Streptococci

Surg Gynecol Obstet, 1992 May, 174(5), 347 - 54
Single dose cephalosporin prophylaxis in high-risk patients undergoing surgical treatment of the biliary tract; Grant MD et al.; During June 1985 through October 1986, 292 patients considered to be at high risk for having postoperative complications develop underwent cholecystectomy and were evaluated in a multicenter, randomized, prospective, double-blind study . Risk factors included age greater than 70 years, acute cholecystitis within the previous six months, obstructive jaundice, obesity and diabetes mellitus . One gram of cefamandole was administered intravenously to 144 patients and 148 patients received 1 gram of cefotaxime intravenously 30 minutes prior to skin incision . Culture-proved bactibilia was found in 55 patients and 11 of the patients had choledocholithiasis . Of the risk factors considered to place patients at high risk for postoperative infectious complications, obesity and acute cholecystitis proved to be the more common . However, age greater than 70 years, diabetes mellitus and obstructive jaundice were more significant risk factors predisposing to bactibilia . The most common organisms isolated from the bile and gallbladder intraoperatively were Staphylococcus, Streptococcus and Klebsiella species along with enterococcus, Escherichia coli and diphtheroids . Clinically significant postoperative infections occurred in eight patients, including six patients in the cefamandole group and two patients in the cefotaxime group . Antibiotic concentrations were measured in the serum, muscle, subcutaneous fat, gallbladder and bile, with cefamandole showing statistically significant greater concentrations in bile, gallbladder and muscle tissue . There was no statistical significance between the postoperative infection rates, total period of hospitalization or total hospital charges for each group . Therefore, there is no significant advantage between a single prophylactic dose of cefamandole versus cefotaxime for high-risk patients undergoing biliary tract operation.

Infect Immun, 1992 May, 60(5), 1957 - 62
Mouse antibody to phosphocholine can protect mice from infection with mouse-virulent human isolates of Streptococcus pneumoniae; Briles DE et al.; Previous studies have demonstrated that mouse antibodies to phosphocholine (PC) can protect mice against fatal infection caused by several, but not all, mouse-virulent laboratory strains of Streptococcus pneumoniae . Because the pneumococcal strains used in previous studies had been mouse passed and were propagated for many years outside of humans, it was not known whether antibody to PC would be able to protect mice against S . pneumoniae freshly isolated from humans . In the present study, we examined the ability of an immunoglobulin G (IgG) monoclonal antibody (MAb) to PC to protect against infections in mice caused by 14 pneumococcal strains of capsular types 3, 4, 6A, and 6B . Nine of these strains were selected as the most virulent strains for mice from a group of 69 fresh clinical isolates . Five were mouse-passed laboratory strains . Mouse IgG3 MAb to PC was able to exhibit protective effects (survival or increased time to death) against infection with virtually all of the strains injected intravenously and against infection with 70% of the strains injected intraperitoneally . The protective effects of antibody to PC appeared to be partially dependent on capsular type . MAb to PC was most effective against capsular type 3 strains and least effective against type 4 strains . With type 3 and type 4 strains, MAb to PC could frequently protect against larger numbers of CFU injected intravenously than intraperitoneally . For capsular type 6A and 6B strains the reverse was true.

Infect Immun, 1992 May, 60(5), 1908 - 12
Penicillin treatment accelerates middle ear inflammation in experimental pneumococcal otitis media; Kawana M et al.; Most Streptococcus pneumoniae strains are killed by very low concentrations of penicillin and other beta-lactam antibiotics, yet middle ear inflammation and effusion persist for days to weeks after treatment in most cases of pneumococcal otitis media . To study the effect of beta-lactam antibiotic treatment on pneumococci and the middle ear inflammatory response during pneumococcal otitis media, we measured concentrations of pneumococci, inflammatory cells, and lysozyme in middle ear fluid (MEF) by using the chinchilla model . Procaine penicillin G given intramuscularly 12 and 36 h after inoculation of pneumococci into the middle ear caused a significant acceleration in the MEF inflammatory cell concentration compared with that in untreated controls, with a significant peak in the inflammatory cell concentration 24 h after pneumococcal inoculation . The lysozyme concentration in MEF also increased more rapidly in treated than in control animals . Viable pneumococci were not detected in MEF after the second dose of penicillin, but the total pneumococcal cell concentration remained unchanged for at least 45 days . Therefore, penicillin treatment accelerated middle ear inflammation while killing pneumococci, but treatment did not accelerate clearance of the nonviable pneumococcal cells from MEF . Further studies will need to define the contribution of these responses to acute and chronic tissue injury.

Infect Immun, 1992 May, 60(5), 1767 - 70
Separation of T-cell-stimulating activity from streptococcal M protein; Fleischer B et al.; The superantigenic properties of M protein type 5 of Streptococcus pyogenes have been implicated as an important pathogenicity factor in streptococcal autoimmune diseases . Here we show that after a single purification step by affinity chromatography on immobilized albumin or fibrinogen, M protein has no mitogenic activity for T cells . We demonstrate that the superantigenicity of M proteins of type 5 and type 1 is due to contamination with the highly potent pyrogenic exotoxins of S . pyogenes in the range of 0.1 to 0.01% . These results raise a general caveat for work with these extremely active T-cell mitogens, because the mitogenicity of other streptococcal or staphylococcal proteins could be due to similar minute contamination with potent superantigens that are undetectable by any biochemical method but extremely effective in stimulating sensitive T cells.

Infect Immun, 1992 May, 60(5), 1740 - 6
Toxicity of pneumolysin to pulmonary endothelial cells in vitro; Rubins JB et al.; Pneumococcal pneumonia and bacteremia are associated with appreciable mortality, most of which occurs very early in the course of infection . An initial step in the pathogenesis of pneumococcal pneumonia may include disruption of the pulmonary endothelial barrier with subsequent alveolar hemorrhage . We sought to determine whether soluble factors from Streptococcus pneumoniae can directly injure pulmonary endothelial cells in vitro and to identify pneumococcal toxins that may be involved in endothelial cell injury . Suspensions of S . pneumoniae (10(8) organisms per ml) caused significant injury to cultured bovine pulmonary artery endothelial cells in a time-dependent manner . The degree of endothelial cell cytotoxicity differed among S . pneumoniae strains; among the strains tested, a type 14 strain was the most cytotoxic and a type 3 strain was the least cytotoxic . During autolysis, type 14 S . pneumoniae released a soluble endothelial cell cytotoxin that was distinct from S . pneumoniae capsular and cell wall polysaccharides . The soluble cytotoxin was further characterized as a thiol-activated, heat-sensitive protein that coeluted with purified pneumolysin during gel filtration . The identity of the S . pneumoniae endothelial cell cytotoxin as pneumolysin was further supported by the ability of purified pneumolysin and the inability of S . pneumoniae mutants which lack pneumolysin to injure endothelial cells, as well as by the inhibition of the soluble S . pneumoniae cytotoxin by a neutralizing antibody to pneumolysin . Pneumolysin appears to be the major S . pneumoniae soluble cytotoxin for pulmonary endothelial cells in vitro and may be an important factor in the pathogenesis of alveolar hemorrhages in S . pneumoniae infections.

J Virol, 1992 May, 66(5), 2860 - 4
The insertion site of the temperate phage HB-746 is located near the phage remnant in the pneumococcal host chromosome; Romero A et al.; Combined Southern blot hybridization analyses of DNA digests of several clinical strains of Streptococcus pneumoniae have revealed the presence of a gene (hblR), or part of it, similar to the hbl7 gene coding for the cell wall lytic enzyme of the temperate HB-746 phage . The results confirmed that the genome of HB-746, which contains protein covalently linked to the 5' ends of its DNA, becomes integrated into the host strain 8R1 and showed that both the host and phage attachment sites, attB and attP, lie downstream of the 3' end of the structural region of the hblR and hbl7 genes, respectively . The data reported also highlight some evolutionary relationships between phage and bacteria.

J Infect Dis, 1992 May, 165(5), 938 - 41
Therapeutic use of recombinant human granulocyte-macrophage colony-stimulating factor in neonatal rats with type III group B streptococcal sepsis; Wheeler JG et al.; The use of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) as therapy in neonatal sepsis has been proposed because of observed defects in polymorphonuclear leukocyte (PMNL) production and function in infected neonates . Newborn rats were infected intraperitoneally (ip) with type III group B streptococcus (III-GBS) and effects of treatment with rhGM-CSF given ip 7-19 h after infection were studied . Overall mortality was 67% in controls and 37% in animals treated with rhGM-CSF (P = .003) . No changes in peripheral blood PMNL number or oxidative metabolic function were found in infected or uninfected animals given rhGM-CSF compared with controls . In uninfected animals, there was an increase in the oxidative burst of peritoneal cells at 3.5 h (P = .043) and in the numbers of peritoneal cells at 3 h (P = .001) in animals receiving ip rhGM-CSF compared with controls . Phagocyte priming, cellular influx into the peritoneum, or both appear to contribute to the decreased mortality observed in this model of rhGM-CSF therapy of III-GBS disease in neonates.

Can J Public Health, 1992 May-Jun, 83(3), 230 - 3
Invasive Streptococcus pyogenes infections in children; Cimolai N et al.; We investigated the epidemiology and clinical features of invasive S . pyogenes infection in a pediatric population over a 7-year period (1984-90) by retrospective review . An increasing frequency in invasive infections had occurred (0-11.81/10,000 admissions) . A large proportion (48%) of these were orthopedic infections . An epidemic strain was typed as M1T1 . This increase appears to have occurred in the context of an overall increase in S . pyogenes infections ("scarlet fever" 1.47-11.22/10,000 outpatients; "strep throat" 4.41-46.54/10,000 outpatients).

Int J Prosthodont, 1992 May-Jun, 5(3), 214 - 20
Efficacy of denture cleansing agents in an in vitro bacteria-yeast colonization model; Drake D et al.; The purpose of this investigation was to develop a new, in vitro bacteria-yeast denture colonization model . Candida albicans and Streptococcus mutans, organisms associated with denture stomatitis, reproducibly colonized denture blanks in high numbers . Both Efferdent and Super-Strength Polident were able to substantially reduce or eliminate colonizing S mutans . In sharp contrast, however, no significant decreases in adherent C albicans were observed with either denture soaking agent.

Clin Prev Dent, 1992 May-Jun, 14(3), 5 - 8
Bacterial growth inhibition and short-term clinical efficacy of a vegetable oil-based mouthrinse: preliminary study; Busscher HJ et al.; Bacterial growth of a vegetable oil-based product was determined in vitro . Growth of Streptococcus mutans and Veillonella alcalescens was strongly inhibited for dilutions up to 50x . On the basis of these results, it was decided to evaluate the short-term, clinical efficacy of a 1:10 dilution of the concentrated product in water . Fifteen human volunteers employed this rinse twice-a-day during a six-day period . Planimetric plaque scores, as well as the plaque and gingival indexes according to Loe, were assessed at the beginning and end of this period . The efficacy of such a rinse, though less than of chlorhexidine-based products, turned out comparable to several other commercially available products with a reasonable potential in maintaining a low gingival index.

Pathol Biol (Paris), 1992 May, 40(5), 483 - 91
{Bacteriostatic activity and killing curves of eight antibiotics against seven strains of penicillin G-resistant pneumococci}; Barakett V et al.; Increasing resistance to multiple antimicrobial agents including penicillins is a current problem with Streptococcus pneumoniae . Seven cases of severe infection due to penicillin G-resistant pneumococci were seen in two teaching hospitals in Paris (France) during the first half of 1991; six of the strains were recovered from pulmonary secretions (protected brush specimens) and one from cerebrospinal fluid (CSF) . The bacteriostatic activity and killing curves of eight antimicrobials against these seven strains were studied . Antimicrobial agents tested included penicillin G (PEN), amoxicillin (AMX), cefotaxime (CTX), imipenem (IPM), rifampin (RIF), vancomycin (VAN), fosfomycin (FOS), and erythromycin (ERO) . MICs were determined using the agar dilution method . Killing curves were obtained using a liquid medium inoculated with 10(5) to 10(6) CFU/ml and subjected to continuous agitation; survivors were counted at baseline and after 1, 3 and 5 hours incubation . MICs of each antimicrobial (mg/l) for the seven strains were in the following ranges: PEN: 0.5-2, AMX: 0.5-2; CTX: 0.125-1; IPM: 0.03-0.25; RIF: 0.12-0.25; VAN: 0.25-1; FOS: 16; ERO: 0.06 greater than 4 . Overall, bactericidal activity was greatest with vancomycin, followed by imipenem, then amoxicillin . The cefotaxime-fosfomycin combination proved synergistic and exhibited bactericidal activity (2MIC + 2MIC) for three of the seven strains . This study demonstrated the value of the cefotaxime-fosfomycin combination . Both these antimicrobials seem appropriate for the treatment of meningitis caused by penicillin G-resistant pneumococci provided their dosage is adjusted to achieve adequate drug levels in the cerebrospinal fluid.

Bioorg Khim, 1992 May, 18(5), 716 - 25
{Synthesis of protected fragments of the capsular polysaccharide of Streptococcus pneumoniae, type 8}; Cherniak AIa et al.; Oxidation of acetates of allyl and 2-(benzyloxycarbonylamino)ethyl beta-cellobiosides (with OH-4' and OH-6' unprotected) with the Jones reagent followed by esterification (with diazomethane or phenyldiazomethane) gave corresponding uronates with OH-4' unsubstituted . Condensation of these glycosyl acceptors and benzylated derivatives of D-galactose or 4-O-(alpha-D-glucopyranosyl)-D-galactose led to the protected tri- and tetrasaccharide fragments of the capsular polysaccharide from Streptococcus pneumoniae type 8.

