chromatography indicated production of a class II-dependent T cell mitogen by a toxic shock-like syndrome (TSLS) strain . The amino terminus of the purified streptococcal superantigen was more homologous to the amino termini of staphylococcal enterotoxins B, C1, and C3 (SEB, SEC1, and SEC3), than to those of pyrogenic exotoxins A, B, C or other streptococcal toxins . The molecule, designated SSA, had the same pattern of class II isotype usage as SEB in T cell proliferation assays . However, it differed in its pattern of human T cell activation, as measured by quantitative polymerase chain reaction with V beta-specific primers . SSA activated human T cells that express V beta 1, 3, 15 with a minor increase of V beta 5.2-bearing cells, whereas SEB activated V beta 3, 12, 15, and 17-bearing T cells . Immunoblot analysis of 75 disease isolates from several localities detected SSA production only in group A streptococci, and found that SSA is apparently confined to only three clonal lineages as defined by multilocus enzyme electrophoresis typing . Isolates of one of these lineages, (electrophoretic type 2) are strongly associated with TSLS . The data identify SSA as a novel streptococcal superantigen that appears to be more related structurally to staphylococcal enterotoxins than to streptococcal exotoxins . Because abundant SSA production is apparently confined to only three streptococcal clonal lineages, the data also suggest that the SSA gene has only recently been acquired by S . pyogenes.

J Exp Med, 1993 Aug 1, 178(2), 759 - 63
Identification of an extracellular plasmin binding protein from nephritogenic streptococci; Poon-King R et al.; Examination of the extracellular products of nephritis(+) and nephritis(-) group A streptococci revealed the presence of a 46-kD protein secreted by nephritogenic strains that binds to human plasmin . Immunological data revealed that this protein, called nephritis plasmin binding protein (NPBP), is not related to group A streptokinase nor to a recently described streptococcal dehydrogenase protein . The binding of human plasmin to this protein can be blocked by epsilon-amino caproic acid, indicating the importance of lysine groups in the binding process . Mutanolysin extracts of cell walls from these nephritogenic strains probed with anti-NPBP antibody were negative for cell wall-bound NPBP . Serological data with acute poststreptococcal glomerulonephritis (APSGN) and acute rheumatic fever sera indicated that the protein reacts preferentially with APSGN sera . Amino acid sequence analysis and immunological reactivity suggest NPBP is the streptococcal pyrogenic exotoxin B precursor, also previously described as zymogen (streptococcal proteinase precursor) . The secretion of both group A streptokinase and a secreted plasmin binding protein in the same nephritogenic strain raises an intriguing hypothesis of the mechanisms of action of this protein in APSGN.

Infect Immun, 1993 Aug, 61(8), 3259 - 64
Isolation and characterization of a Streptococcus pyogenes protein that binds to basal laminae of human cardiac muscle; Winters BD et al.; A 9-kDa glycosaminoglycan-binding protein (GAG-BP) was isolated from Streptococcus pyogenes and purified to homogeneity by affinity chromatography on heparin-agarose . The protein selectively bound to the basal laminae of human cardiac muscle and had an apparent dissociation constant of 2.5 x 10(-7) M . Chemical analyses indicated that the GAG-BP was rich in alanine, lysine, and arginine (pI 9.5) and devoid of tyrosine, methionine, histidine, and half-cystine . There were no detectable carbohydrate or phosphate substituents . The amino acid sequence of the N terminus of GAG-BP showed homology with those of histone-like DNA-binding proteins of several other bacteria . Circular dichroism spectroscopy indicated that the protein was made up of 50% beta-sheet and 50% beta-turn and random coil in aqueous solution; however, when the protein complexed with heparin, it adopted a more ordered structure containing 25% alpha-helix, 50% beta-sheet, and 25% beta-turn and random coil . The GAG-BP cross-reacted serologically with a component of similar size in extracts of other group A streptococci and was present in the culture medium during late logarithmic growth.

Infect Immun, 1993 Aug, 61(8), 3234 - 9
Group B streptococcal neuraminidase is actually a hyaluronidase; Pritchard DG et al.; The extracellular group B streptococcal enzyme described in numerous reports as a neuraminidase is really a hyaluronidase . Over the past 25 years, the enzyme was routinely assayed with bovine submaxillary mucin as the substrate and by the thiobarbituric acid procedure to measure released sialic acid . Characterization of the actual compound released by the enzyme revealed it to be an alpha,beta-unsaturated derivative of hyalobiuronic acid that was derived from hyaluronic acid contaminating the mucin preparation . Previous reports describing an association of elevated levels of extracellular neuraminidase with virulent strains of group B streptococci must be reevaluated with the recognition that the enzyme is really a hyaluronidase.

Zentralbl Veterinarmed B, 1993 Aug, 40(6), 430 - 6
Relation between serotype of streptococci of serological group B and growth rate at early logarithmic phase; Wibawan IW et al.; Determination of growth rate of streptococci of serological group B at early logarithmic phase by measuring optical density of the growth medium and by measuring the change of conductivity of the culture fluid appeared to be closely related to the serotype of the respective cultures . Most of the human and bovine group B streptococci with type patterns Ia/c, II, III and IV exhibited clearly visible growth of the culture medium after 4 h incubation and changed the conductivity of the culture fluid to a point defined as time to detection within 4 h . No comparable growth could be observed with most of the cultures possessing type antigens R and X, either alone, or in combination with polysaccharide antigens . The importance of type specific capsule sialylation to the growth rate of the bacteria could be additionally shown with two group B streptococci of serotype III and their transposon mutagenized asialo capsular mutants . Both sialylated wild-type group B streptococci grew much quicker than their asialo capsular mutants . The results from additional experiments revealed that the growth velocity seemed to be significantly related to the chain length of the bacteria, to growth patterns of the group B streptococci in fluid media and soft agar and to the surface hydrophobicity of the bacteria . Determination of growth rate at early logarithmic phase could be used to predict various degrees of capsular sialylation of group B streptococci . This might help to understand the pathogenicity of individual group B streptococcal isolates in clinical cases.

Diagn Microbiol Infect Dis, 1993 Aug-Sep, 17(2), 93 - 6
Comparison of direct specimen testing utilizing TestPack strep A with testing of specimens following a two-hour broth enrichment; Bourbeau PP et al.; In a previous study, we demonstrated that a 2-h enrichment of throat swabs in broth followed by a direct fluorescent antibody test was significantly more sensitive than the Abbott TestPack Strep A for the detection of group-A streptococci . In this study, in an effort to simplify the technique, we utilized broth enrichment with an enzyme immunoassay detection method . A total of 1017 pharyngeal specimens were tested with TestPack Strep A (DTP), culture on a selective streptococcal agar, and a 2-h broth enrichment in Todd-Hewitt broth (THB) followed by TestPack Strep A (ETP) . Subculture of the THB was used to arbitrate discordant test results . The sensitivities and specificities respectively were as follows: DTP (69% and 99%), ETP (90% and 98%), and SSA (97% and 100%) . This enrichment method offers significantly greater sensitivity than direct testing for antigen yet still allows the potential for finalized same-day reporting of results.

Antimicrob Agents Chemother, 1993 Aug, 37(8), 1717 - 9
Antibiotic susceptibility of group A streptococci: a 6-year follow-up study; Betriu C et al.; The susceptibility patterns of group A streptococci over the last 6 years in our hospital were determined . Since our last study, carried out in 1987, all isolates have remained very susceptible in vitro to penicillin and all of the other beta-lactam agents tested . We observed resistance to erythromycin, clindamycin, tetracycline, and ofloxacin . The prevalence of erythromycin-resistant group A streptococci did not change appreciably throughout the study period.

Antimicrob Agents Chemother, 1993 Aug, 37(8), 1620 - 3
Cefprozil versus penicillin V in treatment of streptococcal tonsillopharyngitis; Milatovic D et al.; In a randomized multicenter study, the efficacy and safety of cefprozil were compared with those of penicillin in the treatment of group A streptococcal tonsillopharyngitis in children . Of the 409 patients enrolled, 323 were evaluable for their clinical and bacteriological responses; of these 323 children, 172 received cefprozil and 151 received penicillin V . The clinical responses in patients treated with cefprozil were significantly better than those in patients who received penicillin (95.3 versus 88.1%; P = 0.023) . Eradication of the original serotype of group A streptococci was achieved in 91.3% of patients treated with cefprozil and 87.4% of patients treated with penicillin, the difference not being statistically significant (P = 0.125) . However, there were significantly more symptomatic patients among the bacteriological failures in the penicillin group (68.4%) than in the cefprozil group (26.7%) . beta-Lactamase-producing Staphylococcus aureus was more frequently isolated from the throat flora during penicillin therapy than during cefprozil treatment . No difference in the incidence of adverse events probably related or of unknown relationship to the study drugs was observed in the two treatment groups (5.2% of those treated with cefprozil and 6.0% of those treated with penicillin) . Cefprozil can be considered a safe and reliable drug for the treatment of streptococcal pharyngitis in children.

Indian Pediatr, 1993 Aug, 30(8), 991 - 5
Differential cell-mediated immune response to S . mutans in children with low and high dental caries; Parkash H et al.; Role of cell-mediated immune response (CMI) in dental caries was studied in 171 subjects, comprising of 86 children with low caries (LC), 31 with high caries (HC), and 54 age matched controls . {3H}thymidine mediated lymphoblast transformation test (LTT) using mutans streptococci antigen as stimulant was used to study the stimulation index (SI) of in vitro cultured lymphocytes from these children . The analysis revealed low stimulation index in high caries children whereas low caries children exhibited high stimulation index normally ranging between 2 to 6 . The findings indicated that low caries children had strong CMI response as compared to high caries children . Although, the findings are based on limited number of samples, it certainly lays emphasis on protective or regulatory role of CMI in different phases of dental caries.

J Clin Pathol, 1993 Aug, 46(8), 769 - 71
Aztreonam selective agar for gram positive bacteria; Wood W et al.; Aztreonam blood agar, a new selective medium for Gram positive aerobic bacteria, was evaluated in comparison with conventional media for skin swabs . Aztreonam agar increased the number of isolates of Staphylococcus aureus by 17% . By producing purer growths on primary isolation, it significantly speeded up the identification and sensitivity testing of staphylococci and streptococci . All major Gram positive aerobic pathogens grow on this medium . Aztreonam agar is now an established addition to our culture media . It is used for swabs which are likely to have a mixed Gram positive and Gram negative flora, such as ears, burns, ulcers, and for the sputa of patients with cystic fibrosis.

Antibiot Khimioter, 1993 Aug-Sep, 38(8-9), 61 - 3
{Antibacterial activity and clinical effectiveness of the new antiseptic miramistin}; Vasil'eva TV et al.; A clinico-laboratory study of miramistin, a new antiseptic was carried out . Susceptibility of 236 bacterial strains to miramistin was tested and its therapeutic efficacy was followed up in 10 patients with purulent inflammatory affections of the locomotor system treated locally . After an 18-hour exposure of the strains to a 0.01 per cent solution of miramistin only 9.3 per cent of the isolates (mainly staphylococci) remained viable . Gram-negative cocci died in 6 hours and streptococci died in 1 hour . The local treatment of the wounds on the average for 14 days provided lower dissemination of the pathological foci . In the majority of the patients there was stated primary union of the wounds . On the whole, the results were good in 7 patients, satisfactory in 2 patients and unsatisfactory in 1 patient . No side effects were recorded . Miramistin may be recommended as an antiseptic for the local treatment of infected wounds in traumatologic and orthopedic patients.

Antibiot Khimioter, 1993 Aug-Sep, 38(8-9), 30 - 3
{Antibiotic sensitivity of streptococci of the A, B, C and G serogroups isolated in 1987-1990}; Kondrakova OA et al.; Antibiotic susceptibility of 1114 cultures of beta-hemolytic streptococci belonging to serogroups A, B, C and G was tested . The cultures were isolated from healthy and diseased children and adults . Group A, C and G streptococci were shown to be highly susceptible to beta-lactams, erythromycin, lincomycin, chloramphenicol and ristomycin . Erythromycin, lincomycin, ristomycin and ampicillin (a beta-lactam) proved to be the most active antibiotics against group B streptococci . Streptococci of the four groups had low susceptibility to tetracycline and especially gentamicin . The different antibiotic susceptibility of the streptococcal cultures isolated from the diseased and healthy children and adults is discussed.

Srp Arh Celok Lek, 1993 Aug-Dec, 121(8-12), 133 - 6
{Is penicillin still the drug of choice in the treatment of diseases caused by beta-hemolytic streptococci?}; Ranin L et al.; During the last ten years a new pathomorphosis of streptococci was noticed and described in the USA, Europe and New Zealand . It was expressed by the rise of virulence of beta haemolytic streptococci (BHS) and development of new clinical and epidemiological features . In such circumstances it appears to be very relevant to examine the susceptibility of BHS to penicillin, which is still considered as a drug of choice for the most of streptococcal diseases . Therefore it was decided: 1 . to make an analysis of continuous susceptibility testing of BHS to penicillin and 2 . to test the possibility of induction and selection of penicillin resistant mutants in vitro . Penicillin susceptibility was examined by broth dilution method Penicillin tolerant strains were separated on the basis of MBC/MIC ratio MBC/MIC > 16 and construction of "killing curves" . The possibility of induction and selection of penicillin resistant mutants was tested by subcultivation technique . MIC values for BHS groups: A, B, C and G were: 0.015, 0.060, 0.015 and 0.030 micrograms/ml respectively . The percentage of penicillin tolerant strains was in the range of 3% for group A BHS to 33% for group G BHS . After 60 subcultures in liquid medium containing increasing concentrations of penicillin . MIC values were raised by 2-32 times in comparison with parental strains . As the maximal induced MIC values were 1 and 2 micrograms/ml (one group G and three groups B BHS strains) it can be concluded that BHS at least in vitro expressed penicillin resistance . Although the obtained results are encouraging (there is so far no penicillin resistant clinical isolates), the increasing percent of penicillin tolerant strains and the possibility to induce penicillin resistance in vitro should be considered as a very serious warning . That makes further investigation of the development of penicillin tolerance and resistance mechanisms very current.

Infect Immun, 1993 Jul, 61(7), 3076 - 7
Species of alpha-hemolytic streptococci possessing a C-polysaccharide phosphorylcholine-containing antigen; Gillespie SH et al.; An enzyme-linked immunosorbent assay technique was used to detect and quantify C-polysaccharide-like antigen in strains of alpha-hemolytic streptococci classified into species by following the latest taxonomic recommendations . C-polysaccharide-like antigen is found only in Streptococcus oralis, S . mitis, and S . pneumoniae, which are genetically closely related.

