Streptococcal

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 mutans streptococci (primarily Streptococcus mutans and S . sobrinu) . Traditional mutant analysis of these organisms further suggested the important role of several of these factors in cariogenicity . However, because these mutations were not clearly defined, the utilization of cloned genes was necessary to verify their significance . The introduction of molecular genetic approaches for characterizing these factors has led not only to a clearer understanding of the role of these virulence factors in cariogenicity but has also suggested some novel approaches for reducing further the incidence of dental caries.

Res Vet Sci, 1993 Jan, 54(1), 124 - 6
An R-like protein of Streptococcus uberis stimulates opsonising antibodies; Groschup MH et al.; A pepsin-sensitive R-like antigen with a molecular mass of 65 kilodaltons was extracted from Streptococcus uberis strain ATCC 19436 by trypsinisation and purified by diethyl-aminoethanol anionic exchange chromatography . The antigen reacted with sera from infected cows and stimulated opsonic antibody in the guinea pig . The amino acid composition of the antigen was generally similar to that previously reported for the R antigen of group C streptococci.

J Clin Pathol, 1993 Jan, 46(1), 79 - 80
Evaluation of new streptococcal latex grouping kit; Vicca AF et al.; AIMS: To evaluate a new streptococcal latex grouping kit (Shield Diagnostics Ltd) and compare it against an established latex agglutination method (Streptex; Wellcome Diagnostics) . METHODS: Two hundred and forty seven strains of streptococci and enterococci were tested with each kit by one operator and according to the manufacturer's instructions . Strains failing to group or giving discordant results were identified to species level . RESULTS: Two discrepant grouping results were observed and 13 non-beta haemolytic streptococci failed to group with either product . The Shield kit successfully identified 232 isolates at 15 minutes of enzyme extraction incubation compared with 224 and 233 on short (15 minutes) and long (1 hour) incubations, respectively, for Streptex (p > 0.23 for both comparisons) . On short incubation only, the Shield kit detected significantly more strains of Enterococcus faecium (p = 0.007) . The reaction strengths were similar for both kits (p > 0.16) . No cross-reactions were observed but the Streptex kit produced significantly fewer tests with visible granularity (p < 0.003) . CONCLUSIONS: Although the Shield product appeared to detect group D antigen more readily, overall no important differences in performance were observed . Prospective users of the new method should first become familiar with its characteristics.

Eur Heart J, 1993 Jan, 14(1), 122 - 8
Rheumatic heart disease in the developing world: prevalence, prevention, and control; Eisenberg MJ; Rheumatic heart disease (RHD) continues to be a common health problem in the developing world, causing morbidity and mortality among both children and adults . Although little longitudinal data are available, evidence suggests that there has been little if any decline in the occurrence of RHD over the past few decades . Recent reports from the developing world have documented rheumatic fever (RF) incidence rates as high as 206/100,000 and RHD prevalence rates as high as 18.6/1000 . The high frequency of RHD in the developing world necessitates aggressive prevention and control measures . The major interventions for prevention and control include: (1) reduction of exposure to group A streptococci, (2) primary prophylaxis to prevent initial episodes of RF, and (3) secondary prophylaxis to prevent recurrent episodes of RF . Because recurrent episodes of RF cause increasingly severe cardiac complications, secondary prophylaxis is the most crucial feature of an effective RHD programme . For some impoverished countries, secondary prophylaxis may be the only intervention that can realistically be implemented . In addition to this intervention, however, financial and human resources must be committed, and all of these elements must be integrated into existing primary health care systems . Because RHD continues to be a common health problem in the developing world, greater emphasis needs to be placed on the simple and cost-effective prevention and control measures that are currently available to combat this disabling disease.

Eur J Cancer, 1993, 29A Suppl 1, S2 - 6
The new fluorinated quinolones for antimicrobial prophylaxis in neutropenic cancer patients; Del Favero A et al.; Fluoroquinolones are the most attractive agents for prophylactic use in neutropenic cancer patients, due to their broad antimicrobial spectrum, high concentration in the faeces, systemic bactericidal activity, uncommon emergence of resistant strains and good tolerability . They have proved to be more effective than placebo, oral non-absorbable antibiotics or cotrimoxazole in the prevention of Gram-negative infections . In a prospective, randomised multicentre study performed by the GIMEMA infection program, ciprofloxacin was demonstrated to be more effective than norfloxacin for the reduction of febrile episodes, use of systemic antibiotics, and Gram-negative infections in neutropenic patients with haematological malignancies . The greater efficacy may be related to its better systemic or greater antibacterial activity . The potential problems related to the prophylactic use of fluoroquinolones are the increasing prevalence of Gram-positive infections caused by streptococci and coagulase-negative staphylococci; the reported emergence and nosocomial spread of resistant strains, especially among coagulase-negative staphylococci; the lack of their usefulness as empirical therapy in febrile neutropenic patients . Fluoroquinolones are today the better choice for preventing Gram-negative infections in neutropenic patients and ciprofloxacin should probably be preferred . More information on their efficacy and their relationship to the overall susceptibility of micro-organisms in patients with cancer would be valuable, and careful monitoring of patients treated with these drugs is therefore warranted.

J Periodontal Res, 1993 Jan, 28(1), 21 - 6
Purification of arginine-sensitive hemagglutinin from Fusobacterium nucleatum and its role in coaggregation; Takemoto T et al.; Hemagglutinin of Fusobacterium nucleatum was extracted from Triton X-100-pronase P-treated cell envelopes, and was purified by affinity chromatography on L-arginine agarose . The hemagglutinin was inactivated by heating at 70 degrees C for 1 min . The activity was inhibited by L-arginine but was not affected by any sugars or by EDTA . The hemagglutinin aggregated 14 out of 17 strains of oral streptococci tested, and the bacterial aggregating activity was also inhibited by L-arginine . The results indicate the dominant role of this hemagglutinin in the adherence of this bacterium both to host cells and to other bacteria.

Biochem J, 1993 Jan 1, 289 ( Pt 1), 179 - 84
Hyaluronate synthase: cloning and sequencing of the gene from Streptococcus sp; Lansing M et al.; The complete nucleotide sequence of hyaluronate synthase from Streptococcus sp . and its flanking regions is presented . The gene locus was designated has . Southern-blotting results suggested that the gene was conserved in hyaluronate-producing streptococci . A putative translation-initiation codon was identified and the open reading frame consists of 1566 bp, specifying a protein of 56 kDa . Sequences resembling the promoter and ribosome-binding site of Gram-positive organisms are found upstream of the synthase . The predicted amino-acid sequence reveals the presence of a 35-residue signal peptide . The sequence has some similarity to bacterial peptide-binding proteins.

Am J Obstet Gynecol, 1993 Jan, 168(1 Pt 1), 39 - 43
Rapid intrapartum detection of group B streptococcal colonization with an enzyme immunoassay; Armer T et al.; OBJECTIVE: The purpose of this study was to determine the accuracy of a rapid immunoenzyme assay for detecting intrapartum colonization with group B streptococci . STUDY DESIGN: Three rayon-tipped swabs were used to collect specimens from the posterior vaginal wall of 424 preterm and term patients in labor . Three tests were performed on specimens obtained from the first 182 patients: semiquantitative culture on blood agar, culture in selective Todd-Hewitt broth, and ICON Strep B (Hybritech, San Diego) immunoconcentration assay . For the remaining 242 patients, the ICON test was performed only when the Todd-Hewitt broth culture was positive . RESULTS: The prevalence of positive cultures was 23% . For the first 182 patients, the immunoassay had a sensitivity of 11%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 78% . The overall sensitivity for all 424 patients was 9% . In eight women with heavy colonization, defined as an inoculum of > 10(5) cfu/ml the sensitivity of the assay was 100% . In the study population there were three cases of group B streptococcal sepsis in infants whose mothers were only lightly colonized . None of these cases of colonization were detected by the assay . CONCLUSION: The ICON immunoconcentration assay is very sensitive in identifying heavy group B streptococcal colonization of > 10(5) cfu/ml but quite insensitive in detecting lower levels of colonization . Thus it is not a suitable test for general screening.

J Med Microbiol, 1993 Jan, 38(1), 61 - 3
Survival of group A streptococci in dried human blood; Reitmeyer JC et al.; The resurgence of streptococcal infections in the USA and Europe and their high incidence in other parts of the world prompted an examination of the survival and maintenance of virulence of group A streptococci . Human blood containing group A streptococci was placed on small pieces of sterile paper towelling and allowed to dry at room temperature . At periods of 2, 8, 15 and 20 weeks later, the paper with the dried blood was placed in Todd-Hewitt broth and incubated at 37 degrees C overnight . All the samples tested at 2 weeks grew in broth, and with only one exception, grew in fresh human blood provided by five donors . At 8 weeks only two of the 10 strains failed to grow in broth; seven of the eight viable cultures also grew in blood . At 15 and 20 weeks after drying the eight cultures were still viable . Since seven were able to grow in fresh blood as well as in broth it is assumed that their virulence factor(s) had been retained.

J Med Microbiol, 1993 Jan, 38(1), 54 - 60
Effects of selected surfactants on purified glucosyltransferases from mutans streptococci and cellular adherence to smooth surfaces; Kawabata S et al.; The inhibitory effect of non-ionic, anionic, cationic and ampholytic surfactants on cellular growth of Streptococcus mutans MT8148 and S . sobrinus 6715, on glucan synthesis by the purified glucosyltransferase (GTase) from these organisms, and on bacterial adherence to glass surfaces was examined in vitro . Cationic surfactants exhibited marked bactericidal activities . Anionic and ampholytic compounds were less strongly bactericidal and non-ionic surfactants produced only slight inhibition of cell growth under the conditions tested . Some non-ionic compounds had no effect on this . Glucan synthesis by GTase from mutans streptococci was inhibited by anionic and cationic surfactants . Among various GTase proteins, insoluble glucan synthesising GTases, i.e., S . mutans CA-GTase and S . sobrinus GTase-I were those most effectively inhibited by these agents . However, it was noted that whereas lower concentrations of cationic surfactants enhanced these GTase activities, higher concentrations of the surfactants were inhibitory . Non-ionic detergents stimulated soluble glucan synthesis from S . mutans CF-GTase and cationic and ampholytic surfactants enhanced or inhibited glucan synthesis depending on the concentrations of the surfactants . Sucrose-dependent cellular adherence of resting cells of mutans streptococci to glass surfaces was inhibited by the addition of surfactants that annulled the GTase activities.

J Dent Res, 1993 Jan, 72(1), 78 - 84
A quantitative study of calcium binding and aggregation in selected oral bacteria; Rose RK et al.; By means of micro-equilibrium dialysis, calcium binding capacities and affinities were measured in three different oral bacteria, and the effects of extracellular polysaccharide, pH, and aggregation were investigated . Binding capacities of 31.0 +/- 2.1 (C . matruchotii), 34.7 +/- 3.7 (S . sanguis), and 41.5 +/- 5.4 (S . downei) mumol calcium/g wet weight of cells were found at pH 7.0, falling to 21.4 +/- 0.8 mumol calcium/g wet wt . cells at pH 5.0 for S . downei . Dissociation constants were found to vary between 0.78 +/- 0.24 and 1.77 +/- 0.30 mmol/L (at pH 7.0, depending on species), and between 0.62 +/- 0.04 and 1.77 +/- 0.30 (in the pH range 5.0 to 7.0, for S . downei only) . Examination suggested that at pH 7.0 calcium-facilitated bacterial association occurs in the streptococci with calcium uptake curves analogous with those of positively cooperative systems . Desorption of calcium from aggregated S . downei suggested that the mechanism of desorption differed from that of uptake . This may be an important factor in plaque formation and in the binding of cells to the surface of formed plaque . Plaque calcium forms a reservoir, readily released by a pH drop, which may increase plaque fluid saturation and reduce demineralization.

J Dent Res, 1993 Jan, 72(1), 31 - 6
Distribution and isolation frequency of eight streptococcal species in saliva from predentate and dentate children and adults; Tappuni AR et al.; The isolation frequency and distribution of eight recently defined streptococcal species have been investigated in the saliva of adults and that of both predentate and dentate children . The effects of frequency of sugar intake and tooth presence on the distribution of streptococcal species were also analyzed . Saliva samples were collected from 121 subjects divided into three study groups: (a) 56 predentate children (predentate group), (b) 37 dentate children (dentate group), and (c) 28 adults (adult group) . Up to 17 biochemical and enzymatic tests were used to categorize streptococcal isolates into S . mitis, S . oralis, S . salivarius, S . anginosus, S . sanguis, S . vestibularis, S . mutans, and S . gordonii . The mean total and streptococcal salivary colony-forming units (CFU) were lowest in the predentate group and highest in the adult group . Streptococci were found in all the study subjects, and there was no obvious relationship between the total or streptococcal CFU and the number of teeth or the frequency of sugar intake . There was a wide variation in the isolation frequency of streptococcal species in the three study groups . S . mitis, S . oralis, and S . salivarius were the most frequent species isolated, and together they comprised 83% of the total streptococcal isolates . In contrast to studies using older classifications, S . sanguis was a minor species in the saliva though found more often in adults than in children (p < 0.04) . S . anginosus was a minor species found in about 10% of adults and children . S . gordonii was detected rarely and only in dentate subjects . S . mutans was detected only in dentate subjects, significantly greater in adults (57.1%) than in children (5.4%, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Infect Immun, 1993 Jan, 61(1), 295 - 302
Effects of N-acetylglucosamine on carbohydrate fermentation by Streptococcus mutans NCTC 10449 and Streptococcus sobrinus SL-1; Homer KA et al.; We have investigated the ability of two species of streptococci isolated from the human oral cavity (Streptococcus mutans NCTC 10449 and Streptococcus sobrinus SL-1) to metabolize N-acetylglucosamine (GlcNAc), a naturally occurring amino sugar present in saliva and human glycoproteins, when provided as the sole fermentable carbohydrate and determined the effects of the presence of GlcNAc on the fermentation of other carbohydrates . S . mutans used GlcNAc at concentrations of up to 10 mM to increase cell numbers, but S . sobrinus was unable to ferment the amino sugar alone and its uptake only occurred in the presence of a fermentable carbohydrate . GlcNAc had a marked inhibitory effect on the ability of S . sobrinus to produce lactic acid from glucose, sucrose, and fructose, at the same time increasing the lag period and doubling time of batch-grown cells . Such patterns of inhibition were found with S . mutans, but the effects were less than those seen in S . sobrinus . In mixed culture studies of the two species, S . sobrinus became the predominant organism when 10 mM glucose was supplied as the sole fermentable carbohydrate, with a concomitant decrease in the numbers of S . mutans cells, but supplementation of the broth with 10 mM glucose and 10 mM GlcNAc resulted in the emergence of S . mutans as the predominant organism . S . mutans and S . sobrinus grown in media containing glucose possessed the ability to transport glucose and GlcNAc, probably via the same glucose-phosphotransferase system at similar rates . However, intracellular levels of N-acetylglucosamine-6-phosphate deacetylase and glucosamine-6-phosphate deaminase were markedly higher in S . mutans grown on glucose and GlcNAc than in S . sobrinus: 34 and 398 and 8 and 17 nmol of NADPH formed per mi per mg of protein for S . mutans and S . sobrinus, respectively . We propose that GlcNAc inhibited growth of S . sobrinus in media containing glucose and GlcNAc by competing with glucose for the glucose phosphotransferase, depleting intracellular levels of phosphoenolpyruvate, and possessing, in contrast to S . mutans, low levels of N-acetyl-glucosamine-6-phosphate deacetylase and glucosamine-6-phosphate deaminase activity . Together, these data suggest that in dental plaque, S . sobrinus when exposed to GlcNAc will have a reduced ability to compete with S . mutans for dietary carbohydrates, contributing to the greater frequency of isolation of S . mutans from human populations.

Infect Immun, 1993 Jan, 61(1), 227 - 35
Cytokine appearance and effects of anti-tumor necrosis factor alpha antibodies in a neonatal rat model of group B streptococcal infection; Teti G et al.; Cytokines are suspected of playing an important role in the pathophysiology of septic shock . This study was undertaken to determine whether tumor necrosis factor alpha (TNF-alpha) induces the production of other cytokines and mediates mortality in a neonatal rat model of sepsis caused by group B streptococci (GBS) . We have measured TNF-alpha, interleukin-1 alpha (IL-1 alpha), interleukin-6 (IL-6), and gamma interferon (IFN-gamma) levels in neonatal rats infected with different strains (H738, 259, and 90) and doses (1 50% lethal dose {LD50} and 5 90% lethal doses {LD90}) of type III GBS . TNF-alpha and IL-6 were detected by the L929 cytotoxicity and the B9 proliferation assays, respectively, in serial plasma samples . IL-1 alpha and IFN-gamma were measured in spleen homogenates by enzyme-linked immunosorbent assay kits by using antibodies raised against the corresponding mouse cytokines . Plasma TNF-alpha levels significantly rose above baseline values within 12 h after intraperitoneal challenge with 5 LD90 of GBS strain H738, corresponding to 3 x 10(3) CFU . A mean peak TNF-alpha concentration of 232 +/- 124 U/ml was reached at 20 h . Peak IL-1 alpha and IL-6 levels of 766 +/- 404 U/g and 1,033 +/- 520 U/ml, respectively, were reached at 24 h after bacterial challenge . Maximal spleen concentrations of IFN-gamma (449 +/- 283 U/g) were measured at 36 h . Concentrations of TNF-alpha, but not other cytokines, remained significantly elevated at 72 h, a time when mortality approached 100% . Significant correlations were found between concentrations of each of the cytokines tested and the logs of CFU concentrations in the blood . In order to ascertain whether TNF-alpha influenced the production of other cytokines, rat pups received two injections of anti-murine TNF-alpha or normal rabbit serum at 2 h before and at 26 h after challenge with live GBS . Plasma TNF-alpha bioactivity was undetectable in anti-TNF-alpha-treated animals, while IL-6 and IFN-gamma, but not IL-1 alpha, levels were significantly reduced, compared with normal serum controls . Rat pups pretreated with anti-TNF-alpha serum and infected with 1 and 5 LD90 of strains H738 and 259 showed enhanced early (48 to 72 h) survival . However, by 96 h this protection was no longer apparent.

Infect Immun, 1993 Jan, 61(1), 182 - 6
Comparison of aminopeptidase activities in four strains of mutans group oral streptococci; Cowman RA et al.; In this study, native cells of Streptococcus mutans VA-29R and Streptococcus rattus FA-1 displayed significantly higher aminopeptidase activity than did cells of Streptococcus cricetus AHT or Streptococcus sobrinus 6715 toward the nitroanilide derivatives of leucine, alanine, methionine, arginine, and lysine . These differences in cellular aminopeptidase activity led us to investigate the subcellular localization of the aminopeptidase in these mutans group streptococci . Following conversion of native cells to protoplasts by treatment with lysozyme, most of the aminopeptidase activity detected in the native-cell preparations remained associated with the intact protoplasts . After lysis of protoplasts and differential centrifugation, most of the total cellular aminopeptidase activity was recovered with the cytoplasmic fraction . Membrane-associated aminopeptidases represented only minor activities in these mutans group streptococci . Although the four strains showed no differences with respect to a predominant cytoplasmic localization for the aminopeptidase activities, the levels of activity in the cytoplasmic fractions from S . cricetus AHT and S . sobrinus 6715 were significantly lower than those measurable in the corresponding fractions from S . mutans VA-29R and S . rattus FA-1 . These results support the conclusion that the differences in aminopeptidase activity expressed by these streptococci reflect quantitative differences rather than differences in enzyme subcellular localization.

J Clin Microbiol, 1993 Jan, 31(1), 78 - 82
Comparison of two antigen assays for rapid intrapartum detection of vaginal group B streptococcal colonization; Green M et al.; As part of a clinical investigation evaluating the efficacy of intrapartum antigen detection for screening for heavy vaginal colonization with group B streptococci (GBS), we compared the performance of modified Bactigen and Directigen GBS latex particle agglutination (LPA) kits . Paired vaginal swabs obtained from women in labor were rapidly transported to the laboratory and used for culturing (both swabs) and LPA testing (one swab by each method) . GBS growth was estimated semiquantitatively and further designated as light or heavy growth . Performance specifications for each method were determined by comparing LPA and culture results from the same swab . A total of 4,251 paired swabs were evaluated during the study period . The performance specifications for detecting GBS growth of any degree for Bactigen and Directigen, respectively, were as follows: sensitivity, 20 and 24%; specificity, 99 and 99% . The performance specifications for heavy colonization for Bactigen and Directigen, respectively, were as follows: sensitivity, 57 and 62%; specificity, 99 and 99% . Neither LPA kit was a sensitive indicator of vaginal colonization with GBS or neonatal infection.

Caries Res, 1993, 27(4), 303 - 6
Effect of single and repeated application of chlorhexidine varnish on mutans streptococci in plaque from fissures of premolar and molar teeth; Ie YL et al.; The aim of this study was to determine the effects of one and two applications of 40% chlorhexidine varnish on the numbers of mutants streptococci in human dental fissure plaques from molar and premolar teeth . Twenty-nine subjects (aged 20-30 years) participated in the study and were randomly assigned to one of three groups . In each subject two fissures with high levels of mutants streptococci were selected . The fissures in group 1 (control group) were treated with placebo varnish containing no chlorhexidine . Fissures in group 2 received a single application of 40% chlorhexidine varnish, whereas fissures in group 3 received an additional chlorhexidine varnish application 1 week after the first application . Fissure plaque samples were taken prior to the first application of chlorhexidine varnish and subsequently 1, 2, and 4 months thereafter . Compared with the fissures in the control group, the suppression of mutans streptococci was significant in plaques from group 2 for up to 2 months and in plaques from group 3 for up to 4 months after application . Mutans streptococci were suppressed more strongly in premolar than in molar teeth and more strongly and for a longer period of time in fissures of premolar teeth treated twice than in fissures of premolars treated once.

Caries Res, 1993, 27(4), 292 - 7
Close association between Streptococcus sobrinus in the saliva of young children and smooth-surface caries increment; Hirose H et al.; Three hundred and thirty-eight children (age range 3-5 years) were examined for the presence of mutans streptococci in their saliva . They were divided into four groups according to the prevalent species that were isolated: (1) Streptococcus mutans and Streptococcus sobrinus group (S . mutans > or = 10(3) CFU/ml and S . sobrinus > or = 10(3) CFU/ml); (2) S . mutans group (S . mutans > or = 10(3) CFU/ml but S . sobrinus < 10(3) CFU/ml); (3) S . sobrinus group (S . sobrinus > or = 10(3) CFU/ml but S . mutans < 10(3) CFU/ml), and (4) children with mutants streptococci absent or barely detectable (mutants streptococci < 10(3) CFU/ml) . The previous caries experience was compared among the groups, as was the caries increment during a 6-month period after the bacterial examination . The subjects in the S . sobrinus group had both higher caries and higher decayed teeth and surface increments than the S . mutans group . The mean decayed smooth-surface increment (delta d-surface) for the S . sobrinus group was 2.6 and was significantly higher than 0.8 for the S . mutans group . For the subjects with delta d-surface > or = 4, the mean number of S . sobrinus in the saliva was 4.29 x 10(5) CFU/ml and was significantly higher than 0.32 x 10(5) CFU/ml for the subjects without delta d-surface . There was no significant difference in the mean number of S . mutants in saliva between the subjects with and without delta d-surface . The prevalence of S . sobrinus in saliva was more closely associated with future caries activity, especially with smooth-surface caries increment, than the prevalence of S . mutants.

Crit Rev Oral Biol Med, 1993, 4(3-4), 435 - 42
Involvement of alpha 2-adrenoreceptors and G proteins in the modulation of platelet secretion in response to Streptococcus sanguis; Herzberg MC et al.; In the presence of plasma, human platelets secrete the contents of their dense granules and then aggregate in response to certain strains of Streptococcus sanguis . After 2 to 5 min of incubation with streptococci, platelets from fast-responding donors will begin to aggregate . Slow responders aggregate after a longer delay . Platelets may secrete after a short (fast responder) or long (slow responder) delay because of differences in the basal levels or responses to potentiating catecholamines . To test this hypothesis in vitro, endogenous basal catecholamine levels in platelets and plasma from fast and slow responders were analyzed by HPLC with electrochemical detection . The total basal concentration of epinephrine in platelets plus plasma was fourfold higher in fast responders, with the platelet compartment showing the greatest difference . The basal affinity of alpha 2-adrenoreceptors in platelets from both groups was similar when estimated using a specific antagonist, {3H}-yohimbine . Platelets from all donors showed decreased alpha 2-adrenoreceptor affinity in the presence of low (2 nM), but not higher (10 nM), concentrations of added epinephrine . Platelets in the two groups were then compared for secretion of ATP . More ATP was secreted after a shorter delay from fast responding platelets, which was mimicked in slow responders by adding physiologically attainable levels (40 nM) of epinephrine . Addition of the alpha 2-antagonist, phentolamine (10 microM), to the platelets of slow and fast responders completely inhibited or reduced secretion by one third, respectively . Therefore, alpha 2-adrenoreceptors modulate the secretory response of platelets to cells of S . sanguis.(ABSTRACT TRUNCATED AT 250 WORDS)

Crit Rev Oral Biol Med, 1993, 4(3-4), 335 - 41
Emergence of immune competence in saliva; Smith DJ et al.; Saliva contains essentially no IgA at birth . However, secretory immune responses to oral and non-oral microbial antigens emerge early in life . We have investigated the characteristics of these responses in salivas of infants less than 1 month through 4 years of age, using cross-sectional and longitudinal approaches . Antibody specificities (IgA, IgA1, and IgA2) were measured in ELISA and Western blot analysis to antigens of Streptococcus mitis and S . salivarius that colonize during the neonatal period . Antibodies reactive with S . sanguis and mutans streptococci, which colonize later in the infant's life, were also determined . Concurrent investigation of the oral flora of each infant was performed and related to the observed antibody specificities . The secretory nature of the immunoglobulins in these salivas was analyzed immunologically and chromatographically . The primary molecular form of salivary IgA was dimeric in all salivas tested . Both IgA subclasses were found, although a subset of infant salivas initially contained > 90% IgA1 . IgM (> 1 microgram/ml) was detected in 58% of 3- to 17-week-old infants . By 2 months of age, salivas from most infants contained IgA antibody reactive with at least two S . mitis components . Many salivas also contained antibody reactive with S . salivarius components . By the end of the first year, most salivas contained IgA1 and IgA2 antibody to S . mitis antigens . Maturation of secretory responses in the second and third year was evidenced by the appearance of increased concentrations and additional specificities of salivary IgA antibodies to S . mitis antigens . Antibody to S . mitis, S . salivarius, and S . sanguis extracellular components was detected only after infection with the respective species.(ABSTRACT TRUNCATED AT 250 WORDS)

Crit Rev Oral Biol Med, 1993, 4(3-4), 301 - 7
Salivary alpha-amylase: role in dental plaque and caries formation; Scannapieco FA et al.; Salivary alpha-amylase, one of the most plentiful components in human saliva, has at least three distinct biological functions . The enzymatic activity of alpha-amylase undoubtedly plays a role in carbohydrate digestion . Amylase in solution binds with high affinity to a selected group of oral streptococci, a function that may contribute to bacterial clearance and nutrition . The fact that alpha-amylase is also found in acquired enamel pellicle suggests a role in the adhesion of alpha-amylase-binding bacteria . All of these biological activities seem to depend on an intact enzyme conformation . Binding of alpha-amylase to bacteria and teeth may have important implications for dental plaque and caries formation . alpha-Amylase bound to bacteria in plaque may facilitate dietary starch hydrolysis to provide additional glucose for metabolism by plaque microorganisms in close proximity to the tooth surface . The resulting lactic acid produced may be added to the pool of acid in plaque to contribute to tooth demineralization.