Int Endod J, 1992 May, 25(3), 142 - 9
Pulp response to, and cariogenicity of, a further strain of Streptococcus mutans (NCTC 10832); Watts A et al.; The pulpal response to and cariogenicity of a third strain of Streptococcus mutans, namely S . mutans (NCTC 10832), was studied in monoinfected gnotobiotic rats of the Fischer strain using the techniques described previously by the present authors . Unlike S . mutans (NCTC 10449 and 10919), S . mutans (NCTC 10832) was associated with the presence of inflammatory cell infiltrates in the coronal pulp of a small number of teeth and extensive periapical inflammation 28 days after the creation of untreated pulpal exposures . S . mutans (NCTC 10832) was associated with the presence of extensive pulpal necrosis and reduced dentine bridge formation . These changes were similar to those noted with the other two strains of S . mutans . S . mutans (NCTC 10832) was non-cariogenic in monoinfected gnotobiotic rats of the Fischer strain.

J Membr Biol, 1992 May, 127(3), 195 - 203
Differential sensitivity of pneumolysin-induced channels to gating by divalent cations; Korchev YE et al.; The induction of channels across planar lipid bilayers by purified, recombinant pneumolysin (a hemolytic protein from Streptococcus pneumoniae) has been studied by measuring increases in electrical conductivity . Pneumolysin-induced channels exhibit a wide range of single channel conductances (less than 50 pS to greater than 1 nS at 0.1 M KCl) . Channels can be categorized on the basis of their K+:Cl- selectivity: the smallest channels are strongly cation selective, with t+ (the cation transference number) approaching 1.0; the largest channels are unselective (t+ approximately 0.5) . Channels tend to remain open at all voltages (-150 to 150 mV); only the smallest channels exhibit any rectification . In the presence of divalent cations (1-5 mM Zn2+; 10-20 mM Ca2+), small (less than 50 pS) and medium-sized (50 pS to 1 nS) channels are closed in a voltage-dependent manner (more closure at higher voltages); at 0 voltage channels reopen . Overall selectivity is reduced by divalent cations, compatible with small, selective channels being closed preferentially to large, nonselective ones . It is concluded that a single molecular species (pneumolysin) induces multiple-sized channels that can be categorized by cation:anion selectivity and by their sensitivity to closure by divalent cations.

Nippon Rinsho, 1992 May, 50(5), 1066 - 74
{Recent trend and development of novel antimicrobial agents for MRSA infections}; Nishino T; Gram-positive organisms such as Staphylococcus aureus (including MRSA), coagulase-negative staphylococci, Enterococcus spp., and Streptococcus spp . have in recent years emerged as significant pathogens in hospitals and are now being isolated more frequently than gram-negative bacilli . These organisms are often multidrug resistant . Therefore, alternative agents with potent activity against gram-positive organisms are of considerable interest . In addition to the glycopeptide antibiotic vancomycin and the aminoglycoside antibiotic arbekacin, which can be used in MRSA infections, teicoplanin, RP 59500 and daptomycin are now under basic research in Japan . These antimicrobial agents are very active against gram-positive organisms, including MRSA and appear to be potent agents against infections due to gram-positive cocci, particularly MRSA.

Med J Aust, 1992 Apr 20, 156(8), 572 - 5
Managing sore throat: a literature review . I . Making the diagnosis; Del Mar C; OBJECTIVE: To assess the justification for the routine use of investigations in the diagnosis of bacterial causes of sore throat . DATA SOURCES: The literature from 1945 to 1990 was systematically screened to identify studies that addressed diagnosis of bacterial infection and the efficacy of antibiotics in sore throat, using the key-words "pharyngitis" and "tonsillitis" . RESULTS: Difficulties were identified with clinical methods and investigations that identify streptococcal infections . The practice of throat-swab culture--the "gold standard"--appears to have developed as a strategy to protect patients from acute rheumatic fever . However, this method may be limited in its usefulness for protection against acute rheumatic fever because: (i) in many cases in which the streptococcus is isolated from symptomatic patients there is no serological evidence of infection; (ii) there are very high asymptomatic carrier rates of the streptococcus; (iii) even after adequate treatment with penicillin there are high bacteriological failure rates; and (iv) those organisms that can be isolated from the mucosal surface are a poor representation of organisms lying deep in the tissues . Evaluation of other diagnostic techniques such as Gram's stain and rapid antigen testing, as well as decision analysis, has also been hampered by the difficulties encountered with use of this inadequate gold standard . CONCLUSION: There is little indication from the literature that any routine system of identifying bacterial causes of sore throat is helpful to the clinician.

J Med Chem, 1992 Apr 17, 35(8), 1392 - 8
Preparation and in vitro and in vivo evaluation of quinolones with selective activity against gram-positive organisms; Cooper CS et al.; A series of quinolones were prepared which contained oximes or substituted oximes as replacements for the amine substituents normally found on the pyrrolidine or piperidine fragments of quinolone antibacterial agents . These substituents led to compounds that had selective activity against Gram-positive organisms . These compounds showed in vivo activity against Staphylococcus aureus . Only compound 29 had in vivo activity against Streptococcus pneumoniae.

FEMS Microbiol Lett, 1992 Apr 15, 71(2), 139 - 45
Duplication of a DNA sequence homologous to genes for immunoglobulin receptors and M proteins in Streptococcus pyogenes; Jeppson H et al.; The nucleotide sequence of an open reading frame of 355 amino acids downstream of the IgA-binding protein gene arp4 in Streptococcus pyogenes M-type 4 has been determined . Analysis of the deduced amino acid sequence for the open reading frame shows an extensive homology to streptococcal M proteins and immunoglobulin binding proteins . Expression of the open reading frame has not been detected and the function may be as a genetic reservoir in the generation of new immunoglobulin receptors and antigenic variants of M proteins.

Carbohydr Res, 1992 Apr 6, 227, 1 - 17
Influence of the culture medium on the synthesis of alpha-D-glucans by Streptococcus cricetus AHT; Walker GJ et al.; Three different alpha-D-glucosyltransferases (GTFs) were separated from culture filtrates of Streptococcus cricetus strain AHT grown in a complex, standard medium in batch culture or under defined conditions of growth in the chemostat . Two of the enzymes (GTF-S1 and GTF-S2) converted sucrose into branched, soluble dextrans, and the third (GTF-I) produced a relatively linear, water-insoluble, predominantly (1----3)-linked alpha-D-glucan . When the organism was grown in complex medium modified by the removal of the fraction of high molecular weight, only GTF-S1 and GTF-S2 were released, and no GTF-I was detected . The water-insoluble glucan fraction obtained by incubating the cell-free filtrate with sucrose contained from 17 to 25% of (1----3)-glucosidic linkages, and accounted for up to 78 and 4% of the total glucans derived from growth in standard and modified medium, respectively . The soluble glucans produced in the same reaction were fractionated with ethanol to give, from both media, two distinct dextrans comprising (1) a highly branched dextran similar to the S1-dextran product of GTF-S1 and (2) a dextran containing fewer branch linkages and up to 86% of (1----6)-alpha-D-glucosidic linkages . A GTF responsible for the synthesis of the latter dextran was not separated . The structures of the glucan fractions and the products of the separated GTF were examined by enzymic degradation and methylation analysis.

Kansenshogaku Zasshi, 1992 Apr, 66(4), 508 - 15
{A case of penicillin-resistant pneumococcal pneumonia and penicillin-binding proteins of the clinical isolates}; Shigeno H et al.; We experienced a case of a 68-year-old female with beta-lactam antibiotics including penicillin G (PCG) resistant pneumococcal pneumonia, leading to death during the treatment with ceftizoxime (CZX) . We reported the clinical course and the mechanism of resistance of isolated bacteria . The present case is the first in Japan . Minimum inhibitory concentration (MIC) against Streptococcus pneumoniae 88031 isolated from the present case was 1.56 micrograms/ml in PCG and 6.25 micrograms/ml in CZX, showing PCG resistance . The isolate was no beta-lactamase production and serotype 23 . The drug susceptibility in 34 strains of S . pneumoniae which were isolated as causative organism of respiratory infection in our department in 1988 was studied . PCG high resistant strain (PCG MIC greater than 1.56 micrograms/ml) was only observed in the isolated strain in the present case and PCG low sensitive strains (PCG MIC = 0.1-1.0 micrograms/ml) were observed in 3 strains (8.8%) . The CZX resistance was observed only in the present case . The detection of penicillin-binding protein (PBP) and binding affinity of beta-lactam antibiotics were studied using PCG sensitive strain, S . pneumoniae type I (preserved strain PCG MIC = 0.05 micrograms/ml, CZX MIC = 0.1 micrograms/ml, CMX MIC = 0.025 micrograms/ml) and PCG resistant strain, S . pneumoniae 88031 . The result obtained showed that PBP1a, detected in sensitive strain type I, was not detected in resistant strain 88031 and PBP1b was increased . The binding of 14C-PCG of PCG resistant strain to PBP1b showed lower affinity for CZX and CMX than PCG sensitive strain.(ABSTRACT TRUNCATED AT 250 WORDS)

Minerva Anestesiol, 1992 Apr, 58(4 Suppl 1), 135 - 7
{Pansinusitis of the face caused by Streptococcus milleri with cerebral thrombophlebitis after naso-sphenoid surgery of the pituitary gland}; Riche H et al.; The authors report a patient operated on trans-nasosphenoidally for a pituitary adenoma (Cushing's disease) in whom a severe infection occurred with cavernous thrombophlebitis responsible for neurological complications.

J Vet Diagn Invest, 1992 Apr, 4(2), 170 - 4
Antimicrobial resistance patterns and plasmid profiles of Streptococcus suis isolates; Cantin M et al.; Streptococcus suis isolates recovered from diseased animals in Quebec and western Canada and from human cases in Europe were tested for their susceptibility to different antimicrobial agents and screened for their plasmid content . Most isolates from Quebec were clindamycin, erythromycin, and tetracycline resistant; animal isolates from western Canada were notably less resistant to clindamycin and erythromycin, whereas human isolates were considerably more susceptible to most antimicrobials tested . More than 60% of isolates had plasmids that ranged from 1.5 to 35 kilobases (kb) . Of the 7 plasmid profiles found, 2 were particularly frequent in isolates from Quebec and western Canada, suggesting the presence of epidemic strains in the swine population . A particular plasmid band of about 5 kb was present in most Canadian isolates . When this band was used as a probe in colony and Southern blot hybridization, most isolates harboring the 5-kb plasmid hybridized, even though their plasmid profiles were different . Human isolates from Europe differed in their plasmid content from Canadian isolates of animal origin . Although a high degree of antimicrobial resistance was associated with the presence of plasmids in most isolates, it was not possible to establish a causative relationship.

Zentralbl Bakteriol, 1992 Apr, 276(4), 521 - 9
Etiology and antibiotic susceptibility of bloodstream Streptococcus sp; Eggers S et al.; 249 episodes of Streptococcus bacteraemia in hospitalized patients were evaluated for both clinical and microbiological features . Specification of the isolates demonstrated that infective endocarditis was predominantly associated with Streptococcus sanguis and Streptococcus bovis whereas Streptococcus pyogenes and Streptococcus milleri were the most common cause of local and/or systemic infections . In vitro-susceptibility tests towards 9 selected antibiotics proved that beta-lactam antibiotics are potent compounds for the treatment of Streptococcus sp . with the exception of enterococci; that ampicillin turned out to be highly effective against enterococci; and that vancomycin may be regarded as a potent alternative in the treatment of streptococcal infections.

Vet Immunol Immunopathol, 1992 Apr, 32(1-2), 93 - 102
Equine glomerulonephritis and renal failure associated with complexes of group-C streptococcal antigen and IgG antibody; Divers TJ et al.; A 12-year-old thoroughbred gelding died from diffuse global glomerulonephritis, 3 months after a lower respiratory infection from which Streptococcus zooepidemicus was isolated . Immunopathological studies (immunofluorescence, immunodiffusion, immunoperoxidase testing and immunoblotting) indicated the presence of an immune reactant renal disease associated with IgG antibody and streptococcal antigens.

Vet Immunol Immunopathol, 1992 Apr, 32(1-2), 13 - 23
MHC class II expression in the bovine mammary gland; Fitzpatrick JL et al.; The distribution of major histocompatibility complex (MHC) class II positive cells within the connective tissue and the epithelium of the involuted bovine mammary gland has been determined . The effect of intramammary administration of the antigens ovalbumin and formalin killed Streptococcus uberis on the distribution pattern has also been investigated . Infusion of formalin killed S . uberis increased cellular expression of class II antigens when compared with quarters either infused with ovalbumin, not infused at all, or from which minor pathogens had been isolated . The increased expression occurred particularly in the area of the gland cistern-secretory tissue junction.

J Antimicrob Chemother, 1992 Apr, 29 Suppl A, 39 - 45
Animal models as predictors of outcome of therapy with broad spectrum cephalosporins; Rouse MS et al.; Broad spectrum cephalosporins have been studied extensively in animal models of experimental infections . There is generally good correlation between the results of therapy of experimental infections and clinical trials in humans . However, the results of animal model studies are better predictors of the failure than of the success of a chemotherapeutic regimen . Cefotaxime and the new 'fourth' generation agent, cefpirome, were comparable in the treatment of experimental meningitis caused by Streptococcus pneumoniae . Cefpirome was the most effective cephalosporin as therapy for methicillin-susceptible Staphylococcus aureus experimental endocarditis . The most effective broad spectrum cephalosporins for the treatment of Gram-negative experimental pneumonia were cefpirome, cefotaxime and cefodizime . Cefpirome was equivalent to ceftazidime or cefazolin as treatment for Pseudomonas aeruginosa or methicillin-susceptible S . aureus experimental osteomyelitis . Because of its potent activity in vitro and in animal models of experimental infections caused by methicillin-susceptible S . aureus and Gram-negative bacilli, cefpirome may offer a therapeutic advantage over currently available broad spectrum cephalosporins.

Bone Marrow Transplant, 1992 Apr, 9(4), 299 - 300
Meningitis due to penicillin-resistant Streptococcus pneumoniae in patients with chronic graft-versus-host disease; D'Antonio D et al.; Two episodes of meningitis due to penicillin-resistant Streptococcus pneumoniae occurring in two patients with chronic graft-versus-host disease (GVHD) are reported . Both patients were treated with ceftazidime . The first patient died, unresponsive to therapy . The second patient showed clinical improvement, reverting to her baseline mental status . This report draws attention to the fact that in chronic GVHD patients: (1) bacterial prophylaxis does not ensure protection against encapsulated bacteria; (2) rapid microbiological investigation is recommended with any upper respiratory tract infections.

