Infect Immun, 1993 Apr, 61(4), 1421 - 6 Restricted ability of group B streptococcal C5a-ase to inactivate C5a prepared from different animal species; Bohnsack JF et al.; Most strains of group B streptococci (GBS) elaborate a cell surface-associated enzyme that rapidly inactivates the human complement-derived chemoattractants C5a and C5adesarg by cleaving the His-Lys bond at positions 67 and 68 in the C5a molecule . We have suggested that rapid inactivation of C5a and C5adesarg by this enzyme, called C5a-ase, can hinder the inflammatory response at sites of GBS infection . We tested the ability of GBS C5a-ase to inactivate C5a preparations from various animal species to determine the proper species for studying the role of GBS C5a-ase in the pathogenesis of GBS infections . Exposure of C5a preparations from humans, monkeys, and cows to GBS caused inhibition of C5a functional activity as measured by the ability of C5a to stimulate human polymorphonuclear leukocyte (PMN) adherence and human PMN chemotaxis . Bovine PMN chemotaxis to bovine C5a was also abolished after exposure of bovine C5a to GBS . In contrast, mouse, rat, guinea pig, rabbit, pig, and sheep C5a preparations retained full functional activity after exposure to GBS as measured by chemotaxis of human PMNs, PMNs from the same animal species, or both . These data suggest that there are structural differences between C5a proteins from different species which alter their susceptibility to GBS C5a-ase and indicate that most commonly used animal models of human GBS infection are inadequate for detection of a contribution of GBS C5a-ase to GBS virulence. Infect Immun, 1993 Apr, 61(4), 1415 - 20 Neutrophil Fc receptor participation in phagocytosis of type III group B streptococci; Noya FJ et al.; Human peripheral blood neutrophils bear receptors for immunoglobulin G, FcRII, and FcRIII that differ structurally and functionally . We investigated the role of FcRII and FcRIII in the phagocytosis of group B streptococci (GBS) by measuring neutrophil uptake of radiolabeled type III GBS . The mean uptake of GBS opsonized with human serum containing complement and specific antibody was 76%, but when this serum was heated, the mean uptake was only 22% . A monoclonal antibody to FcRIII, Leu-11b, inhibited in a dose-dependent manner uptake of GBS opsonized with heated or intact serum to maxima of 40 and 30%, respectively . Conversely, a monoclonal antibody to FcRII, IV.3, inhibited by 77% the uptake of GBS opsonized with heated serum but had no effect when GBS was opsonized with intact serum . Leu-11b and IV.3 had an additive inhibitory effect with heated but not with intact serum . Neither monoclonal antibody inhibited the uptake of GBS opsonized with hypogammaglobulinemic serum . Therefore, FcRII is the primary mediator of the phagocytosis of GBS opsonized by antibody alone, whereas FcRIII plays a lesser role . Surprisingly, FcRII is not necessary for phagocytosis when complement is also present . FcRIII participates, to a limited extent, in phagocytosis of GBS opsonized with antibody whether or not complement is present . These findings suggest that the function of FcRII in triggering phagocytosis may be particularly important in host defense against type III GBS in the setting of complement deficiency of young infants. Infect Immun, 1993 Apr, 61(4), 1378 - 84 Association between expression of immunoglobulin G-binding proteins by group A streptococci and virulence in a mouse skin infection model; Raeder R et al.; In this study, we developed a mouse model of skin infection to test the association between expression of immunoglobulin-binding proteins by and infectivity of group A streptococci . Group A streptococci capable of crossing tissue barriers and establishing a lethal systemic infection in mice showed a higher level of immunoglobulin-binding protein expression . The group A streptococci recovered from the spleen of a mouse that died following a skin infection were found to be more virulent when injected into the skin of naive mice . Together, these results suggest that immunoglobulin-binding protein expression by group A streptococci correlates with their ability to establish invasive skin infections. Infect Immun, 1993 Apr, 61(4), 1272 - 80 Immunochemistry of capsular type polysaccharide and virulence properties of type VI Streptococcus agalactiae (group B streptococci); von Hunolstein C et al.; The immunochemistry of capsular type polysaccharide and virulence characteristics of group B streptococci (GBS), type VI, were studied . By high-pressure anion-exchange chromatography and pulsed amperometric detection, as well as by 13C nuclear magnetic resonance analysis, both extracellular and cell-bound polysaccharides were found to contain glucose, galactose, and N-acetylneuraminic acid in the molar ratio of 2:2:1, respectively . At variance with all other GBS serotypes described to date (Ia, Ib, II, III, IV, and V), no N-acetylglucosamine was present, whatever the source of the material (secreted or cell bound; reference or clinical isolate) . Sialic acid was probably involved in the immunodeterminant structure of this new serotype since cleavage of this sugar from the polysaccharide gave rise to an antigen which reacted very weakly with type VI antiserum and to a precipitation line in immunodiffusion with no identity with the native type VI polysaccharide . By using type VI antiserum and the protein A-gold technique, a large capsule was observed in the type VI GBS reference strain by electron microscopy . All type VI strains examined were lethal for CD-1 mice, the 50% lethal dose after intraperitoneal challenge ranging from 1.0 (+/- 0.9, standard deviation) x 10(5) to 2.5 (+/- 1.5, standard deviation) x 10(5) CFU per mouse . A rabbit antiserum against capsular type polysaccharide exhibited both protective activity for mice injected intraperitoneally with type VI reference strain or with clinical isolates and opsonic activity in a phagocytosis assay. West Afr J Med, 1993 Apr-Jun, 12(2), 114 - 7 Bacterial agents in neonatal septicaemia in Calabar, Nigeria (a review of 100 cases); Antia-Obong OE et al.; This study of bacterial isolates in 100 cases of proven neonatal septicaemia has shown Staphylococcus aureus and coliform bacterials the dominant gram positive and gram negative organisms respectively . Most gram negative bacteria and Staphylococcus aureus were sensitive to gentamycin, while streptococci were sensitive to ampicillin . On the basis of this antimicrobial sensitivity pattern, we recommend the use of gentamycin and ampicillin as initial antibiotics in neonatal septicaemia. Zentralbl Bakteriol, 1993 Apr, 278(2-3), 246 - 57 Polymorphism of the streptokinase gene: implications for the pathogenesis of post-streptococcal glomerulonephritis; Malke H; Recent studies of streptokinase genes from epidemiologically and clinically defined streptococci of groups A, C and G have provided evidence of the polymorphism of the streptokinase locus in the chromosome of pathogenic streptococci . This review considers genetic and pathogenetic data suggesting that there exists a causal relationship between nephritis strain-associated streptokinase production and the initial stages of post-streptococcal glomerulonephritis (PSGN) . Currently available sequence information allows to recognize, in the middle of the streptokinase molecule, a major variable region, V1, of about 70 amino acid residues in which sequence identity drops to below 50% when the proteins from nephritogenic and non-nephritogenic strains are compared . The V1 regions, although showing microheterogeneity within either protein category, appear to be more hydrophobic and possess a higher content of ordered secondary structures in the "nephritogenic" molecules . As a working hypothesis, they may be considered the nephrotropic domain(s) with which streptokinases from nephritogenic strains bind to glomerular structures and activate plasminogen in situ, thus triggering the cascade of proteolytic processes leading to PSGN. Zentralbl Bakteriol, 1993 Apr, 278(2-3), 238 - 45 Identification of a fibronectin-binding protein as adhesin of Streptococcus pyogenes; Valentin-Weigand P et al.; The role of streptococcal fibronectin-binding protein (Sfb protein) in the adherence of Streptococcus pyogenes to epithelial cells was analyzed by using a recombinant Sfb fusion protein which was constructed by fusion of the binding domain of Sfb protein to MS2 polymerase . Sfb fusion protein was overexpressed in Escherichia coli, purified from E . coli lysates by FPLC and analysed in binding experiments with 125I-labelled fibronectin and adherence studies with HEp2 epithelial cells . Lysates from E . coli expressing the fusion protein as well as purified Sfb protein competitively inhibited fibronectin binding and epithelial cell adherence of S . pyogenes, whereas streptococcal lipoteichoic acid (LTA), previously suggested to be the adhesin of S . pyogenes, had no effects . Southern blot analysis of chromosomal DNA from various streptococci revealed that the gene coding for the binding domain of Sfb protein was also present in other S . pyogenes strains . These results indicate that fibronectin-binding protein is the major adhesin of S . pyogenes. APMIS, 1993 Apr, 101(4), 295 - 305 Distribution of presumptive pathogenicity factors among beta-hemolytic streptococci isolated from Ethiopia; Tewodros W et al.; Beta-hemolytic streptococci are known to bind several mammalian proteins, which are presumed to be important in pathogenicity . The distribution of such binding structures was examined for mouse albumin, human serum IgA, human IgG, human fibrinogen, and human plasminogen . A total of 218 group A beta-hemolytic streptococci (GAS) were studied: 5 isolates from children with acute rheumatic fever (ARF), 18 from acute post-streptococcal glomerulonephritis (APSGN), 57 from tonsillitis, 52 from skin infections, and 86 from healthy carriers . Sixty-eight Streptococcus equisimilis and 20 group G streptococci were also included . Most of the S . equisimilis (60/68) and group G (14/20) were obtained from apparently healthy carriers . The results were evaluated with respect to T type, serum opacity reaction (SOR), site of isolation, and disease type . No direct correlation was detected between the protein-binding structures studied . There was no apparent correlation between any particular protein-binding structure and specific T type . Albumin-binding and IgA-binding activities were inversely correlated among skin and nephritis GAS isolates . A strong correlation was demonstrated between IgA-binding activity and SOR production, while albumin-binding activity correlated with SOR-negative strains . Albumin-binding levels in isolates from ARF, APSGN and tonsillitis were significantly higher than in isolates from healthy carriers (P < 0.001) . A higher albumin-binding capacity was shown in skin isolates from APSGN than in isolates from impetigo (P < 0.001). J Laryngol Otol, 1993 Apr, 107(4), 309 - 12 Penetration of penicillin V to tonsillar surface fluid in healthy individuals and in patients with acute tonsillitis; Stjernquist-Desatnik A et al.; In the treatment of group A streptococcal tonsillitis, as the bacteria are located on the epithelial surface, an important determinant of outcome is the concentration of penicillin in extracellular tonsillar surface fluid . Accordingly, we investigated the concentration of penicillin in serum, and penetration to tonsillar surface fluid and saliva in nine patients with acute group A streptococcal tonsillitis and in nine healthy controls . Among the healthy subjects, despite high serum penicillin concentrations (mean, 2.04 micrograms/ml), there was no penetration to tonsillar surface fluid or to saliva, whereas erythromycin penetrated to tonsillar surface fluid in 3/6 cases . Of the nine patients with acute tonsillitis, on the first day of treatment eight manifested high concentrations of penicillin in tonsillar surface fluid (mean, 0.34 micrograms/ml--i.e . well above the minimal inhibitory concentration (MIC) for group A streptococci), but penetration to saliva was found in only two patients . On the tenth day of treatment, penicillin was not present in the saliva of any of the patients and was present in the tonsillar surface fluid of only one . The results suggest that measurable concentrations of penicillin in tonsillar surface fluid can only be obtained in the presence of inflammation with fluid exudation through the tonsillar epithelium. J Hosp Infect, 1993 Apr, 23(4), 271 - 8 Co-existent cross-infection with Streptococcus pneumoniae and group B streptococci on an adult oncology unit; Denton M et al.; An outbreak of respiratory infection in an adult oncology unit is described where there was evidence of co-existent cross-infection with Streptococcus pneumoniae serotype 14 and Lancefield group B streptococcus type Ia . The presumed route of transmission was droplet spread from patient to patient . No further cases arose after the ward had been closed to new admissions and all symptomatic patients were treated with erythromycin . We suggest that patients with pneumococcal pneumonia on units housing elderly debilitated patients should be isolated . Infection control teams should be aware of the ability of Lancefield group B streptococci to spread by cross-infection among