Crit Rev Oral Biol Med, 1993, 4(3-4), 279 - 86
Development of artificial salivas; Levine MJ; Salivary research is at a critical crossroads regarding the clinical application of basic knowledge . Studies by numerous salivary researchers over the last 5 years using advanced technologies (e.g., protein chemistry, molecular biology, and biophysics) have demonstrated that the structural requirements for salivary function are quite complex . Nevertheless, several patterns or principles have evolved . First, the majority if not all salivary molecules are multifunctional . Second, the conformation of a molecule is an important factor in biological activity . Third, many molecules have overlapping functions (e.g., mucins and amylase interact with viridans streptococci; statherin and proline-rich proteins are involved in mineralization) . Thus, saliva has "built-in" compensatory or redundant properties . Nevertheless, it must be determined which molecule is more potent or effective with respect to a particular function . Fourth, salivary molecules may be "amphifunctional" . In other words, the different functions of a single molecule may be protective or potentially harmful depending on the intraoral site of action . Examples of amphifunctional molecules are amylase and statherin . Fifth, functional relationships may exist between different salivary components . The principles mentioned above can provide experimental strategies for the design and synthesis of a first generation of salivary substitutes that can be topically applied to oral surfaces . These molecules should be used to combat microbial mediated diseases and occlusal disharmony in subjects with normal salivary flow as well as those with xerostomia . In general, these substitutes should be long-lasting, biocompatible, biodegradable, and provide specific protective qualities that can be targeted to selected intraoral sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Can J Infect Control, 1993 Spring, 8(1), 7 - 9
Infections in intravenous drug users: a two-year review; Beaufoy A; Community-acquired infections in the intravenous drug user (IVDU) may affect one or more of the body systems . Infections range from minor localized cellulitis to life threatening, even fatal, systemic infections such as endocarditis . The author reviews two years of data related to the type and cause of community-acquired infections in IVDUs which necessitated hospitalization for treatment . During the two-year period, 396 individuals required 464 admissions for a total of 4247 patient days . Of the 464 admissions, 232 (50%) were admitted for suspected or known infection(s) . Positive microbiology cultures were obtained from 143 (62%) of those with suspected or known infections . The major body systems affected were the cutaneous (43.4%), the respiratory tract (21.7%) and the circulatory system (19.6%) . The most commonly isolated pathogen was streptococci.

Caries Res, 1993, 27(2), 124 - 9
Oolong tea polyphenols inhibit experimental dental caries in SPF rats infected with mutans streptococci; Ooshima T et al.; An extract of oolong tea (semifermented tea leaves of Camellia sinensis) and its chromatographically isolated polyphenolic compound was examined for in vitro inhibitory effects on glucosyltransferases (GTases) of mutans streptococci and on caries development in Sprague-Dawley rats infected with mutans streptococci . The samples showed no detectable effect on the growth of mutans streptococci . However, insoluble glucan synthesis from sucrose by the GTases of Streptococcus mutans MT8148R and Streptococcus sobrinus 6715 was markedly inhibited, as was sucrose-dependent cell adherence of these mutans streptococci . The administration of the oolong tea extract and the isolated polyphenol compound into diet 2000 and drinking water resulted in significant reductions in caries development and plaque accumulation in the rats infected with mutans streptococci . The active components in the oolong tea extract were presumptively identified as polymeric polyphenols which were specific for oolong tea leaves . These results indicate that the oolong tea polyphenolic compounds could be useful for controlling dental caries.

Med Dosw Mikrobiol, 1993, 45(2), 229 - 31
{Quantitative changes of bacterial flora from the oral cavity and throat in children with acute lymphoblastic leukemia}; Krzeminski Z et al.; Quantitative investigations were carried on aerobic and anaerobic bacterial flora of oral cavity and throat in 44 children in the age of 5-10 years with acute lymphoblastic leukemia, intensively treated with cytostatics, and in 23 healthy children which served as a control group . Samples of saliva from leukemic children revealed significantly higher than in control group--presence of aerobic bacteria, particularly streptococci and enterococci . Material from throat was differing only in regard to staphylococci . Moreover, in children with leukemia, Gram-negative rods were present, which was not the case in the control group.

Acta Otolaryngol Suppl, 1993, 508, 6 - 10
Role of serum antibodies to streptococci in patients with IgA nephropathy; Kukuminato Y et al.; Serum antibodies to whole cells of streptococci and serum immune complexes were investigated in patients with IgA nephropathy accompanied by tonsillitis and in healthy adult controls by enzyme-linked immunosorbent assay (ELISA) . Serum IgA levels to Streptococcus salivarius, S . sanguis I and S . pneumoniae were higher in patients with IgA nephropathy than in healthy controls . The levels of IgG to S . pyogenes T12, S . gordonii and S . sanguis II in patients with IgA nephropathy were also higher than in healthy controls . Serum immune complexes of IgG and IgA were higher in patients with IgA nephropathy than in healthy controls . Serum levels of IgA to some strains of streptococci tended to correlate with the level of IgA immune complex in both patients and healthy controls . These results suggest that antibodies to some strains of streptococci play a role in the pathogenesis of IgA nephropathy.

Caries Res, 1993, 27(6), 467 - 73
Effect of sucrose concentration on the cariogenic potential of pooled plaque fluid from caries-free and caries-positive individuals; Margolis HC et al.; Pooled plaque samples were obtained from (1) coronal surfaces of two groups of caries-free (CF) subjects, (2) coronal 'white-spot' surface areas of a group of caries-positive (CP) subjects, and (3) exposed, sound root surfaces of root caries-free (RCF) and root caries-positive (RCP) subjects . The plaque samples were obtained before and 3 min after a 1 min rinse with a 0.5, 1, 2, 5 and 10% sucrose solution . Plaque fluid was then isolated from each plaque sample by centrifugation and analyzed for inorganic ions, organic acids, and pH values . With increasing sucrose concentration: (1) plaque fluid pH and the degree of saturation (DS) with respect to tooth mineral decreased; (2) the pH and DS values of CP and RCP samples were consistently lower than those of CF and RCF samples, respectively; (3) plaque fluid lactic acid concentrations increased and were consistently higher in the CP and RCP samples than in the CF and RCF samples, respectively, and (4) plaque fluid lactic acid concentrations leveled off between 1 and 5% sucrose; this occurred at lower sucrose concentrations with CP and RCP samples than with CF and RCF samples, respectively . RCP samples contained consistently higher levels of mutants streptococci than RCF samples . The chemical composition of plaque fluids, following sucrose exposure, were found to correlate well with caries history . The observed differences in lactic acid concentrations in samples from CF and CP subjects are discussed with regard to differences in microbiological composition and possible differences in plaque permeability to sucrose.

Ann Dermatol Venereol, 1993, 120(6-7), 469 - 72
{Epidemiology and etiopathogeny of necrotizing fasciitis and streptococcal shock syndrome}; Simonart T et al.; A significant increase in the frequency of necrotizing fasciitis caused by streptococci of group A has recently been noted . The disease usually appears in individuals without obvious risk factors . The initial lesion is often quite ordinary, and the evolution towards a toxic shock very swift . This evolution can be summarized as follows: 1) localized infection; 2) bacteraemia with circulating toxins and soft tissue necrosis; 3) production of cytokines by the immune cells of the host, leading to a rapidly irreversible toxic shock Serotypes 1, 3, 12 and 28 of group A streptococcus are usually involved . The virulence of some serotypes might be explained by the acquisition of a toxic gene . The sensitivity of the host is linked to the genetic expression of the V . beta . elements on the surface of lymphocytes . Antibiotics cannot save the patient when necrotizing fasciitis is installed . Surgery must be massive and performed early.

Microbios, 1993, 76(306), 7 - 18
Phenotypic characterization of oral streptococci by classical methods; Liebana J et al.; The phenotypic characteristics of 215 strains of oral streptococci were compared on the basis of the results of sorbitol, raffinose and trehalose fermentation, ammonium from arginine production, aesculin hydrolysis, H2O2 production, susceptibility to 2 U bacitracin, and growth in 4% NaCl solution . Eleven different species were identified . Among the most noteworthy findings were the low number of H2O2-producing strains of Streptococcus sobrinus, the effective discrimination between Streptococcus sanguis and Streptococcus mitis on the basis of raffinose fermentation, and the phenotypic similarity between Streptococcus oralis and the former mutans group . To avoid the creation of new species, the term biotype is proposed to designate phenotypically distinct organisms which do not qualify as different species.

J Egypt Public Health Assoc, 1993, 68(1-2), 49 - 62
Collagen type III in normal and prematurely ruptured amniotic membranes; Ghoneim FA et al.; This study was performed on two groups of parturient women . The first group included 20 parturient women with premature rupture of membranes (PROM) and the second group included 20 parturient women with intact membranes . From each case a specimen was taken by a sterile swab from the posterior fornix for bacteriological examination to isolate and identify both aerobic and anaerobic vaginal organisms . Also a specimen 4 x 4 cm was cut from chorioamniotic membrane at site of rupture for histological examination including routine hematoxylin and eosin staining and silver impregnation technique (Gordon & Sweet method) for identification of reticular-argyrophilic fibers (collagen III) . It has been found that collagen type III was significantly decreased in amniotic membranes in cases with PROM, its decrease can be considered as a predisposing factor of PROM . The beta-hemolytic streptococci showed a significant increase in vaginal swabs taken from cases with PROM . No linking correlation was found between types of organisms in vagina and decreased collagen type III in amniotic membrane with premature rupture . Polymorphonuclear leukocytes showed no significant increase in amniotic membrane belonging to cases of PROM.

Indian J Pediatr, 1993 Jan-Feb, 60(1), 43 - 51
Brain abscesses in cyanotic heart disease; Prusty GK; Sixty cases of brain abscesses in patients with cyanotic heart disease is reported . Forty four (73.3%) belonged to pediatric age group . There was only single case of infratentorial abscess located in the cerebellar paravermian region . The abscesses were multiloculated in 42%, multiple in 10% and solitary in 48% cases . Streptococci was the commonest (77%) micro-organism isolated from pus culture . Forty eight patients were treated by aspiration through twist drill, 7 patients conservatively and 5 had primary excision of abscesses . Forty four patients improved in their neurological status, three had fixed neurological deficits and 5 patients deteriorated further . There were 8 deaths . Complication like cyanotic spells was recorded in 17% cases treated by aspiration . None of the patients treated by twist drill aspiration had seizure . It is suggested that aspiration of abscesses through twist drill hole and antibiotic therapy could be the treatment of choice . Vascular slowing in a localised area resulting in infraction and thus preparing the focus for abscess formation is the possible mechanism in the evolution of these abscesses.

Pediatr Dent, 1993 Jan-Feb, 15(1), 41 - 4
Social and biological factors contributing to caries of the maxillary anterior teeth; O'Sullivan DM et al.; Caries prevalence among 3- to 4-year-old Head Start children and psychosocial information from their parents were obtained . The prevalence of maxillary anterior caries in the 369 children was 16%, with the most severely affected tooth surfaces being the mesial surfaces of the central incisors . Approximately 90% of parents whose children were found to have maxillary anterior caries knew that allowing their child to take a bottle to bed would harm the child's teeth . Significant differences were found in mutans streptococci levels between children with and without the anterior caries pattern . Although 86% of children with anterior caries were reported to have taken a bottle to bed, 69% of those children who did not have anterior caries also were reported to have taken a bottle to bed . Of the children with maxillary anterior caries, 87% had posterior caries, suggesting that anterior caries subsequently may contribute to an increased caries risk in other teeth.

Med Dosw Mikrobiol, 1993, 45(1), 33 - 6
{Antagonism between oral cavity streptococci and staphylococci}; Krzeminski Z et al.; The subject of this study was investigation of quantitative relations between streptococci, lactic acid bacilli and actinomycetes and staphylococci present in the oral cavity . It was found that in each tested sample of saliva streptococci are present which inhibit growth of an indicator strain Staphylococcus aureus 209P . Percentage of such streptococci varies from 11.1% to 100% (mean value 52.9 +/- 19.7%) . There is a negative correlation between number of streptococci and staphylococci in samples of saliva delivered from the same oral cavity . Pearson's linear correlation coefficient was r = -0.7962 (p < 0.0001), and Spearman's correlation rank was rs = -0.7667 (p < 0.0001) . Lactic acid bacilli were inhibiting growth of staphylococci only in conditions in which there were not neutralized by organic acids produced by these microorganisms . Actinomycetes had no influence at all on growth of these microorganisms . These results suggest that streptococci are responsible for antagonistic properties of oral cavity bacterial flora in relation to staphylococci . Numbers of streptococci conditions size of staphylococcal population in this environment . Staphylococci practically exert no antagonistic activity against cohabiting with them streptococci.

Med Dosw Mikrobiol, 1993, 45(1), 123 - 6
{Bacterial flora in laryngeal carcinoma and in postoperative scars of patients treated prophylactically by ciprofloxacin}; Michalska W et al.; Microbiological investigations regarded samples from diseased tissue in patients with larynx carcinoma and in 53 patients . Samples were also taken two weeks after surgery from postoperative wounds . The patients received after surgery ciprofloxacin and metronidazole for five days . Cultures were incubated in aerobic and anaerobic conditions . Isolated microorganisms were tested by application of the API system susceptibility to ciprofloxacin, netilmicin and gentamycin were determined . Samples from cancerous tissue and postoperative wounds revealed most frequently presence of streptococci, staphylococci, Bacteroides and intestinal bacteria . It was found, however, that in investigated patients different bacterial flora was present when compared with previously tested cancerous tissue . Hemolytic streptococci and Staphylococcus aureus, and less frequently enterococci, were found much more frequently, Isolated strains were susceptible to ciprofloxacin (93%), netilmicin (76%) and gentamycin (39%).

Drugs, 1993, 45 Suppl 3, 81 - 90
Use of the quinolones in the prophylaxis and treatment of granulocytopenic immunocompromised cancer patients; Van der Auwera P et al.; The potential use of the quinolones in the prophylaxis and treatment of febrile episodes in granulocytopenic patients is reviewed . Of 7 controlled prophylactic studies performed with quinolones, 2 were double-blind and placebo-controlled . The occurrence of fever and mortality due to infection was not reduced with quinolone prophylaxis, although the occurrence of Gram-negative bacteraemia was significantly reduced . The delay to first fever was occasionally increased, and this was associated with a reduction in the number of days with antimicrobial agents . No effect was observed on disseminated fungal infections with quinolone prophylaxis . Breakthrough bacteraemia and subsequent infections were due to resistant organisms, mainly Gram-positive organisms (streptococci, staphylococci) . Tolerability and compliance were excellent and were occasionally better than with the classic regimen {nonabsorbable antibiotics and cotrimoxazole (trimethoprim/sulfamethoxazole)} . Six controlled studies dealing with empiric treatment with the quinolones were reviewed . Overall, the results suggested that monotherapy with ciprofloxacin may be used in patients with a good prognosis (short and less severe neutropenia, solid tumours, compliant patients) . Combinations with broad spectrum penicillins, netilmicin or teicoplanin seem to be as effective as the classic regimens (a broad spectrum penicillin or cephalosporin plus aminoglycosides), although the number of patients was limited (n = 334) . The response rate of Gram-positive bacteraemia was lower with quinolone-containing regimens except for a combination that included teicoplanin.

Drugs, 1993, 45 Suppl 3, 54 - 8
Synergy and antagonism of fluoroquinolones with other classes of antimicrobial agents; Neu HC; In an attempt to overcome some of the gaps in their antibacterial spectrum, e.g . some Gram-positive bacteria (notably streptococci and Streptococcus pneumoniae) and anaerobes, the fluoroquinolones have been combined with other bactericidal and bacteriostatic agents . In general, the fluoroquinolones rarely show either synergy or antagonism when used in combination with other antimicrobial agents against most bacteria . Therefore, in infections where the fluoroquinolones do not provide cover against all potential organisms, combined treatment with an appropriate agent may be considered . Current data suggest that the fluoroquinolones are not antagonistic with beta-lactams, macrolides, clindamycin and the imidazoles . Aminoglycosides in combination with the fluoroquinolones do not show synergy . Antipseudomonal penicillins, ceftazidime or imipenem in combination with the fluoroquinolones are synergistic and may be useful for treating infections in immunocompromised patients . Rifampicin in combination with a fluoroquinolone for the treatment of staphylococcal endocarditis or osteomyelitis may be useful, although in vitro and in vivo results do not always coincide.

Int Arch Allergy Immunol, 1993, 100(1), 12 - 8
Clonal specificity of human gamma delta T cells: V gamma 9+ T-cell clones frequently recognize Plasmodium falciparum merozoites, Mycobacterium tuberculosis, and group-A streptococci; Bender A et al.; Peripheral blood gamma delta T cells expressing a V gamma 9/V delta 2 T-cell receptor are stimulated by killed bacteria including Mycobacterium tuberculosis (m.tb.) and group-A streptococci (strep A) . In addition, recent data indicate that V gamma 9/V delta 2 T cells from unexposed individuals also respond to Plasmodium falciparum (P . falcip.) merozoites . Here we analyzed the reactivity to these ligands of 23 V gamma 9/V delta 2, 3 V gamma 9/V delta 1, and 4 V gamma 9-/V delta 1 clones derived from 8 healthy individuals after phytohemagglutinin stimulation of cell sorter-selected gamma delta T cells . Upon restimulation in the presence of irradiated antigen-presenting cells, the majority of V gamma 9/V delta 2 clones recognized m.tb . and strep A (but not strep D), and about one third of the clones also recognized P . falcip . Some clones, however, recognized only one or two of the tested ligands, and 4 V gamma 9/V delta 2 clones did not react at all . Interestingly, 2 of 3 V gamma 9/V delta 1 clones proliferated in response to m.tb., P . falcip., strep A and strep D, while V gamma 9-/V delta 1 clones were not activated by any of the tested ligands . Nucleotide sequence analysis indicated a broad diversity of V gamma 9 N regions in V gamma 9/V delta 2 clones . At the clonal level, our results demonstrate that individual V gamma 9/V delta 2 T cells can recognize m.tb., strep A, as well as P . falcip.-infected erythrocytes, with no influence of the expressed V gamma 9 N region.

FEMS Microbiol Lett, 1992 Dec 15, 79(1-3), 313 - 22
Erythrogenic toxins A, B and C: occurrence of the genes and exotoxin formation from clinical Streptococcus pyogenes strains associated with streptococcal toxic shock-like syndrome; Reichardt W et al.; We report the study of 53 clinical isolates of group A streptococci, all from patients with streptococcal toxic shock-like syndrome . The strains were analysed for the occurrence of the genes of erythrogenic toxins (pyrogenic exotoxins) types A, B and C and in vitro production of these toxins . In contrast to reports indicating that 85% of the toxic shock-like syndrome-associated isolates contained the erythrogenic toxin A gene, only 58.5% of our strains harboured this gene . The erythrogenic toxin C gene was detected in 22.6% of the isolates . Erythrogenic toxin A and erythrogenic toxin B were produced by 68.7% and 58.3% of the strains containing either gene . For all group A streptococci, irrespective of clinical association, the erythrogenic toxin B gene was detected in all the isolates tested . Thus, it is difficult to define a specific role for erythrogenic toxin B in toxic shock-like syndrome as there was no clear correlation between this disease and the presence of toxin genes . Our results suggest the existence of other pathogenic factor(s) produced by group A streptococci which may stimulate human peripheral T lymphocytes in a manner similar to that of erythrogenic toxins, thus explaining different observations in previous epidemiological genetic studies.

Tidsskr Nor Laegeforen, 1992 Dec 10, 112(30), 3803 - 5
{No connection between scarlet fever and gouty fever . Historical analysis from Ytre Nordhordland during 1862-1884}; Sandvik H; In 1987 there was an unexplained increase in severe streptococcal diseases in Norway and other western countries . In Norway this increase was not accompanied by a corresponding increase in acute rheumatic fever . This study investigated the occurrence of scarlet fever and acute rheumatic fever in a rural district (approximately 15,000 inhabitants) of western Norway during the years 1862-1884 . Four epidemics of severe scarlet fever occurred during this period . The local doctor treated 1,155 patients (96% children), of whom 154 (13.3%) died . Acute glomerulonephritis with subsequent kidney failure seems to have been a major cause of death . During the same period 76 patients (96% adults) were treated for acute rheumatic fever . These cases were not related to the severe epidemics of scarlet fever . It is probable that different, co-circulating strains of streptococci caused the infections, which were followed by glomerulonephritis and rheumatic fever . It is possible that rheumatic fever was caused by the strain that induced the more benign "Angina tonsillaris".

J Biol Chem, 1992 Dec 5, 267(34), 24302 - 6
Analysis of the streptococcal hyaluronic acid synthase complex using the photoaffinity probe 5-azido-UDP-glucuronic acid; van de Rijn I et al.; The mucopolysaccharide, hyaluronic acid, is an important component of both mammals and pathogenic streptococci . This high molecular weight polymer is synthesized by a membrane-associated, multisubunit hyaluronate synthase which utilizes UDP-glucuronic acid and UDP-N-acetylglucosamine as substrates . Using the photoaffinity probe, {beta-32P}5-azido-UDP-glucuronic acid, three streptococcal membrane proteins (42, 33, and 27 kDa) specifically photoincorporated this probe . Labeling of these proteins was enhanced in the presence of UDP-N-acetylglucosamine, whereas UDP-galactose or UDP-glucose had no effect on incorporation . UDP-glucuronic acid inhibited the labeling of the three proteins in a dose-dependent manner . Detergent-solubilized membrane proteins from transposon-inactivated hyaluronic acid capsule mutants no longer incorporated the probe . This was also the case when membranes from stationary phase organisms were tested . Finally, glucuronic acid no longer was incorporated into high molecular weight hyaluronic acid with either the mutant or stationary phase preparations . Further biochemical analysis will be required to demonstrate the exact role each of the proteins play in hyaluronic acid biosynthesis.

APMIS, 1992 Dec, 100(12), 1129 - 32
Binding of human IgA to HCl-extracted c protein from group B streptococci (GBS); Kvam AI et al.; The c beta protein of group B streptococci obtained by HCl extraction appears as a ladder-like pattern in SDS-PAGE when detected by a rabbit anti-c beta serum, and a similar picture is seen when the crude extract is incubated with human IgA and an anti-human IgA conjugate . Affinity-purified c beta antigen and IgA receptors from GBS gave identical pictures in Western blots using rabbit anti-c beta serum . Both the c beta antigen and the IgA receptor are exposed on the surface of GBS as demonstrated by immunofluorescence.

Immun Infekt, 1992 Dec, 20(6), 177 - 80
{Bacterial infections in pregnancy}; Petersen EE; The spectrum of bacterial infections during pregnancy is broad . Among blood-transmitted infections especially listeriosis endangers the child . More frequent are ascending and peripartal infections, which imperil both mother and child . The disturbed vaginal flora, which occurs in 10-30% of all pregnant women, has to be regarded as its reservoir . Cervicitis caused by gonococci or chlamydiae, but also high concentrations of facultative pathogenic bacteria are regarded as the main cause of the preterm rupture of membranes leading to preterm delivery . Especially feared is the group-A-streptococci infection, which appears more frequently . In 5% of all pregnant women a chlamydial cervicitis is found.

J Gen Microbiol, 1992 Dec, 138 ( Pt 12), 2707 - 14
Physico-chemical and structural properties of the surfaces of Peptostreptococcus micros and Streptococcus mitis as compared to those of mutans streptococci, Streptococcus sanguis and Streptococcus salivarius; Cowan MM et al.; The surface properties of nine Streptococcus mitis and four Peptostreptococcus micros strains from the oral cavity were examined and compared with a large group of oral streptococci . Zeta potential and contact angle measurements were employed to determine physico-chemical cell surface properties . In addition, elemental surface concentration ratios were obtained via X-ray photoelectron spectroscopy, and surface structures were examined with transmission electron microscopy . The S . mitis and P . micros strains were found to have higher isoelectric points, higher hydrophobicities and higher N/C surface concentration ratios than some other oral streptococci . The combined data suggest that both species possess large amounts of surface protein . All the S . mitis strains displayed abundant surface fibrils in negative staining, but the P . micros strains were devoid of surface appendages indicating that surface protein is present in different forms in the two species . The surfaces of S . mitis and P . micros type strains differed significantly from the other strains examined.

