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