adult patients. Ned Tijdschr Geneeskd, 1993 Mar 20, 137(12), 609 - 12 {Puerperal toxic shock syndrome caused by Group A beta-hemolytic streptococci}; Dofferhoff AS et al.; This case report describes the history of a young female with a streptococcal toxic shock syndrome secondary to a puerperal sepsis . The syndrome was complicated by severe hypotension, reversible kidney dysfunction, adult respiratory distress syndrome, coagulation disturbances, myositis and rhabdomyolysis . This latter complication required amputation of both lower legs. Ned Tijdschr Geneeskd, 1993 Mar 20, 137(12), 607 - 9 {Necrotizing fasciitis caused by Group A beta-hemolytic streptococci}; Verburgh CA et al.; A case is presented of a 35-year-old man with necrotizing fasciitis caused by group A beta-haemolytic Streptococci, accompanied by severe systemic toxicity, and necessitating amputation of the leg . After prolonged intensive care treatment the patient recovered. Am J Ophthalmol, 1993 Mar 15, 115(3), 309 - 16 Bacterial and fungal endophthalmitis after penetrating keratoplasty; Kloess PM et al.; We analyzed 1,010 consecutive penetrating keratoplasties to determine the incidence of postoperative endophthalmitis, the frequency of positive donor rim cultures, and whether a correlation between these two factors exists . There were three cases of bacterial endophthalmitis, all caused by streptococci, and one case of Candida albicans endophthalmitis . In all cases except one case of streptococcal endophthalmitis, the same organism was cultured from the donor rim . We cultured 138 organisms from 128 of 932 donor rims (14%) . A remarkable percentage of gram-positive organisms were resistant to gentamicin, the only antibiotic contained in corneal storage media . On the basis of our data and previously published data, we believe that donor material is frequently the source of microorganisms in endophthalmitis after penetrating keratoplasty. Am J Ophthalmol, 1993 Mar 15, 115(3), 299 - 308 Combination antibiotic supplementation of corneal storage medium; Hwang DG et al.; Gram-positive cocci frequently contaminate donor corneal tissue and represent the most common cause of postkeratoplasty endophthalmitis . Although gentamicin is currently added to corneal storage medium in an effort to decrease bacterial contamination of donor tissue, it has poor or variable in vitro activity against many strains of streptococci and staphylococci . To investigate whether the antibiotic supplementation of corneal storage media could be improved, we surveyed 11 antibiotics for antimicrobial efficacy under simulated storage conditions against gentamicin-resistant strains of Staphylococcus aureus, S . epidermidis, Streptococcus pneumoniae, and St . viridans . All antibiotics showed markedly reduced activity at 4 C as compared to their predicted activity at 37 C . Bactericidal activity of streptomycin and tobramycin was enhanced by preceding 4 C storage with a three-hour period at room temperature (23 C) . Under these conditions, streptomycin showed the best antimicrobial activity of the 11 antibiotics tested . Addition of gentamicin to streptomycin resulted in further improvement of activity against S . aureus and S . epidermidis, whereas the addition of penicillin G to streptomycin enhanced the activity against St . viridans . Optimal antibiotic activity (99% or more killing) against all four isolates of gentamicin-resistant gram-positive cocci was best achieved with the combination of gentamicin, streptomycin, and penicillin G, coupled with a three-hour period at room temperature before 4 C storage. Ann Intern Med, 1993 Mar 15, 118(6), 401 - 6 Discontinuing rheumatic fever prophylaxis in selected adolescents and young adults . A prospective study; Berrios X et al.; OBJECTIVE: To assess the safety of discontinuing prophylaxis with antimicrobial agents in patients judged to be at relatively low risk for recurrence of acute rheumatic fever . DESIGN: Observational cohort study . SETTING: Public health clinics in the Southeast Health District of Santiago, Chile . PATIENTS: Fifty-nine patients (19 men, 40 women) ranging in age at study entry from 15 to 44 years (mean, 24.5 years) . Forty-eight had completed their prescribed period of prophylaxis . Eleven refused or were allergic to intramuscular benzathine penicillin G and were non-compliant with oral sulfadiazine . INTERVENTION: In patients who did not have carditis during their previous attack(s), prophylaxis was discontinued after 5 years or at age 18, whichever was longer . In those with only mild mitral regurgitation or healed carditis, prophylaxis was stopped after 10 years or at age 25 . Symptomatic intercurrent streptococcal throat infections were treated with antibiotics . MEASUREMENTS: Patients were seen every 3 months during the study (July 1982 to September 1988) . For the first 4.25 years, throat cultures as well as sera samples for antistreptolysin O and anti-DNAse B assays were obtained at each visit . RESULTS: During laboratory surveillance, significant increases in antibody titers were detected in 56 instances (28.1 {95% CI, 21.7 to 36.5} per 100 patient-years), and 29 isolations of group A streptococci occurred (14.5 {CI, 10.1 to 20.8} per 100 patient-years) . The patients were followed for a total of 3349 patient-months, during which time two acute rheumatic fever recurrences were observed (0.7 {CI, 0.2 to 2.6} per 100 patient-years) . No recurrences occurred during an outbreak of acute rheumatic fever in 52 patients in the study area in 1986 . CONCLUSIONS: These and other data indicate that acute rheumatic fever prophylaxis can safely be discontinued in young adults judged to be at low risk for recurrence and who are maintained under careful prospective surveillance. FEMS Microbiol Lett, 1993 Mar 15, 108(1), 93 - 7 A method for the isolation of RNA from Streptococcus salivarius and its application to the transcriptional analysis of the gtfJK locus; Simpson CL et al.; The glucosyltransferases from oral streptococci cleave sucrose and polymerize the glucose moieties . In Streptococcus salivarius ATCC 25975, two glucosyltransferase-encoding genes, gtfJ and gtfK, are closely linked and transcribed in the same direction . A procedure for the isolation of intact RNA from this organism was devised . The procedure incorporated a high-temperature mutanolysin treatment and selective precipitation by LiCl . The RNA was subject to Northern hybridization and RNase protection assays and it was concluded that the two genes are transcribed separately . A potential factor-independent transcription terminator was located in the intergenic region. J Immunol, 1993 Mar 15, 150(6), 2231 - 42 Role of heavy chain constant domains in antibody-antigen interaction . Apparent specificity differences among streptococcal IgG antibodies expressing identical variable domains; Cooper LJ et al.; In this report, we examine the influence of CH domains on antibody specificity, in the context of variable epitope density on bacteria and synthetic glycoconjugates . Hybridomas secreting IgG1 and IgG2b mAb, specific for the N-acetyl-glucosamine (GlcNAc) residues of streptococcal group A carbohydrate, were previously generated from a hybridoma secreting a mouse IgG3 mAb . We show that these three mAb have identical H and L chain V domains, as determined by 1) cDNA sequencing, 2) binding to soluble Ag, and 3) binding to nine monoclonal anti-idiotopes . Nevertheless, the IgG3 mAb binds more effectively than the V region-identical IgG1 or IgG2b mAb to each of three strains of group A streptococci that display different amounts of terminal GlcNAc residues on their cell walls . The magnitude of the subclass-associated differential in binding varies with the target strain, and, whereas the IgG3 mAb binds best to the strain expressing an intermediate amount of GlcNAc, the IgG1 and IgG2b mAb and IgG3-derived F(ab')2 fragments bind best to the strain expressing the highest amount of GlcNAc . The IgG3 mAb also binds better than the IgG1 and IgG2b mAb to solid-phase GlcNAc50-BSA, but the IgG2b mAb binds best to otherwise identical conjugates with lower ratios of GlcNAc to BSA (20:1, 10:1, 5:1, and 1:1) . These results suggest that epitope density can significantly influence the magnitude of IgG subclass-associated binding differences, and that structural differences in the CH regions, particularly the CH2 and CH3 domains, can influence the apparent specificities of IgG molecules for multivalent Ag. Pediatr Dermatol, 1993 Mar, 10(1), 58 - 60 Neonatal group B streptococcal cellulitis-adenitis; Barton LL et al.; A 38-day-old prematurely born infant developed rapidly progressive facial cellulitis in association with ipsilateral submandibular lymphadenopathy and pulmonary consolidation . Group B streptococci (GBS) were isolated from blood, endotracheal, and lesion cultures . Prompt recognition of GBS cellulitis-adenitis and institution of parenteral, synergistic antibiotic therapy are important. Medicine (Baltimore), 1993 Mar, 72(2), 90 - 102 Infective endocarditis at a large community teaching hospital, 1980-1990 . A review of 210 episodes; Watanakunakorn C et al.; We studied 210 episodes of infective endocarditis in 204 patients . The prevalence of this disease in our series ranged from 0.32 to 1.30 (mean, 0.75) episodes per 1000 admissions per year . There were 115 male and 89 female patients, whose ages ranged from newborn to 91 years (median, 60-70) . One-hundred-and-forty-eight episodes involved host valves and another 33 episodes occurred in intravenous drug users . There were 2 episodes of early and 27 episodes of late prosthetic valve endocarditis . Staphylococcus aureus accounted for 99 episodes (47.1%), alpha-hemolytic streptococci for 29 episodes (13.8%), enterococci for 11 episodes (5.2%), culture-negative endocarditis for 11 episodes (5.2%), and other organisms for 60 episodes (28.6%) . Severe back pain was the chief complaint in 15 patients . 2-D echocardiography was performed in 164 episodes, results in 67 (40.9%) of which were positive . Valve surgery was performed in 29 episodes (23 host valves and 6 prosthetic valves) . The overall mortality was 21.4% . Autopsy was performed in 22 of the 45 patients who died (48.9%) . The mortality rate increased with age, (10.1% and 31.5% for patients < 60 years old and 60 years or older, respectively (p < 0.001). J Antimicrob Chemother, 1993 Mar, 31 Suppl C, 89 - 95 Dirithromycin in the treatment of streptococcal pharyngitis; Derriennic M et al.; A double-blind, double-dummy, randomized, multicentre study compared the safety and the efficacy of dirithromycin (two 250 mg tablets, once daily) to erythromycin base (four 250 mg tablets, four times daily) for ten days in the treatment of proven group A beta-haemolytic (GABHs) streptococcal pharyngitis . Five-hundred and fifty-three patients (265 dirithromycin, 288 erythromycin) were enrolled in the trial and analysed for efficacy and safety . Clinical and bacteriological evaluations were performed pre-therapy, during therapy (days 3-5), post-therapy (three to five days after completion of treatment), and late post-therapy (three to five weeks after treatment) . All patients qualified for safety analysis . A negative pre-therapy culture was the predominant reason a patient did not qualify for analysis of efficacy . At post-therapy, favourable clinical responses (cure or improvement) were reported for 94.1% (159/169) of dirithromycin and 94.6% (158/167) of erythromycin patients who qualified for efficacy analysis . Post-therapy throat cultures were negative for GABH streptococci in 79.3% (134/169) of dirithromycin patients and 86.2% (144/167) of patients treated with erythromycin (P = 0.314) . At late post-therapy 87.6% (134/153) of dirithromycin and 88.7% (134/151) of erythromycin patients reported a favourable clinical response; pathogens were absent in 69.9% (107/153) of dirithromycin and 86.1% (130/151) of erythromycin patients (P = 0.001) . The adverse event profile of the two drugs was comparable although digestive and cutaneous adverse events were reported more frequently in the erythromycin treatment group . In this study, more dirithromycin patients had throat cultures positive for GABH streptococci at late post-therapy.