Infect Immun, 1993 Jul, 61(7), 2866 - 71
Capsular polysaccharide regulates neutrophil complement receptor interactions with type III group B streptococci; Edwards MS et al.; The capsular polysaccharide of type III group B streptococci contributes substantially to the virulence of this organism . We explored the extent to which capsular polysaccharide influences neutrophil complement receptor interactions by using a poorly encapsulated strain (COH 31r/s), two well-encapsulated strains (M732 and M912), and strains produced from COH 31r/s by transposon mutagenesis that lacked capsule (COH 31-15) or had capsular polysaccharide lacking terminal sialic acid residues (COH 31-21) . When tested with normal human serum, each strain had initially high bactericidal indices (85 to 96%) . Monoclonal antibody blockade of neutrophil complement receptor 3 (CD11b/CD18) inhibited opsonophagocytosis to a significantly greater extent for the well-encapsulated strain than for the poorly encapsulated, asialo, or unencapsulated mutant strain . The addition of antibody with specificity for capsular polysaccharide reduced the inhibitory effect significantly for the encapsulated but not for the mutant strains . Blockade of neutrophil complement receptor 1 (CD35) effected only low-level inhibition . However, simultaneous blockade of complement receptors 1 and 3 augmented the inhibitory effect . When hypogammaglobulinemic serum was used as an antibody-free complement source, the initial bactericidal index was low (30% +/- 15%) for an encapsulated strain and was not affected for the mutant strains . Blockade of either neutrophil complement receptor 1 or 3 or the combination fully inhibited killing of the encapsulated strain . These results demonstrate that the type III group B streptococcal capsular polysaccharide regulates interactions with neutrophil complement receptors . We conclude that efficient phagocytic killing of encapsulated group streptococci in nonimmune serum requires ligation of complement receptors 1 and 3.

J Gen Microbiol, 1993 Jul, 139 ( Pt 7), 1511 - 22
Sequence of the gtfK gene of Streptococcus salivarius ATCC 25975 and evolution of the gtf genes of oral streptococci; Giffard PM et al.; Many strains of oral streptococci secrete glucosyltransferases (GTFs) that polymerize sucrose into glucans that form an integral part of the plaque matrix on the tooth surface . Recently, we reported the cloning of two closely linked GTF-encoding genes (gtfJ and gtfK) from Streptococcus salivarius ATCC 25975 as well as the sequence of gtfJ, which encodes a primer-dependent GTF that synthesizes an insoluble product (a GTF-I) . In this communication we report the sequence of gtfK, which encodes a primer-dependent GTF that synthesizes a soluble product (a GTF-S), as well as the sequence of a small downstream open reading frame of unknown function . The deduced sequence of GtfK was compared with those of seven other streptococcal Gtfs and an unrooted phylogenetic tree constructed . This analysis suggested that Gtfs with similar product specificities do not form phylogenetic clusters and was consistent with currently accepted phylogenetic schemes . The tree was tested by constructing a series of 'sub-trees' from different blocks of the alignment . Evidence was obtained for recombination events involving gtfB and gtfC from S . mutans GS-5, gtfJ and gtfK from S . salivarius, as well as the gtfI genes from S . downei and S . sobrinus . The recombination events between gtfB and gtfC, and between the two gtfI genes, were confirmed by examining divergences at silent sites.

Antimicrob Agents Chemother, 1993 Jul, 37(7), 1452 - 5
Evaluation of bacterial interference and beta-lactamase production in management of experimental infection with group A beta-hemolytic streptococci; Brook I et al.; The in vivo effects of penicillin and cefprozil therapy on the interaction between organisms commonly recovered from inflamed tonsils were studied by using a subcutaneous abscess model in mice . These organisms were group A beta-hemolytic streptococci (GABHS), Streptococcus salivarius (which is capable of interfering with GABHS), and Staphylococcus aureus . In mice infected with GABHS and S . salivarius alone or in combination, penicillin eliminated both organisms and cefprozil eliminated GABHS and S . aureus but not S . salivarius . Penicillin did not, however, reduce the number of GABHS or S . salivarius in the presence of S . aureus . The present study demonstrated the ability of beta-lactamase-producing S . aureus to protect GABHS from penicillin . However, no such protection was present following the administration of cefprozil . Furthermore, the preservation of S . salivarius that interferes with GABHS growth may provide protection from reinfection with GABHS . This study supports and provides an explanation for the increased efficacies of cephalosporins administered orally over that of penicillin when treating patients with acute GABHS pharyngitis or tonsillitis.

Pediatr Res, 1993 Jul, 34(1), 32 - 7
Intrinsic microbicidal activity and pulmonary hypertension in isolated newborn piglet lungs; Aziz SM et al.; The lung appears to be one of the dominant sites of bacterial clearance from the blood of infant piglets . Part of the lung bacterial clearance involves activation of an oxygen radical bactericidal mechanism that may be central to induction of acute pulmonary hypertension . The present study determined whether this bactericidal activity was intrinsic to resident lung cells . Isolated piglet lung preparations perfused with blood-free salt solution were used to delineate the amount of group B streptococci (GBS) extracted and killed upon transit through pulmonary vasculature . Approximately 45% of infused GBS was deposited in the lung during a single pulmonary transit, whereas nearly 40% of the organisms sequestered in the lung were killed within a 30-min period . Pretreatment with dimethylthiourea, a scavenger of hydroxyl radical that inhibits GBS-induced pulmonary hypertension, attenuated both bacterial uptake and killing to similar extents . Along with its deposition in the lung, GBS also induced concentration-dependent increases in total pulmonary resistance, which were related principally to increases in upstream arterial resistance . Lung weight also increased in a concentration-dependent manner . Both the increase in total pulmonary resistance and lung weight were temporally related to elevation in perfusion medium content of the stable thromboxane degradation product, thromboxane B2 . Pretreatment with indomethacin, a prostaglandin H synthase inhibitor, or sodium(E)-3{4-(1-imidazolyl-methyl)phenyl}-2-propenoic acid a thromboxane synthase inhibitor, reduced GBS-induced pulmonary hypertension and edema . These results suggest that, in isolated piglet lungs, GBS evokes an intrinsic bactericidal response residing within lung cells, probably pulmonary intravascular macrophages, which may be responsible for the initiation of pulmonary hemodynamic changes.(ABSTRACT TRUNCATED AT 250 WORDS)

FEMS Microbiol Lett, 1993 Jul 1, 110(3), 335 - 9
Horizontal spread of an altered penicillin-binding protein 2B gene between Streptococcus pneumoniae and Streptococcus oralis; Coffey TJ et al.; The region encoding the transpeptidase domain of the penicillin-binding protein 2B (PBP 2B) gene of two penicillin-resistant clinical isolates of Streptococcus oralis was > 99.6% identical in nucleotide sequence to that of a penicillin-resistant serotype 6 isolate of Streptococcus pneumoniae . The downstream 849 base pairs of these genes were identical . Analysis of the data indicates that the PBP gene has probably been transferred from S . pneumoniae into S . oralis, rather than vice versa, and shows that one region of this resistance gene has been distributed horizontally both within S . pneumoniae and into two different viridans group streptococci.

FEMS Microbiol Lett, 1993 Jul 1, 110(3), 313 - 7
The in vitro antibacterial activity of ceftriaxone against Streptococcus pyogenes is unrelated to penicillin-binding protein 4; Yan S et al.; The in vitro activities of penicillin and ceftriaxone were compared against 29 strains of Streptococcus pyogenes with the result that ceftriaxone showed greater activity than penicillin . The morphological changes induced by 1/2 and 1x MIC concentrations of penicillin and ceftriaxone, respectively, were very similar using scanning electron microscopy . Competitive binding studies using 'cold' penicillin or ceftriaxone as inhibitors of radiolabeled penicillin binding demonstrated that ceftriaxone had a very low affinity for penicillin binding protein (PBP) 4 compared to that of penicillin . Since ceftriaxone had greater antibacterial activity, this suggests that PBP 4 may not be important to the in vitro activity of ceftriaxone . In contrast, the IC50 for ceftriaxone was much lower (> 200 fold) for PBPs 2 and 3 compared to PBP 4, suggesting greater avidity of these high molecular mass PBPs for ceftriaxone . These data may at least in part explain the superior in vitro activity of ceftriaxone compared to penicillin against S . pyogenes . These data, together with the observation that PBP 1 was saturated at a lower concentration of penicillin than any of the other PBPs, suggest that the inhibition of PBPs 1, 2, and 3 mediates the bactericidal activity of beta-lactam antibiotics against group A streptococci.

Ann Rheum Dis, 1993 Jul, 52(7), 527 - 30
Various rheumatic syndromes in adult patients associated with high antistreptolysin O titres and their differential diagnosis with rheumatic fever; Valtonen JM et al.; OBJECTIVES--The purpose of this study was to analyse retrospectively adult patients with acute joint or muscle symptoms and a high antistreptolysin O (ASO) titre to find out which syndromes of clinical arthritis are associated with serological evidence of streptococcal infection . METHODS--Seventy six adult patients with an acute arthritis syndrome or an exacerbation in their chronic rheumatic disease and simultaneously a high ASO titre (> or = 500 Todd units) were examined in two time periods in the 1980s . RESULTS--Twenty six patients had arthritis associated with a known rheumatic disease, 25 had non-specific arthralgia/myalgia, 20 had reactive arthritis, and five had septic arthritis . No case of classic rheumatic fever classified by two major criteria was found . Six patients fulfilled one major and at least two minor criteria . The frequency of HLA-B27 was significantly higher in the whole patient group than in the healthy Finnish population (30 v 14%) . CONCLUSIONS--It is concluded that classic rheumatic fever is now rare, even in patients with arthritis with a high ASO titre . These results support the suggestion that beta haemolytic streptococci may trigger reactive arthritis as well as rheumatic fever.

Arch Dis Child, 1993 Jul, 69(1 Spec No), 14 - 8
Prospective surveillance of neonatal meningitis; Hristeva L et al.; Neonatal meningitis is a serious problem with a high mortality and frequent neurological sequelae . The incidence of neonatal meningitis was calculated and the aetiology, clinical and laboratory features, and the treatment of cases recorded prospectively over a 7 year 8 month period was documented . It was further investigated whether secondary meningitis had occurred after lumbar puncture . The estimated incidence of bacterial, viral, and fungal meningitis was 0.25, 0.11, and 0.02 per 1000 live births respectively . There were eight cases of early onset meningitis (seven definite, one probable) and group B streptococci accounted for six (75%) of these . Blood cultures were negative in only one of seven cases of definite early bacterial meningitis . Of the 15 late onset cases, Gram negative organisms accounted for six of the seven bacterial cases . The overall mortality was 26% . Of the 11 survivors of bacterial meningitis, three (27%) had significant neurological sequelae at follow up (between three months to three years later) . As in the first 48 hours after birth an initial blood culture is unlikely to be negative if bacterial meningitis is present, lumbar puncture can be deferred if the procedure might exacerbate respiratory distress . Although approximately 1880 infants had a lumbar puncture during the review period, only one case of meningitis was found where it was possible that lumbar puncture in a bacteraemic infant may have caused meningeal infection . The incidence of this potential complication must therefore be low.

J Bacteriol, 1993 Jul, 175(14), 4345 - 53
Molecular characterization of a negative regulator of Streptococcus sobrinus surface protein antigen gene; Takahashi I et al.; Mutans streptococci have been shown to give rise to variants in terms of expression of surface protein antigens by repeated subculturing of the organisms, which in turn induces changes in colonial morphologies . A 2,850-bp upstream region of the gene (pag) for a surface protein antigen, PAg, of Streptococcus sobrinus MT3791 was determined . Analysis of the nucleotide sequence revealed the existence of three open reading frames (ORFs) located upstream of the pag gene . ORF1 extended from an undetermined further upstream sequence to the termination codon TAG lying 1,943 bp upstream of the pag gene . ORF2, consisting of 609 bp lying 1,689 bp upstream of the pag gene, encoded a protein of 23,347 Da and a protein of 22,792 Da . The synthesis of these proteins (protein antigen regulators) was demonstrated by using the in vitro T7 RNA polymerase/promoter system . ORF3, extending from 314 bp upstream of the pag gene to 712 bp upstream of the pag gene, encoded a protein of 14,802 Da . Disruption of chromosomal ORF2 of parent strain MT3791 by allelic exchange resulted in isogenic mutants, termed PAREm-1 and PAREm-2, that synthesized larger amounts of cell-free and cell-associated PAg than did the parent strain . RNA dot blot analysis demonstrated that expression of PAg-specific mRNA transcripts by mutants PAREm-1 and PAREm-2 was about 32-fold higher than that by strain 3791 . Mutants PAREm-1 and PAREm-2 were found to be more hydrophobic than strain MT3791 . Resting cells of these mutants attached in larger numbers to saliva-coated hydroxyapatite than did those of the parent strain . These results suggest that protein antigen regulator regulates the expression of PAg gene in a negative fashion, affecting the colonization of tooth surfaces by the organism . Thus, ORF2 is concluded to be a negative regulator gene of PAg synthesis and was designated par.

Hosp Pract (Off Ed), 1993 Jul, 28 Suppl 2, 6 - 9; discussion 56
Outpatient parenteral antibiotic therapy . Management of serious infections . Part II: Amenable infections and models for delivery . Endocarditis; Durack D; Many endocarditis patients infected with penicillin-sensitive streptococci are excellent candidates for outpatient parenteral therapy, as are those who need long-term suppressive therapy . Patients with staphylococcal endocarditis more often require inpatient care, but some may complete therapy at home . Vigilant monitoring for complications that may occur at home is essential for all patients.

Eur J Epidemiol, 1993 Jul, 9(4), 405 - 10
Asymptomatic pharyngeal carriage of beta-haemolytic streptococci and streptococcal pharyngitis among patients at an urban hospital in Croatia; Begovac J et al.; In a one-year study at the University Hospital of Infectious Diseases in Zagreb, Croatia the rate of asymptomatic throat carriage of beta-haemolytic streptococci was investigated . Throat carriage was investigated in 1796 patients, none of whom had a sore throat nor signs and/or symptoms of a respiratory tract infection . The carrier rate of beta-haemolytic streptococci was 8.3%, for group A streptococci 6%, group B 1.3%, group C 0.3% and group F 0.1% . The highest rate was observed in the 6 to 14 year age group: 13.8% for all streptococcal groups, 11.7% for group A alone . The proportion of non-A streptococci was higher in older age groups . Tonsillectomised individuals were less frequently carriers . No sex or season-dependent variations were observed . In a four-month study of 629 patients with pharyngitis the throat cultures yielded: group A streptococci in 44.7%, group B in 1.7%, group C in 0.8%, and group G in 0.6% of the patients . Group A streptococci in 44.7%, group B in 1.7%, group C in 0.8%, and group G in 0.6% of the patients . Group A streptococcal rates in carriers compared to rates in patients with pharyngitis suggest that approximately one fourth of the schoolchildren with culture-positive pharyngitis actually are not truly infected, but only carriers currently having a sore throat of non-streptococcal etiology . Antibiotics were administrated to 605 (96.2%) patients with pharyngitis; in 571 (94.4%) of the cases before culture results became available . After culture-negative results were obtained the therapy was discontinued in only 28.5% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

J Antimicrob Chemother, 1993 Jul, 32(1), 63 - 9
Susceptibility of alpha-haemolytic streptococci causing endocarditis to benzylpenicillin and ten cephalosporins; Wilcox MH et al.; A clinical case of streptococcal endocarditis in which the isolate proved susceptible to third- but not first-generation cephalosporins prompted us to examine the susceptibility of 44 alpha-haemolytic streptococci from cases of endocarditis to ten cephalosporins and benzylpenicillin . Twenty per cent of strains were resistant to penicillin, and 20% were tolerant . Cefazolin, cefuroxime and cefpirome were the most active first-, second- and third-generation cephalosporins tested . Other first-generation cephalosporins tested compared poorly to cefazolin . Cefotaxime and cefpirome were moderately active against some penicillin-resistant strains . Penicillin tolerance was common in Streptococcus gordonii, but a correlation between tolerance and dextran production could not be confirmed.

