Streptococcal

Endod Dent Traumatol, 1992 Dec, 8(6), 248 - 54
Profiling of Propionibacterium acnes recovered from root canal and blood during and after endodontic treatment; Debelian GJ et al.; This report describes the first results of an ongoing study of bacteremia after endodontic treatment of teeth with Asymptomatic apical periodontitis . After access cavity preparation, microbiological samples were taken from the root canal under aseptic conditions in 4 single-rooted teeth in 4 patients . In treatment of 2 of the patients, the first 3 reamers (sizes 15-25) were deliberately used to a level 2 mm beyond the apical foramen . In 2 patients the instrumentation ended inside the root canal 1 mm short of the apical foramen . Blood samples were taken from the patients during the endodontic instrumentation and 10 min after the treatment was completed . Using lysis-filtration under anaerobic conditions, the blood was passed through a cellulose membrane filter . The filters as well as the root canal samples were incubated using an anaerobic technique . Anaerobic bacteria were isolated from all root canals . In the 2 patients where overinstrumentation had occurred, Propionibacterium acnes was recovered both from the root canals and from the blood samples taken during and after the treatment had been completed . Biochemical profiles, antibiotic susceptibility tests and electrophoresis of soluble proteins revealed that Propionibacterium acnes isolated from the root canal and blood samples were identical within patients, but varied between patients . Facultative anaerobic bacteria including Streptococcus sanguis were recovered from only one root canal sample and not from the blood samples.

Fukuoka Igaku Zasshi, 1992 Dec, 83(12), 420 - 5
Clinical features of patients suffering from Streptococcus milleri infections--a retrospective analysis; Shimono N et al.; We examined the clinical records of patients from whom S . milleri was isolated at Kyushu University Hospital from January 1987 through December 1988 . Sixty-one patients were treated in 64 episodes with drainage or antibiotics . Oral and nasopharyngeal infections were observed in 27 cases, intrathoracic infections in 13, urogenital infections in 8, intraabdominal infections in 6 and skin and subcutaneous infections in 6 . Except for acute bronchitis and urogenital infections, all of them were suppurative . As to underlying diseases, 21 patients had malignancies and 6 had diabetes mellitus . Leukocytopenia was not observed in any of the patients . S . milleri can be eradicated by treatment but it is sometimes replaced by other organisms . However, considering its tendency to cause suppurative infections, its pathogenic significance should be taken into account and patients should undergo surgical drainage combined with antibiotic therapy.

Kinderarztl Prax, 1992 Dec, 60(9-10), 285 - 7
{Pneumococcal cellulitis}; Kassa A et al.; Streptococcus pneumoniae as a cause of cellulitis is rarely reported in children and adults . We report on an infant with facial cellulitis due to pneumococci and review already described cases since 1975 . The main features of this infection, underlying diseases and problems of diagnostics and therapy are discussed.

Hinyokika Kiyo, 1992 Dec, 38(12), 1383 - 6
{Solitary infected renal cyst: a case report}; Ozeki S et al.; A 48-year-old man was admitted to our hospital because of high fever and left flank pain . Laboratory findings revealed a high white blood cell count, high C-reactive protein level, and severe pyuria . Sonographic examination revealed an enlargement of the cyst at the upper pole of the left kidney that had already been detected . Percutaneous drainage was performed for the cyst and 60 ml of purulent fluid was obtained . Bacterial culture of the fluid was positive for Propionibacterium acnes and gamma-Streptococcus . The drainage and administration of povidone-iodine was continued for 7 days . The size of the cyst was reduced with disappearance of symptoms.

Arch Oral Biol, 1992 Dec, 37(12), 983 - 90
Development and characterization of Porphyromonas gingivalis-specific rat T-cell clones; Sakurai K et al.; Porphyromonas gingivalis has been implicated as a major pathogen in periodontitis . To determine the role of T cells in the regulation of this disease, a method was developed for the generation and characterization of rat T-cell clones with antigen specificity to P . gingivalis whole cells . The clones studied so far demonstrated a T-helper (Th) phenotype W3/13+, W3/25+, OX8- and OX22- . These T-cell clones proliferated in vitro in response to P . gingivalis, but not to other bacteria (Prevotella intermedia, Actinobacillus actinomycetemcomitans, Wolinella recta, Fusobacterium nucleatum, Streptococcus sanguis) . Limiting dilution analysis showed W3/25+, OX8- T cells preferentially respond to P . gingivalis, rather than W3/25-, OX8+ T cells . P . gingivalis-reactive W3/25+ T cells belonged to the OX22- population, suggesting that the OX22- T cells may represent memory cells . All clones tested produced interferon gamma, but not interleukin 2 . The cloned T-cell F1 significantly enhanced P . gingivalis-specific antibody production (p < 0.03) . The availability of these cloned T cells should bring new insight into the mechanism by which T cells regulate oral health and periodontal disease.

MMWR CDC Surveill Summ, 1992 Nov 20, 41(6), 25 - 32
Group B streptococcal disease in the United States, 1990: report from a multistate active surveillance system; Zangwill KM et al.; Group B streptococcal (GBS) disease is the most common cause of neonatal sepsis and meningitis in the United States . It is also an important cause of morbidity among pregnant women and adults with underlying medical conditions . Because most states have not designated GBS disease as a reportable condition, previous estimates of the incidence of GBS disease were based on studies from single hospitals or small geographic areas . This report summarizes the results of population-based active surveillance for invasive GBS disease in counties within four states that had an aggregate population of 10.1 million persons in 1990 . A case of GBS disease was defined as isolation of group B streptococcus from a normally sterile anatomic site in a resident of one of the surveillance areas . Age- and race-adjusted projections to the U.S . population suggest that > 15,000 cases and > 1,300 deaths due to GBS disease occur each year . The projected age- and race-adjusted national incidence is 1.8/1,000 live births for neonatal GBS disease and 4.0/100,000 population per year for adult GBS disease . Intrapartum chemoprophylaxis for pregnant women at risk for delivering infants with GBS disease is the most effective strategy available for prevention of neonatal disease . Development of effective GBS vaccines may prevent GBS disease in both infants and adults . Ongoing surveillance for GBS disease is important for targeting preventive measures and determining their effectiveness.

Ugeskr Laeger, 1992 Nov 16, 154(47), 3309 - 12
{Prevention of pneumococcal infections in the elderly by vaccination}; Nielsen SV et al.; Streptococcus pneumoniae still causes serious infections especially in elderly people, despite relevant antibiotic treatment and intensive therapy . At present, Statens Serum-institut annually receives about 650 pneumococcal strains isolated from blood and cerebrospinal fluid for typing from the departments of Clinical Microbiology in Denmark . Of these strains about 55% were isolated from persons aged 60 years or older . The incidence of pneumococcal pneumonia in elderly people is said to be 4-8/1000 persons/year in countries similar to Denmark . In the USA, pneumococcal vaccination is recommended for groups at risk including immunocompetent adults > or = 65 years old . Since 1978, pneumococcal vaccine has been available in Denmark, where the only indication for vaccination has been and still is intended or already performed splenectomy in persons older than two years of age . According to the literature, the protective efficacy of vaccination of elderly persons is 60-70% . Since vaccination is, furthermore, without risks we believe that vaccination of elderly people in Denmark should be advised.

Am J Ophthalmol, 1992 Nov 15, 114(5), 584 - 8
Orbital cellulitis caused by Eikenella corrodens; Hemady R et al.; Eikenella corrodens is a gram-negative, facultative anaerobic bacillus with specific culture and growth requirements and unusual antibacterial susceptibilities . It has only recently been recognized as a human pathogen . Ocular and adnexal infections with this organism are rare especially in children . We treated two children with orbital cellulitis caused by E . corrodens . One was an 8-year-old boy; the other was an 11-year-old girl . Orbital cellulitis in both patients occurred after an upper respiratory tract infection . Sinusitis and a subperiosteal abscess were present in both patients . Eikenella corrodens and Streptococcus viridans were isolated from the boy; E . corrodens was the sole isolate in the girl . Intravenous ampicillin, prolonged hospitalization, and surgical drainage of the orbit were required to control the infection in both patients . Eikenella corrodens must be considered in the differential diagnosis of orbital cellulitis in children, and ophthalmologists must become familiar with the characteristics of this peculiar organism.

J Bacteriol, 1992 Nov, 174(22), 7328 - 36
The gene encoding a Prevotella loescheii lectin-like adhesin contains an interrupted sequence which causes a frameshift; Manch-Citron JN et al.; We cloned and sequenced the Prevotella loescheii gene plaA, which encodes a lectin-like adhesin that mediates the coaggregation of P . loescheii 1295 with Streptococcus oralis 34 . A probe derived from the N-terminal amino acid sequence of the purified adhesin was used to identify the plaA gene from a P . loescheii genomic library constructed in lambda GEM-11 . Sequence analysis of plaA indicates that the initial translation product contains a 22-amino-acid leader . The reading frame of the plaA gene is interrupted after amino acid 28 of the mature protein by a TAA termination codon . Amplification of the P . loescheii genomic DNA in the region surrounding this codon by the polymerase chain reaction followed by DNA sequencing of the cloned DNA fragment established that this stop codon was not an experimental artifact . A frameshift beginning 29 bp downstream of the ochre terminator was required to access the only large open reading frame in the gene . Amino acid sequences of six purified peptides derived by limited proteolysis of adhesin with endoproteinase Lys-C matched the downstream amino acid sequence derived by translation of the large open reading frame . The gene coding sequence of 2.4 kb contains sufficient information for the synthesis of an 89-kDa protein . A putative rho-independent terminator (delta G = -25.5 kcal/mol {ca . -107 kJ/mol}) was detected 38 bp downstream from the plaA stop codon.

Circulation, 1992 Nov, 86(5 Suppl), II68 - 74
Acute bacterial endocarditis . Optimizing surgical results; Larbalestier RI et al.; BACKGROUND . Acute bacterial endocarditis continues to be a condition with high morbidity . Although the majority of patients are treated by high-dose antibiotics, a high-risk patient group requires surgical intervention, which is the subject of this article . METHODS AND RESULTS . From 1972 to 1991, 3,820 patients underwent heart valve replacement at the Brigham and Women's Hospital, Boston . Of this group, 158 patients underwent surgery for acute bacterial endocarditis: 109 had native valve endocarditis (NVE), and 49 had prosthetic valve endocarditis (PVE) . There were 108 men and 50 women with a mean age of 49 years (range, 16-79 years); 64% were New York Heart Association functional class IV before surgery, and 12% of the group had a history of intravenous drug abuse . In both NVE and PVE groups, Streptococcus was the predominant infecting agent . Uncontrolled sepsis, progressive congestive failure, peripheral emboli, and echocardiographically demonstrated vegetations were the most common indications for surgery . Eighty-five percent of patients had a single-valve procedure, 15% had a multivalve procedure, and 34 patients had other associated major cardiac procedures . The operative mortality was 6% in NVE and 22% in PVE . Long-term survival at 10 years was 66% for NVE and 29% for PVE . Freedom from recurrent endocarditis at 10 years was 85% for NVE and 82% for PVE . The main factors associated with decreased survival overall were PVE and nonstreptococcal infection . CONCLUSIONS . The morbidity and mortality after surgical treatment of acute endocarditis depend on the site, the severity, and the subject infected . Early aggressive surgical intervention is indicated to optimize surgical results, especially in patients with nonstreptococcal infection or PVE.

Biochemistry, 1992 Nov 10, 31(44), 10741 - 6
Complete structure of the adhesin receptor polysaccharide of Streptococcus oralis ATCC 55229 (Streptococcus sanguis H1); Glushka J et al.; This report describes the determination of the complete primary structure of the adhesin receptor polysaccharide of Streptococcus oralis ATCC 55229 (previously characterized as Streptococcus sanguis H1), a Gram-positive bacteria implicated in dental plaque formation . The polysaccharide was isolated from S . oralis ATCC 55229 cells after deproteination, enzymatic hydrolysis, and ion exchange chromatography . It was shown to consist of rhamnose, galactose, glucose, glycerol, and phosphate, in molar ratios of 2:3:1:1:1 . Sequence and linkage assignments of the glycosyl residues were obtained by methylation analysis followed by gas-liquid chromatography and electron-impact mass spectrometry . 31P NMR spectroscopy revealed that phosphate was present in a diester, connecting glycerol to one of the galactosyl residues . High-performance liquid chromatography of a partial acid hydrolysate of the polysaccharide confirmed this finding by showing galactose 6-phosphate and glycerol 1-phosphate . The structural determination was completed by the combination of two-dimensional homonuclear Hartmann-Hahn and NOE experiments and heteronuclear {1H,13C} and {1H,31P} multiple-quantum coherence experiments . Thus, the adhesin receptor polysaccharide of S . oralis ATCC 55229 was found to be a polymer composed of hexasaccharide repeating units that contain glycerol linked through a phosphodiester to C6 of the alpha-galactopyranosyl residue and are joined end-to-end through galactofuranosyl-beta(1-->3)-rhamnopyranosyl linkages: {formula: see text} This structure is novel among bacterial cell surface polysaccharides in general and specifically among those implicated in dental plaque formation.

Gene, 1992 Nov 2, 121(1), 71 - 8
Cloning, sequencing and expression in Escherichia coli of the ptsI gene encoding enzyme I of the phosphoenolpyruvate:sugar phosphotransferase transport system from Streptococcus salivarius; Gagnon G et al.; We present the cloning and sequencing of the ptsI gene, encoding enzyme I (EI) of the phosphoenolpyruvate (PEP): sugar phosphotransferase (PTS) transport system from Streptococcus salivarius . The ptsI gene corresponds to an open reading frame of 1731 nucleotides, which translates into a putative 577-amino acid (aa) protein with a M(r) of 62,948 and a pI of 4.49 . The EI was produced in Escherichia coli under the control of its own promoter located immediately upstream of ptsI, a situation never previously reported for any other gene coding for an EI . The deduced aa sequence of the S . salivarius EI shows a high degree of similarity with the E . coli EI and the EI moiety of the multiphosphoryl transfer protein from Rhodobacter capsulatus . The S . salivarius EI also shares a highly conserved aa cluster with a non-PTS protein, the maize pyruvate:orthophosphate dikinase . The conserved cluster is located in a domain which is hypothesized to be the PEP-binding site.

Postgrad Med J, 1992 Nov, 68(805), 930 - 1
Streptococcus bovis endocarditis as a presenting manifestation of idiopathic ulcerative colitis; Moshkowitz M et al.; Streptococcus bovis bacteraemia and endocarditis have been associated with several gastrointestinal diseases, mainly malignant or potentially malignant tumours, and less commonly non-malignant gastrointestinal disorders . We describe a 73 year old man in whom Streptococcus bovis endocarditis developed, and was the presenting manifestation of undiagnosed quiescent ulcerative colitis . Such an association has not been described previously.

J Am Soc Nephrol, 1992 Nov, 3(5), 1092 - 7
Unusual causes of peritonitis in patients undergoing continuous peritoneal dialysis with emphasis on Listeria monocytogenes; Lunde NM et al.; Peritonitis remains a significant cause of morbidity in ESRD patients undergoing continuous ambulatory peritoneal dialysis (CAPD) . Staphylococcus species, Streptococcus species, and less commonly, gram-negative rods comprise the majority of isolated organisms . Other organisms, including unusual bacteria, fungi, and mycobacteria, comprise 5% or less of cases . Many of the uncommon causes of CAPD peritonitis have been reviewed, with special emphasis on antimicrobial therapy and whether catheter removal was required . The presumed third case of CAPD-associated peritonitis caused by Listeria monocytogenes is also described . In contrast to two other reported cases, our patient was not overtly immunosuppressed . L . monocytogenes infection should therefore be considered in CAPD patients with gram-positive rod peritonitis, even if immunocompetence is presumed.

J Laryngol Otol, 1992 Nov, 106(11), 1000 - 1
Acute peritonsillar abscess caused by Arcanobacterium haemolyticum; Barnham M et al.; A patient is reported with a peritonsillar abscess yielding Arcanobacterium haemolyticum . This appears to be only the fifth such case described in the medical literature and the first from Europe . The organism has been reported as an occasional cause of tonsillopharyngitis with rash, resembling infection with Streptococcus pyogenes but often unresponsive to penicillin therapy . A . haemolyticum easily passes unrecognized in bacteriological cultures as a result of its slow growth, coryneform appearance in the Gram's stain and weak haemolytic activity on conventional laboratory media.

APMIS, 1992 Nov, 100(11), 1015 - 21
Mucosal immunoreactivity in experimental pneumococcal otitis media; Svinhufvud M et al.; A rat model was used to investigate immunological events in the middle ear mucosa during pneumococcal acute otitis media (AOM) . Twelve healthy male Sprague-Dawley rats were challenged in the right middle ear with Streptococcus pneumoniae type 3, the presence of AOM being confirmed by otomicroscopy . Randomly selected rats, four at a time, were sacrificed on days 7, 14 and 56 after bacterial challenge . Immunohistochemical staining for IgG, secretory IgA (SIgA), and IgM was performed on tissue specimens from four separate locations in the middle ear and tubal mucosa . Immunoglobulins, especially IgG, were found around blood vessels in the middle ear mucosa . Immunoreactive lymphoid cells of all three Ig classes investigated, undetectable before bacterial challenge, appeared within 7-14 days after middle ear challenge, and the location of these cells in the middle ear mucosa suggests the presence of IgG, SIgA, and IgM, respectively . On the other hand, reactivity with anti-SIgA (but not with anti-IgG or anti-IgM) in Eustachian epithelial cells, and also in the subepithelial glands of tubal mucosa was present both before and after challenge . The results suggest that the middle ear mucosa is an immunoreactive site only after it has been activated with pathogens . In contrast, the tubal mucosa exhibits immunological activity also prior to the antigenic stimulation of present interest.

Eur Heart J, 1992 Nov, 13(11), 1592 - 3
Endocarditis on a left atrial myxoma; ten Berg JM et al.; A 55-year-old woman presented with fever and malaise . Three blood cultures were positive for Streptococcus sanguis . A diagnosis of endocarditis was made and the patient was treated with intravenous penicillin and gentamicin . Endocardiography revealed a large left atrial tumour . At operation a myxoma covered by deposits of fibrin was excised . Microscopy revealed massive infiltrates of neutrophils and remnants of bacteria, indicating that this myxoma was a nest for infection.

Ann Pediatr (Paris), 1992 Nov, 39(9), 583 - 7
{Neonatal streptococcus group B infection in Yaoundé (Cameroon) . Epidemiologic and clinical aspects}; Kago I et al.; This study was designed to investigate epidemiologic and clinical features of neonatal group B streptococcal infections . Sixty cases seen over a 60-month period were reviewed . Incidence was 0.8% of admissions . Most affected infants were from low-income families (86.7% of mothers were unemployed and 73.5% of homes were without running water) . Neonatal infection was delayed in most instances (76.67%) . Fetid vaginal discharge (60%) and premature rupture of the membranes (35%) were the main findings upon history taking . Abnormal body temperature regulation (76.7%) was the most prominent clinical manifestation . Respiratory distress developed in 25% of patients . Meningeal involvement occurred in 73.3% of patients . Serotype B III was recovered in 31 of the 34 cases (91%) in which serotype was determined . Mortality rate was 21.7% and permanent sequelae occurred in 8.3% of patients.

Anaesth Intensive Care, 1992 Nov, 20(4), 484 - 6
The incidence of bacteraemia following laryngeal mask insertion; Brimacombe J et al.; The incidence of bacteraemia following insertion of the laryngeal mask airway (LMA) was investigated in one hundred fit patients . Four cultures were positive: three represented contamination with skin flora; the other was a microaerophilic streptococcus grown from an anaerobic culture bottle . Although this organism can be pathogenic, it may also represent contamination . Our findings suggest that significant bacteraemia on insertion of the LMA is uncommon and is probably no more than with oral intubation . Antibiotic prophylaxis is of doubtful benefit in these circumstances.

Plasmid, 1992 Nov, 28(3), 272 - 6
Nucleotide sequence of the chloramphenicol resistance determinant of the streptococcal plasmid pIP501; Trieu-Cuot P et al.; We have sequenced the chloramphenicol resistance determinant (cat) of plasmid pIP501 from Streptococcus agalactiae to investigate its relationship with other cognate cat determinants . Sequence analysis revealed that it exhibits a high degree of similarity with the cat genes of plasmids pC221 and pUB112 from Staphylococcus aureus and pSCS1 from Staphylococcus intermedius . These genes, however, display several differences in their regulatory and coding regions . These results demonstrate that the cat determinant of plasmid pIP501 belongs to the pC221 subgroup of CAT variants.

FEMS Microbiol Lett, 1992 Nov 1, 77(1-3), 235 - 9
Binding of bovine lactoferrin to Streptococcus agalactiae; Rainard P; Bovine lactoferrin is an iron-binding protein present in mammary gland secretions . The exposure of Streptococcus agalactiae to bovine lactoferrin resulted in the binding of this protein to all the 12 strains of bovine origin tested, and also, although to a lesser degree, to the five tested strains of human origin . The interaction of lactoferrin with one high-binding bovine strain (24/60, the prototype NT/X strain) was studied . Binding was time-dependent, dose-dependent, and saturable . The binding of lactoferrin was slightly affected by cultivation conditions, and appeared to be heat-stable . The binding of biotinylated lactoferrin was inhibited by unlabelled lactoferrin but not by bovine serum albumin.

An Esp Pediatr, 1992 Nov, 37(5), 361 - 5
{High frequency ventilation in the newborn . Study of 27 cases}; Siles Quesada C et al.; The clinical histories of 27 neonates ventilated with high frequency respirators (Volumetric Diffusive Respirator VDR-2) have been analyzed in order to evaluate the efficiency of this type of ventilation in neonatal pathology . The average gestational age of these patients was 32 +/- 4 weeks . Most of them (70%) presented respiratory distress due to hyaline membrane disease . Of the remaining cases, three (11%) presented with congenital diaphragmatic hernia, two with pulmonary hypertension, two with meconium aspiration syndrome, one with Group B Streptococal sepsis/shock and one with case diaphragmatic agenesia . Between two and six hours after initiation of high frequency ventilation (HFV), pH, paCO2 and pO2 improved significantly in relationship to former values (p < 0.05- p < 0.001), reaching values in the normal range at 6.5 +/- 14 hours regarding pH, 30 +/- 50 hours regarding paCO2 and 6.5 +/- 10 hours regarding paO2 . No hemodynamic modification could be attributed to this procedure . The principal complications were ectopic air (62%) and necrotizing tracheobronchitis (TBN) (25%) . Bronchopulmonary dysplasia (BDP) was diagnosed in 20% of the cases, ductus (DAP) in 33% of the cases and intracraneal hemorrhage in 25% of the cases . Mortality was 70% . High frequency ventilation is an alternative procedure to conventional ventilation in this group of neonates . It produces an important number of favorable responses, but has complications that can not be overlookedPIP: Clinical records of 27 newborns treated with high frequency ventilation in a hospital neonatal service in Madrid were retrospectively studied . High frequency ventilation is a technique with specific indications that has recently been applied in some neonatal pathologies as an alternative to conventional ventilation . The respirators, model 2 Volumetric Diffusive Respirators, were used in 24 of the 27 cases because of failure of conventional ventilation . The 27 newborns weighed an average of 1850 +or- 944 g and ranged from 900 to 4000 g . Their average gestational age was 32 +or- 4 weeks, and the range was 26-42 weeks . 19 had respiratory difficulties stemming from hyaline membrane disease, 3 had congenital diaphragmatic hernias, 2 had pulmonary hypertension, and one each had meconium aspiration syndrome, septic shock from group B streptococcus, and diaphragmatic agenesia . 66% were delivered by cesarean . The pH, paCO2, and paO2 improved significantly between 2 and 6 hours after initiation of HFV treatment . Values in the normal range were reached at 6.5 +or- 14 hours for pH, 30 +or- 50 hours for paCO2, and 6.5 +or- 10 hours for paO2 . No hemodynamic modifications were attributed to HFV . The most significant complications were ectopic air (62%) and necrotizing tracheobronchitis (25%) . Broncopulmonary dysphasia was diagnosed in 20%, ductus in 33%, and intracraneal hemorrhage in 25% . The case fatality rate was 70% . Ten newborns improved definitively with HFV and proceeded to conventional ventilation . Two later succumbed to other causes . The study showed that HFV can lead to serious complications and should be applied with great prudence despite it great potential benefit .

Pediatr Infect Dis J, 1992 Nov, 11(11), 919 - 25
Comparative study of the effectiveness of cefixime and penicillin V for the treatment of streptococcal pharyngitis in children and adolescents; Block SL et al.; An open label randomized trial conducted in rural Kentucky compared the efficacy and safety of cefixime (CFX), 8 mg/kg once daily, with those of penicillin V (PEN), 250 mg 3 times daily, in 110 pediatric patients with Group A beta-hemolytic streptococcal pharyngitis . Forty-eight CFX and 47 PEN patients were evaluable for efficacy . At the end of therapy bacteriologic eradication was 45 of 48 (94%) and 36 of 47 (77%) in the CFX and PEN V groups, respectively (P < 0.05) . Up to 6 weeks posttherapy 10 (21%) CFX patients and 21 (45%) PEN patients had positive Group A beta-hemolytic Streptococcus cultures (P < 0.05) . Concordant serotypes were identified from 4 of 7 CFX and 15 of 17 PEN patients with positive repeat cultures . All discordant serotypes (5 of 31) were identified at greater than 19 days posttherapy . Symptomatic treatment failures (concordant serotypes) occurred in 1 (2%) CFX and 8 (17%) PEN patients (P < 0.05) . Drug-related adverse experiences consisted of 2 cases of mild diarrhea and loose stools in the CFX group and none in the PEN group . No clinically significant laboratory test abnormalities occurred in either group . CFX, once daily, was as safe as and significantly more effective than PEN given 3 times daily for the treatment of Group A beta-hemolytic streptococcal pharyngitis.

J Clin Pathol, 1992 Nov, 45(11), 1034 - 5
Pneumococcal endocarditis and disseminated infection; Heard SR et al.; A 61 year old woman presented with back pain and clinical signs of meningitis . Pleocytosis in the cerebrospinal fluid was found, but although Streptococcus pneumoniae was cultured from her blood it failed to grow from the cerebrospinal fluid . An echocardiogram detected vegetations on the mitral valve and a lesion at S1/S2 was demonstrated on a bone scan . Treatment for one month with benzylpenicillin (1200 mg four hourly) was successful for both the cardiac and neurological components of her infection, but her back pain only resolved after treatment was changed to clindamycin . The clinical presentation and metastatic spread of the S pneumoniae infection is much more commonly seen in the context of S aureus endocarditis . It is rare for the pneumococcus to be associated with endocarditis and when it is mortality is usually high . This case shows the metastatic potential of the organism and the requirement for appropriate antibiotics with regard not only to the sensitivity of the organism, but also for the site of infection.

J Clin Microbiol, 1992 Nov, 30(11), 2765 - 71
Seroprevalence of immunoglobulin M (IgM) and IgG antibodies to polysaccharides of Streptococcus pneumoniae in different age groups of Ecuadorian and German children; Brussow H et al.; The age-specific prevalence of serum immunoglobulin M (IgM) antibody to capsular polysaccharides of Streptococcus pneumoniae, as detected by enzyme-linked immunosorbent assay, was studied in 1,301 Ecuadorian children enrolled in a national nutrition and health survey . This prevalence was 6% in infants < 6 months old and increased to 28% in children 6 to 11 months old, 49% in those 12 to 17 months old, and 58% in those 18 to 23 months old . About 80% of the 5-year-old children had this antibody . When tested separately against six different capsular polysaccharides, serum IgM antibody reacted with decreasing frequency with serotype 3, 8, 19, 6, 23, and 1 capsular polysaccharides . We did not observe a broadening of the antibody response with increasing age in the sense that more and more serotypes were recognized . A similar age-related prevalence was found for IgM antibody to the species-specific C-polysaccharide of S . pneumoniae and for IgG antibody to capsular polysaccharides of S . pneumoniae . A smaller German serum collection showed a comparable age-related prevalence of pneumococcus-specific serum IgG and IgM antibodies . The highest incidence of respiratory diseases was observed in 1- and 2-year-old Ecuadorian children . It thus seems that acquisition of serum antibody to S . pneumoniae reflects more the developmental maturation of an immune response than an actual exposure to different pneumococcal serotypes.

J Pharm Sci, 1992 Nov, 81(11), 1126 - 31
Synthesis and antimicrobial properties of 2H-pyran-3(6H)-one derivatives and related compounds; Georgiadis MP et al.; The synthesis of several derivatives of 2H-pyran-3(6H)-ones and their Michael adducts is described . Phenylthio, benzenesulfonyl, p-acetylaminobenzenesulfonyl, and p-bromophenyl substituents are beneficial for activity against gram-positive bacteria . 2-{4-(Phenylthio)phenyl}-2-methyl-6-methoxy-2H-pyran-3(6H)-one (8a) showed a minimum inhibitory concentration of 1.56 micrograms/mL against Staphylococcus aureus ATCC 2593, and 2-{4-(phenylthio)phenyl}-2-methyl-6-{(p-nitrobenzoyl)oxy}-2H-pyran-3 (6H)-one (9) showed a minimum inhibitory concentration of 0.75 microgram/mL against Streptococcus sp . C203M . In general, derivatives of 6-hydroxy-2H-pyran-3(6H)-ones with substituents at C-2 and C-6 showed significant activity against gram-positive bacteria . More specifically, the bulkier the C-2 substituent, the greater the antibacterial activity . Michael adducts of thiols (13) showed activity, which may be due to a retro-Michael reaction . In conclusion, the alpha,beta-enone system is essential for the activity of 6-hydroxy-2H-pyran-3(6H)-ones, and the size and nature of substituents at C-2 are associated with antimicrobial activity.

Clin Infect Dis, 1992 Nov, 15(5), 794 - 8
Capsular types of Streptococcus pneumoniae isolated from blood and CSF during 1982-1987; Nielsen SV et al.; Knowledge about the type distribution of Streptococcus pneumoniae is fundamental to ensure an effective formulation of pneumococcal vaccine, especially with the possibility of producing a polysaccharide-protein-conjugated vaccine for the prevention of invasive disease in children . During the 6-year period 1982-1987, we received and typed 10,298 isolates from patients with invasive pneumococcal disease: 7,812 (76%) from blood and 2,486 (24%) from CSF . Of all isolates, 81% were recovered from individuals in Europe and 23% were from children . In order of frequency, S . pneumoniae types 6A + 6B, 14, 18C, 19F, 1, 7F, 23F, 19A, 4, and 5 were most commonly isolated from children, and types 3, 1, 14, 7F, 4, 6A + 6B, 8, 23F, 9V, and 19F, from adults . The pneumococcal types in the currently available 23-valent vaccine represented 87% of all isolates in this study, but the proportion of vaccine types varied somewhat with age and source . In all pneumococcal groups included in the vaccine, the vaccine types represented > 80% of the isolates, except in groups 6, 15, and 18.

Oral Surg Oral Med Oral Pathol, 1992 Nov, 74(5), 634 - 43
Bacterial microleakage of Cavit, IRM, and TERM; Deveaux E et al.; In this in vitro study, a model system was developed and tested to evaluate the sealing ability of temporary restorative materials used in endodontic access preparations . The materials studied, Cavit, IRM, and TERM, were tested on 40 premolars against a known bacterial species, Streptococcus sanguis . The leakage of bacterial cells was checked 4 and 8 days after initial immersion in the culture . Thermocycling was introduced on the fourth day . After 8 days the cement thicknesses were measured after the teeth had been longitudinally sectioned . Before and after thermocycling, IRM was less leakproof than Cavit (p < 0.05) and TERM (p < 0.05) . Thermocycling aggravated percolation in the case of IRM, and decreased the tightness of Cavit, whereas TERM remained leakproof . The thicknesses were as follows: Cavit, 3.73 mm; IRM, 3.45 mm; and TERM, 5.49 mm . There was no statistically significant relationship between thickness and tightness.

J Occup Med, 1992 Nov, 34(11), 1102 - 5
Streptococcus suis meningitis . A severe noncompensated occupational disease; Dupas D et al.; Meningitis caused by Streptococcus suis type 2, a rare disease first recognized in 1968 (108 cases worldwide in 1989), is contracted by occupational exposure to pigs and often results in very severe disabilities (definitive deafness and ataxia in 50% of cases) . We report the case of an employee in a rendering plant whose initial symptom was deafness . A detailed analysis of medical and veterinary literature is provided concerning the epidemiology of the disease, the clinical forms in man, bacteriological diagnosis and the role of the pig as healthy carrier . It is recommended that this occupational disease be officially recognized for compensation in France.

J Dent Res, 1992 Nov, 71(11), 1792 - 6
Effect of delmopinol on the cohesion of glucan-containing plaque formed by Streptococcus mutans in a flow cell system; Rundegren J et al.; Glucan-containing plaque was formed by Streptococcus mutans adhering to saliva-coated glass slides in flow cells thermostated at 37 degrees C . The substrate was Brain Heart Infusion broth containing 1% sucrose and 10% sterile saliva . During the build-up of the plaque, which lasted for 29 h, the plaque was subjected to three two-minute exposures to either 0.1 mol/L sodium acetate buffer, pH 6.0, or the same buffer containing 6.4 mmol/L (0.2%) of the surface-active anti-plaque substance delmopinol hydro-chloride . The glass slides carrying the plaque were weighed, and plaques subjected to delmopinol treatment weighed only seven percent of the control plaques . The glass slides were then mounted in a beaker containing buffer, subjected to ultrasonication, and re-weighed . The delmopinol-treated plaques lost 59% of their wet weight upon sonication, while the controls lost only 19% . Control plaques having the same weight as delmopinol-treated plaques were not different from the control plaques grown for 29 h with regard to reduction of plaque weight after sonication . Transmission electron micrographs (TEM) showed a plaque dominated by globular or fibrillar matrix components in controls, while the delmopinol-treated plaque showed empty or unordered matrix areas between more densely packed cells . The TEM results were confirmed by scanning electron micrographs, which showed amorphous material associated with the bacterial cells in the control but not in the delmopinol-treated plaque . In conclusion, delmopinol reduced surface-associated glucan synthesis and lowered the cohesion of the plaque, indicating that glucan-containing plaque formed during repeated rinsings with delmopinol may be easier to remove by mechanical means than a non-treated plaque of this type.

Infect Immun, 1992 Nov, 60(11), 4809 - 18
The platelet interactivity phenotype of Streptococcus sanguis influences the course of experimental endocarditis; Herzberg MC et al.; A strain of Streptococcus sanguis that induced rabbit platelets to aggregate in vitro (Agg+ phenotype) was hypothesized to be a more virulent pathogen than an Agg- strain in experimental endocarditis in rabbits . A left ventricular catheter was implanted, and then an Agg+ or Agg- strain was inoculated intravenously . Vegetations formed on the aortic semilunar valves but were unaffected by the duration of implantation of the catheter . Vegetations enlarged by accumulating platelets and their mass increased directly with the duration of endocarditis . Inoculation of the Agg+ strain consistently caused endocarditis with significantly larger vegetations, a more severe clinical course (including febrile episodes, hematological changes, and signs of myocardial ischemia), more gross lesions in major organs, and greater mortality than inoculation with the Agg- strain, saline, or the Agg+ strain pretreated with monospecific rabbit immunoglobulin G or Fab fragments against its platelet aggregation-associated protein (PAAP; class II) . In experimental endocarditis, PAAP expressed by Agg+ S . sanguis appeared to be an important virulence factor.

Infect Immun, 1992 Nov, 60(11), 4801 - 8
Opsonization of Streptococcus agalactiae of bovine origin by complement and antibodies against group B polysaccharide; Rainard P et al.; The contribution of bovine complement and antibodies (Ab) against the group B polysaccharidic antigen (GBA) to the opsonization of Streptococcus agalactiae isolated from bovine mastitis cases was investigated by using affinity-purified Ab . GBA-specific Ab were not opsonic by themselves, but in the presence of complement (precolostral calf serum) with an opsonization time of 15 min, they exhibited a dose-dependent opsonic activity in a polymorphonuclear leukocyte chemiluminescence assay . Kinetic studies of the deposition of complement component C3 on protein X-bearing nontypeable (NT/X) strains with an enzyme-linked immunosorbent assay showed that C3 was deposited on bacteria in the absence of Ab but that GBA-specific Ab markedly accelerated the process by reducing the lag phase, which extended up to 15 min when Ab were absent . In the absence of Ab, C3 deposition was inhibited by 5 mM salicylaldoxime or heat treatment at 56 degrees C for 3 min and necessitated Mg2+ ions but not Ca2+ ions, suggesting that activation of complement was effected by the alternative pathway only . When GBA-specific Ab were added to complement, the inhibitory treatments lost much of their efficacy, suggesting that the classical pathway was recruited . Deposition of C3 on NT/X strains in the absence of Ab induced chemiluminescence and phagocytic killing . With the addition of GBA-specific Ab, the numbers of surviving bacteria were halved (P < 0.05) compared with killing in the presence of complement alone . It can be concluded that NT/X strains are activators of the alternative pathway of complement and that GBA-specific Ab reinforce the opsonic efficiency of serum by recruiting the classical pathway and slightly enhancing phagocytic killing.