Scand J Prim Health Care, 1992 Dec, 10(4), 295 - 300
An algorithm for a selective use of throat swabs in the diagnosis of group A streptococcal pharyngo-tonsillitis in general practice; Hoffmann S; A prospective evaluation was made of an algorithm for a selective use of throat swabs in patients with sore throat in general practice . The algorithm states that a throat swab should be obtained (a) in all children younger than 15 years; (b) in patients aged 15 years or more who have pain on swallowing and at least three of four signs (enlarged or hyperaemic tonsils; exudate; enlarged or tender angular lymph nodes; and a temperature > or = 38 degrees C); and (c) in adults aged 15-44 years with pain on swallowing and one or two of the four signs, but not both cough and coryza . Group A streptococci were found by laboratory culture in 30% of throat swabs from 1783 patients . Using these results as the reference, the algorithm was 95% sensitive and 26% specific, and assigned 80% of the patients to be swabbed . Its positive and negative predictive values in this setting were 36% and 92%, respectively . It is concluded that this algorithm may be useful in general practice.

S Afr Med J, 1992 Dec, 82(6), 432 - 4
Does primary Streptococcus viridans pneumonia exist?
Goolam Mahomed A, Feldman C, Smith C, Promnitz DA, Kaka S.
In 4 adult black patients admitted to an urban general hospital with community-acquired pneumonia, Streptococcus viridans alone was isolated from blood culture (first subculture), in the absence of any other positive microbiological finding . Sputum examination by Gram staining and culture in 3 cases was reported as negative . Echocardiography was performed in 3 cases and was normal, without evidence of endocarditis . The clinical course of illness in the 4 patients is described . The chest radiograph showed a segmental or subsegmental consolidation in all cases; this appeared 'mass-like' in 2 patients . Viridans streptococci may be a more important, if still uncommon, cause of community-acquired pneumonia than previously suspected . The organism should be considered as a possible cause of chest infection, particularly in patients with appropriately positive blood cultures and no other positive microbiological finding.

Scand J Dent Res, 1992 Dec, 100(6), 371 - 6
Effects of food preservatives on growth and metabolism of plaque bacteria in vitro and in vivo; Leikanger S et al.; The aims of the present study were to assess the consumption of food preservatives during the last decades, and to study the effect of the preservatives, sorbic and benzoic acid, on growth and glycolysis of oral bacteria in vitro, and on acid formation by dental plaque in vivo . Five consumption reports from the Central Bureau of Statistics of Norway were used to estimate alterations in consumption of staple food containing the two preservatives . A modified broth dilution method was used to determine the MIC values of the preservatives against Streptococcus sobrinus and Streptococcus sanguis . Extracellular 14C-glycolytic metabolites were studied by HPLC analyses . Plaque-pH measurements were used to assess possible effects on acid production . The consumption reports indicated increased consumption of preservatives . The in vitro testing suggested that legal concentrations of preservatives may inhibit the growth of oral streptococci . However, the preservatives did not inhibit in vitro glycolysis at tested concentrations . In vivo testing with similar concentrations (0.4% w/v) showed a significant effect . A higher concentration (2% w/v potassium sorbate) had a tendency to inhibit acid-formation by dental plaque even more.

J Med Microbiol, 1992 Dec, 37(6), 410 - 2
The clinical comparison of Oxoid Signal with Bactec blood culture systems for the detection of streptococcal and anaerobic bacteraemias; Hutchinson NA et al.; Blood cultures were taken from 47 patients 1-2 min after dental extraction . These samples were tested by the radiometric Bactec 460 and Oxoid Signal systems for the detection of streptococcal and anaerobic bacteraemias . Streptococci were isolated from 19 (40%) patients and anaerobes from 15 (32%) . In this study the Oxoid Signal system was significantly better for isolating oral anaerobes than the Bactec system; five isolates were obtained with the Bactec system and 14 with the Signal system . There was no significant difference in the isolation of streptococci between these two systems (Bactec 14, Oxoid Signal 10) . The contamination rate was 4.1% for Bactec and 7.5% for the Oxoid Signal system.

Clin Infect Dis, 1992 Dec, 15(6), 991 - 1002
Septicemia in 980 patients at a university hospital in Berlin: prospective studies during 4 selected years between 1979 and 1989; Geerdes HF et al.; A total of 980 episodes of clinically and bacteriologically proven septicemia were included in four prospective 1-year studies at a 1,300-bed university hospital in Berlin between 1979 and 1989 . The incidence was 8.1 per 1,000 admissions . The percentage of patients with severe underlying diseases increased significantly from 67% to 95% over the decade . Septicemia due to gram-positive bacteria decreased from 47.3% in 1979 to 43.7% in 1986 and increased again to 51.2% in 1989 . Septicemia due to gram-negative organisms decreased constantly from 45.0% in 1979 to 39.8% in 1989 . The most frequently isolated species were Escherichia coli (26.4%), Staphylococcus aureus (18.9%), coagulase-negative staphylococci (10.2%), enterococci (7.7%), viridans streptococci (6.4%), Klebsiella species (5.5%), and pneumococci (5.0%) . The overall mortality rate decreased significantly from 33.6% in 1979 to 20.8% in 1989 . Mortality for episodes of septicemia due to gram-positive bacteria (25.5%) was higher than that for septicemia due to gram-negative bacteria (18.3%) . Mortality rates associated with polymicrobic and fungal septicemia were higher than the overall mortality rate.

Arch Intern Med, 1992 Dec, 152(12), 2428 - 32
The complications of infective endocarditis . A reappraisal in the 1980s; Mansur AJ et al.; BACKGROUND--The frequency of complications of infective endocarditis and their influence on the outcome of the patients changed in the antibiotic era . Therefore, we evaluated the complications in a recent large series of patients with infective endocarditis . METHODS--We studied 300 episodes of endocarditis in 287 patients in a tertiary cardiology referral center . Predisposing cardiac conditions were valvular heart disease in 147 episodes, congenital heart disease in 37, other heart diseases in five, and prosthetic heart valves in 69 . In 69 episodes, there was no previous heart disease . The infecting microorganisms were streptococci in 147 episodes, Staphylococcus aureus in 59, Staphylococcus epidermidis in 14, gram-negative bacteria in 16, other gram-positive bacteria in eight, and fungi in four . In 52 episodes, blood cultures were negative . Seventy-eight patients (26%) died . Complications were defined as any clinically unfavorable event occurring during treatment . RESULTS--A total of 386 complications occurred in 223 episodes (74%); one complication occurred in 128 episodes (57%), two in 57 (26%), three in 18 (8%), four in 13 (6%), five in three (1%), and six or more in three (1%) . The complications were as follows: cardiac, 100 occurrences; neurological, 72; septic, 46; associated with medical treatment, 41; renal, 27; extracranial systemic arterial embolism, 16; septic pulmonary embolism, 26; complications related to surgical treatment, 11; acute prosthetic heart valve insufficiency, six; splenic infarction or abscess, three; cardiac rhythm disturbances, three; and other, 19 . The distribution of the complications relative to outcome of the patients revealed that fatality exceeded survival rates for neurologic and septic complications . CONCLUSIONS--Complications may be common in patients with infective endocarditis . Cardiac complications were the most common ones, but fatality rates were higher for neurologic and septic complications . Hence, heart failure was replaced by neurologic and septic complications as the leading causes of death in patients with infective endocarditis.

J Clin Oncol, 1992 Dec, 10(12), 1943 - 8
A prospective randomized trial comparing the infectious and noninfectious complications of an externalized catheter versus a subcutaneously implanted device in cancer patients; Mueller BU et al.; PURPOSE: To compare the frequency of infectious episodes or other problems occurring with an externalized catheter (Hickman) versus a subcutaneously implanted device (Port-a-Cath, Pharmacia, Piscataway, NJ) in cancer patients, we performed a prospective, randomized study in 100 cancer patients (age range, 5 to 74 years) . PATIENTS AND METHODS: Patients who were chemotherapy candidates and required an indwelling catheter were monitored prospectively and evaluated during the 180 days after the insertion of the catheter and again at time of study closure . The frequency of catheter use, reason for access, and any problems that might have been related to catheter use were noted . All data were collected prospectively and included the patient's age, sex, underlying malignancy, temperature, and leukocyte and absolute granulocyte counts at the time of catheter insertion and when complications occurred . The time to and reason for removal of the catheter, as well as any intercurrent infectious or mechanical problems, were also determined . RESULTS: Most of the infections that occurred were caused by gram-positive organisms, especially staphylococci or streptococci . A total of 22 complications (11 in each group) resulted in removal of the central line . Only one infection in the Hickman catheter group and four in the Port-a-Cath group led to removal of the central line . All other infectious episodes were successfully treated without removal of the catheters . The mean device life was 230 days for the Hickman catheter and 318 days for the Port-a-Cath (not significant) . CONCLUSION: There were no differences between the two study groups regarding incidence of documented infections or mechanical or thrombotic complications.

J Fam Pract, 1992 Dec, 35(6), 622 - 6
Clarithromycin vs penicillin in the treatment of streptococcal pharyngitis; Schrock CG; BACKGROUND . Streptococcal pharyngitis, caused by group A beta-hemolytic streptococci (GABHS), is among the most common infections seen by primary care physicians . Because the illness can result in rheumatic fever, early eradication of infection is important . Penicillin has been the standard treatment for GABHS pharyngitis for over four decades, but reports of bacteriologic failure with this drug in recent years have led to trials of alternative antimicrobials . METHODS . In this investigator-blind, randomized multicenter trial (30 centers), oral clarithromycin, 250 mg twice daily, or oral penicillin VK, 250 mg three times daily, was given to outpatients > or = 12 years old with GABHS pharyngitis as documented by positive cultures for Streptococcus pyogenes and positive rapid immunoassay tests . The clinical and bacteriologic efficacy of clarithromycin was compared with that of penicillin in the 356 evaluable patients . Safety analysis was performed in all patients who had received at least one dose of the study drug (N = 453) . RESULTS . Overall, clinical outcomes were comparable in the two groups . However, more clarithromycin-treated patients than penicillin-treated patients had resolution of sore throat (94% vs 86%, P = .014) and disappearance of pharyngeal erythema and exudate (89% vs 82%, P = .05) . Bacteriologic cure rates were higher in clarithromycin-treated patients (95% vs 87%, P = .009) . No serious adverse events were observed in either group . CONCLUSIONS . This study suggests that clarithromycin twice daily is as effective and as well tolerated as penicillin in the treatment of streptococcal pharyngitis.

J Clin Microbiol, 1992 Dec, 30(12), 3268 - 9
Novel coagglutination method for serotyping group B streptococci; Hakansson S et al.; A group G streptococcal strain was coated with antibody against six different serotypes (Ia, Ib, II, III, IV, and V) of group B streptococci . The coagglutination patterns of 114 strains of group B streptococci were compared with the serotypes determined after immunoprecipitation . The specificity of the method was 100% and the sensitivity 97% . It was used for the typing of 89 invasive and 101 colonizing isolates . The new method is swift, specific, and highly sensitive . It consumes only minute amounts of antibody.

J Clin Microbiol, 1992 Dec, 30(12), 3127 - 31
Streptococcal erythrogenic toxin genes: detection by polymerase chain reaction and association with disease in strains isolated in Canada from 1940 to 1991; Tyler SD et al.; The presence of genes encoding pyrogenic exotoxins type A (speA), B (speB), and C (speC) and streptolysin O (slo) was determined by the polymerase chain reaction (PCR) to target specific sequences in 152 strains of group A streptococci . These included reference strains, representative M and T type strains, and strains associated with scarlet fever and pharyngitis collected between 1940 to 1991 and included strains from patients with severe invasive streptococcal infections . PCR amplicons were detected by agarose gel electrophoresis, and specificity was established by restriction fragment analysis . The frequency of occurrence for each target gene among all strains tested was 33.6% for speA, 99.3% for speB, 28.9% for speC, and 100% for slo . Strains of non-group A streptococci, recognized toxigenic bacterial pathogens, and pneumolysin-producing Streptococcus pneumoniae strains were negative for all targeted gene sequences . Detection limits in the PCR were found to be 100 pg of total nucleic acids for the speB and speC genes and 1 ng for the speA and slo genes . Isolates associated with scarlet fever, pharyngitis, and severe invasive infections showed statistically significant differences in the presence of speA, with scarlet fever strains having the highest association (81.3%), severe infections the next highest association (42.9%), and pharyngitis the lowest association (18.4%) . Although no significant differences were observed in speC frequencies in isolated associated with the three disease categories, a genotype of speB slo was significantly higher in isolates associated with pharyngitis (54.1%) than in strains associated with scarlet fever (18.8%) or severe invasive disease (23.8%) . Streptolysin O targets were present in all the isolates tested, and only a single strain (T-11-M-11) was devoid of targeted speB sequences, thereby demonstrating that neither speB nor slo is associated with any particular clinical presentation.

J Clin Microbiol, 1992 Dec, 30(12), 3074 - 81
Functional and serological analysis of type II immunoglobulin G-binding proteins expressed by pathogenic group A streptococci; Raeder R et al.; Bacterial immunoglobulin-binding proteins expressed on the surface of group A streptococci represent a heterogeneous family of functionally related proteins . In this report, we describe efficient methods for extracting immunoglobulin-binding proteins and classifying them functionally and antigenically . A common characteristic of immunoglobulin-binding proteins expressed by group A streptococci appears to be the absence of internal methionine residues in the binding protein . This has enabled development of a rapid, efficient, cyanogen bromide-based extraction procedure for solubilizing these molecules from intact bacteria . Studies carried out with a series of monospecific polyclonal antibodies prepared in chickens have identified two major antigenic classes of immunoglobulin-binding proteins . The methods described in this report facilitate a rapid functional and serological screening of immunoglobulin-binding proteins that should now enable detailed epidemiological studies of the importance of these molecules in group A streptococcal infections and their relationship to other surface proteins, in particular, the antiphagocytic M protein.

Infect Immun, 1992 Dec, 60(12), 5219 - 23
Streptococcal C5a peptidase is a highly specific endopeptidase; Cleary PP et al.; Compositional analysis of streptococcal C5a peptidase (SCPA) cleavage products from a synthetic peptide corresponding to the 20 C-terminal residues of C5a demonstrated that the target cleavage site is His-Lys rather than Lys-Asp, as previously suggested . A C5a peptide analog with Lys replaced by Gln was also subject to cleavage by SCPA . This confirmed that His-Lys rather than Lys-Asp is the scissile bond . Cleavage at histidine is unusual but is the same as that suggested for a peptidase produced by group B streptococci . Native C5 protein was also resistant to SCPA, suggesting that the His-Lys bond is inaccessible prior to proteolytic cleavage by C5 convertase . These experiments showed that the streptococcal C5a peptidase is highly specific for C5a and suggest that its function is not merely to process protein for metabolic consumption but to act primarily to eliminate this chemotactic signal from inflammatory foci.

Infect Immun, 1992 Dec, 60(12), 5157 - 63
Respiratory epithelial cell invasion by group B streptococci; Rubens CE et al.; Group B streptococci (GBS) are the most common cause of pneumonia and sepsis during the neonatal period; however, the pathogenesis of this infection is poorly understood . We investigated the ability of GBS to enter epithelial cells in culture . Two strains of GBS were capable of invading immortalized respiratory epithelial cell lines in vitro at different levels, suggesting strain differences in invasiveness . Intracellular replication was not observed . Invasion required actin microfilaments but not microtubular cytoskeletal elements . Active bacterial protein, DNA, and RNA syntheses were required for invasion . These findings are consistent with our previous observation of intracellular GBS in the lungs of infected primates . We hypothesize that this organism may access the bloodstream by direct invasion of the epithelial cell barrier.

Infect Immun, 1992 Dec, 60(12), 5036 - 41
Role of fibrinogen in complement inhibition by streptococcal M protein; Horstmann RD et al.; M protein, the major virulence factor of group A streptococci, has antiopsonic activity in that it inhibits activation of the alternative complement pathway on the streptococcal surface . Two properties of M protein have been claimed to account for the inhibitory activity, namely, (i) its binding affinity for complement factor H, which is an inhibitor of alternative pathway activation, and (ii) its high binding affinity for fibrinogen . We have recently shown that fibrinogen, like M protein, inhibits alternative pathway activation by possessing binding affinity for factor H . Here we report that fibrinogen effectively competes with factor H for binding to M protein but retains its own binding affinity for factor H . The presence of fibrinogen did not significantly affect alternative pathway inhibition on the streptococcal surface.

Infect Immun, 1992 Dec, 60(12), 5030 - 5
Complement and antibody participation in opsonophagocytosis of type IV and V group B streptococci; Hall MA et al.; Requirements for complement and antibody in neutrophil-mediated killing of serotype IV and V group B streptococci were investigated . Neutrophils from adults were tested in an opsonophagocytic assay with sera from healthy adults, healthy newborns, and hypogammaglobulinemic, agammaglobulinemic, and C4-deficient patients . For all serum sources, the bactericidal index for both serotypes exceeded 84% after 40 min of incubation . Heat inactivation of sera ablated killing . Blockade of neutrophil receptor FcIII effected a maximum of 16% inhibition of opsonophagocytosis, and FcII receptor blockade demonstrated negligible inhibition . When neutrophil complement receptor 1 or 3 blockade was employed, the maximum inhibition detected was 26% . Simultaneous blockade of complement receptors 1 and 3 effected maximum inhibition levels of 25 and 65% for serotypes IV and V, respectively . Blockade of complement receptor 3 and neutrophil receptor FcIII inhibited opsonophagocytosis by 56% for both serotypes . When serum complement concentrations were restricted, neutrophil-mediated killing diminished but was restored by the addition of hyperimmune rabbit antiserum . These findings suggest that complement and antibody are major participants in the opsonophagocytosis of serotypes IV and V group B streptococci . A low prevalence of carriage or mediation of efficient phagocytosis by interactions of neutrophil complement and Fc receptors may contribute to the rarity of human infections caused by these two serotypes.

Infect Immun, 1992 Dec, 60(12), 4989 - 94
Protection of neonatal mice from group B streptococcal infection by maternal immunization with beta C protein; Madoff LC et al.; Group B streptococci (GBS) cause the majority of cases of neonatal sepsis and meningitis in the United States . Immunization of women of childbearing age is one strategy under consideration for the prevention of neonatal disease . The beta C protein, a 130-kDa antigen present in many clinical isolates of GBS, was purified from GBS by extraction into sodium dodecyl sulfate (SDS)-containing buffer, preparative SDS-polyacrylamide gel electrophoresis, and electroelution . Purified beta C protein antigen (25 micrograms) with Freund's adjuvant was used to immunize rabbits . Rabbits developed enzyme-linked immunosorbent assay titers of > 1:1.6 x 10(6), and sera from immunized rabbits were administered to pregnant mice . Their neonatal pups were then challenged with a strain of GBS expressing beta C protein; 68% of these pups were protected by immune antiserum, whereas no controls were protected (P < 0.001) . The immune serum (diluted 1:100) facilitated opsonophagocytic killing of GBS strains expressing the beta C protein but not those that do not express the antigen (mean log kill +/- standard deviation = 0.71 +/- 0.8 log10 CFU for beta+ strains and 0.09 +/- 0.2 for beta- strains; P = 0.02) . In subsequent experiments, adult female mice were actively immunized with two doses of 2, 5, or 10 micrograms of beta C protein 2 months prior to mating . One- to two-day-old offspring of these dams were challenged with GBS and were protected in a dose-dependent manner, with 96% survival in the high-dose (10-micrograms) group and 20% survival in a sham-immunized control group (P < 0.001) . Thus, active immunization of mice with the GBS beta C protein confers protection against lethal infection with beta+ GBS to their offspring.

Obstet Gynecol, 1992 Dec, 80(6), 1038 - 47
Assessment of rapid identification tests for genital carriage of group B streptococci; Yancey MK et al.; OBJECTIVE: The purpose of this study was to assess the relative value of reported methods for rapid identification of group B streptococcal colonization of the female genital tract . DATA SOURCES: Trials of group B streptococcal identification techniques published in peer-reviewed journals were located using a computerized literature search and cited references from relevant articles or text chapters . METHODS OF STUDY SELECTION: Reports were included in the analysis if the methodology fulfilled the following criteria: 1) A reference culture method was used for comparison; 2) performance characteristics were presented or could be calculated; 3) the method could be performed in a standard laboratory on a 24-hour-a-day basis; and 4) results could be routinely available within 12 hours . DATA EXTRACTION AND SYNTHESIS: Performance characteristics such as sensitivity, specificity, and predictive values for the various methods were evaluated and compared . Factors such as colonization rates and methods for identifying carriers were included in the overall assessment of test performance . CONCLUSIONS: The overall sensitivity of current methods for the rapid detection of group B streptococcal colonization is low . However, some rapid antigen detection tests are highly sensitive in identifying heavily colonized patients, and therefore may be useful for selecting high-risk patients for intrapartum antibiotic prophylaxis.

Am J Cardiol, 1992 Dec 1, 70(18), 1453 - 8
Active infective endocarditis observed in an Indian hospital 1981-1991; Choudhury R et al.; Clinical data from 186 patients (133 males and 53 females) with 190 episodes of infective endocarditis (IE) occurring between January 1981 and July 1991 were studied retrospectively at a large referral hospital in Northern India with the intention of highlighting certain essential differences from those reported in the West . The mean age was much lower (25 +/- SD 12 years, range 2 to 75 years) . Rheumatic heart disease was the most frequent underlying heart lesion accounting for 79 patients (42%) . This was followed by congenital heart disease in 62 (33%) and normal valve endocarditis in 17 (9%) . Twenty-four patients had either aortic regurgitation (n = 15) or mitral regurgitation (n = 9) of uncertain etiology . Prosthetic valve infection and mitral valve prolapse were present in only 2 patients each . A definite predisposing factor could be identified in only 28 patients (15%) . Postabortal sepsis and sepsis related to childbirth accounted for 6 and 5 cases, respectively . Only 1 patient had history of intravenous drug abuse . Two-dimensional echocardiography showed vegetations in 121 patients (64%) . Blood cultures were positive in only 87 (47%), with a total of 90 microbial isolates . Commonest infecting organisms were staphylococci (37 cases) and streptococci (34 cases) . Except for a significantly higher number of patients with neurologic complications in the culture-negative group, there were no differences between patients with culture-positive and culture-negative IE . Of the 190 episodes of IE, the patients had received antibiotics before admission in 110 (58%) instances . A significantly greater number of culture-negative patients had received antibiotics than did culture-positive patients (87 vs 23, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Exp Dermatol, 1992 Dec, 1(5), 253 - 8
Comparison of skin changes induced on mice by either group A type 12 or group G streptococci; Reitmeyer JC et al.; Adult Swiss webster mice were injected with 3 x 10(6) colony-forming units (cfu) of group G or 2.5 x 10(6) cfu of group A streptococci at intradermal injection sites on the right and left paralumbar areas of the back . The mice were sacrificed at intervals between 4 hours and 14 days post-injection (p.i.) and full thickness biopsies of skin 10 mm in diameter encompassing the sites of injection were taken . One tissue specimen was homogenized in PBS and plated to determine the number of cfu, while another was used for histopathological studies . The number of viable group A and group G streptococci in the tissue increased to 3 x 10(9) cfu by 96 hours p.i.: after 192 hours p.i . the group A cells had declined to 2.7 x 10(6) cfu compared to 1.1 x 10(8) cfu for group G cells . No streptococci of either group were detected at 336 hours (14 days p.i.) . Gross edematous lesions induced by either streptococcus group were evident on all animals at 24 hours (p.i.) . Group G streptococci lesions were larger and persisted longer than lesions induced by group A . Histological examination consistently revealed more inflammation and necrosis in tissue sections from mice injected with group G streptococci.

J Clin Microbiol, 1992 Dec, 30(12), 3190 - 4
Identification of sequence types among the M-nontypeable group A streptococci; Relf WA et al.; Streptococcal diseases, namely, acute glomerulonephritis and acute rheumatic fever, are common features in the aboriginal population of the Northern Territory of Australia . We examined the group A streptococcal M types identified during various surveys conducted since 1987 . Streptococci were predominantly isolated from skin infections . A high proportion of the isolates could not be serotyped by conventional means and were designated M nontypeable (MNT) . M-specific DNA sequences from the MNT isolates were examined, and sequence types were proposed for the classification of MNTs . This allowed a more precise estimate of the M types present in a population study.

Antimicrob Agents Chemother, 1992 Dec, 36(12), 2698 - 703
In vivo efficacy of a new fluoroquinolone, sparfloxacin, against penicillin-susceptible and -resistant and multiresistant strains of Streptococcus pneumoniae in a mouse model of pneumonia; Azoulay-Dupuis E et al.; The increasing emergence of penicillin-resistant and multiresistant strains of Streptococcus pneumoniae may pose a problem in coming years . We therefore compared sparfloxacin, a new fluoroquinolone with improved potency against streptococci, with amoxicillin, the "gold standard" in this setting, and another fluoroquinolone, ciprofloxacin, in a mouse pneumonia model . Their efficacies against penicillin-susceptible (serotype 3), macrolide-resistant (serotype 1), penicillin-resistant (serotype 23), and multiresistant (serotype 6) S . pneumoniae strains were evaluated . Immunocompetent Swiss mice (serotypes 1 and 3) and leukopenic mice (serotypes 6 and 23) were infected by peroral tracheal delivery of 10(4) to 10(6) CFU . Subcutaneous injections of antibiotics were initiated at 6, 18, 48, or 72 h after infection (six injections at 12-h intervals) . In the immunocompetent mice, 100% survival was obtained with sparfloxacin (50 mg/kg) and amoxicillin (5 mg/kg) against both penicillin-susceptible and macrolide-resistant strains; ciprofloxacin gave significantly lower survival rates . Two to four injections of sparfloxacin completely cleared bacteria from lungs and blood; the most rapid eradication was achieved with amoxicillin . Sparfloxacin also fully protected leukopenic mice against penicillin-resistant strains . The dose of amoxicillin (50 mg/kg) required to protect mice and eradicate penicillin-resistant and multiresistant strains was 10 times higher than that effective against penicillin-susceptible strains . The microbiological and pharmacokinetic properties of sparfloxacin (e.g., the time during which concentrations exceed the MIC of the test pathogen) accounted for its efficacy against susceptible and resistant strains of S . pneumoniae in this model.