J Dent Res, 1992 Apr, 71 Spec No, 871 - 8
An improved intra-oral enamel demineralization test model for the study of dental caries; Zero DT et al.; The intra-oral enamel demineralization test (IEDT) was introduced by Brudevold et al . (1984) . This caries model involves human subjects wearing palatal appliances each holding eight bovine enamel blocks covered by a bacterial cell layer prepared by the harvesting of cultures of Streptococcus mutants (test plaque) . The original model used the iodide permeability test for assessment of the extent of demineralization of bovine enamel blocks resulting from acid production by the test plaque after dietary substrate challenge . The IEDT model has been expanded and improved by us in the following ways: (1) Based on encouraging findings from an in vitro study (Zero et al., 1990), the surface microhardness test has been adopted to measure the extent of demineralization occurring at three sites on the enamel blocks corresponding to an area over which the effective plaque thickness is 0.5, 1.5, and 2.5 mm; (2) intra-oral pH of the test plaque is measured by means of a Beetrode miniature pH electrode at baseline, then at five, 10, 15, 30, and 45 min after the start of a test; (3) plaque samples are collected at the end of a test and analyzed for organic acid content by means of HPLC; (4) the bacterial test challenge has been expanded to include different cariogenic bacteria which are grown under various growth conditions . The improved model has the capability of studying fundamental aspects of the caries process, namely, the relationships among dietary substrate challenge, plaque pH change, plaque organic acid profiles, microbial virulence properties, and enamel demineralization . Furthermore, the model has the potential for use in more applied research on caries-preventive agents such as fluoride.

J Dent Res, 1992 Apr, 71 Spec No, 867 - 70
Reduction of intra-oral demineralization of enamel after single exposures to sodium fluoride; Kashket S et al.; Studies demonstrated the effects of single rinses with low concentrations of NaF on the intra-oral demineralization of enamel . Blocks of bovine enamel were covered with Streptococcus mutans IB1600, mounted in palatal appliances, and worn in the mouths of volunteers for specified times . Subjects rinsed with solutions of NaF, with or without sucrose . Demineralization was determined as changes in iodide penetrability (delta Ip) of the enamel, while the pH and F of the streptococcal plaque, and enamel F, were determined with ion-specific electrodes . Delta Ip was reduced by about 80% (from 14.5 +/- 2.7 to 2.8 +/- 2.3 units) when 250 micrograms F/mL was added to the sucrose rinse . Corresponding plaque pH's were 4.1 +/- 0.5 and 4.2 +/- 0.3, consistent with a lack of effect on bacterial acidogenesis . Protection against mineral loss was concentration-dependent . Administration of sucrose at different times after NaF revealed that the effect of F persisted for at least 60 min . Analyses of plaque F demonstrated an initial elevation and concentration within the cells, followed by a drop to stable, baseline values . Enamel F increased slowly to almost 500 micrograms/g enamel after 105 min . The protective effect of F appeared to be manifested in two stages, the first related to a high plaque F and the second to F that became incorporated into the enamel . Analysis of the data suggested that F was transferred from plaque to enamel during the experimental period.

Mikrobiyol Bul, 1992 Apr, 26(2), 149 - 54
{The local prevalence of group B streptococcus in pregnant women and newborn infants}; Celebi S et al.; In this study, group B streptococcus (GBS) were investigated in vaginal swabs obtained from 76 pregnant women and in samples of newborn infants obtained from different areas of their bodies . GBS were determined in 5.2% of women and 3.96% of infants . GBS were recovered in 15.4% of the women in their first pregnancy and in 13.3% of women in their second pregnancy . GBS could not isolated from the women in their third and more pregnancies . All eight species of GBS were sensitive to AMP + Sulbactam, Clavulanic acid + Amox, Lincomycin, Clindamycin, Penicillin G and SMZ + TMP.

An Med Interna, 1992 Apr, 9(4), 178 - 80
{Pleural empyema due to group-A beta-hemolytic Streptococcus}; del Castillo Rueda A et al.; We present the case of a parenteral drug addict with pleural overflow (empyema), in which hemolytic Streptococcus group A was isolated . The absence of an early diagnosis and an effective empirical treatment caused the development of septic shock and the patient died in spite of the therapeutical measures implanted in the emergency unit.

J Inorg Biochem, 1992 Apr, 46(1), 41 - 8
Studies on biologically active complexes of cobalt(II) and nickel(II) with dithiooxamide-derived ligands; Chohan ZH et al.; A number of cobalt(II) and nickel(II) complexes with novel dithiooxamide ligands derived from precursors such as benzonitrile, benzosulfonamide, benzaldehyde, benzoic acid, and phenol have been synthesized and characterized on the basis of their elemental analysis molar conductance, magnetic moment, H NMR and electronic and IR spectral data . These ligands and their complexes have been screened for their antibacterial activities against bacterial species Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Tuberculi bacilli . The studies indicate that in comparison to the ligands their metal complexes are more potent and antibacterial.

Scand J Dent Res, 1992 Apr, 100(2), 104 - 6
Crevicular IgG antibodies and recovery of Streptococcus mutans implanted by mouthrinsing; Camling E et al.; After challenge with a streptomycin-resistant strain of Streptococcus mutans (S . mutans), a tendency to higher recovery of S . mutans was found in gingival crevicular fluid (GCF) from surfaces with a low IgG antibody activity against S . mutans than in GCF from surfaces with a high antibody activity . This suggests that antibodies in GCF may interfere with the establishment of S . mutans on gingival tooth surfaces . In GCF collected from some sites, considerably higher IgG antibody activity was observed than in homologous serum, indicating that part of the IgG response to S . mutans was locally derived.

South Med J, 1992 Apr, 85(4), 378 - 80
Left-sided endocarditis in parenteral drug abusers: recent experience at a large community hospital; Graves MK et al.; Endocarditis in IV drug abusers involves the right side of the heart with much higher incidence than in the general population, being limited to the left in 30% to 40% of cases . The infecting organism is Staphylococcus aureus approximately 50% of the time, followed by Streptococcus (all groups), which accounts for 15% of all cases . In a retrospective study of infective endocarditis in IV drug abusers treated at Charity Hospital over a 5-year period, 67 patients had vegetations documented by two-dimensional echocardiogram . Left-sided involvement was present in 38 (57%) of these patients, a higher prevalence than reported in the literature in such populations . Right-sided involvement was limited to only 27 (40%) . A total of 55 patients had positive blood cultures, most of which yielded Staphylococcus aureus (32 {58%}), with the next largest group being Streptococcus species (14 {25%}) . This distribution of isolates was consistent with that found in the literature . From these data we conclude that the prevalence of left ventricular endocarditis in our population is higher than expected . With the known increase in morbidity and mortality of left-sided endocarditis as compared to right, it is imperative that careful consideration be given this entity often encountered in IV drug abusers.

Clin Pediatr (Phila), 1992 Apr, 31(4), 230 - 3
Systemic infection due to group B beta-hemolytic streptococcus in children . A review of 75 outpatient-evaluated cases during 13 years; Bonadio WA et al.; We reviewed 75 outpatient cases of systemic infection due to group B beta-hemolytic streptococcus (GBS) evaluated during a 13-year period . Patient ages ranged from five days to eight months; 75% were younger than two months . Early-onset (less than or equal to seven days of age) GBS disease occurred in 10% of the patients, and late-onset GBS disease in 90% . The racial distribution was 60% black, 35% white, and 5% Hispanic . Symptoms included fever, irritability, lethargy, and altered-feeding pattern which lasted less than 24 hours in 88% of patients . On presentation, 33% were afebrile (eight had GBS meningitis); 32% did not appear ill (six had GBS meningitis) . Of the total, 40% had GBS meningitis, of these, a greater proportion had either early-onset GBS disease or neutropenia . Infection other than meningitis was identified in 24% of all patients: pneumonia (six cases), cellulitis/adenitis (six cases), osteomyelitis/septic arthritis (five cases), and otitis media (one case) . All patients survived . Systemic GBS infection in an outpatient population can involve infants up to eight months old, is more common in blacks than in whites, can be present without fever or compromised appearance, and usually has low mortality.

Am J Kidney Dis, 1992 Apr, 19(4), 375 - 7
Fatal peritonitis due to group B beta-hemolytic streptococcus in a patient receiving chronic ambulatory peritoneal dialysis; Borra SI et al.; Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients is rarely caused by group B beta-hemolytic streptococcus species . We describe a 52-year-old man with chronic glomerulonephritis who developed a fatal peritonitis due to streptococcus group B in the absence of predisposing factors such as diabetes mellitus, malignancy, human immunodeficiency virus (HIV) infection, or liver disease . This report suggests that although beta-hemolytic streptococcus is a rare cause of peritonitis, the severity of the infection may be overwhelming and may rapidly lead to serious consequences and death.

J Infect Dis, 1992 Apr, 165(4), 671 - 5
Evidence for a clonal origin of relative penicillin resistance among type 9L pneumococci in northwestern Canada; Waltman WD 2nd et al.; The relationships among capsular type, protein type, and penicillin resistance for capsular group 9 Streptococcus pneumoniae collected in northwestern Canada between 1974 and 1987 were examined . The group 9 relatively penicillin-resistant (RPR) isolates were of the rare 9L capsular type . Of 47 penicillin-susceptible (PS) group 9 isolates that were typed for capsule, only 1 was 9L . Among 29 PS group 9 isolates that were protein typed, 9 protein types were observed . Of the 70 RPR isolates, 51 were protein type P23, 1 was P19, and 18 could not be typed (P0) . Protein types P23 differed from P0 by a single epitope on pneumococcal surface protein A . These results suggest that the Canadian P23 and P0 capsular group 9 isolates are likely subclones of a primordial 9L RPR strain.

J Bacteriol, 1992 Apr, 174(7), 2412 - 5
Structure of the gene complementing uvr-402 in Streptococcus pneumoniae: homology with Escherichia coli uvrB and the homologous gene in Micrococcus luteus; Sicard N et al.; The repair ability for UV-induced damage observed for Streptococcus pneumoniae proceeds through a system similar to the Uvr-dependent system in Escherichia coli . The DNA sequence of a gene complementing uvr-402, a mutation conferring UV sensitivity, was determined . Alignments of the deduced amino acid sequence revealed an extensive sequence homology of 55% with the UvrB protein of E . coli and 59% with the UvrB-homologous protein of Micrococcus luteus . Nucleotide-binding site consensus was observed . The high conservation of the uvrB-like gene among these three species suggests that the role of the UvrB protein and excision repair in general might be very important for cell survival.

J Thorac Cardiovasc Surg, 1992 Apr, 103(4), 767 - 72
Donor-transmitted pneumonia in experimental lung allografts . Successful prevention with donor antibiotic therapy; Dowling RD et al.; Bacterial pneumonia is the most common cause of early morbidity and mortality (less than 2 weeks) after heart-lung transplantation . The majority (76%) of cultures taken from human donor tracheas at the time of explant grew bacteria . The abnormal immune response of the lung allograft and the common finding of bacterial contamination of lung donors led us to hypothesize that clinically silent bacterial contamination of the donor lung progresses to pneumonia in the recipient and that antibiotic treatment of donors will prevent the development of pneumonia in the recipient . Inocula of Streptococcus pneumoniae were instilled into the left middle lobe of normal and donor dogs to identify the number of bacteria that would result in pneumonia in a normal animal and the amount that, when given to a donor, would result in pneumonia in the recipient . Initial studies established that inocula of 10(4) colony-forming units of S . pneumoniae did not result in pneumonia in normal or immunosuppressed animals . When 10(4) colony-forming units or as few as 10(2) were instilled into the left middle lobe of donors 24 hours before explantation and use of the lung for transplantation, severe acute bronchopneumonia developed in all 18 recipients . Treatment of donors with aerosol and intravenous antibiotics, but not with either alone, prevented pneumonia in the recipients . We conclude that bacterial contamination of the donor lung leads to pneumonia in recipients . Intravenous and aerosol antibiotic treatment of donors with bacterial contamination prevents pneumonia in canine lung recipients . Treatment of human donors with this antibiotic regimen may decrease the prevalence of early bacterial pneumonia.

Cell Immunol, 1992 Apr, 140(2), 410 - 9
Streptococcal-related antigens stimulate production of IL6 and interferon-gamma by T cells from patients with Behcet's disease; Hirohata S et al.; Greater attention has been recently paid to the role of certain strains of streptococcus as an etiologic agent of Behcet's disease, in which T cell abnormalities are considered to be involved . We therefore examined whether T cells from patients with Behcet's disease might to be stimulated by Streptococcus sanguis-related antigen (RRE KTH-1 antigens) . T cells from 17 patients with Behcet's disease, but not those from 13 healthy individuals or from 13 patients with other rheumatic diseases, were stimulated to produce greater amounts of interleukin 6 (IL6) by addition of RRE KTH-1 antigens {stimulation index: 3.96 +/- 0.56 and 1.35 +/- 0.28 or 1.83 +/- 0.43 (mean +/- SEM), respectively} . The IL6 production by T cells required the presence of either fresh or paraformaldehyde-fixed monocytes . The enhancement of T cell IL6 production was not related to the presence of HLA-B51, which has been shown to be frequently associated with Behcet's disease . These results indicate that T cells from patients with Behcet's disease are stimulated by streptococcal antigens to produce IL6 through T cell-monocyte interactions in which binding of the antigens to monocytes, but not necessarily processing of the antigens by monocytes, is involved . Moreover, RRE KTH-1 antigens as well as Escherichia coli-derived antigens also enhanced the production of interferon-gamma by T cells from patients with Behcet's disease . The data thus suggest that T cell hypersensitivity to several bacterial antigens may play a central role in the pathogenesis of Behcet's disease.