Infect Immun, 1992 Nov, 60(11), 4777 - 80
Purification and characterization of a peptide essential for formation of streptolysin S by Streptococcus pyogenes; Akao T et al.; Peptides in a pronase digest of bovine serum albumin were required for streptolysin S formation by Streptococcus pyogenes besides maltose and a carrier (the oligonucleotide fraction obtained by treatment of Saccharomyces cerevisiae RNA with RNase A) . A peptide essential for streptolysin S formation was purified to homogeneity from a pronase digest of bovine serum albumin by Sephadex G-25 column chromatography, and anion-exchange, reverse-phase, and gel filtration high-performance liquid chromatography . The purified peptide was divided into more than two peptides by HCOOOH oxidation and was composed of four residues of cysteine, three of leucine, and one each of aspartic acid and glutamic acid . Leucine and cysteine were detected as amino-terminal residues, and leucine and glutamic acid were detected as carboxyl-terminal residues, suggesting that two or three peptides are linked by a disulfide bond(s) . A disulfide bond structure in the peptide seemed to be required for streptolysin S formation.

Infect Immun, 1992 Nov, 60(11), 4491 - 5
Identification of proteases from periodontopathogenic bacteria as activators of latent human neutrophil and fibroblast-type interstitial collagenases; Sorsa T et al.; Activation of latent human fibroblast-type and neutrophil interstitial procollagenases as well as degradation of native type I collagen by supra- and subgingival dental plaque extracts, an 80-kDa trypsinlike protease from Porphyromas gingivalis (ATCC 33277), a 95-kDa chymotrypsinlike protease from Treponema denticola (ATCC 29522), and selected bacterial species commonly isolated in periodontitis was studied . The bacteria included were Prevotella intermedia (ATCC 25261), Prevotella buccae (ES 57), Prevotella oris (ATCC 33573), Porphyromonas endodontalis (ES 54b), Actinobacillus actinomycetemcomitans (ATCC 295222), Fusobacterium nucleatum (ATCC 10953), Mitsuokella dentalis (DSM 3688), and Streptococcus mitis (ATCC 15909) . None of the bacteria activated latent procollagenases; however, both sub- and supragingival dental plaque extracts (neutral salt extraction) and proteases isolated from cell extracts from potentially periodontopathogenic bacteria P . gingivalis and T . denticola were found to activate latent human fibroblast-type and neutrophil interstitial procollagenases . The fibroblast-type interstitial collagenase was more efficiently activated by bacterial proteases than the neutrophil counterpart, which instead preferred nonproteolytic activation by the oxidative agent hypochlorous acid . The proteases were not able to convert collagenase tissue inhibitor of metalloproteinase (TIMP-1) complexes into active form or to change the ability of TIMP-1 to inhibit interstitial collagenase . None of the studied bacteria, proteases from P . gingivalis and T . denticola, or extracts of supra- and subgingival dental plaque showed any significant collagenolytic activity . However, the proteases degraded native and denatured collagen fragments after cleavage by interstitial collagenase and gelatinase . Our results indicate that proteases from periodontopathogenic bacteria can act as direct proteolytic activators of human procollagenases and degrade collagen fragments . Thus, in concert with host enzymes the bacterial proteases may participate in periodontal tissue destruction.

EMBO J, 1992 Nov, 11(11), 3831 - 6
Relatedness of penicillin-binding protein 1a genes from different clones of penicillin-resistant Streptococcus pneumoniae isolated in South Africa and Spain; Martin C et al.; Penicillin-resistant strains of Streptococcus pneumoniae have been common in South Africa and Spain for several years . Multilocus enzyme electrophoresis identified one clone of capsular type 6B which was prevalent in Spain and another clone of type 23F that was present in both countries . Genes for penicillin-binding proteins (PBPs) in penicillin-resistant strains are often mosaics where parts of the pneumococcal genes are replaced by homologous genes from other species . We have compared the mosaic structures of the PBP 1a genes from the two clones as well as from genetically distinct South African isolates . Four classes of mosaic PBP 1a genes were found that contained blocks of sequences divergent by 6-22% from those of sensitive genes; two classes contained sequences coming from more than one external source . Data are presented showing that the PBP 1a genes from the 23F and the 6B clone are related, and that the two PBP 1a genes from the South African isolates are also related . We suggest that the type 23F clone originated in Spain prior to distribution into other continents.

J Dent Res, 1992 Nov, 71(11), 1797 - 802
Interactions of delmopinol with constituents of experimental pellicle; Steinberg D et al.; The prolonged retention of an effective chemotherapeutic agent on oral surfaces and in dental plaque aids in plaque control . The objective of this study was to investigate interactions between delmopinol, a morpholinoethanol derivative, and experimental pellicle . Hydroxyapatite beads were coated with different constituents of pellicle (e.g., saliva, carbohydrates, cell-free enzymes, and bacteria) . Delmopinol demonstrated a higher affinity for saliva-coated hydroxyapatite (sHA) and for experimental pellicle coated with in situ-synthesized glucans than for untreated hydroxyapatite . High-molecular-weight (MW) dextran but not low-MW dextran interfered with the adsorption of delmopinol to sHA . Delmopinol did not compete with dextran for the same binding sites on sHA, nor did it compete with saliva for the same binding sites on untreated hydroxyapatite . Delmopinol inhibited the activity of cell-free fructosyltransferase adsorbed onto sHA . In addition, synthesis of glucans by Streptococcus mutans adsorbed onto sHA was significantly reduced in the presence of delmopinol.

Infect Immun, 1992 Nov, 60(11), 4726 - 33
Characterization of an amylase-binding component of Streptococcus gordonii G9B; Scannapieco FA et al.; The goal of the present study was to begin characterizing the amylase-binding component(s) on the surface of Streptococcus gordonii G9B . Alkali extracts but not phenol-water extracts of this bacterium inhibited 125I-amylase binding to S . gordonii G9B . To identify the bacterial components involved in amylase binding, the alkali extract was subjected to affinity chromatography on amylase-Sepharose . Immunoblotting with a rabbit antiserum against S . gordonii G9B revealed that a 20-kDa streptococcal component was eluted from the amylase-Sepharose with 1% sodium dodecyl sulfate (SDS), 2 M KSCN, or 0.1 M sodium citrate buffer, pH 4.5 . Subsequently, the 20-kDa component was prepared from alkali extracts by electroelution from preparative SDS electrophoresis or by gel filtration chromatography . This component was trypsin sensitive, and an antibody raised against it inhibited the binding of 125I-amylase to S . gordonii G9B . Indirect immunofluorescence microscopy and immunogold electron microscopy demonstrated that both bound amylase and the 20-kDa component were localized to the cell division septum on dividing cells or to polar zones on single cells . In addition, exponentially growing bacteria bound more 125I-amylase than stationary-phase cells did . Collectively, these results suggest that a 20-kDa amylase-binding component is present on the surface of the nascent streptococcal cell wall.

Curr Microbiol, 1992 Nov, 25(5), 261 - 7
Purification and characterization of an aminopeptidase from Streptococcus mitis ATCC 903; Andersson C et al.; An aminopeptidase isolated from the cytoplasmic fraction of a cell extract of Streptococcus mitis ATCC 903 was purified 330-fold by ion-exchange chromatography, gel filtration, and hydroxyapatite chromatography . The partially purified enzyme had a broad substrate specificity . Twelve aminoacyl-beta-naphthylamide substrates were hydrolyzed and also several di-, tri-, tetra-, and pentapeptides and bradykinin . The enzyme hydrolyzed arginine-beta-naphthylamide at the highest rate . Optimal conditions for activity were at pH 7.0-7.2 and at 37-40 degrees C . The molecular weight of the enzyme was estimated to be 93,000 . The enzyme was activated by Co2+ ions . Hg2+ inhibited the activity completely . SDS, EDTA, urea, and pCMB also inhibited activity . Inhibition by EDTA could be completely reversed by dialysis and addition of Co2+ ions . Reducing agents, sodium fluoride, and PMSF had no effect on the activity of the enzyme . The isoelectric point of the enzyme was at pH 4.3 . High substrate concentrations inhibited activity . Substrate inhibition increased in the presence of high concentrations of Co2+ ions.

J Biotechnol, 1992 Nov, 26(2-3), 213 - 29
Process development for the recovery and purification of recombinant protein G; Lee SM et al.; The domains of protein G from streptococcus which bind immunoglobulin G have been cloned and expressed in Escherichia coli (Fahnestock et al., 1986) . Because protein G binds to several animal immunoglobulin G's, it has many immunochemical applications . This report describes process development for large-scale production of this recombinant protein G (also known as GammaBind G) . In 200 l cultures of E . coli, this protein G variant was released from the cell into the culture medium by heating at 80 degrees C for 10 min . The concentration was monitored by either a competitive enzyme-linked immunoassay or a liquid chromatographic assay . Cross-flow microfiltration with 0.22 micron membrane was used to remove the cells . The protein G-rich permeate from the cross-flow microfilter was purified by affinity chromatography using a 5 l column of IgG-Sepharose 6 Fast Flow, which yielded 16-18 g of protein G per column cycle . The pools of purified protein G were concentrated and desalted using ultrafiltration . The salt-free protein G was then lyophilized as bulk product . The overall recovery through the entire process was 50-64% . The analysis of the final product included sodium dodecyl sulfate polyacrylamide gel electrophoresis, UV-visible spectrum, high performance gel filtration, endotoxin level and binding efficiency to human IgG Sepharose.

J Hosp Infect, 1992 Nov, 22 Suppl A, 51 - 9
Community-acquired pneumonia; Meyer RD et al.; The aetiology of community-acquired pneumonia is reviewed, and the identification of the most likely pathogens, based on clinical presentation, is discussed . By far the major pathogen in community-acquired pneumonia is Streptococcus pneumoniae; the relative frequency of other pathogens, and particularly the atypical pneumonias caused by Mycoplasma and Legionella spp., will depend on local epidemiological factors . The diagnostic tests to confirm diagnosis and subsequent treatment of these infections are reviewed.

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1992 Nov, 25(4), 276 - 84
In vitro postantibiotic effect of roxithromycin and erythromycin against gram-positive cocci; Chang JC et al.; A persistent suppression of bacterial growth following a brief exposure to an antibiotic (postantibiotic effect {PAE}) has been described for a variety of antibiotics and microorganisms . Data concerning PAE have not yet been demonstrated in Taiwan . In this study, the PAEs of erythromycin (EM) and roxithromycin (RXM) against 4 strains of Staphylococcus aureus, 3 of Streptococcus pyogenes and 1 of Streptococcus pneumoniae were tested . Dilution method was used for removal of drugs . Two controls, one free of drug and one in 1/1000 of the original drug concentrations were used . The results showed that the PAE lasted longer in strains of S . aureus (RXM 1.7-2.1 h; EM 1.7-2.1 h) and S . pyogenes (RXM 1.7-3.0 h; EM 1.9-2.9 h) than those in S . pneumoniae (RXM 0.6-1.6 h; EM 0.8-1.4 h) . There was no difference of PAE between RXM and EM against each bacterial strain tested.

Int J Prosthodont, 1992 Nov-Dec, 5(6), 563 - 7
Disinfection of irreversible hydrocolloid impressions: a comparative study; McNeill MR et al.; This paper demonstrates the potential for cross contamination with bacteria and viruses from impression materials and evaluates the efficacy of four disinfection systems on irreversible hydrocolloid impressions contaminated with Streptococcus sanguis or poliovirus . An irreversible hydrocolloid impression was made of a contaminated acrylic resin template . The impression was disinfected and residual microorganisms were harvested by sonication, cultured, and counted . The results showed that the impression material could act as a vehicle for the transfer of both bacteria and viruses . Further, the virus was shown to be present in the body of the impression and under certain conditions may evade decontamination.

J Periodontal Res, 1992 Nov, 27(6), 609 - 14
Periodontal bone loss in Porphyromonas gingivalis-infected specific pathogen-free rats after preinoculation with endogenous Streptococcus sanguis; Fiehn NE et al.; Anaerobic Gram-negative bacteria dominate in periodontitis locations, while Gram-positive bacteria characterize healthy sites . A well-established Gram-positive flora might therefore inhibit the colonization of Gram-negative pathogens . The purpose of the present investigation was to examine whether endogenous S . sanguis could prevent, or reduce, periodontal bone loss in rats infected with a virulent P . gingivalis strain . Sixty specific pathogen-free Wistar rats were divided into 6 groups . Doxycycline was administered in the drinking water for 2 weeks to the groups A, B, C, and D to suppress the preexisting microflora in the mouth . Rats in groups A and C were subsequently inoculated with an S . sanguis strain, isolated from one of the rats, once a day for 5 d . Infection with P . gingivalis 381 was then carried out for 5 d in groups A, B, and E . Group F was not treated with doxycycline nor infected with bacteria and served as untreated control . Six weeks after the P . gingivalis inoculation, the rats were killed . Periodontal bone levels were assessed radiographically and morphometrically, and serum antibody against P . gingivalis 381 was determined by a fluorescence immunoassay . Periodontal bone support, determined radiographically, was reduced in group B (doxycycline-treated, P . gingivalis-inoculated) compared with the other groups . In contrast, the morphometric determination showed no differences between the groups . In group B antibody levels against two different P . gingivalis 381 cell surface antigens were significantly elevated.(ABSTRACT TRUNCATED AT 250 WORDS)

Zhonghua Kou Qiang Yi Xue Za Zhi, 1992 Nov, 27(6), 326 - 9, 384
{Detection of DNA G+C mol% in taxonomy of Streptococcus mutans by means of high performance liquid chromatography}; Ling JQ; In the present study, DNA G+C mol% of 9 strains of bacteria (including 7 international standard strain, Ingbritt, and 2 other strains extracted in our Lab) were detected with application of High Performance Liquid Chromatograph . The results showed that DNA G+C content of S . mutans was 35-40%, S . sobrinus was 45-46%, S . cricetus was 38%, and S . rattus was 41% . The difference between S sobrinus and S . mutans was higher than 5%, which suggested that S . sobrinus should be identified as an independent classification unit of bacterial species from S . mutans.

Res Immunol, 1992 Nov-Dec, 143(9), 919 - 25
Detection of autologous antiidiotypic antibody-forming cells by a modified enzyme-linked immunospot (ELISPOT); Nicoletti C et al.; We describe here the utilization of a modified enzyme-linked immunospot assay (ELISPOT) in order to detect an autologous antiidiotypic response in mice at the level of single antibody-forming cells (AFC) . Severals assays have been routinely used to detect anti-Id producing cells; however, these approaches often produce contrasting data . We present results obtained with the modified ELISPOT, using as a model system the antiidiotypic response in mice after immunization with a vaccine from Streptococcus pneumoniae R36a, expressing the immunodominant epitope phosphorylcholine (PC) . The response to PC is mediated by a large fraction of antibodies bearing the public idiotype T15 . Mice of different genetics make up were immunized with a single injection of the vaccine . We observed that one mouse strain (D1.LP) out of three was able to mount a significant anti-T15 response during the primary anti-phosphorylcholine response . BALB/c and C57BL/6 mice did not produce significant levels of anti-T15 antibody following a single injection of the antigen . In contrast, BALB/c mice which were repeatedly stimulated showed a specific anti-Id response . Experimental controls were performed using either specific anti-T15 monoclonal antibodies (mAb) or splenocytes from mice immunized with TEPC15 myeloma protein in complete Freund's adjuvant.

Immunobiology, 1992 Nov, 186(5), 435 - 48
Cytokine production by murine cells activated by erythrogenic toxin type A superantigen of Streptococcus pyogenes; Muller-Alouf H et al.; The mode of pathogenic action of the Steptococcus pyogenes superantigen erythrogenic toxin type A (ETA) in causing toxic shock-like syndrome in humans is thought to be mediated by massive release of cytokines by patients immune cells . The cytokine-inducing capacity of ETA as an extracellular protein was compared with that of lipopolysaccharide (LPS), a component of cell wall of gram-negative bacteria . Peritoneal macrophages and splenocytes of BALB/c and C3H/HeJ mice were stimulated by ETA and LPS . Tumor necrosis factor (TNF), interleukin 3 (IL-3) and interleukin 6 (IL-6) activities in the supernatants of stimulated cells were evaluated . In contrast to LPS, ETA induced only low amounts of IL-6 and no detectable TNF activities in peritoneal macrophage supernatants . ETA-triggered BALB/c and C3H/HeJ splenocytes produced great amounts of IL-6 . ETA triggered the production of IL-3 by both mice strains splenocytes in a dose dependent manner . The amounts of IL-3 in supernatants were comparable to those induced by concanavalin A . The simultaneous presence of ETA and LPS in macrophage and splenocyte cultures induced a slight enhancement above an additive value after 72-96 h . Challenge of BALB/c mice with ETA 6 h before the harvest of peritoneal macrophages led to an enhanced production of IL-6 upon stimulation with ETA as well as with LPS . Splenocytes of nude BALB/c mice did not produce IL-6 upon stimulation with ETA, whereas LPS-induced IL-6 production was similar in these mice and in their littermates . The pathogenic effect of ETA on host's immune cells could most likely be explained as a consequence of T cell activation . The results confirm also that LPS- and ETA-induced shock is mediated by different cell types.

Nature, 1992 Oct 22, 359(6397), 752 - 4
Crystal structure of a streptococcal protein G domain bound to an Fab fragment; Derrick JP et al.; Protein G is a cell-surface protein from Streptococcus which binds to IgG molecules from a wide range of species with an affinity comparable to that of antigen . The high affinity of protein G for the Fab portion of IgG poses a particular challenge in molecular recognition, given the variability of heavy chain subclass, light chain type and complementarity-determining regions . Here we report the crystal structure of a complex between a protein G domain and an immunoglobulin Fab fragment . An outer beta-strand in the protein G domain forms an antiparallel interaction with the last beta-strand in the constant heavy chain domain of the immunoglobulin, thus extending the beta-sheet into the protein G . The interaction between secondary structural elements in Fab and protein G provides an ingenious solution to the problem of maintaining a high affinity for many different IgG molecules . The structure also contrasts with Fab-antigen complexes, in which all contacts with antigen are mediated by the variable regions of the antibody, and to our knowledge provides the first details of interaction of the constant regions of Fab with another protein.

J Biol Chem, 1992 Oct 15, 267(29), 21105 - 11
Identification of N-acetylneuraminyl alpha 2-->3 poly-N-acetyllactosamine glycans as the receptors of sialic acid-binding Streptococcus suis strains; Liukkonen J et al.; Streptococcus suis is a common cause of sepsis, meningitis, and other serious infections in young piglets and also causes meningitis in humans . The cell-binding specificity of sialic acid-recognizing strains of Streptococcus suis was investigated . Treatment of human erythrocytes with sialidase or mild periodate abolished hemagglutination . Hemagglutination inhibition experiments with sialyl oligosaccharides indicated that the adhesin preferred the sequence NeuNAc alpha 2-3Gal beta 1-4Glc(NAc) . Resialylation of desialylated erythrocytes with Gal beta 1-3(4)GlcNAc alpha 2-3-sialyltransferase induced a strong hemagglutination, whereas no or only weak hemagglutination was obtained with cells resialylated with two other sialyltransferases . Binding of radiolabeled bacteria to blots of erythrocyte membrane proteins revealed binding to the poly-N-acetyllactosamine-containing components Band 3, Band 4.5, and polyglycosyl ceramides and to glycophorin A . The involvement of glycophorin A as a major ligand was excluded by the strong hemagglutination of trypsin-treated erythrocytes and En(a-) erythrocytes defective in glycophorin A . Sensitivity of the hemagglutination toward endo-beta-galactosidase treatment of erythrocytes and inhibition by purified poly-N-acetyllactosaminyl glycopeptides indicated that the adhesin bound to glycans containing the following structure: NeuNAc alpha 2-3Gal beta 1-4GlcNAc beta 1-3Gal beta 1-.

Cell Immunol, 1992 Oct 15, 144(2), 332 - 46
A study of autologous anti-idiotypic antibody-forming cells in mice of different ages and genetic backgrounds; Nicoletti C et al.; Antibody response to phosphorylcholine, an immunodominant epitope of Streptococcus pneumoniae R36a (Pn), is characterized by a public idiotype, T15, that is expressed on a large proportion of antibody molecules produced by all mouse inbred strains . The ability of the immune system to produce an autologous antibody to T15 upon immunization with Pn vaccine was investigated using a modified ELISA plaque assay for detection of single antibody-forming cells (AFC) . The limit of ELISA assay for detection of specific anti-T15 AFC is approximately 300 cells/spleen . However, our studies failed to detect any autologous anti-T15 AFC in the course of the primary antibody response to Pn vaccine in young/adult (2-4 months) BALB/c and C57BL/6 mice . Aged mice (20-22 months) also failed to develop any specific auto-anti-T15 AFC upon the primary Pn immunization, despite the fact that the anti-Pn response in these animals changes both quantitatively and qualitatively . In order to generate specific anti-T15 AFC, BALB/c mice had to be immunized repeatedly with Pn vaccine (four weekly injections) or immunized directly with T15 protein in CFA . Different results were obtained with D1.LP mice that are low responders to Pn and express lower levels of T15 Id as compared to BALB/c . Young D1.LP mice produced high numbers of auto-anti-T15 AFC of both IgM and IgG isotypes following a single immunization with Pn vaccine . The kinetics of auto-anti-T15 response in D1.LP mice was similar to that of the antigen-specific response . These results demonstrate that the ability of the immune network to produce autologous antibody to a shared Id depends on the genetic makeup of the host, and that this response may be regulated by the level of Id expression.

Oral Microbiol Immunol, 1992 Oct, 7(5), 309 - 14
Reduced nicotinamide adenine dinucleotide oxidase involvement in defense against oxygen toxicity of Streptococcus mutans; Higuchi M; The growth inhibition of the Streptococcus mutans group, including Streptococcus mutans, Streptococcus cricetus, Streptococcus rattus and Streptococcus sobrinus, on glucose by oxygen and the properties of reduced nicotinamide adenine dinucleotide (NADH) oxidase induced by oxygen, using a representative oxygen-tolerant strain, were examined . The growth response to oxygen varied among strains and correlated with the level of NADH oxidase activity in the cell extract . The induced synthesis of NADH oxidase as well as superoxide dismutase was affected by oxygen tension and energy sources . The induced NADH oxidase involved at least two types, major H2O-forming NADH oxidase and minor H2O2-forming NADH oxidase activity . In the presence of a scavenger of H2O2, pyruvate, the growth inhibition by oxygen in an oxygen-sensitive strain (GS5) was protected but not in another oxygen-sensitive strain (MT8148) . The high level of induced H2O-forming NADH oxidase activity protected against oxygen toxicity.

Avian Dis, 1992 Oct-Dec, 36(4), 916 - 25
Experimental Streptococcus bovis infections in pigeons; De Herdt P et al.; Thirty pigeons were experimentally infected with Streptococcus bovis using an intravenous infection model . Ninety percent of the inoculated pigeons developed clinical disease . Disease signs included acute death, inability to fly, lameness, inappetence, emaciation, polyuria, and the production of slimy, green droppings . At necropsy, the septicemic character of the disease was evident . Typical lesions included extensive well-circumscribed areas of necrosis in the pectoral muscle, tenosynovitis of the tendon of the Musculus pectoralis profundus, and arthritis of the stifle, tibiotarsal, or shoulder joints . Focal myocardial necrosis also was seen . Meningitis and encephalitis occurred in the cerebrum and the cerebellum . Disease signs and lesions described here after experimental infection were similar to those in naturally occurring cases of S . bovis septicemia.

Mol Microbiol, 1992 Oct, 6(20), 2939 - 49
Gene disruption identifies a 290 kDa cell-surface polypeptide conferring hydrophobicity and coaggregation properties in Streptococcus gordonii; McNab R et al.; The C-terminal coding region of the gene (denoted cshA) encoding a high-molecular-mass (290 kDa) cell-surface polypeptide in the oral bacterium Streptococcus gordonii was cloned and sequenced . Insertion of ermAM into the S . gordonii chromosome at the 3' end of the coding region of cshA led to the production of isogenic mutants that secreted a truncated form (260 kDa) of the CshA polypeptide into the growth medium . Mutants had reduced cell-surface hydrophobicity and were impaired in their ability to coaggregate with oral actinomyces . The results identify a carboxyl terminus-anchored cell-surface protein determinant of hydrophobicity and coaggregation in S . gordonii.

Rev Esp Cardiol, 1992 Oct, 45(8), 545 - 8
{Supravalvular aortic stenosis and coronary aneurysm}; Martinez Sande JL et al.; A 32-year old woman, with endocarditis caused by Streptococcus mitis, and systolic murmur is presented . The Doppler examination was found a systolic gradient of 150 mmHg . Aortography showed a multiple membranous supravalvular aortic stenosis, with aneurysmal dilatation of the left main coronary artery and circumflex artery, associated with bicuspid aortic valve and mild aortic insufficiency . The patient died suddenly by cardiac arrest in stand by to cardiac surgery . Anatomic comprobation was not possible . The coronary artery anomalies associated with the supravalvular aortic stenosis syndrome are reviewed.

Aust N Z J Med, 1992 Oct, 22(5), 473 - 6
Streptococcus pneumoniae: how common is penicillin resistance in Australia?
Collignon PJ, Bell JM.
Streptococcus pneumoniae in the past were uniformly susceptible to penicillin . Increasing levels of resistance are now seen worldwide . To define the prevalence of this resistance in Australia, a collaborative study was carried out on all pneumococcal isolates at 15 large metropolitan teaching hospitals . During 1989 details of results of penicillin testing using routine methods were recorded . Isolates found resistant to penicillin were forwarded to Woden Valley Hospital for determination of penicillin minimum inhibitory concentration (MIC) . All invasive isolates from five of these hospitals were also forwarded during 1989 and 1990 for MIC testing . Of the 1822 isolates tested, 31 (1.7%) were recorded as penicillin resistant . However, only 16 of 22 resistant isolates forwarded for MIC testing had MICs of > or = 0.1 mg/L confirmed . After adjustment to account for discrepancies with different laboratory testing methods we calculated the likely penicillin resistance to be 1% of isolates . Two of 105 invasive strains tested were found to be penicillin resistant . We conclude that penicillin-resistant S . pneumoniae isolates, including isolates from invasive sites, are found in Australia . All of these isolates had an MIC between 0.1 and 1 mg/L and are thus regarded as 'intermediately' penicillin resistant isolates . No high level resistance (MIC > or = 2 mg/L) was observed . Ongoing surveillance is essential to detect changes in resistance patterns and prevalence, as this will have implications for the empiric treatment of serious disease caused by S . pneumoniae.

Antimicrob Agents Chemother, 1992 Oct, 36(10), 2176 - 84
Analysis of multiply antimicrobial-resistant isolates of Streptococcus pneumoniae from the United States; McDougal LK et al.; Streptococcus pneumoniae isolates resistant to penicillin, chloramphenicol, tetracycline and sulfamethoxazole-trimethroprim are being recovered with increasing frequency in the United States . We analyzed the penicillin-binding proteins (PBPs), multilocus enzyme electrophoresis (MLEE) genotypes, and ribotypes of 22 multiresistant serotype 23F isolates of S . pneumoniae from the United States and 1 isolate each from Spain and South Africa . Also included were seven multiresistant isolates of other serotypes, three penicillin-resistant but chloramphenicol-susceptible serotype 23F isolates, and two penicillin-susceptible isolates (one penicillin-susceptible isolate was serotype 23F) . Fifteen of the 22 multiresistant isolates from the United States and the isolates from Spain and South Africa had identical PBP patterns, MLEE profiles, and ribotypes . Six of the remaining seven multiresistant isolates were related by PBP pattern, but demonstrated slightly different MLEE and/or ribotype profiles, possibly because of acquisition of additional resistance markers (four of the six isolates were also resistant to erythromycin) . The remaining multiresistant serotype 23F isolate had a unique PBP pattern and ribotype and was only distantly related to the other pneumococcal isolates by MLEE analysis . The PBP patterns, MLEE profiles, and ribotypes of the multiresistant serotype 23F isolates were easily distinguished from those of six multiresistant isolates of other serotypes; three other penicillin-resistant, chloramphenicol-susceptible, serotype 23F isolates; and two penicillin-susceptible isolates . One exception was a multiresistant serotype 19A isolate that was highly related to the clonal group by PBP pattern and MLEE analysis and that had a ribotype similar to those of the other erythromycin-resistant serotype 23F isolates . MLEE analysis and ribotyping were more discriminating than were the PBP patterns in discerning strain differences . These data strongly suggest that a multiresistant clone of S . pneumoniae serotype 23F that is related to multiresistant isolates from Spain and South Africa has become disseminated in the United States . Clinicians should be alerted to the spread of these multiresistant strains in the United States.

Alcohol Clin Exp Res, 1992 Oct, 16(5), 846 - 51
Modification of resistance to Streptococcus pneumoniae by dietary ethanol, immunization, and murine retroviral infection; Darban H et al.; Hallmarks of the acquired immune deficiency syndrome (AIDS) are immunologic alterations, frequently associated with opportunistic infections . To study such associations, LP-BM5 murine retrovirus infection was used as a murine model of AIDS . Retrovirally infected and uninfected mice were fed a 5% (v/v) ethanol diet for 55 days and then fed a 7% v/v ethanol diet for the final 7 days to assert the role of ethanol as a cofactor in development of murine AIDS . There was a reduction in polymorphonuclear neutrophils count in ethanol-fed groups . Neutrophils increased in retrovirus-infected groups, except those vaccinated 10 days before challenge with live bacteria . The percentage of splenic lymphocytes in the retrovirus-infected group was reduced in comparison with controls . Survival of the mice challenged intraperitoneally with Streptococcus pneumoniae was increased by vaccination and suppressed by dietary alcohol . Retrovirus infection caused a much faster death rate after bacterial challenge than nonretrovirus infected controls . Vaccination played an important role in delaying the death rate in all treated groups . Transferring spleen cells from healthy, unimmunized mice also enabled the retrovirally infected mice to survive the bacterial infection longer . Enhancement of resistance to S . pneumoniae by vaccination and transfer of immunocompetent cells to mice immunosuppressed by retroviral infection show the potential to use immunomodulation to affect disease resistance in AIDS.

Nippon Ganka Gakkai Zasshi, 1992 Oct, 96(10), 1286 - 9
{Antibody titer to streptococcal and staphylococcal L-form in Behçet's disease and other uveitis}; Namba K et al.; The antibody titer in serum to Streptococcus pyogenes L-form and Staphylococcus aureus L-form were determined by enzyme-linked immunosorbent assay in 28 patients with Behcet's disease, 31 patients with other uveitis (sarcoidosis: 10, Harada's disease: 5, tuberculosis: 4, rheumatoid arthritis: 4, lues: 2, juvenile rheumatoid arthritis: 2, herpes simplex: 2, trauma: 2) and 16 healthy normal controls . All L-forms were induced by the penicillin disk method . The antibody titer to Streptococcus pyogenes L-form in Behcet's disease was lower than that of other cases of uveitis and controls, and showed significant differences between controls, rheumatoid arthritis, sarcoidosis, tuberculosis and Harada's disease by the Student's t-test . The antibody titer to Staphylococcus aureus L-form in Behcet's disease showed no difference between controls and other cases of uveitis . In each uveitis and controls, and between active and inactive stages of all uveitis, there were no differences between titers . In Behcet's disease, antibody formation to Streptococcus pyogenes L-form may be specifically disturbed.

Acta Paediatr Jpn, 1992 Oct, 34(5), 516 - 24
Possible role of Streptococcus pyogenes in mucocutaneous lymph node syndrome . XV . Potential utility of streptococcal pyrogenic exotoxin toxoid for the prophylaxis and treatment of MCLS; Akiyama T et al.; Mice made tolerant to streptococcal pyrogenic exotoxin (SPE) by neonatal inoculation with SPE emulsified in incomplete Freund's adjuvant demonstrated early thrombocytopenia followed by thrombocytosis . This state is the perfect counterpart of patients with mucocutaneous lymph node syndrome (MCLS) . We have hypothesized that by inducing tolerance to SPE, the biological activities of the toxin might play leading roles in the pathogenesis of MCLS . In the present investigations, the efficacy of SPE on the prophylaxis and treatment of diseases caused by Streptococcus pyogenes (including MCLS) were monitored using the murine model system accompanied with a platelet-counting technique . The mice, rendered tolerant due to neonatal SPE inoculation and followed by immunization with SPE toxoid about 1 month prior to the provocative injections with SPE, demonstrated an almost complete lack of response to the provocation, keeping platelet counts within the normal range of values (except for a marginally significant thrombocytosis 7 days postprovocation) . Moreover, anti-SPE titers of the sera from the mice sacrificed on day 35, at which point the observation was terminated, were proved to be markedly elevated when compared with controls . These findings seem to suggest that immunization with the toxoid could overcome tolerance, resulting in the production of an antitoxin . In a second experiment that examined the effect of administration with rabbit antiserum raised against the toxoid, the antiserum-treated mice demonstrated a transitory thrombocytosis on 7 days postprovocation with SPE, followed by an abrupt decrease in the number of platelets from day 10 onward.(ABSTRACT TRUNCATED AT 250 WORDS)

Otolaryngol Head Neck Surg, 1992 Oct, 107(4), 537 - 48
Early mucosal changes in experimental sinusitis; Hinni ML et al.; Normal mucociliary flow is a significant defense mechanism in the prevention of acute sinusitis . We have undertaken a study to examine the early sinus mucosal and mucociliary changes that occur in response to acute infection . Twenty rabbits were evaluated for 5 days after an obstructed maxillary sinus was inoculated with either Streptococcus pneumoniae, Hemophilus influenzae, Pseudomonas aeruginosa, or a sterile saline solution . Data collected included measurements of sinus mucosal ciliary beat frequency, quantitation of ciliated cell losses, and electron microscopic observations . Results demonstrate statistically significant (p < 0.05) changes in mucosal ciliary beat frequency that were either excitatory or inhibitory, depending both on the length of the infection and the specific organism . No changes in ciliary beat frequency were observed in the control animals (p > 0.55) . Control animals likewise demonstrated no loss of ciliated cells from mucosal epithelium; however, dramatic losses of ciliated cells from the sinus mucosa of the experimental groups were observed . These losses occurred at different rates, depending on the infecting organism, but all infected groups demonstrated a > 86% decrease in the number of viable ciliated cells from the sinus mucosa after sinusitis of 5 days duration . We conclude that a significant loss of ciliated cells from sinus mucosa and a corresponding disruption of normal mucociliary flow occurs early after exposure to pathogenic organisms and is a significant predisposing factor in the development of acute sinusitis.

Mikrobiyol Bul, 1992 Oct, 26(4), 307 - 13
{Penicillin resistance in Streptococcus pneumoniae strains}; Tunckanat F et al.; In this study a total of 87 Streptococcus pneumoniae strains were tested for their susceptibility to penicillin with disk diffusion method by using 5 micrograms methicillin disks . In 68 strains susceptibility to penicillin was also determined by using agar dilution method performed in Mueller-Hinton agar supplemented with 5% sheep blood . Of 63 adult isolates tested with disk-diffusion method 35 strains (55.6%) were susceptible to penicillin, 24 strains (38.1%) had low level resistance and 4 strains (6.3%) had high-level resistance to penicillin . Of 24 S . pneumoniae isolates recovered from children 5 (20.8%) were penicillin susceptible, while 11 (45.8%) had low level resistance and 8 (33.4%) had high level resistance to penicillin . These values were 40 (45.9%), 35 (40.3%) and 12 (13.8%) in total isolates respectively . Of 44 isolates in which MIC values of penicillin were determined by agar dilution method, 34 strains (77.3%) were penicillin susceptible and 10 strains (22.7%) had low level resistance while none of these strains had high level resistance to penicillin . Of 24 children isolates tested with agar dilution method 11 strains (45.8%) were susceptible to penicillin, 8 strains (33.4%) showed low level resistance and 5 strains (20.8%) showed high level resistance to penicillin . For total of 68 isolates these values were 45 (66.1%), 18 (26.4%) and 5 (7.3%) respectively . These findings indicate the need to perform antibiotic susceptibility testing of all pneumococcal isolates to avoid therapeutic failure.

J Vet Med Sci, 1992 Oct, 54(5), 871 - 4
Clinicopathology of meningoventriculitis due to Streptococcus bovis infection in neonatal calves; Seimiya Y et al.; Three neonatal calves ranging in age from 4 to 14 days were examined pathologically and bacteriologically . The calves showed depression, anorexia, pyrexia, and difficulty or inability to stand followed by cloudiness of the ocular aqueous humor or cornea . Autopsy revealed congestion, petechiae, and cloudy areas in the meninges . Histologically, the central nervous system (CNS) lesions were prominent and limited to the meninges where fibrinous exudate and infiltrations of neutrophils, macrophages, and lymphocytes were present . There were mild or slight degrees of choroid plexitis and ependymitis . Endophthalmitis was seen as a concurrent lesion in all cases . Fibrinous or fibrinopurulent changes were found in the peritoneum and epicardium as well as in several other organs . Numerous Gram-positive cocci were detected in affected areas of the whole body . Bacteriologically, Streptococcus bovis was isolated from all examined materials consisting of the brain, cerebrospinal fluid, ocular aqueous humor, and several other organs . These results suggest that the lesions were associated with infection of the organism and that the present cases were in the process of septicemia.