(ABSTRACT TRUNCATED AT 250 WORDS) J Antimicrob Chemother, 1993 Mar, 31 Suppl C, 103 - 9 Clinical efficacy of dirithromycin versus miocamycin in tonsillopharyngitis; Ruggiero G et al.; A single-blind, randomized, parallel-group study was conducted to compare the efficacy and safety of dirithromycin with miocamycin in the treatment of streptococcal pharyngitis/tonsillitis caused by Group A streptococci . The study population consisted of 60 patients: 30 were randomized to receive 500 mg dirithromycin od and 30 to receive 600 mg miocamycin bd . All 30 dirithromycin-treated patients were eligible for efficacy analysis . A favourable clinical response was observed in 100% of these patients at the post-therapy visit . In the miocamycin-treated group, 28 of 30 (93.3%) patients were eligible for efficacy analysis; a favourable clinical response was observed in 100% . Bacteriological cure of evaluable dirithromycin- and miocamycin-treated patients was 96.7% and 92.9%, respectively . No statistically significant post-therapy differences in clinical or bacteriological response rates were noted between the two groups . Adverse event analysis showed no significant differences between treatment groups . There were no serious adverse events during the study . Two miocamycin-treated patients were prematurely withdrawn from the study due to adverse events (diarrhoea) . Analysis of clinical laboratory data revealed no statistically significant differences between the treatment groups that were considered to be drug related . The results of this study suggest that dirithromycin has comparable safety and efficacy to miocamycin in the treatment of streptococcal pharyngitis/tonsillitis infections caused by Group A streptococci. Int J STD AIDS, 1993 Mar-Apr, 4(2), 63 - 6 Streptococci and the genital tract; Rowen D; Streptococci of Lancefield Group B (GBS) are known to cause maternal sepsis and neonatal infection, whereas streptococci Lancefield Group A (GAS) cause vulvo-vaginitis in both children and adults . Prevalence of SGB colonization of the lower genital tract of normal women is between 4-18%, with higher rates found in hospital personnel and delivery rooms . Such high carriage rates may be a significant factor in nosocomial transmission of GBS to neonates . Symptomatic infection is uncommon and usually secondary to other pathological states . Amnionitis is a complication of vaginal carriage of GBS and there is now evidence that chorioamnionitis is associated with pre-term labour and its attendant problems . GBS infection of the male genitalia has also been described . Intrapartum chemoprophylaxis has been shown to prevent early onset GBS disease of the neonate . Prevalence of GAS in the genital tract is lower than that for GBS, but is more likely to be symptomatic . The response to penicillin is usually prompt . Optimal drug regimens need to be determined, particularly for use in pregnancy. Med J Aust, 1993 Mar 1, 158(5), 316 - 8 Rheumatic fever and chronic rheumatic heart disease in Yarrabah aboriginal community, north Queensland . Establishment of a prophylactic program; Neilson G et al.; OBJECTIVE: To establish a program for the prevention of rheumatic fever and rheumatic heart disease in a semi-isolated Aboriginal community in far north Queensland and to test its efficacy . DESIGN: A prevalence study of acute rheumatic fever and chronic rheumatic heart disease was conducted in the community in 1985 and subjects with possible acute rheumatic fever were assessed . A prophylactic antibiotic program was instituted . Records were kept of the prevalence of acute rheumatic fever for six years after the 1985 survey . A second survey of the community was held in 1991 to detect chronic rheumatic carditis resulting from undetected acute rheumatic fever . SETTING: The Yarrabah Aboriginal community in north Queensland (latitude 17 degrees S) . The program was conducted by the Yarrabah Health Team, a part of the North Queensland Aboriginal Health Division . PARTICIPANTS: The whole Yarrabah community (population 1250) was invited to participate . In 1985, after the completion of an educational program, 89% of the community cooperated in the survey . There was no educational program before the 1991 survey and the compliance rate was much lower . Importantly, however, 87% of the vulnerable group (4-16 year olds) were examined . INTERVENTIONS: After the 1985 survey, all community members aged 4-16 years had throat swabs taken three times each year . Those with swabs showing Group A streptococci were treated; their contacts were also swabbed and treated if Group A streptococci were found . RESULTS: Before the institution of the swabbing program there were four new cases of acute rheumatic fever each year in the Yarrabah community . In the six years after the program was introduced only one case of acute rheumatic fever occurred . This was at a time when swabbing had temporarily lapsed for a three-month period . CONCLUSIONS: These results support the use of a prophylactic antibiotic program in Aboriginal communities as a cost effective and efficient method for the prevention of rheumatic fever . The cooperation of the community is an integral part of its success and this can be obtained by community education. FASEB J, 1993 Mar, 7(5), 406 - 13 Coaggregation: specific adherence among human oral plaque bacteria; Kolenbrander PE et al.; Nearly all human oral bacteria exhibit coaggregation, cell-to-cell recognition of genetically distinct cell types . Clumps or coaggregates composed of the two kinds of cells are formed immediately upon mixing two partner cell types . Members of all 18 genera tested exhibit lactose-reversible coaggregation . Many of these interactions appear to be mediated by a lectin on one cell type that interacts with a complementary carbohydrate receptor on the other cell type . A lactose-sensitive adhesin has been isolated from Prevotella loescheii PK1295, and it exhibits the adherence properties observed with whole cells . Other adhesins have been identified and the genes for some of them have been cloned and sequenced . One Streptococcus sanguis adhesin is a lipoprotein that appears to have a dual function of recognizing both a bacterial carbohydrate receptor and a receptor in human saliva . Carbohydrate receptors for some adhesins have been purified from five oral streptococci, and they specifically block the coaggregations with the streptococcal partners that express the complementary adhesins . Coaggregation offers an explanation for the temporally related accretion of dental plaque and bacterial recognition of mucosal surfaces . Early colonizers of the tooth surface coaggregate with each other and late colonizers of the tooth surface coaggregate with each other, but with few exceptions, early colonizers do not recognize late colonizers . Furthermore, bacteria that colonize mucosal surfaces coaggregate with each other, indicating the high degree of specificity of coaggregation in the oral bacterial population. J Clin Microbiol, 1993 Mar, 31(3), 762 - 4 Properties and type antigen patterns of group B streptococcal isolates from pigs and nutrias; Wibawan IW et al.; All 59 group B streptococcal cultures isolated from pigs and nutrias reacted with group B-specific antiserum and gave a positive CAMP reaction in the zone of staphylococcal beta-lysin . Most of the cultures were pigmented; all cultures hydrolyzed Na hippurate and utilized salicin, maltose, and saccharose but not esculin, mannitol, or inulin . Fifty-three percent of the group B streptococci from pigs and none of those from nutrias were lactose positive . Serotyping revealed that most of the group B streptococci from pigs were of serotype III and most of those from nutrias were of type Ia/c . Protein c was present as c beta antigen . All group B streptococci were susceptible to penicillin and bacitracin (10 U), and most of the porcine cultures were resistant to tetracycline . According to these results, group B streptococci from pigs and nutrias differ from bovine and human group B streptococci and seem to play no role in cross-infections between animals or between animals and humans. J Med Microbiol, 1993 Mar, 38(3), 197 - 202 Detection of penicillin tolerance in Streptococcus pyogenes; Van Asselt GJ et al.; Three traditional assays were used to determine the minimal bactericidal concentration (MBC) and minimal inhibitory concentration (MIC) for Streptococcus pyogenes (group A streptococci) in two phases of growth and the time taken to kill the organisms . Three other methods were used for the determination of penicillin tolerance: a cell-lysis assay, the beta-lactamase disk method and the replication method . Twenty strains, comprising penicillin-tolerant clinical isolates and two laboratory mutants, were used to evaluate the six tests . Results indicated that two groups of S . pyogenes can be distinguished--four highly tolerant and three moderately tolerant strains . The moderately tolerant strains were not recognised when rapidly growing instead of stationary cultures were used for the MBC and MIC determinations . The MBC/MIC ratio for tolerant strains was > 100 . Tolerance percentage ranged from 0.30 to 1.07 and 0.29 to 3.96 for cultures in the mid-logarithmic and stationary phases of growth, respectively . The cell-lysis assay, the beta-lactamase disk method and the replication method may be used to screen for tolerance . Detection of high or moderate tolerance by determining the MBC/MIC ratio for mid-logarithmic or stationary cultures is recommended. J Med Microbiol, 1993 Mar, 38(3), 191 - 6 Opsonisation of group B streptococci and restriction endonuclease digestion patterns of their chromosomal DNA; Takahashi S et al.; Isolates of group B streptococci (GBS) from neonates with early-onset septicaemia are associated with particular restriction endonuclease digestion patterns (RDP types Ia-3 and III-3) of chromosomal DNA . Opsonophagocytosis of serotype Ia and serotype III GBS isolates was studied by the luminol-enhanced phagocytic chemiluminescence (CL) assay . Pools of serum containing GBS type-specific antibody levels equivalent to or just above levels typically found in sera from mothers of infected infants were used . CL intensities induced by GBS isolates of RDP types Ia-2, Ia-3 and III-3 were lower than those of the other RDP types of the same serotype . Opsonophagocytosis was more efficient with serum containing higher concentrations of type-specific antibodies but for RDP type III-3 strains these differences were much less marked than for other RDP types . CL intensity did not correlate with cell surface charge, hydrophobicity or sialic acid content of GBS . Results demonstrate that certain GBS RDP types are more resistant to opsonophagocytosis and suggest that potentially virulent strains with genetic homogeneity may exist. Int J Pediatr Otorhinolaryngol, 1993 Mar, 26(2), 149 - 55 The membranous tonsillitis during infectious mononucleosis is nevertheless of bacterial origin; Stenfors LE et al.; Samples from the fur covering the palatine tonsils of 10 patients with infectious mononucleosis (IM) were subjected to fluorescence microscopy after staining with acridine orange . Standard aerobic cultures from swabs were set up simultaneously . The fur constituted a mass of variously sized cocci and rods intermingled with granulocytes and cellular detritus . Five patients had growth of beta-haemolytic Streptococci on the tonsils . Bacteria in abundance were found attached to the tonsillar epithelial cells . The B-lymphotrophic Epstein-Barr virus, responsible for the IM infection, causes an immense increase in the bacterial colonization of the tonsillar surfaces, probably due to an increased attachment of bacteria to the tonsillar epithelial cells. Am Rev Respir Dis, 1993 Mar, 147(3), 753 - 60 Ozone-enhanced pulmonary infection with Streptococcus zooepidemicus in mice . The role of alveolar macrophage function and capsular virulence factors; Gilmour MI et al.; Ozone exposure has been shown to increase the susceptibility of mice to pulmonary bacterial infection . We report here the differences in susceptibility of two strains of mice (C3H/HeJ and C57Bl/6) to pulmonary challenge with Streptococcus zooepidemicus, and demonstrate an association between O3 exposure, reduced alveolar macrophage (AM) function, and increased mortality to infection . After a 3-h exposure to air or to 0.4 or 0.8 ppm O3, mice received an infection of bacteria by aerosol . Subsequent mortality observed over a 20-day period for any given exposure concentration was greater in the C3H/HeJ mice than in the C57Bl/6 mice . Phagocytosis assays identified the AM from O3-exposed lungs as having an impaired ability to engulf the bacteria . Baseline phagocytic activity in C3H/HeJ mice was lower than that in C57Bl/6 mice . Microbiologic assessment of the lungs at various times after infection revealed that the streptococci proliferated rapidly in the lungs of O3-exposed mice, grew more quickly upon isolation, and displayed a mucoid colony appearance indicative of increased encapsulation . In vitro assays confirmed that the encapsulated isolates prevented binding of the bacteria to AM, and reinfection of nonexposed mice with the encapsulated isolate resulted in increased mortality compared with infection with similar numbers of the original unencapsulated bacteria . We have demonstrated that O3 inhalation impairs AM activity in the lung . The streptococci are then able to proliferate and more fully express virulence factors, in particular, the antiphagocytic capsule, which prohibits the ingestion of bacteria by pulmonary phagocytes and leads to increased severity of infection. Infect Immun, 1993 Mar, 61(3), 981 - 7 Cloning of the Streptococcus gordonii PK488 gene, encoding an adhesin which mediates coaggregation with Actinomyces naeslundii PK606; Andersen RN et al.; Coaggregation between Streptococcus gordonii PK488 and Actinomyces naeslundii PK606 is mediated by a 38-kDa streptococcal protein, designated ScaA . The gene, scaA, which encodes this protein has been cloned into Escherichia coli . A genomic S . gordonii PK488 library (in Lambda ZAP II) was screened with anti-S . gordonii immunoglobulin G absorbed with S . gordonii PK1804, an isogenic coaggregation-defective mutant of strain PK488 . A positive recombinant phage was isolated, and a phagemid designated pRA1 was obtained which contained a 6.6-kb insert . Expression of scaA from pRA1 and from a subcloned