Gen Pharmacol, 1993 Jul, 24(4), 895 - 8
Ampicillin concentrations in radicular cysts following a single oral administration of bacampicillin; Akimoto Y et al.; 1 . Ampicillin concentrations in cyst wall (wall) and cyst fluid (fluid) of radicular cyst and serum following a single oral administration of bacampicillin (equivalent to 500 mg of ampicillin) were measured by a paper disk method . 2 . The mean peak concentrations of ampicillin in wall, fluid, and serum occurred at identical times, 1.5 hr, and were 2.39 micrograms/g, 0.77, and 10.24 micrograms/ml, respectively . 3 . Mean ampicillin concentration ratios of wall/serum, fluid/serum, and fluid/wall at the peak time were 0.23, 0.07, and 0.40, respectively . 4 . Mean ampicillin concentrations in wall and fluid at the peak time exceeded MIC (minimum inhibitory concentration) for 90% (0.5 microgram/ml) for clinically isolated strains of alpha-hemolytic Streptococci.

Curr Eye Res, 1993 Jul, 12(7), 603 - 8
Antimicrobial activity and in vitro corneal epithelial toxicity of antimicrobial agents for gram-positive corneal pathogens; Cutarelli PE et al.; We assessed in vitro the antimicrobial activity of four agents (vancomycin, teicoplanin, mupirocin, and imipenem) which are effective against Gram-positive cocci causally associated with bacterial keratitis, as well as their corneal epithelial cytotoxicity . Minimal inhibitory concentrations inhibiting 90% of strains (MIC90s) against 10 strains each of methicillin-susceptible and -resistant Staphylococcus aureus and Staphylococcus epidermidis, penicillin-susceptible and -resistant Streptococcus pneumoniae, and viridans group streptococci were as follows: vancomycin (MIC90s 0.25-2 micrograms/ml), teicoplanin (MIC90s 0.25-4 micrograms/ml, mupirocin (MIC90s 0.12-4 micrograms/ml), and imipenem (MIC90s 0.008-0.25 micrograms/ml, except for methicillin-resistant staphylococci with MIC90 of 16 micrograms/ml) . Cytotoxicity was assayed by uptake of 3H-thymidine by rabbit corneal epithelial cell cultures at drug concentrations of 12.5-100 mg/ml for vancomycin and teicoplanin, 1-8 mg/ml for mupirocin and 0.125-8 mg/ml for imipenem, with exposure times of 5, 30 and 60 min . Cytotoxicity was as follows: imipenem < mupirocin < vancomycin < or = teicoplanin . Resistance to methicillin-resistant S . aureus and S . epidermidis for imipenem and resistance to S . epidermidis and cytotoxicity for teicoplanin limit their consideration for suspected Gram-positive keratitis . On the other hand, vancomycin and mupirocin, because of their excellent therapeutic indices, should be considered for this indication.

J Clin Pathol, 1993 Jul, 46(7), 633 - 6
Detection of the C protein gene among group B streptococci using PCR; Mawn JA et al.; AIM--To develop a polymerase chain reaction (PCR) for the specific detection of the C protein gene in strains of group B Streptococcus . METHODS--A single primer pair derived from the nucleotide sequence of the IgA binding beta antigen of the C protein complex permitted the specific amplification of a 592 base pair DNA fragment from the C protein gene . After 35 cycles of amplification this product could be detected by agarose gel electrophoresis . Southern blot hybridisation confirmed that this product was the C protein gene . RESULTS--PCR detected the C protein gene in 75 (63%) of 119 strains of group B streptococci analysed . The product was not detected in other Gram positive organisms, showing that this PCR assay was highly specific . The sensitivity of the assay was satisfactory to a dilution of 1 in 10,000 of extracted DNA . CONCLUSIONS--The C protein of group B streptococci is associated with neonatal sepsis . The specific detection of the C protein gene by PCR may help identify which strains are likely to be associated with infection by the organism.

Zh Mikrobiol Epidemiol Immunobiol, 1993 Jul-Aug, (4), 37 - 41
{The adhesive properties and surface characteristics of streptococci colonizing buccal epithelial cells}; Bazerov MA et al.; The species spectrum of streptococci subjected to desorption has been found to differ from that of streptococci tightly adhering to epithelial cells, the former streptococci having more hydrophilic surface than the latter ones . No difference in their electrophoretic mobility has been detected . The study of the adhesive properties of the isolated strains has revealed that streptococci with the hydrophilic surface, subjected to desorption in the process of cell washing, less actively adhere to cells of the buccal epithelium.

N Engl J Med, 1993 Jun 24, 328(25), 1807 - 11
A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults; Farley MM et al.; BACKGROUND . Group B streptococci (Streptococcus agalactiae) are a major cause of meningitis and septicemia in neonates and pregnant women, but the importance of group B streptococcal disease in nonpregnant adults has not been clearly defined . METHODS . We conducted a prospective surveillance of the pathogens responsible for meningitis for a period of 24 months in 35 hospitals and a referral laboratory in metropolitan Atlanta . We reviewed the clinical and laboratory records of all the nonpregnant adults identified as having invasive group B streptococcal disease during this period . RESULTS . During 1989 and 1990 there were 424 patients with invasive group B streptococcal disease (annual incidence, 9.2 cases per 100,000 population) . Of these patients, 46 percent were 1 month of age or younger, 6 percent were older than 1 month but younger than 18 years of age, and 48 percent were 18 or older . Men and nonpregnant women accounted for 68 percent (n = 140) of all cases among adults (annual incidence, 4.4 per 100,000) . Clinical and laboratory records were available for 137 . In the nonpregnant adult patients (age, 18 to 99 years), the most common clinical diagnoses were skin, soft-tissue, or bone infection (in 36 percent); bacteremia with no identified source (30 percent); urosepsis (14 percent); pneumonia (9 percent); and peritonitis (7 percent) . Risk factors included older age (> or = 60 years), the presence of diabetes mellitus, the presence of malignant neoplasms, and infection with the human immunodeficiency virus . The mortality rate in nonpregnant adults was 21 percent, accounting for 67 percent of all deaths related to group B streptococcal infection during the surveillance period . CONCLUSIONS . Invasive group B streptococcal infection is a major problem not only in pregnant women and neonates but also in nonpregnant adults, especially those who are elderly and those who have chronic diseases.

Ugeskr Laeger, 1993 Jun 7, 155(23), 1806 - 7
{Phlegmonous gastritis in pregnancy--a case with fatal course}; Asnaes S et al.; A case of maternal death and still birth in the 35th week of pregnancy is described where the cause of death was the very rarely diagnosed phlegmonous gastritis . The phlegmonous gastritis is characterised by dangerous, fulminating pyogenic bacterial infection of the gastric wall with alpha-haemolytical streptococci . The entity seems to have been well-known earlier, but has only been reported sparsely in contemporary medical literature . It cannot be ruled out that the disease may have been misdiagnosed on several occasions in recent decades because of symptomatic treatment . In presenting the case, the authors seek to attract attention to this disease--that according to the contemporary medical literature seems mostly to be induced by modern treatment with antacids and after gastroscopy--because it can be effectively treated with modern antibiotics, possibly in combination with gastrectomy.

Pediatrics, 1993 Jun, 91(6), 1166 - 70
Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy; Snellman LW et al.; OBJECTIVE . To determine if it is appropriate to recommend that patients with group A beta-hemolytic streptococcal pharyngitis, who are clinically well by the morning after starting antibiotic treatment, can return to school or day care, or if they should wait until they have completed 24 hours of antibiotics as recommended by the American Academy of Pediatrics Committee on Infectious Diseases . METHODS . We examined the duration of positivity of the throat culture after antibiotics were begun as a means of assessing the potential risk of transmission to close school contacts . Forty-seven children (4 to 17 years of age) with pharyngitis and a positive throat culture for group A streptococci in an outpatient, staff model health maintenance organization clinic were enrolled and were randomly selected to receive therapy with either oral penicillin V, intramuscular benzathine penicillin G, or oral erythromycin estolate . Additional throat cultures were obtained and clinical findings were recorded for each child during three home visits in the 24 hours after their initial clinic visit . Acute and convalescent sera were obtained for determination of anti-streptolysin O and anti-DNase B titers . RESULTS . Seventeen (36.2%) of the 47 patients had a positive culture the morning after initiating antibiotic therapy . However, thirty-nine (83%) of the patients became "culture negative" within the first 24 hours . Neither the time interval to the first negative culture nor the presence or absence of group A streptococcal organisms on any single convalescent culture could be predicted by clinical findings . Six of the eight children who failed to convert to a "negative" throat culture within 24 hours of initiating therapy were receiving erythromycin . We could detect no difference in either time to conversion to a negative culture or the presence of a positive culture 24 hours after starting antibiotics between those who demonstrated a significant antibody increase and those who did not . CONCLUSION . The data from this study strongly suggest that children with group A beta-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare.

Infect Immun, 1993 Jun, 61(6), 2727 - 31
Purification and characterization of streptolysin O secreted by Streptococcus equisimilis (group C); Gerlach D et al.; Streptolysin O (SLO) was purified from culture supernatants of group C streptococci . The final product was either the complete, native molecule (SLOn {pI, 6.0}) with the N-terminal sequence (Asp)-Ser-Asn-Lys-Gln-Asn-Thr-Ala-Asn-Thr-Glu-Thr- or a large fragment (SLOf {pI, 7.3}) with the N-terminal sequence Ala-Pro-Lys-Glu-Met-Pro-Leu-Glu-Ser-Ala-Glu-Lys-Glu-Glu-Lys-.

Infect Immun, 1993 Jun, 61(6), 2277 - 83
Role of M protein in pharyngeal colonization by group A streptococci in rats; Hollingshead SK et al.; As the initial step in infection, group A streptococci (GAS) colonize either the nasopharyngeal mucosa or the skin of humans . A number of virulence factors have been implicated in the colonization phase of pathogenesis based upon their in vitro activities, but the in vivo data supporting their role in colonization of the host tissues is lacking . In this investigation, the potential requirement for M protein in pharyngeal colonization by GAS was explored by using near-isogenic strains in experimental animals studies . Fischer rats were infected by intranasal and oral inoculation with both M-positive and M-negative Streptococcus pyogenes strains . Colonization of the pharyngeal area by the streptococci was monitored at various time intervals . Both M-positive and M-negative strains colonized during the first week following infection, indicating that M protein was not necessary for this initial colonization . Two M-positive strains of S . pyogenes were recovered from the rats up to 23 weeks following inoculation, while the colonization levels for M-negative strains decreased rapidly in the second and third weeks, becoming negligible by the fourth week . This indicates a potential role for M protein in the persistence of colonization at this mucosal surface . Colonization of rats with either M-positive strain of S . pyogenes also resulted in the appearance of salivary and serum antibody responses . This in vivo model should allow further investigation into factors required for GAS disease, including the examination of the potential role of the host immune response both in modulation of the pharyngeal surface and in modulation of antigenic changes in M protein or other surface factors.

J Dent Res, 1993 Jun, 72(6), 1032 - 9
Transformation efficiency of EMS-induced mutants of Streptococcus mutans of altered cell shape; Tao L et al.; Some Streptococcus mutans strains change shape from bacillary to coccal or ellipsoid form in response to the ratio of bicarbonate to potassium or of borate to potassium in growth media . So that insight into determinants of shape of these streptococci could be gained, and future genetic studies facilitated, the shapes of a series of transformable and nontransformable strains of S . mutans were studied and attempts made to isolate a mutant of augmented transformability . Several strains were mutagenized by ethylmethane sulfonate and mutants with altered colonial and cellular morphologies isolated . Cell shapes were studied by Gram stain and Nomarski interference microscopy, and by scanning and transmission electron microscopy . Diverse shape-altered mutants were isolated from seven transformable and two nontransformable strains of S . mutans . Among these, length-to-width ratios ranged from > 10 to about 0.25 . Regulation of timing of cell division, septum formation, or septum completion events may have been altered in these mutants . While most mutants substantially or completely lost transformability, mutant LT11 had transformation efficiency of 1.3 x 10(-4) to 2.3 x 10(-3), more than two to three orders of magnitude greater than its parental UA159 and the well-known transformable strain GS5(HK), respectively . There was no evidence of production of competence factor by LT11 . Competence of LT11 was maintained for at least six months upon storage at -70 degrees C, facilitating its use for genetic studies . While the morphologies of several shape-altered mutants were no longer responsive to changes of the bicarbonate/potassium, unlike those of their parentals, the morphology of LT11 persisted in its response to this condition.(ABSTRACT TRUNCATED AT 250 WORDS)

J Antimicrob Chemother, 1993 Jun, 31 Suppl E, 95 - 101
Multicentre comparison of azithromycin versus erythromycin in the treatment of paediatric pharyngitis or tonsillitis caused by group A streptococci; Weippl G; In this open study, 93 children (aged 2-12 years) with a clinical diagnosis of pharyngitis or tonsillitis caused by Streptococcus pyogenes (culture and/or ELISA test positive) were given azithromycin, as a single daily dose of 10 mg/kg (maximum 500 mg) for three days (n = 46); or erythromycin ethylsuccinate, 30-50 mg/kg daily given in three divided doses, for ten days (n = 47) . Forty-four of 46 azithromycin patients, and 46 of 47 erythromycin patients, had S . pyogenes isolated at baseline and were included in the clinical and bacteriological analyses . At the end of treatment (day 10-12), 38 (86%) of the 44 azithromycin patients were considered cured, four (9%) improved, one (2%) failed and one relapsed . In the erythromycin group, 30 of 46 (65%) were considered cured, 15 (33%) improved and one (2%) failed . Eradication of S . pyogenes was achieved in 40 of 44 (91%) and 45 of 46 (98%) azithromycin and erythromycin patients, respectively . Re-occurrence of S . pyogenes, assessed 28-32 days after start of treatment, occurred in five of 37 (14%) azithromycin patients (three with clinical symptoms) and five of 39 (13%) erythromycin patients (four with clinical signs) . There were no statistically significant differences in clinical or bacteriological efficacy between the two groups . Both drugs were well-tolerated, with side-effects (mainly gastrointestinal) reported in five of 46 (11%) azithromycin patients and in six of 47 (13%) erythromycin patients, one of whom withdrew from treatment . No laboratory abnormalities were observed in the azithromycin patients, but were recorded in two of 43 (5%) erythromycin patients.(ABSTRACT TRUNCATED AT 250 WORDS)