Am Rev Respir Dis, 1992 Oct, 146(4), 1054 - 8
Effect of cirrhosis on the production and efficacy of pneumococcal capsular antibody in a rat model; Preheim LC et al.; We sought to study the immunogenicity of Type 3 pneumococcal capsular polysaccharide (PCP) antigen and the protective efficacy of Type 3 PCP antibodies in a rat model of cirrhosis . Cirrhosis with ascites was induced in male Sprague-Dawley rats by weekly gavage with CCl4 . Cirrhotic and age-matched control rats were vaccinated with 25 micrograms of Type 3 PCP . Serum antibodies against Type 3 PCP were determined before vaccination and on postvaccination Days 5, 7, 10, 14, 21, 28, and 42 by radioimmunoassay . Maximum concentrations occurred at 7 days in cirrhotic rats and 10 to 14 days in control rats . Geometric mean Type 3 PCP antibody levels (ng AbN/ml) were higher in cirrhotic versus control rats before vaccination (75.9 versus 33.8; p = 0.011) and on post-vaccination Day 5 (626 versus 158; p = 0.008) and Day 7 (1,755 versus 493; p = 0.002) . Postvaccination antibody from immunized control and cirrhotic animals provided passive immunity to Type 3 Streptococcus pneumoniae infection in mouse protection studies . Sham-immunized and PCP-immunized control and cirrhotic rats were challenged with 10(7) cfu Type 3 S . pneumoniae . Immunization was associated with a greater reduction in postchallenge mortality in control rats (91% reduced to 36%; p = 0.02) compared with cirrhotic rats (100% reduced to 83%; p = 1.0) . Thus, the increased serum concentrations of functional, type-specific anticapsular antibody in vaccinated cirrhotic rats does not reverse their impaired resistance to Type 3 pneumococcal pneumonia.

Scand J Dent Res, 1992 Oct, 100(5), 299 - 303
Dental caries and Streptococcus mutans in a rural child population in Iceland; Saemundsson SR et al.; In spite of having a high socioeconomic standing, in Iceland caries prevalence has remained stubbornly high . This study reports findings from a mixed fishing and farming community in East Iceland that has traditionally been associated with the highest prevalence of caries . A total of 188 children aged 3-16 yr (96.4% of residents of that age group) were examined . At 6 yr the mean dmfs score was 4.1, DMFS 0 and 48% were caries-free . The mean DMFS score at 12 yr was 4.7 and 22.6% remained caries-free but at 16 yr the DMFS score was 11.6 and no children were caries-free . Caries was unevenly distributed within each age group and was more prevalent among residents of the fishing town than the surrounding farming district . In a pilot study conducted in 1989 mean counts of Streptococcus mutans for children aged 4-7 yr were 2.6 x 10(5) cfu/ml and declined to 4.6 x 10(4) cfu/ml in 1990 after a program of chlorhexidine brushing had been added to the routine caries preventive measures adopted in this community . It may therefore be possible to screen Icelandic children for caries risk and apply preventive measures to those demonstrated to be most in need.

Pediatr Infect Dis J, 1992 Oct, 11(10), 831 - 5
Intermediate resistance of Streptococcus pneumoniae to penicillin in children in day-care centers; Doyle MG et al.; This study was performed to determine the prevalence, serotypes and antibiotic susceptibility patterns of penicillin-resistant Streptococcus pneumoniae in children younger than 3 years of age in day-care centers in Houston, TX . Nasopharyngeal cultures were obtained on two occasions, in March and May, 1989, from 140 children in 4 day-care centers . All penicillin-resistant S . pneumoniae organisms isolated in this study had minimum inhibitory concentrations to penicillin of between 0.1 and 0.5 microgram/ml and were thus intermediately resistant . No highly resistant S . pneumoniae (minimum inhibitory concentration > or = 1.0 microgram/ml) was isolated in this study . Nasal carriage of S . pneumoniae occurred in 39% of children; carriage of intermediately resistant S . pneumoniae occurred in 4% of children . Of the 39% of children who carried S . pneumoniae, 11% carried intermediately resistant strains . In one day-care center with a prior history of intermediately resistant S . pneumoniae (Center 1), the prevalence of intermediate penicillin resistance was significantly (P = 0.047) higher than in the other three centers . Among children surveyed twice 15% of Center 1 children carried an intermediately penicillin-resistant strain at least once, whereas in the other centers 3% of children carried an intermediately resistant strain at least once . Sixty-two percent of intermediately penicillin-resistant strains were resistant to multiple antibiotics and all were serotype 14 . Intermediately penicillin-resistant S . pneumoniae isolates were prevalent among young children in day-care centers in Houston and may persist in some day-care centers and become endemic.

J Prosthet Dent, 1992 Oct, 68(4), 623 - 5
Enhancement of antimicrobial properties of cavity varnish: a preliminary report; Goho C et al.; Bacterial contamination beneath amalgam restorations has been a problem in restorative dentistry . Cavity varnish improves the marginal seal but possesses no antibacterial properties, and chlorhexidine gluconate is a known antimicrobial substance . This study investigated the efficacy of a chlorhexidine gluconate/cavity varnish mixture against Streptococcus mutans, S . salivarius, and Escherichia coli . The in vitro results indicated that the addition of chlorhexidine gluconate to cavity varnish improved its antimicrobial properties.

J Clin Microbiol, 1992 Oct, 30(10), 2725 - 7
Identification of Streptococcus pneumoniae with a DNA probe; Denys GA et al.; The Accuprobe Streptococcus pneumoniae Culture Identification Test (Gen-Probe, Inc.) was evaluated with 172 isolates of S . pneumoniae and 204 nonpneumococcal isolates . The sensitivity and specificity of the Accuprobe test were 100% . Optimum results were obtained when four or more discrete colonies were selected for testing . The Accuprobe test was determined to be an accurate and rapid method for identification of S . pneumoniae.

Int J Dermatol, 1992 Oct, 31(10), 700 - 2
Microbiology of secondarily infected diaper dermatitis; Brook I; Specimens obtained from 67 infants with secondarily infected diaper dermatitis were cultured for aerobic and anaerobic bacteria . Bacteria growth was obtained in 58 . Aerobic facultative bacteria or Candida sp . only were present in 28 patients (48%), anaerobic bacteria only in 11 (19%), and mixed anaerobic with aerobic, facultative, or yeast flora was present in 19 (33%) . Ninety-one bacterial or fungal isolates were recovered (1.6 per specimen), 54 (0.9 per specimen) aerobic or facultative bacteria, 8 (0.1 per specimen) Candida sp., and 31 (0.6 per specimen) strict anaerobes . The predominant aerobic and facultative bacteria were Staphylococcus aureus (23 isolates), Streptococcus sp . (16), and Escherichia coli (6) . The predominant anaerobes included Bacteroides sp . (12, including 9 Bacteroides fragilis group) and Peptostreptococcus sp . (11) . Single bacterial isolates were recovered in 32 (55%) patients, 18 of which were S . aureus . Twenty-five beta-lactamase-producing bacteria were detected in 22 (51%) of the 43 tested patients . These included 16 S . aureus and 6 B . fragilis group . These data highlight the importance of anaerobic bacteria in the polymicrobial nature of secondarily infected diaper dermatitis.

Infect Immun, 1992 Oct, 60(10), 4301 - 8
Adhesion of glucosyltransferase phase variants to Streptococcus gordonii bacterium-glucan substrata may involve lipoteichoic acid; Vickerman MM et al.; Growing Streptococcus gordonii Spp+ phase variants, which have normal levels of glucosyltransferase (GTF) activity, use sucrose to promote their accumulation on surfaces by forming a cohesive bacterium-insoluble glucan polymer mass (BPM) . Spp- phase variants, which have lower levels of GTF activity, do not form BPMs and do not remain in BPMs formed by Spp+ cells when grown in mixed cultures . To test the hypothesis that segregation of attached Spp+ and unattached Spp- cells was due to differences in adhesiveness, adhesion between washed, {3H}thymidine-labeled cells and preformed BPM substrata was measured . Unexpectedly, the results showed that cells of both phenotypes, as well as GTF-negative cells, attached equally well to preformed BPMs, indicating that attachment to BPMs was independent of cell surface GTF activity . Initial characterization of this binding interaction suggested that a protease-sensitive component on the washed cells may be binding to lipoteichoic acids sequestered in the BPM, since exogenous lipoteichoic acid inhibited adhesion . Surprisingly, the adhesion of both Spp+ and Spp- cells was markedly inhibited in the presence of sucrose, which also released lipoteichoic acid from the BPM . These in vitro findings suggest that, in vivo, sucrose and lipoteichoic acid may modify dental plaque development by enhancing or inhibiting the attachment of additional bacteria.

Infect Immun, 1992 Oct, 60(10), 4179 - 83
Induction of procoagulant activity on human endothelial cells by Streptococcus pneumoniae; Geelen S et al.; The inflammatory response in infection caused by gram-negative organisms involves induction of procoagulant activity (PCA) on human endothelial cells . Although infections caused by gram-positive organisms are also associated with fibrin formation and thrombosis, the bacterial determinants inducing PCA are unknown . This study shows that intact pneumococci and the pneumococcal cell wall efficiently induce PCA on human endothelial cells . Upon exposure of endothelial cells to pneumococci, PCA was first detectable at 30 min, peaked at 2 h, and disappeared by 6 h . The specific activities of encapsulated and unencapsulated strains for induction of PCA were equivalent . Purified pneumococcal cell walls were as potent as endotoxin in induction of PCA . The ability to induce a procoagulant state on endothelial cells is a new biological activity of gram-positive cell walls which promotes the participation of the coagulation cascade in the inflammatory response to disease caused by gram-positive organisms.

Infect Immun, 1992 Oct, 60(10), 4146 - 53
SCID-Hu mice immunized with a pneumococcal vaccine produce specific human antibodies and show increased resistance to infection; Aaberge IS et al.; Seventy-eight severe combined immunodeficiency (SCID) mice were administered intraperitoneally 1 x 10(7) to 9 x 10(7) human peripheral blood mononuclear cells (PBL) in five experiments . Human immunoglobulin G (IgG) was detected in 70 to 88% of these SCID-PBL-Hu mice after cell transplantation, and all four subclasses were present . The total concentration of human IgG varied from less than 1 to 10.2 g/liter . The SCID-PBL-Hu mice with high concentrations of human IgG regularly had mono- or oligoclonal human IgG bands in serum, as demonstrated by agarose gel electrophoresis . Of the SCID-PBL-Hu mice that were immunized with a 23-valent pneumococcal polysaccharide vaccine, 63 to 78% developed a significant human IgG antipneumococcal antibody response, whereas only very low levels of human IgM and no human IgA antipneumococcal antibodies could be detected . Twelve to twenty-two percent of the SCID-PBL-Hu mice showed signs of leakiness; these mice developed a significant mouse IgM antipneumococcal antibody response and no human antibodies . SCID-PBL-Hu mice were challenged intraperitoneally with 10 50% lethal doses of Streptococcus pneumoniae serotype 4 to study the protective effect of immunization with pneumococcal vaccine . The immunized SCID-PBL-Hu mice showed less bacteremia than did all control groups, and survival was 45 to 60% . None of the unimmunized SCID-PBL-Hu mice survived.

Infect Immun, 1992 Oct, 60(10), 4119 - 26
Genetic relationships of penicillin-susceptible and -resistant Streptococcus pneumoniae strains isolated on different continents; Sibold C et al.; Sixty-six strains of Streptococcus pneumoniae isolated in different parts of the world, 46 resistant and 22 susceptible to penicillin, were subdivided by multilocus enzyme electrophoresis into 28 distinct electrophoretic types (ETs) . The ETs to which penicillin-susceptible strains were assigned differed from those containing resistant isolates of the same serotype . Five common clones could be recognized among the penicillin-resistant bacteria by combining the ETs, the antigenic properties of penicillin-binding proteins PBP 1a and 2b, and the tetracycline and chloramphenicol resistance profiles . Two clones were found in Finland and were associated with capsular serotypes 6B and 23F, respectively . Two clones were from Spain (type 6B and 9V, respectively) . The fifth clone was isolated in South Africa and in Spain and contained both serotype 23F isolates and one type 19F strain . The other resistant strains were represented by rare isolates distributed among 12 other ETs, confirming that resistance to penicillin has evolved by multiple branches . Because capsular type was mixed in several ETs, the results also demonstrate that it may vary among very closely related pneumococci.

Appl Microbiol Biotechnol, 1992 Oct, 38(1), 70 - 6
DNA amplification fingerprinting of bacteria; Bassam BJ et al.; We have amplified short arbitrary stretches of total bacterial DNA to produce highly characteristic and complex DNA fingerprints . This DNA amplification fingerprinting (DAF) strategy involves enzymatic amplification of DNA directed by a single arbitrary oligonucleotide primer . Amplification produces a characteristic spectrum of products that is adequately resolved by polyacrylamide gel electrophoresis and visualized by silver staining . Although DAF is simple in concept, we found that amplification parameters must be within an optimal range for reproducibility . We establish a safe window for these parameters, which include magnesium, primer and enzyme concentration as well as cycle number . The refined procedure was used to distinguish between clinical isolates of Streptococcus uberis, Klebsiella pneumoniae, and Escherichia coli . The use of template DNA concentrations higher than 1 ng.microliters-1 and high MgCl2 levels was especially important for reproducibility when amplifying small bacterial genomes . We tested a truncated Thermus aquaticus DNA polymerase, the Stoffel fragment, and found it more tolerant of reaction conditions, more efficient in the amplification of short products, and able to produce more informative fingerprints when compared to the normal thermostable polymerase from which it was derived . Because DAF produces representative fingerprints quickly and reliably from bacteria regardless of prior genetic or biochemical knowledge, we anticipate the general use of this diagnostic tool for bacterial identification and taxonomy.

Microb Pathog, 1992 Oct, 13(4), 261 - 9
Molecular localization of variable and conserved regions of pspA and identification of additional pspA homologous sequences in Streptococcus pneumoniae; McDaniel LS et al.; PspA is anchored to the surface of all pneumococci by the C-terminal end of the molecule . The N-terminal half of PspA is known to be serologically variable and to be able to elicit protective immune responses . Molecular analysis with DNA probes spanning different regions of pspA was carried out to identify homologous sequences among pneumococcal isolates . At high stringency, DNA probes derived from the 3'-half of pspA (encoding the C-terminal half of PspA) hybridized to all of 37 pneumococcal isolates tested, representing 20 capsular serotypes and 12 PspA serotypes . Most strains had two sequences highly homologous to this region of pspA . Using derivatives of strain Rx1, with insertion mutations in pspA, it was possible to identify the functional pspA sequence . At 50% stringency, the 3' pspA probes also detected lytA and additional sequences . lytA encodes autolysin and shares homology with the 3' portion of pspA . A probe derived from the 5'-half of pspA (encoding the N-terminal half of PspA) hybridized with only 75% of strains and generally detected only one of the two sequences recognized by the 3' probes . Thus, the 3'-half of pspA appears to contain more highly conserved sequences than the 5'-half of pspA and shares homology with several additional sequences, suggesting that the pneumococcus might make several proteins that interact with the surface by the same mechanism as PspA.

Mol Microbiol, 1992 Oct, 6(20), 3009 - 19
The 5' to 3' exonuclease activity of DNA polymerase I is essential for Streptococcus pneumoniae; Diaz A et al.; Three different mutations were introduced in the polA gene of Streptococcus pneumoniae by chromosomal transformation . One mutant gene encodes a truncated protein that possesses 5' to 3' exonuclease but has lost polymerase activity . This mutation does not affect cell viability . Other mutated forms of polA that encode proteins with only polymerase activity or with no enzymatic activity could not substitute for the wild-type polA gene in the chromosome unless the 5' to 3' exonuclease domain was encoded elsewhere in the chromosome . Thus, it appears that the 5' to 3' exonuclease activity of the DNA polymerase I is essential for cell viability in S . pneumoniae . Absence of the polymerase domain of DNA polymerase I slightly diminished the ability of S . pneumoniae to repair DNA lesions after ultraviolet irradiation . However, the polymerase domain of the pneumococcal DNA polymerase I gave almost complete complementation of the polA5 mutation in Escherichia coli with respect to resistance to ultraviolet irradiation.

Microb Pathog, 1992 Oct, 13(4), 293 - 303
Changes in the structure of the cell surface carbohydrates of the chinchilla tubotympanum following Streptococcus pneumoniae-induced otitis media; Linder TE et al.; Streptococcus pneumoniae (Spn) are among the most frequently isolated pathogens in acute otitis media (AOM) and in otitis media with effusion (OME) . Recently, the specific receptor for Spn has been identified as the trisaccharide unit Gal beta 1-4 GlcNAc beta 1-3 Gal beta with GlcNAc beta 1-3 Gal beta as the principal binding site . During the colonization of mucosal surfaces, pneumococci produce a variety of enzymes . This study was conducted to identify any resulting changes in the cell surface carbohydrate structure due to the action of these enzymes during pneumococcal otitis media (OM) in chinchillas . Using a lectin histochemical method with seven different lectins (SNA, LFA, WGA, Succ WGA, BSL II, PNA, ECL), the labeling pattern revealed not only the removal of the terminal sialic acid, but also the exposure of N-acetyl-glucosamine . These results suggested that Spn-produced enzymes uncover part of their own receptor structure and thus may facilitate adherence and subsequent infection.

Kansenshogaku Zasshi, 1992 Oct, 66(10), 1416 - 21
{Maternal carriage and vertical transmission of group B Streptococcus (GBS)}; Miyazawa H et al.; The pneumonia, sepsis and meningitis are common diseases of GBS infection in infants . There are early-onset and late-onset types in this disease, the result of the infection is unknown . M . Sugiyama reported that M9 is a new type of GBS in Japan in 1989 . Analysis of GBS typing and serum specific antibody concentrations of the type are simple with new technics . By studying the infants' contamination we discovered that GBS appeared to originate from mother-infant sources . The infants were followed for a year . 52% of the infants had GBS contamination in their throat or stool . The most common type was Ia, followed by III, JM9 and NT6 . Those types without III type had been present for more than 9 months in the infant . The contamination term of Ia or III type in infants correlated with the blood specific antibody concentration of the type.

Biochem Biophys Res Commun, 1992 Sep 30, 187(3), 1432 - 8
Molecular characterization and expression of the cell-associated glucosyltransferase gene from Streptococcus mutans; Fujiwara T et al.; A gene encoding cell-associated glucosyltransferase (CA-GTase) was cloned from Streptococcus mutans MT8148 into Escherichia coli DH5 alpha by using a low-copy-number plasmid, pMW119 . After screening of a gene library with the oligonucleotide probe designed on the basis of a partial amino acid sequence of CA-GTase, a recombinant plasmid, pSK6, that had a 5.6 kb insert carrying the CA-GTase gene was selected . The gene product (recombinant CA-GTase) of pSK6 was expressed by using a lac promoter in pMW119 . Western blotting revealed that rCA-GTase reacted with antibody to CA-GTase . rCA-GTase was found to synthesize water-insoluble glucans . Southern blotting indicated that the MT8148 chromosome contained another gene which was homologous to pSK6 . A plasmid harboring this gene (pSK16) was also isolated from the gene library, the gene product of pSK16 exhibited GTase activity but ten times lower than that of pSK6.

Am J Perinatol, 1992 Sep-Nov, 9(5-6), 425 - 7
Group B streptococcal colonization in the diabetic gravida patient; Bey M et al.; Previous reports have suggested that pregnant diabetic patients have higher carriage rates of group B Streptococcus (GBS) than nondiabetic gravidas . In order to evaluate this in our population, we cultured the posterior pharynx, endocervix, vagina, and rectum of 101 diabetic pregnant women and 100 nondiabetic gravida patients . The colonization rate of GBS was higher in the diabetic population, 31.7%, than in the nondiabetic group 19.0%, (p < 0.039) . The vagina was the site most often positive in both diabetic and nondiabetic populations (23.8% and 17.0%, respectively, p = NS) . The second site to culture positive overall and the only individual site that was positive significantly more often in diabetics was the rectum (16.9% versus 7.0%, p < 0.05) . Differences in colonization rates were not evident when insulin requirement and diabetic classes were considered.

Clin Infect Dis, 1992 Sep, 15(3), 525 - 7
Group A Streptococcus septicemia and an infected, ruptured abdominal aortic aneurysm associated with pharyngitis; Valero G et al.; A 65-year-old man had a 3-day history of sore throat, fever, rigors, back pain, abdominal discomfort, nausea, vomiting, and diarrhea . The patient's daughter had group A streptococcus pharyngitis . The patient was found to have a ruptured abdominal aortic aneurysm . He underwent resection of the aneurysm and right axillary femoro-femoral bypass graft . The patient died 40 hours after admission . Gram stain of the aneurysm showed numerous gram-positive cocci . Group A streptococcus grew from cultures of blood, throat, and aneurysm . The group A streptococcus was M type 3, T type 3 and produced streptococcal pyrogenic exotoxin A . This case is a very rare fatal complication of group A streptococcus pharyngitis.

Arch Intern Med, 1992 Sep, 152(9), 1808 - 12
Pneumococcal pneumonia in adult hospitalized patients infected with the human immunodeficiency virus; Garcia-Leoni ME et al.; PURPOSE--To determine the attack rate; clinical, radiologic, and laboratory characteristics; and outcome of pneumococcal pneumonia in patients infected with the human immunodeficiency virus (HIV) and to compare these characteristics with those of pneumococcal pneumonia in the general population . PATIENTS AND METHODS--This is a retrospective (13-month), prospective (14-month) study . All adult hospitalized patients with pulmonary infiltrates and isolation of Streptococcus pneumoniae in blood, pleural fluid, transtracheal aspirate, or respiratory secretions obtained by plugged telescoped catheter (counts greater than 10(3) colony-forming units per milliliter) are included . MAIN RESULTS--We identified 22 HIV-infected patients and 84 HIV-seronegative patients with pneumococcal pneumonia (76% and 56%, respectively, were bacteremic) . The estimated attack rate was 5.9 per 1000 for HIV-infected patients and 0.31 per 1000 for HIV-seronegative patients . Pneumococcal pneumonia was the first manifestation of HIV infection in 48% of cases . Seventy-two percent of patients younger than 40 years of age with pneumococcal pneumonia were HIV infected . No predisposing factors for pneumococcal pneumonia were identified in 76% and 2% of HIV seropositive and seronegative patients, respectively . Clinical and radiologic presentation was similar in the two populations . Of all S pneumoniae isolates, 35% were resistant to penicillin and 10% to erythromycin, without differences in the two groups . Prognosis was good, with only one infection-related death in the HIV-infected group (10 patients died in the other group) . No relapses were documented in HIV-infected patients . CONCLUSION--The HIV-infected patient is at increased risk for pneumococcal pneumonia and bacteremia . Patients younger than 40 years of age who present with pneumococcal pneumonia should be considered for HIV testing, since it may be the first manifestation of HIV infection . Specific antimicrobial therapy is curative in the majority of HIV-infected patients.

J Pediatr, 1992 Sep, 121(3), 434 - 43
Intravenous immune globulin therapy for early-onset sepsis in premature neonates; Weisman LE et al.; Newborn infants may have IgG deficiencies that increase their susceptibility to bacterial infection . To determine whether intravenous immune globulin (IVIG) therapy improves survival rates in early-onset sepsis, we prospectively entered 753 neonates (birth weight 500 to 2000 gm, gestation less than or equal to 34 weeks, age less than or equal to 12 hours) into a multicenter, double-blind, controlled trial . Blood culture specimens were obtained and infants randomly assigned to receive 10 ml (per kilogram) intravenously of a selected IVIG (500 mg/kg) or albumin (5 mg/kg) preparation . Maternal and neonatal risk factors were not different between groups . Thirty-one babies (4.2%) had early-onset sepsis; the causative organisms were group B streptococcus (12 babies), Escherichia coli (6), and others (13) . Of these 31 neonates, 7 (23%) died . Total serum IgG was higher for 7 days after IVIG therapy than after albumin treatment (p less than 0.05) . During these 7 days, 5 (30%) of 17 albumin-treated and none of 14 IVIG-treated patients died (p less than 0.05) . The survival rate at 56 days of age, however, was not significantly improved . Group B streptococcus type-specific IgG antibody was significantly increased after IVIG treatment and appeared to be related to the amount of IVIG specific antibody . Infusion-related adverse reactions were less frequent in patients receiving IVIG therapy (0.5%) than in those receiving albumin . The IVIG therapy in neonates with early-onset sepsis, while reducing the early mortality rate, did not significantly affect the overall survival rate . Further studies are necessary to confirm these findings and to determine more effective therapeutic regimens.

J Pediatr, 1992 Sep, 121(3), 428 - 33
Early-onset group B streptococcal sepsis: a current assessment; Weisman LE et al.; Group B streptococcus (GBS) is a common cause of early-onset sepsis in neonates . The most recent reviews describing incidence, diagnosis, treatment, and outcome evaluated data on patients from the early 1980s . To obtain current information about this disease, we retrospectively evaluated data on neonates with GBS early-onset sepsis from nine hospitals in the United States between Jan . 1, 1987, and Dec . 31, 1989 . There were 245 infants with GBS bacteremia identified among 61,809 live births, resulting in an incidence of 0.32% . Ninety-six infants (39%) were preterm (less than 38 weeks of gestational age) . Maternal risk factors for infected preterm and term infants were similar . Antibiotics were administered during parturition in 10% of infants with bacteremia . Mothers of preterm infants received antibiotics up to 48 hours before delivery; mothers of term infants received antibiotics less than 4 hours before delivery . All preterm infants with bacteremia had symptoms; 22% of term infants with bacteremia had no symptoms . Group B streptococcal meningitis was confirmed in 6.3% of infants . Although 86% survived, GBS sepsis increased the birth weight-specific mortality rate up to eightfold in preterm infants and more than 40-fold in term infants . Although the incidence of GBS early-onset sepsis is not changing, we speculate that the improved birth weight-specific survival rate and the changing clinical presentation are due to improved intrapartum and neonatal management.

J Exp Med, 1992 Sep 1, 176(3), 855 - 66
Generation and analysis of random point mutations in an antibody CDR2 sequence: many mutated antibodies lose their ability to bind antigen; Chen C et al.; We have investigated the impact of mutations on the binding functions of the phosphocholine (PC)-specific T15 antibody in the absence of antigen selection pressure . The H chain complementarity determining region 2 (CDR2) sequence of T15 antibody was saturated with point mutations by in vitro random mutagenesis . From the mutant library, 289 clones were screened by direct DNA sequencing . The point mutations generated by this method were randomly distributed throughout the CDR2 region and included all kinds of substitutions . 46 unique mutant antibodies, containing one to four point mutations each, were expressed in SP2/0 myeloma cells . Functional analysis on these antibodies has provided insights into several aspects of somatic mutation . (a) The majority (26/46) of mutant antibodies either lost (20/46) or had reduced (6/46) ability to bind PC-protein conjugates or R36a, a PC-expressing strain of Streptococcus pneumoniae . In contrast, none of the mutant antibodies displayed increased binding for these PC antigens . Taken together with calculations of destructive mutations elsewhere in the V region, the data suggest that somatic mutation may cause extensive wastage among B cells during clonal expansion after antigen stimulation . (b) The frequency of binding-loss mutants increased sharply when a second mutation was introduced into the CDR2 sequence; it appears that, in some cases, two or more mutations are needed to destroy binding . (c) The mutant antibodies were tested for their reactivity to 11 non-PC antigens as well as to three PC analogues . None of the mutants gained new reactivity or changed their ability to discriminate structural analogues, supporting the notion that the major role of somatic mutation is to increase or decrease affinity rather than to create new specificities . (d) Mutations in at least five different positions in CDR2 were deleterious, suggesting that these residues may be essential for antigen binding . Three of these positions are novel in that they had not been identified to be important for binding PC by previous crystallographic analysis . (e) Introduction of mutations into two highly conserved residues in CDR2 did not alter the overall conformation of the V region as judged by antiidiotypic analysis, and, in some cases, did not affect the antigen binding function . The results thus indicate that even nonconservative substitutions of invariant residues need not be deleterious, suggesting that their conservation may be due to reasons other than maintaining antibody structure or specificity.

J Infect Dis, 1992 Sep, 166(3), 632 - 4
Role of cell wall polysaccharide in the assessment of IgG antibodies to the capsular polysaccharides of Streptococcus pneumoniae in childhood; Goldblatt D et al.; The interference of antibodies to pneumococcal cell wall polysaccharide (CWPS) in the measurement of antibodies to capsular polysaccharides in children was assessed after vaccination with pneumococcal polysaccharide vaccine . ELISAs were developed to measure IgG subclasses specific for pneumococcal types 3, 6, 19, and 23 and CWPS . Analysis of antibody levels to all four capsular polysaccharides was affected by the presence of antibodies to CWPS, and their removal altered both anti-capsular polysaccharide antibody levels and the interpretation of responses to the vaccine . Thus, it is likely that CWPS contaminating pure capsular polysaccharide reagents used in most standard immunoassays is responsible for falsely elevated measurements of antibodies to capsular polysaccharide and the incorrect assessment of anti-pneumococcal antibody status in childhood.

Infect Immun, 1992 Sep, 60(9), 3878 - 84
Influence of saliva on aggregation and adherence of Streptococcus gordonii HG 222; Ligtenberg AJ et al.; The influence of saliva on the aggregation and adherence of Streptococcus gordonii HG 222 was studied . The aggregation was measured spectrophotometrically, and the adherence of S . gordonii to microtiter plate wells was measured in an enzyme-linked immunosorbent assay system . The aggregation of HG 222 was induced primarily by mucous saliva, whereas the adherence of HG 222 to microtiter plates was mediated by both mucous and serous saliva . Fractions of submandibular saliva, obtained by gel filtration and containing low-molecular-weight mucins (MG-2), induced both bacterial aggregation and adherence . Purified MG-2 induced aggregation and promoted adherence, whereas high-molecular-weight mucins (MG-1) did not . After incubating clarified human whole saliva with HG 222, only MG-2, and not MG-1, was bound by the bacteria . Proline-rich proteins (PRPs) and proline-rich glycoprotein (PRG) promoted the adherence of HG 222 . These proteins in solution bound to HG 222 but did not induce aggregation of the bacterial cells . PRPs and PRG in solution were not able to inhibit adherence to microtiter plate wells coated with the same components . Purified alpha-amylase hardly promoted adherence to microtiter plates but, in the soluble state, readily bound to HG 222 . In conclusion, these results indicate that the aggregation of S . gordonii HG 222 is mediated primarily by MG-2 . These mucins also promote adherence . Several other salivary components, such as PRPs and PRG, are also involved in the adherence of HG 222.

Infect Immun, 1992 Sep, 60(9), 3673 - 81
Characteristics and cariogenicity of a fructanase-defective Streptococcus mutants strain; Wexler DL et al.; Polymers of D-fructose produced by a variety of oral bacteria are believed to function as extracellular carbohydrate reserves . Degradation of these polysaccharides in plaque following exhaustion of dietary carbohydrates is thought to contribute to the extent and duration of the acid challenge to the tooth surface and thus to the initiation and progression of dental caries . Streptococcus mutans produces a fructanase, the product of the fruA gene, which is capable of degrading beta(2,6)- and beta(2,1)-linked fructans that are commonly synthesized by dental plaque microorganisms . To evaluate the role of the FruA protein in exopolysaccharide metabolism and to assess the contribution of this enzyme to the pathogenic potential of S . mutans, a fructanase-deficient strain of S . mutans was constructed . Inactivation of a cloned fruA gene was accomplished in Escherichia coli by using a mini-Mu dE transposon, and then an isogenic mutant of S . mutans UA159 was constructed by allelic exchange . Successful inactivation of fruA was confirmed through the use of biochemical assays, Western blotting (immunoblotting) with anti-recombinant FruA antisera, and Southern hybridization . The data indicated that FruA was the only fructan hydrolase produced by S . mutans UA159 . Inactivation of fruA had no significant effects on glucosyltransferase or fructosyltransferase activity . In the rat caries model using animals fed a high-sucrose diet and ad libitum, there were no significant differences in the number or severity of smooth surface, sulcal, or root caries elicited by the fruA mutant and the wild-type organism.

Infect Immun, 1992 Sep, 60(9), 3571 - 8
Protective effect of a T-cell-dependent immunosuppressive, B-cell-mitogenic protein (F3'EP-Si, or P90) produced by Streptococcus intermedius; Lima M et al.; The role of a previously described bacterial protein (F3'EP-Si), now designated P90, in the survival of Streptococcus intermedius in the host was investigated, and the immunosuppressive and B-cell-mitogenic effects of this protein were further characterized . C57BL6 mice treated with P90 were about 50 times more susceptible to infection with this bacterium than untreated mice . One of seven splenocytes of C57BL/6 mice were activated by P90 . Marked splenomegaly was observed in mice treated with P90, with increased numbers of splenic mononuclear cells and polyclonal immunoglobulin-secreting plaque-forming cells . Peak responses were seen on day 3 for immunoglobulin M (IgM) and on day 5 for IgG, with an isotypic pattern consisting predominantly of IgG2a and IgG2b . When mice were treated with P90 before being primed with sheep erythrocytes, polyclonal immunoglobulin synthesis was accompanied by an ephemeral stimulation of the specific immune response against sheep erythrocytes that was quickly replaced by a dramatic immunosuppression . In contrast, when mice were treated with P90 after being primed, the polyclonal activation was comparatively much less evident and there was no suppression of the specific immune response . Immunosuppression was considerably reduced in mice thymectomized as adults or depleted of CD8+ cells . Adoptive transfer experiments showed that B cells obtained from P90-treated mice were less able to respond to an antigenic challenge, even in the presence of normal T cells, and that T cells obtained from P90-treated mice could actively suppress the specific immune response of normal B cells.

Infect Immun, 1992 Sep, 60(9), 3528 - 32
Synthesis of a conjugate vaccine composed of pneumococcus type 14 capsular polysaccharide bound to pertussis toxin; Schneerson R et al.; Type 14 is one of the common types isolated from patients of all ages with infections caused by Streptococcus pneumoniae . Its capsular polysaccharide (Pn14) is composed of a neutrally charged tetrasaccharide repeat unit . Pn14 does not elicit protective levels of antibodies in infants and children and is a less than optimal immunogen of the 23-valent vaccine for adults . Pertussis toxin (PT) is both a virulence factor and protective antigen of Bordetella pertussis: it is not soluble at neutral pH and forms insoluble complexes with acidic polysaccharides . Both Pn14 and PT are potential components of vaccines for infants and children . Accordingly, a synthetic scheme was devised to prepare a conjugate of Pn14 and PT . An adipic acid hydrazide derivative of Pn14 was bound to PT at pH 3.9 by carbodiimide-mediated condensation . The conjugation procedure inactivated the PT as assayed by CHO cell and histamine-sensitizing activity . The Pn14-PT conjugate elicited antibodies in mice to Pn14 at levels estimated to be protective in humans and elicited neutralizing antibodies to PT . We plan to evaluate Pn14-PT clinically.

Infect Immun, 1992 Sep, 60(9), 3513 - 7
Molecular population genetic evidence of horizontal spread of two alleles of the pyrogenic exotoxin C gene (speC) among pathogenic clones of Streptococcus pyogenes; Kapur V et al.; It has recently been demonstrated that the bacteriophage-borne gene (speC) encoding pyrogenic exotoxin C is harbored by phylogenetic lineages representing virtually the entire breadth of genomic differentiation present in the species Streptococcus pyogenes (J . M . Musser, A . R . Hauser, M . H . Kim, P . M . Schlievert, K . Nelson, and R . K . Selander, Proc . Natl . Acad . Sci . USA 88:2668-2672, 1991) . To determine whether the speC genes occurring in association with divergent chromosomal genotypes (clones) are identical or represent a group of allelic variants, we sequenced speC from 23 S . pyogenes strains representing 15 clones identified by multilocus enzyme electrophoresis . Two alleles of speC are present in natural populations, and each allele occurs in clones that are well differentiated in overall chromosomal character; in one case, isolates of a single clone had different speC alleles . We interpret these patterns of toxin allele-clone distribution as evidence of occasional episodes of speC horizontal dissemination, presumably by bacteriophage-mediated gene transfer and recombination.

Pediatr Med Chir, 1992 Sep-Oct, 14(5), 507 - 8
{The micro-ESR with the capillary tube inclined to 45 degrees in the "sepsis screen" of neonatal infection due to beta-hemolytic B-group Streptococcus}; Trevisanuto D et al.; The authors describe the advantages of a new method to determinate the erythrocyte sedimentation rate (micro-ESR) during neonatal GBS infections . They utilize a capillary tube placed at a 45 degrees angle and have the results of this test only after 15 minutes . The micro-ESR is proposed as a simple and quick method of sepsis screen in term and preterm newborns.

Eur J Clin Microbiol Infect Dis, 1992 Sep, 11(9), 836 - 8
First reported case of Streptococcus pyogenes infection with toxic shock-like syndrome in Italy; Cherchi GB et al.; A 43-year-old male who sustained a superficial hand injury developed streptococcal toxic shock-like syndrome and died within 48 hours . The clinical course of the illness in this previously well patient was rapid and fulminant . The organism responsible was a group A beta-hemolytic streptococcus which was identified as opacity factor negative, M serotype 1, T type 1 . The organism produced streptococcal pyrogenic exotoxins B and C, but no detectable exotoxin A although it carried speA, the gene for exotoxin A . This is the first case reported in Italy, and further emphasizes the virulence of these organisms and the rapidity with which the illness can progress.