internal 2.1-kb fragment was observed . The absorbed antiserum cross-reacted with a 34.7-kDa protein, SsaB, from S . sanguis 12, also a coaggregation partner of A . naeslundii PK606 . Absorbed antiserum to S . gordonii PK488 and antiserum to SsaB both reacted with 38-kDa proteins in supernatants from mildly sonicated preparations from 11 other coaggregation partners of A . naeslundii PK606 . Putative adhesin genes were identified in each of these coaggregation partners by Southern analysis of their genomic DNA with the cloned 2.1-kb fragment as a probe . A 30-base oligonucleotide probe based on the sequence of ssaB of S . sanguis 12 hybridized in an identical manner . These data extend the notion that most of the viridans streptococci that coaggregate with actinomyces are capable of expressing ScaA-related proteins. Indian J Pediatr, 1993 Mar-Apr, 60(2), 289 - 98 Coxsackie virus infections in rheumatic fever; Zaher SR et al.; The close relationship between Group A beta Hemolytic Streptococci (GABS) and rheumatic fever is a well established one . However, the concept of the streptococcus as the sole etiologic agent of the rheumatic heart disease (RHD) has been challenged over the past years . Since coxsackievirus group B (CVB) has long been proposed as a cause of acquired valvular disease simulating rheumatic fever, we attempted in this study to document infections with this group of viruses in patients with rheumatic fever . We obtained blood samples from 106 patients with old (quiescent) rheumatic fever/rheumatic heart disease {group I}, 94 patients with acute rheumatic fever (ARF) {group II}, and 74 normal matched controls . We tested for the presence of neutralizing antibodies to the 6 serotypes of CVB by a micro neutralization test . We have found that infection with CVB, especially types B2 and B4, was common in the studied population . Forty-two percent of normal individuals had evidence of infection with any of the 6 serotypes of CVB . Patients of group I had significantly more frequent infections with CVB 2 . Patients in group II had significantly more frequent infections with CVB 2 and CVB 6 . There was no clear correlation between such infections and the clinical course of rheumatic fever . There was no difference in the incidence of CVB infections between patients with definite ARF, and patients with suspected ARF . We set a low order association between rheumatic fever and infection with CVB types B2 and B6 . We emphasize the importance of pursuing the investigation of the role of CVB in relation to RHD. J Assoc Physicians India, 1993 Mar, 41(3), 175 - 6 Toxic strep syndrome; Peter JV et al.; Group A beta-hemolytic streptococci are known to produce infections with protean manifestations . We report here a case of toxic streptococcal syndrome in a patient who presented with a multisystemic disease . Serological and bacteriological evidence strongly suggested an infection by Group A beta hemolytic streptococci. Eur J Prosthodont Restor Dent, 1993 Mar, 1(3), 103 - 10 Effects of root planing on the distribution of microorganisms adult periodontitis sites; Rawlinson A et al.; The aims of this study were to identify the microbial species present in subgingival plaque in patients with adult periodontitis, and to investigate the effects of root planing upon the microbial flora for 12 months following root planing . Microorganisms from samples of subgingival plaque obtained from adult periodontitis sites in 15 patients were cultured, both aerobically and anaerobically, on a variety of media and identified . Prevotella intermedia and Porphyromonas asaccharolytica were the most frequently identified species before treatment . Bacteroides ureolyticus, the Prevotella veroralis/buccalis complex and other microorganisms including Capnocytophaga ochracea, species of streptococci, staphylococci and diphtheroids were also frequently isolated . Root planing improved periodontal health, and was accompanied by reductions in the frequencies with which P . intermedia, P . asaccharolytica, the P . veroralis/buccalis complex and C . ochracea were isolated . Regular scaling and oral hygiene reviews maintained the clinical improvements and balance in favour of beneficial microbial species during the study. Infect Immun, 1993 Mar, 61(3), 1016 - 22 Overexpression and purification of a fimbria-associated adhesin of Streptococcus parasanguis; Oligino L et al.; A Streptococcus parasanguis adhesin that blocks the attachment of S . parasanguis FW213 to saliva-coated hydroxyapatite (SCHA) has been purified . Previous work demonstrated that the attachment of FW213 to SCHA is mediated by fimbriae and that one component associated with fimbriae is a 36-kDa protein (FimA) that reacts with antifimbria serum in Western blots (immunoblots) and is not present in afimbriated mutants . To obtain amounts of FimA sufficient for adhesion blocking assays, we cloned the gene coding for FimA into an Escherichia coli T7 overexpression system . The resulting strain produced large amounts of FimA, as much as 50% of the total cell protein . FimA was purified by elution from sodium dodecyl sulfate-polyacrylamide gels, and its native conformation was reestablished by sodium dodecyl sulfate removal, resolubilization in guanidine hydrochloride, and 50-fold dilution . Some refolded FimA aggregated into dimers and trimers . Preincubation of SCHA with 100 micrograms of purified, renatured FimA per ml blocked 85% of the binding of FW213 . The FimA-SCHA complex was quite stable and could be washed continuously for at least 2 h with only a slight loss of FimA blocking activity . When FimA was added to preformed bacterium-SCHA complexes, it displaced 40% of the bacteria already bound to SCHA . The results suggest that FimA is an adhesin with a high substrate affinity and may prove useful in the development of a therapeutic agent for the prevention of plaque formation and endocarditis initiated by the sanguis streptococci. Zh Mikrobiol Epidemiol Immunobiol, 1993 Mar-Apr, (2), 106 - 11 {The use of streptococcal immunoglobulin Fc receptors in the technology of producing a pseudotuberculosis diagnostic test system}; Burova LA et al.; The conditions of obtaining the IgM from hyperimmune sera to Yersinia pseudotuberculosis have been established . The process includes the adsorption of these sera by streptococci belonging to serological groups G and A and having receptors which bind the Fc-fragment of IgG and IgA molecules . The data confirming the fact that specific antibodies to Y . pseudotuberculosis belong to IgM have been obtained . The use of isolated IgM fractions for the preparation of a pseudotuberculosis diagnostic assay system has made it possible to establish that the new method of obtaining sensitin is economical and ensures a 3.5-fold greater yield of the conjugate and simplifies the technological cycle of its preparation. Srp Arh Celok Lek, 1993 Mar-Jul, 121(3-7), 87 - 8 {Changes in sensitivity to penicillin and an increase in virulence in beta-hemolytic streptococci followed by changes in the clinical picture of streptococcal syndrome}; Berger-Jekic O et al.; According to reports from different geographic areas, the last decade has been characterised with an increasing number of streptococcal diseases . The new streptococcal "pathomorphosis" is presented by alteration of adhesive properties and distribution of various serotypes (domination of M1 and M18 serotypes) . It is also expressed by an increased production of pyrogenic exotoxin and necrotic factor . As a consequence, apart from increasing incidence of streptococcal infections, it is observed that the streptococcal syndrome has often grave prognosis followed with a high percentage of mortality . Also a new clinical entity is also described; that of Toxic Shock Like Syndrome . The results of investigation concerning the susceptibility of beta-haemolytic streptococci to penicillin are encouraging . Penicillin resistant strains are not discovered among clinical isolates so far . However, the increased percentage of penicillin tolerant strains, and possibility of induction of penicillin resistance, can be considered as a serious warning . For that reason, further investigation of the mechanisms of developing penicillin tolerance and resistance appears to be highly recommended. J Clin Microbiol, 1993 Mar, 31(3), 584 - 7 Genetic diversity within isolates of mutans streptococci recognized by an rRNA gene probe; Saarela M et al.; A total of 79 clinical isolates of mutans streptococci and five laboratory strains representing serotypes c, d, e, f, and g were genotyped by a nonradioactive hybridization method with the rrnB rRNA operon of the Escherichia coli chromosome as a probe . The hybridization patterns of chromosomal DNA fragments obtained by digestion with restriction endonucleases HindIII, SmaI, and BamHI revealed genotypic heterogeneity among the serotypes and among isolates of the same serotype recovered from unrelated subjects . Diversity also existed among isolates obtained from a single subject . For 5 of 13 subjects studied, two or three genotypes within serotypes were found, while eight subjects harbored the same number of genotypes as serotypes . The data show that the method utilizing the rRNA gene probe is of value in determining the molecular epidemiology of isolates of mutans streptococci. J Am Vet Med Assoc, 1993 Feb 15, 202(4), 595 - 600 Prevalence of contagious pathogens of bovine mastitis and use of mastitis control practices; Sischo WM et al.; A cross-sectional study of 1,032 dairy herds in Ohio was conducted to determine the prevalence of the major contagious pathogens of mastitis (Streptococcus agalactiae and Staphylococcus aureus) and the use of common mastitis control measures . Herd owners were surveyed by mail concerning their use of mastitis control measures . The survey focused on treatment of nonlactating cows, postmilking teat dipping, culling practices, milking machine maintenance, treatment for clinical mastitis, and premilking hygiene practices . Nearly 90% of questionnaires were returned . The prevalence of Streptococcus agalactiae and Staphylococcus aureus was determined by use of bulk-tank milk samples . Most herds (n = 802) met the criteria for classification into 1 of 4 groups: (1) Free of contagious pathogens, as determined by inability to isolate coagulase positive staphylococci (CPS) and esculin-negative CAMP positive streptococci (ENCPS) from 3 bulk-tank milk samples, (2) CPS, but not ENCPS, isolated from at least 1 sample, (3) ENCPS, but not CPS, isolated from at least 1 sample, (4) both ENCPS and CPS isolated from at least 1 sample . The number of herds in which both ENCPS and CPS were isolated was low; therefore, these herds were grouped with herds in which ENCPS alone was isolated for the evaluation of mastitis control practices related to herd pathogen status . Herd somatic cell count (SCC) was determined using Dairy Herd Improvement Association data by calculating the geometric mean SCC from individual cow test day SCC . Twelve months of SCC data from 741 herds were included in this study.(ABSTRACT TRUNCATED AT 250 WORDS) Am J Ophthalmol, 1993 Feb 15, 115(2), 202 - 8 Spontaneous ulcerative keratitis in immunocompromised patients; Aristimuno B et al.; We studied the occurrence of ulcerative keratitis in five eyes of four patients who were examined at the University of Maryland Hospital ophthalmology clinic over a 12-month period . All were young women who were intravenous drug abusers, with no known predisposing factors for ulcerative keratitis . Two patients had acquired immunodeficiency syndrome (AIDS), one was human immunodeficiency virus (HIV)-positive, and the fourth refused HIV testing . One had a corneoscleral limbus to corneoscleral limbus keratitis; three had inferiorly located corneal ulcers (bilateral in one patient with AIDS) . Corneal cultures disclosed Capnocytophaga species in the corneoscleral limbus to corneoscleral limbus keratitis . The remaining ulcers were polymicrobial; cultures of three grew Candida albicans, cultures of two grew alpha-hemolytic streptococci, cultures of two grew Staphylococcus aureus, and culture of one grew Pseudomonas aeruginosa . Treatment with topical fortified antibiotics and antifungal agents resulted in complete healing in all four inferiorly located ulcers . The corneal ulcer became perforated and the eye was eviscerated . Histopathologic analysis of the eviscerated specimen disclosed acute keratitis with necrosis and no microorganisms. Postgrad Med, 1993 Feb 15, 93(3), 141 - 5 Pharyngitis in children; Feldman WE; Although the group A beta-hemolytic streptococcus is the most important treatable cause of pharyngitis, other organisms, including viruses and groups C and G streptococci, should always be considered in the diagnosis of pharyngeal symptoms . Clinical findings and a rapid strep test aid in making the diagnosis of group A streptococcal pharyngitis . In nonallergic patients with the latter, penicillin V potassium is the antibiotic of choice; for those allergic to penicillin, erythromycin is my preferred alternative. Oral Microbiol Immunol, 1993 Feb, 8(1), 1 - 4 Oral streptococcal colonization of infants; Smith DJ et al.; The objective of this study was to determine the prevalence and proportions of different streptococcal species among the streptococcal flora during infancy . A total of 60 oral samples were collected by oral swabbing of the buccal mucosa and alveolar ridges of 18 infants before tooth eruption and from buccal and lingual surfaces of teeth after tooth eruption . A total of 549 isolates on mitis salivarius agar were speciated, principally by recently revised biochemical criteria of Kilian et al . Streptococcus mitis biovar 1 predominated, both in prevalence (89%) and proportion of oral streptococci recovered in each sample (median = 87% of streptococcal flora) . Streptococcus salivarius was also prevalent (94%) but generally represented a small percentage of the total streptococcal flora (median = 3%) . Streptococcus oralis and Streptococcus anginosus strains were detected in approximately one third of predentate and dentate infants in the first year of life . Streptococcus sanguis strains were not detected before tooth eruption, but could be detected in 7/14 of the infants with teeth . Thus, S . mitis constitutes the major component of the initially colonizing streptococcal microbiota of the young infant. Eur J Clin Microbiol Infect Dis, 1993 Feb, 12(2), 124 - 7 Evaluation of two enzyme immunoassays for rapid detection of group B streptococci in pregnant women; Wust J et al.; The performance of two enzyme immunoassays for rapid detection of group B streptococci (GBS) was evaluated in comparison to culture using cervical swabs from 191 pregnant women . Ten percent of the women harboured GBS . There were two positive results in the Icon assay (Hybritech), both in women with heavy growth in the culture, and four positive results in the Quidel assay (Quidel), two in the women with heavy colonization and one each in women with moderate and light growth of GBS respectively . The sensitivity of both assays was low, being 11% (2/18) for the Icon assay and 24% (4/17) for the Quidel assay . The specificity of both assays was 100% . Both assays could detect > or = 10(6) group B streptococci per swab . A positive result justifies ampicillin prophylaxis due to the high risk for the newborn . A negative result should be confirmed by rapid culture techniques. APMIS, 1993 Feb, 101(2), 141 - 8 Adherence and surface properties of buoyant density subpopulations of group B streptococci, type III; Granlund-Edstedt M et al.; From clinical isolates of group B streptococci, buoyant density subpopulations with variable amounts of type-specific polysaccharide can be derived . The ability of these subpopulations to adhere to vaginal epithelial cells and to glass was assessed by using {3H}-labeled bacteria . Subpopulations with no or minute amounts of capsule showed good adherence capacity and a hydrophobic cell surface . In contrast, a large capsule made the bacteria less adherent and rendered their surface hydrophilic . A negative cell surface charge, judged by determination of the z-potential, was directly related to the amount of capsule . Proteinase K treatment of less encapsulated variants significantly decreased the cell hydrophobicity . The ability of a GBS strain to express different surface characteristics may be a mechanism for adaptation to environmental changes, and may thereby contribute to the pathogenicity of GBS. Enferm Infecc Microbiol Clin, 1993 Feb, 11(2), 70 - 9 {Perinatal Streptococcus agalactiae infections . Clinical epidemiological study and evaluation of a prevention program}; Bosch J et al.; BACKGROUND: To prove both the importance of SGB (group B streptococci) as a cause of perinatal infection and the efficacy of a prophylactic treatment in pregnant women with cervicovaginal colonization by SGB . METHODS: Retrospective study of 197 third trimester pregnant women who were carriers of SGB (155 received intrapartum prophylaxis) and of 44 patients with SGB infections during pregnancy, post-partum and neonatal periods . RESULTS: No neonatal sepsis was detected in the group of SGB carrier mothers who received antibiotic prophylaxis . In carrier pregnant women who did not receive prophylaxis, one case of neonatal sepsis by SGB was detected and a greater prevalence of intrapartum fever, and neonatal infection with negative cultures was observed . SGB was frequently isolated as a cause of early sepsis and neonatal meningitis (13 cases), intraamniotic infection (12 cases) and puerperal endometritis (8 cases) . In 45% of the patients with perinatal infections by SGB, the cervicovaginal culture performed in the third trimester of pregnancy did not detect the presence of SGB . CONCLUSIONS: The administration of intrapartum ampicillin to pregnant SGB carriers permits the prevention of perinatal infections by this microorganism in a great number of patients, although the possibility of late colonization, which may not be detected during pregnancy, stil remains. Tierarztl Prax, 1993 Feb, 21(1), 75 - 8 {Sugar diffusion test, an adjuvant method for the diagnostic differentiation of streptococci of different serological groups}; Muller W; A sugar differentiation test which allows the differentiation of streptococcal serological groups by means of visual comparison of degree of haemolysis is introduced . The test uses the reagents glucose, lactose and aesculin and is both time- and cost-effective. J Clin Pathol, 1993 Feb, 46(2), 145 - 8 New phenotypic typing scheme for group B streptococci; Heard SR et al.; AIMS: To develop a new typing system for group B streptococci based on 35S-methionine-labelled protein profiles of bacterial proteins . METHODS: 377 clinical isolates of group B streptococci were examined by incorporation of 35S-methionine into bacterial proteins under strict anaerobic conditions . After sodium dodecylsulphate-polyacrylamide gel electrophoresis, autoradiography was performed . The patterns produced were visually analysed and categorised into clusters of organisms based on the pattern of band production between 32-46 kilodaltons . RESULTS: 294 of the typed strains classified into seven different groups designated a-g . 32 strains failed to incorporate 35S-methionine sufficiently to be grouped and 11 strains did not fall into one of the seven identified groups . Typability, reproducibility, and discrimination of the system was evident . CONCLUSIONS: This typing system may help to distinguish between colonising and invasive strains of the organism. Br J Dermatol, 1993 Feb, 128(2), 151 - 8 Immunoblotting of streptococcal antigens in guttate psoriasis; Wilson AG et al.; Guttate psoriasis may be precipitated by acute streptococcal infection, usually of the upper respiratory tract . We have studied the immune response to streptococci in 26 patients presenting with a first or recurrent episode of acute guttate psoriasis (AGP), using immunoblotting . Eighteen of 26 patients studied had a demonstrable response to a wide range of streptococcal antigens using this approach, compared with 14 of 26 patients who demonstrated a response using more conventional antistreptococcal antibody tests . Patients with AGP had a significantly higher antibody detection score using immunoblotting than did control subjects (P < 0.005) . We conclude that immunoblotting is a useful technique in studying this condition and may be of benefit in exploring the immunopathogenesis of AGP. Mol Gen Genet, 1993 Feb, 237(1-2), 287 - 300 Three different types of organization of the vir regulon in group A streptococci; Podbielski A; The DNA of group A streptococci (GAS) encodes several important virulence factors such as the antiphagocytic M protein, the Ig-Fc-binding M-related proteins (FcrA-like and EnnX-like) and the complement factor-inactivating C5a peptidase . The corresponding genes emm, fcrA, ennX, and scpA, respectively, were assumed to be located close together in the GAS genome . Additionally, emm and scpA have been found to be under the positive, coordinate control of the virR locus, which led to the designation "vir regulon" for the corresponding genomic segment . In order to map the vir regulons of many GAS serotypes and to analyse any correlation between the organization of vir regulons and circumscribed heterogeneities within the emm, virR, and scpA genes, an approach using several distinct sets of polymerase chain reaction (PCR) experiments was chosen . By examination of the genomic DNA of 42 GAS isolates from 36 different M serotypes three patterns of vir regulon topography were found . The first, designated "large vir regulon" (LVR), consists of virR--fcrA(-like)--emm--ennX(-like)--scpA . The second, designated "small vir regulon" (SVR), contains virR--emm--scpA, and the last, designated "unusual vir regulon" (UVR), resembles SVR but contains additional heterogeneous sequences between emm and scpA . The patterns correlate with heterogeneities at the 3' ends of the virR and scpA genes, with the M classification system and the occurrence of specific non-coding intervening sequences within the vir regulons . The potential impact of these patterns on models to account for generation of vir regulons is discussed. Antimicrob Agents Chemother, 1993 Feb, 37(2), 159 - 63 Efficacy of cefuroxime axetil suspension compared with that of penicillin V suspension in children with group A streptococcal pharyngitis; Gooch WM 3rd et al.; The bacteriological and clinical efficacies of cefuroxime axetil suspension (20 mg/kg of body weight per day in two divided doses) were compared with those of penicillin V suspension (50 mg/kg/day in three divided doses) in a multicenter, randomized, evaluator-blinded study . Children aged 2 to 13 years with clinical signs and symptoms of acute pharyngitis and a positive throat culture for group A beta-hemolytic streptococci (GABHS) were eligible . Patients were assessed and samples from the throat for culture were obtained at the time of diagnosis, 3 to 7 days after the initiation of treatment, and 4 to 8 days and 19 to 25 days after the completion of 10 days of therapy . Of the 385 evaluable patients, GABHS were eradicated from 244 of 259 (94.2%) cefuroxime-treated patients and 106 of 126 (84.1%) penicillin-treated patients (P = 0.001) . Complete resolution of the signs and symptoms present at the time of diagnosis was achieved in 238 of 259 (91.9%) cefuroxime-treated patients and 102 of 126 (81.0%) penicillin-treated patients (P = 0.001) . Potential drug-related adverse events were reported in 7.0 and 3.2% of the cefuroxime- and penicillin-treated patients, respectively (P = 0.078) . In the present study, cefuroxime axetil suspension given twice daily resulted in significantly greater bacteriological and clinical efficacies than those of penicillin V suspension given three times daily to pediatric patients with acute pharyngitis and a positive throat culture for GABHS. Ann Ophthalmol, 1993 Feb, 25(2), 51 - 3 Endophthalmitis caused by nutrient variant streptococci after filtering bleb surgery; Lee K et al.; Late-onset endophthalmitis after filtering bleb surgery is most often caused by streptococci . We report the first case of endophthalmitis caused by nutrient variant streptococci (NVS), which probably originated from the oral cavity . This patient's vision improved from light perception to 20/80 with intravitreal and systemic antibiotic administration . In late-onset endophthalmitis, NVS can be pathogenic; the laboratory must be alerted to culture specifically for this fastidious bacterium. Eur J Pediatr, 1993 Feb, 152(2), 82 - 92 Probable role of Streptococcus pyogenes in Kawasaki disease; Akiyama T et al.; Over the past 25 years, the clinical course of Kawasaki disease has been defined, the prevalence and nature of the cardiovascular effects widely understood, and pathological changes in the most severe cases well described . However, the aetiology and pathogenesis of this puzzling disease have remained unclear, thus specific therapy is not yet available . Because of some close clinical similarities between this disease and streptococcal scarlet fever, particular attention has been paid to the possible role of Streptococcus pyogenes as an aetiological agent in this illness . Until now, however, group A beta-haemolytic streptococci have never been consistently isolated from any patients; in addition, the titre of anti-streptolysin 0 is not raised, and lack of response to antibiotics is a feature of this disease . Our long series of investigations over more than 10 years, which will be covered in the present review, were performed in an attempt at elucidating causative agent(s) of Kawasaki disease . This has led to our firm belief in the probable role of S . pyogenes in the pathogenesis of this disease, despite the lack of fulfillment of Koch's postulates, on the basis of the following findings . Patients with Kawasaki disease recovering from the acute, febrile phase of the illness exhibited an exaggerated cell-mediated reactivity, as measured by the macrophage migration inhibition test, to group A beta-haemolytic streptococci, their pyrogenic exotoxin and streptolysin 0 as well as to several mammalian muscle cell extracts which are allegedly related antigenically to the cell wall and/or cytoplasmic membrane of S . pyogenes . Protoplast-like "spherical bodies" varying in diameter from 0.5 to 1.5 microns, and devoid of cell walls, were detected in the buffy coats of peripheral blood from patients with this disease, and stained distinctly by immuno-electron microscopy using, as a primary antibody, a rabbit antiserum to S . pyogenes- derived protoplasts, and followed by absorption with protoplasts from Staphylococcus aureus and Escherichia coli . Newborn mice infected with S . pyogenes having no capacity to confer cell-mediated immunity even in adult murine hosts, and reinfected 4-6 weeks later with another strain of the same species of bacteria which is able to elicit cellular immunity, showed a lack of humoral response to streptococcal antigens, leaving intact cell-mediated immunity . Such a biased immunological characteristic is an exact counterpart of that of Kawasaki disease patients.