J Antimicrob Chemother, 1993 Jun, 31 Suppl E, 89 - 94
Multicentre evaluation of azithromycin and penicillin V in the treatment of acute streptococcal pharyngitis and tonsillitis in children; Hamill J; Of 96 children (aged 2-12 years) with either acute pharyngitis or acute tonsillitis, 49 received a single daily dose of azithromycin 10 mg/kg (maximum 500 mg) for three days, and 47 received penicillin V at a dose of 125 mg or 250 mg qid (depending on body weight) for ten days . Clinical assessments and laboratory safety tests were performed during and after therapy . Before enrollment, all patients were screened for group A beta-haemolytic streptococci (GABHS) with a rapid test, and a throat swab was taken for confirmatory culture . The presence of GABHS at baseline was confirmed in 41 azithromycin- and 44 penicillin V-treated patients . Cure or improvement was seen in 98% and 100% of azithromycin- and penicillin V-treated patients, respectively . At day 11, bacterial eradication was achieved in 39/41 (95%) azithromycin-treated patients, 38 (93%) of whom were considered clinically cured, while one patient (2%) relapsed . In the penicillin V group, 42/44 (95%) had GABHS eradicated, with 41 (93%) clinically cured and three patients (7%) improved . The remaining two patients in each group were clinically cured despite persistence of Streptococcus pyogenes . At follow-up evaluation (day 30), re-occurrence was observed in 5/37 (14%) and 3/40 (8%) of azithromycin- and penicillin V-treated patients, respectively; all patients were asymptomatic . Both drugs were well-tolerated with only two patients in the azithromycin group complaining of side effects . Treatment related laboratory test abnormalities were observed in 6/47 (13%) and 4/45 (9%) azithromycin- and penicillin V-treated patients, respectively, but none was judged to be clinically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

J Antimicrob Chemother, 1993 Jun, 31 Suppl E, 29 - 37
The comparative activity of azithromycin, macrolides and amoxycillin against streptococci in experimental infections; Girard AE et al.; Since serious sequelae may follow streptococcal infections, eradication is viewed as necessary for successful therapy . Studies were therefore conducted to compare the effectiveness of azithromycin with other macrolide antibiotics and amoxycillin to eliminate these organisms in experimental localized infections . In a Streptococcus pneumoniae lung infection induced by transtracheal challenge, the pathogen was not recovered after therapy with azithromycin (ED50 7.9 mg/kg), while clarithromycin was not effective (ED50 > 100 mg/kg) . However, in a S . pneumoniae middle ear infection, azithromycin and clarithromycin were effective (ED50 2.9 and 6.3 mg/kg, respectively) in eradicating the pathogen from this closed space infection . Against a localized Streptococcus pyogenes infection (implanted inoculated disc), azithromycin effectively eradicated the pathogen, while clarithromycin, roxithromycin and erythromycin did not . Eradication of a viridans streptococcus or Streptococcus gordonii (formerly Streptococcus sanguis) from heart tissue in experimental bacterial endocarditis was also evaluated . Azithromycin given prophylactically or therapeutically was efficacious in eliminating the viridans streptococcus and S . gordonii in the bacterial endocarditis model of infection; erythromycin was only marginally effective in the same studies . All studies provided evidence of the bactericidal action of azithromycin in vivo and demonstrated the ability of the compound to eradicate streptococcal pathogens in localized infections.

Inflammation, 1993 Jun, 17(3), 227 - 43
Chemiluminescence in activated human neutrophils: role of buffers and scavengers; Ginsburg I et al.; Human neutrophils (PMNs) suspended in Hanks' balanced salt solution (HBSS), which are stimulated either by polycation-opsonized streptococci or by phorbol myristate acetate (PMA), generate nonamplified (CL), luminol-dependent (LDCL), and lucigenin-dependent chemiluminescence (LUCDCL) . Treatment of activated PMNs with azide yielded a very intense CL response, but only a small LDCL or LUCDCL responses, when horse radish peroxidase (HRP) was added . Both CL and LDCL depend on the generation of superoxide and on myeloperoxidase (MPO) . Treatment of PMNs with azide followed either by dimethylthiourea (DMTU), deferoxamine, EDTA, or detapac generated very little CL upon addition of HRP, suggesting that CL is the result of the interaction among H2O2, a peroxidase, and trace metals . In a cell-free system practically no CL was generated when H2O2 was mixed with HRP in distilled water (DW) . On the other hand significant CL was generated when either HBSS or RPMI media was employed . In both cases CL was markedly depressed either by deferoxamine or by EDTA, suggesting that these media might be contaminated by trace metals, which catalyzed a Fenton-driven reaction . Both HEPES and Tris buffers, when added to DW, failed to support significant HRP-induced CL . Nitrilotriacetate (NTA) chelates of Mn2+, Fe2+, Cu2+, and Co2+ very markedly enhanced CL induced by mixtures of H2O2 and HRP when distilled water was the supporting medium . Both HEPES and Tris buffer when added to DW strongly quenced NTA-metal-catalyzed CL . None of the NTA-metal chelates could boost CL generation by activated PMNs, because the salts in HBSS and RPMI interfered with the activity of the added metals . CL and LDCL of activated PMNs was enhanced by aminotriazole, but strongly inhibited by diphenylene iodonium (an inhibitor of NADPH oxidase) by azide, sodium cyanide (CN), cimetidine, histidine, benzoate, DMTU and moderately by superoxide dismutase (SOD) and by deferoxamine LUCDCL was markedly inhibited only by SOD but was boosted by CN . Taken together, it is suggested that CL generated by stimulated PMNs might be the result of the interactions among, NADPH oxidase, (inhibitable by diphenylene iodonium), MPO (inhibitable by sodium azide), H2O2 probably of intracellular origin (inhibitable by DMTU but not by catalase), and trace metals that contaminate salt solutions . The nature of the salt solutions employed to measure CL in activated PMNs is critical.

J Clin Microbiol, 1993 Jun, 31(6), 1430 - 4
Typing of group B streptococci: comparison of pulsed-field gel electrophoresis and conventional electrophoresis; Gordillo ME et al.; The SmaI restriction endonuclease digestion patterns of chromosomal DNAs from 35 group B streptococci were analyzed by pulsed-field gel electrophoresis (PFGE) . Nineteen different patterns and four possible variants were identified . Twenty-four isolates were previously analyzed by conventional electrophoresis of HindIII-digested and/or BglII plus EcoRI double-digested chromosomal DNA . Although interpretations by both methods were essentially the same, PFGE identified as variants two isolates that were previously classified as the same isolate . More importantly, PFGE of the chromosomal DNA of group B streptococci digested with SmaI generated more easily defined patterns, since fewer and better separated bands were obtained, whereas digestion with HindIII or EcoRI plus BglII typically generated 100 or more bands . SalI digestion also yielded easily evaluable results, although the SalI fragments were somewhat smaller than those generated by SmaI . In our hands, PFGE patterns were more easily discerned and interpreted than were patterns previously generated by conventional electrophoresis.

Infect Immun, 1993 Jun, 61(6), 2334 - 9
Mechanism of fibronectin enhancement of group B streptococcal phagocytosis by human neutrophils and culture-derived macrophages; Hill HR et al.; In previous studies, we reported that fibronectin (FN) markedly enhances phagocytic uptake of antibody-coated group B streptococci (GBS) by human polymorphonuclear leukocytes . Furthermore, administration of FN along with a GBS type-specific monoclonal or polyclonal antibody to infected neonatal rats significantly enhances survival . In this study, we have examined the molecular mechanism of this enhancement through phagocyte receptors which recognize the Arg-Gly-Asp (RGD) peptide sequences contained within the FN molecule . Incubation of human polymorphonuclear leukocytes or culture-derived macrophages on coverslips coated with GRGDSP but not GRGESP markedly enhanced uptake of immunoglobulin G-coated GBS . The enhancing effect of the RGD-containing peptides was blocked by monoclonal antibodies B6H12 (directed against the integrin-associated protein) and 7G2 (directed against the beta 3-integrin receptor for RGD) . These data suggest that FN enhancement of antibody-coated GBS uptake is mediated by the critical RGD sequence . Furthermore, this active peptide sequence may have an important role in immunotherapy of bacterial infections, especially in patients with decreased plasma FN concentrations.

FEMS Immunol Med Microbiol, 1993 Jun, 7(1), 47 - 54
Antigenic diversity of IgA receptors in Streptococcus pyogenes; Burova LA et al.; In a previous study, group A and group B streptococcal IgA receptors were shown to differ serologically, in agreement with their known structural unrelatedness . The present study was undertaken to serologically compare the IgA binding epitopes of group A streptococcal strains representing various serotypes by the use of antisera to this species . It was found that blocking antibodies occurred in antisera to IgA binding but not to non-binding strains and that binding of IgA to a streptococcal strain was generally blocked by antiserum to the homologous type . However, cross-testing of a panel of 11 IgA binding strains, representing various M and T serotypes, with 10 different antisera to group A streptococci, demonstrated that IgA receptors were inhibited to a highly variable degree and that inhibition patterns were unique for each type . Comparing solubilized IgA receptors of various strains in immunoblot experiments, a variation in the molecular mass, between approximately 35 and 45 kDa, emerged . The IgA binding epitopes, analogous to protective sites of streptococcal M-protein, thus exhibited hypervariability which may suggest that IgA binding also plays a key role for evading host immune defence mechanisms.

FEMS Immunol Med Microbiol, 1993 Jun, 7(1), 39 - 45
Prevalence of IgA receptors in clinical isolates of Streptococcus pyogenes and Streptococcus agalactiae: serologic distinction between the receptors by blocking antibodies; Schalen C; Group A and B streptococci (Streptococcus pyogenes and Streptococcus agalactiae) are the only known bacterial pathogens expressing IgA Fc-receptors . However, the IgA binding proteins of the two species have been found genetically unrelated . In the present investigation the binding of human IgA among clinical isolates of group A and group B streptococci was studied and the respective IgA-binding epitopes were compared serologically . Surface binding of radiolabelled, monoclonal human IgA1 occurred in 38% of 115 unselected group A streptococcal isolates . Comparing four predominant T-types, IgA-binding was found in 77% and 85%, respectively, of types T4 and T28 strains but only in 5% and 25%, respectively, of T1 and T12 strains . In group B streptococci, 70% of 58 type Ib strains but only 2% of 399 strains of other serotypes bound IgA . Using rabbit immune sera raised to the two streptococcal species it was found that strains exhibiting IgA Fc-receptors often induced antibodies blocking the binding of IgA to bacteria . Furthermore, the blocking shown by an individual serum was restricted to the streptococcal group used for immunization showing that also the IgA-binding eptiopes in group A and B streptococci are conformationally distinct . Though infections with serotypes often binding IgA, compared to other types, are not known to differ, it is assumed that the non-immune binding of IgA might favour mucosal colonization of the organisms.

Anticancer Drugs, 1993 Jun, 4(3), 381 - 8
Enhancement of LAK-like activity and cytokine induction in regional lymph nodes and spleen cells of mice after intralymphnodal injection of OK-432, a killed streptococcal preparation; Sakakura C et al.; A single dose of inactivated streptococci (OK-432) was injected into the popliteal lymph nodes of male CDF1 mice and its effects on popliteal, inguinal, and para-aortic lymph node cells and spleen cells were investigated and compared with the effects of subcutaneous injections of the same dosage of OK-432 . Regional lymph node cells and spleen cells obtained from intralymphnodally injected mice lysed not only natural killer (NK)-sensitive YAC-1 cells, but also NK-resistant P-815 and meth-A cells . Lysis of target cells was inhibited when effector cells were treated with anti-Thy-1.2 or anti-Lyt-2.2 monoclonal antibody and complement, but no inhibition was apparent after treatment with anti-asialo-GM1 or anti-Lyt-1.2 antibody and complement . These results suggest that the effector cells are lymphocyte-activated killer (LAK) cells . An enhanced capacity of lymph node cells to produce cytokines, tumor necrosis factor and interleukin 1 upon restimulation with lipopolysaccharide was found only in intralymphnodally injected mice . Thus, the induction of LAK-like cells and cytokine production in regional lymph nodes and spleen cells by the intralymphnodal administration of OK-432 should be effective for the inhibition or treatment of lymph node metastases.

Zentralbl Bakteriol, 1993 Jun, 278(4), 541 - 52
Characterization of the murine macrophage receptor for group B streptococci; Sloan AR et al.; The macrophage has been shown to bind potentially pathogenic bacteria in the absence of serum components or opsonins but the mechanism is poorly understood . The rich array of sugars on the surface of group B streptococci plus the presence of membrane-associated lectin receptors on the macrophage suggests that this is a likely means for bacterial recognition by these host defense cells . Inhibition studies with free sugars and neoglycoconjugates of bovine serum albumin, however, failed to confirm this hypothesis . Furthermore, neuraminidase-treatment to expose galactose residues and the use of isogenic bacterial strains having no capsule or no capsular sialic acid yielded no confirmation of lectin-mediated recognition . The trypsin-sensitive receptor exhibited temperature dependence and a requirement for divalent cations distinct from that reported for the lectin-like galactose receptor . The activity of this streptococcal binding receptor was inhibited by 2-deoxy-D-glucose but not by neutrophil elastase . Pre-exposure of macrophages to bound fibronectin and treatment with phorbol ester each enhanced bacterial binding . These data fail to support a role for the galactose lectin and provide preliminary evidence for involvement of the leukocyte integrins in macrophage recognition of group B streptococci.

J Rheumatol, 1993 Jun, 20(6), 982 - 7
Gamma delta + T cells from patients with psoriatic and rheumatoid arthritis respond to streptococcal antigen; Grinlinton FM et al.; OBJECTIVE . To investigate cellular immune responses to streptococcal antigens in patients with psoriatic arthritis (PsA) . To specifically examine responses of the gamma delta + T cell subset . METHODS . Proliferation of PsA synovial fluid lymphocytes (SFL) and peripheral blood lymphocytes (PBL) cultured with streptococcal antigen was measured using a 3H thymidine (3HTdr) uptake assay system . gamma delta + T cells from PsA PBL and SFL were phenotyped by flow cytometry . Following culture with streptococcal antigen, gamma delta + enriched SFL were sorted by automated flow cytometry and 3HTdr uptake measured . RESULTS . Patients with PsA and the control group did not differ significantly in their PBL responses to 2 strains of streptococci, one of which was isolated from a patient with guttate psoriasis (Strep 1) and the other from a patient with rheumatic fever (Strep 2) . There was also no difference in their responses to a cell wall preparation derived from the former strain . SFL from 8 of 9 patients with PsA responded to both streptococcal strains as did SFL from 3 patients with rheumatoid arthritis (RA) . gamma delta + SFL from 7 patients with PsA 3 patients with RA responded only to the psoriasis associated strain . CONCLUSIONS . PsA PBL and SFL responded to stimulation by streptococcal antigen but this reactivity was not disease specific . We have demonstrated that gamma delta + T cells from PsA SF proliferated when cultured with a psoriasis associated strain of streptococcus (Strep 1) . However, RA gamma delta + SFL responded similarly suggesting that gamma delta + T cell reactivity to streptococcal antigen may be a feature of inflammatory arthritis.