Can J Microbiol, 1992 Sep, 38(9), 983 - 5
Inhibition of microbial adherence by sphinganine; Bibel DJ et al.; Sphingosines (precursors and degeneration products of complex sphingolipids) are mediators in membrane second-messenger cascades and in a wide variety of functions in eukaryotic cells . Sphingosines are also lethal for gram-positive microorganisms . In addition to its direct effect, sphinganine is here reported to affect the adherence of Streptococcus mitis to buccal epithelial cells and of Staphylococcus aureus to nasal mucosal cells after incubation for 90 min at 37 degrees C . When the bacteria were pretreated with 8.1, 16.2, 32.5, or (for Strep . mitis) 65 microM sphinganine for 60 min at 37 degrees C, adherence counts were reduced for Staph . aureus by 27, 37, and 60% and for Strep . mitis by 19, 44, 54, and 73%, respectively (p < 0.001) . In contrast, pretreatment of buccal cells with 81.2 microM lipid increased adherence by 14% (p < 0.01), but no change occurred at either 16.2 or 325 microM lipid . These results further demonstrate the double-edged ability of sphingosines to regulate cellular activities and their potential as multifunctional therapeutic agents for infectious diseases.

Clin Exp Rheumatol, 1992 Sep-Oct, 10(5), 483 - 4
Pneumococcal septic arthritis as the first manifestation of multiple myeloma; Cuesta M et al.; In this paper we report a 47 year old woman with septic arthritis due to Streptococcus pneumoniae . No known predisposing factor was found . After an extensive workup a multiple myeloma was discovered . In our case septic arthritis was the first manifestation of multiple myeloma.

Mikrobiol Zh, 1992 Sep-Oct, 54(5), 35 - 41
{The properties of cell wall hydrolysates of Streptococcus group A}; Shmakovoa ZF et al.; Products obtained from lysis in the cell wall of group A streptococcus have been studied in different growth phases: at the end of the exponential phase and in the stationary one . Endo-beta-N-acetylmuramidase extracted from the culture liquid of Streptomyces levoris 96 has been used for lysis of streptococcus . It is stated that streptococcus cell walls isolated at different growth stages differ in the protein and polysaccharide content . High content of protein in the cell wall of a young culture makes lower the initial rate of the walls' hydrolysis by endo-beta-N-acetylmuramidase . However, with the enzyme penetration into peptidoglycan the rate of hydrolysis of cell walls gets higher and after four-hour incubation the lysis degree of walls of the 16- and 8-hour cultures reaches the equal value (63%) . Studies in the protein composition of lysates of the streptococcus cell walls have shown that they contain at least 12 proteins most of which are acid and neutral ones.

Kokubyo Gakkai Zasshi, 1992 Sep, 59(3), 578 - 84
{Studies on caries of Ishibashi rat--III . Experimental caries in Ishibashi rat}; Ozaki F et al.; Dental caries was experimentally induced in the Ishibashi rats (ISR) by feeding them with conventional diets or with caries-producing diets, and the pattern and severity of their induced carious lesions were compared with those of the Sprague-Dawley rats (SD) . Simultaneously, serum antibody titers against Streptococcus mutans and calcium and phosphorus concentration in the sera and in the femurs were compared between the ISR and SD . The results were as follows: 1 . When judged by cavities, ISR showed a higher carious incidence and average number of cavities per one rat than the SD, whichever diet the rats were fed . 2 . When judged by fissure caries observed on the thin sections of the teeth, both the carious incidence and average number of fissure lesions in the ISR were not always high compared with those in the SD, and there seemed to be a great variation of caries-susceptibility in the ISR . 3 . Caries in the ISR seemed to be more progressive than that in the SD . 4 . There were no differences in the serum antibody titers against the S . mutans between the ISR and SD . 5 . No differences in the concentration of calcium and phosphorus in the sera and femurs were observed between the ISR and SD, whichever diet they were fed.

J Pediatr Surg, 1992 Sep, 27(9), 1207 - 12
Splenic autotransplantation provides protection against fatal sepsis in young but not in old rats; Willfuhr KU et al.; Splenectomy increases the risk of contracting infections with high mortality . Thus, splenic tissue should be repaired orthotopically whenever possible . If all attempts fail, splenic autotransplantation might be a suitable method for splenic salvage . The protective function of such transplants in adults has been questioned, leading to a decreased frequency of splenic autotransplantations . However, the regeneration of splenic tissue is better in the young organism than in the old, suggesting that the protection provided by regenerated splenic tissue might be more reliable in children than in adults . In addition, children are at a higher risk in the case of overwhelming postsplenectomy sepsis . The protection warranted by regenerated splenic tissue after autotransplantation at different ages was examined using a highly standardized animal model . Sham operation, splenectomy, and splenic autotransplantation were performed on adult, weanling, and newborn rats, and Streptococcus pneumoniae was applied intranasally 9 months after the operation . After pneumococcal challenge about 80% of the splenectomized animals in the different age groups died of infection, whereas only 20% of the sham operated rats died . Regenerated splenic tissue resulting from splenic autotransplantation performed on adult or weanling rats demonstrated no protective function . However, in newborn rats with transplanted splenic tissue, both survival rate and survival time were increased significantly . Determination of lymphocyte subsets in the blood did not allow the protective role of splenic transplants to be predicted . This study indicates that disappointing results of splenic autotransplantation in adult patients should not lead to false pessimism about the role of this operation in children.

Infect Control Hosp Epidemiol, 1992 Sep, 13(9), 515 - 25
A study of the etiologies and treatment of nosocomial pneumonia in a community-based teaching hospital; Schleupner CJ et al.; OBJECTIVE: To compare the frequency of the pathogens of nosocomial pneumonia in a community-based teaching hospital to the frequencies previously published, and to evaluate recommendations for the therapy of nosocomial pneumonia in this setting . DESIGN: Retrospective review of prospectively acquired data accrued during 9 randomized single-blinded and 4 single-agent investigational antibiotic studies for the therapy of pneumonia in hospitalized patients between 1981 and 1989 . SETTING: The study was performed at a university affiliated, community-based teaching Department of Veterans Affairs Medical Center . PATIENTS: Patients were hospitalized on the acute medical/surgical and intermediate medicine wards . Informed consent was obtained prior to enrolling patients into the respective antimicrobial studies . Pneumonia was documented radiographically and clinically for each patient . RESULTS: Two hundred thirty-one episodes of nosocomial pneumonia were treated . Overall, 51% of pneumonias were caused by Streptococcus pneumoniae or Hemophilus influenzae with or without other organisms that were not gram-negative bacilli . Gram-negative bacilli, with or without other organisms, accounted for only 26% of all nosocomial pneumonias . Overall, monotherapy with a cephalosporin (usually a broad-spectrum agent) was equally efficacious compared with combination therapy (87% versus 81%, respectively) . Cure rates for nosocomial pneumonias from gram-negative bacilli treated with these 2 therapies also were similar (70% versus 60%, respectively) . CONCLUSIONS: In nontertiary care settings, gram-negative bacilli may cause fewer episodes of nosocomial pneumonia (26% in this study) than noted by previously published reports, which indicated that these organisms account for 50% of nosocomial pneumonias . Further, S pneumoniae and H influenzae may account etiologically for many of these nosocomial pneumonias . Monotherapy with an extended-spectrum cephalosporin may be more appropriate than combined treatment with a beta-lactam and an aminoglycoside in a nontertiary care setting, thereby reducing potential toxicity in an older, hospitalized patient population.

Cornea, 1992 Sep, 11(5), 479 - 83
Infectious crystalline keratopathy with ring opacity; McDonnell JM et al.; A 41-year-old physician was treated for 3 months with antiviral medications, antibiotics, and steroids for presumed herpetic keratitis . When seen by us, an annular infiltrate was observed, along with crystalline-like opacities in the superficial one third of the stroma . Cultures of scrapings and of subsequent biopsies were positive for Streptococcus mitis of the viridans group; histopathology demonstrated large aggregates of cocci between the stroma lamellae . Tapering of topical corticosteroids and treatment with topical penicillin resulted in resolution of the infiltrates . The clinical appearance and findings in this patient suggest that infectious crystalline keratitis can produce an annular infiltrate . Injection of the organism into rabbit corneas produced a crystalline infiltrate, but no annular opacity was observed . Corticosteroids altered the clinical and histopathologic appearance of the lesions in rabbits.

Cornea, 1992 Sep, 11(5), 404 - 8
Recurrence of microbial keratitis concomitant with antiinflammatory treatment in an animal model; Gritz DC et al.; Recurrence of Pseudomonas keratitis during treatment with corticosteroids has been reported previously in humans . Rabbits with keratitis due to Pseudomonas aeruginosa or Streptococcus pneumoniae were treated with antibiotics and either vehicle, methylprednisolone acetate, flurbiprofen, or nordihydroguaiaretic acid (NDGA) . Cultures performed after 7 days were negative, and antibiotics were discontinued . Two weeks later, Pseudomonas keratitis recurred in 6 of 7 (85.7%) steroid-treated rabbits, 1 of 8 (12.5%) flurbiprofen-treated rabbits, 1 of 8 (12.5%) NDGA-treated rabbits, and none of 8 vehicle-treated rabbits . None of the 31 rabbits infected with Streptococcus pneumoniae experienced recurrence . These data confirm the clinical observation that Pseudomonas keratitis may recur if antibiotic therapy is discontinued and corticosteroids are administered; the risk of recurrence appears to be much less with nonsteroidal antiinflammatory agents.

Cornea, 1992 Sep, 11(5), 370 - 5
Corneal storage medium preservation with defensins; Schwab IR et al.; We used a synthetic defensin (rabbit neutrophil peptide-1; NP-1) as a microbicide in a corneal storage medium, Optisol without antimicrobial compounds . We established growth curves in Optisol for Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa . Each organism was evaluated separately at 4 degrees C, 23 degrees C, and 37 degrees C in Optisol with NP-1 at each of four different concentrations including 1, 10, 100, and 200 micrograms/ml . When the three organisms were evaluated in Optisol containing NP-1, we found that a concentration of 200 micrograms/ml of NP-1 successfully killed 99.9% (the limits of our assay) of all three organisms at all temperatures tested . We conclude that NP-1 exhibits promise as a nonantibiotic preservative agent in corneal storage media, since it was effective in killing organisms at all temperatures, including 4 degrees C.

Am J Vet Res, 1992 Sep, 53(9), 1715 - 21
Managerial risk factors of intramammary infection with Streptococcus agalactiae in dairy herds in Ohio; Bartlett PC et al.; Dairy herds in Ohio were selected by stratified random sampling for participation in a disease-monitoring study to relate Streptococcus agalactiae intramammary prevalence to herd management and environmental conditions . Of 48 herds studied, 27 herds had at least 1 cow infected with this pathogen . Management and environmental conditions were assessed by direct observation as well as by an interview with the dairy producers . One-way ANOVA or chi 2 analysis, with presence or absence of Streptococcus agalactiae as the dependent variable, was used to test each of 70 independent variables . Variables found significant at P less than 0.20 were further evaluated by use of logistic regression . Our sample size permitted only 4 independent variables to be simultaneously evaluated by logistic regression . The most predictive risk factors were identified as poor teat and udder hygiene, poor environmental sanitation, large herd population, and use of a shared washcloth for premilking cleaning of teats and udders.

Am J Vet Res, 1992 Sep, 53(9), 1641 - 4
Measurement of total volume and protein concentration of intrauterine secretion after intrauterine inoculation of bacteria in mares that were either resistant or susceptible to chronic uterine infection; Troedsson MH et al.; Undiluted uterine secretion was used to determine the concentration of total protein and the accumulated volume of uterine secretion after a bacterial inoculation in mares susceptible and resistant to chronic uterine infection (CUI) . The uterus of 6 susceptible and 5 resistant mares was inoculated with 5 x 10(6) Streptococcus zooepidemicus on the third day of estrus . Using a tampon inserted in the uterus, secretions were sampled at 5, 12, 24, and 36 hours after inoculation, followed by intrauterine lavage with phosphate buffered saline solution . The concentration of protein was determined in the undiluted secretion as well as in the uterine washing and the total amount of accumulated uterine secretion was calculated . Protein concentrations in plasma were compared before and after absorption by the tampon . Protein concentration of plasma before and after absorption by the tampon did not differ . Mares susceptible to CUI accumulated significantly (P less than 0.001) more fluid in the uterus than mares resistant to CUI, and uterine washings from the resistant mares were significantly (P less than 0.05) more dilute than those from the susceptible mares . Significant differences in protein concentrations between susceptible and resistant mares were not found . It was concluded from this study that the described method to sample undiluted uterine secretion was practical and reliable for the analysis of protein concentration . Various concentrations of uterine secretions in washings from susceptible and resistant mares emphasizes the importance in using undiluted uterine secretions or dilution markers in washings when intrauterine products are analyzed.

Mol Microbiol, 1992 Sep, 6(17), 2461 - 5
Genetics of resistance to third-generation cephalosporins in clinical isolates of Streptococcus pneumoniae; Munoz R et al.; Resistance to third-generation cephalosporins in a clinical isolate of Streptococcus pneumoniae was shown to be due to the production of altered forms of penicillin-binding proteins (PBPs) 2X and 1A . The cloned PBP2X gene from the resistant strain was able to transform a susceptible strain to an intermediate level of resistance . The resulting transformant could be transformed to the full level of resistance of the clinical isolate using the cloned PBP1A gene from the latter strain . Chromosomal DNA from the resistant strain (and from other resistant strains) could readily transform a susceptible strain to the full level of resistance to third-generation cephalosporins (greater than 250-fold for cefotaxime; greater than 100-fold for ceftriaxone) in a single step (transformation frequency of about 10(-5)) . The resistant transformants obtained with chromosomal DNA were shown by gene fingerprinting to have gained both the PBP1A and PBP2X genes from the DNA donor.

J Emerg Med, 1992 Sep-Oct, 10(5), 577 - 9
Necrotizing myositis and toxic strep syndrome in a pediatric patient; Boyle MF et al.; Group A beta hemolytic streptococcus (GABHS) is a common pathogen in infections of skin, soft tissue structures, and muscle . Most infections, when recognized and treated appropriately, result in a benign course . The development of more virulent forms of this organism have resulted in severe life-threatening infections . The following case of an immunocompetent host with necrotizing myositis and septic shock emphasizes the potential morbidity of GABHS infection . The spectrum of soft tissue and muscle infections is reviewed . The pathophysiology and emergency management of septic shock from GABHS is discussed.

J Clin Microbiol, 1992 Sep, 30(9), 2432 - 4
Biochemical and antigenic properties of Streptococcus bovis isolated from pigeons; De Herdt P et al.; Biochemical and serological properties of 60 strains of Streptococcus bovis isolated from healthy pigeons and from pigeons that died from S . bovis septicemia were determined . On the basis of the hemolysis of bovine erythrocytes, the production of polysaccharides on saccharose-containing media, and the fermentation of mannitol, inulin, trehalose, and L-arabinose, the isolates were classified in five biotypes and two subbiotypes . Slide agglutination and microagglutination tests using monospecific rabbit antisera allowed the classification of all isolates in five serotypes.

J Clin Microbiol, 1992 Sep, 30(9), 2391 - 7
M protein gene typing of Streptococcus pyogenes by nonradioactively labeled oligonucleotide probes; Kaufhold A et al.; A new approach for the typing of Streptococcus pyogenes is described . Oligonucleotide probes of 30 nucleotides in length were derived from currently known sequences of the N-terminal regions of M protein genes (emm genes) . The oligonucleotides were labeled with digoxigenin-dUTP and hybridized to dot-blotted genomic DNA from 116 group A streptococcal strains of serotypes M-1, M-2, M-3, M-5, M-6, M-12, M-18, M-19, M-24, and M-49 . Hybridization reactions were visualized with a chemiluminescent substrate . In comparison with conventional serological typing of expressed M proteins, the binding of the probes to the corresponding emm genes exhibited 100% sensitivity and specificity . The results emphasize the high degree of type-specific conservation of the N-terminal regions of emm genes from reference strains and epidemiologically unrelated U.S . and European clinical isolates . The existence of two distinct genetic subgroups among eight investigated M-49 strains was unequivocally shown by hybridization assays and further confirmed by nucleotide sequence data obtained from four selected M-49 strains . Because oligonucleotide probes are relatively easy to prepare, easy to handle, and known to give consistent interlaboratory results, the "oligotyping" technique appears to offer potential advantages over conventional serological typing methods.

J Bacteriol, 1992 Sep, 174(17), 5639 - 46
Mechanism of Streptococcus mutans glucosyltransferases: hybrid-enzyme analysis; Nakano YJ et al.; Streptococcus mutans GS5 expresses three glucosyltransferases (GTFs): GTF-I and GTF-SI, which synthesize water-insoluble glucans in a primer-independent manner, and GTF-S, which is responsible for the formation of primer-dependent soluble glucan . The amino acid sequences of the GTF-I and GTF-S enzymes exhibit approximately 50% sequence identity . Various hybrid genes were constructed from the structural genes for the enzymes, and their products were analyzed . Three different approaches were used to construct the hybrid enzymes: (i) ligation of DNA fragments containing compatible endonuclease restriction sites of the two genes at homologous positions; (ii) in vivo recombination between the homologous regions of each gene; and (iii) random fusion of DNA fragments from each gene generated following exonuclease III digestion of tandemly arranged fragments corresponding to the two functional domains of each enzyme . Hybrid GTFs composed of the sucrose-binding domain of one enzyme (GTF-I or GTF-S) with the glucan-binding domain of the other synthesized insoluble glucan exclusively in the absence of primer dextran . Insoluble glucan synthesis by some, but not all, of the GTF-S:GTF-I chimeric enzymes was stimulated by primer dextran T10 addition . In addition, glucan binding by the former but not latter group of hybrid GTFs was demonstrated . These results suggest that the glucan-binding domain alone does not solely determine primer dependence or independence or the structure of the resulting glucan product, although this carboxyl-terminal domain containing direct repeating units does appear to play a significant role in primer dependence.

Cell Immunol, 1992 Sep, 143(2), 253 - 60
MHC-unrestricted recognition of bacteria-infected target cells by human CD8+ cytotoxic T lymphocytes; Hermann E et al.; A CD8+ alpha beta TCR+ T cell clone (A35) was isolated from the synovial fluid of a patient with post-enteric reactive arthritis caused by Yersinia enterocolitica . This clone efficiently killed autologous and allogeneic target cells that had been preincubated with live but not with heat-killed bacteria . There was no restriction by polymorphic parts of HLA-A, -B, or -C molecules and a HLA class II-deficient mutant cell line was lysed as efficiently as its normal counterpart, whereas infected HLA class I-deficient cells (Daudi cells) were not . The clone showed crossreaction between Yersinia enterocolitica, Escherichia coli, Pseudomonas aeruginosa, and Streptococcus pyogenes, but did not lyse target cells preincubated with Staphylococcus epidermidis . MAb to CD2, CD3, and CD8 efficiently blocked A35, whereas the addition of mAb to HLA class II or to HLA class I did not . This clone apparently represents a novel effector mechanism against bacteria-infected or -modified cells that could be involved in the immunopathology of reactive arthritis.

Infect Immun, 1992 Sep, 60(9), 3932 - 6
Evidence for actinlike proteins in an M protein-negative strain of Streptococcus pyogenes; Barnett LA et al.; Antigens shared between Streptococcus pyogenes and heart tissue may play an important role in autoimmune cardiac injury associated with acute rheumatic fever . Antiheart/antistreptococcal antibodies found in the disease react with antigens of S . pyogenes, including M protein and a 60-kDa antigen distinct from M protein . Heart antigens recognized by these cross-reactive antistreptococcal antibodies include myosin and actin . To investigate the presence of a streptococcal actin, established protocols for the polymerization and isolation of eukaryotic actin were used to extract and concentrate actinlike proteins from M- streptococcal cells . The polymerized bacterial actin from the streptococcal extract was probed in immunoblots with an antiactin monoclonal antibody . Two proteins of about 60 kDa in the polymerized bacterial actin reacted with the antiactin antibody . Proteins in the polymerized bacterial actin extract of about 43 and 60 kDa behaved like eukaryotic actin by binding to myosin and DNase I affinity columns . Filaments were demonstrated by electron microscopy in the polymerized bacterial actinlike extract, which also enhanced the ATPase activity of eukaryotic myosin . The data suggest that proteins resembling actin are present in S . pyogenes.

J Med Microbiol, 1992 Sep, 37(3), 162 - 4
DNA restriction fragment length polymorphism differentiates recurrence from relapse in treatment failures of Streptococcus pyogenes pharyngitis; Bingen E et al.; In the evaluation of treatment failure in Streptococcus pyogenes pharyngitis it is necessary to distinguish between persistence of the original streptococcus and acquisition of a new strain . We used the analysis of restriction fragment length polymorphism (RFLP) of total DNA and of ribosomal DNA (rDNA) regions (ribotypes) as epidemiological tools to compare 43 pre- and post-treatment S . pyogenes strains obtained from 20 patients . In 16 cases pre- and post-treatment strains gave indistinguishable RFLP patterns of total DNA, strongly suggesting relapse with the same strain . However, in four cases different patterns were obtained for the pre- and post-treatment isolates, indicating recurrence due to the acquisition of a new strain . Ribotyping did not improve discrimination among strains . Thus, analysis of DNA RFLP is a promising method for distinguishing recurrence from relapse in failures of pharyngitis treatment.

J Bacteriol, 1992 Sep, 174(17), 5516 - 25
EJ-1, a temperate bacteriophage of Streptococcus pneumoniae with a Myoviridae morphotype; Diaz E et al.; The first temperate bacteriophage (EJ-1) of Streptococcus pneumoniae with Myoviridae morphotype A1 isolated from a clinical atypical strain has been purified and characterized . This phage has a double-stranded linear genome about 42 kb long, but in contrast to the other pneumococcal temperate phages that have been characterized so far, EJ-1 does not contain any protein covalently linked to it . We have sequenced a fragment of EJ-1 DNA containing the ejl gene, encoding a cell wall lytic enzyme (EJL amidase) . This gene has been cloned and expressed in Escherichia coli, and the EJL enzyme was purified and biochemically characterized as an N-acetylmuramyl-L-alanine amidase that shares many similarities with the major pneumococcal autolysin . The EJL amidase is a choline-dependent enzyme that needs the process of conversion to achieve full enzymatic activity, but in contrast to the wild-type pneumococcal LYTA amidase, this process was found to be reversible . Comparisons of the primary structure of this new lytic enzyme with that of the other cell wall lytic enzymes of S . pneumoniae and its bacteriophages characterized so far provided new insights as to the evolutionary relationships between phages and bacteria . The nucleotide sequences of the attachment site (attP) on the phage genome and one of the junctions created by the insertion of the prophage were determined . Interestingly, the attP site was located near the ejl gene, as previously observed for the pneumococcal temperate bacteriophage HB-3 (A . Romero, R . Lopez, and P . Garcia, J . Virol . 66:2860-2864, 1992) . A stem-and-loop structure, some adjacent direct and inverted repeats, and two putative integration host factor-binding sites were found in the att sites.

J Bacteriol, 1992 Sep, 174(17), 5508 - 15
Role of the major pneumococcal autolysin in the atypical response of a clinical isolate of Streptococcus pneumoniae; Diaz E et al.; The autolytic enzyme (an N-acetylmuramyl-L-alanine amidase) of a clinical isolate, strain 101/87, which is classified as an atypical pneumococcus, has been studied for the first time . The lytA101 gene coding for this amidase (LYTA101) has been cloned, sequenced, and expressed in Escherichia coli . The LYTA101 amidase has been purified and shown to be similar to the main autolytic enzyme (LYTA) present in the wild-type strain of Streptococcus pneumoniae, although it exhibits a lower specific activity, a higher sensitivity to inhibition by free choline, and a modified thermosensitivity with respect to LYTA . Most important, in contrast with the LYTA amidase, the activity of the LYTA101 amidase was inhibited by sodium deoxycholate . This property is most probably responsible of the deoxycholate-insensitive phenotype shown by strain 101/87 . Phenotypic curing of strain 101/87 by externally adding purified LYTA or LYTA101 amidase restored in this strain some typical characteristics of the wild-type strain of pneumococcus (e.g., formation of diplo cells and sensitization to lysis by sodium deoxycholate), although the amount of the LYTA101 amidase required to restore these properties was much higher than in the case of the LYTA amidase . Our results indicate that modifications in the primary structure or in the mechanisms that control the activity of cell wall lytic enzymes seem to be responsible for the characteristics exhibited by some strains of S . pneumoniae that have been classically misclassified and should be now considered atypical pneumococcal strains.

Antimicrob Agents Chemother, 1992 Sep, 36(9), 1852 - 8
Postantibiotic sub-MIC effects of vancomycin, roxithromycin, sparfloxacin, and amikacin; Odenholt-Tornqvist I et al.; The sub-MIC effects (SMEs) and the postantibiotic sub-MIC effects (PA SMEs) of vancomycin, roxithromycin, and sparfloxacin for Streptococcus pyogenes and Streptococcus pneumoniae and of amikacin for Escherichia coli and Pseudomonas aeruginosa were investigated . A postantibiotic effect was induced by exposing strains to 10x the MIC of the antibiotic for 2 h in vitro . After the induction, the exposed cultures were washed to eliminate the antibiotics . Unexposed controls were treated similarly . Thereafter, the exposed cultures (PA SME) and the controls (SME) were exposed to different subinhibitory concentrations (0.1, 0.2, and 0.3x the MIC) of the same drug and growth curves for a period of 24 h were compared . In general, the PA SMEs were much more pronounced than the SMEs . However, for amikacin and E . coli the SME of 0.2 and 0.3x the MIC also had an initial bactericidal effect . The longest PA SMEs were demonstrated for the combinations with the most pronounced killing during the induction and for the combinations which exhibited the longest PAEs.

J Marmara Univ Dent Fac, 1992 Sep, 1(3), 215 - 7
Streptococcus mutans in plaque from margins of conventional and high copper amalgam restorations; Gencoglu N et al.; Levels of Streptococcus mutans in plaque samples from margins of conventional and high copper amalgam restorations were compared in fourteen patients, each having one conventional amalgam filling in each quadrant and one high copper amalgam filling on the contra-lateral side were examined . The percentage of S . mutans of total CFU count in plaque was higher on conventional amalgam than on high copper amalgam . The difference was statistically significant (p < 0.01).

Pediatr Dent, 1992 Sep-Oct, 14(5), 322 - 5
Effects of phenytoin on dental caries and plaque in Streptococcus sobrinus-infected rats; Morisaki I et al.; Effects of phenytoin (PHT) administration on dental caries in rats infected with Streptococcus sobrinus 6715 were investigated . Twenty-day-old specific pathogen-free Fischer male rats were infected with S . sobrinus 6715 and fed diet 2000 containing 56% sucrose with or without PHT for 52 days . Antibody responses against anti-S . sobrinus in serum and saliva failed to show a statistical difference between PHT-treated and nontreated rats . These results indicate that PHT treatment increased plaque deposition and dental caries in the rats infected with S . sobrinus 6715 and fed diet 2000 containing PHT (1-2 mg/g), as compared with those similarly infected and fed diet without PHT (P < 0.001).

Trop Med Parasitol, 1992 Sep, 43(3), 186 - 90
Identification of a lectin activity in Pneumocystis carinii; Ortega-Barria E et al.; Pneumocystitis carinii is known to adhere to pulmonary alveolar epithelial cells in vivo and to epithelial cell lines in vitro by a mechanism unknown at the molecular level . P . carinii is now found to adhere to rabbit and human red blood cells leading to rosette formation and hemagglutination . P . carinii erythrocyte-adherence was best inhibited by bovine submaxillary mucin and by a polysaccharide from the wall of group A Streptococcus, and to a lesser extent by Streptococcus group C polysaccharide, asialofetuin and fetuin . Among the mono- and oligosaccharides tested, only lactose inhibited hemagglutination . Other glycoconjugates and oligosaccharides tested were inactive . P . carinii also bound to purified glycoproteins coupled to Sepharose or adsorbed to plastic, and the binding was inhibited by soluble bovine submaxillary mucin . These results indicate that P . carinii has a novel surface lectin that may be important in adherence to lung alveolar epithelial cells.

Nucleic Acids Res, 1992 Aug 25, 20(16), 4167 - 72
Cloning and sequence analysis of the StsI restriction-modification gene: presence of homology to FokI restriction-modification enzymes; Kita K et al.; StsI endonuclease (R.StsI), a type IIs restriction endonuclease found in Streptococcus sanguis 54, recognizes the same sequence as FokI but cleaves at different positions . A DNA fragment that carried the genes for R.StsI and StsI methylase (M.StsI) was cloned from the chromosomal DNA of S.sanguis 54, and its nucleotide sequence was analyzed . The endonuclease gene was 1,806 bp long, corresponding to a protein of 602 amino acid residues (M(r) = 68,388), and the methylase gene was 1,959 bp long, corresponding to a protein of 653 amino acid residues (M(r) = 76,064) . The assignment of the endonuclease gene was confirmed by analysis of the N-terminal amino acid sequence . Genes for the two proteins were in a tail-to-tail orientation, separated by a 131-nucleotide intercistronic region . The predicted amino acid sequences between the StsI system and the FokI system showed a 49% identity between the methylases and a 30% identity between the endonucleases . The sequence comparison of M.StsI with various methylases showed that the N-terminal half of M.StsI matches M.NIaIII, and the C-terminal half matches adenine methylases that recognize GATC and GATATC.

Ann Intern Med, 1992 Aug 15, 117(4), 314 - 24
Pneumococcal disease during HIV infection . Epidemiologic, clinical, and immunologic perspectives; Janoff EN et al.; OBJECTIVE: To characterize the epidemiology, clinical manifestations, and immunologic risk factors for infections with Streptococcus pneumoniae among persons infected with human immunodeficiency virus (HIV); and to delineate a practical approach for diagnosis, treatment, and prevention of these infections . DATA SOURCES: English-language articles from Index Medicus and their references as well as abstracts from conference proceedings that compared rates as well as clinical and microbiologic features of S . pneumoniae infections in HIV-infected patients . STUDY SELECTION: All human studies that included denominators, appropriate control groups, or sufficient clinical descriptions and animal studies with key immunologic observations were cited . DATA EXTRACTION: We compared epidemiologic and clinical responses to pneumococcal disease in HIV-infected patients and control subjects and correlated clinical and experimental data on immunologic defects associated with HIV infection with those on regulation of pneumococcal infections . DATA SYNTHESIS: Among patients with HIV infection, the incidence of invasive pneumococcal disease is high, bacteremia is a common complication of pneumonia, and relapses occur frequently . However, the clinical presentation, response to therapy, and serotypes isolated are similar to those in persons without HIV infection, and mortality is similar or lower . Specific local and systemic defects in host defense, particularly humoral immunity, may contribute to the high incidence of invasive pneumococcal disease . CONCLUSIONS: Streptococcus pneumoniae is the leading cause of invasive bacterial respiratory disease in adults and children with HIV infection . Prompt diagnosis and antimicrobial therapy are associated with a favorable clinical outcome . Characterizing the specific immunologic defects associated with invasive pneumococcal disease in HIV-infected patients may facilitate development of successful, cost-effective strategies for prophylaxis.

Lancet, 1992 Aug 15, 340(8816), 396 - 7
Risk of pneumonia in patients previously treated in hospital for pneumonia; Hedlund JU et al.; Although elderly patients who are admitted to hospital for any disease have a higher risk of pneumonia subsequently, whether those treated in hospital for pneumonia are at even greater risk is unknown . Therefore we retrospectively assessed morbidity and mortality due to pneumonia after discharge in 573 consecutive patients admitted to hospital for pneumonia, gastrointestinal infection, renal infection, or erysipelas . Average follow-up was 34 months . The incidence rate for pneumonia was 5.45 times higher in the group of patients discharged after pneumonia than in the other groups combined (95% confidence interval 2.89-10.26; p less than 0.001), and this group also had more deaths due to pneumonia (p = 0.06) . For patients 50 years or older Streptococcus pneumoniae is the main cause of pneumonia . Pneumococcal vaccination after hospital treatment for an episode of pneumonia might be a cost-effective means of preventing disease in this group.

JAMA, 1992 Aug 12, 268(6), 766 - 70
Elementary school students' performance with two ELISA test systems; Ferris DG et al.; OBJECTIVE--To examine analytic performance by previously untrained and inexperienced subjects using enzyme-linked immunosorbent assay (ELISA) tests developed for decentralized laboratories . Performance variability between tests assigned to the "simple" and "moderately complex" Health Care Financing Administration laboratory levels was evaluated . DESIGN--A nonrandomized trial of the Surecell Strep-A chorionic gonadotropin ELISA tests . Each subject processed nine unknown specimens (three negative, three weakly positive, and three strongly positive) for each ELISA test . Subjects were blinded to expected test results . SETTING--An elementary school . SUBJECTS--A convenience sample of 52 students enrolled in the sixth and seventh grades . This age group was chosen because of their ability to generally comprehend instructions and remain attentive to the testing task . INTERVENTIONS--Subjects were either self-trained by reading package insert directions or trained by a manufacturer's sales representative . MAIN OUTCOME MEASURES--Performance was measured as the percentage of correct test results for the unknown specimens . The sensitivity and specificity for each test by operator group were calculated . RESULTS--Subjects demonstrated an overall sensitivity of 97.1% and specificity of 94.7% for human chorionic gonadotropin unknown specimens and a 95.9% sensitivity and 96.8% specificity for group A streptococcus unknown specimens . No significant differences between the self-trained group and the representative-trained group were observed for either group A streptococcus or human chorionic gonadotropin tests . Performance was so high with the first specimen that improvement over time (ie, a "learning curve") could not be demonstrated . CONCLUSION--These ELISA test systems are able to achieve high levels of performance by subjects with no formal laboratory background, no previous method specific experience, and limited self-training.

J Pediatr Surg, 1992 Aug, 27(8), 1075 - 8; discussion 1078-9
Sacrococcygeal teratoma: the experience of four decades; Schropp KP et al.; To determine the extent of progress in the treatment of sacrococcygeal teratomas (SCTs), we evaluated the experience with 73 patients over 40 years . The medical records of the children were reviewed for demographics, histology, clinical course, and outcome . Therapy differed depending on the type of SCT, histology, and decade of diagnosis . The female:male ratio was 4.2:1 and did not vary significantly with the histology of the tumor . Fifty-seven patients presented with benign disease . There were five recurrences in this group, only one of which did not have an initial coccygectomy . One tumor, originally thought to be benign with immature elements, had a local recurrence at 7 months, 10 months, and 16 months after the original operation and was discovered to have embryonal carcinoma with nodal involvement . This child was treated with chemotherapy and is disease-free at 7 years . Morbidity in the benign group included 3 postoperative wound infections . Three infants died, one before operation with beta-hemolytic Streptococcus sepsis . Two neonates died in the early postoperative period, one on day 1 with a ruptured subcapsular hematoma of the liver, and the second on day 2 with disseminated intravascular coagulation/sepsis . Benign SCT occurs at a younger age than malignant tumors . The average age of presentation of benign tumors is 20 days versus 468 days in children with malignant disease . The technique of wide resection of benign lesions with coccygectomy is helpful in preventing recurrence and has changed little over the last four decades . Malignant SCT occurred in 16 children (22%).(ABSTRACT TRUNCATED AT 250 WORDS)

FEBS Lett, 1992 Aug 10, 308(1), 30 - 4
A new type of mitogenic factor produced by Streptococcus pyogenes; Yutsudo T et al.; A new type of mitogenic factor (protein) was purified from the culture supernatant of a strain of Streptococcus pyogenes by SP-Sephadex C-25 column chromatography, preparative isoelectric focusing and reversed-phase high-performance liquid chromatography . The purified factor, showing marked mitogenic activity in rabbit peripheral blood lymphocytes, gave a single-band staining for protein on SDS-PAGE . The molecular weight of the purified mitogenic factor was determined to be 25,370, which was different from those calculated from reported amino acid sequences deduced from 4 different nucleotide sequences of 3 kinds of streptococcal pyrogenic exotoxins (two SPEAs, SPEB and SPEC) . The amino acid sequence of the N-terminal region of the purified mitogenic factor was determined to be Gln-Thr-Gln-Val-Ser-Asn-Asp-Val-Val-Leu-Asn-Asp-Gly-Ala-Ser-Lys-Tyr-Leu- Asn-Glu - Ala-, which was also different from the reported N-terminal sequences deduced from the 4 different nucleotide sequences . These data indicate that this mitogenic factor is distinct from the already described streptococcal pyrogenic exotoxins.

FEBS Lett, 1992 Aug 10, 308(1), 70 - 4
One step purification and characterization of the pyrrolidone carboxyl peptidase of Streptococcus pyogenes over-expressed in Escherichia coli; Awade A et al.; Pyrrolidone carboxyl peptidase (EC 3.4.11.8) (Pcp), an enzyme which selectively removes pyrrolidone carboxylic acid (PCA) from some PCA-peptides and -proteins, was demonstrated in bacteria and in plant, animal and human tissues . In this paper we describe the purification to homogeneity of the enzyme of Streptococcus pyogenes, over-expressed in Escherichia coli . This was achieved, for the first time in one step, by hydrophobic interaction chromatography . Analysis under non-denaturing conditions revealed a molecular mass of 85 kDa and in the presence of sodium dodecyl sulfate gave a molecular mass of 23.5 kDa . Investigations on enzymatic properties showed that the Pcp over-expressed in E . coli disclosed properties similar to those found for the enzyme extracted from S . pyogenes or for some other Pcps studied previously . Thus the over-expressed enzyme should serve as a suitable source for N-terminal unblocking prior to some PCA protein sequencing.