(ABSTRACT TRUNCATED AT 400 WORDS) Ann Surg, 1993 Feb, 217(2), 109 - 14 Streptococcal toxic shock-like syndrome . The importance of surgical intervention; Wood TF et al.; Pyrogenic exotoxins A, B, and C produced by group A beta-hemolytic streptococci (Streptococcus pyogenes) may cause a syndrome characterized by fever, rash, desquamation, hypotension, and multi-organ-system dysfunction . This syndrome, the streptococcal toxic shock-like syndrome (TSLS), has a rapid and fulminant course closely resembling the staphylococcal toxic shock syndrome (TSS) caused by the staphylococcal toxic shock syndrome toxin-1 (TSST-1) . The recent recognition of this syndrome is thought to stem from the appearance of more virulent strains of streptococci that have a greater tendency to produce potent exotoxins than prior strains . During the past 6 years, the authors have treated six patients with TSLS; three of these patients have presented recently . The sites of streptococcal infection associated with the development of the syndrome are frequently in soft tissue and skin . Early diagnosis, treatment with penicillin, and radical operative debridement are required. Am J Obstet Gynecol, 1993 Feb, 168(2), 624 - 5 Amniorrhexis lowers the incidence of positive cultures for group B streptococci; Henderson CE et al.; OBJECTIVE: Our purpose was to determine the effect of amniorrhexis on cultures for group B streptococci . STUDY DESIGN: Intrapartum vaginal cultures for group B streptococci were obtained before and after rupture of membranes in 166 women; in addition, rectal cultures were obtained from the last 35 patients . RESULTS: Before rupture of membranes 49 of 166 (30%) of the vaginal cultures were positive for group B streptococci; only 28 of 166 (17%) remained positive after rupture of membranes (p = 0.0009) . Similarly, before rupture of membranes 10 of 35 (30%) rectal cultures were positive, whereas only three of 35 (0.9%) remained positive for group B streptococci after rupture of membranes (p = 0.03) . CONCLUSION: The prevalence of positive genital cultures for group B streptococci is significantly lower immediately after rupture of membranes. Epidemiol Infect, 1993 Feb, 110(1), 87 - 94 Sialic acid content and surface hydrophobicity of group B streptococci; Teixeira LA et al.; The sialic acid content and the cell-surface hydrophobicity index of 40 group B streptococci (GBS) strains were assessed . GBS isolated from invasive infections (virulent strains) presented an increased level of sialic acid content (1.4%) when compared with GBS isolated from asymptomatic patients (0.53%) . Treatment of GBS strain 85634 with neuraminidase resulted in a decrease (about 25%) in the net negative surface charge as assessed by cell electrophoresis . This finding suggests that sialic acid residues are important anionogenic groups exposed on GBS cell surface . N-acetylneuraminic acid was the only sialic acid derivative characterized in the strain 85634 as evaluated by gas-liquid chromatography . GBS from different serotypes presented a hydrophobic index mean value of 0.9 . Even though the sialic acid contributed effectively to the negative charge on GBS cell surface, no difference was observed in the hydrophobic index when virulent and avirulent strains were compared. Infect Immun, 1993 Feb, 61(2), 785 - 90 Role of antigen-presenting cells in activation of human T cells by the streptococcal M protein superantigen: requirement for secreted and membrane-associated costimulatory factors; Majumdar G et al.; The requirements for T-cell activation by the streptococcal superantigen (SAg), pepsin-extracted M protein from type 5 streptococci (pep M5), were studied by monitoring Ca2+ influx and cell proliferation . Cells from a pep M5-specific T-cell line showed no change in intracellular Ca2+ levels in response to pep M5 when added alone or with freshly isolated autologous antigen-presenting cells (APC) . However, after being incubated with pep M5 overnight, the APC secreted soluble factors that together with pep M5 induced a marked increase in intracellular Ca2+ levels in pep M5-specific T cells or freshly isolated, purified T cells . Removal of the SAg from the overnight APC-derived supernatants resulted in loss of the Ca(2+)-mobilizing activity, which was restored within seconds of addition of SAg, suggesting that both the SAg and the soluble factors synergize to induce the Ca2+ influx . Induction of cell proliferation required additional signals inasmuch as the activated APC-derived supernatant failed to synergize with pep M5 to induce the proliferation of purified T cells and required the presence of phorbol myristate acetate for this activity . Metabolically inactive, fixed APC were impaired in their ability to present pep M5 to T cells . Presentation of pep M5 by fixed APC was, however, restored when the APC-derived soluble costimulatory factors were added to the culture . Our data suggest that pep M5-induced activation of T cells is dependent on APC-derived soluble factors and an APC membrane-associated costimulatory molecule(s) . These interactions may be important in regulating the in vivo responses to M proteins, could contribute to the severity or progression of infections with Streptococcus pyogenes, and may influence the susceptibility of individuals to its associated nonsuppurative autoimmune sequelae. Infect Immun, 1993 Feb, 61(2), 478 - 85 Group B streptococci invade endothelial cells: type III capsular polysaccharide attenuates invasion; Gibson RL et al.; Group B streptococci (GBS) are the most common cause of neonatal sepsis and pneumonia . The pathogenesis of GBS disease is not completely defined . GBS-induced endothelial cell injury is suggested by histological findings at autopsy and in animal studies . We hypothesized that (i) type III GBS (COH-1) invade and injure human umbilical vein endothelial (HUVE) cells and (ii) isogenic mutations in GBS capsule synthesis would influence HUVE invasion . Confluent HUVE monolayers were infected for 0.5, 2, or 6 h . Media with penicillin plus gentamicin were added and incubated for 2 h to kill extracellular bacteria . Cells were washed and lysed, and the number of live intracellular bacteria was determined by plate counting . COH-1 invaded HUVE cells in a time-dependent manner at levels 1,000-fold higher than those of the noninvasive Escherichia coli strain but significantly lower than those of Staphylococcus aureus . There was no evidence for net intracellular replication of GBS within HUVE cells . COH-1 infection of HUVE cells caused the release of lactate dehydrogenase activity . GBS invasion was inhibited by cytochalasin D in a dose-dependent manner; GBS-induced lactate dehydrogenase release was attenuated by cytochalasin D . The isogenic strains COH 1-11, devoid of capsular sialic acid, and COH 1-13, devoid of all type III capsule, invaded HUVE cells three- to fivefold more than the parent COH-1 strain . The type III capsular polysaccharide and particularly the capsular sialic acid attenuate GBS invasion of HUVE cells . Electron micrographs of lung tissue from a GBS-infected newborn Macaca nemestrina also showed GBS within capillary endothelial cells . We conclude that endothelial cell invasion and injury are potential mechanisms in the pathogenesis of GBS disease. J Bacteriol, 1993 Feb, 175(3), 819 - 25 Acquisition of manganous ions by mutans group streptococci; Bauer PD et al.; The cariogenic bacteria Streptococcus sobrinus and S . cricetus were shown to have an absolute requirement for manganous ion in order to bind glucans or to adhere to glass in the presence of sucrose . The bacteria possessed a reasonably high affinity transport system for 54Mn2+, yielding a Km of about 12 microM . The Vmax for uptake of 54Mn2+ in S . sobrinus was increased when the bacteria were grown in Mn-depleted medium, but the Km remained the same . There was no evidence for two Mn2+ uptake systems, commonly observed for many bacteria . Ions such as Ca2+, Co2+, Co3+, Cu2+, Fe2+, Fe3+, Hg2+, Mg2+, Ni2+, and Zn2+ did not inhibit the uptake of 54Mn2+ by the bacteria, although Cd2+ was a potent inhibitor . Fractionation experiments showed that manganese was distributed in protoplasts (67%) and in the cell wall (33%) . Approximately 80% of the 54Mn2+ in S . sobrinus was rapidly exchangeable with nonradioactive Mn2+ . Electron spin resonance experiments showed that all of the manganese was bound or restricted in mobility . Proton motive force-dissipating agents increased the acquisition of 54Mn2+ by the streptococci, probably because the wall became more negatively charged when the cell could no longer produce protons. Lett Appl Microbiol, 1993 Feb, 16(2), 72 - 4 Streptococci and enterococci associated with tonsils of cattle; Cruz Colque JI et al.; Streptococcus suis, Streptococcus bovis and the mastitis pathogens Streptococcus dysgalactiae and Streptococcus uberis were the most frequently occurring streptococci in tonsils of cattle . Streptococcus suis dominated in samples from calves between 1 month and 1 year of age, but was much less frequent in calves less than 1 month old . The mastitis pathogen Strep . dysgalactiae was found more often in calves than in older animals . Enterococci were relatively rare, except in the youngest age group . Nearly one third of the strains examined could not be identified to known species. FEMS Microbiol Lett, 1993 Jan 15, 106(2), 139 - 42 Covalently immobilized DNA plate for luminometric DNA-DNA hybridization to identify viridans streptococci in under 2 hours; Adnan S et al.; Single-stranded chromosomal DNA was covalently bound to a microdilution plate and used for quantitative DNA-DNA hybridization . After 30 min, hybridized DNA was quantitatively detected by alkaline phosphatase and a chemiluminescent substrate . This method was successfully used for the rapid identification of viridans streptococci. Ugeskr Laeger, 1993 Jan 11, 155(2), 74 - 8 {Toxic shock syndrome in group A streptococcal infection}; Hasselbalch HC; Three new cases of toxic shock syndrome due to infection with group A beta-hemolytic streptococci are described and similar cases in the literature are reviewed . The typical features of this disease include rapid development of multiorgan failure with renal impairment and, in many patients, also the respiratory distress syndrome . Cardiac dysfunction with myocardial depression is a prominent feature which is most reasonably explained by an effect of the septicaemia per se but may also be toxic cardiomyopathy mediated by circulating toxins . Other major findings include exanthema--often with the development of haemorrhagic bullae as part of toxic epidermal necrolysis . In patients with initial soft tissue infection this is rapidly progressive and often associated with necrotizing fasciitis and myositis, which may give rise to a compartment syndrome with rhabdomyolysis . In addition to conventional therapy with antibiotics, fluid replacement and inotropics, most patients with extensive soft tissue infection also require surgical intervention with debridement and occasionally fasciotomy. J Gynecol Obstet Biol Reprod (Paris), 1993, 22(2), 191 - 6 {Fever during labor . Evaluation of the risk of maternal-fetal infection and reflections concerning prophylactic measures based on a prospective study of 6,305 deliveries}; Blanchot J et al.; The authors have evaluated the risk of neonatal infection (NNI) by materno-fetal contamination when a rise in temperature occurs in labour and they have worked out the prophylactic measures that should be taken . This has been the results of a prospective study carried out on 6305 deliveries . Any significant conditions associated with NNI are stained liquor and a low Apgar score at birth . When high temperature develops in labour it is important to deliver the infant as quickly as possible particularly if the labour is a premature one . Prevention carried out by very early diagnosis of amniotic fluid infection in pregnancy and by careful attention to the high risk conditions of: early rupture of the membranes, a high level of vaginal infection particularly with Beta streptococci. Caries Res, 1993, 27 Suppl 1, 72 - 6 Antimicrobial strategies in the prevention of dental caries; Marsh PD; Antimicrobial agents, applied either professionally or delivered from dentifrices or mouthwashes, could reduce caries by controlling plaque formation, suppressing cariogenic species, or by inhibiting bacterial metabolism . Chlorhexidine has proven anticaries activity; other agents might also prevent caries by means of their antiplaque properties . Sugar substitutes stabilize the microflora by reducing the number of acid challenges to plaque and stimulating saliva flow; some also have antimicrobial properties, especially against mutans streptococci . Vaccines have been