Cesk Epidemiol Mikrobiol Imunol, 1993 Jun, 42(2), 76 - 7
{Differentiation of serologic group A streptococci from group C and G using disks with various bacitracin levels}; Urbaskova P et al.; It was revealed that a diameter of the inhibition zone of 10 mm or more surrounding a disk with 0.04 U bacitracin differentiates reliably strains of the serological group A form strains of group C and G with the exception of 7.3% strains of group C and G with a high susceptibility for bacitracin . The disks with a higher bacitracin content gives less reliable results.

J Hand Surg {Br}, 1993 Jun, 18(3), 358 - 9
Paronychia: a mixed infection . Microbiology and management; Brook I; Cultures of paronychia of the fingers have grown aerobic and anaerobic bacteria . Each was recovered individually in only about a quarter of the patients and a mixed aerobic/anaerobic flora was isolated in half of the patients . The predominant anaerobic organisms were Gram-positive anaerobic cocci, Bacteroides species and Fusobacterium species . The predominant aerobic organisms were Staphylococcus aureus, gamma-haemolytic streptococci, Eikenella corrodens, group A beta-hemolytic streptococci, alpha-hemolytic streptococci, and Klebsiella pneumoniae . Candida albicans was recovered in about 15% of the cases . The management of this infection is discussed.

Z Gesamte Inn Med, 1993 Jun-Jul, 48(6-7), 267 - 71
{Thrombolytic therapy in the past, present and future}; Gulba DC et al.; During the last decade, thrombolysis has developed in a unique and unprecedented way from an outsider method to a well-established standard treatment in acute myocardial infarction . Since the use of thrombolytic techniques in other entities of thromboembolic disease has been prompted by this success . As an introduction into this intriguing and inspiring field in clinical science, the present paper tries to summarise briefly the development of thrombolysis since 1933 when "fibrinolysin" was discovered in the culture medium of beta-haemolysing streptococci, as well as the presence and future of thrombolytic therapy.

Inflammation, 1993 Jun, 17(3), 295 - 319
Killing of endothelial cells and release of arachidonic acid . Synergistic effects among hydrogen peroxide, membrane-damaging agents, cationic substances, and proteinases and their modulation by inhibitors; Ginsburg I et al.; 51Chromium-labeled rat pulmonary artery endothelial cells (EC) cultivated in MEM medium were killed, in a synergistic manner, by mixtures of subtoxic amounts of glucose oxidase-generated H2O2 and subtoxic amounts of the following agents: the cationic substances, nuclear histone, defensins, lysozyme, poly-L-arginine, spermine, pancreatic ribonuclease, polymyxin B, chlorhexidine, cetyltrimethyl ammonium bromide, as well as by the membrane-damaging agents phospholipases A2 (PLA2) and C (PLC), lysolecithin (LL), and by streptolysin S (SLS) of group A streptococci . Cytotoxicity induced by such mixtures was further enhanced by subtoxic amounts either of trypsin or of elastase . Glucose-oxidase cationized by complexing to poly-L-histidine proved an excellent deliverer of membrane-directed H2O2 capable of enhancing EC killing by other agonists . EC treated with rabbit anti-streptococcal IgG were also killed, in a synergistic manner, by H2O2, suggesting the presence in the IgG preparation of cross-reactive antibodies . Killing of EC by the various mixtures of agonists was strongly inhibited by scavengers of hydrogen peroxide (catalase, dimethylthiourea, MnCl2), by soybean trypsin inhibitor, by polyanions, as well as by putative inhibitors of phospholipases . Strong inhibition of cell killing was also observed with tannic acid and by extracts of tea, but less so by serum . On the other hand, neither deferoxamine, HClO, TNF, nor GTP gamma S had any modulating effects on the synergistic cell killing . EC exposed either to 6-deoxyglucose, puromycin, or triflupromazin became highly susceptible to killing by mixtures of hydrogen peroxide with several of the membrane-damaging agents . While maximal synergistic EC killing was achieved by mixtures of H2O2 with either PLA2, PLC, LL, or with SLS, a very substantial release of {3H}arachidonic acid (AA), PGE2, and 6-keto-PGF occurred only if a proteinase was also added to the mixture of agonists . The release of AA from EC was markedly inhibited either by scavengers of H2O2, by proteinase inhibitors, by cationic agents, by HClO, by tannic acid, and by quinacrin . We suggest that cellular injury induced in inflammatory and infectious sites might be the result of synergistic effects among leukocyte-derived oxidants, lysosomal hydrolases, cytotoxic cationic polypeptides, proteinases, and microbial toxins, which might be present in exudates . These "cocktails" not only kill cells, but also solubilize AA and several of its metabolites . However, AA release by the various agonists can be also achieved following attack by leukocyte-derived agonists on dead cells . It is proposed that treatment by "cocktails" of adequate antagonists might be beneficial to protect against cellular injury in vivo.

Clin Infect Dis, 1993 Jun, 16(6), 792 - 800; discussion 801-2
Severe invasive group A streptococcal infections in Ontario, Canada: 1987-1991; Demers B et al.; During the past few years, there has been an apparent increase in serious infections due to group A streptococci (GAS) worldwide . We describe our experience with severe invasive GAS infections in Ontario, Canada, during the past 5 years (February 1987 through December 1991) . A case was defined as the isolation of GAS from blood or normally sterile tissue in association with hypotension (systolic blood pressure, < 90 mm Hg) . Fifty cases were identified in patients ranging in age from 4 to 100 years (median age, 47 years); 29 (58%) of the patients died . A primary focus of infection was identified in 38 cases (76%), with soft tissue being the site involved most frequently (68%) . No focus of infection was found in 12 patients, and 36 patients (72%) were bacteremic . Complications included acute respiratory distress syndrome (21 of 50), acute renal failure (20 of 50), hypocalcemia (19 of 24), elevated creatinine kinase values (21 of 27), coagulation abnormalities (15 of 21), and hepatitis (15 of 24) . Eleven cases (22%) were nosocomial; one of these was secondary to another nosocomial case . Thirty-three isolates were available for M and T typing and for determination of the presence of the genes for streptococcal pyrogenic exotoxin (SPE) . The most frequent types were M1T1 (10) and M12/T12 (8) . Twelve isolates possessed the speA gene, and 16 isolates had the speC gene . Only three isolates possessed both speA and speC . All isolates possessed the speB gene.

Ann Rheum Dis, 1993 Jun, 52(6), 483 - 7
Beta haemolytic streptococci and musculoskeletal sepsis in adults; Deighton C; Lancefield group A streptococci (GAS) account for 3-17% cases of septic arthritis, but other beta haemolytic streptococci (BHS) (groups B, C, and G) are being increasingly implicated . Epidemiological evidence suggests that the increase of BHS sepsis in adults is a true increase and not simply a reflection of better reporting . While underlying predisposing disease and old age are common concomitants of BHS sepsis, some subjects with devastating disease have been young and healthy . This is particularly the case for highly virulent M1 serotypes of GAS, where a toxic shock-like syndrome has led to a number of deaths in young adults in the United Kingdom and elsewhere . Musculoskeletal features, such as myalgias, painful swollen limbs, myositis, and fasciitis, are important features of this condition, so that rheumatologists may be involved in management . Group C and G musculoskeletal sepsis remains uncommon, with a high prevalence of underlying predisposing disease, or pre-existing arthritis in the septic joint . Group B BHS septic disease appears to be increasing in incidence . Musculoskeletal sepsis with these organisms usually takes place in subjects with other diseases, but healthy subjects have not been spared . Multiple septic foci and a rapidly destructive arthritis are not uncommon, and a recently described extra-articular feature is potentially blinding metastatic endophthalmitis . Clinicians need to be aware of an apparently increasing incidence of BHS musculoskeletal sepsis in adults so that early identification can lead to aggressive management in these potentially fatal infections.

Ann Rheum Dis, 1993 Jun, 52(6), 475 - 82
Beta haemolytic streptococci and reactive arthritis in adults; Deighton C; There is an increasing occurrence of reactive group A beta haemolytic streptococci (BHS) phenomena . This review makes a case for considering BHS in the differential diagnosis of adult reactive arthritis . This is based on (a) published reports over the past 45 years describing first attacks of rheumatic fever in adults; (b) the longstanding observation that polyarthritis is the most commonly expressed Jones major criterion in adults; (c) the broad spectrum of clinical expression of disease following streptococcal infection, with the re-emergence of the term 'poststreptococcal reactive arthritis' . The arthritis in adult rheumatic fever is characterised by sequential involvement of large weightbearing joints . Recurrent, severe, prolonged arthritis has been a prominent feature of adult poststreptococcal reactive arthritis . Carditis has been reported in 33% of adult patients with rheumatic fever . Consequently long term antibiotic prophylaxis for adults with reactive BHS phenomena should be strongly considered, and guidelines are suggested for this in individual patients . Further areas for research are discussed, particularly the interrelations between bacteria and host in disease expression, and the possibility that BHS might play a part in chronic arthritides and vasculitides.

J Clin Microbiol, 1993 Jun, 31(6), 1648 - 51
Chondroitin sulfate depolymerase and hyaluronidase activities of viridans streptococci determined by a sensitive spectrophotometric assay; Homer KA et al.; Sensitive spectrophotometric assays for the detection of bacterial chondroitin sulfate depolymerase and hyaluronidase activities were developed by using Stains-all (1-ethyl-2-{3-(1-ethylnaphtho-{1,2-d}thiazolin-2-ylidene)-2- methylpropenyl}naphtho-{1,2-d}thiazolium bromide) . Stains-all interacts with hyaluronic acid to produce a shift in the absorption spectrum with a distinct absorption peak between 620 and 660 nm, while chondroitin sulfate interacts to form a distinct shoulder between 440 and 500 nm . Assays measure undegraded substrate . A collection of 110 strains of viridans streptococci, including representatives of all the currently recognized species, was studied . Streptococcus intermedius and S . constellatus degraded hyaluronic acid, while only strains of S . intermedius, primarily isolated from brain and liver abscesses, produced chondroitin sulfate depolymerase . S . intermedius, of all the viridans streptococci, produces the widest range of glycoprotein- and glycosoaminoglycan-degrading enzymes, which may contribute to the virulence of this species.

Oral Microbiol Immunol, 1993 Jun, 8(3), 161 - 6
Immunochemical characterization of the carbohydrate antigens of serotype c/Lancefield group C "Streptococcus milleri"; Kitada K et al.; Carbohydrate antigens of the serotype c/Lancefield group C "Streptococcus milleri" were extracted by autoclaving whole cells of the type c reference strain K51Y . The type c and group C antigen molecules were separated and partially purified by a DEAE-Sephadex A-25 column chromatography followed by Sephadex G-100 gel filtration . The purified type c antigen and group C antigen were homogeneous in the double diffusion and in the immunoelectrophoresis . The type c antigen was composed principally of glycerol, rhamnose, glucose and N-acetylglucosamine in a molar ratio of 0.22:0.27:1.00:0.48 . The quantitative precipitin inhibition test indicated that N-acetylglucosamine played a major role in immunodeterminant structure . Thus, the type c antigen of "S . milleri" is a new carbohydrate type antigen and is immunochemically different from the Ottens-type antigen III found occasionally in group C streptococci . In contrast, the group C antigen preparation contained a high proportion of N-acetylgalactosamine in addition to glycerol, rhamnose, glucose and N-acetylglucosamine, and the N-acetylgalactosamine residue was involved in the immunodominant epitope, being in good agreement with the previously proposed chemical structure of the group antigen . N-acetylgalactosamine was detected in the autoclaved extracts of a nontypeable/group C strain but not of a type c/ungroupable strain.

Presse Med, 1993 May 29, 22(19), 896 - 8
{Septicemia caused by A, B, C and G groups of beta-hemolytic streptococci}; Kechrid A et al.; During a five and a half years' period, 805 strains of beta-haemolytic groups A, B, C and G streptococci were isolated . Among these, 28 were responsible for bacteremia; 57 percent group B and 32 percent group A . All strains were susceptible to beta-lactam antibiotics; 4 strains were resistant to macrolides . The majority of patients had underlying diseases . Mortality was high in this group.

Vet Rec, 1993 May 22, 132(21), 528 - 31
An outbreak of strangles in young ponies; Dalgleish R et al.; A natural outbreak of strangles occurred in a group of 19 young experimental ponies . The disease was diagnosed in 11 of them within two days of their arrival at Glasgow University veterinary school and five others developed clinical signs within a further four days, a morbidity rate of 84 per cent . All of the affected ponies had typical signs of strangles including dullness, anorexia, pyrexia, regional lymphadenitis, occasionally with rupture of the lymph node, conjunctivitis and a mucopurulent nasal discharge . Nine of the affected ponies were destroyed during the clinical phase of the disease for post mortem studies . The clinical disease in the remaining animals lasted approximately 21 days although one pony had to be destroyed 10 days after the onset of clinical signs because of the development of septic arthritis . All 16 affected animals exhibited peripheral blood neutrophilia and high plasma fibrinogen levels . beta haemolytic streptococci were isolated by nasopharyngeal swabbing from 18 of the 19 ponies . Streptococcus equi was confirmed only in three animals within the first four days of the outbreak . The majority of the other isolates identified to species were S zooepidemicus . beta haemolytic streptococci were still present in six ponies 40 days after they had clinically recovered and were isolated regularly from three ponies which did not develop clinical strangles but remained in contract with affected animals throughout the study.

J Immunol, 1993 May 15, 150(10), 4693 - 701
Surface-exposed conserved region of the streptococcal M protein induces antibodies cross-reactive with denatured forms of myosin; Vashishtha A et al.; Vaccines based on a highly conserved cell surface exposed C-repeat region of the group A streptococcal M protein molecule have been found to induce protection against mucosal challenge by homologous and heterologous streptococcal serotypes . Rabbit hyperimmune antisera were produced to four partially overlapping peptides of the C-repeat region of M6 protein . These were examined by both direct and competitive ELISA and by Western blotting for their reactivity against mammalian coiled coil proteins such as laminin, myosin, light meromyosin, heavy meromyosin, and cardiac tropomyosin, and to the denatured forms of some of these molecules . All sera reacted strongly with the recombinant M6 protein molecule . In addition, antibodies to three of the peptides displayed generally low levels of cross-reactivity with at least one of the mammalian proteins, whereas antibodies to one peptide did not cross-react with any of the proteins tested . The observed reactivity was found to be directed predominantly against denatured forms of the mammalian molecules . For instance, the cleaved forms of myosin bound better to the cross-reactive antibodies than the intact molecule . Furthermore, heat-denatured heavy meromyosin competed severalfold better in competitive ELISA than the non-heat-denatured "native" form . Our results demonstrate that M protein peptides corresponding to epitopes shared among rheumatic fever-associated strains of streptococci can lead to the production of low levels of antibodies reactive with mammalian coiled coil molecules . These antibodies are directed against the denatured forms of these molecules.

