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 . BACK