prepared from purified antigens of mutans streptococci . These vaccines confer protection in non-human primates, but have yet to be tested in a human clinical trial. Caries Res, 1993, 27 Suppl 1, 56 - 63 Relative consumption of sucrose and other sugars: has it been a factor in reduced caries experience? Burt BA. This paper examines the impact on the development of caries, especially on the proximal and the free smooth surfaces, that follows the reduction in sucrose consumption and the increase in consumption of the monosaccharides in the United States and Great Britain . Laboratory evidence shows that sucrose has a special role in proximal- and smooth-surface caries because of its ability to produce extracellular polysaccharides with the mutans streptococci, thus increasing plaque's ability to adhere to the enamel surface . Evidence from human studies, however, is less clear about the relative cariogenicity of the various sugars, possibly because experimental conditions are difficult to maintain in such studies . In the USA sucrose consumption has been diminishing for some year and is now only 47% of the total sugar consumption of 61 kg per person annually . The change in Britain has been less pronounced, sucrose there in 1984 constituted 83% of total consumption of 47.9 kg per person . Sucrose consumption in Britain is, therefore, higher than in the United States, even though the average total consumption of all sugars is higher in the USA . Limited data suggest that proximal- and smooth-surface lesions also constitute a higher proportion of caries incidence in Britain than in USA, and a cause-and-effect hypothesis between these factors is explored . Dietary education for oral health should harmonize with that for general health by emphasizing sensible food choices, which generally means selection of low-fat, low-sugar foods. Schweiz Monatsschr Zahnmed, 1993, 103(4), 409 - 12 {The salivary content of Streptococcus mutans in Basel children and adolescents}; Buttner M; The search for a feasible method to estimate the caries risk in humans is going on since several years . Such risk assessments should especially be performed in persons clinically suspected to be at risk . The quantitative determination of Mutans Streptococci (SM) in whole saliva has been proposed to serve as a measure of the caries risk . SM tests have been performed in a group of 5743 5 to 16 year old children and adolescents living in the city of Basle in 1991 . Levels of SM in whole saliva were correlated with caries prevalence both in the deciduous and permanent teeth . SM counts have become a valuable diagnostic tool for the early identification of children at risk for caries development . SM tests have equally become a helpful pedagogic instrument used to motivate patients for individual prophylactic activities. Vet Med (Praha), 1993, 38(2), 75 - 81 {Occurrence of streptococci resistant to antibiotics in the rumen of calves}; Jonecova Z et al.; The occurrence and antibiotic-resistance spectrum of some strains of rumen streptococci were investigated in calves of four age categories in the milk diet period at 1-3, 4-7, 8-14 days of age and 6-8 weeks of age . More than 75% of the strains isolated from the calves of all age categories were resistant to more than one tested antibiotic (tetracycline, neomycin, erythromycin, streptomycin, chloramphenicol) . The average number of streptococci isolated from the ingesta of calves during the period of observation was 10(5) per ml . The per cent of resistant strains showed an increasing trend from birth to the age of 8-14 days (Tab . I) . The occurrence of resistant strains in 6-8 week calves was even lower than in the calves of the youngest age category . A four-marker type of resistance (41.6-50%) prevailed within 14 days of age . Two-marker types of resistance (42.6%) occurred most frequently in the calves of the oldest age category . Tab . II shows the spectrum of resistant strains . Tetracycline-resistant amylolytic strains of Streptococcus bovis were selected from among the isolated strains to be used as donor strains in conjugation experiments . Successful resistance transmission was observed in solid-surface conjugation . The transmission frequency ranged within the transconjugate values of 10(-3) to 10(-5) per donor cell within the species (Tab . III) . A chromosomally rifampicin-resistant strain of Streptococcus bovis BM114 was used as a recipient as it did not contain any plasmids and was sensitive to the tested antibiotics . Agarose-gel electrophoresis was used to visualize the presence of plasmid DNA in donor strains (Fig . 1). Gen Pharmacol, 1993 Jan, 24(1), 143 - 5 Josamycin concentrations in radicular cysts following a single oral administration; Akimoto Y et al.; 1 . Josamycin concentrations in cyst wall (wall) and cyst fluid (fluid) of radicular cyst and serum following a single oral administration of josamycin (600 mg) were assayed by a paper disk method . 2 . The mean peak josamycin concentrations in wall, fluid and serum occurred at 1.5, 2 and 1.5 hr, respectively, and were 1.33 micrograms/g, 0.53 and 0.74 micrograms/ml, respectively . 3 . The mean concentration ratios of wall/serum, fluid/serum and fluid/wall at the peak times (1.5, 2 and 2 hr) were 1.80, 0.64 and 0.42, respectively . 4 . Josamycin concentrations in wall and fluid at the peak time exceeded MIC for 80% for clinically isolated strains of alpha-hemolytic Streptococci. Scand J Rheumatol, 1993, 22(2), 49 - 52 Association of HLA class I and class II antigens with rheumatic fever in a Turkish population; Olmez U et al.; The distribution of class I and class II HLA antigens of 100 Turkish patients with rheumatic fever, 77 of whom had cardiac involvement, was examined . We compared the results with a control group of identical origin . The frequency of HLA A10 and HLA B35 antigens were found significantly higher in patients with rheumatic fever (p < 0.05, p < 0.01, respectively) . The frequency of HLA A10 and HLA DRw11 in patients with cardiac involvement were significantly higher than in those without cardiac involvement (p < 0.05, p < 0.01, respectively) . On the other hand, HLA Cw2 antigen frequency was found significantly higher in patients without cardiac involvement than in those with rheumatic heart disease (p < 0.05) . We support the concept that rheumatic fever is an immunological reaction to group A, beta hemolytic streptococci in individuals who have genetic predisposition. Acta Neurochir (Wien), 1993, 121(1-2), 12 - 4 Penetration of fusidic acid into human brain tissue and cerebrospinal fluid; Mindermann T et al.; Penetration of fusidic acid into brain tissue in six patients and cerebrospinal fluid in seven patients was determined . Tissue samples, taken during surgery revealed drug levels at about 7% of simultaneous serum concentrations . In contrast, cerebrospinal fluid concentrations were below 1% of serum levels . Since serum- and tissue levels of fusidic acid were far above the minimal inhibitory concentration (MICs) of staphylococci and streptococci, and since it has a long serum half-life of about 10 hours, it is a promising candidate for prophylaxis in neurosurgery. Wien Klin Wochenschr, 1993, 105(6), 176 - 8 {Anaphylactic reaction in streptokinase therapy}; Hohage H et al.; Streptokinase is used worldwide as thrombolytic agent . Indications are deep vein thrombosis, arterial thrombosis and embolism, arteriovenous cannula occlusions, acute coronary artery thrombosis, and acute renal vein thrombosis . The major drawback in comparison with other thrombolytic drugs is its antigenicity . Allergic reactions have been reported but the underlying mechanisms have not yet been fully elucidated . A 58 year-old man with acute myocardial infarction developed an anaphylactic reaction immediately after commencement of streptokinase infusion, although immunological laboratory findings were not affected . The patient had no history of prior exposure to streptokinase, infections with streptococci, or chronic allergic reactions . 2 months after streptokinase therapy increased plasma levels were detected of specific IgG antibodies to streptokinase . The levels of specific IgE antibodies to streptokinase and other anti-streptococcal antibodies were within the normal range . A prick test performed 4 months later with 100 I.U . streptokinase was unremarkable . The problems of such allergic reactions are discussed on the basis of this case report and a review of the literature. Nihon Kyobu Shikkan Gakkai Zasshi, 1993 Jan, 31(1), 20 - 5 {Experimental epithelioid cell granuloma formation in Lewis rats induced by injection of cell wall fragments derived from alpha-streptococcus--etiologic relationship between bacterial cell wall and sarcoid granuloma}; Miyagawa Y et al.; We observed the presence of epithelioid granulomas in follicles near lacunae in the tonsils from patients with active sarcoidosis . Bacteria isolated in these tissues were mostly alpha-streptococci . The present study was undertaken to determine whether alpha-streptococcus can induce granuloma formation . Streptococcal cell wall (SCW) fragments were injected into the foot pads of female Lewis rats . Epithelioid granulomas were abundantly formed in popliteal lymph nodes when SCW aqueous suspension was injected four times . SCW antigens were detected in macrophages in the granuloma but not in epithelioid cells, by immunoperoxidase method . These findings suggest that macrophages transform into epithelioid cells after phagocytosis and digestion of SCW, and that components of bacterial cell wall such as SCW may induce the granuloma formation in sarcoidosis. Zentralbl Gynakol, 1993, 115(3), 136 - 9 {Maternal deficiency of IgG 2 and IgG 4 and neonatal infection caused by B-streptococci}; Maak B et al.; We describe here an newborn infant born in the 39th week of gestation with an early onset sepsis caused by group B streptococci . The intravenous administration of antibiotics and immunoglobulin preparation was unable to prevent the fatal outcome . The boy died after 16 hours of life . In the maternal serum a marked deficiency of IgG 2 and IgG 4 could be demonstrated . According to the results from the literature it seems possible that partial immunodeficiencies are important factors in the pathogenesis of the B-streptococcal disease of the newborn. Scand J Infect Dis, 1993, 25(1), 51 - 6 The role of antigen detection in pneumococcal carriers: a comparison between cultures and capsular antigen detection in upper respiratory tract secretions; Boersma WG et al.; During the winter season upper respiratory tract secretions from 166 patients with stable chronic obstructive pulmonary disease (COPD) or asthma were simultaneously cultured for Streptococcus pneumoniae and tested for pneumococcal capsular antigen . Latex agglutination was employed to investigate the effect of pneumococcal carriership on pneumococcal capsular antigen detection in upper respiratory tract secretions . All specimens originating from the oropharynx, nasopharynx and saliva were both cultured and investigated in parallel for the presence of antigen . The recovery of pneumococci from the different areas was unequally distributed (oropharynx 29%, nasopharynx 8%, and saliva 16%), with the highest isolation rate from the oropharynx alone . Only 4 (3%) of the oropharyngeal swabs, 1 (1%) of the nasopharyngeal swabs and 14 (9%) of the saliva specimens yielded both pneumococcal antigen and a positive culture for S . pneumoniae . A further 9 (6%) of the oropharyngeal swabs, 5 (3%) of the nasopharyngeal swabs, and 50 (33%) of the saliva specimens were antigen positive only, with no pneumococci isolated on culture . It is speculated that these reactions were due to cross-reacting microorganisms (especially alpha-haemolytic streptococci) present in saliva and contaminating the oropharynx and the nasopharynx . Quantitative cultures of 9 oropharyngeal swabs yielded S . pneumoniae in concentrations too low to be detectable by latex agglutination . The study indicates that there is a poor relation between pneumococcal colonization and antigen detection in the oropharynx and nasopharynx . Antigen present in these secretions is probably not an important disrupting factor by contamination when detecting pneumococcal antigen in washed sputum . The false positive antigen results in saliva are probably due to cross-reactions with alpha-haemolytic streptococci. Scand J Infect Dis, 1993, 25(1), 43 - 50 Failure of clindamycin to influence the course of severe oromucositis associated with streptococcal bacteraemia in allogeneic bone marrow transplant recipients; Donnelly JP et al.; 33 consecutive allogeneic bone marrow transplant recipients who were likely to develop streptococcal bacteraemia were treated for 5 days with clindamycin (900 mg i.v . t.d.s) and ceftazidime (2 g t.d.s.) for the initial management of fever associated with severe oral mucositis . Bacteraemia due to 'viridans' streptococci was encountered in 23 cases (70%) as mucositis progressed to peak severity and occurred a day before fever in 8 cases . At the end of treatment with clindamycin only 2 patients had defervesced although the streptococci were successfully eradicated . C-reactive protein (CRP) levels continued to rise in 18 cases and declined by more than 10% in only 7 cases . Severe oromucositis rather than infection