J Gen Microbiol, 1992 Apr, 138 ( Pt 4), 769 - 77
Expression of an inducible enzyme II fructose and activation of a cryptic enzyme II glucose in glucose-grown cells of spontaneous mutants of Streptococcus salivarius lacking the low-molecular-mass form of IIIman, a component of the phosphoenolpyruvate:mannose phosphotransferase system; Bourassa S et al.; We have reported previously that the phosphoenolpyruvate:mannose phosphotransferase system (mannose PTS) of Streptococcus salivarius, consisting of an Enzyme II mannose (EIIman) and two forms of Enzyme III mannose (IIIman) with Mr values of 38,900 and 35,200, respectively, concomitantly transports and phosphorylates mannose, as well as glucose and fructose . In this paper, we report the presence, in S . salivarius, of alternative specific fructose and glucose PTSs encoded by inducible and cryptic genes, respectively . Protein phosphorylation experiments conducted with {32P}phosphoenolpyruvate have allowed us to identify by SDS-PAGE and autoradiography the EII fructose (EIIfru) (Mr 57,500) and the EII glucose (EIIglc) (Mr 58,700) . No proteins corresponding to IIIfru or IIIglc could be detected . EIIfru phosphorylated fructose on the C-1 position rather than, as with the constitutive mannose PTS, on the C-6 position . Growth on fructose resulted in the induction of EIIfru as well as an increase of 1-phosphofructokinase activity . Nevertheless, the genes encoding these proteins were independently regulated . Studies carried out with spontaneous mutants lacking the low-molecular-mass form of IIIman (mutants A37, G29 and B31) showed that EIIfru was expressed in glucose-grown cells of strains G29 and B31, but not in strain A37, whereas the cryptic gene encoding EIIglc was activated in all three mutant strains . The results obtained with the mutants suggest that the three spontaneous mutants were not all mutated on the gene encoding IIIman although all of them lacked IIIman.

Br J Dermatol, 1992 Apr, 126(4), 362 - 6
Staphylococcus aureus and intra-nasal mupirocin in patients receiving isotretinoin for acne; Williams RE et al.; Thirty patients commencing isotretinoin for acne were entered into a double-blind, randomized, placebo-controlled trial to investigate the effect of pulsed intra-nasal mupirocin ointment on Staphylococcus aureus colonization and isotretinoin-related side-effects . In both mupirocin and placebo groups there was an increase in isolation of S . aureus throughout the period of treatment with isotretinoin from the anterior nares, facial skin and lips . However, these increases were significantly less in the mupirocin-treated group . A high proportion of all patients suffered inflammatory side-effects of isotretinoin such as cheilitis and nasal vestibulitis, with their maximum severities being recorded 2 months after starting isotretinoin . In spite of the smaller increase in S . aureus colonization in the mupirocin-treated group no difference was demonstrated in either the incidence of specific S . aureus infections (e.g . furunculosis) or the prevalence of isotretinoin-related inflammatory side-effects . Furthermore, no relationship between the presence of S . aureus and the severity of inflammatory side-effects was shown . Streptococcus species were isolated on four separate occasions from four different patients during the study but their pathogenicity was unclear . These findings suggest that although pulsed intra-nasal mupirocin produces a significant reduction in isotretinoin-related staphylococcal colonization, its routine use cannot be justified on the basis of clinical benefit.

Infect Immun, 1992 Apr, 60(4), 1618 - 24
Molecular analysis of a Streptococcus mutans strain exhibiting polymorphism in the tandem gtfB and gtfC genes; Yamashita Y et al.; Streptococcus mutans UA101, which was previously demonstrated to be highly cariogenic in gnotobiotic rats, exhibited much lower water-insoluble glucan (IG) synthetic activity compared with that of S . mutans GS5 and was unable to express sucrose-dependent colonization of smooth surfaces in vitro . On the basis of Southern and Western blot (immunoblot) analyses, it was demonstrated that, unlike most S . mutans strains, strain UA101 contained a single copy of a gene coding for IG synthesis . The gene was isolated from a clone bank constructed with the plasmid pTH10 clone bank in Escherichia coli and had apparently evolved after homologous recombination of the gtfB and gtfC genes present on the chromosome of a recent ancestor of strain UA101 . The enzyme expressed from the gene, gtfBC, was purified to near homogeneity by utilizing a single-step preparative sodium dodecyl sulfate-polyacrylamide gel electrophoresis system and was characterized . A derivative of strain UA101, UA101LBS, containing a chromosomal insertion of the GS5 gtfC gene was constructed after transformation . UA101LBS exhibited high IG synthetic activity and colonized smooth surfaces in vitro . By utilizing a conventional rat model system involving animals fed a high-sucrose diet, strain UA101 exhibited low levels of smooth surface caries activity relative to Streptococcus sobrinus 6715 . By contrast, UA101LBS was as cariogenic as strain 6715 . However, sulcal caries occurred equally well with all of the strains tested . These results are evaluated relative to the role of gtf gene products in cariogenicity.

Oral Microbiol Immunol, 1992 Apr, 7(2), 96 - 9
Isolation and properties of the Capnocytophaga ochracea bacteriocin; Nakamura T et al.; A bacteriocin from a subgingival plaque isolate of Capnocytophaga ochracea was purified and characterized . It was isolated from cell extract and had a molecular weight of 100,000 . Streptococcus sanguis, Streptococcus mitis, Streptococcus mutans and Propionibacterium acnes were susceptible to the bacteriocin.

Oral Microbiol Immunol, 1992 Apr, 7(2), 124 - 6
Effects of xylitol and fluoride on the response to glucose pulses of Streptococcus mutans T8 growing in continuous culture; Rogers AH et al.; Streptococcus mutans T8 was grown glucose-limited at pH 7.0 in a chemostat and pulsed, under pH free-fall conditions, with glucose, xylitol or a mixture of the two . Experiments were conducted in the absence or continual presence of low levels (1 mmol.l-1) of fluoride . Culture filtrates of samples taken at frequent intervals were assayed for carbohydrate and fermentation end-products . Fluoride had little effect on the organism's response to glucose until the culture pH fell to ca . 5.0, at which point the rate of lactate production was reduced some 3-fold . Xylitol affected the response to glucose but its effect was most marked in the presence of fluoride . Under these conditions, the rate of lactate production was reduced at least 3-fold, the pH did not fall to 5.0 and only about 50% of the added glucose was consumed . This suggests that xylitol can augment the metabolic effects on S . mutans of low levels of fluoride.

Antimicrob Agents Chemother, 1992 Apr, 36(4), 886 - 9
A pneumococcal clinical isolate with high-level resistance to cefotaxime and ceftriaxone; Figueiredo AM et al.; A beta-lactam-resistant serotype 23F Streptococcus pneumoniae clinical isolate from the cerebrospinal fluid of a pediatric patient from California is unusual in that the MICs of cefotaxime and ceftriaxone (2.5 micrograms/ml each) are higher than that of benzylpenicillin (0.3 micrograms/ml); the isolate also has patterns of penicillin-binding proteins and of cell wall peptides which are atypical compared with those of previously examined penicillin-resistant pneumococci.

Eur J Pediatr, 1992 Apr, 151(4), 271 - 3
Iatrogenic IgG2 deficiency in a leukaemic child . A case report; de Boer AW et al.; A girl with acute non-lymphoblastic leukaemia was treated with immunosuppressive chemotherapy . After cessation of therapy she had three consecutive episodes of infection due to Streptococcus pneumoniae from which she recovered and was shown to have developed a combined deficiency of both IgG2 and IgG4 . The patient eventually relapsed and died 3 years after the initial diagnosis . The importance of measuring IgG subclasses in patients treated with immunosuppressive chemotherapy is discussed.

J Dev Physiol, 1992 Apr, 17(4), 195 - 200
Effect of aminophylline on the pulmonary and systemic hemodynamic response to group B beta-hemolytic Streptococcus and leukotriene D4 in newborn lambs; Schreiber MD et al.; Aminophylline, a methyl xanthine, has been used for many years in the treatment of apnea of prematurity and bronchospasm . Aminophylline relaxes smooth muscle through several proposed mechanisms . We hypothesized that aminophylline might be effective in relaxing preconstricted pulmonary vascular smooth muscle and would be ideally suited for clinical trial in babies with pulmonary hypertension . To test this hypothesis, the haemodynamic response of chronically instrumented newborn lambs to injections of heat-killed Group B beta-hemolytic Streptococcus (GBS) and leukotriene (LT) D4, potent pulmonary vasoconstrictors was compared before and after pretreatment with a clinically therapeutic dose of intravenous aminophylline . GBS (10(9)cfu) significantly increased pulmonary arterial pressure 130% . LTD4 (1.0 microgram/kg) significantly increased pulmonary arterial pressure 142% and systemic arterial pressure 23% and decreased cardiac output 47% . Aminophylline did not significantly affect the baseline variables or alter the pulmonary or systemic haemodynamic response to either stimuli . Therefore, it is unlikely that aminophylline will be clinically useful in the treatment of babies with persistent pulmonary hypertension whose etiology is infectious or leukotriene-mediated.

Oral Microbiol Immunol, 1992 Apr, 7(2), 118 - 20
Glucosyltransferase phase variation in Streptococcus gordonii modifies adhesion to saliva-coated hydroxyapatite surfaces in a sucrose-independent manner; Vickerman MM et al.; Phase variation of Streptococcus gordonii between high (Spp+) and low (Spp-) levels of glucosyltransferase (GTF) activity resulted in the greater adhesion of Spp- strains to saliva-coated hydroxyapatite (S-HA) in a washed-cell adhesion test . Specific GTF mutants did not show this response . Although washed Spp+ cells produced 5-fold or more glucan from sucrose than Spp- cells did under the conditions of the adhesion test, sucrose elevated the adhesion of both phenotypes to hydroxyapatite (HA) equally, but had no effect on adhesion to S-HA . This effect was not sucrose-specific, however, because equimolar amounts of other carbohydrates and NaCl elevated adhesion of both Spp types to levels similar to those seen with sucrose . Adhesion did not correlate with relative changes in cell hydrophobicity . These results suggest that, in addition to changes in GTF activity, other changes relevant to adhesion may occur during Spp phase variation.

Antimicrob Agents Chemother, 1992 Apr, 36(4), 723 - 6
4-week treatment of streptococcal native valve endocarditis with high-dose teicoplanin; Venditti M et al.; The efficacy and safety of a 4-week course of intravenous teicoplanin (500 mg every 12 h for the first 2 days and 10 mg/kg of body weight every 24 h thereafter) in the treatment of streptococcal native valve endocarditis in 20 patients were evaluated . All blood isolates were inhibited by a concentration of 0.12 micrograms of teicoplanin per ml . Serum bactericidal activity levels were measured 1/2 and 24 h after antibiotic infusion on days 5 to 7 of therapy in 19 patients, and titers of greater than or equal to 1:32 and greater than or equal to 1:8, respectively, were obtained with 17 patients (89%) . On the other hand, for two patients who were infected with teicoplanin-tolerant Streptococcus bovis, serum bactericidal activity levels of less than 1:2 were found . Of 20 patients, 4 were excluded from further analysis because of protocol violation or prosthetic valve infection . Of the remaining 16 patients, 6 did not complete teicoplanin therapy because of early death (1 patient) or drug fever (5 patients) . Among patients who developed drug fever, three who discontinued teicoplanin by day 15 were switched to penicillin therapy, whereas the remaining two, who discontinued teicoplanin on day 22 and 25, respectively, did not receive any further therapy and have shown no relapse during the follow-up . Of 10 patients who completed trial therapy, 9 were cured and 1 relapsed . It is concluded that a 4-week course of high-dose teicoplanin may be a useful regimen for home treatment of selected cases of streptococcal native valve endocarditis . However, drug fever and infection with teicoplanin-tolerant S . bovis may be factors of concern with this therapeutic approach.

Singapore Med J, 1992 Apr, 33(2), 167 - 9
Necrotising fasciitis: an entity revisited; Chin CM et al.; Necrotising fasciitis is a disease that still carries a high morbidity and mortality despite our better understanding and advances in treatment since 1924 when Meleney first studied it . In our Department of Orthopaedics, this condition appears to be on the increase, and we therefore felt this entity deserved a restudy . Since 1985, 15 cases were seen, of which 10 were encountered in 1989 . There were no recorded case prior to 1985 . Our initial results show that the background and outcome parallel that of previous authors . Most were elderly with some form of underlying chronic disease . The duration from symptom onset to presentation was short, with many being in a state of septicaemia at the time of admission with fever, metabolic acidosis and marked leucocytosis . Repeated desloughings were common, and four ended up with some form of limb amputation . As with Meleney's study, the consistent pathogen cultured was B-haemolytic streptococcus . Our recommendation is that we should be more aware of this entity in view of its fulminant course, with early and aggressive surgical intervention being the keystone to management.

Antimicrob Agents Chemother, 1992 Apr, 36(4), 856 - 9
Susceptibilities of penicillin-susceptible and -resistant strains of Streptococcus pneumoniae to RP 59500, vancomycin, erythromycin, PD 131628, sparfloxacin, temafloxacin, win 57273, ofloxacin, and ciprofloxacin; Spangler SK et al.; The MICs of four new quinolones, sparfloxacin (AT-4140, CI-978), PD 131628 (the active form of the prodrug CI-990), temafloxacin, and Win 57273, compared with those of ciprofloxacin and ofloxacin were tested against 53 penicillin-susceptible, 35 penicillin intermediate-resistant, and 51 penicillin-resistant pneumococci . Susceptibility to RP 59500, a new streptogramin, was also tested and compared with those to the quinolones, erythromycin, and vancomycin . All MICs were determined by a standardized agar dilution method by using Mueller-Hinton agar supplemented with sheep blood . Quinolone, vancomycin, and RP 59500 susceptibilities were not affected by susceptibility or resistance to penicillin . For Win 57273, the MICs for 50% (MIC50) and 90% (MIC90) of strains tested were 0.015 and 0.03 micrograms/ml, respectively . MIC50S of both sparfloxacin and PD 131628 were 0.25 micrograms/ml, and MIC90S were 0.5 micrograms/ml . The MIC50 of temafloxacin was 0.5 micrograms/ml, and the MIC90 was 1.0 micrograms/ml . By comparison, ofloxacin and ciprofloxacin both yielded MIC50S of 1.0 micrograms/ml and MIC90s of 2.0 micrograms/ml . RP 59500 yielded an MIC50 of 0.5 microgram/ml and an MIC90 of 1.0 microgram/ml and was only 1 doubling dilution less active against 17 erythromycin-resistant strains . Vancomycin was active against all strains (MIC50, 0.25 microgram/ml; MIC90, 0.5 microgram/ml) . All four experimental quinolones as well as RP 59500 show promise for therapy of infections with penicillin-resistant and -susceptible pneumococci.