Zentralbl Bakteriol, 1992 Dec, 277(4), 493 - 503
Extracellular deoxyribonucleases of streptococci: a comparison of their occurrence and levels of production among beta-hemolytic strains of various serological groups; Ferreira BT et al.; Production of extracellular deoxyribonuclease by 394 strains of beta hemolytic streptococci was examined employing a deoxyribonucleic acid-methyl green assay . Enzymatic activities were measured in supernatants of bacterial cultures . Of the strains tested, 316 (80%) produced the enzyme . Nuclease production was demonstrated in 100% of group A strains and in 85, 74 and 58% of groups B, C and G, respectively . Levels of nuclease activity were then evaluated statistically . The analysis of variance showed that group A strains produced more enzyme than did streptococci of groups B, C or G . Group B strains produced less nuclease than did isolates of groups C or G . There was no significant difference in the levels of nuclease produced by groups C and G or by the various serological types of group B streptococci . Human group C strains produced more enzyme than animal strains.

Minerva Stomatol, 1992 Dec, 41(12), 577 - 81
{Roxithromycin in dental infections}; Pappalardo G et al.; Roxithromicin is a semisynthetic macrolide antibiotic, with similar antibacterial activity to erythromycin . It is characterized by an excellent pharmacokinetic profile and a good tissue penetration . Particularly at the dose of 300 mg per day the dental tissue diffusion is extremely good, and this is important to oppose the oral cavity infections . Oral cavity infections can be either odontogenic or non odontogenic . Odontogenic infections are typically primary and are caused by commensal bacteria (oral Streptococci, Bacteroides sp., Veillonella sp . and Fusobacterium sp.) . The antibacterial spectrum of roxithromycin is very large and includes many of the most frequent strains responsible for oral cavity infections . A very interesting characteristic of roxithromycin is its penetration in macrophages (uptake) that allow a more rapid inhibition of bacterial activity . To evaluate the clinical efficacy and tolerance of roxithromycin in the treatment of odontogenic infections, an open study was performed . This study evaluated both the microbiological and clinical aspects . Thirty patients (21 females and 9 males) who had not been previously treated with antibiotic or antibacterial drugs, affected by infective dysodontiasis, gingivitis and periodontal diseases, received 300 mg per day (once a day) of roxithromycin for an average period of 6 days . The symptomatology considered was: intumescence, redness, pain, lymphangitis and presence of trismus . Clinical symptomatology was assessed at the start and at the end of the treatment . The symptomatological improvement due to roxithromycin was rapid and very effective . After 6 days of therapy, the improvement was statistically significant (p < 0.01) compared to basal conditions . No adverse reactions or side-effects were complained during the study . No changement were detected in laboratory parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral Microbiol Immunol, 1992 Dec, 7(6), 326 - 31
Immunoglobulin A antibody activity to mutans streptococci in parotid, submandibular and whole saliva; Widerstrom L et al.; Antigen extracts of 9 strains of Streptococcus mutans, Streptococcus sobrinus, Streptococcus salivarius and Streptococcus mitis were separated in acrylamide gels by electrophoresis . Strains of the same genotype of mutans streptococci were found to have virtually identical sodium dodecyl sulfate-polyacrylamide gel electrophoresis patterns but differed clearly from other genotypes of mutans or with the reference strains S . salivarius and S . mitis . Immunoglobulin A (IgA) antibody activity to antigens of S . mutans, S . sobrinus and S . mitis in the parotid, submandibular and whole saliva of 12 people was detected by Western blotting . IgA antibodies reacted with several of the antigens, and the reaction pattern was unique for each of the individuals . To certain antigens, all the salivas blotted bands if both clear and questionable bands were counted . Significantly more blotted bands were revealed with antigens from S . mutans than S . sobrinus . The results of the 3 different salivas of the same individual had a high degree of resemblance but in a few individuals, more blotted bands were obtained with parotid saliva to S . mutans and S . sobrinus antigens.

Oral Microbiol Immunol, 1992 Dec, 7(6), 321 - 5
Serum antibody responses to Streptococcus mutans antigens in humans systemically infected with oral streptococci; Russell MW et al.; Sera from patients with subacute bacterial endocarditis (SBE) due to Streptococcus mutans or other oral streptococci and from normal subjects were assayed by enzyme-linked immunosorbent assay for antibodies to defined S . mutans antigens . Antibodies of IgG and IgA isotypes to Ag I/II and Ag III were greatly elevated in S . mutans-SBE sera, and the IgA antibodies in 3 sera included both polymeric and monomeric forms . Elevated IgM and IgG anti-lipoteichoic acid and IgG and IgA anti-serotype c polysaccharide antibodies were also found . The sera of 4 of 6 patients infected with other oral streptococci also displayed antibodies to S . mutans Ag I/II . Sera of 3 patients infected with Streptococcus mitis or Streptococcus oralis, but none of the S . mutans-infected cases, showed elevated antibodies to human heart sarcolemma, and all SBE sera had elevated rheumatoid factor . These results suggest that the known surface protein antigens of S . mutans are immunodominant in humans, and are not likely to be heart cross-reactive.

Southeast Asian J Trop Med Public Health, 1992 Dec, 23(4), 705 - 10
Streptococcal throat carriage in school children with special reference to seasonal incidence; Prakash K et al.; A number of studies on throat carriage of beta hemolytic streptococci (BHS) carried out during the years 1972-90 in urban and rural school children from low socioeconomic groups in the age group of 5-15 years in and around Delhi showed an overall carriage rate of BHS varying from 12.2%-64.3% depending upon the season and number of swabs taken . Group A was found to be the most predominant serological group (31.1%-62.6%) . The T-typability was found to be 98.2% . The most prevalent T-patterns observed during 1972-78 study were 3/13/B3264 followed by 5/11/12/27/44 . A significant difference was observed in the prevalence of T-patterns during the study of 2,034 children from 1979-83 and 3,094 children from 1984-90 . When the most prevalent T-patterns were found to be 5/11/12/27/44 followed by 3/13/B3264 . The study of the school children from 1972-90 showed the isolation of BHS as well as significant predominance of GAS (p < 0.001) in winter months than summer months . There was no difference in the distribution of carriage of BHS and GAS amongst rural or urban school children . Since RF/RHD are illnesses which were often encountered in school children among socially and economically disadvantaged populations stronger support for streptococcal surveillance programs should be encouraged.

Kansenshogaku Zasshi, 1992 Dec, 66(12), 1634 - 8
{Significance of normal oral flora, particularly group oral streptococci as defense mechanism against infection in healthy individuals (normal defense mechanism by oral Streptococcus group)}; Fujimori I et al.; The alpha-streptococci, consisted of normal oral flora mainly, with inhibitory activity against pathogenic microbes in healthy individuals was investigated by group A Streptococcus (indicator strain 6-22 nonmucoid T-12) . Rate of alpha-streptococci with inhibitory activity against group A Streptococcus was increased as aging, and the rate in pre-school children was higher than that in school children . These results suggested that more than 90% of the tested alpha-streptococci with strong inhibitory activities (S . salivarius) against indicator strain had inhibitory activities against group A Streptococcus (mucoid T-6), H . influenzae, S . pneumoniae, group C Streptococcus, and from 40% to 70% of the tested strains had also inhibitory activities against other pathogens . As there were many strains of alpha-streptococci with inhibitory activities against pathogens, that usually detected in the upper respiratory infection, the problem on the strains in the future will explain significance of the defense mechanism against upper respiratory infection and this can be applied clinically.

Indian Pediatr, 1992 Dec, 29(12), 1491 - 4
Subclinical group A streptococcal throat infection in school children; Gupta R et al.; Seven hundred and forty nine apparently healthy school children aged 5-15 years were investigated for throat infection with Group A streptococci (GAS) during December 1990 to May 1991 . The prevalence of beta hemolytic streptococci (BHS) was 18.8%; most organisms belonged to Group A streptococci (13.7%) . The prevalence of BHS in throat was significantly higher (p < .001) in girls as compared to boys . Immune response to extracellular antigens was studied in 53 children who had GAS strain in their throat, 54.7% had elevated titers of antistreptolysin O or antideoxyribonuclease B or both indicating subclinical infection with GAS . Thus it is recommended that serological examinations should be done along with throat culture to identify subclinical Group A streptococcal throat infection.

Eur J Clin Microbiol Infect Dis, 1992 Dec, 11(12), 1136 - 43
Virulence properties of erysipelas-associated group A streptococci; Norrby A et al.; Group A streptococcal isolates (n = 53) recovered from 38 erysipelas patients in 1988 and 1990 in Sweden were analysed with respect to serotype, erythrogenic toxin production and polymorphism in the emm gene region . Serotype determination showed a dominance of type T1M1 (28.6% of the strains), but T type 8 was also prevalent (14.3%) . In the majority of the strains only a low production of erythrogenic toxin A was demonstrated, while both toxin B and C production were high . Polymorphism was detected in the emm gene region of T1M1 strains at a frequency of 64% . These erysipelas associated group A streptococci were more heterogenic with respect to serotype distribution and polymorphism in the emm gene region compared to previously studied group A streptococci isolated during an outbreak of serious streptococcal infections in Sweden in 1988/1989 . The material included isolates from two cases of recurrence, and typing of the isolates indicated that the patients had been infected by the same serotype as in the primary infection.

Rev Port Cardiol, 1992 Dec, 11(12), 1067 - 76
{Infective endocarditis: analysis of 300 episodes}; Mansur AJ et al.; PURPOSE: Study of clinical features and etiologic agents, treatment and mortality of patients with infective endocarditis (IE) . PATIENTS AND METHODS: 300 episodes of IE occurring in 288 patients, ages ranged between 0.2 and 78 (mean 30.76) years; 185 (62%) episodes occurred in males . RESULTS: a) etiologic agents: viridans group streptococci in 93 (31%) episodes, enterococci en 21 (7%), group D-non enterococci in 19 (6%) (13 S . bovis), other streptococci in 14 (5%), Staphylococcus aureus in 59 (20%), Staphylococcus epidermidis in 14 (5%), gram-negative bacteria in 16 (5%), gram-positive bacteria other than streptococci and staphylococci and staphylococci in 8 (3%), fungi in 4 (1%) . The etiologic agents were not identified in 52 (17%) episodes; b) underlying cardiac diseases: valvular heart disease in 119 (40%) episodes, congenital heart disease in 37 (12%), prosthetic heart valves in 69 (23%), other heart diseases in 6 (2%) . There was no evidence of previous heart disease in 69 (23%); c) treatment: surgical treatment was undertaken in 102 (34%) episodes . The frequency of surgical treatment in relation to the etiologic agents ranged between 1% (non-group D streptococcus) and 62% (negative blood cultures) . The frequency of operation in relation to underlying heart disease ranged between 17% (other heart diseases), 19% (congenital heart disease) and 54% (prosthetic heart valve); d) mortality: 78 (26%) patients died, 56 (28%) of the 198 submitted to medical treatment and 22 (21%) of the 102 submitted also to surgical treatment . The mortality in the different groups of etiologic agents ranged between 5% (non group D streptococcus) and 62% (gram-positive bacteria other than streptococci ans staphylococci); in relation to the underlying with other heart disease, 19% in valvular heart disease patients, 21% in patients with congenital heart disease, 23% in patients without known heart disease and 43% in patients with prosthetic heart valves . CONCLUSION: The mortality associated with IE remains still high in spite of modern treatment; the mortality is different in relation to the cardiac status before the IE.

Jpn J Antibiot, 1992 Dec, 45(12), 1609 - 21
{Antibacterial activity of rokitamycin against fresh clinical isolates}; Deguchi K et al.; We obtained bacterial strains which were clinically isolated and identified from outpatients with various infections in medical institutions throughout Japan . Possible antibacterial activities of rokitamycin (RKM) were examined against these isolates . Minimum inhibitory concentrations (MICs) were determined through a comparative study with reference drugs . The results of the study are summarized as follows . 1 . Resistance patterns of 400 isolates which were highly resistant to macrolides (MLs) with MIC values > 100 micrograms/ml were classified into 55 patterns . Staphylococcus spp . showed cross resistance to 14-membered ring MLs with 100% cross resistance observed between erythromycin (EM) and clarithromycin (CAM), and 85.2% between EM and oleandomycin (OL) . Fewer isolates showed strong resistance to 16-membered ring MLs than to 14-membered ring MLs . Cross resistances observed among the Staphylococcus isolates were 100% between acetylmidecamycin (MDM-AC) and kitasamycin (leucomycin (LM)), 93.9% between MDM-AC and josamycin (JM), and 53.3% between MDM-AC and RKM . Streptococcus spp . and Peptococcus spp . showed very similar resistance patterns to both 14- and 16-membered ring MLs, but resistance patterns to RKM were quite different . Most of anaerobic streptococci and Bacteroides fragilis group had similar resistance patterns to 14- and 16-membered ring MLs, but in some cases a pattern similar to that of Staphylococcus spp . was observed . 2 . When ML-resistant bacteria isolated during 1975 to 1980 were compared to those isolated in 1986 and 1989, it was observed that resistance of Staphylococcus aureus remained almost unchanged, that of Streptococcus pyogenes was lower in the later years than during 1975 to 1980, but that of Streptococcus pneumoniae increased . 3 . Most of ML-resistances of the resistant isolates were inducible, but extents of induction varied depending on drugs tested . Strong inductions were observed when 14-membered ring MLs were used, but inductions were minimal with 16-membered ring MLs . RKM appeared to induce resistance to the least extent . From these results, it appears that the RKM is quite useful clinically even in the 1990s.

Antimicrob Agents Chemother, 1992 Nov, 36(11), 2539 - 41
Penetration of vancomycin in uninfected sternal bone; Massias L et al.; Concentrations of vancomycin in sternal bones of 10 patients undergoing cardiac surgery were studied at steady state, 48 h after starting intravenous prophylaxis . A sample of sternal bone was taken before (group I) or after (group II) cardiopulmonary bypass . The mean vancomycin concentrations in sternal bones were not significantly different between the groups and were 9.3 +/- 3.0 micrograms/g . The concentrations of vancomycin in sternal bones were always above the MICs for staphylococci, streptococci, and enterococci.

Antimicrob Agents Chemother, 1992 Nov, 36(11), 2403 - 7
Optimal aminoglycoside dosing regimen for penicillin-tobramycin synergism in experimental Streptococcus adjacens endocarditis; Saleh-Mghir A et al.; The combination of penicillin and aminoglycoside is the recommended therapy for endocarditis caused by nutritionally variant streptococci (NVS) . However, the optimal aminoglycoside dosing regimen remains controversial . We compared the efficacies of four regimens of tobramycin alone or combined with procaine penicillin in the therapy of rabbits with endocarditis caused by Streptococcus adjacens, a new species of NVS . Animals were injected intramuscularly for 4 days with procaine penicillin (150,000 U/kg of body weight twice daily) or tobramycin at a low dose (3 mg/kg every 24 h) or a high dose (12 mg/kg every 24 h) either once or three times daily (t.i.d.) alone or in combination with procaine penicillin . Additional groups of animals were treated with the combination regimens for a shorter period of time (2 days) in order to demonstrate a possible difference in the rapidity of efficacy between the regimens . The MICs and MBCs were 0.015 and 1 micrograms/ml and 8 and 16 micrograms/ml for penicillin and tobramycin, respectively . The mean peak tobramycin levels in plasma were 2.4 +/- 1.3 (1 mg/kg t.i.d.), 5.4 +/- 3.7 (4 mg/kg t.i.d.), and 25 +/- 9.3 (12 mg/kg once daily) . The mean penicillin levels in serum were always above the MIC . In vitro kill curves plotted at the time that peak concentrations were reached in plasma showed a concentration-dependent killing effect of tobramycin alone but not in combination with penicillin . In vivo, low-dose tobramycin was significantly less effective than the high dose . Results for the combinations of the different dosing regimens of tobramycin with procaine penicillin were not significantly different . Our results suggest that (i) against susceptible strains of streptococci, aminoglycoside alone exhibits a concentration-dependent killing effect both in vitro and in vivo; (ii) against NVS strains, combinations of penicillin and high- or low-dose tobramycin are equally effective; and (iii) aminoglycoside given once daily or at a low dose t.i.d . with penicillin could be a cost-effective alternative with reduced toxic risk for patients with NVS endocarditis when the bacteria are susceptible to the killing activities of both compounds.

Chem Pharm Bull (Tokyo), 1992 Nov, 40(11), 2970 - 4
Isoflavanones from the heartwood of Swartzia polyphylla and their antibacterial activity against cariogenic bacteria; Osawa K et al.; The methanolic extract of Swartzia polyphylla DC . heartwood had antibacterial activity against cariogenic bacteria, the mutans Streptococci . The chromatographic purification of the extract afforded seven flavonoids . Among them, three known isoflavanones, dihydrobiochanin A, ferreirin and darbergioidin, and one new isoflavanone, 5,2',4'-trihydroxy-7-methoxyisoflavanone (dihydrocajanin) had potent antibacterial activity against cariogenic bacteria . This effect was not detected on isoflavone derivatives . A comparative antibacterial study of various flavonoids was further performed, and their structure-activity relationship was discussed.

Acta Pathol Jpn, 1992 Nov, 42(11), 832 - 6
An autopsy case of invasive pituitary adenoma (prolactinoma) with rapid fatal clinical course due to streptococcal meningitis; Onoda N et al.; A 44-year-old male suffered epistaxis and headache of sudden onset and was diagnosed as having suppurative meningitis due to streptococci . Four days after the onset of symptoms, he died despite treatment with antibiotics . Destruction and ballooning of the sella turcica was revealed by a plain head X-ray examination during the clinical course . At autopsy, a massive tumorous lesion extended from the ballooned sella turcica to the paranasal cavities, nasopharynx and facial bone, and this had resulted in suppurative meningitis . The tumor was also disseminated to the basal skull . The tumor cells possessed prominent nuclear atypia and were immunohistochemically positive for prolactin . This was diagnosed as a case of pituitary adenoma with markedly invasive pathological findings and a rapid and fatal clinical course.

Pediatr Infect Dis J, 1992 Nov, 11(11), 914 - 9
Outbreak of group A streptococcal infection in a day-care center; Falck G et al.; During an outbreak of streptococcal infections in a day-care center it is often difficult to determine the source and extent of the outbreak and the optimal means of management . An intervention strategy based on repeated throat cultures and initial antibiotic treatment of culture-positive individuals was used during an outbreak of respiratory tract infections with Group A streptococci at a day-care center . The spread of streptococci carriers was studied . Two weeks after the diagnosis of the index case, 61% of the 30 children were colonized with Group A streptococci . From 20 to 30% of the children remained streptococcal carriers, but they did not give rise to secondary cases . Initially the environment was heavily contaminated with Group A streptococci . Damp material might constitute a potential source of streptococcal spread . All Group A streptococcal strains belonged to the same serotype, T12M12 . Prompt recognition and intervention are important to prevent spread of streptococcal infection to many day-care attenders.

Pediatr Infect Dis J, 1992 Nov, 11(11), 907 - 12
Infective endocarditis in children; Baltimore RS; IE in children is associated primarily with underlying congenital structural heart lesions, predominantly septal defects or complex lesions involving septal defects . During the past 20 years IE associated with rheumatic heart disease has declined to a negligible number . Recently nosocomial catheter-associated bacteremia has been associated with the development of IE, especially in infants . Streptococci are most frequently associated with IE involving natural valves . Although streptococci have also been implicated in cases of IE associated with previous surgery or catheter-related infection, staphylococci, Gram-negative rod species and multiple infecting species are also encountered in this setting . Because infection can often be managed medically, removal of grafts or prosthetic valves is not necessary unless clinical or microbiologic failure occurs . Penicillin with or without an aminoglycoside is the regimen for most community-acquired streptococcal IE . A penicillinase-resistant beta-lactam generally is substituted for penicillin in IE caused by an unknown agent and is used in cases of staphylococcal IE . For IE caused by resistant staphylococci, vancomycin is the alternative agent . Currently there is limited information on the efficacy of alternative agents for treating IE caused by enterococci or staphylococci with multiple antibiotic resistance.

J Clin Microbiol, 1992 Nov, 30(11), 3028 - 9
Detection of diacetyl (caramel odor) in presumptive identification of the "Streptococcus milleri" group; Chew TA et al.; The caramel odor associated with the "Streptococcus milleri" group was shown to be attributable to the formation of the metabolite diacetyl . Levels of diacetyl in the 22- to 200-mg/liter range were produced by 68 strains of the "S . milleri" group; apart from one strain of Streptococcus mutans, all 92 other strains of streptococci belonging to 12 species produced < 13 mg of diacetyl per liter . Quantitation of diacetyl levels from cultures of streptococci is suggested as a rapid presumptive test for the "S . milleri" group.

Proc Natl Acad Sci U S A, 1992 Nov 1, 89(21), 10060 - 4
Large, identical, tandem repeating units in the C protein alpha antigen gene, bca, of group B streptococci; Michel JL et al.; Group B Streptococcus (GBS) is the leading cause of neonatal sepsis and meningitis in the United States . The surface-associated C protein alpha antigen of GBS is thought to have a role in both virulence and immunity . We previously cloned the C protein alpha antigen structural gene (named bca for group B, C protein, alpha) into Escherichia coli . Western blots of both the native alpha antigen and the cloned gene product demonstrate a regularly laddered pattern of heterogeneous polypeptides . The nucleotide sequence of the bca locus reveals an open reading frame of 3060 nucleotides encoding a precursor protein of 108,705 Da . Cleavage of a putative signal sequence of 41 amino acids yields a mature protein of 104,106 Da . The 20,417-Da N-terminal region of the alpha antigen shows no homology to previously described protein sequences and is followed by a series of nine tandem repeating units that make up 74% of the mature protein . Each repeating unit is identical and consists of 82 amino acids with a molecular mass of 8665 Da, which is encoded by 246 nucleotides . The size of the repeating units corresponds to the observed size differences in the heterogeneous ladder of alpha C proteins expressed by GBS . The C-terminal region of the alpha antigen contains a membrane anchor domain motif that is shared by a number of Gram-positive surface proteins . The large region of identical repeating units in bca defines protective epitopes and may play a role in generating phenotypic and genotypic diversity of the alpha antigen.

J Pediatr, 1992 Nov, 121(5 Pt 1), 735 - 7
Arcanobacterium haemolyticum in children with presumed streptococcal pharyngotonsillitis or scarlet fever; Karpathios T et al.; Arcanobacterium haemolyticum was cultured from pharyngeal specimens obtained from 12 of 129 children with pharyngotonsillitis, some of whom had a scarlatiniform rash . This organism should be considered to be a cause of infections that are clinically similar to those caused by beta-hemolytic streptococci.

J Infect Dis, 1992 Nov, 166(5), 1014 - 20
Genetic diversity in T1M1 group A streptococci in relation to clinical outcome of infection; Norgren M et al.; Genetic diversity was found at high frequency downstream of the emm1 gene among T1M1 group A streptococci (GAS) isolated in Scandinavia during a recent epidemic . Clonal variation was also seen in the speA and speB genes but at much lower frequency; no variation was detected in the speC gene . Erythrogenic toxin A was found to be expressed at low levels in all strains; erythrogenic toxins B and C were produced in high amounts . All strains were found to harbor the speA, speB, and speC genes, regardless of the amount of toxin produced . No correlation was found between one specific T1M1 clone and the more serious infections when isolates from bacteremic patients (fatalities or survivors), those with uncomplicated infections, and healthy carriers were compared . Similar results were obtained in a family study in which 3 family members were found to be asymptomatic carriers of the same GAS T1M1 clone as in the bacteremic patient, defined by genotypic and phenotypic experiments.

J Infect Dis, 1992 Nov, 166(5), 1006 - 13
Prevalence and characteristics of pharyngeal group A beta-hemolytic streptococci in US Navy recruits receiving benzathine penicillin prophylaxis; Heggie AD et al.; US military recruits receive benzathine penicillin prophylaxis because of endemicity of group A beta-hemolytic streptococcal (GABHS) infections . GABHS prevalence in Navy recruits receiving single-dose benzathine penicillin prophylaxis was assessed during spring and fall 1989 by culturing throat specimens from randomly selected groups of approximately 230 men before and 2, 4, and 7 weeks after prophylaxis and from men with pharyngitis diagnosed at sick call . Of 60 GABHS isolates, 75% were serotype M-3 . The pharyngitis rate increased from 0.18% in the spring to 1.55% in the fall with a concurrent increase in serotype M-3 prevalence from 35% to 91% . The GABHS prevalence rate was three- to fourfold lower after prophylaxis . There were no cases of acute rheumatic fever (ARF) despite predominance of M-3, a rheumatogenic serotype . It was concluded that penicillin prophylaxis continues to be effective for control of GABHS infections and prevention of ARF in Navy recruits.