Infect Immun, 1992 Aug, 60(8), 3128 - 35
Mechanism of stimulation of T cells by Streptococcus pyogenes: isolation of a major mitogenic factor, cytoplasmic membrane-associated protein; Itoh T et al.; Our previous studies established that heat-killed Streptococcus pyogenes, as well as other gram-positive cocci, when incubated with human peripheral blood leukocytes (PBLs) in culture, induced polyclonal activation of T lymphocytes . The activated T lymphocytes included CD4+ CD8- helper T cells and CD3+ and CD4- CD8- double-negative T cells with gamma delta T-cell receptors . In the present study, we isolated a major factor with this unique mitogenic activity against human T lymphocytes from S . pyogenes . This active fraction was found in the cytoplasmic membrane (CM) of the heat-killed organisms but not in other cellular fractions such as cell walls, peptidoglycan, lipoteichoic acids, or cytoplasmic soluble fractions . An active molecule(s) was further isolated from the CM by cholic acid extraction followed by Sephacryl S-200 chromatography . The molecule was protease labile but highly resistant to heat, had a pI of greater than or equal to 9.3 and a molecular weight of 10,000 to 15,000 according to gel filtration experiments, and was termed CM-associated protein . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of the protein purified by anion-exchange chromatography showed a single band with a molecular weight of 15,000, corresponding to mitogenically active regions . Purified CM-associated protein induced activation of T lymphocytes, which consisted of CD4+ CD8- T cells and CD4- CD8- double-negative T-cell receptor gamma/delta + T-cell populations, as did the whole cells of S . pyogenes.

Infect Immun, 1992 Aug, 60(8), 3065 - 71
Identification of eNAP-1, an antimicrobial peptide from equine neutrophils; Couto MA et al.; Endogenous, cysteine-rich antimicrobial peptides known as defensins are prominent components of human, rabbit, and rat neutrophils, yet little is known about their occurrence in other mammalian species . Although we did not detect mature (i.e., processed) defensins in equine neutrophil granules, we found that these granules contained small amounts of other cysteine-rich peptides with antimicrobial activity . One of these, eNAP-1, was purified by a combination of gel permeation and reversed-phase high-performance liquid chromatography from acid extracts prepared from the cytoplasmic granules of equine neutrophils . The molecular mass of eNAP-1 was approximately 7.2 kDa, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis . Amino acid analysis revealed that eNAP-1 had an unusually high cysteine content and that it was relatively enriched in alanine, glycine, lysine, and proline residues . The partial (N-terminal) amino acid sequence of eNAP-1 was DVQCGEGHFCHDXQTCCRASQGGXACCPYSQGVCCADQRHCCPVGF . Thirty-six of these residues (78.3%) were identical to those of a recently cloned human neutrophil peptide of unknown function and belonging to the granulin family . Homologous peptides have also been noted in rat bone marrow cells and rat kidney epithelins . We tested the ability of eNAP-1 to kill several equine uterine pathogens . Streptococcus zooepidemicus was killed most effectively, sustaining a greater than 99.8% decrease in CFU per milliliter after a 2-h exposure to 100 micrograms of eNAP-1 per ml (approximately 15 microM) . Escherichia coli and Pseudomonas aeruginosa were somewhat less susceptible, manifesting 87.0 and 87.1% mean decreases in CFU per milliliter, respectively, after incubation for 2 h with 200 micrograms of eNAP-1 per ml . Klebsiella pneumoniae numbers were not significantly reduced after exposure to eNAP-1 . These antimicrobial properties suggest that eNAP-1 may contribute to phagocyte-mediated host defense against equine infections.

Am J Dis Child, 1992 Aug, 146(8), 920 - 3
Antibiotic-resistant pneumococcal disease in South African children; Friedland IR et al.; OBJECTIVE--To determine the incidence of antibiotic-resistant pneumococcal disease and to compare the presentation and outcome of penicillin-resistant infections with penicillin-susceptible infections . DESIGN--Patient series . SETTING--General community hospital . PATIENTS--Eighty-three children with penicillin-resistant pneumococcal bacteremia or meningitis and 124 children with penicillin-susceptible pneumococcal bacteremia or meningitis . SELECTION PROCEDURES--Consecutive patients admitted between 1989 and 1991 . INTERVENTIONS--None . MEASUREMENTS AND RESULTS--Forty percent of community-acquired isolates and 95% of hospital-acquired isolates were resistant to penicillin . Eighty-three (82%) of 101 penicillin-resistant infections were community acquired . Resistance to chloramphenicol, tetracycline, and erythromycin occurred in 9%, 12%, and 4% of all isolates, respectively . The proportion of penicillin-resistant pneumococci with cefotaxime minimum inhibitory concentrations greater than or equal to 0.5 micrograms/mL increased from 0% in a 1986 study to 21.5% in this study . The sites of infection, underlying diseases, and mortality of patients with penicillin-resistant infections outside the central nervous system did not differ significantly from those of penicillin-susceptible infections . CONCLUSIONS--The resistance of Streptococcus pneumoniae to beta-lactam antibiotics has increased alarmingly in South Africa . Penicillin-resistant and penicillin-susceptible pneumococcal infections cause a similar spectrum of illness.

Stroke, 1992 Aug, 23(8), 1175 - 8
Fatal basilar vasculopathy complicating bacterial meningitis; Perry JR et al.; BACKGROUND: Bacterial meningitis complicated by thrombosis, vasculitis, and aneurysm formation affecting both small and distal branches of cerebral vessels has been well described . Involvement of major cerebral vessels is rare and has only been documented late in the course of disease . CASE DESCRIPTION: We describe the clinical and pathological findings in a young man who presented with pontine infarction as an early manifestation of bacterial meningitis . Streptococcus milleri, an unusual organism in this setting, was cultured . Despite improvement with antibiotic therapy, the patient experienced fatal subarachnoid hemorrhage . A ruptured inflammatory aneurysm of the basilar artery, evidence of residual meningitis and vasculitis, and basilar thrombosis associated with pontine infarction were found . CONCLUSIONS: Bacterial meningitis, which may be associated with severe vasculopathy of the basilar artery and lead to cerebral infarction, aneurysm formation, and subarachnoid hemorrhage, should be considered in the differential diagnosis of these conditions . The role of S . milleri in meningitis and its vascular complications merits further study.

Obstet Gynecol, 1992 Aug, 80(2), 301 - 9
Prevention of neonatal group B streptococcal infections: advances in maternal vaccine development; Coleman RT et al.; OBJECTIVE: We describe the current state of prevention of neonatal group B streptococcal infections and present recent advances toward the development of a maternal vaccine for prevention of this disease . DATA SOURCES: We used a MEDLINE search of the Index Medicus from 1976-1992 for articles regarding group B streptococcus classification and immunology . Group B streptococcus was also cross-referenced with bacterial antigens, antibodies, and vaccines . Relevant textbooks were reviewed . METHODS OF STUDY SELECTION: Fifty-seven articles were selected as providing important background and new findings pertinent to this topic . DATA EXTRACTION AND SYNTHESIS: The literature supports prophylactic use of intrapartum antibiotics in mothers who are known carriers of group B streptococcus but highlights the need for more sensitive rapid screening techniques to identify this high-risk population . The promise of intravenous immunoglobulin for neonatal prophylaxis has not been borne out, although hyperimmune and monoclonal preparations offer renewed hope for prophylaxis and adjuvant therapy . Native bacterial polysaccharides, conjugated oligosaccharides and polysaccharides, and C proteins have been investigated as antigens for candidate vaccines . Antibodies elicited in human and animal studies provide protection against bacterial strains possessing these determinants . The theoretical existence of a "universal antigen" is significant because polysaccharide and C protein formulations are required to be polyvalent . CONCLUSIONS: The development of a vaccine for prevention of neonatal group B streptococcal sepsis is an attainable goal . Further study of the immunogenic properties of bacterial-cell-wall polysaccharides and their conjugates, C proteins, and the potential universal antigen is required.

J Infect Dis, 1992 Aug, 166(2), 365 - 73
Broad and persistent effects of benzathine penicillin G in the prevention of febrile, acute respiratory disease; Gunzenhauser JD et al.; After an outbreak of acute rheumatic fever at a US Army training installation, a benzathine penicillin G prophylaxis program was instituted . Surveillance data were analyzed to measure rates of febrile, acute respiratory disease (ARD) among trainees before and after prophylaxis was begun . Annual admissions for ARD decreased from 1927 to 690 (-64.2%) after benzathine penicillin G prophylaxis was begun . Admissions with throat cultures positive for Streptococcus pyogenes fell from 595 to 63 (-89.4%), a reduction that accounted only for a minority (43%) of the total 1237 "prevented" admissions . Temporal changes in disease rates at other installations where drug was not administered were also analyzed . Only a small decrease in the number of annual ARD admissions (-6.3%) was observed at other training installations . These findings support a hypothesis that benzathine penicillin G has a broad effect in the prevention of ARD that extends beyond the simple elimination of group A streptococcal infection.

J Bacteriol, 1992 Aug, 174(15), 5152 - 5
Altered murein composition in a DD-carboxypeptidase mutant of Streptococcus pneumoniae; Severin A et al.; The muropeptide composition of a Streptococcus pneumoniae mutant in which the DD-carboxypeptidase (penicillin-binding protein 3) gene was interrupted by plasmid insertion close to the 3' end of the gene was examined . Extensive compositional changes were observed: the linear pentapeptide, a minor component of the parental cells, became the most abundant monomeric peptide in the mutant wall, while the proportion of tripeptides that represent the main monomers in the parental cells was greatly reduced . The amount of the major dimer of parental cells, the directly cross-linked tri-tetrapeptide, was also reduced by a factor of 4 . It was partially replaced by a novel dimer: the cross-linked product of a linear pentapeptide and a pentapeptide carrying a serylalanine dipeptide substituent on the epsilon-NH2 group of its lysine residue . This dimer together with two other dimeric peptides, each containing the serylalanine cross bridge, became the quantitatively major components of the mutant peptidoglycan.

Gan To Kagaku Ryoho, 1992 Aug, 19(10 Suppl), 1429 - 32
{Differences of antitumor effect of various BRMs by intratumoral administration}; Ebina T et al.; The antitumor effects of biological response modifiers (BRM) in a new experimental mouse model, the "double grafted tumor system", were analysed . BALB/c mice received simultaneous inoculations of Meth-A fibrosarcoma cells on right flank (10(6) cells) and left flank (2 x 10(5) cells) on day 0, and BRMs were injected intratumorally into right tumor on day 3, 4 and 5 . The growth of the left-flank tumor was the real target for the evaluation of a given drug after 21 days . PSK (a protein-bound polysaccharide preparation), IL-1 and Cepharanthin cured not only the right, but also the left, non-treated tumor in a double grafted tumor system . OK-432 (a Streptococcus preparation) and BCG cured the right tumor and inhibited the growth of the left tumor . Lentinan (a polysaccharide preparation) inhibited neither the right nor the left tumor . Spleen cells from PSK-treated tumor bearing mice produced macrophage chemotactic factor (MCF) after 48 hrs cultivation in the presence of Con A or Meth-A tumor cells . MCF producing cells were indicated to be L3T4 positive cells . On the other hand, PMN activated by PSK treatment produced MCF in the culture supernatant . Therefore, our present and previous studies on the antitumor effect of BRM in the double grafted tumor system show that intratumoral administration of BRM first induces neurophils in the right tumor via an IL-8-like factor and then cytotoxic macrophages are induced by MCF . Then Lyt-1 (L3T4)-positive cells are induced in the right regional lymph nodes and in the spleen, probably via IL-1, which might be produced from macrophages in contact with tumor cells . Subsequently, Lyt-1-positive cells reach the left tumor through the blood stream, come into contact with Meth-A tumors and then produce MCF . Intratumoral administration of PSK in the right tumor thus induces cytotoxic macrophages in the left, non-treated tumor, thereby bringing about the regression of the distant tumor.

Gastroenterol Nurs, 1992 Aug, 15(1), 50 - 3
Small intestinal complications in progressive systemic sclerosis; Wilkinson MM; A case report of a 33-year-old woman with progressive systemic sclerosis and polymyositis is presented . Admitted with a beta-hemolytic Streptococcus infection of the right knee joint, she had progressive systemic sclerosis with small intestinal involvement, which is rare . This led to more serious complications, malabsorption, pneumoperitoneum, and pneumatosis cystoides intestinalis, which forced a decision to treat her with home total parenteral nutrition . The diagnostic as well as treatment problems encountered in this patient illustrate the importance of nursing care in the overall management of patients with this disease.

Pediatr Infect Dis J, 1992 Aug, 11(8), 648 - 52
Colonizing and invasive strains of Streptococcus pneumoniae in Uruguayan children: type distribution and patterns of antibiotic resistance; Mogdasy MC et al.; For the first time in Uruguay the frequency of moderate to heavy colonization of the upper respiratory tract by Streptococcus pneumoniae was investigated in children with acute respiratory infections (n = 717) and in healthy controls (n = 564) . Serotypes of S . pneumoniae were identified as colonizing and invasive strains and their susceptibility to antibiotics was determined . Semiquantitative cultures of nasopharyngeal aspirates yielded 42.1% of positives in ambulatory patients and 15.2% in controls . Throat swabs from hospitalized children and matched controls revealed, respectively, 18.4 and 11.5% colonization . Different sampling and culture procedures were evaluated . Seasonal variations in colonization were also detected . Geographic variations in serotype frequency and distribution were assessed . Serotype 14 was predominant among invasive and colonizing strains in patients . Ten serotypes, included in the 23-valent S . pneumoniae vaccine, were not detected . Intermediate resistance to penicillin was seldom observed, but 37.2% of the invasive strains were resistant to cotrimoxazole, indicating the need for a permanent surveillance of isolates to antibiotic susceptibility.

Clin Infect Dis, 1992 Aug, 15(2), 313 - 20
Superantigens, T cells, and microbes; Zumla A; It is well recognized that toxins of Staphylococcus aureus and Streptococcus pyogenes are responsible for a wide range of clinical conditions, although their precise mode of action remains unclear . Recently, there has been a resurgence of interest in these toxins, now grouped with superantigens, because they cause profound alterations in the immune system homeostasis . Superantigens are molecules, including endogenous retroviral gene products and microbial toxins, that share a unique set of characteristics . They bind with high affinity to major histocompatibility complex class II at regions distinct from the conventional antigen binding groove and cause prolific activation or anergy of T cells with certain T cell receptor variable-region gene families . Whilst most of the superantigens described to date are products of bacteria or viruses, the presence of superantigens in parasites and their role in disease pathogenesis remain to be defined . It is probable that associations are present between superantigen-induced proliferation or anergy of peripheral blood T cells and clinical manifestations of human infectious diseases . The identification of these may pave the way toward a better understanding of disease pathogenesis and the possible development of newer immunotherapeutic regimes . This review summarizes the current thinking on microbial superantigens, their association with human T cells, and speculations about their significance.

J Clin Microbiol, 1992 Aug, 30(8), 2150 - 2
Evaluation of the E test by using selected gram-positive bacteria; Ngui-Yen JH et al.; The E test (AB Biodisk NA Inc.) was compared with standard reference methods using the National Committee for Clinical Laboratory Standards's recommendations for determining the MICs of four selected antibiotics against 208 clinical isolates of gram-positive bacteria . These bacteria included 32 strains of Streptococcus pneumoniae, 25 strains of Enterococcus faecium, 20 strains of oxacillin-sensitive Staphylococcus aureus (OSSA), 96 strains of oxacillin-resistant S . aureus (ORSA), and 35 strains of coagulase-negative staphylococci . Evaluation included MIC accuracy within 1 dilution, reproducibility testing, and cost analysis . There was 94% agreement between the E test and the reference method in testing S . pneumoniae and penicillin G . There was 92% agreement with ampicillin and 100% agreement with vancomycin in testing E . faecium isolates . Accuracy of the oxacillin E test with staphylococci was significantly improved by the use of salt-supplemented Mueller-Hinton agar, for an agreement of 100% with coagulase-negative staphylococci and oxacillin-sensitive S . aureus and that of 85% with oxacillin-resistant S . aureus, with no major discrepancies . The E test with American Type Culture Collection isolates and clinical strains gave excellent reproducibility and was less costly than microdilution panels when used to test fewer than three antibiotics . The E test is a simple, reliable, reproducible, and cost-effective method for MIC determination for gram-positive organisms.

Eur J Biochem, 1992 Aug 1, 207(3), 943 - 9
Penicillin-binding protein 2x of Streptococcus pneumoniae . Expression in Escherichia coli and purification of a soluble enzymatically active derivative; Laible G et al.; A 2.5-kb DNA fragment including the structural gene coding for the penicillin-binding protein 2x (PBP 2x) of Streptococcus pneumoniae has been cloned into the vector pJDC9 and expressed in Escherichia coli . Mapping of RNA polymerase binding sites by electron microscopy indicated that the pbpX promoter is well recognized by the E . coli enzyme . However, high-level expression occurred mainly under the control of the lac promoter upstream of the pJDC9 multiple cloning site . After induction with isopropyl beta-d-thiogalactopyranoside, PBP 2x was expressed as one of the major cellular proteins . PBP 2x produced in E . coli corresponded to the pneumococcal PBP 2x in terms of electrophoretic mobility, fractionation with the cytoplasmic membrane, and penicillin-binding capacity . Deletion of 30 hydrophobic N-terminal amino acid residues at positions 19-48 resulted in high-level expression of a cytoplasmic, soluble PBP 2x derivative (PBP 2x*) which still retained full beta-lactam-binding activity . A two-step procedure involving dye affinity chromatography was established for obtaining large amounts of highly purified enzymatically active PBP 2x*.

Arch Intern Med, 1992 Aug, 152(8), 1641 - 5
Pneumococcal endocarditis in Alaska natives . A population-based experience, 1978 through 1990; Finley JC et al.; BACKGROUND . Streptococcus pneumoniae is an uncommon cause of infective endocarditis (IE) . We studied the presentation, microbiologic characteristics, and outcome of nine cases of S pneumoniae IE during a 12 1/2-year period in a population of 75,000 indigenous Alaska Natives (ANs), who have documented high rates of invasive pneumococcal disease . METHODS . Fifty-six cases of IE occurred in ANs statewide during 1978 through 1990 . Medical records of all nine confirmed cases of S pneumoniae IE were reviewed . Incidence rates for S pneumoniae IE and all IE were calculated . RESULTS . Alaska Natives experience S pneumoniae IE as a fulminant illness, with acute aortic valve insufficiency (100%) frequently requiring emergent valve replacement, S pneumoniae meningitis (56%), and death (33%) . No patient with S pneumoniae IE had known preexisting heart disease, and the most common underlying disease was alcoholism (56%) . Pneumonia was diagnosed and embolic complications were suspected in 33% . All five S pneumoniae isolates examined were penicillin sensitive and were of serotypes included in the pneumococcal vaccine . Pneumococcal IE accounted for 15.8% of all IE diagnosed in ANs . Age- and sex-adjusted incidence rates for IE of all causes and S pneumoniae IE were 8.5 and 1.5 per 10(5) persons per year, respectively . During 1986 through 1988, 4.3% of AN adults diagnosed with S pneumoniae bacteremia developed S pneumoniae IE . CONCLUSIONS . Pneumococcal endocarditis in all but one AN case required emergent valve replacement and had a 33% mortality . The annual incidence rate of S pneumoniae IE in this population was five to 37 times higher than contemporary rates elsewhere . Increased efforts to prevent pneumococcal disease in ANs appear warranted . Clinicians everywhere should anticipate the possible development of S pneumoniae IE in adult patients with pneumococcal sepsis, especially with meningitis, even with previous vaccination and prompt adequate antimicrobial therapy.

J Thorac Cardiovasc Surg, 1992 Aug, 104(2), 487 - 90
Cardiac operations during active endocarditis; al Jubair K et al.; Between December 1982 and March 1990, 65 patients with active infective endocarditis underwent cardiac operations . Their mean age was 28.6 years (range 1 to 65 years) . The most common infecting organisms were staphylococcus (33.8%), streptococcus (18.5%), and brucella (16.9%); 11 patients (16.9%) had cultures negative for infection . A rheumatic, native valve, most commonly the aortic, was involved in 40 patients, a prosthetic valve (with the mitral most common) in 18 patients, and in seven patients the infection involved a congenitally abnormal valve . Aortic root abscess developed in 21.5% of patients . In 30 patients operation was performed within 3 days of the start of intravenous antibiotic therapy, usually within 3 days of admission (group A); this resulted in fewer preoperative complications and a significantly lower postoperative complication rate than in those 35 patients who underwent operations more than 3 days after starting antibiotic therapy (group B) . Preoperative embolic phenomena occurred in eight (12.3%) of the 31 patients who had large, mobile vegetations (2/16 {12.5%} in group A and 6/15 {40%} in group B) . Overall there was no reinfection . No postoperative paravalvular leaks developed in group A . Nine patients died in the hospital (13.8%) (four in group A and five in group B); in all patients the infecting organism was staphylococcal or fungal . There was one late death . Early operation should always be considered in active infective endocarditis, especially when a prosthetic valve is involved or the infecting organism is staphylococcal or fungal . The disclosure of moderate to large vegetations by two-dimensional echocardiography is an indication for operation.

Bioorg Khim, 1992 Aug, 18(8), 1098 - 103
{Synthesis and expression in Escherichia coli of the gene for the albumin-binding domain of Streptococcus protein G}; Chakhmakhcheva OG et al.; The chemical-enzymatic synthesis of a gene coding for A2B2 repeats of the albumin-binding domain of streptococcal protein G has been accomplished . The codon usage of the natural gene has been modified to adapt an artificial sequence for the efficient translation in E . coli . The gene (238 b.p.) was cloned in the polylinker plasmid pUCL1 and then fused in frame to the 3'-terminus of the gene for the IgG-binding domain of staphylococcal protein A, which was earlier cloned in the expression plasmid pUCL2 . A fused polypeptide composed of the E and B domains of protein A and A2B2 repeats of protein G was produced in E . coli cells under the lac promoter control . The resulted product was isolated by affinity chromatography on IgG-sepharose and (or) albumin-sepharose.

Scand J Dent Res, 1992 Aug, 100(4), 204 - 6
Evidence for xylitol 5-P production in human dental plaque; Waaler SM; The Turku sugar studies indicated that xylitol may possess a caries-therapeutic effect . More recent data show that xylitol exhibits a bacteriostatic activity on a wide range of bacteria based on uptake and expulsion of xylitol . Intracellular xylitol 5-P appears to be a key substance associated with inhibition of bacterial metabolism by xylitol . This has been shown in studies with pure strains of bacteria, mainly Streptococcus mutans . The aim of the present study was to examine if production of xylitol 5-P occurs in freshly collected dental plaque which is exposed to labeled xylitol . Plaque extracts were analyzed by thin-layer chromatography combined with autoradiography and high performance liquid chromatography . Strong indications were obtained that xylitol 5-P is readily produced by dental plaque . No other significant xylitol metabolites were identified . The bacteriostatic properties of xylitol in plaque are a mechanism which may well account for the caries-therapeutic effect of xylitol.

Helv Chir Acta, 1992 Aug, 59(2), 341 - 4
{Severe necrotizing fasciitis}; Frick T et al.; The pathophysiology of necrotizing fasciitis remains unclear in patients with no apparent immunologic disorders . Between 1987 and 1990 we treated six patients with necrotizing fascitis and septic-toxic multiple organ failure, three patients survived . The mean age was 38 years (25-62) . In all patients the primary bacteriological examination revealed streptococcus . Between the first symptoms and an adequate therapy were 4 days in surviving patients and 7 days in patients who died . Four patients showed spread of the gangrene into the adjacent tissue: muscles (n = 3), bowel (n = 2), mediastinum (n = 1) . Adequate debridement was not possible or not performed in patients with spread into the abdominal cavity or the mediastinum . These patients did not survive . The duration of intensive care treatment in surviving patients were 14 to 78 days . We conclude that survival of patients with severe necrotizing fasciitis is influenced by the delay before adequate treatment, the localisation of the gangrene and intensive care facilities.

Int J Paediatr Dent, 1992 Aug, 2(2), 81 - 5
Dental health and salivary Streptococcus mutans levels in a group of children with heart defects; Pollard MA et al.; One-hundred children aged 2-16 years who were attending the Outpatients Department of the Yorkshire Regional Cardiac Centre were examined for dental caries, gingivitis, plaque and calculus . A control group of 100 children was also examined . A saliva sample was taken from each child in the study group to assess the level of Streptococcus mutans colonization . Comparing study and control groups, dental caries experience (dmft) was significantly higher only in the primary teeth of 5-9-year-old children in the study group, and there were no significant differences in gingivitis, plaque or calculus . The S . mutans count was found to be positively correlated to the number of decayed teeth in the study group.

Antimicrob Agents Chemother, 1992 Aug, 36(8), 1614 - 8
Evaluation of cefuroxime axetil and cefadroxil suspensions for treatment of pediatric skin infections; Jacobs RF et al.; A randomized, single-blind, multicenter study was conducted to evaluate the safety and efficacy of cefuroxime axetil and cefadroxil suspensions for the treatment of skin or skin structure infections in 287 children . Each drug was given at a dosage of 30 mg/kg of body weight per day in two divided doses . Staphylococcus aureus and Streptococcus pyogenes, or a combination of the two, were the primary pathogens isolated from infected skin lesions . A satisfactory bacteriological response (cure or presumed cure) was obtained in 97.1 and 94.3% of children in the cefuroxime axetil and cefadroxil groups, respectively (P greater than 0.05) . Satisfactory clinical responses (cure or improvement) were more likely to occur in cefuroxime axetil recipients than in cefadroxil recipients (97.8 versus 90.3%; P less than 0.05) . Both regimens were equally well tolerated, with adverse events occurring in 7.9 and 6.1% of cefuroxime axetil and cefadroxil recipients, respectively . There were more patients who refused to take cefuroxime axetil (7 of 189) than there were who refused to take cefadroxil (0 of 98), but the difference was not statistically significant (P = 0.1) . In this study, cefuroxime axetil was at least as effective as cefadroxil in resolving skin and skin structure infections in children.

Tierarztl Prax, 1992 Aug, 20(4), 347 - 54
{Ocular manifestations of selected zoonoses in humans}; Knorr HL et al.; A report is given on the epidemiology and clinical signs of some selected zoonoses that may be of significance for ocular infections in man: brucellosis, leptospirosis, Lyme borreliosis, lymphocytic choriomeningitis, Newcastle Disease, ornithosis (chlamydiosis), rabies, Streptococcus suis infection, larva migrans ocularis by Toxocara canis or Baylisascaris procyonis, toxoplasmosis and tularemia.

Scott Med J, 1992 Aug, 37(4), 116 - 7
Streptococcus milleri and complex groin abscesses in intravenous drug abusers; Hemingway DM et al.; Intravenous drug abuse is an increasing problem . Septic complications occur frequently at the injection site, especially in the groin where large abscesses around the femoral vessels can threaten life or limb . We report four patients with extensive or complex groin abscesses following attempted self-injection into the femoral vein . Streptococcus milleri was cultured from all of these abscesses and prompted a review of the isolation of this organism in this hospital.

Neuropediatrics, 1992 Aug, 23(4), 196 - 8
Acute encephalomyelitis: extending the neurological manifestations of acute rheumatic fever?
Munn R, Farrell K, Cimolai N.
The clinical course of a five-year-old boy who developed meningeal irritation, encephalomyelitis, and optic neuritis four weeks after Streptococcus pyogenes pharyngitis is detailed . The patient responded to therapy with corticosteroids and recovered fully . Review of the literature reveals that a wide range of neurological disorders have been described in association with rheumatic fever . We suggest that disseminated encephalomyelitis in this child most probably was related to the streptococcal infection and that the spectrum of post-infectious neurological disorders associated with Streptococcus pyogenes may be broader than is currently appreciated.

Mol Microbiol, 1992 Aug, 6(16), 2253 - 65
Surface protein-CAT reporter fusions demonstrate differential gene expression in the vir regulon of Streptococcus pyogenes; Podbielski A et al.; Streptococcus pyogenes expresses at least two virulence factors, the anti-phagocytic M protein and an inhibitor of chemotaxis, the C5a peptidase (ScpA), under control of the virR locus . To facilitate studies of this regulatory unit, we constructed a new shuttle vector with a staphylococcal chloramphenicol acetyl transferase (CAT) reporter box which replicates in S . pyogenes . We cloned polymerase chain reaction (PCR)-derived potential promoter regions of the virR, M protein (emm12), and ScpA (scpA) genes from an M type 12 S . pyogenes, strain CS24 . Promoter activity was assessed by measurements of specific mRNAs, transacetylase activity, and minimum inhibitory concentrations (MICs) for chloramphenicol resistance . We demonstrated that VirR is a necessary but not always sufficient positive trans-acting regulator of emm12 and scpA expression; however, virR is not autoregulated . A potential virR-binding consensus sequence is postulated for emm12, scpA and other M-like protein genes . Promoter activity of the structural genes was found to be dramatically influenced by growth conditions such as anaerobiosis . Levels of control, over and above the requirement for virR, are realized . The virR and scpA promoters were mapped for the first time using primer extension analysis . The observed mRNA start sites did not completely agree within the sequence predicted start sites . Data suggest that scpA could be subject to transcription attenuation.

J Surg Res, 1992 Aug, 53(2), 109 - 16
Optimal site and amount of splenic tissue for autotransplantation; Iinuma H et al.; Clinical and basic studies have documented a high susceptibility to pneumococcal infection in asplenic humans and animals . It has been suggested that autotransplantation of splenic tissue might be a method of providing host resistance when total splenectomy is necessary . However, the effect of splenic autograft has remained controversial . This study was performed to evaluate the most effective site and amount of splenic autograft using rats . Rats were divided into five groups for the purpose of determining the site of splenic autotransplantation: splenectomy, sham operation, implantation into the omental pouch, intraperitoneal implantation, and intramuscular implantation . For determining the amount for autotransplantation, the rats were divided into seven groups: splenectomy, sham operation, and implantations of 25, 50, 100, 200, or 300 mg of splenic tissue . All animals were challenged with Streptococcus pneumoniae type 6, 16 weeks after surgery . Howell-Jolly bodies appeared postsplenectomy, but disappeared in the implanted rats 16 weeks after the operation . Histologically, the implanted tissue was indistinguishable from that of a normal spleen . Pneumococcal clearance from the bloodstream and survival rate were significantly higher in rats implanted in the omental pouch as compared with splenectomized rats . Intraperitoneal and intramuscular implanted rats did not show a significant difference from the splenectomized rats . More than 50% of splenic tissue for autograft showed a significant increase in pneumococcal clearance and survival rate as compared with that of splenectomized rats . It was suggested that the most effective site of autotransplantation is the omental pouch and approximately 50% of the whole spleen would be necessary for prevention from sepsis.

J Rheumatol, 1992 Aug, 19(8), 1305 - 7
Streptococcus pyomyositis occurring in a patient with dermatomyositis in a country with temperate climate; Soriano ER et al.; We describe a man in whom pyomyositis developed in a temperate climate . Three facts make this case unique . First the pyomyositis developed in someone with underlying dermatomyositis, this being the second reported case to our knowledge . Second, the organism involved was a Streptococcus and not a Staphylococcus as in most cases described, and the course of the disease was acute and not subacute as is usually reported . Finally, contrary to most described cases, surgical drainage was not necessary, probably because of the early diagnosis . Pyomyositis should be considered a possible cause of localized pain in patients with underlying inflammatory muscle disease.

Nippon Jibiinkoka Gakkai Kaiho, 1992 Aug, 95(8), 1229 - 38
{Bacteriology of infectious disease in otorhinolaryngology (1) . Bacteriological study of paranasal cyst}; Ito K et al.; The bacteriology of chronic sinusitis has been reported in several studies, but there have been few bacteriological studies on paranasal cyst . Also, details of the techniques of transportation and processing of clinical specimens have only rarely been described . Therefore, this study was undertaken with attention to the above, and to obtain information on appropriate antimicrobial therapy, we conducted a dilution antimicrobial susceptibility test of isolates . Fifteen patients with paranasal cyst participated in this study . Their lesions were frontal sinus (3), ethmoid sinus (2), sphenoid sinus (2) and maxillary sinus (8) . We punctured the cyst using an 18-gauge needle attached to a syringe at the time of operation, and paranasal cyst effusions were promptly transported to the laboratory . The specimen was immediately inoculated under a set of aerobic and prereduced anaerobic plates, which were incubated in appropriate conditions . Most specimens were completely processed within one hour . Antimicrobial susceptibility testing of isolates was done with MIC panel by the Sceptor system . Positive results of bacterial cultures were found in 60% of all cases (all of the frontal sinus specimens and half of those with other lesions) . A total of 38 bacteria, including 24 anaerobic and 14 aerobic species, were isolated from 9 paranasal cysts, yielding an average of 4.2 species per positive case (2.9 anaerobes and 1.3 aerobes) . Monomicrobial flora were found, anaerobes only in 2 cases and aerobes only in 2 others . Mixed flora were found in 5 cases in which both anaerobes and aerobes were isolated . The bacterial concentration in the maximal case was 4.9 x 10(4) CFU/ml . The organisms most frequently isolated were Propionibacterium spp . (7), Peptostreptococcus spp . (7), Staphylococcus spp . (7), Prevotella spp . (5) and Streptococcus spp . (4) . On the basis of the results of antimicrobial susceptibility testing of isolates in vitro, the use of Cephems, Clavulanic acid/Amoxicillin, Norfloxacin and Chloramphenicol proved to be clinically effective.

J Autoimmun, 1992 Aug, 5(4), 479 - 93
Cross-reactive maternal autoantibodies and congenital heart block; Horsfall AC et al.; Epitopes with linear sequences recognized by anti-La autoantibodies from seven mothers of children with congenital heart block were recently defined . Eight of these epitopes share sequence identity with three other proteins in addition to the original autoantigen, La . The three proteins are human cardiac myosin beta heavy chain, laminin B1 chain and the M6 protein of Streptococcus pyogenes . Affinity purified anti-La antibodies from a further three mothers bound to the La antigen and also to human cardiac myosin and mouse laminin . Affinity purified antibodies from three mothers of healthy children bound to the La antigen but showed minimal binding to either human cardiac myosin or mouse laminin . Cardiac myosin inhibited the binding of CHB-related anti-La antibodies to both La and myosin . These data support a role for maternal autoantibodies crossing the placenta and recognizing foetal cardiac antigens accessible at a critical developmental stage during gestation . We suggest that this would lead to complement fixation, inflammation and the subsequent pathology associated with congenital heart block.

J Dairy Sci, 1992 Aug, 75(8), 2126 - 30
Increased susceptibility to intramammary infection following removal of teat canal keratin; Capuco AV et al.; Influence of teat canal keratin on susceptibility to intramammary infection was investigated in lactating Jersey cows . In each of two replicate trials, keratin was removed from the left teats of 20 cows immediately before milking . Immediately after milking, all teats were exposed to bacterial challenge by immersion in a suspension of Streptococcus agalactiae (5 x 10(7) cfu/ml) . Bacterial challenge was repeated after the next four milkings . Foremilk samples were obtained for 8 d after keratin removal to determine infection status . A mammary quarter was classified as infected based solely upon the bacteriological criteria outlined by the National Mastitis Council . The rate of infection in quarters from which keratin was removed was greater than that in control quarters . Infection rates were 26.3% for keratin-removed quarters and 8.3% for control quarters in trial 1 and 13.5 and 0%, respectively, in trial 2 . When more stringent criteria (recovery of greater than 100 cfu of S . agalactiae/ml in three or more successive milk samples and a SCC of greater than 10(6)) were used to identify a subset of infections that were clearly intramammary, infection rates were 9.3% for keratin-removed quarters and 1.4% for control quarters . Thus, partial removal of keratin from the teat canal compromised the ability of the teat to prevent passage of bacterial pathogens from the external environment into the mammary gland.

Curr Microbiol, 1992 Aug, 25(2), 77 - 81
Sensitization of oral bacteria to killing by low-power laser radiation; Wilson M et al.; Twenty-seven compounds were screened for their ability to sensitize Streptococcus sanguis to killing by light from a 7.3-mW Helium/Neon (HeNe) laser . Bacteria were mixed with various concentrations of the test compounds, spread over the surfaces of agar plates, and then exposed to light from the HeNe laser for various time periods . The plates were then incubated and examined for zones of inhibition . Those compounds found to be effective photosensitizers were then tested against Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, and Fusobacterium nucleatum . Toluidine blue O, azure B chloride, and methylene blue at concentrations of 0.005% (wt/vol) were effective photosensitizers of all four species, enabling killing of bacteria following exposure to laser light for only 30 s.

J Formos Med Assoc, 1992 Aug, 91(8), 814 - 7
Streptococcus bovis endocarditis associated with colonic adenocarcinoma: report of a case; Ma HM et al.; Streptococcus bovis (S . bovis) endocarditis has been increasing over recent decades, especially among the senile population . A 74-year-old man presented with intermittent fever for two months . He had a past history of aortic dissection and underwent a Bentall operation one year before admission . A Janeway lesion was noted on his right hand and six blood cultures grew S . bovis . He was treated with penicillin-G, 3 microU intravenously, every six hours, and became afebrile three days later . A colonofiberoscopy was carried out despite the absence of any gastrointestinal symptoms, and a 2 x 2 cm mass was found at the cecum, with pathologic proof of adenocarcinoma . The patient died from a massive intracranial hemorrhage on the 23rd hospital day . Review of the literature revealed an intimate association between S . bovis bacteremia (or endocarditis) and underlying colonic neoplasia . Failure to be aware of the possible consequences of this combination may lead to detrimental patient prognosis . We strongly advise that every patient presenting with bacteremia or endocarditis due to this organism, even if they are free from gastrointestinal symptoms, should undergo a thorough lower gastrointestinal investigation to rule out colonic neoplasia.