Pediatr Res, 1992 Apr, 31(4 Pt 1), 386 - 90
Role of capsule in pulmonary hypertension induced by group B streptococcus; Philips JB 3rd et al.; The type-specific polysaccharide capsule of group B streptococcus (GBS) is thought to be an important factor in the pathogenesis of disease . We used an acutely instrumented piglet model to assess the hemodynamic effects of rapid infusions of two heat-killed GBS type Ib strains isolated from the spinal fluid of an infant with late-onset meningitis and from the vaginal culture of his mother . These strains expressed different amounts of capsule, as determined by buoyant density centrifugation and electron micrographs, and they produced different hemodynamic effects in the piglets . The mother's strain, which had a smaller capsule, caused significantly higher increases in pulmonary artery pressure and vascular resistance than did the infant's strain, which had a larger capsule . Transposon mutants were then made from the infant's isolate to further study the role of capsule in pulmonary hypertension . Two mutants lacking detectable capsular type-specific polysaccharide were compared with the original isolate and with an isogenic mutant containing transposons but having a large capsule . The nonencapsulated mutants caused significantly higher changes in pulmonary artery pressure and resistance than did the encapsulated strains . Pulmonary hypertension may play a role in the pathophysiology of GBS sepsis, but the presence of a large capsule may partially cloak the hemodynamically active component(s) of the bacteria . The lower initial host response to heavily encapsulated GBS may play a role in pathogenesis by helping the organisms avoid host defense mechanisms.

Commun Dis Rep CDR Rev, 1992 Mar 27, 2(4), R37 - 43
Antibiotic-resistant pneumococci in the United Kingdom; George RC et al.; Pneumococcal pneumonia and meningitis remain common infections with significant morbidity and mortality . For many years, penicillins or cephalosporins, erythromycin and chloramphenicol have been the mainstay of chemotherapy for these and other pneumococcal infections . Resistance to these antimicrobial agents has increased worldwide and resistant pneumococci are now isolated with increasing frequency in the United Kingdom . This article reviews the results of antimicrobial susceptibility and serotyping studies carried out over the last five years on UK isolates of Streptococcus pneumoniae referred to the Streptococcus and Antibiotic Reference Laboratories of the Division of Hospital Infection for serotyping or confirmation of antibiotic resistance . During this period there has been a marked increase in the referral of pneumococcal isolates resistant to one or more of the antimicrobials commonly used for treatment . The implications for antimicrobial therapy and vaccination policy are discussed.

FEMS Microbiol Lett, 1992 Mar 15, 70(3), 219 - 24
Cloning of the phospho-beta-galactosidase gene in Escherichia coli from lactose-negative mutants of Streptococcus mutans isolated following random mutagenesis with plasmid pVA891 clone banks; Sato Y et al.; In order to mutagenize Streptococcus mutans a marker rescue plasmid, pVA891, was employed . The plasmid was ligated with Sau3AI digested chromosomal DNA fragments from S . mutans GS-5IS3 and the resultant plasmids were amplified in Escherichia coli . These plasmids were then randomly integrated into the chromosome of strain GS-5IS3 following transformation . Lactose-negative transformants were isolated as white colonies on lactose-BTR-Xgal agar plates containing erythromycin . Six lactose-negative mutants representing three different chromosomal sites of integration were isolated from about eight thousand transformants . Mutant chromosomal DNA fragments flanking the plasmids were recovered by a marker-rescue method in E . coli and exhibited phospho-beta-galactosidase activity.

Pediatr Res, 1992 Mar, 31(3), 222 - 7
Group B streptococcal sepsis in piglets: effect of combined pentoxifylline and indomethacin pretreatment; Gibson RL et al.; Group B streptococcus (GBS), a common neonatal gram-positive pathogen, causes similar pathophysiology in human newborns and neonatal animal models of sepsis . Animal models of GBS sepsis demonstrate a two-phase response: 1) an acute phase (less than 1 h) of increased pulmonary artery pressure (Ppa) and reduced arterial oxygen pressure (PaO2) that is associated with increased serum thromboxane B2 (TxB2) and 2) a late phase (2-4 h) of persistently increased Ppa and reduced PaO2, reduced systemic arterial pressure, and progressive fall in cardiac output that is associated with increased serum TxB2, 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), and tumor necrosis factor-alpha (TNF alpha) . We hypothesized that pretreatment of piglets with both pentoxifylline (PTF), an inhibitor of TNF alpha production and activity, and indomethacin (INDO) would 1) inhibit GBS-induced TxB2, 6-keto-PGF1 alpha, and TNF alpha and 2) prevent both the acute- and late-phase physiologic responses of GBS sepsis . Combined PTF and INDO pretreatment of anesthetized, mechanically ventilated piglets infused with GBS (1.25 x 10(9) colony forming units/kg/h) for 4 h prevented GBS-induced increases in Ppa at 1 h (GBS + PTF + INDO: 1.8 +/- 0.07 kPa versus GBS alone: 4.7 +/- 0.1 kPa) and markedly attenuated increases in Ppa at 4 h (GBS + PTF + INDO: 2.1 +/- 0.1 kPa versus GBS alone: 4.4 +/- 0.1 kPa).(ABSTRACT TRUNCATED AT 250 WORDS)

Ned Tijdschr Geneeskd, 1992 Mar 7, 136(10), 481 - 2
{Primary pneumococcal abscess in the psoas muscle}; Bruggeling W et al.; Primary psoas abscesses are rare and the pathogenesis is obscure . In most cases Staphylococcus aureus is the causative bacterium . Therapy consists of drainage of the abscess and antibiotics . In this article we present a patient with a primary psoas abscess caused by a Streptococcus pneumoniae infection.

J Biol Chem, 1992 Mar 5, 267(7), 4631 - 7
A binding protein-dependent transport system in Streptococcus mutans responsible for multiple sugar metabolism; Russell RR et al.; An 11-kilobase gene region of Streptococcus mutans has been identified which contains eight contiguous genes involved with the uptake and metabolism of multiple sugars (the msm system) . Sequence analysis of this region indicates that several of these genes specify proteins with strong homology to components of periplasmic binding protein-dependent transport systems of Gram-negative bacteria . Additionally, this operon is controlled by a regulatory gene (msmR) that acts as a positive effector . The proteins specified by the structural genes of the msm operon include alpha-galactosidase (aga), a "periplasmic-like" sugar-binding protein (msmE), two membrane proteins (msmF, msmG), sucrose phosphorylase (gtfA), an ATP-binding protein (msmK), and dextran glucosidase (dexB) . Insertional inactivation of each of these genes along with uptake data indicate that this system is responsible for the uptake of melibiose, raffinose, and isomaltotriose and the metabolism of melibiose, sucrose, and isomaltosaccharides.

Carbohydr Res, 1992 Mar 2, 225(2), 229 - 45
Synthesis of trisaccharide methyl glycosides related to fragments of the capsular polysaccharide of Streptococcus pneumoniae type 18C; van Steijn AM et al.; The synthesis is reported of methyl 3-O-(4-O-beta-D-galactopyranosyl-alpha-D- glucopyranosyl)-alpha-L-rhamnopyranoside (1), methyl 2-O-alpha-D-glucopyranosyl-4-O-beta-D-glucopyranosyl-beta-D- galactopyranoside (3), methyl 3-O-(4-O-beta-D-galactopyranosyl-alpha-D-glucopyranosyl)-alpha-L- rhamnopyranoside 3"-(sn-glycer-3-yl sodium phosphate) (2), and methyl 2-O-alpha-D-glucopyranosyl-4-O-beta-D- glucopyranosyl-beta-D-galactopyranoside 3-(sn-glycer-3-yl sodium phosphate) (4), which are trisaccharide methyl glycosides related to fragments of the capsular polysaccharide of Streptococcus pneumoniae type 18C ({----4)-beta-D- Glcp-(1----4)-{alpha-D-Glcp-(1----2)}-{Glycerol-(1-P----3)}-beta-D-Galp - (1----4)-alpha-D-Glcp-(1----3)-alpha-L-Rhap-(1----}n) . Ethyl 4-O-acetyl-2,3,6-tri-O-benzyl-1-thio-beta-D-glucopyranoside (10) was coupled with benzyl 2,4-di-O-benzyl-alpha-L-rhamnopyranoside (6) . Deacetylation of the product, followed by condensation with 2,4,6-tri-O-acetyl-3-O-allyl-alpha-D-galactopyranosyl trichloroacetimidate (18), gave benzyl 2,4-di-O-benzyl-3-O-{2,3,6-tri-O- benzyl-4-O-(2,4,6-tri-O-acetyl-3-O-allyl-beta-D-galactopyranosyl)-alpha- D- glucopyranosyl}-alpha-L-rhamnopyranoside (19) . Acetolysis of 19, followed by methylation, deallylation (----22), and further deprotection afforded 1 . Condensation of methyl 2,4-di-O-benzyl-3-O-{2,3,6-tri-O-benzyl-4-O-(2,4,6-tri- O-acetyl-beta-D-galactopyranosyl)-alpha-D-glucopyranosyl}-alpha-L- rhamnopyranoside (22) with 1,2-di-O-benzyl-sn-glycerol 3-(triethyl-ammonium phosphonate) (24), followed by oxidation and deprotection, yielded 2 . Condensation of ethyl 2,3,4,6-tetra-O-benzyl-1-thio-beta-D-glucopyranoside (27) with methyl 3-O-allyl-4,6-O-benzylidene-beta-D-galactopyranoside (28), selective benzylidene ring-opening of the product, coupling with 2,3,4,6-tetra-O-acetyl-alpha-D-glucopyranosyl trichloroacetimidate (31), and deallylation afforded methyl 6-O-benzyl-4-O-(2,3,4,6-tetra-O-acetyl-beta-D-glucopyranosyl)-2-O- (2,3,4,6-tetra-O-benzyl-alpha-D-glucopyranosyl)-beta-D-galactopyranoside (33) . Deprotection of 33 gave 3, and condensation of 33 with 24, followed by oxidation and deprotection, gave 4.

Eur J Epidemiol, 1992 Mar, 8(2), 238 - 42
Epidemiological survey of Streptococcus mutans in a group of adult patients living in Pisa (Italy); Batoni G et al.; An epidemiological investigation was carried out to evaluate the prevalence of Streptococcus mutans in a group of 134 adult patients . Markedly higher frequency of isolation was observed in caries-active subjects than in caries-inactive or caries-free subjects, indicating a significant association between the prevalence of the microorganism and the caries status . Moreover, the presence of the microorganism appeared to have a significant association with the extent of caries experience evaluated by the DMF score . These findings are in agreement with those reported previously for school children in other areas of Italy . Isolation of S . mutans was compared among patients groups with different caries activity in relation to culture times of dental plaque samples in a transport medium (Colorimetric Broth Medium) . S . mutans was most frequently isolated from caries-active subjects when the medium was incubated for 48 h after inoculation with dental plaque samples.

Paraplegia, 1992 Mar, 30(3), 200 - 3
Septic ischial bursitis in patients with spinal cord injury; Rubayi S et al.; Septic ischial bursitis is described in 4 patients with spinal cord injury . In these patients a pre-existing ischial bursitis probably became secondarily infected . Because these patients lack sensation, diagnosis may be difficult . The disease process in one patient with a prolonged fever was only recognized after a leucocyte scan detected an abscess extending to the thigh . At surgery it was found that the infection extended from the ischial bursa to the upper lateral thigh . Infection in these patients was due to beta hemolytic streptococcus, S . aureus, and S . epidermidis . The patients all responded well to local drainage and excision of the bursa.

Kansenshogaku Zasshi, 1992 Mar, 66(3), 297 - 301
{Persistent non-inflammatory carriage of group B Streptococcus in organs of newborn mice}; Kobayashi M; Group B Streptococcus (GBS) is an important pathogen in newborn infants and has shown a remarkable increase in Japan since 1970 . It has been reported that the early-onset type of GBS infection may be caused by vertical transmission whereas the late-onset type may be caused by horizontal or nosocomial transmission . However we think that the late-onset type may be caused by continuous carriage of GBS after vertical transmission . Therefore, we studied the continuous carriage of GBS using mice . Mice were separated into two groups, and one was given 10(3) colony-forming units of type Ia and the other type III GBS (isolated from the affected human neonates) by intraperitoneal injection on the first day of life . Then, on the 2nd, the 5th, the 8th and the 10th day after injection, viable counts were obtained per 10 mg of liver, spleen, lung and brain tissues . Each organ was homogenized and dissolved in 1 ml physiological saline per 10 mg of tissue, and 0.1 ml of each was infused into brain-heart infusion agar and incubated for 36 hours at 37 degrees C . The type III GBS isolated from many organs on these days, but type Ia was isolated in only two among 72 mice . These results suggested the possibility that type III GBS acquired by vertical transmission at birth may be carried over in a non-inflammatory state for a long time, and that the symptoms will become manifest only when the host-parasite relationship is disturbed later.