J Dent Res, 1992 Nov, 71(11), 1785 - 91
Effect of xylitol consumption on the plaque-saliva distribution of mutans streptococci and the occurrence and long-term survival of xylitol-resistant strains; Trahan L et al.; Since the exposure of mutans streptococci to xylitol is known to select for xylitol-resistant (XR) natural mutants, the occurrence and long-term survival of such xylitol-resistant strains was evaluated in a cross-sectional sampling of participants of the Ylivieska xylitol study four years after the original two-year experimental period . Paraffin-stimulated whole saliva was first collected, and then plaque was collected and pooled . The salivary and dental plaque mutans streptococci were enumerated after growth on TSY20B agar . The proportion of XR strains was determined by autoradiography with 14C-xylitol . A strong and significant correlation (r = 0.645 and p = 0.005) between the number of mutans streptococci in saliva and in dental plaque was observed in non-consumers of xylitol . Such a correlation totally disappeared (r = 0.098 and p = 0.612) in xylitol-exposed consumers (habitual and former xylitol-consumers) . The proportion of the salivary XR mutants (35%) in non-consumers (n = 16) was significantly lower than in the xylitol-exposed consumers (79%) (n = 27), (p = 0.0001) or in former consumers (75%) (n = 13), (p = 0.0008) or in the habitual consumers (83%) (n = 14), (p = 0.004) . The proportion of XR mutants in dental plaque was, on the average, much lower than in the corresponding saliva . The proportion of XR in the plaque of xylitol non-consumers was half of that of the xylitol-exposed group, but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Infect Immun, 1992 Nov, 60(11), 4621 - 32
Characterization of the Streptococcus mutans GS-5 fruA gene encoding exo-beta-D-fructosidase; Burne RA et al.; The complete nucleotide sequence (5,010 bp) of the fructanase gene (fruA) and flanking regions of the chromosome of Streptococcus mutans GS-5 was determined . The fruA gene appears to be the sole transcript arising from a proximal promoter . The presumed precursor of the secreted FruA protein consists of 1,423 amino acids, and it has an M(r) of 158,656 and a pI of 4.82 . The N terminus of FruA has characteristics in common with signal peptides of gram-positive organisms . The C terminus consists of a serine- and threonine-rich region, followed by the peptide LPDTGD, 4 charged amino acids, 21 amino acids with a strongly hydrophobic character, and a charged pentapeptide tail, which are proposed to correspond to the wall-spanning region, the LPXTGX consensus sequence, and the membrane-spanning domains of surface-associated proteins of gram-positive cocci . The FruA protein has significant homology with the Bacillus subtilis levanase (SacC), the Bacteroides fragilis levanase (ScrL), yeast invertases, and a number of other beta-fructosidases but not with fructosyltransferase, glucosyltransferases, or glucan-binding proteins of oral streptococci . Genes with homology to fruA were detected in S . mutans serotype c, e, and f strains, Streptococcus rattus, Streptococcus salivarius, and Streptococcus sanguis . A deletion derivative of FruA lacking the C-terminal 437 amino acids was still functional and could hydrolyze beta-(2,6)- and beta-(2,1)-linked sugars, but with altered preference for substrates . The data begin to define functional domains of the FruA protein and potential regulatory sites for induction, repression, growth rate control, and posttranslational localization of this multifunctional enzyme.

Infect Immun, 1992 Nov, 60(11), 4558 - 62
Influence of serotype of group B streptococci on C3 degradation; Campbell JR et al.; Serotype III strains of group B streptococci (GBS) are isolated from the majority of young infants with bacteremia or meningitis . We hypothesized that serotype-associated differences in structure of the type-specific capsular polysaccharide or the presence of c protein would influence the extent to which C3 degradation occurs on GBS and that type-specific antibody would alter C3 deposition or degradation patterns . When clinical isolates of GBS representing serotypes Ia, Ib/c, II (with or without c protein) and III were employed with hypogammaglobulinemic serum as an opsonic source, a remarkable similarity was observed in patterns of C3 deposition and degradation for each of the four GBS serotypes and between strains with or without c protein . Both C3b and iC3b were detected by 5 min and throughout a 90-min opsonization interval . Less deposition occurred at 5 min on serotypes Ia and Ib/c than on types II and III GBS . Minimal degradation to C3d or smaller fragments was observed . Type-specific antibody facilitated C3b deposition on GBS and C3b degradation to iC3b early in opsonization . Possibly, accessibility of C3 fragments to neutrophil receptors, rather than the extent to which the surface permits C3 degradation, accounts for differential virulence among GBS serotypes.

Curr Microbiol, 1992 Nov, 25(5), 245 - 50
A 28-kilodalton fibronectin-binding protein of group A streptococci; Courtney HS et al.; Lipoteichoic acid (LTA) has been implicated as a major adhesin of group A streptococci that interacts with fibronectin (Fn) . It has been suggested that protein adhesins may also be involved in the binding of Fn to streptococci . We searched for such a protein by transblotting membrane preparations from M types 5, 19, and 24 group A streptococci to nitrocellulose and reacting the blot with 125I-Fn . The Fn reacted with a 28-kDa polypeptide from all three serotypes of streptococci . Using affinity-purified antibodies to the 28-kDa protein in immunoblots of membrane preparations from various streptococci, we demonstrated that the 28-kDa protein is present in all 17 strains tested . Affinity-purified antibodies to the 28-kDa protein also reacted in varying degrees with intact streptococci, demonstrating that the antigen is exposed on the surface of intact organisms . Our results suggest that, in addition to LTA, group A streptococci contain a common Fn-binding moiety that is expressed as a major component of membrane preparations and that is accessible on the surface of streptococci for interactions with Fn.

Antibiot Khimioter, 1992 Nov, 37(11), 37 - 40
{Etiology of inflammatory maxillofacial diseases and estimation of the effectiveness of antibacterial drugs in vitro}; Oleinik II et al.; The results of identification of 710 clinical strains of anaerobic microorganisms isolated from the pathological foci of patients with maxillofacial diseases are presented . The species composition of the microflora associations in the cases with abscesses, phlegmon, lymphadenitis, osteomyelitis and parodontitis is described . Along with a high frequency of nonsporulating anaerobes, staphylococci, microaerophilic streptococci and in the cases with parodontitis actinomycetes, Bacillus licheniformis and Bacillus coagulans strains (1.6-15% of the isolated strains) were first detected in cases with various forms of the disease . Two groups of the drugs effective against the anaerobes were identified by the data on the antibiotic sensitivity . The lowest MICs along with the activity broad spectrum were defined for gramicidin, levomycetin and nitazol.

Eur J Clin Microbiol Infect Dis, 1992 Nov, 11(11), 1074 - 80
German multicentre study on the in vitro susceptibility of Bacteroides species . The German Bacteroides Study Group; Rodloff AC et al.; In 1990 the first German multicentre study on the in vitro susceptibility of Bacteroides species was completed . Employing a commercially prepared microbroth dilution assay, nine participating institutions evaluated approximately 100 consecutive isolates of Bacteroides species from relevant clinical specimens . A total of 911 strains (449 Bacteroides fragilis, 201 Bacteroides thetaiotaomicron, 79 Bacteroides ovatus, 78 Bacteroides vulgatus, 77 Bacteroides distasonis, 25 Bacteroides uniformis, 2 others) were tested . Most of the isolates came from surgical patients (72%); other sources included gynaecological patients (9%) and medical patients (5%) . Seventy-eight percent of the anaerobes were found in mixed culture together with at least one aerobic organism (Escherichia coli 36%, streptococci 15%, or enterococci 13%), while in 22% of the cases, the anaerobes were the only bacteria grown from the specimens . The results showed that many of the strains were potent beta-lactamase producers (as judged by resistance to amoxicillin) . However, all but one of the isolates demonstrated susceptibility in vitro when clavulanic acid was added to amoxicillin or ticarcillin . At the same time, 13% of the organisms were resistant to mezlocillin, 5% to cefoxitin and 4% to clindamycin . Three strains were reported resistant to imipenem and one strain to metronidazole.

Kansenshogaku Zasshi, 1992 Nov, 66(11), 1497 - 501
{Characteristics of group A streptococci isolated from children with non-suppurative complication or severe infection}; Fujita K et al.; We determined the characteristics of group A streptococci isolated from 29 sporadic cases with non-suppurative complication or severe infection during a 15-year period from 1977 to 1991 . The clinical diagnoses of children included 4 patients with rheumatic fever, 2 with reactive arthritis, 2 with central nervous system complication, 5 with glomerulonephritis, 11 with Honoch-Scholein purpura, 4 with sepsis and 1 with empyema . Twenty-four strains were isolated from throat swabs, 4 from blood specimens and one from pleural fluid . M/T-serotypes and the number of isolates were as follows; 1/1:10, 3/3:1, 3.3R/3:3, 4/4:7, 5/NT:1, 12/12:3, 18/18:2, 62/12:1, NT/13:1 . All 29 isolates had productivity for at least one of streptococcal pyrogenic exotoxins (SPEs) A, B and C . Two strains were positive for A, 2 for A and B, 3 for A, B and C, 9 for B and 13 for B and C . Of 11 isolates from patients with Henoch-Schonlein purpura, 7 and 2 strains were serotyped in M1 and M4, respectively, but none was in M12 . Ten of 11 isolates were positive for SPE B or SPEs B and C.

Z Geburtshilfe Perinatol, 1992 Nov-Dec, 196(6), 229 - 37
{Further experiences with ovum lavage with respect to preventing premature labor}; Brandt-Niebelschutz S et al.; Between January and December 1990, lavage of the ovum was performed in 64 gravidae with actual or potential symptoms of premature labour . Subsequently the lavage fluid was microbiologically examined . The present study discusses the indications for this new method, how it is performed and the results obtained . Microorganisms possibly necessitating treatment were detected in the lavage fluid of 30 (47%) of the gravidae at risk . Thirty-nine patients manifested actual symptoms of imminent premature birth, such as labour or critical cervical status . Results of fluid tests were positive in 23 (59%) of these patients, while according to the results of conventional cervical or vaginal smear tests performed simultaneously, treatment was necessary in only 13% of them . The majority of the microorganisms in the lavage fluid (coagulase-negative, haemolytic and group D streptococci were usually detected) are only facultatively pathogenic and are found in small quantities in cervical smears as normal "local flora" . The mean delivery date was in gestational week (GW) 37/1, and for patients with antibiosis produced by a suitable antibiotic in GW 38/3 (10 weeks after lavage was performed) . In view of the results of this study, bacteriological testing of ovum lavage fluid may be regarded as a useful complementary method for detecting ascending infections . It may advance pathogenetic research into late abortion and premature birth and further reduce the premature birth rate.

Int J STD AIDS, 1992 Nov-Dec, 3(6), 418 - 22
The role of maternal syphilis, gonorrhoea and HIV-1 infections in spontaneous abortion; Temmerman M et al.; The role of the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) as risk factor for spontaneous abortion was investigated in a case-control study in Nairobi, Kenya . Cases (n = 195) were women admitted with clinical signs and symptoms of spontaneous abortion, before 20 weeks of gestation . Patients with induced or clinically septic abortion were excluded . Controls were unselected pregnant women in their second or third trimester (n = 195) . Spontaneous abortion was independently associated with maternal HIV-1 antibody (14.4% versus 6.2%; adjusted odds ratio, 2.3; 95% confidence interval, 1.1-4.8), with maternal syphilis seroreactivity (6.8% vs 2.1%, adjusted odds ratio, 4.3; 95% confidence interval 1.2-15.6), and with vaginal colonization with group B streptococci (15.6% vs 5.2%; adjusted odds ratio, 3.2; 95% confidence interval, 1.5-6.7) . No significant association was found between maternal infections with gonococci and genital mycoplasmas, and spontaneous abortion.

Med J Aust, 1992 Oct 19, 157(8), 521 - 2
Group A streptococcal infection in an aboriginal community; Nimmo GR et al.; OBJECTIVE: To determine whether group A streptococcal infection and poststreptococcal sequelae are still a significant health issue for Aboriginal communities . DESIGN: A cross-sectional survey of streptococcal carriage, infection and antibody levels . SETTING: A north Queensland Aboriginal community . PARTICIPANTS: One hundred and twenty preschool and school-aged children (2 to 12 years of age) living in the Lockhart River Community on Cape York Peninsula . RESULTS: Pyoderma was present in 43% of the children and in 76% of these culture of skin lesions grew group A streptococci . Group A streptococci also grew from 13% of throat swabs, making a total of 36% of children culture positive . Anti-streptolysin O and anti-DNAase B levels were remarkably high and increased with age . CONCLUSIONS: The evidence presented confirms a high level of group A streptococcal carriage and infection in children of the Lockhart River Community . Further investigation of this problem is warranted in other Aboriginal communities with a view to instituting appropriate control programs.

J Immunol, 1992 Oct 15, 149(8), 2729 - 35
Conserved T and B cell epitopes on the M protein of group A streptococci . Induction of bactericidal antibodies; Pruksakorn S et al.; To identify conserved T and B cell epitopes on the M protein of group A beta-hemolytic streptococci, overlapping synthetic peptides that span the conserved carboxyl-terminal segment of the M-5 protein were constructed and used to immunize a panel of H-2 congenic mice . Proliferative T cell epitopes were identified and, in many cases, mice immunized with these peptides produced high titer antibodies to the same peptides indicating that these proliferative epitopes could also stimulate Th cells . Peptide-specific T cells and antisera were tested for their reactivity with porcine myosin, tropomyosin, human heart myosin synthetic peptides, and extracts of human pericardial and atrial heart tissue . Although there was minimal response of M peptide-specific T cells to any of these Ag, certain M peptide-specific antisera reacted to immunoblotted porcine myosin and to an immunoblotted extract of human atrial heart tissue . However, two conserved peptides, LRRDLDASREAKKQVEKALE and KLTEKEKAELQAKLEAEAKA, stimulated peptide-specific antibodies in B10.BR and B10.D2 mice respectively, which reacted minimally if at all with human atrial heart tissue extract . Furthermore, antisera to the former peptide, in a bactericidal assay involving human monocytes, could mediate killing of streptococci (82% of bacteria) . Although this level of killing is less than that produced by antisera to the highly polymorphic type-specific aminoterminus (up to 100% killing), it provides evidence that conserved epitopes can be the targets of bactericidal antibodies . These conserved epitopes may be useful in a vaccine because they also stimulate T cells, thus allowing development of immunologic memory and natural boosting of an immune response after natural exposure.

Blood, 1992 Oct 15, 80(8), 2012 - 20
Modulation of granulocyte survival and programmed cell death by cytokines and bacterial products; Colotta F et al.; Mature circulating polymorphonuclear cells (PMN) have the shortest half-life among leukocytes and undergo rapid programmed cell death in vitro . In this study, we have examined the possibility that inflammatory signals (cytokines and bacterial products) can regulate PMN survival . PMN in culture were found to rapidly die, with percentages of survival at 24, 48, 72, and 96 hours of 97.3% +/- 1.9%, 36.8% +/- 5.3%, 14.5% +/- 3.1%, and 4.2% +/- 2.9%, respectively (mean +/- SE of 20 different donors) . PMN incubated with interleukin-1 beta (IL-1 beta), tumor necrosis factor, granulocyte-macrophage colony-stimulating factor (CSF), granulocyte-CSF, and interferon-gamma (IFN-gamma), but not with prototypic chemoattractants (fMLP, recombinant C5a, and IL-8), showed a marked increase in survival, with values ranging at 72 hours of incubation from 89.5% +/- 5.8% for IL-1 beta to 47.6% +/- 6.4% for IFN-gamma . The calculated half-life was 35 hours for untreated and 115 hours for IL-1-treated PMN . PMN activated with lipopolysaccharide (LPS) or inactivated streptococci also showed a longer survival compared with untreated cells (94.4% +/- 3.2% and 95.5% +/- 2.4%, respectively, at 72 hours) . PMN surviving in response to LPS or IL-1 beta retained the capacity to produce superoxide anion when treated with phorbol esters or fMLP . All inducers of PMN survival protect these cells from programmed cell death because they reduced cells with morphologic features of apoptosis and the fragmentation of DNA in multiples of 180 bp . Thus, certain cytokines and bacterial products can prolong PMN survival by interfering with the physiologic process of apoptosis . Prolongation of survival may be important for the regulation of host resistance and inflammation, and may represent a crucial permissive step for certain cytokines and microbial products that activate gene expression and function in PMN.

Gene, 1992 Oct 12, 120(1), 27 - 32
Protein V, a novel type-II IgG receptor from Streptococcus sp.: sequence, homologies and putative Fc-binding site; Smirnov OYu et al.; We have cloned and sequenced the Fc-receptor-encoding gene, fcrV, from a group G streptococcus . Considerable similarity was revealed between the FcRV, FcRA76 and M proteins of group A streptococci in their signal sequences and 3' termini, and between the Fc-binding regions of FcRV and FcRA76 . The promoter and terminator regions showed no homology with those of the fcrA76 and M protein-encoding genes . The A1-A4 domains of FcrV (protein V) exhibit a heptapeptide repeat motif which is characteristic of alpha-helical coiled-coil proteins . The sequence, Ser-Asn-Arg-Ala-Ala, in the outer position, 'f' of each domain is highly conserved and may be involved in FcR-IgG interactions.

Gene, 1992 Oct 12, 120(1), 105 - 10
Novel streptococcal-integration shuttle vectors for gene cloning and inactivation; Tao L et al.; Seven new streptococcal integration shuttle vectors have been constructed which contain different antibiotic-resistance-encoding genes capable of expression in both Streptococcus sp . and Escherichia coli . These plasmids can replicate in E . coli, but not in streptococci because of the absence of a streptococcal origin of replication . The size, antibiotic resistance, and number of unique restriction sites available for cloning for each plasmid are as follows: pSF141 (7.6 kb, CmR and KmR, 7 sites), pSF143 (5.7 kb, TcR, 6 sites), pSF148 (7.3 kb, CmR and SpR, 7 sites), pDL285 (3.4 kb, KmR, 3 sites), pDL286 (3.1 kb, SpR, 4 sites), pSF151 (3.5 kb, KmR, 10 sites), pSF152 (3.2 kb, SpR, 9 sites) . If these plasmids carry a fragment of streptococcal DNA they can specifically integrate into the chromosome via Campbell-like, homologous recombination . Therefore, they should be useful for gene inactivation, cloning, chromosomal walking, or linkage analysis in streptococci . The availability of these integration plasmids resistant to different antibiotics, along with the previously described plasmid, pVA891 (ErR), should also allow the construction of mutants possessing multiple insertionally inactivated genes useful for a variety of genetic studies.

J Immunol Methods, 1992 Oct 2, 154(2), 217 - 23
A quantitative method for measuring the adherence of group B streptococci to murine peritoneal exudate macrophages; Sloan AR et al.; We have developed a solid phase, direct binding, enzyme-linked immunosorbent assay (ELISA) to detect and quantify the adherence of group B streptococci to murine macrophages . The assay correlated well with direct microscopic quantification of adherence . As few as 3.8 x 10(4) bacteria/assay well or less than one bacterium per macrophage could be detected . This assay is both quantitative and selective, and is readily adaptable for multiple sample analysis . It provides a valuable alternative to visual detection of bacterial adherence.

J Infect Dis, 1992 Oct, 166(4), 818 - 26
Role of pulmonary phagocytes in host defense against group B streptococci in preterm versus term rabbit lung; Sherman MP et al.; Intrapulmonary clearance of group B streptococci (GBS) occurred in term rabbits 4 and 8 h after infection; GBS growth was evident in preterm rabbits at 8 h . Bronchoalveolar lavage revealed 17-fold higher numbers of pulmonary alveolar macrophages (PAM) in term versus preterm animals immediately after infection, whereas polymorphonuclear leukocyte (PMNL) recruitment was 13-fold greater in preterm than term rabbits at 8 h . Anti-CD18 monoclonal antibody R15.7 did not reduce PMNL influx or GBS killing in term animals . R15.7 failed to inhibit PMNL influx but augmented GBS growth in preterm animals . R15.7 significantly impaired GBS phagocytosis by preterm and term PMNL in vitro but had no effect on ingestion of GBS by preterm and term PAM . Thus, GBS infection initiates PMNL recruitment into lungs of preterm rabbits by CD18-independent mechanisms, but phagocytosis of GBS by PMNL is largely CD18-dependent . The poorer outcome of GBS pneumonia in preterm versus term newborns may result from low levels of PAM, thereby mandating recruitment of PMNL as a second phagocytic defense.

J Infect Dis, 1992 Oct, 166(4), 783 - 91
Interactions between bacteria and influenza A virus in the development of influenza pneumonia; Scheiblauer H et al.; Different proteases from various microorganisms present in the respiratory tract were capable of enhancing influenza virus infectivity and pathogenicity in mice by proteolytic activation of hemagglutinin (HA) . Aerococcus viridans, isolated from a patient with pneumonia, secreted a protease that could activate HA directly, similarly to some Staphylococcus aureus strains . The protease of Pseudomonas aeruginosa could not activate HA directly, but combined application of P . aeruginosa protease and virus into mice enhanced virus titers and pathogenicity . Generation of trypsin-like activity in bronchoalveolar lavage fluids resulting from this combination treatment may be responsible for HA activation . A similar indirect effect on HA activation was induced by streptokinase and staphylokinase, which are known to generate plasmin by plasminogen activation . It was concluded that plasminogen-activating streptococci and staphylococci facilitate viral replication and pathogenicity of plasmin-sensitive influenza virus strains by amplification of the plasminogen/plasmin system.

Oral Microbiol Immunol, 1992 Oct, 7(5), 304 - 8
Acid production by streptococci growing at low pH in a chemostat under anaerobic conditions; Iwami Y et al.; Streptococcus mutans and other oral streptococci were grown in continuous culture under strictly anaerobic conditions . When the cultural pH was kept at 7.0, the main acid products were formate and acetate, as reported previously . However, more lactate was produced at pH values of 5.5 or 6.0, with a concomitant decrease in formate and acetate production . This change in fermentation products could partly be ascribed to a change in intracellular pH and difference in the pH optima between pyruvate formate-lyase (PFL) and lactate dehydrogenase (LDH) . At extracellular pH values of 7.0 and 5.5, the intracellular pH values of S . mutans NCIB 11723 were 7.5 and 6.6, respectively . The pH optima of PFL and LDH were 7.8 and 5.5-6.3, respectively . The cells had also a larger amount of LDH during growth at pH 5.5 than at pH 7.0.

East Afr Med J, 1992 Oct, 69(10), 547 - 9
Lung abscess in children in Harare, Zimbabwe; Tumwine JK; Despite the rarity of lung abscess in children, 24 patients were treated at Harare Central Hospital during the 10 year period (1979 to 1988) . The bacteriology and clinical findings of the 24 patients are presented . Bacteria were isolated from 18 patients . The most frequent isolates were Staphylococcus aureus, group A beta haemolytic streptococci, and Pseudomonas aeroginosa . Most of the abscesses followed measles, empyema or an episode of aspiration . The patients were managed with bronchoscopy, physiotherapy, and appropriate antibiotics, and had a mortality of 25% . Efforts at controlling measles as well as early and appropriate management of empyema are likely to reduce the number of lung abscesses in childrenPIP: The clinical features, microbiology, treatment, and outcome in 24 children diagnosed with lung abscess at Harare Central Hospital during 1979-88 were reviewed retrospectively . This condition is rare in children, and the present study is the first to address lung abscess in Zimbabweans . 17 (71%) of the 24 patients were male and their mean age was 4.9 years . The most common presenting symptoms were fever, cough, and breathlessness . Abnormal chest signs (e.g., localized dull percussion note, with amphoric or bronchial breathing) were detected in 18 cases . Foremost among the predisposing factors were measles (25%), empyema thoraxis (17%), and unconsciousness (13%) . Bacteria were isolated from 18 children, with Staphylococcus aureus (8 cases), group A beta hemolytic streptococci (4 cases), and Pseudomonas aeruginosa (3 cases) the most common . Treatment consisted of bronchoscopy to aspirate pus from the bronchus and exclude foreign bodies as well as antibiotic administration . There were 6 deaths (25% case fatality rate) . The prevention or prompt treatment of measles is urged to reduce further the incidence of this rare health condition . However, the spread of human immunodeficiency virus infection among children in sub-Saharan Africa is likely to be accompanied by pediatric lung abscess cases secondary to pneumonia .

Immun Infekt, 1992 Oct, 20(5), 161 - 8
{The vir-regulon of Streptococcus pyogenes: coordinate expression of important virulence factors}; Podbielski A et al.; Streptococcus pyogenes (group A streptococci; GAS) expresses important virulence factors like the antiphagocytic M protein, the complement factor-inactivating C5a peptidase and the immunoglobulin-Fc-binding proteins on its surface . The corresponding emm, scpA, and emm-related (fcrA, ennX) genes are adjacently encoded on the genome . They are coordinately in trans regulated by the positive regulatory VirR factor . The responsible virR gene is also located within this segment of the genome which was called vir-regulon . There are at least three different types of organization of the vir-regulon . A frequently encountered type is the "Large vir-regulon" . It comprises from 5' to 3' the following genes: virR, fcrA, a relatively small emm, ennX, and a 4.6 kb version of scpA . Another common type is the "Small vir-regulon", which contains a virR deviating in its 3'-region, a relatively large emm, and a 3.5 kb version of scpA . The "Unusual vir-regulon" is less frequently detected . It closely resembles the small one, but harbors an additional 3 to 4 kb DNA fragment between emm and scpA, occasionally encoding an emm-related gene . The type of vir-regulon encoded by a GAS strain correlates to its serotype, its M class, and its expression of serum opacity factor . The structural genes of the vir-regulon are expressed at a high level during growth in exponential phase, under anaerobiosis, and at body temperature . The sensor molecule which modulates VirR activity according to these environmental conditions has not yet been detected.(ABSTRACT TRUNCATED AT 250 WORDS)

J Dairy Sci, 1992 Oct, 75(10), 2706 - 12
Use of augmented cultural techniques in the diagnosis of the bacterial cause of clinical bovine mastitis; Dinsmore RP et al.; Preculture incubation, preculture freezing, and increased plate inoculation volumes were tested in an attempt to increase the recovery rate of pathogens in milk from cases of clinical bovine mastitis . Culture of milk from 291 cases of clinical bovine mastitis was performed using standard milk culture techniques (.01 ml of fresh milk streaked on trypticase soy agar plates with 5% sheep blood and .1% esculin) . The sensitivity of this method was compared with that of cultures performed using augmented techniques: 4 and 18 h of preculture incubation; preculture freezing of samples overnight at -20 degrees C; and increasing the plate inoculation volume to .05 and .1 ml for fresh, incubated, and frozen samples . Preculture incubation and larger plate inoculation volumes significantly increased the recovery rate of bacterial pathogens over the standard culture method . The greatest improvement in sensitivity without a concomitant increase in contamination was achieved when samples were incubated for 4 h and plates were inoculated with .1 ml of the sample . Recovery was enhanced significantly by this method for several organisms, including environmental streptococci and coliform bacteria . Freezing milk before culture yielded a significantly higher positive culture rate overall, but freezing did not affect the positive culture rate of any individual bacterial species.