Cutis, 1993 May, 51(5), 353 - 4
Blistering distal dactylitis caused by Staphylococcus aureus; Norcross MC Jr et al.; Blistering distal dactylitis is a superficial infection of the anterior fat pad on the volar surface of the distal portion of ordinarily a single finger . Although most commonly caused by group A beta-hemolytic streptococci, we report a case of blistering distal dactylitis caused by Staphylococcus aureus involving all the fingers and thumbs of a child . After results of a Gram's stain and culture established the diagnosis, the child responded rapidly to oral amoxicillin trihydrate/clavulanate potassium (Augmentin) . Multiple fingers affected in blistering distal dactylitis may be a predictor of S . aureus as the causative agent.

Clin Infect Dis, 1993 May, 16(5), 719 - 24
Neonatal sepsis and meningitis in Mallorca, Spain, 1977-1991; Hervas JA et al.; In a retrospective study at Son Dureta Hospital (Palma de Mallorca, Mallorca, Spain) of the period 1977-1991, 334 cases of culture-proven sepsis and/or meningitis in neonates born at the facility were identified . Overall, there was an incidence rate of 4.9 cases per 1,000 live births . The case-fatality rate was 7.5% . Infection was more frequent in infants of low birth weight, with the exception of infants with meningitis and infections due to group B Streptococcus and Listeria species . The patterns of predominance among bacterial pathogens that were isolated changed during the period studied . From 1977 to 1984, Klebsiella pneumoniae was the most frequent such isolate, but this frequency declined in the following years . Group B Streptococcus organisms and Staphylococcus epidermidis replaced K . pneumoniae as the predominant pathogens in early- and Staphylococcus epidermidis replaced K . pneumoniae as the predominant pathogens in early- and late-onset infections, respectively . The frequency with which other pathogens were isolated did not vary significantly during the study period . Invasive infection caused by Candida organisms was found in two patients . The incidence of infection due to group B streptococci has increased in the last few years (to 2.4 cases per 1,000 live births in 1991) and has become a significant problem that requires a thorough epidemiological evaluation.

Br J Dermatol, 1993 May, 128(5), 493 - 9
Group A streptococcal antigen-specific T lymphocytes in guttate psoriatic lesions; Baker BS et al.; A strong association exists between guttate psoriasis and group A, beta-haemolytic streptococcal infections . To demonstrate the presence of streptococcal-specific T cells in psoriatic skin, T-cell lines (TLs) were established from biopsies of lesions from five patients with guttate psoriasis, and compared with TLs from five patients with eczema, five with lichen planus, two with pityriasis rosea and three with nickel contact dermatitis . TLs from purified protein derivative (PPD)-induced delayed hypersensitivity sites in three normal individuals were also studied . All five of the psoriatic TLs responded in a proliferation assay to heat-killed isolates of group A streptococci, compared with only one eczema, two lichen planus and one pityriasis rosea . The response of one nickel contact dermatitis and two PPD TLs to group A streptococci was markedly less than to nickel and PPD, respectively . One of the psoriatic TLs was cloned in the presence of type 5 streptococcal M protein . The nine clones obtained were all CD3+, CD4+, CD45RO+, TCR alpha, beta+, gamma, delta- . However, they were all unreactive with antibodies to TCR V beta 5, 6, 8 or 12 . Eight of the nine clones reacted, to a varying extent, to one or two of three preparations of group A streptococci expressing different M proteins . The streptococcal response of four consistently reactive clones from this patient was HLA-DR-restricted and inhibited by anti-HLA-DR antibody in a dose-dependent manner . On stimulation these four clones secreted high levels of gamma-interferon and detectable levels of IL-2, IL-10 and granulocyte/macrophage colony stimulating factor (GM-CSF) depending upon the nature of the stimulus, but no IL-4 or TNF-alpha production was detected . This study has demonstrated, for the first time, that T lymphocytes specific for group A streptococcal antigens can be consistently isolated from guttate psoriatic lesions . The role of streptococcal-specific T cells in the pathogenesis of psoriasis remains to be determined.

Infect Control Hosp Epidemiol, 1993 May, 14(5), 265 - 7
A cluster of surgical wound infections due to unrelated strains of group A streptococci; Jamieson FB et al.; Group A streptococci account for less than 1% of all surgical wound infections but are an important cause of nosocomial outbreaks . We report here a cluster of four group A streptococcal infections that occurred within an 11-day period on a single surgical service . The index case presented with toxic shock-like syndrome . Epidemiologic investigation did not identify any relationship between infections . Restriction endonuclease analysis and M and T typing found the four isolates to be unrelated . Restriction endonuclease analysis is a useful tool for determining relatedness of nosocomial isolates of group A streptococci.

Dev Med Child Neurol, 1993 May, 35(5), 424 - 30
Neonatal bacterial meningitis in the middle belt of Nigeria; Airede AI; A three-year prospective study of neonatal meningitis in a tertiary hospital in Nigeria was carried out to determine its clinical spectrum and particular characteristics . The 36 infants studied represented a high incidence of 1.9 per 1000 live births, and the infection was significantly higher among low-birthweight babies . Non-specific signs and symptoms were common, and temperature instability was a constant finding . Specific neurological manifestations were noted that differed from other reports in the literature and contributed significantly to outcome . The most common aetiological pathogen isolated was Gram-positive Staphylococcus aureus and the most common Gram-negative organisms were Klebsiella spp: there was no case of group B streptococci . The pathogens isolated were also at variance with other reports . The mortality rate was 33 per cent and was higher for females . There was no significant difference in outcome between inborn and referred infants, nor between early onset and late onset of the disease . A bulging anterior fontanelle was a significant indicator of poor prognosis . Gentamicin and ceftazidime were the most appropriate antibiotics.

J Med Microbiol, 1993 May, 38(5), 311 - 5
A review of the correlation of T-agglutination patterns and M-protein typing and opacity factor production in the identification of group A streptococci; Johnson DR et al.; The classical techniques of M protein and opacity factor (OF) typing and T agglutination typing remain the "gold standard" in identifying group A streptococci, although newer techniques have been proposed to assist laboratory scientists, microbiologists, epidemiologists and clinicians in the precise identification and characterisation of these organisms . Because of the current scarcity of M-typing sera and the increased use by many laboratories of T typing as the sole method of group A identification, a table is presented to indicate specific correlation between the T-agglutination pattern and the M serotype . The use of this table will enable not only more selective use of typing sera but also, perhaps, result in improved understanding and ultimately in correlating these defined patterns with newer and more sensitive techniques.

J Infect Dis, 1993 May, 167(5), 997 - 1002
Role of superantigens in human disease; Schlievert PM; Superantigens include bacterial products (mainly of streptococci and staphylococci) that stimulate T cells to proliferate nonspecifically through interaction with class II major histocompatibility complex products on antigen-presenting cells and then with variable regions on the beta chain of the T cell receptor complex . They include pyrogenic toxins (streptococcal scarlet fever toxins of serotypes A, B, and C, toxic shock syndrome toxin 1, and staphylococcal enterotoxin serotypes A, B, Cn, D, E, and G), streptococcal M protein, staphylococcal exfoliative toxin, and recently identified pyrogenic toxins made by groups B, C, F, and G streptococci and Streptococcus sanguis . Pyrogenic toxin superantigens cause acute toxic shock syndrome and are associated with toxic shock-like syndromes . Superantigens cause symptoms via release of immune cytokines . These proteins should be considered potential causes of illnesses such as rheumatic fever, arthritis, Kawasaki syndrome, atopic dermatitis, and guttate psoriasis because of their potent immune system-altering capacity.

J Infect Dis, 1993 May, 167(5), 1123 - 30
Inhibition of platelet binding and aggregation by streptococcal exopolysaccharide; Sullam PM et al.; Streptococcal exopolysaccharides are major virulence factors in the pathogenesis of endocarditis . They promote bacterial adherence to valves and subsequent vegetation formation . Since platelet binding and aggregation by streptococci are postulated mechanisms for endocardial colonization and vegetation production, the effect of exopolysaccharide on binding and aggregation was evaluated by flow cytometry and aggregometry . Streptococcus salivarius D1, a minimal exopolysaccharide producer, bound human platelets extensively (86.8% of bacteria bound by 1 min) . S . Salivarius M13 and M15 and Streptococcus mitis M4 produced larger amounts of exopolysaccharide and bound platelets significantly less (52.6%, 51.2%, 52.8%, respectively) . Exopolysaccharide also inhibited platelet aggregation: Strains with minimal exopolysaccharide aggregated platelets maximally, while strains with extensive exopolysaccharide failed to induce aggregation . Removal of exopolysaccharide by shearing restored aggregation by these latter strains . Thus, exopolysaccharides can inhibit the binding and aggregation of platelets by streptococci . The virulence associated with exopolysaccharide may result from the inhibition of platelet-mediated interactions that limit disease progression.

Crit Care Med, 1993 May, 21(5), 712 - 20
Effects of pentoxifylline on in vivo leukocyte function and clearance of group B streptococci from preterm rabbit lungs; Mah MP et al.; OBJECTIVES: Pentoxifylline was evaluated for its ability to enhance inactivation of group B streptococci in lungs of prematurely born rabbits . Mechanisms associated with intrapulmonary streptococcal clearance and the pharmacodynamics of pentoxifylline were also investigated . DESIGN: Randomized, controlled animal trial . SETTING: University research laboratory . SUBJECTS: A total of 123 New Zealand rabbits were delivered prematurely by cesarean section and were used for clearance studies . Twenty-three preterm pups were additionally utilized to study the pharmacodynamics of pentoxifylline . INTERVENTIONS: Preterm rabbits were infected with group B streptococcal aerosols and given intraperitoneal injections of either pentoxifylline (25, 12.5, and 12.5 mg/kg) or placebo at 0, 6, and 12 hrs after infection . MEASUREMENTS AND MAIN RESULTS: At 0, 4, and 24 hrs, the numbers of streptococci were determined in the left lung, while the right lung underwent bronchoalveolar lavage to quantify intra-alveolar leukocytes, phagocytosis of inhaled bacteria, and concentrations of lysozyme and tumor necrosis factor . In a separate experiment, blood and bronchoalveolar fluid from infected animals were analyzed for pentoxifylline content . Streptococcal proliferation was less in pentoxifylline-treated animals than in controls at 24 hrs (p < .01) . Pulmonary macrophages and polymorphonuclear leukocytes recovered from bronchoalveolar lavage fluid did not differ in numbers or phagocytic activity . Pentoxifylline-treated animals had lower levels of lysozyme (p < .02) and tumor necrosis factor (p < .005) in bronchoalveolar lavage fluid compared with placebo-treated pups . Therapeutic levels of pentoxifylline were achieved in blood and bronchoalveolar lavage fluid . CONCLUSIONS: Despite lowering lysozyme and tumor necrosis factor content in epithelial lining fluid, pentoxifylline improves the inactivation of group B streptococci in preterm rabbit lungs . These findings suggest that increased group B streptococcal clearance was coincident with an anti-inflammatory effect due to pentoxifylline . We conclude pentoxifylline may be clinically useful as an adjunctive therapy for group B streptococcal pneumonia in newborns.

Infect Immun, 1993 May, 61(5), 2096 - 103
Nucleotide sequence analysis of the gtfT gene from Streptococcus sobrinus OMZ176; Hanada N et al.; The gtfT gene and its upstream region isolated from the Streptococcus sobrinus OMZ176 chromosomal DNA were sequenced . The gtfT gene was preceded by a potential Shine-Dalgarno sequence . The gtfT gene product, glucosyltransferase (GTF), displays a typical gram-positive bacterial signal peptide sequence and both an active site peptide sequence and carboxy-terminal repeats typical of GTFs . The signal sequence is similar to those of other known GTF proteins . The putative active-site peptide sequence of this enzyme was DGIRVDAVD, which was different by one amino acid from the active-site peptide sequence derived from two different types of the S . sobrinus GTFs reported previously (G . Mooser, S . A . Hefta, R . J . Paxton, J . E . Shively, and T . D . Lee, J . Biol . Chem . 266:8916-8922, 1991) . The gtfT gene product has three repeated sequences of 51 to 52 amino acids and a partial repeat of 18 amino acids . Another open reading frame (ORF) was detected in the region immediately upstream of the gtfT gene . The upstream ORF showed substantial DNA homology with the gtfS gene isolated from Streptococcus downei MFe28 . The inferred amino acid sequence of the upstream ORF has four repeating units and has extensive homology with the repeated peptides coded by the S . downei gtfS gene . These results suggested that the gtfT gene was a typical gtf gene isolated from the mutans streptococci and that the two gtf genes were located in tandem on the chromosomal DNA of S . sobrinus OMZ176.

J Immunol, 1993 May 1, 150(9), 4151 - 9
Superantigen can reactivate bacterial cell wall-induced arthritis; Schwab JH et al.; Intravenous injection of toxic shock syndrome toxin-1 (TSST-1) produced by Staphylococcus aureus, can reactivate arthritis in a rat ankle joint that has been previously inflamed by injection of peptidoglycanpolysaccharide polymers isolated from the cell walls of group A streptococci . The severity and chronicity of this renewed arthritis is dose dependent and at higher doses (125 micrograms/kg) a prolonged joint inflammation with pannus formation and marginal erosion of cartilage and bone is induced after a single injection of TSST-1 . Only modest synovial hyperplasia is induced in control ankle joints by systemic injection of TSST-1 . Another superantigen, streptococcal pyrogenic exotoxin induces a much weaker, acute reactivation of arthritis that resolves by 2 days . Repeated injections of TSST-1 at 7-day intervals give the same undiminished pattern of joint response, but the joint swelling persists at a higher level with each succeeding injection . Cyclosporin A suppresses all phases of the recurrent arthritis, indicating that TSST-1 could be functioning through its property of a superantigen activating T lymphocytes . II-1 receptor antagonist and anti-TNF-alpha neutralizing antibody, which reduce reactivation of arthritis by peptidoglycan-polysaccharide polymers, have no effect on reactivation by TSST-1 . This experimental model provides a means to examine in vivo the possible role of superantigens in rheumatoid arthritis and related diseases, and to analyze the cellular and molecular pathways induced by this family of microbial products.

Arch Oral Biol, 1993 May, 38(5), 377 - 86
Longitudinal study of relations between human salivary antimicrobial proteins and measures of dental plaque accumulation and composition; Rudney JD et al.; Many studies have attempted to relate levels of antimicrobial proteins in saliva to oral health; results have been inconsistent, and one reason might be inconsistency of measures of plaque and saliva within subjects . This study investigated associations between plaque and salivary variables in longitudinal data . Whole saliva, and 8-h plaque pooled from buccal first permanent molars, was obtained from 32 dental students on Tuesdays from 3:00-6:00 p.m . over 4 weeks . Salivary flow rate was determined, and samples were assayed for lysozyme, lactoferrin, total peroxidase, myeloperoxidase, OSCN-, sIgA and total protein . Colonies on mitis-salivarius agar were assigned to Streptococcus sanguis, Strep . mutans or Strep . salivarius on the basis of morphology, supplemented by the API Rapid Strep identification system . Consistency of values within subjects across weeks was evaluated by repeat-measures analysis of variance and intraclass correlation; data were transformed to reduce skewness . Pearson's r was used to determine associations between plaque and salivary variables . Significant intraclass correlations (alpha = 0.05) were found for all salivary variables except myeloperoxidase, and for total flora, total streptococci, Strep . sanguis and Strep . sanguis as a proportion of total streptococci . Significant Pearson correlations with Strep . sanguis as a proportion of total streptococci were found for total protein (r = -0.24), sIgA (r = -0.22), lactoferrin (r = -0.19) and OSCN- (r = 0.20) when data from all weeks were pooled (n = 128) . Strep . sanguis proportions tended to be low in subjects with high values for salivary proteins; the range of proportions was wider in subjects with low salivary values . These findings suggest some consistency of weekly values for many plaque and salivary variables . They also support previous cross-sectional data which suggested that salivary antimicrobial proteins may have some effect on plaque composition . This study was made before recent revisions in streptococcal taxonomy, and further research is needed to clarify interactions of salivary proteins with currently defined species.