Ann Cardiol Angeiol (Paris), 1992 Mar, 41(3), 127 - 35
{Vascular complications in infectious endocarditis . Apropos of 86 cases}; Beard T et al.; During a 20 year period, 285 patients were hospitalised for infectious endocarditis (IE) in the Department of Cardiology of the Ernest-Conseil Hospital in Tunis and 86 of them, i.e . 30%, developed a vascular complication (VC) . Among these 86 patients, there were a total of 108 lesions, including 52 neurological complications, 14 peripheral acute ischemic syndromes, 16 peripheral arterial aneurysms, 9 aortic aneurysms, 7 pulmonary embolisms, 6 splenic infarctions and 4 coronary lesions . The mortality in this patient group proved to be slightly greater than in the series as a whole, in particular concerning patients with multiple lesions and those with an artificial valve . No prognostic difference was seen between patients with a VC of aneurysmal type and of ischemic type, but the presentation and severity of lesions was very variable . The vascular complication was a presenting feature of IE in almost 40% of cases . The organism found most often was the streptococcus, above all in ischemic type IE as well as in the total patient group . Similarly, the preferential site was aortic, above all for aneurysmal type IE . Ultrasonography revealed a higher incidence of vegetations in this series of patients, above all in ischemic type VC, but anatomical studies have shown this to be an investigation of moderate sensitivity and poor specificity, poorly correlated from a prognostic standpoint with the risk of embolism . The conclusion of the study is above all the need to prevent such complications: embolic complications by early antibiotic treatment and valve replacement and aneurysmal complications by methodical routine angiographic evaluation and appropriate treatment.

Head Neck, 1992 Mar-Apr, 14(2), 143 - 7
Streptococcal gangrene of the head and neck: a case report and review of the literature; Miles LT et al.; Necrotizing bacterial infections that occur in the head and neck are exceedingly rare and are often associated with a group A beta-hemolytic streptococcus (Streptococcus pyogenes) . The disease is associated with soft tissue necrosis and vascular thrombosis . There appears to be an increasing incidence of hyperaggressive beta hemolytic streptococcal infections associated with high mortality rates . We report the survival of an otherwise healthy patient who developed a flu-like illness followed by a rapidly progressive toxic systemic illness associated with subtotal facial soft tissue necrosis down to bone . The recent literature related to this necrotizing bacterial infection is reviewed . Otolaryngologists must be aware of this entity since survival depends upon aggressive early wound management and high-dose intravenous antibiotics.

Arch Oral Biol, 1992 Mar, 37(3), 187 - 91
Effect of timing of administered calcium lactate on the sucrose-induced intraoral demineralization of bovine enamel; Kashket S et al.; A number of soluble calcium salts are known to reduce the demineralization of enamel in the mouth . The present study was undertaken to examine the effects of rinses containing different concentrations of calcium lactate, and the time of giving the rinses with respect to sucrose challenges . Subjects wore palatal appliances containing blocks of bovine enamel whose surfaces were covered with Streptococcus mutans IB 1600, and rinsed with 10% sucrose for 1 min . Changes in iodide penetrability of the enamel, and the pH and extracellular ion concentrations of the streptococcal plaque were determined . When added to the sucrose rinse, 100 or 150 mM calcium lactate reduced demineralization by about 35%, although the plaque pH was not affected . Plaque calcium was elevated but diffused away rapidly so that concentrations after 45 min were close to control values . Plaque inorganic phosphate and lactate were not affected . Ongoing demineralization appeared to be stopped when 100 mM calcium lactate was given 15 min after the sucrose rinse . When the lactate was given 15 min before the sucrose rinse, demineralization was reduced by only about 25%, consistent with the rapid diffusion of plaque calcium . The combination of (i) pretreatment with calcium lactate and (ii) admixture of calcium lactate with sucrose was most effective . Demineralization was reduced about 55% with 100 mM calcium lactate under these conditions, and protective effects were seen with as little as 25 mM . In summary, the findings demonstrate the enamel-protective effect of relatively low concentrations of calcium lactate, and point to the need to sustain a high plaque calcium during periods of maximum acidogenicity.

Am J Forensic Med Pathol, 1992 Mar, 13(1), 28 - 32
Rapid death due to group A streptococcal infections . Necrotizing fasciitis and acute bacterial myositis; James DS et al.; Soft tissue infections due to the group A Streptococcus are difficult to diagnose and rapidly fatal . They may present to the forensic pathologist as an "obscure autopsy" . Death may occur within or outside the hospital and with or without a history of fulminant infection or predisposing factors . It is important for the pathologist to exclude this condition through awareness of its existence and by appropriate dissection with retention of materials for microbiological and histological examination.

Clin Rheumatol, 1992 Mar, 11(1), 109 - 11
Septic Streptococcus milleri prepatellar bursitis; Meys E et al.; The osteoarticular affinity of Streptococcus milleri has only recently been recognized . We report a case of septic prepatellar bursitis caused by this pathogen . The recent literature concerning osteoarticular involvement by S . milleri is reviewed.

Infect Dis Clin North Am, 1992 Mar, 6(1), 149 - 61
Invasive group A streptococcal infections; Ferrieri P et al.; Beginning in the mid-1980s and continuing to the present, there has been an apparent increase in the number of severe group A streptococcal infections and their suppurative and nonsuppurative sequelae . The reasons for this epidemiologic change remain incompletely explained . At present, the data seem to suggest that this change is related to the reappearance in the population of not only "new" serotypes, but most likely virulent strains of these serotypes . This has been suggested by available epidemiologic surveys . The pathogenetic mechanism by which these virulent strains cause an increased severity of disease is also incompletely understood . It has been suggested that certain of the streptococcal pyrogenic exotoxins (pyrogenic exotoxin A or B) are associated with strains isolated from severe cases of systemic group A streptococcal infections, but the data conflict in many instances . Clinically, this is an extraordinarily virulent syndrome often leading to the death of the patient within a matter of hours or days . This is despite what would seem to be adequate and appropriate antimicrobial therapy with agents which are effective in vitro against the offending group A streptococcus . Therapy therefore is still based on appropriate antibiotic therapy and support of other systemic manifestations with appropriate medical therapy . At present, prevention of these suppurative and nonsuppurative sequelae is impractical simply because the initial streptococcal infection or colonization is rarely recognized . These events of the last half decade strongly support the need for additional understanding of the epidemiology, pathogenesis, treatment, and prevention of serious group A beta-hemolytic streptococcal infections.

J Burn Care Rehabil, 1992 Mar-Apr, 13(2 Pt 2), 298 - 304
Infection in the upper body: hand and burn-wound microbiology and considerations for antimicrobial therapy; Zellweger G et al.; Gram-positive bacteria are the predominant organisms in hand infection and in burn wounds of the upper extremities . In a recent study of isolates from patients who were treated at our institution, Staphylococcus aureus and beta-hemolytic Streptococcus group A organisms were the most common organisms in infection of the hand; they were found in 36.3% and 14.4% of cases, respectively . The most common organisms in burn wounds were Enterococcus species, S . aureus, and Escherichia coli, which were found in 21.2%, 20.5%, and 16.7% of patients, respectively . Between 1969 and 1989, the prevalence of Pseudomonas species in burns decreased markedly, whereas that of S . aureus remained relatively stable and that of Enterococcus increased substantially . Over this period, both enterococci and coagulase-negative staphylococci emerged as troublesome pathogens in patients with burns . Methicillin-resistant S . aureus, which was first seen in our institution in 1981, continues to be found in a small proportion of patients . We have achieved successful results in certain surgical settings with the use of gentamicin-dispersing polymethyl-methacrylate beads to provide sufficient antimicrobial concentrations in poorly vascularized or avascular tissue . Additional topical antimicrobials that are potent against gram-positive bacteria are needed.

Enferm Infecc Microbiol Clin, 1992 Mar, 10(3), 138 - 42
{Epidemiologic characteristics of pneumococcal bacteremia in the era of AIDS}; Teira R et al.; BACKGROUND: The HIV infection and the development of penicillin-resistant pneumococci justify the review of the epidemiologic features of pneumococcal pneumonia in the last years . METHOD: A retrospective chart review of all patients admitted between 1987 and 1990 with a positive blood culture to Streptococcus pneumoniae was conducted . Different epidemiologic variables were selected ad compared . RESULTS: Streptococcus pneumoniae was isolated in 147 blood cultures from 147 patients . The estimated incidence of pneumococcal bacteremia was 10 cases per 100,000 inhabitants/year . The figure increases from 7 to 12 cases during the study period . The risk factors identified were: HIV infection, 27 patients (19%); cancer, 14 patients (10%); cirrhosis of the liver, 13 patients (9%) . In 56 cases (38%) no special risk factors were identified . All bacteremic episodes were from a pulmonary source . In 66% of patients, no special complications were recorded . Mortality outcome was related to age (28% if aged more than 60 years, 7% if less; p = 0.001, chi 2, and with the underlying condition (p = 0.034, chi 2) . Resistance to penicillin increases from 0.0% to 21% during the study period (p = 0.03, chi 2) but it seems not to have any impact in mortality nor in the nosocomial origin of the bacteremia . CONCLUSIONS: In the last 4 years we have observed an increase in the incidence of pneumococcal bacteremia related to an increase in cases among HIV infected patients, and also the emergence of penicillin-resistant strains . However, none of the two mentioned conditions seems to have any impact on mortality.

Ann Rheum Dis, 1992 Mar, 51(3), 402 - 3
Infectious arthritis in patients with rheumatoid arthritis; Mateo Soria L et al.; Eleven cases of infectious arthritis occurring in patients with rheumatoid arthritis are reported . Staphylococcus aureus was the causative organism in eight patients . Streptococcus anginosus and Streptococcus agalactiae in one patient each, and Mycobacterium tuberculosis in two patients . The mean duration of symptoms before diagnosis was 16 days in patients with pyogenic arthritis . The diagnosis of joint infection caused by Mycobacterium tuberculosis was especially delayed (57 days) . Four patients died; they were found to have a longer time to diagnosis and two of them had multiple joint infection . Although Staphylococcus aureus is the microorganism most often affecting patients with rheumatoid arthritis, infection caused by Mycobacterium tuberculosis must also be considered in such patients.

J Dent Res, 1992 Mar, 71(3), 484 - 90
Lysozyme enhances the inhibitory effects of the peroxidase system on glucose metabolism of Streptococcus mutans; Lenander-Lumikari M et al.; The combined effect of the salivary peroxidase system and lysozyme on the glucose uptake of Streptococcus mutans NCTC 10449 was investigated . The bacteria were grown to late-exponential phase, washed, re-suspended in buffer at pH6, and incubated with (1) 50 micrograms/mL lysozyme from human milk for 60 min; (2) 7-15 mumol/L hypothiocyanous acid/hypothiocyanite for 10 min; and (3) lysozyme for 60 min prior to addition of and incubation with hypothiocyanous acid/hypothiocyanite for 10 min . Glucose uptake was initiated by adding the bacterial suspensions to 10 mL of pre-warmed 50 mumol/L glucose containing 0.98 mumol/L D-(U-14C-)-glucose, and the mixture was incubated in a shaking water-bath at 37 degrees C . Samples were withdrawn at various time intervals, rapidly filtered through 0.45-microns membranes, washed with ice-chilled buffer, and the incorporated radioactivity determined . Lysozyme stimulated S . mutans glucose uptake slightly, but significantly inhibited S . rattus glucose metabolism . A 20-30% inhibition of radiolabeled glucose incorporation was observed with hypothiocyanous acid/hypothiocyanite alone . Incubation of the bacteria with lysozyme prior to addition of hypothiocyanous acid/hypothiocyanite containing peroxidase resulted in a total inhibition of the glucose uptake . In contrast, lysozyme in combination with hypothiocyanous acid/hypothiocyanite without peroxidase gave only a 30-50% inhibition . The addition of 5 mmol/L dithiothreitol after incubation with lysozyme and hypothiocyanous acid/hypothiocyanite eliminated the inhibition of the bacterial glucose uptake . The viability of S . mutans was not affected by treatment with any of the components used . Our results indicate that physiological concentrations of lysozyme and the salivary peroxidase system components have a synergistic effect which results in a significant inhibition of glucose metabolism by S . mutans.

J Am Acad Dermatol, 1992 Mar, 26(3 Pt 2), 458 - 61
A therapeutic trial of the use of penicillin V or erythromycin with or without rifampin in the treatment of psoriasis; Vincent F et al.; BACKGROUND: After the publication of an uncontrolled trial of nine patients with streptococcus-associated psoriasis who appeared to benefit from a course of oral penicillin or erythromycin with the addition of rifampin in the last 5 days, we wished to confirm or refute the validity of this observation . OBJECTIVE: Our purpose was to confirm the effectiveness of antibiotics in the treatment of streptococcus-associated psoriasis . METHODS: Twenty patients were placed randomly into two groups . One group was given penicillin or erythromycin for 14 days with a placebo added during the last 5 of the 14 days . The other group received the same medication with the addition of rifampin in the last 5 days . RESULTS: Although all the patients studied met the criteria of the reported preliminary study, we were unable to detect any evidence of improvement in their psoriasis . CONCLUSION: There was no apparent benefit for patients with streptococcus-associated psoriasis from a course of oral penicillin or erythromycin with the addition of rifampin in the last 5 days in a 14-day trial.

Clin Nephrol, 1992 Mar, 37(3), 155 - 7
CAPD peritonitis--initial presentation as an acute abdomen with a clear peritoneal effluent; Korzets Z et al.; Accepted criteria for the diagnosis of peritonitis in CAPD include: 1 . symptoms and signs of peritoneal irritation; 2 . a cloudy effluent with white blood cell (WBC) count greater than 100/microliters and; 3 . a positive culture . In fact, the earliest suggestive sign of peritonitis is a turbid effluent . However, symptomatology of peritoneal irritation may precede the development of a cloudy fluid . We hereby report on two CAPD patients with culture proven peritonitis whose initial presentation was that of an acute abdomen . Although diffuse rebound tenderness was elicited the initial effluent, after an overnight dwell, was clear with a WBC count of 80 and 70/microliters, respectively . Working diagnoses on admission included a ruptured cyst and a perforated peptic ulcer . Both patients were in line for a laparotomy . After a period of 7 and 12 hours, respectively the ensuing effluents turned turbid with WBC counts of 6,400 and 2,500/microliters . Cultures eventually grew Staphylococcus aureus and Streptococcus viridans . Appropriate antibiotic treatment resulted in full recovery.