Mol Microbiol, 1992 Aug, 6(15), 2051 - 63
Molecular characterization of pcp, the structural gene encoding the pyrrolidone carboxylyl peptidase from Streptococcus pyogenes; Cleuziat P et al.; This paper describes the cloning of a gene (pcp) coding for pyrrolidone carboxylyl peptidase (PYRase), an enzyme which selectively removes N-terminal pyroglutamic acid residues from polypeptides . This gene was isolated from Streptococcus pyogenes by construction of a gene library with a bacteriophage lambda-derived cosmid-Escherichia coli host system . Nucleotide sequence determination of a 1.3 kb restriction fragment revealed a 645 bp open reading frame encoding a 215-amino-acid product of M(r) 23,135 consistent with the 26 kDa polypeptide obtained from in vivo overexpression in E . coli . Southern hybridization confirmed that pcp is a single-copy gene on the S . pyogenes chromosome . 5' and 3' endpoint mapping of the 0.7 kb specific transcript observed by Northern analysis permitted the identification of transcriptional initiation and termination signals . Structural features of the pcp gene product from S . pyogenes are discussed and compared with that from Bacillus subtilis . The lack of sequence identity with any other known protein or nucleotide sequence suggests that this enzyme belongs to a new class of peptidase.

Hum Pathol, 1992 Aug, 23(8), 911 - 5
Quantitation of cytomegalovirus DNA in lung tissue of bone marrow transplant recipients; Shibata M et al.; Five bone marrow transplant recipients who died of respiratory failure were retrospectively analyzed with polymerase chain reaction (PCR) assay for pulmonary cytomegalovirus (CMV) infection . Two patients had CMV interstitial pneumonitis according to the virus isolation and the histologic and immunofluorescent examinations of the lungs, while the other three patients had non-CMV diseases (ie, idiopathic interstitial pneumonitis, pulmonary aspergillosis, or Streptococcus mitis septicemia) . Cytomegalovirus DNA was amplified from the postmortem lung tissue with PCR . The PCR assay showed apparent PCR signals specific to CMV DNA in the two patients with CMV pneumonitis . In contrast, CMV DNA was hardly detectable or undetectable in the three patients without CMV disease . With quantitative PCR assay the initial CMV copy number in the lung tissue of the two patients with CMV pneumonitis was more than 10(4) copies/micrograms DNA and was over 1,000-fold more than that of the three patients without CMV pneumonitis . These results show that quantitative PCR assay could be useful as a diagnostic measure for pulmonary CMV infection.

Infect Immun, 1992 Aug, 60(8), 3175 - 85
Cloning of a locus involved in Streptococcus mutans intracellular polysaccharide accumulation and virulence testing of an intracellular polysaccharide-deficient mutant; Harris GS et al.; The streptococcal transposon Tn916 (Tcr) was used to isolate mutants of Streptococcus mutans altered in glycogen accumulation to investigate whether glycogenlike intracellular polysaccharides (IPS) play an important role in S . mutans-induced caries formation . S . mutans UA130 (serotype c) was transformed with the Escherichia coli plasmid pAM620 (Tn916), and the resultant transposon libraries were screened for glycogen content by iodine staining . A transposon mutant, designated SMS201, demonstrated a glycogen-deficient phenotype on glucose-enriched medium . Quantitative electron microscopy confirmed that IPS concentrations were significantly reduced in SMS201 relative to the wild-type progenitor strain, UA130 . Importantly, reversion to wild type correlated at all times with loss of the transposon . Transposon excisants were used to facilitate cloning of the streptococcal gene(s) involved in glycogen biosynthesis and storage . A 2.1-kb chromosomal determinant (glgR) which encodes a putative regulator of S . mutans glycogen accumulation was isolated . A stable deletion mutation (delta glgR) was subsequently generated in E . coli and introduced into S . mutans by allelic exchange . The resultant glycogen synthesis-deficient mutant, SMS203, demonstrated a significantly reduced cariogenic potential (P less than 0.01) on the buccal, sulcal, and proximal surfaces of teeth in germfree rats, relative to animals challenged with the glycogen synthesis-proficient progenitor strain, UA130 . These observations confirm previous reports (J . M . Tanzer, M . L . Freedman, F . N . Woodiel, R . L . Eifert, and L . A . Rinehimer, p . 597-616, in H . M . Stiles, W . J . Loesche, and T . L . O'Brien, ed., Proceedings in Microbiology . Aspects of Dental Caries . Special Supplement to Microbiology Abstracts, vol . 3, 1976) which implicate IPS as significant contributors to the S . mutans cariogenic process.

J Bacteriol, 1992 Aug, 174(15), 4928 - 34
Nucleotide sequence of Streptococcus mutans superoxide dismutase gene and isolation of insertion mutants; Nakayama K; A gene (sod) encoding superoxide dismutase (SOD) was cloned from Streptococcus mutans in Escherichia coli, and its nucleotide sequence was determined . The presumptive amino acid sequence of its product revealed that the SOD is basically of Mn type . Insertional inactivation of the sod gene resulted in the loss of SOD activity in crude extracts, indicating that the gene represents the only functional gene for SOD in S . mutans . Moreover, Southern blot analysis indicated that the S . mutans chromosome had no additional gene which was hybridizable with an oligonucleotide probe specific for an SOD motif . The SOD-deficient mutants were able to grow aerobically, albeit more slowly than the parent strains.

Carbohydr Res, 1992 Jul 20, 232(1), 131 - 42
Immunochemical characterization of polyclonal and monoclonal Streptococcus group A antibodies by chemically defined glycoconjugates and synthetic oligosaccharides; Reimer KB et al.; Synthetic oligosaccharides of increasing complexity that represent different epitopes of the Streptococcus Group A cell-wall polysaccharide were used as haptens and glycoconjugates of bovine serum albumin (BSA) and horse hemoglobin (HHb) to characterize polyclonal and monoclonal antibodies . Rabbits were immunized with the BSA glycoconjugates of a linear trisaccharide, branched trisaccharide, and branched pentasaccharide . The binding specificities of the polyclonal antisera were determined by a series of inhibition ELISA studies in which disaccharide through pentasaccharide haptens were used as inhibitors of antibody-glycoconjugate binding . Monoclonal antibodies derived from mice immunized with a killed bacterial vaccine were selected for their binding to native polysaccharide antigen coupled to BSA and the BSA glycoconjugates of the di- and linear tri-saccharides . Polyclonal antibodies were moderately specific for the oligosaccharide epitope of the immunizing glycoconjugate and only those antibodies raised to the branched pentasaccharide antigen showed cross-reaction with the bacterial antigen . The behaviour of selected monoclonal antibodies parallels the binding profile of polyclonal antibodies in that the two highest-titre antibodies were directed toward an epitope displayed by the branched pentasaccharide.

Biochim Biophys Acta, 1992 Jul 15, 1131(3), 287 - 99
cDNA cloning, sequencing, expression and possible domain structure of human APEX nuclease homologous to Escherichia coli exonuclease III; Seki S et al.; cDNA encoding the human homologue of mouse APEX nuclease was isolated from a human bone-marrow cDNA library by screening with cDNA for mouse APEX nuclease . The mouse enzyme has been shown to possess four enzymatic activities, i.e., apurinic/apyrimidinic endonuclease, 3'-5' exonuclease, DNA 3'-phosphatase and DNA 3' repair diesterase activities . The cDNA for human APEX nuclease was 1420 nucleotides long, consisting of a 5' terminal untranslated region of 205 nucleotide long, a coding region of 954 nucleotide long encoding 318 amino acid residues, a 3' terminal untranslated region of 261 nucleotide long, and a poly(A) tail . Determination of the N-terminal amino acid sequence of APEX nuclease purified from HeLa cells showed that the mature enzyme lacks the N-terminal methionine . The amino acid sequence of human APEX nuclease has 94% sequence identity with that of mouse APEX nuclease, and shows significant homologies to those of Escherichia coli exonuclease III and Streptococcus pneumoniae ExoA protein . The coding sequence of human APEX nuclease was cloned into the pUC18 SmaI site in the control frame of the lacZ promoter . The construct was introduced into BW2001 (xth-11, nfo-2) strain and BW9109 (delta xth) strain cells of E . coli . The transformed cells expressed a 36.4 kDa polypeptide (the 317 amino acid sequence of APEX nuclease headed by the N-terminal decapeptide derived from the part of pUC18 sequence), and were less sensitive to methylmethanesulfonate and tert-butyl-hydroperoxide than the parent cells . The N-terminal regions of the constructed protein and APEX nuclease were cleaved frequently during the extraction and purification processes of protein to produce the 31, 33 and 35 kDa C-terminal fragments showing priming activities for DNA polymerase on acid-depurinated DNA and bleomycin-damaged DNA . Formation of such enzymatically active fragments of APEX nuclease may be a cause of heterogeneity of purified preparations of mammalian AP endonucleases . Based on analyses of the deduced amino acid sequence and the active fragments of APEX nuclease, it is suggested that the enzyme is organized into two domains, a 6 kDa N-terminal domain having nuclear location signals and 29 kDa C-terminal, catalytic domain.

J Clin Microbiol, 1992 Jul, 30(7), 1856 - 62
Isotype antibody response in cows to Streptococcus agalactiae group B polysaccharide-ovalbumin conjugate; Rainard P; Adult dairy cows were immunized with group B antigen (GBA) of Streptococcus agalactiae or GBA coupled to ovalbumin, both emulsified in incomplete Freund adjuvant, and their sera were examined by an enzyme-linked immunosorbent assay measuring bovine immunoglobulin isotypes (immunoglobulin G1 {IgG1}, IgG2, and IgM) specific for GBA . All of the cows possessed naturally acquired antibodies against GBA, which implied that primary antibody responses could not be studied . At the highest dose tested (200 micrograms), free GBA elicited a slight increase in antibody titers only in the IgM isotype, to which most of the naturally acquired antibodies to GBA belonged . A second administration of antigen was not more effective . The conjugate was able to induce a strong humoral response against GBA, particularly in the IgG1 and IgG2 subisotypes, and a second injection of the conjugate induced a doubling of the peak antibody titers . Therefore, conjugation of GBA to a protein carrier markedly improved the antibody response, which showed the main characteristics of T-cell dependency . The opsonic activity of serum against an unencapsulated strain of S . agalactiae was reinforced by the immunization with the conjugate.

Am J Med, 1992 Jul, 93(1), 91 - 3
Subacute bacterial endocarditis secondary to Streptococcus pneumoniae; Gelfand MS et al.; Pneumococcal endocarditis characteristically presents as an acute illness, often accompanied by purulent meningitis, rapid destruction of the heart valves, congestive heart failure, and high mortality . We describe two patients with subacute pneumococcal endocarditis without a known primary source of pneumococcal bacteremia, fever, meningitis, or congestive heart failure . Both patients were cured with medical therapy . Pneumococcal endocarditis can present as an indolent illness resembling viridans streptococcal endocarditis.

J Bacteriol, 1992 Jul, 174(13), 4517 - 23
Nucleotide sequences of genes encoding penicillin-binding proteins from Streptococcus pneumoniae and Streptococcus oralis with high homology to Escherichia coli penicillin-binding proteins 1a and 1b; Martin C et al.; The nucleotide sequence of a 3,378-bp DNA fragment of Streptococcus pneumoniae that included the structural gene for penicillin-binding protein (PBP) 1a (ponA), which encodes 719 amino acids, was determined . Homologous DNA fragments from an S . oralis strain were amplified with ponA-specific oligonucleotides . The 2,524-bp S . oralis sequence contained the coding region for the first 636 amino acids of a PBP . The coding sequence differed by 437 nucleotides (27%) and one additional triplet, resulting in 87 amino acid substitutions (14%), from S . pneumoniae PBP 1a . Both PBPs are highly homologous to bifunctional high-M(r) Escherichia coli PBPs 1a and 1b.

J Vasc Surg, 1992 Jul, 16(1), 71 - 4
Mycotic aneurysm of the tibioperoneal trunk: case report and review of the literature; Akers DL Jr et al.; Peripheral mycotic aneurysms can occur when septic emboli lodge in either the lumen or the vasa vasorum of a peripheral vessel . Such aneurysms have become rare after the widespread use of aggressive antibiotic treatment for bacterial endocarditis . We report the case of a large mycotic aneurysm of the tibioperoneal trunk 18 months after an episode of Streptococcus viridans bacterial endocarditis . Treatment included complete resection of the aneurysmal sac with restoration of circulation to the posterior tibial artery with a reversed saphenous vein graft . To our knowledge, this is the first case of a mycotic aneurysm of the tibioperoneal trunk reported in the English literature . It also represents the first case in which a mycotic aneurysm of an infrapopliteal vessel was managed successfully with restoration of circulation.

Clin Infect Dis, 1992 Jul, 15(1), 99 - 105
Trends in antimicrobial resistance of clinical isolates of Streptococcus pneumoniae in Bellvitge Hospital, Barcelona, Spain (1979-1990); Linares J et al.; From January 1979 to December 1990 we studied the susceptibility of 1,492 pneumococcal strains isolated from adult patients in Bellvitge Hospital, Barcelona, Spain, to nine antimicrobial agents . Among clinically significant pneumococci, the incidence of penicillin-resistant strains increased from 4.3% in 1979 to 40% in 1990, and that of erythromycin-resistant strains also rose from 0% in 1979 to 9.4% in 1990 . On the other hand, the incidence of strains resistant to tetracycline decreased from 76.1% to 37.6%, as did that of chloramphenicol-resistant strains, from 56.5% to 29.4% . The incidence of co-trimoxazole-resistant strains was about 40% throughout the study . Even more alarming was the finding that about 70% of penicillin-resistant strains showed multiple resistance to non-beta-lactam antibiotics . All pneumococci were susceptible to vancomycin, and all but six were susceptible to rifampin . We observed that isolates from cerebrospinal fluid and the respiratory tract were significantly more resistant to penicillin than were isolates from blood . The majority of strains (95%) belonged to serogroups or serotypes included in the 23-valent pneumococcal vaccine and 77.6% of penicillin-resistant strains belonged to groups 23, 6, 9, and 19.

Clin Infect Dis, 1992 Jul, 15(1), 95 - 8
Antimicrobial resistance in Streptococcus pneumoniae: an epidemiological survey in France, 1970-1990; Geslin P et al.; The antimicrobial resistance of Streptococcus pneumoniae was surveyed in 1970-1990 at Saint Joseph and Broussais hospitals in Paris (3,279 isolates) and in 1984-1990 at the National Reference Center for Pneumococci (NRCP) in Creteil (8,128 isolates) . All isolates were tested for susceptibility and serotyped . At St . Joseph and Broussais hospitals, the rate of resistance to tetracycline increased from 14% in 1970 to 46.5% in 1978 and then decreased to approximately 20% in 1988-1990 . Resistance to chloramphenicol appeared in 1972; its frequency remained at less than 10% until 1990 . Resistance to macrolides was first detected in 1976, increased to 20% in 1984, and reached 29% in 1990 . Among strains submitted to the NRCP, resistance to penicillin (MIC, greater than or equal to 0.1 mg/L) remained infrequent (less than or equal to 1.1%) between 1984 and 1986 but then increased steadily, reaching 12% in 1990 . The frequency of high-level resistance to penicillin (MIC, greater than 1 mg/L) among penicillin-resistant pneumococci increased from 13% in 1988 to 48% in 1990 . Compared with other serotypes, the penicillin-resistant serotype isolated most frequently (23F, 49.3%) was more often highly resistant to penicillin and was more often multiresistant.

Clin Infect Dis, 1992 Jul, 15(1), 84 - 94
Antimicrobial resistance in Streptococcus pneumoniae: a South African perspective; Koornhof HJ et al.; Resistance to penicillin among South African strains of Streptococcus pneumoniae increased from 4.9% in 1979 to 14.4% in 1990 . Except for resistance to co-trimoxazole (44%), resistance to other antimicrobial agents remained relatively low . Multiply resistant strains belonged mainly to serovars 6B, 19A, 14, and, more recently, 23F . Use of chloramphenicol to treat meningitis caused by strains relatively resistant to penicillin proved to be unsatisfactory, probably because of the inadequate bactericidal activity of chloramphenicol against these strains . Spread of penicillin-resistant nasopharyngeal strains in pediatric wards was most common among children who received antimicrobial therapy . Penicillin-binding protein (PBP) patterns were shown to vary in resistant clinical strains . Interspecies transfer of penicillin resistance between Streptococcus mitis and S . pneumoniae was demonstrated and antigenic homology was found in PBPs 1A and 2B of strains belonging to these species . Restriction enzyme mapping following DNA amplification of the PBP 2B gene revealed six arrangements among South African strains within serogroup 19 . Despite extensive studies in South Africa and several other countries, many questions with regard to the global problem of antimicrobial resistance among S . pneumoniae strains remain unanswered, especially those that relate to prevalence in developing regions of the world.

Clin Infect Dis, 1992 Jul, 15(1), 77 - 83
Antimicrobial resistance in Streptococcus pneumoniae: an overview; Appelbaum PC; Clinical resistance to penicillin in Streptococcus pneumoniae was first reported by researchers in Boston in 1965; subsequently, this phenomenon was reported from Australia (1967) and South Africa (1977) . Since these early reports, penicillin resistance has been encountered with increasing frequency in strains of S . pneumoniae from around the world . In South Africa strains resistant to penicillin and chloramphenicol as well as multiresistant strains have been isolated . Similar patterns of resistance have been reported from Spain . Preliminary evidence points to a high prevalence of resistant pneumococci in Hungary, other countries of Eastern Europe, and some countries in other areas of Europe, notably France . In the United States most reports of resistant pneumococci come from Alaska and the South, but resistance is increasing in other states and in Canada . Pneumococcal resistance has also been described in Zambia, Japan, Malaysia, Pakistan, Bangladesh, Chile, and Brazil; information from other African, Asian, and South American countries is not available . The rising prevalence of penicillin-resistant pneumococci worldwide mandates selective susceptibility testing and epidemiological investigations during outbreaks.

Clin Infect Dis, 1992 Jul, 15(1), 119 - 27
Treatment and diagnosis of infections caused by drug-resistant Streptococcus pneumoniae; Jacobs MR; Drug-resistant strains of Streptococcus pneumoniae have now been reported from all continents and have become the predominant pathogens in some areas; many strains are resistant to multiple agents . Because of the importance of pneumococci in the etiology of meningitis, the criteria used to assess susceptibility are conservative: strains with minimal inhibitory concentrations (MICs) of penicillin G of less than or equal to 0.06 microgram/mL are regarded as susceptible, those with MICs of 0.1-1 microgram/mL are considered intermediately resistant, and those with MICs of greater than 1 microgram/mL are designated highly resistant . The diagnosis, treatment, and prevention of infections due to resistant pneumococci are the subjects of this review . Methods of susceptibility testing have now been well defined for pneumococci . Screening for penicillin resistance with 1-microgram oxacillin disks is recommended for all clinically significant isolates . The activity of other beta-lactam agents against penicillin-resistant strains has been documented, and the MICs of a number of non-beta-lactam agents have been determined as well . Treatment of resistant pneumococcal infections depends on the site of infection, the degree of resistance to penicillin G, the resistance of the infecting strain to other agents, the severity of disease, the presence of underlying conditions, and the dose and route of administration of antimicrobial agents . Current recommendations for treatment are based on retrospective case studies, and adequate prospective studies providing more definitive data are needed . Prevention of pneumococcal infections in children less than 2 years of age and in the elderly remains a problem . Improved vaccines must be developed for this purpose.

Clin Infect Dis, 1992 Jul, 15(1), 112 - 8
Geographic distribution of penicillin-resistant clones of Streptococcus pneumoniae: characterization by penicillin-binding protein profile, surface protein A typing, and multilocus enzyme analysis; Munoz R et al.; Examination of several hundred penicillin-resistant clinical isolates of Streptococcus pneumoniae has revealed extensive strain-to-strain variation in the number and molecular size of penicillin-binding proteins (PBPs) . This polymorphism has been used to classify resistant isolates into groups (PBP families) that share distinct electrophoretic profiles . We describe herein properties of four such PBP families: two from Spain (and/or Ohio) and one each from Hungary and Alaska . We have discovered that representative isolates assigned to each PBP family also share capsular serotype, antibiotic resistance pattern, pneumococcal surface protein A type, and multilocus enzyme genotype . The results demonstrate independent clonal origin for strains assigned to each PBP family . Each resistant clone occurs with uniquely high incidence within specific geographic areas.

Clin Infect Dis, 1992 Jul, 15(1), 106 - 11
Pneumococcal antimicrobial resistance: the problem in Hungary; Marton A; An epidemiological survey of penicillin resistance as determined by minimum inhibitory concentrations (MICs) in Streptococcus pneumoniae strains collected from several Hungarian laboratories in 1988-1989 indicated a prevalence of 58% among a total of 135 isolates . A significantly higher resistance rate (69.2%) was found for isolates from pediatric patients than from adult patients (44.0%) . Penicillin-resistant strains were more frequently resistant to non-beta-lactam antibiotics (tetracycline, erythromycin, co-trimoxazole, and chloramphenicol) than were penicillin-sensitive strains . On the basis of the MIC50 and MIC90 values of ampicillin and five cephalosporins for penicillin-resistant strains, it was established that ampicillin and cephalexin were not superior to penicillin . The low MIC90 of ceftriaxone and cefotaxime for these organisms reflects promising therapeutic potential, even in septicemia and meningitis caused by penicillin-resistant strains . The therapeutic alternative to penicillin in the treatment of respiratory tract infection may be second-generation cephalosporins such as cefuroxime or cefamandole.

Infect Immun, 1992 Jul, 60(7), 2850 - 4
Role of the bacterial cell wall in middle ear inflammation caused by Streptococcus pneumoniae; Carlsen BD et al.; The pathogenesis of middle ear inflammation caused by Streptococcus pneumoniae was explored in the chinchilla model with different pneumococcal cell wall (CW) preparations, including isolated native CW, M1 muramidase CW (M1-CW) digest, amidase CW digest, and M1 peptidoglycan (M1-PG) digest . Inflammatory cell and lysozyme concentrations in middle ear fluid (MEF) were measured between 6 and 72 h after the middle ears were inoculated with one of the preparations or sterile saline . Middle ear histopathology was measured quantitatively at 72 h . Native CW, M1-CW digest, and amidase-CW digest caused significantly more inflammatory cell influx and lysozyme accumulation in MEF than saline did . M1-PG digest also caused more inflammatory cell influx and lysozyme accumulation in MEF than saline did but caused less inflammation than native CW or either CW digest . Epithelial metaplasia was significantly greater in ears inoculated with native CW than in ears inoculated with the CW or PG digest or with saline . Pneumococcal CW is, therefore, the principal factor that initiates middle ear inflammation in acute pneumococcal otitis media, and CW teichoication seems to be important in initiating this response.

J Infect Dis, 1992 Jul, 166(1), 38 - 42
IgG antibody reactive with five serotypes of Streptococcus pneumoniae in commercial intravenous immunoglobulin preparations; Hamill RJ et al.; Intravenous immunoglobulin replacement is recommended for immunoglobulin deficiency, but comparison of the efficacy of intravenous immunoglobulin preparations (IVIGs) has been hindered by the lack of standardized assays to measure immunoglobulin levels against important bacterial pathogens . IgG reactive with five commonly isolated serotypes of Streptococcus pneumoniae in four commercially available IVIGs was measured by ELISA . Specific antibody to capsular polysaccharide was quantitated before and after adsorption with cell wall polysaccharide (CWPS) . All IVIGs contained measurable levels of antibody to the five pneumococcal serotypes, although the levels against an individual serotype varied by as much as sevenfold from one preparation to another . Each IVIG also contained substantial concentrations of IgG reactive with CWPS . The amount of each IVIG that protected mice was nearly identical after the doses were adjusted on the basis of specific IgG measured by ELISA, thereby providing proof in vivo of the validity of this in vitro assay system.

J Infect, 1992 Jul, 25(1), 77 - 81
Prosthetic hip-joint infection associated with a penicillin-tolerant group B streptococcus; Cunningham R et al.; We report a case of prosthetic hip-joint infection with Streptococcus agalactiae (Lancefield group B streptococcus) . The infection recurred after 3 months' treatment with amoxycillin . On further investigation, the isolate was found to be amoxycillin-tolerant . Addition of gentamicin abolished tolerance in vitro and the patient has remained asymptomatic since receiving a 10-day course of amoxycillin and gentamicin followed by amoxycillin alone.

FEMS Microbiol Lett, 1992 Jul 1, 73(1-2), 89 - 93
Production of monovalent antisera by induction of immunological tolerance for capsular typing of Streptococcus pneumoniae; Henrichsen J et al.; Hyperimmune and high-titered polyclonal pneumococcal antisera, specific for cross-reactive types within groups, were produced in adult rabbits . Purified capsular polysaccharide was injected intravenously into adult rabbits . One week later, these rabbits were given multiple intravenous injections of formalin-inactivated pneumococci of the cross-reactive type by an established method . Each of the resultant antisera were specific for the cross-reactive type indicating that the previous injection of the polysaccharide had induced epitope-specific tolerance . This method was successful for production of antisera against pneumococcal types 6A, 6B, 9N, 9V, 19F and 19A . Polyclonal rabbit pneumococcal antisera have some advantages over murine monoclonal antibodies for serologic studies and this method should be applicable for producing type-specific antibodies to cross-reactive polysaccharides of clinical interest . Further, this method is simpler and generally produces higher titered monovalent (factor) reagents than absorbed antisera.

Pharmazie, 1992 Jul, 47(7), 495 - 8
Studies on azopyrazole derivatives . Part 9: Synthesis and antibacterial evaluation of novel phenylhydrazones and their substituted 4-arylazopyrazole derivatives; Ergenc N et al.; 6-Methyl-2,4-heptandione (1) was coupled with diazonium salts of sulfanilamide (2) and 4-aminobenzoic acid (3) . Resulting new hydrazones, namely 4-methyl-2-oxovaleraldehyde p-substituted phenylhydrazones 4 and 5, were refluxed with various hydrazines to synthesize the title compounds 6-15 . Their structure elucidation was made on the basis of their analytical and spectroscopic data . The antibacterial activity was evaluated . Some of the compounds tested exerted moderate to potent antibacterial activity against Staphylococcus aureus, Staphylococcus epidermidis and Streptococcus pyogenes.

Berl Munch Tierarztl Wochenschr, 1992 Jul 1, 105(7), 224 - 30
{Characterization of Streptococcus uberis with special consideration of supposed pathogenicity factors}; Christ D et al.; Streptococcus uberis, as one of the principal causes of bovine streptococcal mastitis, has been characterized serologically and biochemically . Serological grouping of S . uberis revealed polysaccharide antigens of groups E, G, P and U . The biochemical properties of S . uberis, determined with the Strep-Zym identification system, differed clearly from those of S . agalactiae and S . dysgalactiae . Some cultures of S . uberis produced the enzymes hyaluronidase and neuraminidase . In addition S . uberis partly demonstrated CAMP-like synergistic hemolytic activities on sheep blood agar, reacted specifically with the lectins from Helix pomatia and Dolichos biflorus and produced bacteriocin-like inhibitors . This reactions, possibly of importance as virulence factors, as well as "DNA-fingerprinting" of S . uberis, might serve as individual markers of the respective cultures in epidemiological studies.

Res Microbiol, 1992 Jul-Aug, 143(6), 549 - 58
Introduction of the emm6 gene into an emm-deleted strain of Streptococcus pyogenes restores its ability to resist phagocytosis; Perez-Casal J et al.; To complete the formal proof that the M protein functions to protect the group A streptococcus from phagocytosis and to lay the groundwork for the molecular genetic dissection of this major virulence factor, we have reintroduced a wild-type allele of the M protein gene (emm) into the chromosome of a strain from which it had previously been deleted . For this purpose, we used homologous recombination with an engineered plasmid that was introduced into the Streptococcus pyogenes chromosome by an electroporation technique that we developed . The plasmid pJRS120E was constructed in Escherichia coli and contains the structural gene for the antiphagocytic M6 protein (emm6) of S . pyogenes JRS4 and a selectable marker (ermAM) between the chromosomal regions that flank emm6 in S . pyogenes . This plasmid was introduced into S . pyogenes strain JRS75, a strain that is not resistant to phagocytosis as a result of the allelic replacement of the emm6 gene by a kanamycin resistance gene (aphA3) . DNA hybridization analysis indicated that in erythromycin-resistant strain JRS115, homologous recombination resulted in the replacement of the aphA3 gene of JRS75 with the introduced emm6 allele . Strain JRS115 produces approximately the same amount of M6 as does the parental emm6+ strain JRS4, as assayed by Western blot analysis, and is resistant to phagocytosis.

J Parenter Sci Technol, 1992 Jul-Aug, 46(4), 130 - 4
A comparison of two commercially irradiated Trypticase Soy Agars containing lecithin and polysorbate 80; Marsik F et al.; Gamma-radiation sterilized Trypticase Soy Agar containing lecithin and polysorbate 80 (TSA++) (Becton Dickinson Microbiology Systems, Cockeysville, MD) and irradiated TSA++ (Adams Scientific, West Warwick, RI) were tested by a quantitative spread plate method . Four bacteria Bacillus subtilis ATCC 6633, Pseudomonas aeruginosa ATCC 10145, Staphylococcus aureus ATCC 25923, Streptococcus pyogenes ATCC 19615 and the yeast Candida albicans ATCC 10231 were tested in two separate experiments using different lots of media . A strain of Aspergillus niger ATCC 16404, was tested by a qualitative streak plate method . The Becton Dickinson Microbiology Systems (BDMS) irradiated TSA++ overall recovered a greater number of organisms than the Adams Scientific TSA++ in both experiments and allowed for the earlier recovery of S . pyogenes ATCC 19615 . The growth of A . niger ATCC 16404, was comparable on both media . Efficacy of the media to neutralize 1, 2 and 3% phenol as well as 0.001, 0.01 and 0.1% benzalkonium chloride (BC) solutions was done by a disk diffusion method using 2 gram-positive and 4 gram-negative bacteria . Both media showed complete neutralization of the 0.001 and 0.01% BC solutions and partial neutralization of the 0.1% BC solution . The BDMS TSA++ showed better neutralization of the 2 and 3% phenol solutions than the Adams Scientific TSA++ . This data indicates that not all irradiated TSA++ media perform in an equivalent manner.

Pharm Res, 1992 Jul, 9(7), 920 - 4
An in vitro pharmacodynamic model to simulate antibiotic behavior of acute otitis media with effusion; Vance-Bryan K et al.; The purpose of this investigation was to develop an in vitro pharmacodynamic model (IVPM) that would simultaneously simulate in vivo serum and middle ear amoxicillin pharmacokinetic characteristics of acute (purulent) otitis media and then utilize the IVPM to assess amoxicillin-mediated killing of a type 7F Streptococcus pneumoniae (MIC = 0.002 mg/L) . The IVPM consisted of a sterile central compartment and a membrane-bound "infected" peripheral compartment . Peak peripheral compartment amoxicillin concentrations occurred within 2 hr after its introduction into the central compartment and were approximately 30% of peak central compartment concentrations . Amoxicillin elimination from the central compartment was designed to provide a 1-hr t 1/2 . Amoxicillin elimination from the peripheral compartment was slower than from the central compartment, with an average half-life of 2.3 hr . Significant concentration-related differences in maximal bacterial kill rates were not detected over the range of amoxicillin concentrations studied (0.26 to 14.6 mg/L) . However, at peak central compartment amoxicillin concentrations of less than or equal to 2 mg/L, a lag phase in killing was observed . In general, the in vitro pharmacokinetic data derived from this model compare well with published in vivo data.

J Antimicrob Chemother, 1992 Jul, 30(1), 39 - 46
In-vitro activity of ten antimicrobial agents against penicillin-resistant Streptococcus pneumoniae; Neal TJ et al.; The minimum inhibitory concentrations (MICs) of ten antibiotics were determined by the agar dilution method for 40 strains of penicillin-resistant Streptococcus pneumoniae, all of which were clinical isolates from this laboratory . The antibiotics tested were clarithromycin, erythromycin, teicoplanin, vancomycin, ceftriaxone, cefodizime, azithromycin, ramoplanin, ciprofloxacin and MDL 62873 . Of these agents, clarithromycin, vancomycin, teicoplanin, ceftriaxone, ramoplanin and MDL 62873 were the most active . The role of these antibiotics as alternatives to penicillin for the treatment of infections caused by penicillin-resistant S . pneumoniae is discussed.

Alcohol Alcohol, 1992 Jul, 27(4), 345 - 52
Influence of the level of dietary ethanol in mice with murine AIDS on resistance to Streptococcus pneumoniae; Shahbazian LM et al.; Chronic ethanol consumption impairs cellular immune functions . This may explain the increased occurrence of various opportunistic infections in heavy ethanol users . Immunological alterations associated with Acquired Immune Deficiency Syndrome (AIDS) also permit more opportunistic infections . In this study, we used a murine model of retrovirus infection induced by LP-BM5 murine leukemia virus . The combined effects of ethanol use and early retroviral infection (prior to the development of AIDS) on resistance to Streptococcus pneumoniae were investigated . Consumption of ethanol by non-retrovirus-infected mice resulted in decreased resistance to S . pneumoniae . However, retrovirus-infected mice fed a diet containing high concentrations of ethanol (6 and 7% v/v) exhibited a greater resistance to S . pneumoniae infection than retrovirus-infected mice fed diets with lower concentrations (5%) or no ethanol . The total number of white blood cells also decreased as serum ethanol levels increased . There were also fewer lymphocytes and more neutrophils and monocytes in retrovirus-infected mice fed ethanol . Diet consumption decreased as the concentration of ethanol increased in the diet . Consumption was dependent upon the dark-light cycle . The highest diet consumption was observed during the first 4 hr of the dark period . The level of ethanol in serum was influenced by the amount of the diet consumed and its ethanol concentration . Both retrovirus infection and ethanol consumption effected survival after S . pneumoniae infection.

J Antimicrob Chemother, 1992 Jul, 30 Suppl A, 95 - 9
In-vitro and in-vivo synergic activity and fractional inhibitory concentration (FIC) of the components of a semisynthetic streptogramin, RP 59500; Bouanchaud DH; RP 59500 is a new semisynthetic injectable streptogramin antibiotic composed of two compounds which interact synergically, RP 57669 and RP 54476, derived from pristinamycin IA and pristinamycin IIB, respectively . The bacteristatic and bactericidal activities of RP 57669 and RP 54476 alone or combined in various proportions were tested by the chequerboard dilution technique . The fractional inhibitory concentration (FIC) index was determined for 14 Staphylococcus aureus isolates (including methicillin- and macrolide-resistant strains) and one culture collection strain . The FIC index was found to be much lower than 0.5, indicating the presence of synergy for all strains tested, whatever their resistance pattern . The ED50 of RP 57669 and RP 54476 in various combinations were also determined in three experimental murine models of septicaemia, caused by either S . aureus or Streptococcus pneumoniae, and a thigh abscess model caused by S . aureus . The combinations which performed best in the model of septicaemia were those in which the RP 57669: RP 54476 ratio ranged from 16:84 to 92:8, while those active against the thigh abscess model had ratios ranging from 8:92 to 84:16 . That the drugs were active over a wide range of ratios suggests that synergy will be maintained even if one drug is cleared more rapidly than the other . The combination of 30:70, referred to as RP 59500, was selected for further studies, both in vitro and in various experimental models of infections.

J Antimicrob Chemother, 1992 Jul, 30 Suppl A, 19 - 23
In-vitro antibacterial activity of RP 59500, a semisynthetic streptogramin, against Streptococcus pneumoniae; Fremaux A et al.; The in-vitro activity of the new streptogramin RP 59500 was determined against 100 strains of Streptococcus pneumoniae . In all, 48 erythromycin-sensitive strains and 52 erythromycin-resistant strains were tested by an agar dilution method (MIC determination), 20 strains (eight erythromycin-sensitive and 12 erythromycin-resistant) were tested by a broth microdilution technique (MIC and MBC determination) and ten strains (two erythromycin-sensitive and eight erythromycin-resistant) were tested for bactericidal kinetics . The study showed that RP 59500 had good bacteristatic and bactericidal activity against both erythromycin-sensitive and erythromycin-resistant strains . On the basis of these results, and because the number of erythromycin-resistant strains of S . pneumoniae isolated in France has increased steadily since 1985, RP 59500 might be useful for the treatment of pneumococcal infections and warrants further investigation.

Eur J Clin Microbiol Infect Dis, 1992 Jul, 11(7), 642 - 5
Post-antibiotic effect of the new streptogramin RP 59500; Chin NX et al.; The post-antibiotic effect (PAE) of RP 59500, a new streptogramin antibiotic, was determined for Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus, Streptococcus pneumoniae, and Streptococcus pyogenes . A 30 min exposure of Staphylococcus aureus to 5 micrograms/ml of RP 59500 produced a PAE of 1.9-6.9 h, and a 60 min exposure of 2.5 micrograms/ml produced a PAE of 3.2-8 h . A 30 min exposure of 5 micrograms/ml of RP 59500 of coagulase-negative staphylococci produced a PAE of 2.5-7.5 h . PAEs of constitutively erythromycin-resistant staphylococcal isolates were shorter than were the PAEs of highly susceptible isolates . A 30 min exposure to 5 micrograms/ml of RP 59500 produced a PAE of 7.5-9.5 h for Streptococcus pneumoniae and a PAE of greater than 18 h for Streptococcus pyogenes . RP 59500 produced a longer PAE with Staphylococcus aureus than did vancomycin, oxacillin or erythromycin . These results suggest that RP 59500 may be administered less frequently than would be suggested by its half-life.