appeared to induce an acute phase response with fever suggesting bacteraemia due to 'viridans' streptococci to have been a consequence of mucosal damage . Indeed, oromucositis was the only primary focus of inflammation in 22 patients and only after its resolution did both fever and CRP levels diminish . By then, patients had also begun to recover from granulocytopenia . These data indicate that rather than including a specific antimicrobial like clindamycin in an empirical regimen, it would be more beneficial to evolve strategies that minimise mucosal damage in this patient population. Scand J Infect Dis, 1993, 25(1), 37 - 42 In vitro effect on group A streptococci of loracarbef versus cefadroxil, cefaclor and penicillin V; Kamme C et al.; The in vitro activity of loracarbef, penicillin V, cefaclor and cefadroxil against log and stationary phase cultures of group A streptococci was compared . MICs and MBCs were determined with the broth dilution method and by a modified agar plate dilution technique where the beta-lactams were inactivated after the MICs were determined allowing inhibited but not killed organisms to grow on further incubation . The MICs of loracarbef and the two cephalosporins were 16-32 times higher than those of penicillin V . In plate dilution the MBC/MIC ratios of all agents were < or = 2 for log phase cultures . With stationary phase cultures, especially in the broth dilution test, the MBC/MIC ratios of loracarbef and the two cephalosporins were > or = 32 for a large number of strains . The phenotype response of stationary phase cultures to beta-lactam antibiotics may not only be related to the physiological status of the streptococci, to the culture conditions and to the beta-lactam under test . The present investigation indicated that the phenotypic response was also an intrinsic property of certain strains. Scand J Infect Dis, 1993, 25(1), 31 - 5 Alpha-streptococci as supplementary treatment of recurrent streptococcal tonsillitis: a randomized placebo-controlled study; Roos K et al.; Recurrences are a common finding after antibiotic treatment of acute group A streptococcal tonsillitis . This has been attributed to several factors, among others a disturbed normal throat flora and especially a lack of alpha-streptococci . It thus seems logical in patients with recurrent streptococcal tonsillitis, to restore the normal alpha-streptococcal flora by reimplantation of alpha-streptococci . This was performed in a double blinded, randomized, placebo-controlled study . 36 patients with recurrent streptococcal group A tonsillitis were treated with antibiotics followed by either placebo (19 patients) or a pool of 4 selected alpha-streptococcal strains (17 patients) with good interfering activity against clinical isolates of beta-streptococci . No patient recurred during the first 2 months of follow-up in the alpha-treated group, but 7 in those treated with antibiotics and placebo . After 3 months 1 in the patient group treated with antibiotics and alpha-streptococci and 11 in the placebo-treated group recurred . These results are statistically highly significant and show that recolonisation with alpha-streptococci seems to offer a new way to lower the rate of recurrence in streptococcal throat infections. Clin Ther, 1993 Jan-Feb, 15(1), 107 - 13 In vitro activity of clarithromycin, cefprozil, and other common oral antimicrobial agents against gram-positive and gram-negative pathogens; Ritchie DJ et al.; Macrolide and beta-lactam antimicrobial agents are frequently used for the treatment of upper and lower respiratory tract infections and skin or skin structure infections . To evaluate the relative in vitro activity of these antimicrobial drugs against organisms commonly involved in these infections, we tested clarithromycin, erythromycin, cefprozil, cefuroxime, cefaclor, cephalexin, amoxicillin, amoxicillin/clavulanate, and doxycycline against 174 gram-positive and gram-negative clinical isolates, including Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, group A beta-hemolytic streptococci, alpha-hemolytic streptococci, Escherichia coli, and Klebsiella pneumoniae . Manual broth microdilution susceptibility testing was used with a standard inoculum of 5 x 10(4) colony-forming units/well at pH of 7.2 . Clarithromycin was the most active agent against streptococci . Methicillin-susceptible S aureus exhibited resistance to both clarithromycin and erythromycin, but was susceptible to cefprozil, cefuroxime, amoxicillin/clavulanate, and doxycycline . Cefprozil was at least as active as cefuroxime, cefaclor, and cephalexin against all organisms tested, but was fourfold less active than doxycycline against E coli and 16-fold less active than clarithromycin versus S pneumoniae . The gram-negative isolates tested showed resistance to clarithromycin and erythromycin; however, cefprozil was as active as amoxicillin/clavulanate against K pneumoniae and E coli . These results demonstrate that clarithromycin provides superior in vitro activity against common streptococci, while cefprozil, cefuroxime, amoxicillin/clavulanate, and doxycycline provide greater activity against methicillin-susceptible S aureus, K pneumoniae, and E coli . Prospective clinical trials are needed to determine the clinical significance of these findings. APMIS, 1993 Jan, 101(1), 41 - 9 Antibody profiles to the group B streptococcal beta antigen in maternal and infant paired sera; Flores AE et al.; Antibody profiles to the purified beta antigen of the c protein of group B streptococci (GBS) were studied by ELISA and Western immunoblot (WB) . The sera from 139 parturient women colonized with GBS, 35 non-colonized parturients and their newborn infants were studied by ELISA; WB was done on 76 maternal and 26 infant sera . Enzyme-labeled anti-IgA (alpha), -IgG (gamma), -IgM (mu), or -IgG (H&L) were used as secondary antibodies . A high prevalence of antibody to the beta antigen was observed by both ELISA and WB among parturient women and their newborns . IgG (H&L) ELISA titers > or = 200 were found in 84% and > or = 800 in 31% of the maternal sera . A significantly higher percentage of women colonized than those non-colonized with GBS had IgG (gamma) titers > or = 800 . A significantly higher percentage of women colonized with c protein-positive than c-negative strains of GBS had IgG (H&L) titers > or = 3200 . Twelve of 27 women with IgM antibody to the beta antigen also had IgG (gamma) titers > or = 800 and were, in addition, colonized with GBS . Multiple molecular forms of the antigen from 25 to 140 kDa were blotted by the maternal and infant sera . Concordance in the IgG but not in IgA or IgM antibody profiles of maternal and infant paired sera was observed in the overall blotting patterns and ELISA titers . The same titer as the mother was found in 55% of the infant sera and within one dilution in 97% . This suggests active transfer of IgG antibody to the beta antigen across the placenta from mother to baby. Zentralbl Gynakol, 1993, 115(2), 68 - 76 {Clinical results of pediatric gynecologic consultation at the Heidelberg University Gynecologic Clinic}; Ropke-Brandt B et al.; During the research period from January 1984 through June 1991 649 patients between the age of 0 and 16 were examined . Divided into 13 diagnostic groups the vulvovaginitis occurred most frequently with 30.6% . The predominant causal agents were E . coli (18.1%) and streptococci B (11.5%) . Almost 24% did not show any agents . Aside from malformations of the genitals (6%), the genital bleedings (8.3%), genital tumours (2.7%), the search for anticonceptives (7.5%), examinations by specialists (8.1%) and borderline surgical problems, cycle disorders (14.7%) were most frequent . Among the cycle disorders dysmenorrhea and oligomenorrhea were predominant . The hormonal inhibition of growth was also checked very carefully . Thus the necessity of well-aimed training of children's gynaecology becomes dear . Our results stress the importance of an intensive disciplinary contact between gynaecologists who are interested in pediatrics and pediatricians. Caries Res, 1993, 27(1), 31 - 7 Effect of monoclonal antibodies on the colonization of rats by Streptococcus sobrinus; van Raamsdonk M et al.; Local passive immunization has been suggested as a method of preventing colonization of teeth by mutans streptococci . In this study we describe the effect of local application of monoclonal antibodies (Mabs) on the colonization of Streptococcus sobrinus . The rats, 37 days old, were divided in 4 groups: group 1 received Mab OMVU10 (Mab reactive with Antigen B of S . sobrinus, IgG2b), group 2 received Clone 24 (Mab reactive with lipid A of Escherichia coli, IgG2b), group 3 received uninoculated culture medium, and group 4 received phosphate-buffered saline (PBS) . Mabs were applied 6 times on the surfaces of the molars and the labial surfaces of the incisors of the rats, on days 37, 40, 44, 46, 49 and 54 after birth . After the third application of Mabs, all rats were inoculated with S . sobrinus (day 45) . Subsequently, the rats were fed a cariogenic diet containing 20% sucrose and 5% glucose . The rats were killed 34 days after inoculation and the maxillary molars were extracted and homogenized in order to determine the numbers of S . sobrinus . The proportions of S . sobrinus, expressed as a percentage of the total cultivable microflora, in rats which received OMVU10 (group 1) were 23.1 +/- 14.8%, whereas in rats which received Clone 24, culture medium or PBS the levels were 34.5 +/- 11.3%, 40.7 +/- 14.9% and 36.7 +/- 9.7%, respectively . Statistical analysis showed that the level of colonization of rats which received OMVU10 was significantly lower than that of rats which received Clone 24, culture medium or PBS (p < 0.001, p < 0.013 and p < 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS) Vet Microbiol, 1993 Jan, 34(1), 71 - 82 Discrimination between virulent and nonvirulent Streptococcus suis type 2 strains by enzyme-linked immunosorbent assay; Vecht U et al.; Discrimination between virulent and nonvirulent strains of Streptococcus suis type 2 will allow proper diagnosis of diseased pigs and the identification of carrier pigs . To discriminate between virulent and nonvirulent strains, we developed two double antibody sandwich (DAS) enzyme-linked immunosorbent assays (ELISA) using specific monoclonal antibodies directed against two virulence markers of S . suis type 2 . One mAb was directed against the 136-kilodalton (kDa) cell-wall-associated protein, designated muramidase-released-protein (MRP) . The other mAb was directed against a 110-kDa extracellular protein, provisionally called extracellular factor (EF) . We examined 179 strains of S . suis serotype 2, 22 strains of S . suis serotypes 1 to 22, 22 other streptococci, 20 other bacterial strains, and one yeast . The ELISA results were almost identical with western blot analysis of these strains . Visual readings of the two DAS-ELISAs were enough to discriminate accurately between the three phenotypes of S . suis type 2 . We concluded that the two DAS-ELISAs are reliable, rapid, and simple assays to identify virulent strains of S . suis type 2. Int J Pediatr Otorhinolaryngol, 1993 Jan, 25(1-3), 141 - 8 Interfering alpha-streptococci as a protection against recurrent streptococcal tonsillitis in children; Roos K et al.; Recurrent streptococcal tonsillitis/pharyngitis is a great problem, especially in certain epidemiological situations . Patients treated with antibiotics often have a disturbed normal throat flora and may lack, e.g., alpha-streptococci known in vitro to have an interfering activity against group A streptococci . Thirty-one patients with recurrent streptococcal tonsillitis were given antibiotics for 10 days . At the end of this treatment they were sprayed in their mouths with four selected alpha-streptococcal strains known to have strong growth inhibiting activity in vitro against most beta-streptococci group A . The follow-up period after this colonization was 3 months . After alpha-streptococcal treatment, none of the patients attracted a new tonsillitis during the follow-up period while 8% of the controls had a second tonsillitis . Treatment of streptococcal tonsillitis/pharyngitis with antibiotics followed by recolonization with alpha-streptococci seems to hinder further recurrences. Chirurg, 1993 Jan, 64(1), 63 - 7 {Fournier's gangrene . Case report and review of the literature}; Kaulbars E; Fournier's gangrene is a rare condition, far from being 'idiopathic', which must be taken seriously and which is, although at first manifesting itself only locally, a generalized condition with high mortality and--unless recognized--taking a rapid course with lethal outcome . Many risk factors have been recognized which favor an often lethal outcome . Although oftentimes not recognized, a port of entry is always present and haemolytic streptococci are as a rule involved . Since Fournier the age limit has moved to the 5th and 6th decades . Early recognition, prompt and aggressive surgical treatment and antibiotic coverage are mandatory to offer patients a chance to survive. Crit Rev Oral Biol Med, 1993, 4(2), 159 - 76 Virulence factors of mutans streptococci: role of molecular genetics; Kuramitsu HK; Biochemical approaches were utilized initially to identify the virulence factors of the