J Periodontal Res, 1993 May, 28(3), 204 - 10
Lethal photosensitization of bacteria in subgingival plaque from patients with chronic periodontitis; Sarkar S et al.; Subgingival plaque samples from patients with chronic periodontitis were exposed to light from a 7.3 mW Helium/Neon laser for 30 s in the presence and absence of 50 micrograms/ml toluidine blue O as a photosensitizer . Viable counts of various groups and species of bacteria were carried out before and after irradiation . The median numbers of viable bacteria initially present in the 30-microliters aliquots irradiated were 1.13 x 10(5) cfu (aerobes), 4.08 x 10(5) cfu (anaerobes), 4.92 x 10(3) cfu (black-pigmented anaerobes), 4.75 x 10(2) cfu (Porphyromonas gingivalis), 6.15 x 10(3) cfu (Fusobacterium nucleatum) and 1.7 x 10(4) cfu (streptococci) . The dye/laser combination achieved significant reductions in the viability of these organisms, the median reductions in the viable counts being 91.1% for aerobes, 96.6% for anaerobes, 100% for black-pigmented anaerobes, P . gingivalis and F . nucleatum and 94.2% for streptococci . Overall, the viability of bacteria in the 20 plaque samples was not significantly decreased by the dye alone . However, in a small minority of samples there were indications of light-independent, dye-induced toxicity . Low-power lasers, in conjunction with appropriate photosensitizers, may be a useful adjunct to mechanical debridement in the treatment of inflammatory periodontal diseases if a similar effectiveness against subgingival plaque bacteria can be achieved in vivo.

Mol Microbiol, 1993 May, 8(5), 981 - 91
Nucleotide substitutions and small-scale insertion produce size and antigenic variation in group A streptococcal M1 protein; Harbaugh MP et al.; The presence of M protein on the surface of group A streptococci (GAS) confers the ability of the cell to resist phagocytosis in the absence of type-specific antibodies . It undergoes antigenic variation with more than 80 different serotypes having been defined . We have sequenced the M protein gene (emm1.1) from strain CS190 and present evidence that individual nucleotide substitutions are responsible for sequence variation in the N-terminal non-repeat region of emm1.1 and these substitutions have altered antibody recognition of opsonic epitopes . The N-terminal non-repeat domains of two other closely related strains, 71-155 and 76-088, were found to have sequence identical to emm1.1 with the addition of a 21 bp insert . This study provides the first evidence that nucleotide substitutions and small insertions are responsible for size and antigenic variation in the N-terminal non-repeat domain of the M protein of GAS.

Mol Microbiol, 1993 May, 8(5), 809 - 19
An M protein with a single C repeat prevents phagocytosis of Streptococcus pyogenes: use of a temperature-sensitive shuttle vector to deliver homologous sequences to the chromosome of S . pyogenes; Perez-Casal J et al.; The major virulence factor of the important human pathogen Streptococcus pyogenes is the M protein, which prevents phagocytosis of the bacterium . In different strains of streptococci, there are over 80 serologically different M proteins and there are additional M-like proteins, some of which bind immunoglobulins . Although the sequence of the M molecules differs among different S . pyogenes strains, all M proteins, and some of the immunoglobulin-binding molecules, have at least two copies of the C repeat region . We describe construction of a deletion mutation in S . pyogenes, which has only one C repeat copy, and show that the mutant strain is still resistant to phagocytosis . The mutation was constructed in vitro and used to replace the resident emm allele in an S . pyogenes strain . To facilitate homologous recombination into the streptococcal chromosome, we adapted a shuttle vector which is temperature sensitive for replication in Gram-positive bacteria but not in Gram-negative hosts . This new method for delivery of a homologous DNA fragment to the S . pyogenes chromosome is efficient and reproducible and should be of general use.

Klin Padiatr, 1993 May-Jun, 205(3), 140 - 4
{Preventive antibiotic administration for prevention of nosocomial septicemia in very small premature infants (VLBW infants)--preventive vancomycin administration against infections with coagulase negative streptococci--prevention of translocation with oral cefixime therapy in intestinal colonization with pathogenic gram-negative pathogens}; Moller JC et al.; VLBW-infants below 1500 g of birth weight have a quite high risk to acquire a nosocomial sepsis . 20-40% of all infants exhibit signs of nosocomial infection once during neonatal intensive care . The rate of infection is related to technique and amount of used invasive devices as to gestational age . Coagulase-negative staphylococci (CONS) and gram-negative organisms contribute most to these cases of sepsis . In a three phase study we tried to demonstrate the efficacy of different mechanisms to change the rate of nosocomial sepsis . During the first phase a strict hygienical protocol was enforced as isolation, care with sterile gloves and aseptic techniques in introducing and maintaining i.v . lines . In a second phase we started a randomized controlled study of prophylactic vancomycin (10 mg/kg/day in two doses) . In a third phase we added an oral antibiotic regime with cefixime for all patients with positive cultures for gramnegative organisms under the hypothesis of translocation from the gut as the way of infection . During the first phase 23.7% of 76 patients enrolled acquired CONS-sepsis, 0.52% gramnegative sepsis . During the second phase (41 patients) 6 patients in the control group acquired CONS-sepsis, none in the vancomycin-group . The rate of gramnegative infections was not different (4 and 3 cases) . During the third phase (vancomycin plus cefixime eventually in cases of positive stool cultures) no case of nosocomial sepsis occurred (35 patients, 11 positive cultures) . The management used in phase 3 reduced the rate of nosocomial infections in VLBW-infants drastically.

Free Radic Biol Med, 1993 May, 14(5), 495 - 500
Interaction of viable group A streptococci and hydrogen peroxide in killing of vascular endothelial cells; Ginsburg I et al.; Previous studies have shown that the streptococcal hemolysin, streptolysin S, is capable of interacting with hydrogen peroxide (H2O2) to injure vascular endothelial cells (Free Radic . Biol . Med . 7:369-376; 1989) . To extend these observations, intact group A streptococci (strain 203S) were examined for ability to injure endothelial cells alone and for ability to injure the same cells in the presence of sublethal concentrations of H2O2 (generated from glucose/glucose oxidase) . While neither control bacteria nor bacteria that had been pretreated with poly-L-histidine to render them cationic were cytotoxic to endothelial cells by themselves under the conditions of the experiment, endothelial cells were injured by combinations of streptococcal cells and sublytic amounts of H2O2 . Taken together, these data suggest that the sequelae which often occur following primary infection with group A streptococci may be the result of a combined assault of host inflammatory cells and the invading bacteria on the vascular lining cells of the host.

J Perinatol, 1993 May-Jun, 13(3), 212 - 6
Failure of intrapartum antibiotics to prevent culture-proved neonatal group B streptococcal sepsis; Ascher DP et al.; Early-onset group B streptococci (GBS-EOS) sepsis may be prevented by intrapartum antibiotics administered for GBS maternal colonization, premature labor, or prolonged rupture of membranes . We sought to identify cases of neonatal GBS sepsis after apparent failure of intrapartum chemotherapy and to determine the factors associated with failure of intrapartum antibiotics in these cases . We identified 96 GBS blood culture-positive infants at five military medical centers from 1987 to 1990 . Eighteen (18.7%) of these infants had mothers who had received intrapartum antibiotics; 16 of 18 cases were early-onset disease, 15 of which initially had symptoms at less than 1 hour of age . Two infants had late-onset disease develop at 3 weeks of age . At least one perinatal risk factor (prematurity, prolonged rupture of membranes > 12 hours, maternal fever) was present in each of the 16 cases . Indications for intrapartum antibiotics were suspected chorioamnionitis (13 cases), GBS colonization and prolonged rupture of membranes or prematurity (3), and GBS colonization alone (2) . Maternal antibiotics included ampicillin (14 cases), cephadyl (1), vancomycin (1), clindamycin (1), and gentamicin alone (1) . The median number of doses of ampicillin before delivery was 1 (range, 1 to 21), which was administered at a median of 4 hours (range, 1 to 84) before birth . The mean dose of ampicillin was 1.8 gm/dose (range, 1 to 2 gm/dose) . Two of 16 (12.5%) infants with GBS-EOS died as a result of GBS sepsis . In our population of neonates with GBS-EOS, 18.4% (16 of 87) of the infants had positive blood cultures despite intrapartum antibiotics . Intrapartum antibiotics may fail to prevent GBS sepsis in a number of infants born to mothers colonized with GBS or to those with acute chorioamnionitis.

J Antimicrob Chemother, 1993 May, 31 Suppl D, 149 - 58
Post-antibiotic effects in experimental infection models: relationship to in-vitro phenomena and to treatment of infections in man; Craig WA; Persistent suppression of bacterial growth, called the post-antibiotic effect (PAE), has been studied in six different animal infection models . Prolonged in-vivo PAEs are observed for all antimicrobials with staphylococci and for imipenem and inhibitors of protein and nucleic acid synthesis with streptococci and Gram-negative bacilli . Penicillins and cephalosporins produce short or no in-vivo PAEs with these latter organisms . The presence of neutrophils prolongs the in-vivo PAEs found with aminoglycosides and quinolones . Simulation of human pharmacokinetics also enhances the duration of in-vivo PAE for aminoglycosides . In-vivo PAEs tend to be longer than those observed in vitro . The in-vitro PAE for penicillin with streptococci has been observed in vivo in only one of four experimental infection models . The presence of a prolonged in-vivo PAE can allow wider dosing intervals . The primary clinical application of the in-vivo PAE has been with once-daily dosing of aminoglycosides.

J Antimicrob Chemother, 1993 May, 31(5), 783 - 7
The selection of appropriate dosages for intravenous ciprofloxacin; Echols RM; A variety of toxicological, clinical and pharmacokinetic parameters were utilized in an evolving process to determine the optimum dosage for intravenous ciprofloxacin . Despite the clinical efficacy of 200-300 mg administered every 12 h, there have been concerns that this might be inadequate for certain pathogens, including Pseudomonas aeruginosa, Staphylococcus aureus and streptococci . Pharmacokinetic studies have established the bioequivalence of the iv and oral formulations of ciprofloxacin . With respect to the AUC, 400 mg of iv ciprofloxacin was equivalent to 500 mg po and the Cmax of 400 mg administered iv over 1 h approximated that following a 750 mg tablet . Final FDA approval of iv ciprofloxacin was ultimately based on the demonstration of the bioequivalence of the iv and oral formulations, the latter having proven clinical efficacy . For severe systemic infections, a daily dosage of 1200 mg (400 mg tds) of iv ciprofloxacin would be equivalent to 1500 mg (750 mg bd) taken by mouth.

Mol Microbiol, 1993 May, 8(4), 707 - 17
Structural heterogeneity of the emm gene cluster in group A streptococci; Hollingshead SK et al.; One or more distinct copies of emm genes lie within a gene cluster that is located downstream from a transcriptional regulatory gene (mry) . Mry is a positive regulator for the genes in this cluster and for the downstream gene, scpA . The objective of this study is to examine the structure of this cluster and the distribution of specific alleles within the cluster among group A streptococcal isolates of 32 different serotypes . The peptidoglycan (PG)-spanning domain, which exists in four divergent forms, was used to identify specific alleles of the genes within the emm cluster . Gene content of the cluster was determined by Southern hybridization with allele-specific oligonucleotides . Five different chromosomal patterns for this cluster were observed . Sequence heterogeneity in the adjacent mry locus was demonstrated by the ability of some of the isolates to hybridize with a whole mry gene probe, but not with mry-based oligonucleotide probes . A PCR-based chromosomal mapping technique was used to examine further the gene order within the emm gene clusters . Structural heterogeneity of the emm gene cluster was found within class I isolates in this study, while class II isolates were relatively homogeneous at this chromosomal locus and distinct from class I.

APMIS, 1993 May, 101(5), 403 - 8
Adherence of group B streptococci to human endothelial cells in vitro; Kallman J et al.; A model using human umbilical vein endothelial cells was developed to study the adhesion of group B streptococci . Ten clinical isolates of serotypes Ia, Ib and III, including six blood isolates from neonates with early-onset disease, were studied . Isogenic variants with different ability to express capsule substance were also included . Clinical isolates of serotype III adhered significantly better than other serotypes . Strains with high ability to adhere to endothelial cells also had high ability to bind to plastic . Isogenic variants of serotype III with low amounts of capsule substance adhered significantly better to cells than variants expressing high amounts of capsule substance . These results show that the higher adherence of serotype III strains may be a virulence factor and contribute to the finding that this serotype dominates in invasive group B streptococcal disease.

Zhonghua Kou Qiang Yi Xue Za Zhi, 1993 May, 28(3), 160 - 3, 191
{Experimental study on the interaction of fibronectin with oral Streptococci}; Ling JQ; Interaction of fibronectin (Fn) with Streptococcus mutans, S . sorbrinus, and S . milleri is demonstrated by an enzyme-linked immunosorbent assay (ELISA) . The results show that the three strains are able to adhere to Fn . The interaction may be strengthened while the concentration of Fn increases (q test P < 0.01) . The ability of adherence among S . mutans, S . sorbrinus and S . milleri is different in Fn high concentration (q test P < 0.01) . It is speculated the free Fn in saliva may serve as an agglution for elimination of the organisms from the oral cavity, or as a receptor when immobilized on the tooth surface for cariogenic streptococci to form plaque . A balance between these two functions of Fn may play a role in modulating the microbial ecological environment of the oral cavity.

J Biol Chem, 1993 Apr 5, 268(10), 7118 - 24
Molecular characterization of hasB from an operon required for hyaluronic acid synthesis in group A streptococci . Demonstration of UDP-glucose dehydrogenase activity; Dougherty BA et al.; The membrane-associated hyaluronate synthase produces capsular hyaluronate in group A streptococci by the alternate addition of UDP-N-acetylglucosamine and UDP-glucuronic acid . Previous studies identified a locus required for hyaluronate synthase activity and suggested that a gene involved in the production of UDP-glucuronic acid (UDP-glucose dehydrogenase) also mapped to the locus . In the present study the putative UDP-glucose dehydrogenase gene (hasB) was cloned and the DNA sequence determined . The hasB gene product was shown to have global similarity with AlgD, a dehydrogenase, which catalyzes the production of GDP-mannuronic acid for the alginate capsule of Pseudomonas aeruginosa . Regions of local homology have been identified which apparently correspond to the NAD-binding and enzyme active sites of HasB and AlgD . In order to show that hasB expression correlated with UDP-glucose dehydrogenase activity, the hasB gene was cloned under control of the T7 promoter . Hyperexpression of hasB resulted in a protein of approximately 47 kDa and high levels of UDP-glucose dehydrogenase activity were observed . These data demonstrate that hasB encodes the UDP-glucose dehydrogenase of group A streptococci.