Proc Natl Acad Sci U S A, 1992 Jul 1, 89(13), 6172 - 6
Protein F, a fibronectin-binding protein, is an adhesin of the group A streptococcus Streptococcus pyogenes; Hanski E et al.; Binding to fibronectin has been suggested to play an important role in adherence of the group A streptococcus Streptococcus pyrogenes to host epithelial cells; however, the identity of the streptococcal fibronectin receptor has been elusive . Here we demonstrate that the fibronectin-binding property of S . pyogenes is mediated by protein F, a bacterial surface protein that binds fibronectin at high affinity . The gene encoding protein F (prtF) produced a functional fibronectin-binding protein in Escherichia coli . Insertional mutagenesis of the cloned gene generated a mutation that resulted in the loss of fibronectin-binding activity . When this mutation was introduced into the S . pyrogenes chromosome by homologous recombination with the wild-type allele, the resulting strains no longer produced protein F and lost their ability to bind fibronectin . The mutation could be complemented by prtF introduced on a plasmid . Mutants lacking protein F had a much lower capacity to adhere to respiratory epithelial cells . These results demonstrate that protein F is an important adhesin of S . pyogenes.

Infect Immun, 1992 Jul, 60(7), 2815 - 22
Expression of Streptococcus mutans gtf genes in Streptococcus milleri; Fukushima K et al.; The Streptococcus mutans glucosyltransferase (GTF) genes gtfB and gtfC were ligated into Escherichia coli-streptococcus shuttle plasmids and introduced into Streptococcus milleri . gtfB transformant KSB8 formed an S . mutans-like rough colony on mitis salivarius agar and expressed an extracellular GTF-I, of 158 kDa, and two cell-bound GTF-Is, of 158 and 135 kDa . gtfC transformant KSC43 formed a semirough colony on mitis salivarius agar and expressed primarily an extracellular GTF-SI, of 146 kDa, and two cell-bound GTF-SIs, of 146 and 152 kDa . The extracellular GTFs from KSB8 and KSC43 were purified and characterized . The two types of GTF also reacted specifically with monoclonal antibodies directed against each enzyme . Both enzymes synthesized significant amounts of oligosaccharides, consisting primarily of alpha-1,6-glucosidic linkages, as well as water-insoluble glucans, containing alpha-1,3-glucosidic linkages . Insoluble-glucan-synthesizing activities of both enzymes were stimulated (three- to sixfold) by the addition of dextran T10 and were inhibited in the presence of 1.5 M ammonium sulfate . The Km(s) for sucrose and the optimal pHs were also similar for both enzymes . However, when the transformants were grown in Todd-Hewitt broth supplemented with sucrose, KSC43 cells, expressing GTF-SI activity, adhered to glass surfaces in vitro, while KSB8 cells, expressing GTF-I activity, did not . These results are discussed relative to the potential role of the gtfB and gftC genes in S . mutans cariogenicity.

Blood, 1992 Jul 1, 80(1), 96 - 101
Effect of stem cell factor with and without granulocyte colony-stimulating factor on neonatal hematopoiesis: in vivo induction of newborn myelopoiesis and reduction of mortality during experimental group B streptococcal sepsis; Cairo MS et al.; Neonatal hematopoiesis and host defense are developmentally immature and under states of increased demand predispose the newborn to peripheral cytopenias and depletion of bone marrow storage pool reserves . We have previously demonstrated that recombinant human granulocyte colony-stimulating factor (rhG-CSF) can significantly modulate neonatal rat granulopoiesis and act synergistically with antibiotic therapy to reduce the mortality rate during experimental group B streptococcal sepsis . Stem cell factor (SCF) has been shown to stimulate early hematopoietic progenitor cells and, in the presence of lineage-specific CSFs, enhance committed progenitor cell proliferation . In the present study we examined the in vivo neonatal hematologic effects of recombinant rat (rr) SCF (14 days), simultaneous rrSCF + rhG-CSF (14 days), and sequential combination of rrSCF (7 days) + rhG-CSF (7 days) . Sprague-Dawley newborn rats (less than or equal to 24 hours) were injected intraperitoneal (IP) x 14 days with the above combinations . rrSCF (0 to 200 micrograms/kg/d) had a negligible effect on the peripheral platelet count and absolute neutrophil count (ANC) but the diminution in the hematocrit during the first 10 days of treatment was less pronounced (P = .0001) . However, the simultaneous use of rrSCF + rhG-CSF synergistically increased the circulating day 6 to 13 ANC (P = .001) . Similarly, sequential rrSCF + rhG-SCF also had a synergistic significant effect during the second week of therapy on the circulating ANC (P = .01) . The bone marrow neutrophil storage and proliferative pools were also significantly increased in newborn rats treated with rrSCF + rhG-CSF versus rhG-CSF (P = .02) . The bone marrow and liver/spleen CFU-GM pool was unchanged; however, the CFU-GM proliferative rates were significantly increased in the rrSCF + rhG-CSF group (P = .04) . rrSCF also induced a significant increase in the bone marrow and liver/spleen mast cell pool (P = .002) . Lastly, rrSCF x 14 days +/- rhG-CSF significantly reduced the mortality rate at 48 and 120 hours after experimental group B streptococcus sepsis (P = .03 and .05, respectively) . These data suggest that combination SCF + G-CSF therapy compared with G-CSF alone significantly increases the neonatal rat peripheral neutrophil count, bone marrow myeloid pools and proliferative rates, and induces a reduction in the mortality rate during experimental bacterial sepsis . SCF therapy may have future potential applications in the modulation of human neonatal hematopoiesis and host defense.

Vet Microbiol, 1992 Jul, 32(1), 81 - 8
Comparative bacteriological studies on summer mastitis in grazing cattle and pyogenes mastitis in stabled cattle in Denmark; Madsen M et al.; A total of 143 secretions from clinical cases of summer mastitis (SM) in grazing cattle and from 89 cases of pyogenes mastitis (PM) in stabled cattle were examined bacteriologically . The typical bacteriological finding was a mixed flora in which the predominant organisms were Actinomyces pyogenes (SM-70%, PM-85%), Peptostreptococcus indolicus (54%, 54%), a microaerophilic coccus (Stuart-Schwan coccus) (26%, 25%), Fusobacterium necrophorum biovar B (22%, 12%), Bacteroides melaninogenicus (20%, 9%) and Streptococcus dysgalactiae (21%, 5%) . All except six cases occurred in non-lactating animals or within three weeks after parturition . The majority of animals (about 90%) had only one quarter affected and no differences in quarter distribution were observed between the two groups.

Rev Paul Med, 1992 Jul-Aug, 110(4), 152 - 7
Sydenham chorea: clinical and laboratory findings . Analysis of 187 cases; Goldenberg J et al.; Sydenham's chorea (chorea minor, St . Vitus dance, rheumatic encephalitis), described by Thomas Sydenham in 1686, is considered one of the major manifestations of rheumatic fever (1, 2, 3, 4) . Clinically it is characterized by involuntary movements, hypotonia, dysarthria, emotional disorders, and less frequently, by other neurological manifestations such as weakness, headache, seizures and sensory abnormalities (1,4) . The motor disorders may be generalized or unilateral, in this case constituting a hemichorea (3) . Chorea may present associated to other rheumatic fever manifestations during an acute episode, or in isolated form, characterizing the so-called "pure" chorea (5, 6, 7) . Its etiology and pathophysiological mechanisms are still unclear, although its relation with a previous pathophysiological group A Beta-hemolytic streptococcus infection is well established (8) . There is also evidence of the participation of immunological mechanisms in its pathogenesis, such as the finding of serum anti-nucleus caudatus and anti-subthalamic antibodies (9) and increase in IgG levels in cerebrospinal fluid of patients with chorea (10) . In developed countries due to the reduction in rheumatic fever incidence and decrease in frequency of chorea as its manifestation (3, 11), the latter has become rare . However, in developing countries rheumatic fever remains a public health problem . In Brazil, in the last years an increase in the incidence of chorea has been observed as part of the clinical picture of rheumatic fever (12) . The present study reports the clinical and laboratory findings of 187 cases of Sydenham's chorea followed-up during the period of January 1980 to December 1990 in two university centers in the city of Sao Paulo, Brazil.

Bacteriol Virusol Parazitol Epidemiol, 1992 Jul-Dec, 37(3-4), 1 - 8
{Lantibiotics}; Israil A; Lantibiotics synthesized by gram positive bacteria (Staphylococcus, Streptococcus, Bacillus, genera) are a special group of polycyclic polypeptides constituted of protein amino acids and unusual amino acids (i.e . lanthionine, beta-methyllantionine etc.) these last ones exhibiting interchain thioeter bridges and ring structures . Some lantibiotics are already used in medical therapy (nisin, gallidermin, epidermin) as well as for food preservation (nisin) . Their special structures and synthesis have focused substantial scientific interest, the lantibiotics proving to be ideal experimental models not only for microbiology but also for biochemistry, molecular biology, gene technology and protein engineering in the purpose to get more insights in the fundamental aspects of the cell biology.

J Antimicrob Chemother, 1992 Jul, 30(1), 89 - 100
Safety and efficacy of temafloxacin versus ciprofloxacin in lower respiratory tract infections: a randomized, double-blind trial; Lindsay G et al.; Temafloxacin, a new fluoroquinolone with broad-spectrum anti-bacterial activity and a favourable pharmacokinetic profile, was evaluated in a prospective, randomized double-blind multicentre study in which 564 patients were enrolled . Ambulatory adults with lower respiratory tract infections were randomly assigned to receive temafloxacin 600 mg or ciprofloxacin 750 mg, each given every 12 h for 7-14 days . Cure or improvement occurred in 93.8% of temafloxacin patients and 93.1% of ciprofloxacin recipients (P greater than 0.05) . Bacteriological eradication rates were higher in the temafloxacin group than in the ciprofloxacin group (99.5% vs 92.5%; P = 0.001) primarily because of the failure of ciprofloxacin to eradicate Streptococcus pneumoniae (P = 0.01) . Both regimens were well tolerated . In patients who received concomitant theophylline, gastrointestinal and central nervous system disturbances occurred in a higher percentage of patients in the ciprofloxacin group than the temafloxacin group (36.4% vs 9.4%; P less than 0.05) . This study indicates that temafloxacin would be suitable for the empirical treatment of lower respiratory tract infections, including high-risk groups such as the elderly and heavy smokers.

JAMA, 1992 Jun 24, 267(24), 3315 - 6
Intravenous immunoglobulin therapy for toxic shock syndrome; Barry W et al.; Staphylococcus aureus and group A Streptococcus pyogenes produce toxic shock syndrome characterized by hypotension and multisystem organ failure . While conventional therapy has consisted of antibiotics and intensive supportive care, some experimental evidence suggests that immunoglobulins directed against the toxins may be effective additional therapy . We report a case of "toxic strep syndrome" in which intravenous immunoglobulin was administered when signs and symptoms were worsening while the patient was receiving conventional therapy . Within hours of administration of the intravenous immunoglobulin, the patient experienced dramatic clinical improvement . This response suggests a possible therapeutic benefit of intravenous immunoglobulin in toxic shock syndrome.

Vet Rec, 1992 Jun 6, 130(23), 510 - 3
Pharmacokinetics and bioavailability of spiramycin in pigs; Sutter HM et al.; The pharmacokinetics of spiramycin in pigs were investigated after intravenous and oral administration . The potential therapeutically effective blood level was established after a single administration and examined in a subsidiary five day study . The rapid intravenous injection of 25 mg spiramycin/kg bodyweight produced marked salivation in all the test animals . The elimination half-life (2.3 +/- 1.2 hours) was relatively short, in accordance with the total body clearance rate (27.3 +/- 10.1 ml/minute/kg) . The high volume of distribution (5.2 +/- 2.2 litres/kg) was due to the accumulation of the drug in the body tissues . The maximum plasma concentration (4.1 +/- 1.7 micrograms/ml) after oral administration of 85 to 100 mg spiramycin/kg bodyweight was reached after 3.7 +/- 0.8 hours and the half-life of the elimination phase was 6.0 +/- 2.4 hours . The oral bioavailability was 45.4 +/- 23.4 per cent . Ad libitum feeding of a diet containing 2550 mg spiramycin/kg produced a steady state concentration of 0.96 +/- 0.27 micrograms/ml . This plasma concentration would provide a potentially therapeutically effective blood concentration against Mycoplasma species, Streptococcus species and Staphylococcus species.

Am J Infect Control, 1992 Jun, 20(3), 142 - 8
Streptococcus pyogenes outbreak in a long-term care facility; Harkness GA et al.; BACKGROUND: Although outbreaks involving Streptococcus pyogenes have been uncommon among the elderly population, recent reports suggest that this organism is an important nosocomial pathogen among institutionalized older patients and carries significant morbidity and mortality . An outbreak of S . pyogenes, type M12, T12, occurred in a large long-term care institution serving the ill and chronically disabled . The outbreak involved 14 residents of the intermediate care facility and lasted for 4 months . METHODS: A prospective epidemiologic investigation was initiated at the onset of the outbreak . Pertinent clinical and demographic information regarding both residents and personnel was obtained by interview, review of medical and surveillance records, and examination of patients for lesions . Cultures were obtained within 24 hours of symptom onset from those with characteristic clinical symptoms . Unpaired convalescent sera were tested for group A streptococcal extracellular antigens by a rapid hemagglutination slide test . Control measures included active surveillance of residents and staff for suspicious clinical syndromes, transfer of high-risk patients, elimination of a common seating area, and improved handwashing and hygiene measures . RESULTS: The attack rate was 7.5%, with 64.3% of these patients residing on one unit . S . pyogenes was isolated from eight residents, 5 residents had a characteristic syndrome and an elevated streptozyme hemagglutination titer of 400, and 1 resident died within hours of having cellulitis of the groin . Clinical syndromes included cellulitis, pharyngitis, bronchitis, pneumonia, and septicemia . Seven residents required acute care; two residents died within 3 weeks of the onset, yielding a case fatality rate of 14.3% . CONCLUSIONS: The major means of transmission appeared to be direct contact between residents, although transmission from an infected staff member may have accounted for some cases . The hypothesis of long-term colonization was supported by the extended times between infections . The severity of illness and the apparent transmission through direct contact between residents warrants (1) early detection of infected lesions, (2) recognition of invasive illness, (3) prompt effective treatment, and (4) surveillance for S . pyogenes infections among residents and personnel.

J Anim Sci, 1992 Jun, 70(6), 1677 - 81
Subclinical mastitis in ewes and its effect on lamb performance; Keisler DH et al.; Two studies were conducted to 1) assess the effectiveness of the California mastitis test (CMT) relative to direct microscopic somatic cell count (DMSCC) and(or) somatic cell count (SCC) procedures for detecting subclinical mastitis in ewes, 2) determine the incidence of subclinical mastitis based on repeated or single sample measures and organisms associated with the inflammation, and 3) assess the relationship between milk quality measures and lamb performance . The relationship between DMSCC and SCC scores was significant (P less than .01); 90% of the variation in DMSCC scores was accounted for by SCC scores . In contrast, CMT scores accounted for only 26% of the variation in DMSCC and 30 to 34% of the variation in SCC scores . Incidence of inflammation varied from 17 to 50% of ewes tested, depending on the study and the method of assessment . Staphylococcus species were cultured from 14/41 samples tested, with cultures of Streptococcus species (3/41) and Micrococcus species (1/41) also present . The effect of subclinical mastitis in ewes on lamb performance was minimal when assessed by regressing lamb weights on subclinical mastitis and milk quality scores . In conclusion, growth performance of lambs in a management system where they had access to supplemental feed was not influenced by the quality of milk produced by ewes, or by the degree of subclinical mastitic inflammation present when they suckled.

Eur Respir J, 1992 Jun, 5(6), 670 - 4
Lung function impairment following mycoplasmal and other acute pneumonias; Laitinen LA et al.; We prospectively studied the lung function of 106 consecutive young patients with pneumonia . At the time of hospital admission we observed impaired spirometric function in 48% of the patients . During and following treatment, the frequency of abnormalities in pulmonary function tests decreased rapidly . However, at the 15th day of hospitalization, abnormal ventilatory function was still demonstrated in 21% of the patients . Such prolonged impairment of ventilatory function was significantly more likely to result from pneumonia caused by Mycoplasma pneumoniae than from forms caused by adenovirus or Streptococcus pneumoniae.

J Clin Microbiol, 1992 Jun, 30(6), 1485 - 90
Enzyme immunoassay for detection of immunoglobulin G (IgG), IgM, and IgA antibodies against type 6B pneumococcal capsular polysaccharide and cell wall C polysaccharide in chinchilla serum; Koskela M et al.; Conjugation of the capsular polysaccharides of Streptococcus pneumoniae to protein carriers has introduced a new generation of pneumococcal vaccines which may be efficacious in preventing pneumococcal otitis media during infancy . The chinchilla model has been used extensively for studying the pathogenesis of pneumococcal otitis media and for testing the efficacy of early pneumococcal capsular polysaccharide (PCP) vaccines, but immunologic studies in the chinchilla have been limited by the lack of antibodies against specific immunoglobulin isotypes . By using affinity-purified rabbit immunoglobulin G (IgG) anti-chinchilla IgG, IgM, and IgA, we developed a sensitive enzyme immunoassay that is highly specific for IgG, IgM, and IgA antibodies against type 6B PCP (anti-6B) and against C polysaccharide in chinchilla serum . Antibody titers increased in serum from five chinchillas immunized with a type 6B outer membrane protein complex vaccine . Increases of anti-6B IgG and IgM antibody titers were more striking than increases of anti-6B IgA or anti-C polysaccharide IgG, IgM, or IgA titers were.

J Am Vet Med Assoc, 1992 Jun 1, 200(11), 1698 - 700
Tracheal obstruction from tracheal collapse associated with pneumonia in a horse; Fenger CK et al.; A 20-month-old Quarter Horse stallion was admitted for evaluation of labored breathing, honking cough, and bilateral epistaxis that were caused by pneumonia and collapsed trachea . A transtracheal aspiration revealed highly cellular, serosanguineous fluid . Radiography revealed a patchy alveolar pattern and a narrowed tracheal lumen . Endoscopy confirmed narrowing of the tracheal lumen . Streptococcus zooepidemicus was isolated on culture of the transtracheal aspirate . The horse responded to penicillin treatment, and the tracheal collapse improved endoscopically after 4 days, with complete recovery within 1 year . Tracheal collapse has been reported to be a disease of older horses associated with degenerative cartilage . The findings in the horse of this report suggested that tracheal collapse may result from inflammation secondary to pneumonia and, therefore, may be reversible.

Clin Infect Dis, 1992 Jun, 14 Suppl 2, S218 - 23; discussion S231-2
Streptococcal pharyngitis: current therapy and criteria for evaluation of new agents; Peter G; Penicillin has been the recommended drug of choice in most cases of group A streptococcus (GAS) pharyngitis for nearly 40 years based on its efficacy in the prevention of acute rheumatic fever . Since trials of other drugs for the prevention of rheumatic fever are no longer feasible in the United States, eradication of GAS pharyngitis has become the surrogate for their evaluation . On the basis of this criterion, specific therapeutic regimens have been recommended, and numerous other drugs have gained approval as alternatives to penicillin . Current therapeutic issues include possible decreased efficacy of penicillin, timing of the initiation of therapy, and drugs of choice for patients whose treatment fails, who are chronic carriers, or who have frequent infections . Criteria for assessment of new drugs include clinical response, likelihood of prevention of rheumatic fever, rates of relapse and recurrent infection, and drug safety . The establishment of uniform guidelines and definitions of response for new drug evaluations by the Infectious Diseases Society of America should aid in the further assessment of new antibacterial agents as therapy for GAS pharyngitis . However, no data yet suggest that any of these drugs should replace penicillin as the drug of choice.

Clin Exp Immunol, 1992 Jun, 88(3), 512 - 9
Class- and subclass-specific pneumococcal antibody levels and response to immunization after bone marrow transplantation; Lortan JE et al.; Immunoglobulin class- and subclass-specific antibodies to a polyvalent pneumococcal capsular polysaccharide vaccine (Pneumovax II) were measured before and after immunization in children, 1 year or more after bone marrow transplantation for a variety of genetic disorders . The median titres of specific IgG, IgG1 and IgG2 pneumococcal antibodies fell significantly (P less than 0.05) from pre-transplantation levels . The levels of pneumococcal antibodies in the patients before immunization were markedly lower than those in control children of comparable age, for antibodies of IgM, IgG, IgG1 and IgG2 classes (P = less than 0.001 in each case) . Apart from IgG2 antibodies, the median response to immunization with Pneumovax II was not significantly different from the controls (P greater than 0.05) . However, because of the lower pre-immunization levels, the patients did not achieve a high post-immunization-specific antibody titre in any immunoglobulin class or subclass, when compared with normal children . Neither the pre-immunization specific antibody levels nor the response to immunization were affected by splenectomy or the presence of chronic graft-versus-host disease . Immunization of the donor before bone marrow harvest did not influence the level of specific antibody 1 year or more after transplantation . No significant correlation was found between the total serum IgG2, the patients' age at the time of assessment, or time after transplantation, and the IgG2-specific antibody response . The lack of specific antibodies and the poor IgG2 response to pneumococcal antigens may contribute towards the occurrence of infection with Streptococcus pneumoniae in the late post-transplantation period.

J Infect Dis, 1992 Jun, 165 Suppl 1, S44 - 8
T cell regulation of the antibody response to bacterial polysaccharide antigens: an examination of some general characteristics and their implications; Baker PJ; The characteristics of thymus-derived (T) lymphocytes that regulate the magnitude of the antibody response to the capsular polysaccharide antigen of type III Streptococcus pneumoniae are considered within the context of a general homeostatic model for controlling the antibody response to microbial antigens of medical importance . Some experimental approaches are described in which the activities of such regulatory T cells are modulated to provide an increase in the development of host immunity, to improve the immunogenicity of poorly immunogenic antigens, or to eliminate the inhibitory effects of suppressor T cells.

Infect Immun, 1992 Jun, 60(6), 2361 - 7
Cloning and nucleotide sequence of the gene encoding the 136-kilodalton surface protein (muramidase-released protein) of Streptococcus suis type 2; Smith HE et al.; We cloned and sequenced the gene encoding the muramidase-released protein (MRP) of a pathogenic Streptococcus suis type 2 strain to determine whether its amino acid sequence resembles that of proteins with known functions and to determine its function in virulence . The complete nucleotide sequence composing the gene and the regions flanking it was determined . The deduced amino acid sequence revealed the presence of a signal peptide at the N terminus and a cell envelope anchor at the C terminus, both of which resembled similar regions in several other surface proteins from gram-positive bacteria . The processed form of MRP has a length of 1,209 amino acids and a calculated molecular weight of 131,094 . A highly repetitive region preceded the envelope anchor . The repeated units were preceded by a proline-rich stretch of amino acids (26 of 86) . No overall homologies were observed between the amino acid sequence of MRP and protein sequences in the EMBL data bank . A particular region within the amino acid sequence, however, showed some similarity with the fibronectin-binding protein of Staphylococcus aureus . Binding of MRP to human fibronectin, however, could not be confirmed.

J Infect Dis, 1992 Jun, 165(6), 1049 - 55
Development of IgM antibody to group B Streptococcus type III in human infants; Boyer KM et al.; An ELISA was developed to measure IgM antibody to albumin-coupled native capsular polysaccharide of type III group B streptococcus (GBS) . The assay was standardized by two double-label methods that agreed within 33% . In quantitative assays, the range of IgM antibody to type III GBS in the sera of 94 adult pregnant women was 1.2-50.6 micrograms/ml (median, 5.4), while each of 38 cord serum samples contained less than 0.03 micrograms/ml IgM antibody . Neonatal rats were passively immunized with a serially diluted human serum containing 15 micrograms/ml IgM and undetectable IgG antibody to type III GBS . The rats were protected against lethal infection with an IgM antibody concentration of 0.5 micrograms/ml . In single serum samples from 31 healthy infants less than 2 years old and serial specimens from 5 infants with type III GBS infections, specific IgM antibody was detectable by 3 months of age . Levels greater than or equal to 0.5 micrograms/ml were present in all samples from infants greater than 7 months of age . The acquisition of specific IgM antibody is inversely correlated with the age-limited incidence of type III GBS infections in young children.

J Bacteriol, 1992 Jun, 174(11), 3577 - 86
Identification of a gene, rgg, which regulates expression of glucosyltransferase and influences the Spp phenotype of Streptococcus gordonii Challis; Sulavik MC et al.; Streptococcus gordonii Challis was previously shown to give rise to phase variants expressing high (Spp+) or low (Spp-) levels of extracellular glucosyltransferase (GTF) activity . Here, shotgun cloning of an S . gordonii Spp+ chromosomal digest resulted in a chimeric plasmid (pAM5010) able to complement the Spp- phenotype . In addition, introduction of pAM5010 into an Spp+ strain resulted in a 10-fold increase in GTF expression . Deletion analysis of pAM5010 identified a 1.2-kb DNA segment which exhibited the same functional properties as pAM5010 . Nucleotide sequence analysis of this region revealed a gene approximately 1 kb in size . The gene was designated rgg . Disruption of the chromosomal rgg gene open reading frame in an Spp+ strain resulted in strain DS512, which displayed an Spp(-)-like phenotype and had 3% of wild-type GTF activity . A plasmid containing the rgg gene was able to complement the DS512 phenotype and significantly increase GTF expression above wild-type levels . Sequence analysis and other data showed that the S . gordonii GTF determinant, designated gtfG, is located 66 bp downstream of the rgg gene . The sequence also revealed interesting inverted repeats which may play a role in the regulation of gtfG . We conclude that rgg positively regulates the expression of GTF and influences expression of the Spp phenotype.

J Nat Prod, 1992 Jun, 55(6), 780 - 5
Antibacterial activity of crinitol and its potentiation; Kubo I et al.; An acyclic diterpene alcohol, crinitol {1}, was identified in a marine brown alga, Sargassum tortile, as the principal antibacterial agent against Gram-positive bacteria, among which Propionibacterium acnes was most sensitive and, Staphylococcus aureus was least . To enhance its activity, crinitol was combined with several antioxidants, which presumably retard oxidative destruction of this molecule which possesses two easily oxidizable allylic alcohol groups . Two synthetic antioxidants, BHA (butylated hydroxyanisole) and BHT (butylated hydroxytoluene), significantly enhanced the activity of crinitol, especially against Streptococcus mutans . Interestingly, crinitol also synergized BHT and BHA against this cariogenic bacterium.

Zentralbl Bakteriol, 1992 Jun, 277(1), 1 - 9
The characterization of two new low molecular weight proteins (LMPs) from Streptococcus pyogenes; Gerlach D et al.; Two novel extracellular mitogenic substances were isolated from Streptococcus pyogenes strain NY-5 and characterized . The purification steps involved an initial enrichment of the proteins from culture supernatant by silica gel adsorption, followed by ion exchange chromatography and gel filtration . The purified materials were homogeneous in SDS-PAGE, showed estimated molecular weights of 12 kD and isoelectric points of 4.7 and 4.3, respectively . Both proteins (LMP-12k-4.3pI and LMP-12k-4.7pI) demonstrated lymphocyte transformation activity at a concentration of 0.1 microgram/ml . The LMP-12k-4.7pI showed a 69.2% homology of the amino acid sequence with that of a phosphocarrier protein of Staphylococcus aureus and with a total identity in the active centre . The same protein was also isolated from streptococcal group C strain H46A with an N-terminal amino acid sequence being identical . The LMP-12k-4.7pI demonstrated biochemical properties identical with those of the earlier described streptococcal pyrogenic exotoxin type D . The LMP-12k-4.3pI did not show such a clear relation to other functional proteins.

J Dairy Sci, 1992 Jun, 75(6), 1725 - 30
Evaluation of postmilking teat germicides containing Lauricidin, saturated fatty acids, and lactic acid; Boddie RL et al.; The efficacies of postmilking teat germicides containing Lauricidin (glyceryl monolaurate), saturated fatty acids, lactic acid, and lauric acid were determined against new IMI caused by Staphylococcus aureus and Streptococcus agalactiae in three controlled infection trials . In trial 1, a germicide was evaluated containing 1% Lauricidin, 5% caprylic and capric acids, 6% lactic acid, and .85% lauric acid . New IMI with Staph . aureus and Strep . agalactiae were reduced 81.3 and 49.6%, respectively . Trial 2 germicide involved an artificially aged sample of the formulation evaluated in trial 1 . The germicide was aged at 40 degrees C for 5 mo, which was approximately equal to 2 yr at room temperature (24 degrees C) . Reductions in new IMI were 81.2 and 27.5% for Staph . aureus and Strep . agalactiae, respectively . In trial 3, a teat germicide aged at ambient temperature for 33 mo, which was originally formulated to contain 1% Lauricidin, 5% caprylic and capric acids, and 6% lactic acid, was evaluated . Reductions in new IMI were 75.5 and 40.4% for Staph . aureus and Strep . agalactiae, respectively . The formulation evaluated in trial 1 was superior to other formulations in reducing new IMI by the two test organisms.

J Antibiot (Tokyo), 1992 Jun, 45(6), 839 - 45
Mersacidin, a new antibiotic from Bacillus . In vitro and in vivo antibacterial activity; Chatterjee S et al.; Mersacidin is a new peptide antibiotic of the proposed lantibiotic family . It is active in vitro and in vivo against Gram-positive bacteria including the methicillin-resistant Staphylococci . Its in vitro activity is less than those of vancomycin and erythromycin but it shows much higher activity in the in vivo system than can be expected from the in vitro testing results . A water soluble potassium salt has been prepared which has an activity profile similar to that of mersacidin, but has better in vivo activity against Streptococcus pyogenes than the parent compound.

Kinderarztl Prax, 1992 Jun, 60(4-5), 131 - 3
{Fatal course of B-streptococcal infection in early infancy}; Weigt G et al.; We report on a fatal case of "late onset" -sepsis by B-streptococcus in a seven weeks olk suckling . B-Streptococcus is considered to be a typical strain of early stage neonatal sepsis that is connected with foudroyant progress and high letality . As in our case the outcome is decisively determined by early diagnosis and timely beginning therapy for the strain can still be controlled effectively . Misjodging early symptoms of the infection may lead to fateful progression even after the neonatal period.

Res Microbiol, 1992 Jun, 143(5), 449 - 57
Expression of M6 protein gene of Streptococcus pyogenes in Streptococcus gordonii after chromosomal integration and transcriptional fusion; Pozzi G et al.; The M6 protein of Streptococcus pyogenes was expressed on the cell surface and secreted in Streptococcus gordonii Challis (formerly Streptococcus sanguis) after chromosomal integration of a promoterless M6 protein gene (emm-6.1) . The ermC gene, conferring resistance to erythromycin, was cloned downstream of emm-6.1, within the same ClaI fragment . The initiation codon of emm-6.1 was 19 bp downstream of a ClaI site, so that ClaI cleavage would leave the gene promoterless . The ClaI fragment containing the promoterless emm-6.1 and ermC was ligated in vitro with a ClaI digest of S . gordonii chromosomal DNA . Random chromosomal integration of the heterologous DNA was obtained by using the ligation mixture to transform the naturally competent S . gordonii Challis . Twenty-eight percent of transformants selected for erythromycin resistance also expressed M6 . Among the best M6 producers, 10 clones were selected for the stability of their phenotype . Nine of the 10 clones were shown to harbour one intact copy of the emm-6.1/ermC ClaI fragment integrated into the chromosome . These strains both expressed M6 protein on the surface and secreted different amounts of the molecule, since in each case the protein was produced after a transcriptional fusion of emm-6.1 with a different chromosomal promoter . A S . gordonii strain expressing large amounts of surface M6 protein, as judged by immunofluorescence and Western blot, was compared to the M- parental strain in a standard opsonophagocytosis assay . Of the isogenic pair, M6+ S . gordonii survived better in human blood and was phagocytosed at a slower rate.

Acta Med Port, 1992 Jun, 5(6), 335 - 7
{Adenocarcinoma of the colon disclosed by endocarditis caused by Streptococcus bovis}; Almeida J et al.; The association of Streptococcus bovis endocarditis with colonic neoplasms has been well documented . We describe a patient in whom the finding of a Str . bovis endocarditis stimulated investigation which resulted in the diagnosis and surgical treatment of an adenocarcinoma of the colon.

Oral Microbiol Immunol, 1992 Jun, 7(3), 159 - 64
Processes involved in the regulation of urease levels in Streptococcus salivarius by pH; Sissons CH et al.; Urease levels in Streptococcus salivarius are regulated by pH . There is either increased synthesis at low pH (5.5) or enhanced degradation at neutral pH, suggested by urease instability during stationary phase . To establish which mechanism predominates, protein synthesis was inhibited by chloramphenicol (CAP) in cultures grown at pH 5.8, 6.8 and 7.3 . There was no significant urease degradation detectable in mid-exponential and early-stationary phase at any pH . Urease degradation occurred in both control and CAP cultures later in stationary phase, but with a faster rate of decline in the low pH culture . After CAP addition there was detectable assembly of urease from pools of post-translational subunits to give an approximately 20% increase in enzyme . Above pH 7, 0.1% cysteine inhibited urease synthesis but not growth, and evidence was obtained for O2 inhibition of growth and urease synthesis . Regulation of urease levels in S . salivarius by pH primarily involves an effect on urease synthesis . There may be cross-regulation between pH control, anaerobiosis-controlled enzyme regulatory circuits and thiols.

Oral Microbiol Immunol, 1992 Jun, 7(3), 155 - 8
Mechanism of water-insoluble glucan synthesis in Streptococcus sobrinus; Takehara T et al.; Synthesis of water-insoluble glucan (IG) by 1,3-alpha-D-glucan synthase from Streptococcus sobrinus was examined using methylation analysis . The purified enzyme was incubated with sucrose and dextran T2000 (DT2000) for a given time and only IG was harvested by centrifugation . The remaining supernatant was incubated again, and IG was obtained . By repeating the above method using the residual supernatant, we obtained 5 varieties of IG precipitated in different periods . These IGs were methylated and examined using gas chromatograph mass spectrometry . The DT2000 water-insolubilized in the early reaction stage tended to have a highly ramified structure, with 1,3-alpha-D-glucan on a 1,6-alpha-D-glucan chain as the main chain . On the contrary, the DT2000 water-insolubilized in the late stage tended to have sparse side chains of 1,3-alpha-D-glucan which elongated with incubation . Specifically, the greater the number of side chains, the sooner the DT2000 was insolubilized . These results suggest that water-insolubilization of the water-soluble glucan not only depends on the increase of the ratio of 1,3-alpha-glucoside linkages to 1,6-alpha-glucoside linkages but also on the degree of branching of the 1,3,6-alpha-branched glucoside linkages.

Oral Microbiol Immunol, 1992 Jun, 7(3), 142 - 7
Assessment of the cariogenic potential of Streptococcus mutans strains and its relationship to in vivo caries experience; Macpherson LM et al.; Strains of Streptococcus mutans isolated from the plaque of 6 subjects were studied using an in vitro model to determine whether differences in their cariogenic potential could be detected, and if so, whether the results correlated with the caries experience of the individuals . Each strain was incubated with a bovine enamel slab and 5% (w/v) sucrose for 24-h periods . The acidogenic potential was assessed by pH measurement and analysis of acid anion production . Microradiographic and microdensitometric assessment of the enamel, together with measurement of the change in calcium concentration of the reaction mixture were used to determine the demineralizing potential of each strain . Significant differences in cariogenic potential were found between some of the strains tested, and correlations were found between 3 of the test parameters and the decayed-missing-filled-surface score of the individuals . The results suggest that the caries experience of individuals may be related, to some extent, to the cariogenic potential of their S . mutans strains.

J Dent Assoc S Afr, 1992 Jun, 47(6), 253 - 6
Growth interaction between Candida albicans and Streptococcus salivarius: in vitro and in vivo studies; de Miranda CM et al.; Suppression of Candida albicans in the mouth by oral flora has been proposed as one of the mechanisms preventing candidal overgrowth . According to Liljemark and Gibbons (1973), Streptococcus salivarius plays a significant role in this process . The aim of this investigation was to study the growth interaction between C . albicans and S . salivarius in vitro and in vivo . An aerobic continuous-flow system was used for the in vitro study . Pure and mixed cultures of C . albicans (NCPF 3118) and S . salivarius (NCTC 8618) were inoculated into a buffered medium containing either 0.1 per cent or 0.001 per cent glucose concentrations and incubated at 37 degrees C for 55 hours . Two in vivo investigations were undertaken using inbred germfree C3H mice . In the first, mice were exposed to a mixed suspension of S . salivarius and C . albicans for 48 hours . In the second the mice were exposed to S . salivarius for 48 hours . Fourteen days later they were contaminated with C . albicans . A comparison of growth curves showed no growth inhibition between the species . The in vivo studies showed that oral lesions from candidal infestation occurred in all mice . We were therefore unable to demonstrate in vitro or in vivo suppression of C . albicans in the presence of S . salivarius.