J Clin Microbiol, 1992 Mar, 30(3), 600 - 3
Streptococcus pyogenes pharyngitis: characterization of strains by multilocus enzyme genotype, M and T protein serotype, and pyrogenic exotoxin gene probing; Musser JM et al.; Multilocus enzyme electrophoresis, serological characterization of M and T proteins, and probing for pyrogenic exotoxin A and C genes were used to investigate the bacteriologic epidemiology of strains of Streptococcus pyogenes recovered primarily from patients with recurrent pharyngitis . A total of 164 strains recovered from individuals living in nine states of the United States was analyzed . Two-thirds of the patients in our sample were infected with the homologous strain following antibiotic therapy and presumably represented treatment failures, whereas the other one-third of the patients were infected with a heterologous strain after therapy and probably represented reinfections . Multilocus enzyme electrophoresis was as efficacious in strain discrimination as serologic typing techniques were and, in addition, successfully characterized all organisms that were serologically nontypeable . Two clones of S . pyogenes responsible for most of the episodes of toxic shock-like syndrome in the United States are geographically widespread, but they vary by locality in the frequency of their occurrence . Compared with a sample of strains cultured from patients whose pharyngeal infections were eliminated by antimicrobial therapy, these two clones were statistically overrepresented among organisms that cause recurrent pharyngitis.

Int J Biochem, 1992 Mar, 24(3), 509 - 14
On the mechanism of xylitol-dependent inhibition of glycolysis in Streptococcus sobrinus OMZ 176; Forbord B et al.; 1 . The mechanism of xylitol-dependent inhibition of glycolysis in Streptococcus sobrinus OMZ 176 was investigated in aerobically and anaerobically grown cells . 2 . Glucose-stimulated glycolysis was followed polarographically, by radio-HPLC-analyses of glycolytic intermediates, by measurement of ATP generated, and spectrophotometric monitoring of extent of NAD(P)+/NADPH-status . 3 . Xylitol added to suspensions of S . sobrinus inhibited O2 uptake by approximately 20%, and led to a corresponding decrease in rate of lactate formation in aerobic and anaerobic cells . 4 . Xylitol also delayed the onset of the glucose-dependent rapid reduction of NAD(P)+ by approximately 1 min, although the total extent of reduction was not significantly affected compared to control cells . 5 . The inhibitory effect of xylitol on glucose dependent ATP synthesis, however, was decreased by 70-80% . 6 . Hence the dramatic decrease in glucose-dependent synthesis of ATP may be the direct cause of decreased bacterial growth in the presence of xylitol . 7 . A mechanism explaining the observed phenomena is proposed.

J Med Microbiol, 1992 Mar, 36(3), 149 - 55
A numerical taxonomic study of the "Streptococcus milleri" group based upon conventional phenotypic tests and pyrolysis mass spectrometry; Winstanley TG et al.; Clinical strains presumptively identified as Streptococcus milleri (60), and blind coded collection strains (21) were characterised in conventional tests and pyrolysis mass spectrometry . Comparison of the clusters found by these two approaches revealed five clearly distinct centres of variation . Three corresponded to the DNA homology groups suggested by Whiley and Hardie (1989) as representing the species S . anginosus, S . intermedius and S . constellatus; a fourth comprised three Lancefield group C beta-haemolytic strains; the fifth may represent a biotype of S . anginosus . The characteristics of the latter group are described.

J Med Microbiol, 1992 Mar, 36(3), 143 - 8
Serological and biological characteristics of "Streptococcus milleri" isolates from systemic purulent infections; Kitada K et al.; Ninety-one Streptococcus milleri strains isolated from various systemic purulent lesions of 68 patients were examined by physiological and serological tests . Most strains formed a smooth colony (66 strains), did not form spontaneous aggregation of cells in BHI broth culture (79), were non-beta-haemolytic (alpha-35 or non-41), and belonged to biotype Ia (49) or Ib (34) and to API taxa S . milleri I (41) or II (38) . Almost all of the beta-haemolytic strains as well as two-fifths of the non-beta-haemolytic belonged to API taxon I; strains of API taxa II and III were non-beta-haemolytic and non-haemolytic, respectively . Two-fifths (38) of the isolates belonged to one of eight serotypes, a-g and k, and more than half (47) to Lancefield groups A, C, F or G, the most frequent being type b (19) and group F (33) . Fifteen strains carried simultaneously type a/group A, b/C, c/C, e/G, f/F or k/G antigens . Nineteen were neither typable nor groupable . All the 38 serotypable isolates were non-beta-haemolytic and not members of API taxon III, and were serologically and physiologically similar to oral S . milleri . The isolates from various infected sites--sputum, thorax, abdomen, urogenitalia, skin, eye and dental--exhibited distinct combinations of biological and serological properties . These results suggest that serotyping, haemolytic properties and API taxon, and their combinations, would be useful methods to trace oral S . milleri in systemic infections.

J Bacteriol, 1992 Mar, 174(6), 2014 - 24
Streptococcus pneumoniae DNA polymerase I lacks 3'-to-5' exonuclease activity: localization of the 5'-to-3' exonucleolytic domain; Diaz A et al.; The Streptococcus pneumoniae polA gene was altered at various positions by deletions and insertions . The polypeptides encoded by these mutant polA genes were identified in S . pneumoniae . Three of them were enzymatically active . One was a fused protein containing the first 11 amino acid residues of gene 10 from coliphage T7 and the carboxyl-terminal two-thirds of pneumococcal DNA polymerase I; it possessed only polymerase activity . The other two enzymatically active proteins, which contained 620 and 351 amino acid residues from the amino terminus, respectively, lacked polymerase activity and showed only exonuclease activity . These two polymerase-deficient proteins and the wild-type protein were hyperproduced in Escherichia coli and purified . In contrast to the DNA polymerase I of Escherichia coli but similar to the corresponding enzyme of Thermus aquaticus, the pneumococcal enzyme appeared to lack 3'-to-5' exonuclease activity . The 5'-to-3' exonuclease domain was located in the amino-terminal region of the wild-type pneumococcal protein . This exonuclease activity excised deoxyribonucleoside 5'-monophosphate from both double- and single-stranded DNAs . It degraded oligonucleotide substrates to a decameric final product.

Curr Opin Dent, 1992 Mar, 2, 157 - 62
Changing paradigms in caries management; Anderson MH; Management of dental caries patients is taking on a new look . Caries is the clinical manifestation of an oral infection . The primary organisms involved are Streptococcus mutans . The infective nature of the disease has been well researched and reported . Treatment of this infection with antibacterial measures is becoming routine in developed countries . In the United States, the overall caries rate is decreasing . However, the distribution of caries is now skewed . Twenty percent of the population has 60% of the caries . These individuals have a significant level of infection or a major lack of resistance to the organisms and their by-products . Major strategies are being developed to control these infections and limit their recurrence . This review focuses on the developments in prevalence studies, diagnosis, and treatment of the caries infection.

J Oral Rehabil, 1992 Mar, 19(2), 111 - 3
The antimicrobial effect of an iron-binding agent on Streptococcus mutans; Bapna MS et al.; The antimicrobial activity of 2,2'-bipyridine, an iron-binding agent, was investigated by incorporating this agent into Scotchbond dental adhesive resin . The growth of Streptococcus mutans on the surface of resin, media and culture vessel was determined by optical density measurements . It was observed that 2,2'-bipyridine exhibited excellent antimicrobial properties.

Med J Malaysia, 1992 Mar, 47(1), 44 - 50
A microbiological study of vaginal discharge in women attending a Malaysian gynaecological clinic; Cheong YM et al.; Vaginal discharge is a common complaint of women attending gynaecological clinics . The purpose of this study was to compare the occurrence of commonly implicated microorganisms in vaginal discharge amongst women with or without the complaint, attending a gynaecological and family planning clinic . The association of Gardnerella vaginalis with bacterial vaginosis was also studied . It was found that there were no significant differences between the cases and controls in the isolation rate of Gardnerella vaginalis, Torulopsis glabrata, Ureaplasma urealyticum, Mycoplasma ssp and Group B streptococcus (p greater than 0.05) . Only the isolation rate of Candida albicans was significantly higher in the cases than controls (p less than 0.01) . However, there was a significant association of G . vaginalis with bacterial vaginosis.

Infect Immun, 1992 Mar, 60(3), 1095 - 100
Isolation and characterization of Actinomyces viscosus mutants defective in binding salivary proline-rich proteins; Nesbitt WE et al.; Recent studies have provided evidence for human salivary proline-rich proteins (PRPs) serving as potential receptors in the acquired pellicle for Actinomyces viscosus type 1 fimbriae . We report here the isolation of mutants derived from A . viscosus T14V-J1 which are defective in binding to PRPs partially purified from parotid gland saliva . Mutagenesis with ethyl methanesulfonate preceded enrichment for cells nonreactive with PRPs by successive adsorptions with PRP-treated latex beads . Screening was accomplished by random selection of 250 isolated colonies from each of four enrichment cycles and reaction with PRP-treated latex beads in microtiter plates . Two mutants of independent origin were examined for adherence to hydroxyapatite treated with either PRPs, proline-rich glycoproteins, deglycosylated proline-rich glycoproteins, or whole saliva . Additional surface properties that were examined included agglutination with polyclonal antisera to type 1 and type 2 fimbriae, agglutination by a monoclonal antibody to type 1 fimbriae that inhibits adherence of the parent strain to saliva-treated hydroxyapatite, the ability to bind monoclonal antibody to the type 1 fimbrial subunit, and lactose-reversible coaggregation with Streptococcus sanguis 34 . Both mutants exhibited reduced binding to hydroxyapatite treated with whole saliva or salivary protein preparations but were still capable of reaction with antiserum to type 1 and type 2 fimbriae . In addition, these mutants possessed the ability to bind monoclonal antibody to the type 1 fimbrial subunit in amounts comparable to the amount bound by the parent strain but were not agglutinated by the adherence-inhibiting monoclonal antibody . When considered with previously published data, these results suggest that an adhesive molecule is probably associated with type 1 fimbriae and allows for the interaction of A . viscosus with constituents in the salivary pellicle.

J Infect Dis, 1992 Mar, 165(3), 569 - 73
Analysis of DNA restriction fragment length polymorphism extends the evidence for breast milk transmission in Streptococcus agalactiae late-onset neonatal infection; Bingen E et al.; Analysis of restriction fragment length polymorphism (RFLP) of total DNA and of ribosomal DNA (ribotyping) was used to document four cases of Streptococcus agalactiae mother-to-infant transmission potentially associated with ingestion of infected mother's milk . Twenty strains were analyzed . Ten strains were mother-baby pairs, five from the milk of five mothers, four from their neonates with late-onset infection, and one from a colonized neonate . All mothers had early postpartum mastitis . Ten unrelated strains were studied for comparison . In each case, the two strains of each mother-baby pair produced identical RFLP patterns of total DNA . The 10 unrelated strains generated 10 different patterns, one of which, though, was observed in one of the mother-baby pairs . Ribotyping was less discriminative than total DNA RFLP analysis (6 different patterns vs . 13) . These data extend the evidence for breast milk transmission in S . agalactiae late-onset neonatal infection.

J Infect Dis, 1992 Mar, 165(3), 553 - 6
Antibody to capsular polysaccharides of Streptococcus pneumoniae after vaccination of human immunodeficiency virus-infected subjects with 23-valent pneumococcal vaccine; Rodriguez-Barradas MC et al.; The Centers for Disease Control recommends that, because of a greatly increased susceptibility to pneumococcal infection, all persons infected with human immunodeficiency virus (HIV) receive pneumococcal vaccine . Using an ELISA specific for antibody to capsular polysaccharide, a postvaccination antibody was evaluated to five commonly infecting serotypes of Streptococcus pneumoniae . Thirty-nine HIV-infected persons with less than or equal to 500 CD4 cells exhibited significantly fewer responses than did healthy controls; overall, only 46 (24%) of 195 possible responses were positive compared with 45 (75%) of 60 in 12 HIV-infected subjects with greater than 500 CD4 cells and 92 (74%) of 125 in 25 healthy controls (P less than .001) . Subjects with less than or equal to 500 CD4 cells responded to a mean of 1.1 antigens versus a mean of 3.8 and 3.7 in those with greater than 500 CD4 cells and controls, respectively (P less than .001) . There were no differences between responses in those with less than 200 and those with 200-500 CD4 cells . Within groups stratified by CD4 cell counts, further stratification by clinical status did not reveal significant differences . Since asymptomatic HIV-infected persons with less than 500 CD4 cells show abnormal responses, pneumococcal vaccine should be given when HIV infection is first detected.

Infect Immun, 1992 Mar, 60(3), 1225 - 8
Adherence, coaggregation, and hydrophobicity of Streptococcus gordonii associated with expression of cell surface lipoproteins; Jenkinson HF; Streptococcus gordonii Challis incorporated exogenous {3H}palmitate into 13 polypeptides extractable from intact cells with sodium dodecyl sulfate . A 76-kDa surface-exposed polypeptide, implicated previously as a cell aggregation determinant, was shown to be one of these lipid-modified polypeptides . Differences in sodium dodecyl sulfate-polyacrylamide gel electrophoresis patterns of lipopolypeptides were detected with mutants of S . gordonii that were altered in adherence, aggregation, coaggregation, or hydrophobicity . Lipid-modified polypeptides, tightly associated with the cell membrane, may be involved in the expression of cell surface properties of S . gordonii important for colonization of the human oral cavity.

Plasmid, 1992 Mar, 27(2), 155 - 60
A truncated Tn916-like element in a clinical isolate of Enterococcus faecium; Fletcher HM et al.; A 58.7-kb nonconjugative plasmid (pKQ1) previously reported in a clinical isolate of Enterococcus faecium was found to contain both a tetM and an erythromycin resistance (erm) determinant . The plasmid contained a region homologous to the A, F, H, and G HincII fragments of Tn916 . However, the 4.8-kb B fragment of Tn916 which contained the tetM determinant was replaced by a 7.3-kb fragment, and the 3.6-kb HincII C fragment of Tn916 was missing . An element homologous to Tn917 was juxtaposed to the truncated Tn916-like element . The Tn917-like element was similar in size to the erm transposon Tn917 as determined by a ClaI restriction digest which spanned approximately 99% of the transposon . When Bacillus subtilis or Streptococcus sanguis were transformed with pKQ1, no zygotically induced transposition of the tetM element was detected . Similarly no transposition of the Tn917-like element was detected.