J Appl Bacteriol, 1992 Oct, 73(4), 331 - 6
Incidence of pathogenic bacteria in raw milk in Ireland; Rea MC et al.; Raw milk from 70 farms was sampled over 13 months for salmonellas, listerias, Escherichia coli, Staphylococcus aureus and mastitic streptococci; total bacterial counts (TBC), coliforms and somatic cells were also counted . TBC < or = 30,000/ml were obtained in 63% of samples . High count milks were found mainly during the winter months: 13% of samples had > 10(4) mastitis pathogens/ml of milk . The mean somatic cell count varied from 4.0 x 10(5) to 8.0 x 10(5)/ml throughout the year with highest counts during the late lactation period . Coliforms were present in all samples, but 65-71% of samples had < 100 coliforms/ml . Up to 60% of supplies had < or = 10 E . coli/ml . One of the 589 samples tested (0.1%) was positive for salmonellas . Yersinia enterocolitica and Y . enterocolitica-like organisms were isolated from 39% of samples with up to 68% of samples positive at some sampling periods . A total of 222 strains of yersinias were isolated; Y . enterocolitica (59%) was the most common strain followed by Y . fredriksenii (35%), Y . kristensenii (1.0%), Y . intermedia (4.5%) and Y . aldovae (0.5%) . Listerias were isolated from 8.3% of samples tested; 4.9% were Listeria monocytogenes and 3.4% were L . innocua . There was a significant rise in the isolation rate between December and April from a base line of 0-5% during the spring and summer to 35-37% during the winter months while the cows were indoors . Of 66 silage samples tested from the farms involved in the survey 9% of samples were positive for listerias; 3% of these were L . monocytogenes and 6% were L . innocua.(ABSTRACT TRUNCATED AT 250 WORDS)

Inflammation, 1992 Oct, 16(5), 519 - 38
Synergism among oxidants, proteinases, phospholipases, microbial hemolysins, cationic proteins, and cytokines; Ginsburg I et al.; A striking similarity exists between the pathogenetic properties of group A streptococci and those of activated mammalian professional phagocytes (neutrophils, macrophages) . Both types of cells are endowed by the ability to adhere to target cells; to elaborate oxidants, hydrolases, and membrane-active agents (hemolysins, phospholipases); and to freely invade tissues and destroy cells . From the evolutionary point of view, streptococci might justifiably be considered the forefathers of "modern" leukocytes . Our earlier findings that synergy between a streptococcal hemolysin (streptolysin S, SLS) and a streptococcal thiol-dependent proteinase and between cytotoxic antibodies+complement and streptokinase-activated plasmin readily killed tumor cells, led us to hypothesize that by analogy to the pathogenetic mechanisms of streptococci, the mechanisms of tissue destruction initiated by activated leukocytes in inflammatory sites, as well as in tissues undergoing episodes of ischemia and reperfusion, might also be the result of the synergistic effects among leukocyte-derived oxidants, phospholipases, proteinases, cytokines, and cationic proteins . The current report extends our previous synergy studies with endothelial cells to two additional cell types--monkey kidney epithelial cells and rat beating heart cells . Monolayers of 51Cr-labeled cells that had been treated by combinations of sublytic amounts of hydrogen peroxide (generated either by glucose oxidase, xanthine-xanthine oxidase, or by paraquat) and with sublytic amounts of a variety of membrane-active agents (streptolysin S, phospholipases A2 and C, lysophosphatides, histone, chlorhexidine) were killed in a synergistic manner (double synergy) . Crystalline trypsin markedly enhanced cell killing by combinations of oxidant and the membrane-active agents (triple synergy) . Injury to the cells was characterized by the appearance of large membrane blebs that detached from the cells and floated freely in the media, looking like lipid droplets . Cytotoxicity induced by the various combinations of agonists was depressed, to a large extent, by scavengers of hydrogen peroxide (catalase, dimethyl thiourea, and by Mn2+) but not by SOD or by deferoxamine . When cationic agents were employed together with hydrogen peroxide, polyanions (heparin, polyanethole sulfonate) were also found to inhibit cell killing . It is proposed that in order to effectively combat the deleterious toxic effects of leukocyte-derived agonists on cells and tissues, antagonistic "cocktails" comprised of cationized catalase, cationized SOD, dimethylthiourea, Mn(2+)+glycine, proteinase inhibitors, putative inhibitors of phospholipases, and polyanions might be concocted . The current literature on synergistic phenomena pertaining to mechanisms of cell and tissue injury in inflammation is selectively reviewed.

Circ Shock, 1992 Oct, 38(2), 138 - 44
Production of tumor necrosis factor-alpha and interleukin-6 in mice infected with group B streptococci; Teti G et al.; Group B streptococci (GBS) are a leading cause of sepsis and meningitis in neonates . Since cytokines are thought to play an important role in septic shock, we have studied serum levels of tumor necrosis factor-alpha (TNF alpha) and interleukin-6 (IL-6) in BALB/c mice infected with type III GBS . TNF alpha and IL-6 were detected by the L929 cytotoxicity and the B9 proliferation assays, respectively, in serial serum samples obtained after infection . After i.p . challenge with an LD50, serum TNF alpha rose above baseline values as early as 3 hr, peaked at 7 hr, and returned to baseline values at 20 hr . IL-6 serum levels rose concomitantly with TNF alpha, peaking 8 hr after challenge . No serum TNF alpha activity was detected in the course of sublethal infections . However, a transient rise in TNF alpha levels was observed after i.v . inoculation of high numbers (greater than or equal to 1 x 10(8) of heat-killed GBS . When groups of mice were injected i.v . with a single dose of anti-TNF alpha rabbit serum 2 hr before challenge with an LD90 or LD30, no effect was noted in terms of survival, although the serum TNF alpha peak was completely abrogated . Serum TNF alpha does not seem to play an obligatory role in GBS-induced lethality of adult mice . However, further studies are needed to assess better the role of this cytokine in the pathogenesis of GBS sepsis.

Clin Microbiol Rev, 1992 Oct, 5(4), 387 - 99
Bacterial resistance to tetracycline: mechanisms, transfer, and clinical significance; Speer BS et al.; Tetracycline has been a widely used antibiotic because of its low toxicity and broad spectrum of activity . However, its clinical usefulness has been declining because of the appearance of an increasing number of tetracycline-resistant isolates of clinically important bacteria . Two types of resistance mechanisms predominate: tetracycline efflux and ribosomal protection . A third mechanism of resistance, tetracycline modification, has been identified, but its clinical relevance is still unclear . For some tetracycline resistance genes, expression is regulated . In efflux genes found in gram-negative enteric bacteria, regulation is via a repressor that interacts with tetracycline . Gram-positive efflux genes appear to be regulated by an attenuation mechanism . Recently it was reported that at least one of the ribosome protection genes is regulated by attenuation . Tetracycline resistance genes are often found on transmissible elements . Efflux resistance genes are generally found on plasmids, whereas genes involved in ribosome protection have been found on both plasmids and self-transmissible chromosomal elements (conjugative transposons) . One class of conjugative transposon, originally found in streptococci, can transfer itself from streptococci to a variety of recipients, including other gram-positive bacteria, gram-negative bacteria, and mycoplasmas . Another class of conjugative transposons has been found in the Bacteroides group . An unusual feature of the Bacteroides elements is that their transfer is enhanced by preexposure to tetracycline . Thus, tetracycline has the double effect of selecting for recipients that acquire a resistance gene and stimulating transfer of the gene.

Curr Opin Rheumatol, 1992 Oct, 4(5), 718 - 24
Rheumatic fever and disorders of the musculoskeletal system; Coovadia HM; New information provided on the pathogenesis and management of rheumatic fever is of current interest . Invasive disease by group A streptococci has been shown to be due to production of toxin A . The natural history and immunopathologic basis for chronic Lyme arthritis are reported . Attention is drawn to pyomyositis and clinical presentation of chronic fatigue syndrome in children . Patients with Sweet's syndrome often have antineutrophil cytoplasmic autoantibodies . Biopsy specimens of panniculitis should be taken to aid treatment . Long-term outcome in chronic osteomyelitis is favorable; recommendations on the rational use of imaging have been reported.

Ann Otol Rhinol Laryngol, 1992 Oct, 101(10), 866 - 9
Aerobic bacteriology of chronic suppurative otitis media without cholesteatoma in children; Fliss DM et al.; Medical management of chronic suppurative otitis media without cholesteatoma in children was shown recently to be efficacious . We undertook a prospective study in order to determine 1) the organisms associated with the disease and their sensitivity to various antibiotics and 2) their association with clinical variables . Pseudomonas was isolated from 84% of the patients, enteric gram-negative bacilli from 32%, Staphylococcus aureus from 20%, streptococci from 14%, and Hemophilus influenzae from 15% . Pseudomonas aeruginosa was the sole isolate in 48 of the 128 patients (38%) . The sensitivity of P aeruginosa (78 isolates) was 100% (of isolates) to mezlocillin and ciprofloxacin, 99% to tobramycin and ceftazidime, 97% to piperacillin, 94% to gentamicin, and 78% to ceftriaxone . The isolated organisms and their sensitivity to antibiotics were not associated with age, sex, duration of otorrhea, or the presence of granulation tissue or polyps . We believe that our data may contribute to the appropriate choice of antibiotics when nonsurgical management of chronic suppurative otitis media without cholesteatoma is considered.

J Lab Clin Med, 1992 Oct, 120(4), 553 - 8
Pigs with von Willebrand disease may be resistant to experimental infective endocarditis; Johnson CM et al.; Indirect evidence suggests that the blood platelet is important in the pathogenesis of experimental infective endocarditis . Mechanical injury to the endocardial surface causes deposition of fibrin and platelets; injected microorganisms quickly localize to this lesion . Endocarditis pathogens also bind to and activate platelets . We used our previously described animal model for inducing infective endocarditis in normal pigs and applied it to animals with severe von Willebrand disease . The model uses catheter-induced trauma to the aortic valve and endocardium, followed by intravenous injection of group C streptococci . Control animals all showed typical clinical and laboratory evidence of endocarditis . In contrast, in pigs with von Willebrand disease (n = 4) endocarditis failed to develop . Studies in vitro of platelet-bacteria interactions showed that platelets derived from both normal and diseased pigs were equal in their ability to bind to and be activated by group C streptococci . These data suggest that normal platelet function is important in the pathogenesis of experimental infective endocarditis.

Infect Immun, 1992 Oct, 60(10), 4239 - 44
Similarity between the group B and A streptococcal C5a peptidase genes; Cleary PP et al.; Group B streptococci (GBS) and group A streptococci (GAS) are known to have surface-associated peptidase activity which specifically cleaves C5a (C5a-ase), the primary chemotaxin for polymorphonuclear leukocytes . Amplification products were obtained from GBS genomic DNA template by using the polymerase chain reaction and primers corresponding to the C5a peptidase gene of GAS (scpA12) . A restriction map of the GBS full-length amplified gene (scpB) was developed . The scpB restriction map was found to be highly similar to that of the analogous gene in GAS . A 50-bp deletion was located near the 5' end of scpB in a region where repeat sequences are found in scpA12 . Hybridization experiments confirmed that other serotypes of GBS also carry an scpB-like gene . These results show that GBS contain a gene, scpB, which is very similar to that harbored by M12 GAS . The probability that scpB encodes the C5a-ase protein is discussed.

Infect Immun, 1992 Oct, 60(10), 4032 - 9
Identification and characterization of a surface protein-releasing activity in Streptococcus mutans and other pathogenic streptococci; Lee SF; Surface proteins of Streptococcus mutans have been reported to be released into the culture filtrate at concentrations that vary with the growth conditions . The reason for this is not clear . The present study attempts to investigate the mechanism of the protein release . The results showed that whole cells and raffinose-stabilized protoplasts of S . mutans NG8, when incubated in buffers, were capable of releasing their surface proteins in a pH-dependent manner with optimal release at pH 5 to 6 . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis revealed that the released proteins were very complex . Two proteins, adhesin P1, which has been previously shown to interact with a human salivary agglutinin, and glucosyltransferase have been identified among the released proteins . The release of adhesin P1 and other proteins was found to be inhibited by heat, Cu2+,Zn2+, and thiol-blocking reagents . The inhibition by heat and Cu2+ was irreversible, whereas that by the thiol-blocking reagents was reversible . EDTA, phenylmethylsulfonyl fluoride, and N-p-tosyl-L-lysyl-chloromethyl ketone had no effect on the release of P1, indicating that the release was probably not due to proteolytic activity . Adhesin P1 from Cu(2+)-inactivated S . mutans NG8 protoplasts could be released by mixing with fresh whole cells and protoplasts, but not the culture filtrate, of a P1-negative mutant of NG8, suggesting that the enzyme is located on the cell surface . This P1-releasing activity was also detected in two other strains of S . mutans and one strain each of S . gordonii, S . agalactiae, S . pneumoniae, and S . pyogenes . The biological role(s) of this enzyme activity remains to be determined . However, owing to its ability to release virulent surface proteins from the cell, it may play an important role in cell surface modulation among the pathogenic streptococci.

Infect Immun, 1992 Oct, 60(10), 4009 - 14
Group B Streptococcus type II polysaccharide-tetanus toxoid conjugate vaccine; Paoletti LC et al.; Group B streptococci (GBS) are the most common cause of bacterial sepsis and meningitis in neonates in the United States . Although the capsular polysaccharide of GBS is an important virulence factor, it is variably immunogenic in humans . In this report, we have increased the immunogenicity of GBS type II polysaccharide by coupling it to tetanus toxoid (TT) . Like other GBS capsular polysaccharides, the type II polysaccharide has side chains terminating in sialic acid . Controlled periodate oxidation of native II polysaccharide resulted in the conversion of 7% of sialic acid residues to an analog of sialic acid, 5-acetamido-3,5-dideoxy-D-galactosyloctulosonic acid . TT was conjugated to free aldehyde groups created on the oxidized sialic acid residues by reductive amination . Serum from rabbits vaccinated with type II-TT conjugate (II-TT) vaccine contained antibodies specific to type II polysaccharide as well as to TT, whereas rabbits vaccinated with uncoupled native type II polysaccharide failed to produce a type-specific antibody response . Antibodies elicited by II-TT vaccine were serotype specific and mediated phagocytosis and killing in vitro of type II GBS by human peripheral blood leukocytes . Serum from rabbits vaccinated with II-TT vaccine provided 100% protection in a mouse model of GBS type II infection . Antibodies induced by II-TT vaccine were specific for the native but not desialylated type II polysaccharide, suggesting that an important antigenic epitope of II-TT vaccine was dependent on the presence of sialic acid . Therefore, the coupling strategy which selectively modified a portion of the sialic acid residues of types II polysaccharide before coupling the polysaccharide to TT preserved the epitope essential to protective immunity and enhanced the immunogenicity of the polysaccharide.

Infect Immun, 1992 Oct, 60(10), 3986 - 93
Prevention of C3 deposition by capsular polysaccharide is a virulence mechanism of type III group B streptococci; Marques MB et al.; Strains of type III group B streptococci isolated from patients with neonatal sepsis are generally resistant to complement-mediated phagocytic killing in the absence of specific antibody . It has been suggested that the resistance of type III group B streptococci to phagocytosis results from inhibition of alternative-complement-pathway activation by sialic acid residues of the type III polysaccharide . To better define the relationship between structural features of the type III capsule and resistance of type III group B streptococci to complement-mediated phagocytic killing, we measured deposition of human C3 on group B streptococcal strains with altered capsule phenotypes . C3 binding was quantified by incubating bacteria with purified human 125I-C3 in 10% serum . Wild-type group B Streptococcus sp . strain COH1 bound eightfold fewer C3 molecules than did either of two isogenic mutant strains, one expressing a sialic acid-deficient capsule and the other lacking capsule completely . Similar results were obtained when the incubation with 125I-C3 was performed in serum chelated with Mg-ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'- tetraacetic acid (MgEGTA), suggesting that the majority of C3 deposition occurred via the alternative pathway . In contrast to the wild-type strain, which was relatively resistant, both mutant strains were killed by human leukocytes in 10% serum with or without MgEGTA . We also measured C3 binding to 14 wild-type strains of type III group B streptococci expressing various amounts of capsule . Comparison of degree of encapsulation with C3 binding revealed a significant inverse correlation (r = -0.72; P less than 0.01) . C3 fragments released by methylamine treatment of wild-type strain COH1 were predominantly in the form of C3bi, while those released from the acapsular mutant were predominantly C3b and those from the asialo mutant represented approximately equal amounts of C3b and C3bi . We conclude from these studies that the sialylated type III capsular polysaccharide inhibits alternative-pathway activation, prevents C3 deposition on group B streptococci, and protects the organisms from phagocytic killing.

Epidemiol Infect, 1992 Oct, 109(2), 211 - 25
A one-year study of streptococcal infections and their complications among Ethiopian children; Tewodros W et al.; Post-streptococcal complications are known to be common among Ethiopian children . Little is known, however, about the epidemiology of beta-haemolytic streptococci in Ethiopia . A total of 816 children were studied during a one-year period: 24 cases of acute rheumatic fever (ARF), 44 chronic rheumatic heart disease (CRHD), 44 acute post streptococcal glomerulonephritis (APSGN), 143 tonsillitis, 55 impetigo, and 506 were apparently healthy children . Both ARF and APSGN occurred throughout the year with two peaks during the rainy and cold seasons . The female:male ratio among ARF patients was 1.4:1 and 1:1.9 among APSGN . The monthly carrier rate of beta-haemolytic streptococci group A varied from 7.5-39%, average being 17% . T type 2 was the most frequent serotype . Marked seasonal fluctuations were noted in the distribution of serogroups among apparently healthy children . Beta-haemolytic streptococci group A dominated during the hot and humid months of February-May . Strains were susceptible to commonly used antibiotics, except for tetracycline.

Epidemiol Infect, 1992 Oct, 109(2), 199 - 209
Splenomegaly in acute infections due to group A streptococci and viruses; Higgins PM; Over a period of 9 years in general practice temporary enlargement of the spleen was found in 29 episodes of pharyngitis or tonsillitis, in 2 episodes of acute upper respiratory tract infection other than pharyngitis and in 6 episodes of acute cervical lymphadenitis . In five patients more than one episode of illness associated with splenomegaly was recorded . In 26 of the 37 episodes a possible aetiology was identified . Evidence only of infection with group A streptococci was found in 14 episodes, adenoviruses or coxsackie B viruses were isolated alone in 4 episodes and in 4 episodes the only finding was the presence in the blood of more than occasional atypical mononuclear cells; in 4 episodes there was evidence of both streptococcal and viral infection . Episodes with evidence of streptococcal infection only tended to be of shorter duration and to be more evenly distributed over the year than were episodes without such evidence . Temporary splenomegaly was noted also in two children with varicella (one of whom also had streptococcal infection) and in an adult with probable rubella.

Epidemiol Infect, 1992 Oct, 109(2), 181 - 9
Streptococcal pharyngitis in general practice . 1 . Some unusual features of the epidemiology; Higgins PM; This report is based on a study of acute infections of the upper respiratory tract in 1965 and detailed records of such infections in 1963 and 1964 . A change from illnesses mainly yielding viruses to illnesses mainly yielding group A streptococci was noted around the age of 5 years . A positive culture for group A streptococci in patients over 4 years of age was highly correlated with a complaint of sore throat and with serological evidence of streptococcal infection . A bimodal age distribution curve for pharyngitis associated with a positive culture for group A streptococci was consistently noted . The incidence was highest in children aged 5-9 but a second smaller peak occurred among adults in the 30-39 age group . The evidence suggests that being female increases the risk of acquiring group A streptococci and of experiencing sore throat.

Clin Pediatr (Phila), 1992 Oct, 31(10), 596 - 601
Emergence of invasive group A streptococcal disease among young children; Novotny W et al.; Eight cases of invasive group A streptococcal disease in young children were reported over a three-month period, February to April 1990 . The spectrum of clinical disease included: pneumonia with bacteremia (two patients), osteomyelitis/septic arthritis (three patients), epiglottitis/supraglottitis (two patients), and sepsis without a focus (one patient) . Three cases followed chicken pox . Three children were in shock at the time of presentation, including one child who had a toxic shock-like appearance . Only four children had pharyngitis . Bacteremia was confirmed in three children and presumed in another three . All the subjects survived . Four isolates of group A streptococci were tested for exotoxin A, B, and C (A-0, B-4, C-1) production . These data confirm the reappearance of a highly invasive strain of group A streptococci capable of producing a variety of clinical diseases, including bacteremia and shock, in a significant proportion of victims.

Biotechnology (N Y), 1992 Oct, 10(10), 1138 - 42
High level expression of streptokinase in Escherichia coli; Estrada MP et al.; Streptokinase (SK), which activates human plasminogen by promoting its conversion to plasmin, is normally obtained from beta-hemolytic streptococci . Treatment with SK is an effective therapy for improving survival and preserving left ventricular function after coronary thrombosis . We report the cloning, expression in E . coli to levels of 25% of the total cell protein, and characterization of a novel SK (SKC-2) gene, the product of which is functionally equivalent to the naturally-derived protein . The availability of a recombinant streptokinase (rSK) in high yield and purity offers a potentially attractive alternative source of this important therapeutic agent.

J Clin Periodontol, 1992 Oct, 19(9 Pt 2), 715 - 22
Comparative clinical and microbiological effects of topical subgingival application of metronidazole 25% dental gel and scaling in the treatment of adult periodontitis; Pedrazzoli V et al.; The aim of the study was to compare the clinical and microbiological effects of topical application of a metronidazole gel and a single session of subgingival scaling in the treatment of adult periodontitis . An open, randomized controlled clinical study design was employed . Each of 24 subjects received the 2 treatments simultaneously each in 2 randomly selected quadrants of the dentition . The metronidazole, 25% gel was applied subgingivally on days 0 and 7 . Scaling was carried out in one quadrant on day 0 and in one quadrant on day 7 . Clinical and microbiological examinations were carried out before treatment and on days 21, 49, 91, 133, and 175 of the experimental period . The microbiological analyses included determination of total anaerobically cultivable bacteria, and relative proportions of anaerobes, aerobes, black-pigmented anaerobic Gram negative rods, Actinobacillus actinomycetemcomitans, streptococci, and spirochetes . Both treatments were effective in reducing probing pocket depth and bleeding on probing . Metronidazole tended to be a little better than scaling during the study period and the clinical effects of both treatments persisted during the whole 6 months observation period . Local metronidazole treatment induced a significant and long-lasting shift in the subgingival flora towards a composition more compatible with health and comparable to that obtained by mechanical debridement . Proportions of black pigmented anaerobes including Prevotella intermedia, and the number of spirochetes were significantly reduced after both treatments with a concomitant increase in the proportions of streptococci . While scaling resulted in a statistically significant increase in the proportion of A . actinomycetemcomitans, this was avoided after metronidazole treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Antimicrob Agents Chemother, 1992 Oct, 36(10), 2216 - 21
Efficacy of temafloxacin in experimental Streptococcus adjacens endocarditis and autoradiographic diffusion pattern of {14C}temafloxacin in cardiac vegetations; Cremieux AC et al.; Temafloxacin, a new fluoroquinolone, alone or in combination with tobramycin, was compared with penicillin, tobramycin, and their combination in the therapy of rabbits with endocarditis caused by Streptococcus adjacens GaDT, a new species of nutritionally variant streptococci . Animals were injected intramuscularly for 4 days with temafloxacin (50 mg/kg of body weight twice daily {b.i.d.}) alone or combined with tobramycin (12 mg/kg once daily), with procaine penicillin (150,000 U/kg b.i.d.) alone or combined with tobramycin (12 mg/kg once daily), or with tobramycin (12 mg/kg once daily) alone . Another group of animals was treated with a higher dose of temafloxacin (100 mg/kg b.i.d.) . Temafloxacin, penicillin, and tobramycin MICs and MBCs were 1 and 2, 0.015 and 1, and 8 and 16 micrograms/ml, respectively . Time-kill curves showed that the addition of tobramycin to penicillin or temafloxacin increased the killing rate . In vivo, treatment with temafloxacin (50 and 100 mg/kg b.i.d.) alone reduced the bacterial counts in vegetations (3.9 +/- 0.9 and 3.1 +/- 0.8 log10 CFU/g of vegetation) compared with those in the vegetations of control animals (7.5 +/- 0.9 log10 CFU/g of vegetation) . This result was similar to that obtained with penicillin alone (4.5 +/- 0.8 log10 CFU/g of vegetation) . The combination of temafloxacin (50 mg/kg) and tobramycin was as effective as penicillin plus tobramycin (2.5 +/- 0.3 versus 2.3 +/- 0.4 log10 CFU/g of vegetation, respectively) . The autoradiographic pattern of {14C}temafloxacin diffusion into infected cardiac vegetations was studied . Thirty minutes after the end of infusion of 250 microCi of {14C}temafloxacin, the {14C}temafloxacin was homogeneously distributed throughout the vegetations . These data support further evaluation of quinolones in experimental endocarditis.