J Antimicrob Chemother, 1992 Jun, 29(6), 677 - 85
Individual efficacy of clarithromycin (A-56268) and its major human metabolite 14-hydroxy clarithromycin (A-62671) in experimental pneumococcal pneumonia in the mouse; Bedos JP et al.; In man, clarithromycin (A-56268) is metabolized to a 14-hydroxy derivative (14-OH clarithromycin, A-62671); this metabolite is absent in mice . An experimental mouse model was used to compare the efficacy of clarithromycin versus 14-OH clarithromycin in pneumococcal pneumonia by treatment with either the parent drug or its 14-OH metabolite alone . Four groups of 15 mice were infected intra-tracheally with a virulent strain of Streptococcus pneumoniae serotype 3 (approximately 10(5) cfu/mouse) . Treatment was begun 18 h post infection, with clarithromycin or erythromycin 50 mg/kg subcutaneously (sc) bd, 14-OH clarithromycin 25 mg/kg sc bd or antibiotic free saline sc bd for 24 or 48 h . Survival rates ten days after one day of treatment with clarithromycin, 14-OH clarithromycin, erythromycin, or saline were 53%, 60%, 27% and 0% respectively . After two days treatment the rates were 100%, 100%, 53% (P less than 0.01) and 0% respectively . Thirty-six h after two doses, 14-OH clarithromycin demonstrated superior intra-pulmonary killing activity to erythromycin (2.7 +/- 0.4 vs 6.6 +/- 0.8 log10 cfu/mL lung homogenate) (P less than 0.001) and comparable activity to clarithromycin (3.6 +/- 1.3 log10 cfu/mL) . These results show that clarithromycin (50 mg/kg sc) and 14-OH clarithromycin (25 mg/kg sc) have similar in vivo efficacy in a mouse model, in which the 14-OH metabolite is not produced from clarithromycin . This suggests that in man, the clinical efficacy of clarithromycin is not impaired by metabolism to 14-OH clarithromycin, which achieves serum concentrations in man of approximately 1 mg/L after multiple doses of clarithromycin 500 mg po.

Zentralbl Bakteriol, 1992 Jun, 277(1), 80 - 3
Binding of laminin, type IV collagen, and vitronectin by Streptococcus pneumoniae; Kostrzynska M et al.; Forty-three strains of Streptococcus pneumoniae were tested for their ability to bind radiolabelled laminin, collagen types I, II and IV, fibronectin, and vitronectin . Two basement membrane components, laminin and type IV collagen, interacted with many S . pneumoniae strains . All strains bound laminin and 28 (65%) bound collagen type IV . Approximately 60% of the strains bound vitronectin but only a few strains showed low binding of fibronectin and collagen type I and II.

J Clin Microbiol, 1992 Jun, 30(6), 1499 - 504
Length polymorphisms in tRNA intergenic spacers detected by using the polymerase chain reaction can distinguish streptococcal strains and species; McClelland M et al.; Intergenic tRNA spacers from strains of streptococcal groups A, B, and G were amplified by using the polymerase chain reaction (PCR) at low stringency with consensus tRNA gene primers . Cloning and sequencing showed that many of the homologous intergenic spacers differed in length between species . The sequences of the tRNA genes that flank these polymorphic spacers were determined and used to synthesize fully complementary primers . With these primers at high stringency, PCR products which varied in lengths from 53 to 71 bp, depending on the species or strain, were obtained from streptococcal DNAs, even in the presence of a 1,000-fold mass excess of human DNA . PCR products, the lengths of which could also be used for classification, were obtained at high stringency from a few genera closely related to Streptococcus . No products were obtained from genomic DNAs from more distantly related genera . Production of species- or strain-specific tRNA intergenic length polymorphisms with primers that generate characteristic products from a variety of species within the same genus should be applicable to many organisms, including those that would otherwise be difficult to culture or identify.

Recenti Prog Med, 1992 Jun, 83(6), 330 - 6
{Appendicitis: microbial interactions and new pathogens}; Dionisio D et al.; The Authors present an exhaustive review on microbial agents of appendicitis by means of literature and personal research data . Thus, a detailed analysis is made on common autochthonous agents and their pathogenetic interactions and on less common exogenous bacterial, viral, mycotic, protozoan and helminthic agents with emphasis to the role of Yersinia enterocolitica . In fact this bacterium seems responsible for 3% to 8% of cases in accordance with literature and personal research data (more detailed, Y . enterocolitica has been isolated in 3.8% of 208 inflamed appendices from both pediatric and adults surgical florentine patients) . At the end, the pathogenetic role of "new" other bacteria, like Buttiauxella agrestis, Aeromonas hydrophila, Arizona, Streptococcus lactis, is debated on the basis of a personal study.

J Immunol, 1992 Jun 1, 148(11), 3588 - 95
In vitro, Candida albicans releases the immune modulator adenosine and a second, high-molecular weight agent that blocks neutrophil killing; Smail EH et al.; We previously described a lyophilized supernatant from germinated Candida albicans that blocks human neutrophil (PMN) O2- production and degranulation stimulated by several PMN agonists but does not block stimulation by PMA . In studies to further characterize this Candida hyphal inhibitory product (CHIP), we noted several physicochemical parallels with the purine nucleoside adenosine (Ado) . A Sephadex G-10 semipurified fraction of CHIP had an absorption peak near 260 nm, an apparent m.w . of less than 400, and was resistant to boiling and proteases . Maximally effective doses of CHIP (100 micrograms/ml) and Ado (100 microM) blocked 0.1 microM FMLP-stimulated O2- production by 76.8 +/- 4.1 and 81.7 +/- 4.8%, respectively . Ado deaminase, known to inactivate Ado, reversed inhibition by both Ado and CHIP . Results were comparable for the effect of CHIP and Ado on FMLP-stimulated beta-glucuronidase and lactoferrin release . Activation of the respiratory burst by opsonized C . albicans yeast was also inhibited by CHIP and Ado, but the extent of inhibition was less than for FMLP . At yeast:PMN ratios of 4:1, 10:1, and 40:1, CHIP inhibited O2- by -3.8%, 14.3%, and 12.8%, respectively; Ado blocked production by 32.9%, 24.2%, and 11.5%, respectively . The effect of CHIP and Ado on Candida killing by PMN was compared using two viability assays in each of four experiments . Ado (100 microM) had no effect on killing, although CHIP (100 micrograms/ml) inhibited killing in the MTT assay at 15 and 45 min by 81.6 +/- 6.3 and 24.7 +/- 6.2%, respectively; as assayed by CFU, CHIP inhibited killing by 34.1 +/- 6.2 and 10.3 +/- 2.5%, respectively . The ability of CHIP to inhibit killing was not affected by adding Ado deaminase, providing additional evidence that an Ado-like effect by CHIP is not essential for killing inhibition . Killing of opsonized Streptococcus pneumoniae was also inhibited in a concentration-dependent manner . Reverse-phase HPLC of the semipurified fraction revealed a peak, eluting identically to authentic Ado, which was eliminated by adding Ado deaminase . Ado content of the G-10 fraction was sufficient to account fully for the FMLP-inhibitory activity . The antikilling activity was resistant to boiling and proteases but was eliminated by mild periodation . Fractions eluting from a Sephadex CL6B column between 0.8 and 2.0 x 10(6) m.w . had increased sp . act . for killing inhibition . Sp . act . increased as carbohydrate content increased, but killing inhibition by various Candida cell wall constituents was absent to modest compared to inhibition induced by CHIP.(ABSTRACT TRUNCATED AT 400 WORDS)

Orv Hetil, 1992 May 31, 133(22), 1367 - 9
{Rational means of the determination of costs and etiological diagnosis of community-acquired pneumonia}; Karolyi A et al.; The cost and effectiveness of examinations (sputum staining and culturing, antitest determination for Influenza A and B, RSV, Adenovirus, Chlamydia psittaci and pneumoniae, Coxiella burnetii, Mycoplasma pneumoniae and Legionella pneumophila, and determination for Streptococcus pneumoniae antigen) performed to explore the aetiology of community-acquired pneumonia in the case of 258 hospitalised patients were analysed . The aetiology could be determined in 44.2% of the cases . On the basis of prevailing prices in 1986-88 one pneumonia case with determinable aetiology costs 8111 Forint . The authors have come to the conclusion that in the present epidemiological situation in this country it is not worthwhile to look for so-called non-bacterial microorganisms routinely, because of their rarely occurrence (16.7%) the cost per one positive finding is unrealistically high . Comparing the cost and the practical use the examinations applied the rational choice seems to be to culture the sputum with deep airway origin and to determine the Streptococcus pneumoniae antigen routinely . In the case of suspicion of non-bacterial origin to perform complement fixation test for Mycoplasma pneumoniae and in a severe clinical state to culture the blood is recommended.

Harefuah, 1992 May 15, 122(10), 636 - 7, 687
{Pyogenic liver abscess caused by Streptococcus milleri}; Reichman N et al.; Streptococcus milleri is a facultative anaerobic pathogen of the viridans group associated with serious suppurative infections, mainly abscesses . We saw 3 cases of liver abscess due to this organism in 1990 in women aged 43, 59 and 67 years, respectively . The coccus was grown from blood cultures in 2 of the cases and from abscess drainage in the 3rd . The importance of prompt diagnosis of liver abscess by means of CT and ultrasonography is stressed . Conservative treatment consists of CT-guided percutaneous drainage, followed by prolonged antibiotic treatment . Such conservative measures avoid complex and sometimes hazardous surgical procedures.

J Biol Chem, 1992 May 15, 267(14), 10018 - 23
Cross-reactive immunodeterminants on Streptococcus sanguis and collagen . Predicting a structural motif of platelet-interactive domains; Erickson PR et al.; Cross-reactive immunodeterminants on a fibril-associated surface antigen of Streptococcus sanguis and types I and III collagen participate in the induction of aggregation of human platelets . To further understand the basis for this apparent molecular mimicry, antitype-specific collagen antibodies, anti-KPGEPGPK (an analogue of platelet-interactive domains on collagen) and a panel of KPGEPGPK-like synthetic peptides were used as probes . When collagen or S . sanguis cells were pretreated with the anti-collagen antisera, the induction of aggregation of platelet-rich plasma was greatly delayed or abrogated . These anti-collagen antibodies also neutralized KPGEPGPK and purified S . sanguis platelet-interactive antigens as inhibitors of S . sanguis or collagen-induced aggregation of platelets in plasma . In immunoblot analyses, these anti-collagen antibodies reacted with S . sanguis platelet-interactive antigens . Additionally, antisera against the platelet-interactive antigen of S . sanguis selectively reacted with undigested type I collagen and with fragments CB3 and CB6 of cyanogen bromide-treated type I collagen . Finally, when platelets were pretreated with synthetic peptides containing specific amino acid substitutions within the KPGEPGPK sequence, the time to onset of platelet-rich plasma aggregation by both agonists was altered . The hierarchical pattern of responses of platelets to these peptides and predictions of the structural changes produced by simulated insertions of each peptide into the CB4 sequence of type III collagen suggested conformational requirements for interactions with platelets . Thus, these data show that cross-reactive immunodeterminants of S . sanguis and collagen induce platelet aggregation . The platelet-interactive domains are predicted to be characterized by a structural motif with the consensus sequence X-P-G-E-P/Q-G-P-X.

J Antibiot (Tokyo), 1992 May, 45(5), 613 - 7
Sporeamicin A, a new macrolide antibiotic . III . Biological properties; Morishita A et al.; Sporeamicin A is a new erythromycin-type antibiotic isolated from a species of Saccharopolyspora . It was active in vitro against a wide variety of Gram-positive bacteria . In vitro studies indicated that the sporeamicin A was stable in the presence of human serum, although it was bound to serum proteins . Sporeamicin A was effective in the mouse protection test against Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae . Sporeamicin A attained higher plasma and tissue levels in the rat than did erythromycin stearate.

Diagn Microbiol Infect Dis, 1992 May-Jun, 15(4 Suppl), 67S - 70S
The effect of roxithromycin on the virulence of gram-positive cocci; Gemmell CG et al.; Antibiotics whose recognized mode of action comprises inhibition of bacterial protein biosynthesis are also recognized to modulate the expression of bacterial virulence factors when incorporated into culture media at sub-MIC levels . In this respect, one of the new macrolides, roxithromycin, has been examined for its effect on toxin/enzyme production by strains of Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae . Biosynthesis of staphylococcal coagulase and DNase could be potentiated, whereas that of staphylococcal alpha-hemolysin, streptolysins O and S, and pneumolysin were unaltered . Expression of one structural virulence factor, pneumococcal polysaccharide, was repressed in the drug's presence, resulting in potentiation of phagocytic ingestion of the drug-exposed bacteria . The drug failed to have any effect on ingestion of Staph . aureus or Strep . pyogenes . These studies provide evidence that roxithromycin may exhibit "added value" as an antibiotic in its ability to potentiate the susceptibility of Strep . pneumoniae to host defenses such as phagocytosis.

Age Ageing, 1992 May, 21(3), 216 - 20
Bacterial meningitis in elderly patients: clinical picture and course; Rasmussen HH et al.; We reviewed the case records of 48 patients aged 60 years and older with a diagnosis of acute bacterial meningitis made during the period 1976-88 . Predisposing conditions were present in 26 patients (54%) and concurrent infections in 24 patients (50%) . Streptococcus pneumoniae accounted for 41% of all isolates and 56% were Gram-positive organisms . The most common symptoms were fever (79%), meningism (54%) and change in mental status (69%) . Sixty-three per cent of the patients survived . Increased fatality was associated with absence of typical symptoms and signs and was presumably due to a delay in diagnosis . Other clinical and biochemical variables and antimicrobial therapy before admission to hospital and the presence of underlying disease were not associated with outcome.

Eur Respir J, 1992 May, 5(5), 576 - 83
The interaction of Streptococcus pneumoniae with intact human respiratory mucosa in vitro; Feldman C et al.; The interaction of Streptococcus pneumoniae with human ciliated upper respiratory mucosa was studied in an agar-embedded organ culture of nasal turbinate tissue, which only exposed the intact epithelial surface and its secretion . The ciliary beat frequency, measured along the edge of the organ culture, was slowed by 13% in the presence of S . pneumoniae after 16 h (p less than 0.05) compared with the control, and by 24% after 24 h (p less than 0.01) . Light microscopy showed bacteria in a thickened gelatinous layer, which obscured the surface of the organ culture . Transmission and scanning electron microscopy confirmed the association of bacteria with the gelatinous layer above an epithelial surface which showed only minor changes compared to uninfected control organ cultures . Contact between bacteria and normal or damaged epithelial cells was not seen . S . pneumoniae in organ culture developed projections from their surface, which were not present after broth culture . S . pneumoniae interactions with epithelial-derived secretions, the formation of a thickened gelatinous layer, and the effects of bacterial toxins on ciliary motility, may be important during colonization of the respiratory tract.

Conn Med, 1992 May, 56(5), 261 - 3
Ofloxacin vs ciprofloxacin: a comparison; Nicolau D et al.; Ofloxacin and ciprofloxacin are fluoroquinolones with similar characteristics . However, important differences can be observed in their antimicrobial activity, clinical utility, and pharmacokinetic and interaction profiles . Ofloxacin is more active in urethral chlamydia infections; it also may more effectively eradicate staphylococcal infections and Streptococcus pneumoniae pulmonary infections . Furthermore, ofloxacin does not significantly alter theophylline concentrations . Ciprofloxacin has better activity against gram-negative bacilli, an advantage which may be negated by ofloxacin's longer half-life and higher serum levels . Therefore, while both drugs are effective as treatment of infections due to gram-negative organisms, ofloxacin is also appropriate in the treatment of: 1) infections where both aerobic gram-negative rods and staphylococci or S . pneumoniae are documented or suspected, 2) urethritis, particularly when C . trachomatis is documented or suspected, 3) infections in patients concomitantly receiving theophylline.

Diagn Microbiol Infect Dis, 1992 May-Jun, 15(4), 295 - 300
Rapid, direct identification of Staphylococcus aureus and Streptococcus pneumoniae from blood cultures using commercial immunologic kits and modified conventional tests; Davis TE et al.; To develop safe and rapid methods for identification of Staphylococcus aureus and Streptococcus pneumoniae directly from positive blood culture bottles (BCB) (BACTEC, Johnston Laboratories), several commercial biochemical and immunological tests as well as modified conventional tests were evaluated . Preliminary studies demonstrated that both S . aureus and St . pneumoniae could be identified directly using only a small aliquot (100 microliters) of the blood culture broth obtained via vent without need for centrifugation or other separation steps . A simple tube coagulase exhibited 98% sensitivity and 100% specificity for 32 S . aureus isolates and 157 blood cultures positive for coagulase-negative staphylococci when read at 2 hr . All systems employed for direct identification of St . pneumoniae exhibited excellent sensitivity and specificity using aliquots from blood culture broths, but Pneumoslide (BBL Microbiology Systems, Cockeysville, MD) was easiest to perform and interpret . The results of this study show that S . aureus and St . pneumoniae can be identified directly from blood culture broth aliquots using rapid methods that eliminate the need for centrifugation or use of needles and syringes.

J Dent Res, 1992 May, 71(5), 1166 - 8
The effects of sucralose, xylitol, and sorbitol on remineralization of caries lesions in rats; Bowen WH et al.; The purpose of this study was to determine whether ingestion of sucralose, xylitol, sorbitol, or distilled water alone could enhance remineralization of early caries lesions in rats . Rats were infected by Streptococcus sobrinus, fed diet 2000 (Ziegler Brothers, Gardners, PA) ad libitum for two weeks, and, in addition, were offered drinking water sweetened by sucrose (10% w/v) . A group of rats terminated at this time displayed significant levels of sulcal and smooth-surface caries . The remaining animals, for the ensuing three weeks, either continued on the same cariogenic challenge or received their essential nutrition by gavage and drank water, sweetened by one of the agents listed above, ad libitum . At the end of the additional three-week period, animals receiving sucralose, xylitol, sorbitol, or distilled water had fewer lesions than did the animals terminated after the two-week cariogenic challenge . The results show that removal of the cariogenic challenge allowed remineralization to occur and that no sweetening agent was superior to another in this respect.

J Dent Res, 1992 May, 71(5), 1159 - 65
pH regulation by Streptococcus mutans; Dashper SG et al.; The intracellular pH (pHi) optimum for glycolysis in Streptococcus mutans Ingbritt was determined to be 7.0 by use of the ionophore gramicidin for manipulation of pHi . Glycolytic activity decreased to zero as the pHi was lowered from 7.0 to 5.0 . In contrast, glycolysis had an extracellular pH (pHo) optimum of 6.0 with a much broader profile . The relative insensitivity of glycolysis to the lowering of pHo was attributed to the ability of S . mutans to maintain a transmembrane pH gradient (delta pH, inside more alkaline) at low pHo . At a pHo of 5.0, glycolyzing cells of S . mutans maintained a delta pH of 1.37 +/- 0.09 units . The maintenance of this delta pH was dependent on the concentration of potassium ions in the extracellular medium . Potassium was rapidly taken up by glycolyzing cells of S . mutans at a rate of 70 nmol/mg dry weight/min . This uptake was dependent on the presence of both ATP and a proton motive-force (delta p) . The addition of N-N'-dicyclohexylcarbodiimide (DCCD) to glycolyzing cells of S . mutans caused a partial collapse of the delta pH . Growth of S . mutants at pHo 5.5 in continuous culture resulted in the maintenance of a delta pH larger than that produced by cells grown at pH 7.0 . These results suggest the presence of a proton-translocating F1Fo-ATPase in S . mutans whose activity is regulated by the intracellular pH and transmembrane electrical potential (delta psi) . The production of an artificial delta p of 124 mV across the cell membrane of S . mutans did not result in proton movement through the F1Fo-ATPase coupled to ATP synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Curr Eye Res, 1992 May, 11(5), 411 - 9
Hyaluronic acid--syneretic glycosaminoglycan; Bettelheim FA et al.; Hyaluronic acid from different sources, umbilical cord, vitreous, rooster comb and streptococcus, all exhibit a unique hydration behavior . Each hyaluronic acid and each different salt form has a maximum non-freezable water content at a set concentration beyond which the bound (non-freezable) water decreases . This type of behavior indicates a syneretic process simply due to concentration alone.

J Infect, 1992 May, 24(3), 247 - 55
Bacteraemic pneumococcal pneumonia: a continuously evolving disease; Marrie TJ; During an 8 year prospective study of community-acquired pneumonia (CAP) requiring hospitalisation we found that 47 of 1118 (4.2%) patients had Streptococcus pneumoniae bacteraemia . Females outnumbered males 27:20 . The mean age was 63.4 years and 25% of our patients were admitted from a nursing home . A comparison with the 1071 other patients with CAP showed that patients with bacteraemic pneumococcal pneumonia (BPP) were more likely to be female and to have alcoholism, diabetes mellitus, and chronic obstructive pulmonary disease as co-morbidities . The mortality rate of 19% in BPP was not significantly lower than the 22% rate for the remaining patients with CAP . Four of the nine (44%) patients with BPP who died, did so within 24 h of admission, compared with 29 of 236 (12.3%) (P less than 0.02) who died of CAP . A notable clinical feature was the absence of cough in 19% while overall in only 66% was the cough productive . Most of the patients had a non-specific clinical presentation . Fifty-three per cent had an uncomplicated stay in hospital . We conclude that bacteraemic pneumococcal pneumonia is a continuously evolving disease and for the first time may now be more common in women.

Clin Infect Dis, 1992 May, 14(5), 1140 - 1
A case of bacteremia due to resistant Streptococcus pneumoniae; Rahman S et al.; Streptococcus pneumoniae isolates with varying degrees of resistance to penicillin have been described . Strains that are highly resistant to penicillin (MIC, greater than 1 microgram/mL) and that are resistant to multiple antibiotics have been reported primarily in South Africa and Spain . We report a case of an adult patient with bacteremia due to S . pneumoniae that was highly resistant to penicillin (MIC, 4 micrograms/mL) and resistant to erythromycin, clindamycin, chloramphenicol, and co-trimoxazole who was successfully treated with vancomycin.

Clin Infect Dis, 1992 May, 14(5), 1124 - 36
Infection caused by Streptococcus pneumoniae in children with sickle cell disease: epidemiology, immunologic mechanisms, prophylaxis, and vaccination; Wong WY et al.; The incidence of invasive infection due to Streptococcus pneumoniae is 6.9 infections per 100 patient-years among children with sickle cell anemia (SS genotype) who are less than 5 years of age; this rate is 30-100 times that which would be expected in a healthy population of this age . Splenic dysfunction is the major contributor to the increased risk . Postulated abnormalities of immunologic defense mechanisms, including synthesis of polyclonal IgG and IgM, the alternative complement pathway, opsonic activity, and T and B cell interaction, may also enhance risk . Preceding or concomitant viral infection is suspected of predisposing to pneumococcal infection, but no definitive data are available . The most prevalent pneumococcal serotypes causing disease in this setting include types 6, 14, 18, 19, and 23; these same serotypes are most frequently involved in "vaccine failure." Current evidence demonstrates only modest protective efficacy for contemporary pneumococcal vaccines in young patients with sickle cell anemia; thus alternative vaccines are required . Convincing evidence for a protective effect of antibiotic prophylaxis has been obtained in limited time trials . However, presently used prophylactic regimens pose problems related to compliance and provide imperfect protection; moreover, their optimal duration remains unknown.

Clin Infect Dis, 1992 May, 14(5), 1074 - 7
Streptococcal toxic shock syndrome due to noninvasive pharyngitis; Chapnick EK et al.; Serious infections due to group A beta-hemolytic streptococcus (GABHS) have been reported with increasing frequency in recent years . We report a case of toxic shock syndrome (TSS) due to GABHS pharyngitis in an otherwise healthy 14-year-old boy . The organism was found to produce toxin A . To our knowledge, this is the second reported case of streptococcal TSS associated with the production of toxin A that is not associated with an invasive disease and the first case associated with a documented rise in the level of antibody to the streptococcal toxin itself . Clinicians must be especially vigilant for this entity in patients who have streptococcal pharyngitis because early recognition and institution of aggressive supportive therapy can be lifesaving.

Clin Infect Dis, 1992 May, 14(5), 1050 - 4
Relapsing pneumococcal bacteremia in immunocompromised patients; Kuhls TL et al.; Relapse of Streptococcus pneumoniae bacteremia after appropriate therapy is thought to be rare, even in immunocompromised patients . We describe three immunodeficient patients who experienced repeated episodes of pneumococcal bacteremia within 8 weeks after receiving appropriate therapy . Serotyping and DNA fingerprinting of respective isolates strongly suggested that each patient's bacteremic relapse was caused by the same pneumococcal strain . Relapsing and recurrent infections with an identical pneumococcal strain, especially in immunodeficient individuals, may be more common than is generally appreciated.

J Dairy Sci, 1992 May, 75(5), 1233 - 40
In vitro germicidal activity of teat dips against Nocardia asteroides and other udder pathogens; Larocque L et al.; Nine commercial teat dip formulations containing 1.94% linear dodecylbenzene sulfonic acid, or 1% available iodine from nonylphenoxypoly (ethyleneoxy) ethanol-iodine complex, or .5% chlorhexidine acetate were tested for contamination with aerobic and anaerobic bacteria and their in vitro germicidal activity against Staphylococcus aureus, Streptococcus agalactiae, Escherichia coli, and Nocardia asteroides . All products were free of bacteria when neutralized samples were tested on blood agar or liquid thioglycollate media . To test for in vitro efficacy, each teat dip preparation was mixed with a suspension of one of the pathogenic test organisms containing 10(8) bacteria/ml (final concentration) for .5 to 15 min . Viable bacteria were evaluated by direct plating of neutralized aliquots and by filtration techniques . All products were effective against E . coli, Staph . aureus, and Strep . agalactiae . With N . asteroides, the direct plating method gave equivocal results . The filtration experiments indicated that all teat dips containing dodecylbenzene sulfonic acid and nonylphenoxypoly (ethyleneoxy) ethanol-iodine complex were effective against all four pathogens . Three of the teat dips containing chlorhexidine acetate were ineffective against N . asteroides . The fourth teat dip, containing chlorhexidine acetate and an emollient, was partially effective.

Am J Obstet Gynecol, 1992 May, 166(5), 1541 - 5
The mechanisms of preterm labor: common genital tract pathogens do not metabolize arachidonic acid to prostaglandins or to other eicosanoids; Bennett PR et al.; OBJECTIVE: Our aim was to determine the ability of pathogens commonly associated with genital tract infection and preterm labor to incorporate arachidonic acid and to metabolize it to prostaglandins or to other eicosanoids . STUDY DESIGN: Four common genital tract pathogens, Escherichia coli, Streptococcus viridans, Bacteroides fragilis, and a group B beta-hemolytic streptococcus, were incubated with tritium-labeled arachidonic acid for 2 to 48 hours . Uptake of arachidonic acid was calculated from uptake of radioactivity into the organisms . Tritium-labeled arachidonic acid within the medium was separated from any metabolites by high-performance liquid chromatography to assess metabolism of arachidonic acid within the bacteria . RESULTS: Although all organisms were able to take up arachidonic acid, analysis of its metabolism with high-performance liquid chromatography demonstrated that none of these organisms will synthesize cyclooxygenase, lipoxygenase, or epoxygenase products . CONCLUSION: Bacterial infection cannot initiate preterm labor by intrinsic biosynthesis and release of prostaglandins or other eicosanoids by the bacteria themselves.

Cornea, 1992 May, 11(3), 200 - 3
Survival of Streptococcus pneumoniae in corneal storage media; Weckbach LS et al.; The Cincinnati Eye Bank had six corneoscleral rims in which Streptococcus pneumoniae was cultured after preservation in corneal storage media . To determine the survival of this organism under conditions common for corneal storage, gentamicin-supplemented McCarey-Kaufman (M-K) medium and chondroitin sulfate/Dextran medium (Dexsol, Ciron Ophthalmics, Irvine, CA, U.S.A.) were inoculated with S . pneumoniae and kept at 4 degrees C . Thioglycollate broth plus 10% rabbit serum (Thio-S) and tryptic soy broth (TSB) served as growth controls . At day 14 after inoculation of 10(5) colony-forming units (CFU)/ml, Dexsol showed a 1-log decrease in bacterial concentration, the M-K medium a 2-log decrease and Thio-S a 4-log decrease, whereas TSB showed no detectable organisms . By day 21 Dexsol had only a 2-log decrease in bacteria . These data suggest that corneal storage medium supplemented with gentamicin does not exert bactericidal activity against S . pneumoniae and may actually support its survival at 4 degrees C.

Am Rev Respir Dis, 1992 May, 145(5), 1172 - 7
Intrapulmonary bacterial clearance of type III group B streptococcus is reduced in preterm compared with term rabbits and occurs independent of antibody; Hall SL et al.; Intrapulmonary clearance of type III group B streptococcus (GBS) and related phagocytic recruitment was studied in preterm and term rabbits at 4 and 8 h after aerosol infection using left lung homogenates to quantify GBS and right lung bronchoalveolar lavage (BAL) to recover phagocytes . Opsonophagocytosis of type III GBS by pulmonary alveolar macrophages (PAM) was studied in vitro with a modified differential fluorescence-quenching method using PAM lavaged from preterm, term, and adult rabbits . Sera of experimental animals were tested for opsonization of type III GBS using fluorescein-labeled antibodies to rabbit IgG and C3 . Although term animals showed some clearance at 8 h, preterm animals had marked intrapulmonary proliferation of GBS . The number of PAM in BAL fluid was 20-fold higher in term than in preterm rabbits at 0 h, but by 8 h, preterm rabbits had a large influx of PAM, whereas PAM remained constant in term BAL fluid . Rates of phagocytosis of GBS were twice as high in term versus preterm PAM during in vivo and in vitro studies . Among PAM from term and adult animals, opsonization of GBS with MgEGTA-sera promoted phagocytosis in vitro at levels comparable to pooled adult sera, whereas opsonization with EDTA-sera resulted in a significantly lower rate of ingestion . None of the experimental animals' sera were able to deposit IgG, but all deposited C3 on the surface of GBS . In summary, preterm rabbits had a diminished bronchoalveolar PAM population that did not ingest GBS as well via the alternative complement pathway when compared with term rabbits.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Microbiol, 1992 May, 30(5), 1347 - 50
Subtyping of Streptococcus uberis by DNA amplification fingerprinting; Jayarao BM et al.; Total DNA of Streptococcus uberis from cows with mastitis was analyzed by DNA amplification fingerprinting (DAF) and compared with restriction endonuclease fingerprinting (REF) . DAF grouped 22 strains into 15 distinct patterns, while REF grouped them into 12 patterns . These results suggest that DAF is a useful technique for subtyping strains of S . uberis.

Chest, 1992 May, 101(5), 1207 - 10
Etiologic study of patients with community-acquired pneumonia; Pareja A et al.; Community-acquired pneumonias are difficult to diagnose . For this reason, we have attempted to evaluate the correct diagnosis by using noninvasive methods which are easy to follow outside the hospital environment . To achieve this, 165 patients exhibiting the clinical and roentgenographic symptoms characteristic of pneumonia, have been studied from a bacteriologic, serologic, and statistical stand point . The correct diagnosis was made in 75 percent of the cases . Of the total 124 cases, 69 (41.8 percent) were of bacterial origin . Streptococcus pneumoniae was the most common agent, followed by Gram-negative bacilli . In 73 cases showing positive serologic evidence, 22 (42 percent) could be attributed to the so-called atypical pneumonias, 18.18 percent to the viral, and 1.21 percent to the mycotic.

Clin Pediatr (Phila), 1992 May, 31(5), 274 - 8
Once-daily ceftriaxone to complete therapy of uncomplicated group B streptococcal infection in neonates . A preliminary report; Bradley JS et al.; Newborn infants minimally symptomatic with non-central nervous system (CNS) infections due to Streptococcus agalactiae (group B streptococcus {GBS}) and other pathogens may not require skilled nursing care during the entire course of parenteral antibiotic therapy . In 1985, treatment guidelines were made available to private practitioners in Oregon for therapy of newborn infants at low risk of complications from their infections . In 1988, patient data were collected and analyzed retrospectively . Outpatient management during convalescence of 51 infants (21 with culture-positive infections due to GBS) was accomplished with once-daily physician follow-up examinations and IM injection of ceftriaxone . Long-term (greater than or equal to two months) follow-up data were available for 67% of GBS-infected infants, with no complication of infection or significant complication of therapy reported . Outpatient parenteral antibiotic management of selected, low-risk infants may offer the clinician an alternative to hospitalization for a portion of the duration of parenteral antibiotic therapy.

J Fam Pract, 1992 May, 34(5), 625, 630 - 2
Poststreptococcal glomerulonephritis: a rare complication in pregnancy; Shepherd J et al.; Streptococcus pyogenes rarely causes glomerulonephritis in pregnant women . The family physician must consider this nonsuppurative cause, however, in the differential diagnosis of a pregnant patient with edema, abnormal urinalysis, and declining renal function, as this case study demonstrates.

J Bacteriol, 1992 May, 174(10), 3236 - 41
Extracellular and cellular distribution of muramidase-2 and muramidase-1 of Enterococcus hirae ATCC 9790; Kariyama R et al.; A substantial portion of the second peptidoglycan hydrolase (muramidase-2) activity of Enterococcus hirae ATCC 9790 (formerly Streptococcus faecium) is present in the supernatant culture medium . In contrast, nearly all muramidase-1 activity is associated with cells in the latent, proteinase-activatable form . Muramidase-2 activity is produced and secreted throughout growth, with maximal levels attained at or near the end of exponential growth in a rich organic medium . Muramidase-2 activity in the culture medium remained high even during overnight incubations in the absence of proteinase inhibitors . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of supernatant culture medium concentrated by 60% saturated ammonium sulfate precipitation showed the presence of several Coomassie blue-staining bands . One intensely staining protein band, at about 71 kDa, selectively adsorbed to the insoluble peptidoglycan fraction of cell walls of E . hirae, retained muramidase-2 activity, and reacted in Western immunoblots with monoclonal antibodies to muramidase-2 . The mobility of extracellular muramidase-2 in sodium dodecyl sulfate-polyacrylamide gel electrophoresis was indistinguishable from that of muramidase-2 extracted with 6 M guanidine hydrochloride from intact bacteria . Muramidase-2 appears to have only a limited number of binding sites on the peptidoglycan of E . hirae cell walls but binds with high affinity . Although high levels of muramidase-2 activity were present in supernatants of stationary-phase cultures, the bacteria were resistant to autolysis . Thus it appears that the peptidoglycan in walls of intact cells of E . hirae is somehow protected from the hydrolytic action of extracellular muramidase-2.

Am J Perinatol, 1992 May, 9(3), 139 - 41
Removal of retained intrauterine contraceptive devices in pregnancy; Sachs BP et al.; Using real-time ultrasound and clinical expertise gained from chorionic villus sampling, we describe a technique for ultrasound-guided intrauterine device removal in those cases in which the string is not visible . Utilizing a stone clamp for intrauterine manipulation, we were easily able to extract the device without interrupting the pregnancy . We concur with recent recommendations advocating all intrauterine devices can be removed if pregnancy termination is declinedPIP: Physicians at leading hospitals in Boston, Massachusetts were able to remove a retained IUD from 3 women who were in their 1st trimester of pregnancy . They took cervical cultures to test for chlamydia, beta-hemolytic Streptococcus, and gonococcus before attempting to remove the IUD . They used a 3.5 MHz transducer from an Acuson 128 machine to perform a transabdominal ultrasound scan . The physicians used a transcervically introduced stone clamp to retrieve the IUD . The technique was like that used for transcervical chorionic villus sampling . The 1st case was a 36-year old gravida 3 with a copper-7 IUD whose string had disappeared from sight . She was 8 weeks' gestation . The IUD was laying below the gestational sac . She delivered a full-term healthy infant weighing 3348 gm . The 2nd patient was a 27-year old Chinese woman who had been pregnant before, but had no living children . She was 9 weeks' gestation and had a stringless metal ring IUD . It was in the lower uterus . She experienced some bleeding afterwards . She did not experience any difficulties during the rest of her pregnancy and delivered a full-term infant (2665 gm) . The 3rd case was also a Chinese woman with a metal ring IUD . She was gravida 2 para 1 at 10 weeks' gestation . Like the other Chinese woman, the IUD was in the lower uterus . She experienced bleeding throughout the 1st trimester . Nevertheless, at 40 weeks' gestation, she had a healthy 2665 gm infant . This method is best accomplished by someone skilled in in utero manipulation as is done with chorionic villus sampling . The physicians recommend that other physicians should try to remove a retained IUD using this technique no matter its location, type, or the presence of a visible string or not, if the patient indeed wants to continue the pregnancy .

Arch Otolaryngol Head Neck Surg, 1992 May, 118(5), 469 - 71
Diagnosis and management of parotitis; Brook I; Of all the salivary glands, the parotid gland is most commonly affected by an inflammatory process . Infections of the parotid gland range from acute to severe . Assessment of the disease process should differentiate local primary parotid infection from systemic infection when this gland is also involved as part of a generalized inflammatory condition . Viral parotitis can be caused by paramyxovirus (mumps), Epstein-Barr virus, coxsackievirus, and influenza A and parainfluenza viruses . Acute suppurative parotitis is generally caused by Staphylococcus aureus, Streptococcus species, and rarely, gram-negative bacteria . Anaerobic bacteria, mostly Peptostreptococcus species and Bacteroides species, and pigmented Porphyromonas species and Prevotella species have been recently recognized as an important cause of this infection . beta-Lactamase-producing organisms can be isolated in almost three fourths of the patients . Predisposing factors to suppurative infections are dehydration, malnutrition, oral neoplasms, immunosuppuration, sialolithiasis, and medications that diminish salivation . Pus, aspirated from a suppurative parotic abscess, should be plated on media that are supportive for the growth of aerobic and anaerobic bacteria, mycobacteria, and fungi . Early and proper antimicrobial therapy may prevent suppuration . Initial empiric therapy that is directed against both aerobic and anaerobic bacteria may be required until a specific causal diagnosis is available . Surgical drainage may be indicated when pus has formed . This may prevent complications and facilitate recoveryPublication Types:

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