Nihon Kyobu Shikkan Gakkai Zasshi, 1993 Apr, 31(4), 486 - 91
{Bacteriological and clinical studies in 23 cases of thoracic empyema--the role of oral streptococci and anaerobes}; Shinzato T et al.; The bacteriology of empyema fluid and the clinical background of 23 cases from July 1987 through July 1992 were studied . Nineteen cases were male and 4 female, with a mean age of 59.6 years (range; 33 to 84 y.o.) . There were 15 cases of community-acquired infection and 8 of nosocomial infection . Acute pneumonia and/or lung abscess developed into empyema in 19 cases . Sixteen cases had associated predisposing conditions, such as diabetes, chronic bronchitis, disorders with dysphagia, and excess alcohol intake . Forty-one strains were isolated from empyema in 22 cases . The predominant organisms, in order of prevalence, were "Streptococcus milleri" group (11 strains), Peptostreptococcus spp . (6), Prevotella spp . (6), Fusobacterium spp . (5) and other viridans streptococci (3) . The majority of streptococcal infections, which were primarily caused by "S . milleri" group, were mixed with anaerobes and/or aerobes/facultatives . These results demonstrate that oral streptococci, especially "S . milleri" group, and anaerobes play a significant role as pathogens in empyema.

Antimicrob Agents Chemother, 1993 Apr, 37(4), 746 - 9
In vitro activity of MDL 62,879 (GE2270 A) against aerobic gram-positive and anaerobic bacteria; King A et al.; The in vitro activity of MDL 62,879, a new peptide antibiotic that inhibits protein synthesis through an interaction with elongation factor Tu, against a wide range of recent clinical isolates of common aerobic gram-positive and anaerobic organisms was determined . MDL 62,879 was highly active against staphylococci (MIC for 90% of isolates {MIC90}, 0.125 microgram/ml), streptococci (MIC90, 1 microgram/ml), and enterococci (MIC90, 0.03 microgram/ml) . All isolates of peptostreptococci and Mobiluncus spp . were susceptible, as were most isolates of clostridia . MDL 62,879 was not active against isolates of fusobacteria or Bacteroides spp., but some isolates of Prevotella spp . and Porphyromonas asaccharolytica were susceptible.

Appl Environ Microbiol, 1993 Apr, 59(4), 968 - 73
Inhibitory effect of oolong tea polyphenols on glycosyltransferases of mutans Streptococci; Nakahara K et al.; Oolong tea extract (OTE) was found to inhibit the water-insoluble glucan-synthesizing enzyme, glucosyltransferase I (GTase-I), of Streptococcus sobrinus 6715 . The GTase-inhibitory substance in the OTE was purified successive adsorption chromatography on Diaion HP-21 and HP-20 columns; this was followed by further purification by Sephadex LH-20 column chromatography . A major fraction that inhibited GTase activity (fraction OTF10) was obtained, and the chemical analysis of OTF10 indicated that it was a novel polymeric polyphenol compound that had a molecular weight of approximately 2,000 and differed from other tea polyphenols . Catechins and all other low-molecular-weight polyphenols except theaflavin derived from balck tea did not show significant GTase-inhibitory activities . It was found that OTE amd PTF10 markedly inhibit GTase-I and yeast alpha-glucosidase, but not salivary alpha-amylase . Various GTases purified from S . sobrinus and Streptococcus mutans were examined for inhibition by OTE and OTF10 . It was determined that S . sobrinus GTase-I and S . mutans cell-free GTase synthesizing water-soluble glucan were most susceptible to the inhibitory action of OTF10, while S . sobrinus GTase-Sa and S . mutans cell-associated GTase were moderately inhibited; no inhibition of S . sobrinus GTase-Sb was observed . Inhibition of a specific GTase or specific GTases of mutants streptococci resulted in decreased adherence of the growing cells of these organisms . The inhibitory effect of OTF10 on cellular adherence was significantly stronger than that of OTE.

J Am Osteopath Assoc, 1993 Apr, 93(4), 508 - 9
Group C streptococcal arthritis; Cook MA et al.; Septic arthritis is a common disorder that is rarely caused by group C streptococci . This infectious process usually occurs in patients with a preexisting rheumatologic condition . Treatment consists of intravenous antibiotics, joint aspiration, and physical therapy . Prolonged recovery and septic complications are expected . This report describes a case typical of group C streptococcal arthritis.

Arch Ophthalmol, 1993 Apr, 111(4), 528 - 30
Infectious crystalline keratopathy . The role of bacterial exopolysaccharide; Hunts JH et al.; OBJECTIVES--Infectious crystalline keratopathy is a unique pauci-inflammatory infection of the cornea most commonly due to viridans type streptococci . We investigated the hypothesis that production of exopolysaccharide by streptococci, a property that can be induced by growth conditions, may contribute to the pathogenesis of infectious crystalline keratopathy by suppressing the ocular immune response . METHODS--Streptococcus sanguis type II was grown under two conditions, conventionally in brain-heart infusion broth and in 5% sucrose-supplemented brain-heart infusion broth, to promote exopolysaccharide formation . Rabbit corneas were inoculated by passage of 9-0 silk sutures soaked in bacterial suspensions . RESULTS--Arborizing, sharply demarcated pauci-inflammatory lesions were noted in 71% of rabbit corneas inoculated with S sanguis type II grown in sucrose-supplemented media and in 25% of control corneas (P = .05) . Suppurative lesions developed in the remaining corneas . Histologic evaluation of infectious crystalline keratopathy lesions revealed characteristic features . CONCLUSION--Increased exopolysaccharide formation by S sanguis type II is associated with production of infectious corneal lesions that resemble those of infectious crystalline keratopathy.

J Clin Microbiol, 1993 Apr, 31(4), 865 - 71
Controlled comparison of the BACTEC high-blood-volume fungal medium, BACTEC Plus 26 aerobic blood culture bottle, and 10-milliliter isolator blood culture system for detection of fungemia and bacteremia; Wilson ML et al.; The BACTEC high-blood-volume fungal medium (HBV-FM) (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md.) was compared with the Isolator (IS) tube and the BACTEC Plus 26 (BP26) blood culture bottle for the ability to recover fungi from the blood of adult patients suspected of having fungemia . A total of 6,836 blood culture sets that fulfilled criteria for inclusion in the study were received . Three separate comparisons were performed: 4,907 HBV-FM versus IS, 4,886 BP26 versus HBV-FM, and 4,949 BP26 versus IS . For the HBV-FM versus IS comparison, 218 isolates were recovered: 125 (57.3%) were bacteria and 93 (42.7%) were fungi . HBV-FM was comparable to IS for recovery of yeasts, but IS was superior for recovery of Histoplasma capsulatum (25 versus 0 isolates recovered {P < 0.001}) . Growth of Torulopsis glabrata was detected earlier (P < 0.05) in HBV-FM bottles . For the BP26 versus HBV-FM comparison, 229 isolates were recovered: 161 (70.3%) were bacteria, and 68 (29.7%) were fungi . HBV-FM was superior for recovery of T . glabrata (P < 0.025) and all fungi combined (P < 0.025) . There were no statistically significant differences in the speed of detection of microbial growth . For the BP26 versus IS comparison, 251 isolates were recovered: 165 (65.7%) were bacteria, and 86 (34.2%) were fungi . IS was superior for recovery of H . capsulatum (P < 0.001), T . glabrata (P < 0.05), and fungi other than H . capsulatum (P < 0.025) . BP26 was superior for recovery of all bacteria combined (P < 0.001) and viridans group streptococci (P < 0.01) . Growth of T . glabrata (P < 0.05) was detected earlier in IS tubes . Growth of Staphylococcus aureus (P < 0.01), viridans group streptococci (P < 0.01), Pseudomonas aeruginosa (P < 0.05), and all microorganisms combined (P < 0.05) was detected earlier in BP26 bottles . For yeast, 57 of 59 (96.6%), 79 of 80 (98.7%), and 64 of 67(95.5%) were recovered from BP26 bottles, HBV-FM bottles, and IS tubes, respectively, by day 14; for H . capsulatum, 14 of 36 (38%) isolates were recovered from IS tubes by day 14 . Mean times of recovery were similar for BACTEC bottles and IS . We conclude that (i) for recovery of fungi from blood cultures, HBV-FM is equivalent to IS (with the exception of H . capsulatum); (ii) for recovery of bacteria, BP26 is superior to IS; (iii) BP26 bottles are inferior to both HBV-FM bottles and IS tubes for recovery of T . glabrata; and (iv) HBV-FM bottles must be paired with another blood culture bottle or system to optimize detection of bacteremia.

J Clin Microbiol, 1993 Apr, 31(4), 839 - 44
Novel, rapid optical immunoassay technique for detection of group A streptococci from pharyngeal specimens: comparison with standard culture methods; Harbeck RJ et al.; A novel immunoassay system based on the changes in the reflection of light, termed an optical immunoassay (OIA), was utilized to directly detect group A streptococcal (GAS) carbohydrate antigen from clinical specimens . In two studies, a total of 1,275 throat swabs were tested for the presence of this antigen with the Strep A OIA rapid detection system and the results were compared with those of standard culture methods . In both studies, the Strep A OIA yielded more positive results than plating of the throat swab onto a selective agar, Trypticase soy agar containing sheep blood, or an enriched broth . In one study, the sensitivity and specificity of Strep A OIA compared with those of the broth-enriched culture were 97.4 and 95.6%, respectively . In a second study a sensitivity of 98.9% and a specificity of 98.6% were achieved . It was also shown that the carbohydrate antigen could be detected in the absence of viable GAS organisms . The Strep A OIA is an easily interpretable method and was shown to be more sensitive than routine culture methods for detecting GAS infections directly from throat swabs.

J Clin Microbiol, 1993 Apr, 31(4), 808 - 11
Role of group C beta-hemolytic streptococci in pharyngitis: epidemiologic study of clinical features associated with isolation of group C streptococci; Turner JC et al.; All Lancefield group C beta-hemolytic streptococci isolated over 12 months from college students with clinical pharyngitis and age-matched healthy controls were identified . Clinical features of upper respiratory tract infection and pyogenic pharyngitis as well as colony counts were tabulated for each patient according to throat culture results . Of 1,480 patients, Lancefield group C Streptococcus equisimilis was isolated from 45 (3%) patients and Streptococcus anginosus ("Streptococcus milleri") was isolated from 164 (11.1%) patients . Patients from whom S . equisimilis was isolated had clinical features more suggestive of pyogenic infection than did patients from whom S . anginosus was isolated . Colony counts on primary throat culture plates from patients from whom S . equisimilis and Streptococcus pyogenes were isolated were higher than those from patients from whom S . anginosus was isolated . This study presents epidemiologic evidence supporting a role for S . equisimilis in causing pharyngeal infection and for S . anginosus as representing part of the normal oropharyngeal flora.

J Clin Microbiol, 1993 Apr, 31(4), 804 - 7
Role of beta-hemolytic group C streptococci in pharyngitis: incidence and biochemical characteristics of Streptococcus equisimilis and Streptococcus anginosus in patients and healthy controls; Fox K et al.; The biochemical characteristics and the isolation rates of the two Lancefield group C streptococcal species (S . equisimilis and S . anginosus) from patients with pharyngitis and asymptomatic controls were compared . Some 239 strains of beta-hemolytic group C streptococci were isolated from 1,480 patients (209 strains) with pharyngitis and 227 controls (30 strains) . A total of 44 strains displayed broad hemolysis, were Voges-Proskauer test negative, and produced glucuronidase . Some 72.7% of these strains also fermented ribose . A second group of 159 strains was Voges-Proskauer test positive and glucuronidase negative; 98.8% also displayed minute hemolysis and only 3.7% fermented ribose . These two groups represent typical large-colony S . equisimilis and small-colony S . anginosus, respectively . A small number of strains (36 in total) exhibited intermediate characteristics; morphologically, all 36 strains resembled S . anginosus, but 6 strains biochemically resembled S . equisimilis . No strains of S . equisimilis fermented sorbitol (unlike S . zooepidemicus) and all fermented trehalose (unlike S . equi) . The structural carbohydrate profiles of S . equisimilis and S . anginosus both included galactosamine (consistent with their being group C organisms), but the profiles were not distinguishable . In total, 78.5% of strains from controls and 83.3% of strains from patients were determined to be the species S . anginosus . S . equisimilis was isolated from 3.0% of patients and 2.2% of controls, and S . anginosus was isolated from 11.1% of patients and 11.0% of controls . Thus, S . equisimilis and S . anginosus are both members of the normal flora of asymptomatic individuals . The incidence and biochemical characteristics of these two species are similar in patients who are healthy and those who have disease . However, a companion article provides clinical evidence associating S . equisimilis (but not s . anginosus) with pharyngitis.

Br J Rheumatol, 1993 Apr, 32(4), 342 - 5
Group G streptococcal osteomyelitis of the spine; Hall M et al.; Two elderly men, one with definite and one with probable malignancy, presented with severe back pain . Both had osteomyelitis of the lumbar spine due to Group G streptococci which responded to chemotherapy.

Obstet Gynecol, 1993 Apr, 81(4), 635 - 40
Use of a DNA probe for the rapid detection of group B streptococci in obstetric patients; Yancey MK et al.; OBJECTIVE: To determine the accuracy of a DNA probe as a rapid diagnostic test for detecting colonization of the female genital tract by group B streptococci during pregnancy . METHODS: Two rayon-tipped applicators were used to collect secretions from the posterior vaginal wall of 440 pregnant women . One of the applicators was inoculated into selective Todd-Hewitt broth and used as the reference standard for identification of group B streptococci . The other applicator was used for analysis with the DNA probe, preceded by either 2.5 hours of incubation for the initial 75 patients, or 3.5 hours' incubation for the remaining women . Following hybridization with an acridinium-labeled probe, chemiluminescence was measured with a luminometer . RESULTS: The prevalence of positive cultures was 20% . For the initial 75 patients whose cultures were amplified by incubation for 2.5 hours, the DNA probe had a sensitivity of 44%, specificity 94%, positive predictive value 79%, and negative predictive value 77% . For the cultures that were incubated for 3.5 hours, respective values were 71, 90, 61, and 94% . All vaginal specimens that had an average initial cell count of 1.5 x 10(3) cells/mL were accurately detected by the probe after 3.5 hours' growth amplification . False-positive results occurred primarily when the specimens were grossly contaminated with blood (26 of 39) . The mean time required to perform the assay, including 3.5 hours of growth amplification, was 4.3 hours . CONCLUSIONS: The DNA probe demonstrated good overall sensitivity and gave no false-negative results when group B streptococci were present in concentrations of 1 x 10(4) cells/mL or greater . Sensitivity improved significantly with 3.5 hours' growth amplification as compared with 2.5 hours (P < .05), reflecting better identification of lightly colonized patients.

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