Am J Dent, 1992 Oct, 5(5), 280 - 2
Pit and fissure sealing and mutans streptococci levels in saliva; Carlsson A et al.; The effect of preventive pit and fissure sealants with a resin-based material on the number of salivary mutans streptococci was evaluated in 46 healthy 12-year-old school children (F group) with medium or high counts during a 1-year study period . As controls served 33 children of the same age with the same bacterial levels at baseline (C group) and 55 children with low levels (L group) . Caries prevalence and incidence were registered clinically and radiographically . Sealing of all accessible pit and fissures was carried out in the F group with a light-cured Bis-GMA sealant . Bacterial levels at baseline and 3, 6, 12 and 52 weeks after treatment were estimated with a chairside method . The results disclosed a significant (P < 0.05) drop in the number of salivary mutans streptococci in the F and C groups at all sampling occasions compared to baseline . There were however no differences between the groups during the study period . Both the caries prevalence and incidence were significantly (P < 0.05) higher in F and C groups when compared to the L group . The results suggest that preventive pit and fissure sealing with a resin based material does not affect salivary mutans streptococci levels.

Tidsskr Nor Laegeforen, 1992 Sep 20, 112(22), 2866 - 8
{Streptococci group B and pregnancy . Need for routine check-ups?}; Andersen BM et al.; Group B streptococci are a major cause of perinatal infections and affect 1-5 infants out of every 1,000 live births . Maternal vaginal colonization with these bacteria is common (5-25%), and has been associated with late abortions, foetal growth retardation, early rupture of membranes and premature delivery . Colonization with group B streptococci may be observed in more than 70% of neonates born to mothers with the bacteria in their vaginal tracts at delivery . A high number of bacteria in the maternal urogenital tract during pregnancy may predispose to early-onset disease in neonates . The estimated attack rate in colonized neonates is 1-2% . A high specific IgG antibody concentration in the mother may protect the infant, but probably not before 32 weeks of gestation . Colonized women who are unable to produce such antibodies risk having affected offspring . Neonatal infection with group B streptococci frequently results in death or permanent neurologic morbidity; especially from the early-onset type (case-fatality more than 50%) which is most often vertical transmitted . Four cases with early-onset disease illustrate the severity of perinatal group B streptococcal infections . The severity and outcome of the disease may be moderated by screening for group B streptococci during late pregnancy . This screening must be combined with special attention to irregularities in pregnancy or perinatal complications.

J Immunol Methods, 1992 Sep 18, 154(1), 69 - 76
Use of defined oligosaccharide epitopes in an ELISA for group B streptococcus; Chalifour RJ et al.; A single-site ELISA for group B streptococcal polysaccharide based on a monoclonal antibody against an immunodominant trirhamnoside epitope was inhibited at high capture antibody coating densities . The inhibition was eliminated when less antibody was coated or when high antigen concentrations were tested . This antigen is polyvalent with respect to the terminal trirhamnoside epitope and therefore it appears that closely spaced capture antibodies bound the epitope completely, leaving no sites for attachment of the enzyme-labeled second antibody with the same specificity . To make use of the trirhamnoside epitope feasible, a two-site ELISA was evaluated with this monoclonal antibody and a polyclonal antibody isolated by affinity chromatography . ELISA inhibition studies using oligosaccharides derived from the group B polysaccharide were used to evaluate the specificity of the polyclonal antibody . This showed that the antibody recognized both alpha-L-rhamnose (1----3)-D-galactose and alpha-L-rhamnose(1----3)-D-glucitol side chains, which together represent 30 potential binding sites per antigen molecule . A two-site ELISA with the anti-trirhamnoside monoclonal antibody to capture the antigen and the polyclonal antibody as enzyme conjugated second antibody reacted with only group B streptococci when tested against a panel of bacteria representative of the vaginal flora and was able to detect 3 x 10(4) cfu/test of group B streptococci . This two-site ELISA, based on well defined oligosaccharide epitopes had the sensitivity and specificity necessary to identify women at risk of infecting their newborns with group B streptococcus.

Proc Natl Acad Sci U S A, 1992 Sep 15, 89(18), 8661 - 5
Two major classes in the M protein family in group A streptococci; O'Toole P et al.; The M protein family of molecules in the group A streptococcus comprises a number of cell surface proteins that interact with the immune system of the host . One of the proteins in this family is the IgA receptor Arp4, which has C repeats similar to those that characterize the known M proteins . The streptococcal strain expressing Arp4 also expresses a second immunoglobulin-binding protein, Mrp4, which is shown here to be encoded by a gene located immediately upstream of the gene for Arp4 . In addition to binding IgG, Mrp4 also binds fibrinogen, a property ascribed to M proteins . DNA sequence analysis demonstrated that the Mrp4 protein indeed is a member of the M protein family, but it was unexpectedly found to have a type of repeat that is identical to the A repeat described for FcRA76, a partially sequenced streptococcal Fc receptor . Purified FcRA76 was shown to bind fibrinogen and IgG, like Mrp4 . These data show that the known molecules in the M protein family can be divided into two classes, A and C, according to the type of repeat region found . Hybridization studies with a panel of clinical isolates indicate that many streptococcal strains express class A and class C proteins, whereas some strains express only class C proteins . Class A molecules show amino-terminal sequence variation, like class C molecules, which suggests that proteins of both classes are targets for the immune response.

FEMS Microbiol Lett, 1992 Sep 15, 75(2-3), 193 - 8
De novo glucan synthesis by mutants streptococcal glucosyltransferases present in pellicle promotes firm binding of Streptococcus gordonii to tooth surfaces; Hiroi T et al.; Adherence of 3H-labelled cells of Streptococcus gordonii and Streptococcus milleri to artificial pellicles prepared from saliva supplemented with glucosyltransferases from mutants streptococci was examined using a new assay for sucrose-dependent cell-to-pellicle attachment . Results indicate that S . gordonii, but not S . milleri, could attach tightly to hydroxylapatite surfaces through de novo glucan synthesis by mutants streptococcal glucosyltransferases present in the experimental salivary pellicles.

J Dent Res, 1992 Sep, 71(9), 1582 - 6
Effects of chlorhexidine-containing gel and varnish on abutment teeth in patients with overdentures; Keltjens HM et al.; Previous experiments have shown that daily use of 1% chlorhexidine gel strongly reduced caries development in the abutment teeth under overdentures . The present experiment was designed to determine whether intermittent application of chlorhexidine, either in a varnish or in a gel, might be used as an alternative preventive method, less demanding for the patient . To this end, 31 patients were distributed among four treatment groups, with the number of mutans streptococci in plaque and saliva used as a balancing criterion . The treatments consisted of a single application of 40% chlorhexidine varnish, daily application of 1% chlorhexidine gel for one week, or the corresponding placebo treatments with varnish or gel without chlorhexidine . Patients were re-called for bacteriological and clinical examination at various intervals during an eight-week period following treatment . Chlorhexidine varnish and chlorhexidine gel applications significantly suppressed mutans streptococci on the abutment teeth for four and eight weeks, respectively . In agreement with earlier findings, the numbers of Actinomyces viscosus/naeslundii in plaque were significantly increased after chlorhexidine varnish treatment . The chlorhexidine gel reduced plaque accumulation and gingival bleeding for one week but had no long-lasting effect . The results seem to justify a long-term clinical test of intermittent chlorhexidine applications as an alternative for daily use in patients with overdentures.

Arch Intern Med, 1992 Sep, 152(9), 1863 - 8
Epidemiology of bacterial endocarditis in The Netherlands . I . Patient characteristics; van der Meer JT et al.; BACKGROUND--Studies of the epidemiology of bacterial endocarditis are usually based on a retrospective review of medical records from referral centers serving diverse patient populations . These studies are therefore likely to suffer from selection bias . We conducted a nationwide prospective epidemiologic study of endocarditis in the Netherlands . METHODS--During a 2-year period, all cases of consecutively hospitalized patients with suspected endocarditis in the Netherlands were reported to us . While hospitalized, patients were visited for an in-person interview and a review of the medical record . RESULTS--Of 559 episodes, 438 met the criteria for endocarditis; these included 89 episodes of prosthetic valve endocarditis and 349 episodes of native valve endocarditis . Adjusted for age- and sex-specific population figures, the incidence was 19 per million person-years . The incidence increased significantly with age, and men were more often affected than women (266 and 172 cases, respectively) . Rheumatic and congenital cardiac lesions formed most of the underlying heart diseases . Mitral valve prolapse was present in only 29 patients with native valve endocarditis (8.3%) . A history of intravenous drug abuse was present in 32 patients (7.3%) . Viridans streptococci, staphylococci, and enterococci together constituted 86% of the isolated bacterial strains . Only 1.1% of the patients had culture-negative endocarditis . Overall case fatality was 19.7% and varied widely according to causative microorganism . CONCLUSION--The distribution of causal microorganisms, the case fatality rate, and the incidence rate of endocarditis are age related . Therefore, a meaningful comparison of data is only possible between population-based cohorts of patients with endocarditis.

Proc Natl Acad Sci U S A, 1992 Sep 1, 89(17), 7924 - 8
Multicellular oxidant defense in unicellular organisms; Ma M et al.; Although catalase is thought to be a major defense against hydrogen peroxide (H2O2), the catalase activity within individual Escherichia coli fails to protect against exogenous H2O2 . Contrary to earlier reports, we find that dilute suspensions of wild-type and catalase-deficient E . coli are identical in their sensitivity to H2O2, perhaps because even wild-type, catalase-positive E . coli cannot maintain an internal/external concentration gradient of this highly diffusible oxidant . However, concentrated suspensions or colonies of catalase-positive E . coli do preferentially survive H2O2 challenge and can even cross-protect adjacent catalase-deficient organisms . Furthermore, high-density catalase-positive--but not catalase-negative--E . coli can survive and multiply in the presence of competitive, peroxide-generating streptococci . These observations support the concept that bacterial catalase may defend colonial, but not individual, E . coli against environmental H2O2 . Group protection by the activity of enzymes that mitigate oxidative stress may have been a driving force in the evolution of multicellular organisms.

J Med Microbiol, 1992 Sep, 37(3), 211 - 3
Restricted distribution of Streptococcus milleri carbohydrate type antigens amongst other viridans streptococci; Inoue M et al.; The distribution of oral Streptococcus milleri carbohydrate type antigens in other viridans streptococcus species was examined . Rantz-Randall extracts of cells of the test strains grown in broth containing glucose were allowed to react with typing or grouping antisera for S . milleri serotypes a-k, or Lancefield groups A-G and K . Of 93 strains comprising more than 12 streptococcal species that included S . mutans and S . sanguis complexes, only 15 S . salivarius strains and one S . mitis strain were immunologically related to S . milleri serotype f . Unlike S . milleri strains, S . salivarius type f strains belonged to Lancefield group K, whereas the S . mitis strain was closely related to S . milleri serotype f but did not react with any of the Lancefield grouping antisera tested . Results suggest that oral S . milleri strains can be distinguished serologically from other oral viridans streptococci and that the typing antisera used in our researches might differentiate S . milleri isolates from the mouth from those associated with systemic purulent infections.

J Bacteriol, 1992 Sep, 174(17), 5693 - 701
Environmental regulation of virulence in group A streptococci: transcription of the gene encoding M protein is stimulated by carbon dioxide; Caparon MG et al.; We have found that different atmospheres can have significant effects on the transcription of emm, the gene that encodes M protein, the major virulence factor of the group A streptococcus (Streptococcus pyogenes) . Expression of emm was monitored by constructing a transcriptional fusion of the promoter for emm6.1 from S . pyogenes JRS4 to a promoterless chloramphenicol acetyltransferase gene . Transcription, as measured by determining chloramphenicol acetyltransferase specific activity, was stimulated by as much as 25-fold by increased carbon dioxide tension . Expression was greater in the latter stages of growth and was not affected by growth at 30 instead of 37 degrees C . Insertional inactivation of mry, a gene encoding a positive regulator of emm6.1, reduced chloramphenicol acetyltransferase activity below the detectable level . We conclude that expression of emm is influenced by environmental factors and that the level of carbon dioxide is one signal that may influence expression of M protein during infection.

Infect Immun, 1992 Sep, 60(9), 3807 - 13
Chelating agents inhibit activity and prevent expression of streptococcal glucan-binding lectins; Lu-Lu et al.; Several of the cariogenic mutans streptococci produce cell wall-associated glucan-binding lectins (GBLs) . The lectins bind alpha-1,6-linked glucans and have no affinity for other polysaccharides or anomeric linkages . When citrate or lactate was included in the growth medium, expression of the activities of the GBLs of Streptococcus cricetus and S . sobrinus was prevented . Furthermore, chelating agents, including citrate, lactate, EDTA, and acetylacetone, were able to reversibly inhibit glucan-induced aggregation of GBL+ streptococci . In addition, the chelating agents prevented sucrose-dependent streptococcal adhesion to glass surfaces and dispersed preformed adherent masses of the streptococci . Neither citrate nor other chelating agents modified the activities of glucosyltransferases . Expression of the lectin could only be achieved by the addition of manganous ion to the growth medium . Chloramphenicol and other metabolic inhibitors prevented synthesis of GBL in cells obtained from manganese-deficient medium and shifted to manganous ion-sufficient medium . The GBL may be a manganoprotein, the manganese of which may be perturbed, but not removed, by chelating agents . During synthesis of the GBL, manganous ion may be required in order for the protein to achieve an active conformation . Citrate or other chelating agents may have promise as anticaries agents.

Infect Immun, 1992 Sep, 60(9), 3689 - 96
Group G streptococcal M protein exhibits structural features analogous to those of class I M protein of group A streptococci; Collins CM et al.; We have previously studied a collection of group G streptococcal strains isolated from bacteremic human infections and demonstrated that such strains resist phagocytosis by human polymorphonuclear leukocytes but are type specifically opsonized by homologous antiserum . We have now performed Southern hybridization analysis on genomic DNA from eight blood isolates . All eight isolates showed DNA homology to a group A emm24 gene probe . The M-protein gene of one of the isolates, strain 1750, has now been isolated . This gene (emmG1) encodes a polypeptide of 67 kDa (MG1) which is reactive with antibodies to the partially purified M protein of the parent strain . The predicted amino acid structure of MG1 demonstrates significant identity with the carboxy terminus (C, D, and anchor domains) of M6 and M24 but only limited identity with the amino terminus (variable portion) of these group A M proteins . Southern hybridization of genomic DNA of the eight group G blood isolates with an emmG1 gene probe indicated there were at least four emm alleles associated with these strains . These studies indicate that M proteins of group G streptococci, like those of group A, are genetically heterogeneous . Moreover, MG1 appears to conform to the recently proposed class I structure of M-protein molecules and thus shares certain distinct structural features with the M proteins of well-established rheumatogenic group A streptococcal serotypes . Further comparison of the structures of group G and group A M proteins of throat and skin isolates may cast light on those configurations of the M protein molecules which are and are not critical for the expression of rheumatogenicity.

Infect Immun, 1992 Sep, 60(9), 3601 - 8
Isolation and molecular characterization of a novel albumin-binding protein from group G streptococci; Sjobring U; Many streptococcal strains are known to bind the two most abundant plasma proteins, namely, immunoglobulin G and albumin . Protein G isolated from group C and G streptococci has been demonstrated to have separate binding regions for each of these proteins . However, some group G streptococcal strains bind only serum albumin . This report describes the isolation of a 48-kDa albumin-binding protein from such a strain (DG12) . The affinity constant of this protein for human serum albumin was determined to be 5 x 10(9) M-1, and the protein interacted strongly also with serum albumin from several other mammalian species . The gene encoding the albumin-binding protein was cloned and expressed in Escherichia coli . DNA sequence analysis of this gene revealed a unique NH2-terminal sequence and three types of repeats in the encoded protein . One of these repeated sequences has significant homology with the albumin-binding domains of protein G, and it was demonstrated that the albumin binding of the DG12 protein was localized within these domains . Another type of repeat is localized in the putative wall-spanning region of the molecule . This repeat sequence, which has the length of only 4 amino acids (LysProGluVal), is repeated 14 times . The relationship of the albumin-binding protein to other cell-wall-associated proteins of pathogenic streptococci is discussed.

Clin Ther, 1992 Sep-Oct, 14(5), 740 - 54
Therapy for pharyngitis and tonsillitis caused by group A beta-hemolytic streptococci: a meta-analysis comparing the efficacy and safety of cefadroxil monohydrate versus oral penicillin V; Deeter RG et al.; A meta-analysis was conducted to compare the efficacy and safety of oral cefadroxil monohydrate (30 mg/kg QD or 15 mg/kg BID) with that of oral penicillin V (8, 10, or 15 mg/kg BID, TID, or QID) in the treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis and tonsillitis treated for 10 days . A simple random effects model was used for combining the efficacy and safety results of nine comparative trials performed in the United States . A total of 1646 patients aged < or = 19 years were considered evaluable; 1406 patients were evaluable using revised bacteriologic criteria, and 1499 patients were considered fully evaluable for safety . The results demonstrate significantly better response rates (P < 0.05) with cefadroxil monohydrate than with penicillin V for overall cure (91.8% versus 81.3%), bacteriologic cure (92.6% versus 81.4%), and bacteriologic recurrence (4.2% versus 10.5%); clinical cure rates were statistically similar (90.5% versus 90.2%) . Revised bacteriologic criteria analysis revealed bacteriologic cure rates of 95.8% versus 88.7% (P < 0.05) and bacteriologic recurrence rates of 4.9% versus 7.1% (P = NS) for cefadroxil monohydrate and penicillin V, respectively . Adverse events related to drug administration occurred infrequently and did not differ significantly between treatment groups (P > 0.05) . Compliance with cefadroxil monohydrate was at least as good as with penicillin V . Penicillin is currently the drug of choice in the treatment of GABHS pharyngitis and tonsillitis . Based on the information described in this large meta-analysis, cefadroxil monohydrate is an excellent alternative to oral penicillin V in the treatment of GABHS pharyngitis and tonsillitis.

Fam Pract, 1992 Sep, 9(3), 255 - 62
Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries; Touw-Otten FW et al.; The diagnostic and prescribing habits of general practitioners from 17 European countries for 4094 patients with acute tonsillitis were assessed, and differences in outcome were identified . At least 10 general practitioners from each country filled in a questionnaire for each episode of acute tonsillitis treated during a three month period, November 1989-May 1990 . Differences in days of fever and illness were tested by one-way analysis of variance . Bacteriological tests were rarely used for diagnosis in East Germany, Poland and the Netherlands, while a high percentage (70-96%) occurred in Turkey, Romania, Israel, Yugoslavia, Finland and Greece . Group A beta-haemolytic streptococci (40 per cent) and a negative test result (43 per cent) were the most common results . Ninety per cent or more patients were treated with an antibiotic . Oral penicillin was especially prescribed in the northern countries of Europe and parenteral penicillin in southern Europe . For almost all countries the mean number of days with fever was between 2 or 3 days . The mean number of days with illness differed greatly (F = 62.12; P = 0.0000) . Turkey had the lowest mean (2.56), while Poland had the highest mean (8.23).

J Antimicrob Chemother, 1992 Sep, 30(3), 349 - 52
Amoxycillin-resistant oral streptococci and experimental infective endocarditis in the rabbit; Longman LP et al.; The ability of three amoxycillin-resistant strains of Streptococcus sanguis 254, 24 and 297 (MIC 40 mg/L) to cause infective endocarditis (IE) in the rabbit was investigated . These strains all produced infection in the rabbit, as did an antibiotic sensitive control strain NCTC 7864 . Prophylactic amoxycillin (400 mg/kg body weight) administered one hour before bacterial challenge prevented 80% of the animals developing IE irrespective of the challenging strain . It is concluded that amoxycillin-resistant strains of S . sanguis can cause IE and that amoxycillin prophylaxis can still be effective against these bacteria.

Res Vet Sci, 1992 Sep, 53(2), 244 - 6
Testing meningeal strains of Streptococcus suis to detect M protein genes; Mogollon JD et al.; Previous reports have suggested that the surface proteins found in meningeal strains of Streptococcus suis might be similar to the M protein of group A streptococci . Fifty-five strains of S suis, including human and swine meningeal and pneumonic isolates, were tested for M protein genes by DNA probes representing the constant domain of the 3' end of the group A, M protein gene . None of the S suis strains examined was positive, indicating that these organisms either lack M protein genes or harbour different genes, not expressing the constant domains of protein M from group A.

Obstet Gynecol Clin North Am, 1992 Sep, 19(3), 483 - 96
Clindamycin; Soper DE; Clindamycin has been extensively used in the therapy of obstetric and gynecologic infections for over 20 years . This antibiotic is well known for it activity against anaerobic bacteria, particularly beta-lactamase-producing strains of the Bacteroides species . Clinicians should also recognize its very good activity against aerobic gram-positive cocci, such as the group B streptococci, but be aware of its absence of activity against aerobic gram-negative rods, such as E . coli . In combination with an aminoglycoside, clindamycin has become the standard by which other antimicrobials have been judged in the treatment of pelvic infections . A dose of 900 mg administered intravenously every 8 hours is recommended when treating the serious infections discussed . Although concern about the potential side effect of pseudomembranous colitis is valid, in practice, this is an uncommon problem that responds well to the discontinuation of clindamycin and to the treatment of the C . difficile-induced condition with vancomycin or metronidazole.

J Pak Med Assoc, 1992 Sep, 42(9), 213 - 5
Prevalence of mutans streptococci and dental caries in Pakistani children; Maher R et al.; The caries status of two hundred and eighteen 12 year old school children from four schools of Karachi and Lahore was determined through a WHO pathfinder survey . In addition, the levels of mutans streptococci in the sample were estimated in order to define the proportion of children with high and low mutans levels . A mean DMFT of 1.82 (1.67-0.03-0.12), for decayed and filled teeth respectively; 42% were caries free . Four mutans streptococci; 22% had mutans class 0, 22% class 1, 31% class 2 and 25% class 3 . The mean DMFT was respectively, 1.0 + 1.23, 0.98 + 1.52, 2.03 + 2.36 and 3.04 + 3.08 . The difference was statistically significant . Twenty four children had 5 or more DMF all except two of them, belonging to mutans classes 2 or 3.

Cytokine, 1992 Sep, 4(5), 397 - 402
In-vitro stimulation of TNF-alpha from human whole blood by cell-free supernatants of gram-positive bacteria; Bayston K et al.; Gram-positive bacteria are being recognized increasingly as the cause of shock-like syndromes, clinically indistinguishable from those seen in association with Gram-negative endotoxic shock . Much clinical and experimental data link tumour necrosis factor-alpha (TNF-alpha) with the pathogenesis of endotoxic shock, and a number of studies of individual Gram-positive species have also implicated TNF-alpha . We report here the first systematic study of the ability of cell-free supernatants of common Gram-positive bacteria to induce TNF-alpha from human peripheral blood monocytes in vitro . Almost all the 63 strains were able to induce TNF-alpha, although the levels were substantially lower than those obtained from supernatants of Gram-negative bacteria, used as controls . Streptococcus pneumoniae, S . pyogenes, viridans streptococci and coagulase-negative staphylococci were consistently more active than group B and D streptococci . TNF-alpha induction did not correlate with conventional markers of pathogenicity; amongst strains of Staphylococcus aureus, commensal and blood culture isolates did not induce significantly different amounts of TNF . We conclude that cell-free supernatants of most Gram-positive bacteria are capable of inducing TNF-alpha from human peripheral blood monocytes in vitro, but the significance of this finding remains to be determined.

Am J Perinatol, 1992 Sep-Nov, 9(5-6), 338 - 9
Perinatal bacteremia due to group F streptococci; Hill WC et al.; Perinatal septicemia due to Lancefield groups A, B, C, and G, but not the group F, streptococci have been documented . A case of perinatal bacteremia and septicemia due to group F streptococci is described.

Plasmid, 1992 Sep, 28(2), 130 - 45
Molecular, genetic, and functional analysis of the basic replicon of pVA380-1, a plasmid of oral streptococcal origin; LeBlanc DJ et al.; The 4.2-kb cryptic plasmid pVA380-1 has been used as a vector for the cloning of antibiotic resistance genes directly in streptococci, and in the construction of Escherichia coli/Streptococcus shuttle vectors . The results of subcloning experiments located the basic replicon of pVA380-1 within a 2.5-kb region . The nucleotide base sequence of this region was determined and contained a single complete open reading frame (ORF) encoding a 237-amino-acid peptide with a predicted size of 29 kDa . This peptide and a region of the DNA molecule 5' to the ORF encoding it shared homology with the replication protein and plus origin, respectively, of the Staphylococcus aureus plasmid pUB110 . Data from Tn5 mutagenesis and complementation studies indicated that the protein product of the ORF was required for pVA380-1 replication in streptococci . Deletion of a region of the basic replicon distal to the plus origin and ORF produced an unstable derivative, and resulted in the accumulation of single-stranded replicative intermediates, consistent with the loss of a minus origin . All of these results suggest that pVA380-1 replicates by a rolling circle mode, and is most closely related to the pC194 family of single-stranded DNA plasmids.

Jpn Circ J, 1992 Sep, 56(9), 970 - 4
Fragmentation hemolysis in a patient with hypertrophic obstructive cardiomyopathy and mitral valve prolapse; Maeda T et al.; We encountered a 65-year-old female with hypertrophic obstructive cardiomyopathy and mitral valve prolapse who had infective endocarditis and hemolytic anemia . The infecting organism of endocarditis was group A streptococci . With regard to the etiology of the hemolytic anemia, fragmentation hemolysis was considered because fragmented red cells and elevated lactic dehydrogenase were observed . Haptoglobin was markedly decreased . Coombs' test, Ham's test and abnormal hemoglobin were negative . She had not had a hemolytic attack in the past . Ultrasonic cardiography showed asymmetrical septal hypertrophy, mitral valve prolapse and 285 mmHg of calculated pressure gradient in the left ventricle . Cardiac catheterization showed 115 mmHg of left intraventricular pressure gradient and mitral regurgitation (grade 2) . Hemolysis was slightly improved after treatment with propranolol . Thus, fragmentation of the normal red cells seemed to be due to shear stress.

Nippon Jibiinkoka Gakkai Kaiho, 1992 Sep, 95(9), 1332 - 8
{A report of two cases of cervical necrotizing soft-tissue infection}; Motohashi H et al.; Two recent cases of cervical necrotizing soft-tissue infection are herein presented . Case 1 . A 52-year-old man with uncontrolled diabetes was hospitalized because of an erythematous swelling of the left side of his neck and high grade fever . Fetid yellowish pus exuded from the left parotid area . The swelling extended from the left temporal area to the left supraclavicular fossa, with necrosis of the parotid gland, sternocleidomastoid, masseter and a portion of the strap muscles . Wound cultures revealed Staphylococcus aureus and alpha-hemolytic streptococcus . No anaerobic bacteria were detected . Treatment consisted of intravenous administration of antibiotics, control of diabetes with insulin, and debridement of the necrotic tissue, which left an epidermal defect in the initially swollen area . Transfer of a forearm free flap was done after the growth of healthy granulation tissue over the affected area . Case 2 . A 55-year-old woman with rheumatoid arthritis was transferred to our hospital after tracheotomy performed in another hospital because of dyspnea due to severe crepitant swelling of her cheeks and submandibular areas bilaterally, and her left temporal area . A copious amount of fetid pus exuded from the incisions made in the left temporal area, left cheek, and right submandibular area . There were bilateral diffuse rales . Culturing the pus revealed alpha-hemolytic streptococci, while MRSA and Pseudomonas aeruginosa were detected from cultures of sputum . No anaerobic bacteria were found . After intravenous administration of antibiotics, infected wounds and pneumonia were ameliorated, and necrotic subcutaneous tissue and fascia were debrided . The patient was discharged with a residual depression in her left cheek and a scar on her left temporal area.

J Clin Microbiol, 1992 Sep, 30(9), 2471 - 3
Endocarditis caused by a group B Streptococcus strain, type III, in a nonencapsulated phase; Sellin M et al.; A nontypeable blood isolate of group B streptococci (GBS) from a patient with endocarditis is suggested to be the nonencapsulated phase of a GBS strain, type III . From the original high-density isolate, a low-density, encapsulated phase was selected by Percoll gradient centrifugation . This phenomenon should be considered before a GBS strain is classified as truly nontypeable.

Curr Opin Dent, 1992 Sep, 2, 72 - 80
Immunization against dental caries; Russell MW; The development of a vaccine against dental caries involves identification of appropriate antigens of mutans streptococci against which protective immune responses can be mounted, and the selection of a method of immunization that will generate sustained levels of salivary antibodies . Antigens receiving most attention include streptococcal surface proteins that are involved in attachment to tooth surfaces and glucosyltransferases that synthesize adhesive glucans from sucrose . Recent advances in mucosal immunology and the introduction of novel strategies for inducing mucosal immune responses now raise the possibility of constructing an effective and safe vaccine . Passive immunization by the oral application of performed antibodies against selected antigens of mutans streptococci has also shown promise and may facilitate understanding of the mechanisms of protective immunity against caries.

Infect Immun, 1992 Sep, 60(9), 3837 - 44
Fibronectin-binding protein of Streptococcus pyogenes: sequence of the binding domain involved in adherence of streptococci to epithelial cells; Talay SR et al.; The sequence of the fibronectin-binding domain of the fibronectin-binding protein of Streptococcus pyogenes (Sfb protein) was determined, and its role in streptococcal adherence was investigated by use of an Sfb fusion protein in adherence studies . A 1-kb DNA fragment coding for the binding domain of Sfb protein was cloned into the expression vector pEX31 to produce an Sfb fusion protein consisting of the N-terminal part of MS2 polymerase and a C-terminal fragment of the streptococcal protein . Induction of the vector promoter resulted in hyperexpression of fibronectin-binding fusion protein in the cytoplasm of the recombinant Escherichia coli cells . Sequence determination of the cloned 1-kb fragment revealed an in-frame reading frame for a 268-amino-acid peptide composed of a 37-amino-acid sequence which is completely repeated three times and incompletely repeated a fourth time . Cloning of one repeat into pEX31 resulted in expression of small fusion peptides that show fibronectin-binding activity, indicating that one repeat contains at least one binding domain . Each repeat exhibits two charged domains and shows high homology with the 38-amino-acid D3 repeat of the fibronectin-binding protein of Staphylococcus aureus . Sequence comparison with other streptococcal ligand-binding surface proteins, including M protein, failed to reveal significant homology, which suggests that Sfb protein represents a novel type of functional protein in S . pyogenes . The Sfb fusion protein isolated from the cytoplasm of recombinant cells was purified by fast protein liquid chromatography . It showed a strong competitive inhibition of fibronectin binding to S . pyogenes and of the adherence of bacteria to cultured epithelial cells . In contrast, purified streptococcal lipoteichoic acid showed only a weak inhibition of fibronectin binding and streptococcal adherence . These results demonstrate that Sfb protein is directly involved in the fibronectin-mediated adherence of S . pyogenes to epithelial cells.

J Med Assoc Thai, 1992 Sep, 75(9), 517 - 23
Comparative efficacy of spiramycin and erythromycin in acute exudative tonsillitis in adults: a randomized controlled trial; Leelarasamee A et al.; A randomized control trial was designed to compare the efficacies of spiramycin given one gram twice daily and erythromycin given 500 mg thrice or four times daily in the treatment of acute exudative tonsillitis in adults whose ages were over 13 years old from January 1989 to January 1991 at a community clinic . A total of 120 cases were enrolled in the study . Fifty-three patients received spiramycin while 67 received erythromycin . Group A beta-hemolytic streptococci (GABHS), S . aureus, and positive titer of Mycoplasma pneumoniae were detected in 19, 47 and 8 per cent in spiramycin group and 21, 36 and 11 per cent in erythromycin group respectively . GABHS were totally eradicated on day 3 of treatment in both groups through eradication of S . aureus was slightly slower initially in the spiramycin group . Marked improvement was similarly achieved in both groups after 3 days of therapy . Dyspepsia was felt in 34.4 and 8.2 per cent of erythromycin and spiramycin groups respectively but was tolerable by most patients . We concluded that spiramycin given twice daily was as effectively as conventional erythromycin but spiramycin is more convenient to administer and causes much less gastro-intestinal side-effect.

J Infect Dis, 1992 Aug, 166(2), 374 - 82
Epidemiologic analysis of group A streptococcal serotypes associated with severe systemic infections, rheumatic fever, or uncomplicated pharyngitis; Johnson DR et al.; More than 1100 group A streptococcal isolates collected in the United States (1988-1990) were examined to document an association of individual serotypes with specific clinical infections during the recent resurgence of group A infections and their sequelae . The most commonly isolated strains from patients with only uncomplicated streptococcal pharyngitis ("control" strains) were M serotypes 1, 2, 4, and 12 . M1, M3, and M18 were statistically significantly more frequently isolated from patients with serious invasive infections and M3 and M18 from patients with rheumatic fever compared with the distribution of serotypes from the 866 control strains . An unexpected and important finding indicated that isolation rates of M1 streptococci varied geographically within the United States by year . The propensity for M1 streptococci to be statistically associated with severe systemic infections appeared unrelated to the M1 isolation rates from patients with only uncomplicated pharyngitis, thus offering additional support for the concept of strain-associated virulence rather than virulence broadly related to a given serotype.

Anaesth Intensive Care, 1992 Aug, 20(3), 317 - 21
Contamination of anaesthetic tubing--a real hazard?
Ibrahim JJ, Perceval AK.
This study aimed to find whether a patient placed on an anaesthetic machine could contaminate the tubing resulting in possible cross-infection to subsequent patients . Twenty randomly chosen anaesthetic circuits were collected after use during operations and cultured for bacteria and fungi . These were compared with ten circuits which had been washed and dried . Another ten washed circuits were attached to an anaesthetic machine and each circulated with air for four hours before similar cultures were performed . No accepted respiratory pathogens were found contaminating the tubing in any of the above situations . Cleaned circuits purposely seeded with either 'viridans streptococci' or staphylococcal bacteriophage were attached to an anaesthetic machine, the other end being held over an air sampler to collect organisms which might be blown out . Seeded tubing did not contaminate the air passing through it, demonstrating that dry anaesthetic gases do not facilitate pick-up and carriage of microorganisms.

Arch Oral Biol, 1992 Aug, 37(8), 613 - 22
The influence of morphological variation on Candida albicans adhesion to denture acrylic in vitro; Vasilas A et al.; Using denture acrylic pieces coated with either whole human stimulated saliva or oral streptococci, the binding ability of three different Candida albicans strains was investigated . The C . albicans strains include a clinical isolate with the commonly observed, smooth, round colonial morphology (strain 613p), a morphological variant spontaneously derived from the clinical isolate strain 613p (strain 613m1BK) and a clinical isolate from an oral lesion that was also a morphological variant upon primary isolation (strain 228) . Levels of adhesion to the acrylic pieces were determined radiometrically using C . albicans cells metabolically labelled with {35S}-methionine . Whole stimulated saliva significantly increased the binding of all strains compared to uncoated acrylic . However, the level of binding of strain 613p to saliva-coated acrylic was significantly greater than the levels observed for the morphological variant strain 613m1BK . Coating acrylic pieces with either Streptococcus sanguis NCTC 10904, Strep . mutans GS-5 or Strep . sobrinus ATCC 27352 instead of saliva resulted in significantly greater binding by strain 613p compared to uncoated acrylic . Pre-coating the acrylic with the oral streptococci did not significantly increase the binding of morphological variant strains 613m1BK and 228 compared to uncoated acrylic . In general, preincubation of adherent streptococci with sucrose to induce the synthesis of extracellular carbohydrate polymers did not significantly increase the binding levels of the C . albicans strains above those observed using streptococci in buffer alone . Compared to its parental strain 613p, morphological variant strain 613m1BK adhered poorly to denture acrylic coated with either salivary constituents or oral streptococci, while strain 228 adhered to the same substrates at an intermediate level . Furthermore, physical disaggregation of clusters of the morphological variant strain 613m1BK did not appear to increase its binding capacity to saliva-coated denture acrylic . The effect of whole stimulated saliva on the adherence of C . albicans 613p to a variety of plastic substrates in addition to denture acrylic was examined . Overall, saliva pre-coating of the various plastics promoted C . albicans 613p adhesion . The adhesion of strain 613p to denture acrylic coated with whole stimulated saliva from each of five different donors or with parotid and submandibular/sublingual saliva from each of two donors was also examined . Regardless of donor, a coating of whole stimulated saliva significantly increased the binding of strain 613p to denture acrylic compared to uncoated acrylic . In addition, a coating of parotid saliva significantly increased the binding of strain 613p to denture acrylic compared to submandibular/sublingual saliva.

Pediatr Emerg Care, 1992 Aug, 8(4), 209 - 10
Pediatric streptococcal toxic shock syndrome; Janner D et al.; Two children who presented with fever, rash, and hypotension were found to have group A beta hemolytic streptococcal toxic shock syndrome . These cases are reported to remind physicians who care for acutely ill children that exotoxin-producing streptococci can produce clinical features and multisystem failure similar to staphylococcal toxic shock syndrome.

Pediatr Infect Dis J, 1992 Aug, 11(8 Suppl), S20 - 6
Loracarbef (LY163892) vs . penicillin VK in the treatment of streptococcal pharyngitis and tonsillitis; Disney FA et al.; A double blind, randomized clinical trial compared loracarbef (LY163892) with penicillin VK . Two hundred thirty-three pediatric patients (less than or equal to 12 years) with a diagnosis of pharyngitis or tonsillitis resulting from Group A beta-hemolytic streptococci were randomized to treatment . Patients in the loracarbef group (n = 120) received loracarbef as a 15-mg/kg/day oral suspension or 200-mg capsule taken twice daily for 10 days . Patients in the penicillin group (n = 113) received penicillin VK as a 20-mg/kg/day oral suspension or 250-mg capsule taken four times daily for 10 days . Successful clinical responses were demonstrated in 101 of the 104 (97.1%) evaluable patients treated with loracarbef compared with 83 of 88 (94.3%) of evaluable patients treated with penicillin . The clinical relapse rate for the loracarbef group was 2.9% vs . 5.7% for the penicillin group . Bacteriologic response data approximated the clinical response data, as eradication of Group A beta-hemolytic streptococci was found in 86.5 and 81.8% of the loracarbef group and the penicillin group, respectively . No statistically significant difference in the incidence of treatment-emergent adverse reactions was noted between the two groups . The results indicate that loracarbef taken twice daily was comparable in safety and efficacy to penicillin VK taken four times daily in the treatment of Group A beta-hemolytic Streptococcus-associated pharyngitis and tonsillitis in children.

J Exp Med, 1992 Aug 1, 176(2), 415 - 26
A major surface protein on group A streptococci is a glyceraldehyde-3-phosphate-dehydrogenase with multiple binding activity; Pancholi V et al.; The surface of streptococci presents an array of different proteins, each designed to perform a specific function . In an attempt to understand the early events in group A streptococci infection, we have identified and purified a major surface protein from group A type 6 streptococci that has both an enzymatic activity and a binding capacity for a variety of proteins . Mass spectrometric analysis of the purified molecule revealed a monomer of 35.8 kD . Molecular sieve chromatography and sodium dodecyl sulfate (SDS)-gel electrophoresis suggest that the native conformation of the protein is likely to be a tetramer of 156 kD . NH2-terminal amino acid sequence analysis revealed 83% homology in the first 18 residues and about 56% in the first 39 residues with glyceraldehyde-3-phosphate dehydrogenase (GAPDH) of eukaryotic or bacterial origin . This streptococcal surface GAPDH (SDH) exhibits a dose-dependent dehydrogenase activity on glyceraldehyde-3-phosphate in the presence of beta-nicotinamide adenine dinucleotide both in its pure form and on the streptococcal surface . Its sensitivity to trypsin on whole organism and its inability to be removed with 2 M NaCl or 2% SDS support its surface location and tight attachment to the streptococcal cell . Affinity-purified antibodies to SDH detected the presence of this protein on the surface of all M serotypes of group A streptococcal tested . Purified SDH was found to bind to fibronectin, lysozyme, as well as the cytoskeletal proteins myosin and actin . The binding activity to myosin was found to be localized to the globular heavy meromyosin domain . SDH did not bind to streptococcal M protein, tropomyosin, or the coiled-coil domain of myosin . The multiple binding capacity of the SDH in conjunction with its GAPDH activity may play a role in the colonization, internalization, and the subsequent proliferation of group A streptococci.

J Clin Microbiol, 1992 Aug, 30(8), 2135 - 8
Comparison of three methods for detection of group A streptococci in throat swabs; Anhalt JP et al.; Group A streptococci are generally detected in throat swabs by (i) rapid antigen tests, (ii) conventional culture, or (iii) combinations of both . Direct fluorescent-antibody testing of a 2-h enrichment broth (FA/EN) was an accepted method for same-day results before the advent of rapid antigen tests . We compared FA/EN in Todd-Hewitt Broth (THB) with conventional culture and a rapid antigen test, TestPack Strep A (TPS) . Nine hundred seventy specimens were evaluated in this study . Cultures were performed for 48 h on sheep blood agar (SBA) incubated aerobically and on a selective agar for group A streptococci (SSA) incubated in 5 to 10% CO2 . Following a 2-h incubation, the fluorescent-antibody test was performed . A subculture of the centrifuged sediment from the THB enrichment was also done . In comparison with a positive culture on SBA or SSA or subculture of the THB pellet, the sensitivities and specificities of the different methods were as follows: SBA, 92 and 100%; SSA, 92 and 100%; TPS, 68 and 99%; FA/EN, 88 and 98% . The FA/EN method offers the potential for definitive finalized reports on the same day as specimen collection with greater sensitivity than TPS . This study included sequential plating and rapid antigen testing of a single swab . In a separate set of experiments to validate this study design, it was shown that recovery of streptococci from swabs plated sequentially on five plates did not vary with the order of plating and the actual proportion of organisms recovered from a swab on a single plate was only 1%.

Monatsschr Kinderheilkd, 1992 Aug, 140(8), 457 - 9
{Transient, prolonged, combined sicca syndrome of the eyes and mouth . Occurrence along with a common cold in an 8-year-old girl}; Rebmann H et al.; A girl of eight years fell ill with signs of common cold and bronchitis . Already on the second day of illness, before any treatment was started, she showed symptoms of a sicca-syndrome, beginning in the eyes, later the mouth . Ophthalmologic examination showed keratitis filiformis, histology of the salivary glands in the mucosa of the mouth was normal . Local substitution therapy led to subjective improvement . The disorder of secretion persisted for four months only, then rapid restitutio ad integrum of tears and saliva production occurred . Pathogenetically a parainfectious immunologic mechanism seems probable . During the observed period there were significant changes of antibody titers against RS-virus and streptococci, but it is not possible to identify the cause of the illness really . We conclude that a sicca-syndrome with normal histology of mouth-mucosa-glands is not necessarily prognostically infavorable.

Anasthesiol Intensivmed Notfallmed Schmerzther, 1992 Aug, 27(5), 325 - 7
{Spontaneous bacterial peritonitis without ascites}; Brase R et al.; A 34-year-old woman with acute pain in the lower abdomen and a history of non-A-non-B-hepatitis underwent laparotomy . A diffuse light redness of the small bowel without ascites was the only abnormal finding . An appendectomy was performed . The patient deteriorated into a sepsis during the next 60 hours . Relaparotomy established acute diffuse peritonitis with ascites and without any apparent intra-abdominal source of infection . Tracheal, blood, and intraperitoneal cultures of both procedures grew group A streptococci and proved a haematogenous spread of the infection . The sepsis was successfully treated with antibiotics and peritoneal lavage . The course of the infection and the findings are discussed and the case is interpreted as a spontaneous bacterial peritonitis without ascites.

Clin Exp Immunol, 1992 Aug, 89(2), 301 - 4
Preferential activation of peripheral blood V gamma 9+ gamma/delta T cells by group A, B and C but not group D or F streptococci; Bender A et al.; Previous studies have established that inactivated mycobacteria are potent and selective activators of V gamma 9+/V delta 2+ human gamma/delta T cells . Here we have analysed the proliferative response of human gamma/delta T cells to five serologically distinct groups of streptococci . While heat-inactivated streptococci of all five serogroups tested (A, B, C, D and F) induced a strong proliferative response in peripheral blood mononuclear cells (PBMC), only groups A, B and C elicited a selective activation of V gamma 9+ gamma/delta T cells in 10 (serogroup B) or 11 (serogroups A and C) of 11 tested healthy individuals . In striking contrast, groups D and F streptococci failed to activate gamma/delta T cells in nine of 11 donors and induced only a weak gamma/delta T cell response in two additional individuals . Depletion of V gamma 9+ T cells before culture completely eliminated all gamma/delta T cell responses to streptococci . These data indicate that groups A, B and C (but not D or F) streptococci can be included in the growing list of selective ligands for V gamma 9+/V delta 2+ human gamma/delta T cells.

J Infect Dis, 1992 Aug, 166(2), 436 - 40
Streptokinase-producing streptococci grown in human plasma acquire unregulated cell-associated plasmin activity; Lottenberg R et al.; Group A streptococci grown in the presence of human plasma generated plasmin from plasminogen and captured the functional enzyme to a specific cell-surface receptor . Bacteria-bound plasmin was not regulated by alpha 2-antiplasmin present in the medium . The ability of the bacteria to acquire cell-associated plasmin activity was dependent on both the presence of plasminogen in the culture medium and the production of a bacterial plasminogen activator, streptokinase . The ability of group A streptococci to produce a plasminogen activator and capture resulting plasmin in an unregulatable form could provide the organism with a mechanism for invasion of normal tissue barriers.

J Bacteriol, 1992 Aug, 174(15), 4967 - 76
Architecture of the vir regulons of group A streptococci parallels opacity factor phenotype and M protein class; Haanes EJ et al.; Group A streptococci have traditionally been categorized into two broad groups based on the presence or absence of serum opacity factor (OF) . Recent studies show that these two groups vary in a number of properties in addition to the OF phenotype, including sequence variations in the constant region of the antiphagocytic M protein genes, the presence or absence of immunoglobulin G Fc receptor proteins, and the presence or absence of multiple M protein-like genes situated in a tandem array . The M protein genes (emm) in OF- streptococcal strains are known to be part of a regulon of virulence-related genes controlled by the trans-acting positive regulatory gene, virR, situated just upstream of emm . In OF+ strains, however, the region adjacent to virR is occupied by an M protein-related, type IIa immunoglobulin G Fc receptor gene (fcrA), and the relative position of emm has not been determined . To further define the vir regulon in OF+ streptococci, we used the polymerase chain reaction to show that fcrA49 is situated immediately upstream of emm49 in the OF+ type 49 strain CS101 . This result shows for the first time the separate identity and genetic linkage of these two genes in the vir regulon of an OF+ group A streptococcal strain and confirms our previous hypothesis that emm49 exists as the central gene in a trio of emm-like genes . Additionally, using DNA hybridizations, we found considerable sequence divergence between OF- and OF+ group A streptococci in virR and in the noncoding sequences between virR and the emm or fcrA expression site . We found, however, a high degree of sequence conservation in this region within each of the two groups of strains.

Oral Microbiol Immunol, 1992 Aug, 7(4), 193 - 7
Characterization of the adherence of Porphyromonas gingivalis to oral streptococci; Lamont RJ et al.; Adherence of Porphyromonas gingivalis to strains of Streptococcus sanguis and Streptococcus mitis deposited on nitrocellulose paper was investigated . A variety of laboratory strains and clinical isolates of P . gingivalis bound to both S . sanguis and S . mitis . Binding of P . gingivalis to all but one of the streptococci was not inhibited by salivary molecules . Pretreatment of P . gingivalis with periodate and pretreatment of S . sanguis and S . mitis with pronase decreased binding, suggesting that adherence may be mediated by a protein on the streptococci interacting with a carbohydrate on P . gingivalis . Binding was not inhibited by a selection of simple sugars . The ability to adhere to early plaque bacteria such as S . sanguis and S . mitis may be important in the colonization of the mouth by P . gingivalis.

Infect Immun, 1992 Aug, 60(8), 3268 - 77
Actinomyces tissue specificity may depend on differences in receptor specificity for GalNAc beta-containing glycoconjugates; Stromberg N et al.; Actinomyces naeslundii 12104 and A . viscosus LY7 were compared for receptor specificities and adherence properties because these relate to their oral colonization sites . Both strains bind GalNAc beta-containing glycosphingolipids (GSLs) in a GalNAc beta 1-3Gal alpha Oethyl-sensitive fashion but differ with respect to the number of cells bound to GSLs and the effect of neighboring sugar groups on the binding . Their hemagglutination and saccharide inhibition profiles confirms the existence of two receptor specificities (for example, when GalNAc beta 1-3Gal alpha Oethyl is multivalently conjugated to albumin, its inhibitory activity increases fourfold toward strain 12104 but decreases fourfold toward strain LY7) . Trypsin or chymotrypsin treatment of human erythrocytes, which possess receptor GSLs, improves their hemagglutination with strain 12104 . In contrast, the same treatment of chicken erythrocytes, which lack receptor GSLs, abolishes their hemagglutination . These findings suggest that both GSLs and glycoproteins act as functional receptors on eukaryotic cells . The strains also differ with respect to the following GalNAc beta 1-3Gal alpha Oethyl-sensitive adherence properties: (i) strain LY7 adheres somewhat better than does strain 12104 to buccal epithelial cells; (ii) in spite of their similar overall coaggregation patterns with streptococci, strain 12104 coaggregates with Streptococcus oralis MPB1 but strain LY7 does not; (iii) strain 12104 alone shows GalNAc beta-sensitive saliva aggregation and adherence to saliva-coated hydroxyapatite . The GSL binding patterns of fresh Actinomyces isolates reveal a high prevalence of LY7-like specificities among buccal isolates, whereas 12104-like specificities are most prevalent among plaque isolates . These findings strongly suggest that fresh Actinomyces isolates use fine specificity for GalNAc beta-containing glycoconjugates in recognition and subsequent colonization of specific oral surfaces.

J Photochem Photobiol B, 1992 Jul 30, 14(4), 369 - 79
Mode of photocatalytic bactericidal action of powdered semiconductor TiO2 on mutans streptococci; Saito T et al.; Powdered semiconductor TiO2 has a photocatalytic bactericidal capacity on some kinds of bacteria, but its mechanism still remains unclear . The mode of its photocatalytic bactericidal action on the mutans group of streptococci was investigated . Powdered TiO2 had a bactericidal capacity on all serotypes of mutans streptococci . Streptococcus sobrinus AHT was mainly used for these experiments . The most effective concentration of TiO2 was about 1 mg ml-1 and, at this concentration, 10(5) colony-forming units of S . sobrinus AHT per millilitre were completely killed within 1 min . In order to search for the mechanism of this effect, a high bacterial cell density (10(9) colony-forming units ml-1) was used in the following studies . "Rapid" leakage of potassium ions from the bacteria occurred parallel to the decrease in cell viability . Protein and RNA were "slowly" released from bacterial cells for a reaction time up to 120 min . The pH of the reaction mixture decreased continuously to 4.5 after 120 min . Co-aggregation of S . sobrinus AHT and powdered TiO2 occurred at high bacterial densities (above 10(8) colony-forming units ml-1) . Aggregates gradually decomposed with light irradiation . Transmission electron microscopy of S . sobrinus AHT after photocatalytic action for 60-120 min indicated complete destruction of bacterial cells . From these results, bacterial death appears to be caused by a significant disorder in cell membranes and finally the cell walls were decomposed.

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