Am J Vet Res, 1992 Mar, 53(3), 364 - 7
Inoculation of pigs with Streptococcus suis type 2 alone or in combination with pseudorabies virus; Iglesias JG et al.; Pigs (9 {+/- 1} weeks old) were inoculated with Streptococcus suis type 2, pseudorabies virus (PRV), or both . For each pig of groups A, B, and C the inoculum of S suis was 10(9) colony-forming units . For each pig of groups A, B, and D the inoculum of PRV was 5 x 10(3) TCID50 of either PRV strain 4892 (group A, n = 9) or PRV isolate B (group B, n = 9) . The PRV strain 4892 is a highly virulent strain; isolate B causes mild clinical signs of infection in inoculated pigs . Group-C pigs (n = 9) were given S suis alone, and group-D pigs (n = 3) were inoculated only with PRV isolate B . Clinical signs of infection and development of lesions were readily seen in pigs of groups A, B, and C . Duration and severity of clinical signs of disease and lesions were reduced in pigs of group C, compared with those of the other 2 groups . Lesions, such as polyarthritis and fibrinous pericarditis, were more abundant and acute in the groups of pigs given mixed challenge exposure, compared with pigs inoculated exclusively with S suis type 2 (group C) . The group of pigs inoculated with PRV isolate B alone did not manifest clinical signs of disease or lesions . Average daily gain for group-C pigs was higher, compared with that of other groups; the difference was statistically significant at P less than 0.02 and P less than 0.05 for groups B and D, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

J Antimicrob Chemother, 1992 Mar, 29(3), 299 - 302
Comparative in-vitro activity of four peptide antibiotics against penicillin-resistant Streptococcus pneumoniae isolated from cerebrospinal fluid (CSF); Rodriguez-Tudela JL et al.; The in-vitro activity of four peptide antibiotics against 43 penicillin-resistant Streptococcus pneumoniae isolated from cerebrospinal fluid (CSF) was evaluated . The activity of SKF104662 was slightly greater to that of vancomycin, teicoplanin and daptomycin (MICs for 90% of the isolates tested 0.06, 0.25, 0.12 and 0.25 mg/L, respectively) and superior to the other 15 drugs tested . The serotype of these penicillin-resistant strains was also determined . The strains that belonged to the predominant serotype 9 were resistant only to penicillin . All six erythromycin- and clindamycin-resistant strains belonged to serotype 6 and three of them were also resistant to chloramphenicol and tetracycline (plus penicillin).

J Vet Pharmacol Ther, 1992 Mar, 15(1), 62 - 71
Pharmacokinetics of enrofloxacin in fingerling rainbow trout (Oncorhynchus mykiss); Bowser PR et al.; The pharmacokinetics of intravenously and orally administered enrofloxacin was determined in fingerling rainbow trout (Oncorhynchus mykiss) . Doses of 5 or 10 mg enrofloxacin/kg body weight were administered intravenously to 26 fish for each dose and blood was sampled over a 60-h period at 15 degrees C . Two groups of fish were treated orally with 5, 10, or 50 mg/kg (80 fish/dose at each temperature) and held at 15 degrees C or 10 degrees C during the 60-h sampling period . Following intravenous administration, the serum concentration-time data of enrofloxacin in rainbow trout were best described by a two-compartment open model for both doses of 5 and 10 mg enrofloxacin/kg . The hybrid rate constants alpha and beta did not differ between doses . The distributional phase was rapid with a half-life of 6-7 min for both doses . Overall half-lives of elimination were 24.4 h (95% CI = 20.2-30.8) and 30.4 h (24.2-41.0), respectively, for the 5- and 10-mg/kg doses . A large Vd(area) was observed following dosing of either 5 or 10 mg enrofloxacin/kg,: 3.22 and 2.56 l/kg, respectively . Whole body clearance for 5 mg/kg was 92 ml/h.kg and 58 ml/h.kg at the 10-mg/kg dose . Following oral administration, the serum concentration-time data for enrofloxacin were best described as a one-compartment open model with first-order absorption and elimination . Apparent Ka over all doses at 10 degrees C averaged 62% less than apparent Ka at 15 degrees C . Estimates of the apparent t(1/2)e over both temperatures ranged from 29.5 h (18.4-73.4) to 56.3 h (38.3-106.6) . Bioavailability averaged 42% over all doses at 15 degrees C and was decreased to an average of 25% at 10 degrees C . Peak serum concentrations appeared between 6 and 8 h following dosing . A dose of 5 mg/kg/day was estimated to provide average steady-state serum concentrations at 10 degrees C that are approximately 4.5 times the highest reported MIC values for Streptococcus spp., the fish pathogen least sensitive to enrofloxacin . Owing to the long apparent half-life of elimination of enrofloxacin in fingerling trout, it would take approximately 5 to 9 days to achieve these predicted steady-state serum concentrations; this estimate is important when considering the duration of therapy in clinical trials.

Lancet, 1992 Feb 29, 339(8792), 518 - 21
Clonal basis for resurgence of serious Streptococcus pyogenes disease in the 1980s; Cleary PP et al.; During the 1980s there was a resurgence of serious Streptococcus pyogenes infections with complications, including rheumatic fever, sepsis, severe soft-tissue invasion, and toxic-shock-like syndrome (TSLS) . We have investigated the suggested association between expression of a scarlet fever toxin, SPE A, and systemic toxicity, and the possibility that a new highly virulent clone of S pyogenes has emerged and spread world wide . We studied serotype M1 strains, the serotype most commonly associated with serious complications . 19 isolates from patients with sepsis, with or without TSLS, and 48 from patients with uncomplicated pharyngitis or superficial skin infection were subjected to restriction-enzyme digestion and electrophoresis; 56 isolates (19 serious, 37 uncomplicated disease) were then examined by hybridisation to an speA gene probe . 17 (90%) of the 19 serious-disease isolates had a characteristic ("invasive", I) restriction-fragment profile and were positive for the speA gene . Significantly lower proportions of the isolates from patients with uncomplicated disease had the I profile (21/48 {44%}; p = 0.0035) and speA (20/37 {54%}; p less than 0.001) . These findings suggest that the strains from patients with serious disease are a unique clone, which became the predominant cause of severe streptococcal infections in the United States and elsewhere in the late 1980s.

Lancet, 1992 Feb 15, 339(8790), 405 - 8
Failure of chloramphenicol therapy in penicillin-resistant pneumococcal meningitis; Friedland IR et al.; First-line therapy for meningitis is often penicillin plus chloramphenicol . Penicillin-resistant Streptococcus pneumoniae (PRSP) infections are increasing world wide, but the efficacy of chloramphenicol for PRSP meningitis is unknown . We therefore prospectively assessed children with pneumococcal meningitis treated with penicillin plus chloramphenicol over 27 months to compare outcome of penicillin-susceptible S pneumoniae (PSSP) meningitis with that of PRSP meningitis . 68 children with pneumococcal meningitis who survived 24 hours were evaluated, of whom 25 had chloramphenicol-susceptible PRSP meningitis that was treated initially with chloramphenicol . 20 (80%) of these 25 children had an unsatisfactory outcome (death, serious neurological deficit, or poor clinical response) . By contrast, 14 (33%) of 43 children with PSSP meningitis (treated with benzylpenicillin) had an adverse outcome (p less than 0.001) . Despite similar zone sizes on antibiotic disc testing (indicating chloramphenicol susceptibility) the chloramphenicol minimum bactericidal concentrations (MBCs) of PRSP isolates were significantly higher than those of PSSP isolates . The higher chloramphenicol MBCs resulted in borderline cerebrospinal-fluid bactericidal activity in many cases of PRSP meningitis and frequent treatment failure . Current definitions of chloramphenicol susceptibility of S pneumoniae may be inappropriate for management of pneumococcal meningitis . We suggest that chloramphenicol should not be used for the management of PRSP meningitis; alternative agents, such as third-generation cephalosporins, are more appropriate.

Proc Natl Acad Sci U S A, 1992 Feb 15, 89(4), 1320 - 4
Cytotoxic and viral neutralizing antibodies crossreact with streptococcal M protein, enteroviruses, and human cardiac myosin; Cunningham MW et al.; The development of autoimmunity in certain instances is related to infectious agents . In this report, cytotoxic monoclonal antibodies (mAbs) that recognize epitopes on both enteroviruses and the bacterium Streptococcus pyogenes are described . Murine anti-streptococcal mAbs that were crossreactive with streptococcal M protein, human cardiac myosin, and other alpha-helical coiled-coil molecules were found to neutralize coxsackieviruses B3 and B4 or poliovirus type 1 . The viral-neutralizing anti-streptococcal mAbs were also cytotoxic for heart and fibroblast cell lines and reacted with viral capsid proteins on a Western immunoblot . Alignment of amino acid sequences shared between streptococcal M protein, coxsackie-virus B3 capsid protein VP1, and myosin revealed 40% identity in a 14- to 15-amino acid overlap . Synthetic peptides containing these sequences blocked mAb reactivity with streptococcal M protein . The data show that antibodies against alpha-helical structures of bacterial and viral antigens can lead to cytotoxic reactions and may be one mechanism to explain the origin of autoimmune heart disease.

Ugeskr Laeger, 1992 Feb 10, 154(7), 412 - 5
{Incidence and diagnosis of pneumococcal pneumonias requiring admission to hospital}; Nielsen SV et al.; A prospective investigation of patients admitted to the local hospital during a period of one year was undertaken . A total of 107 patients participated . 50% of the cases of pneumonia were found by Streptococcus pneumoniae . The diagnosis was established partly by demonstration of antigens and increase in antibody titre and also employing the traditional methods: Blood culture, microscopic examination and culture of the expectorate or tracheal secretion . 70% of the patients were over the age of 60 years . The mortality was found to be 17% . The difficulties in etiological investigations of infections in the lower respiratory tract are discussed.

J Med Microbiol, 1992 Feb, 36(2), 132 - 8
Factors affecting production of the group A streptococcus bacteriocin SA-FF22; Jack RW et al.; Factors influencing the production of streptococcin A-FF22 (SA-FF22) in liquid media were examined . Despite good growth of the producer strain, no SA-FF22 was detected during incubation at 40 degrees C, at pH 7, in Brain Heart Infusion Broth or in Mg(2+)-supplemented media . Optimal SA-FF22 production occurred at 32 degrees C, at pH 6.7, in cultures in Tryptic Soy Broth supplemented with glucose 2.25% and yeast extract 1% . Under these conditions SA-FF22 remained cell-associated but could be extracted with acid.

J Med Microbiol, 1992 Feb, 36(2), 117 - 20
Congenital bacterial sepsis in very preterm infants; Thompson PJ et al.; The results of body fluid and surface cultures from 148 preterm infants less than 33 weeks gestational age obtained routinely on admission to a neonatal intensive care unit were reviewed . The aim was to determine the occurrence of congenital bacterial sepsis in this population and to examine whether surface cultures yielded information helpful in management . Gastric aspirate and umbilical, nasal and ear swabs were cultured and the results were compared to those of blood cultures . Nine infants (5.4%) had congenital bacterial sepsis diagnosed by positive blood cultures . Only the results of microscopy of gastric aspirate were available within hours of birth and before the results of blood culture . Microscopy of gastric aspirate, demonstrating pus cells, alone had a sensitivity of 0.86 in predicting congenital sepsis but a specificity of 0.49; the specificity, however, rose to 0.80 if both organisms and pus cells were observed on microscopy . Thus, only this combination was a useful pre-indicator of congenital sepsis . In infants who did not develop septicaemia, treatment was modified only if Streptococcus agalactiae was cultured from surface sites; in all such cases, the organism was grown from the ear swab . Our results demonstrate that congenital bacterial sepsis is common amongst very preterm infants admitted for neonatal intensive care but routine screening of surface cultures should be restricted to an ear swab only.

Am Rev Respir Dis, 1992 Feb, 145(2 Pt 1), 471 - 5
Group B streptococcus has no effect on piglet diaphragmatic force generation; Murphy TD et al.; Recent studies indicate that diaphragmatic contractility is adversely affected by bacterial infection . Using transdiaphragmatic pressure (Pdi) with phrenic nerve stimulation, the effect of continuous Group B Streptococcus (GBS) infusion on diaphragmatic force output was studied in seven anesthetized, spontaneously breathing 1-month old piglets . Pdi was measured under baseline condition (50% O2/50% N2) and at 1, 2, and 4 h of GBS infusion . The GBS was infused at a level that caused a doubling of the pulmonary artery pressure and a 32% decrease in cardiac output but which avoided hypotension or acidosis--both of which can decrease diaphragmatic contractility . In addition, the piglets were kept hyperoxic (PaO2 greater than 100) and no piglet with hypercapnia (PaCO2 greater than 65) was studied, as hypoxia and hypercapnia also can cause respiratory muscle dysfunction . Pdi in response to phrenic nerve stimulation did not change during GBS infusion . We conclude that GBS infusion, in the absence of hypotension, hypercapnia, hypoxia, or acidosis, has no effect on diaphragmatic force generation in the piglet.

J Pediatr, 1992 Feb, 120(2 Pt 1), 281 - 5
Randomized trial of granulocyte transfusions versus intravenous immune globulin therapy for neonatal neutropenia and sepsis; Cairo MS et al.; We prospectively studied newborn infants with sepsis and neutropenia who were randomly selected to receive standard supportive care and either adjuvant granulocyte transfusions or intravenous immune globulin (IVIG) infusions; 21 infants received granulocyte transfusions and 14 received IVIG infusions . Half of the patients were premature (gestational age less than or equal to 32 weeks); the average postnatal age was 5 days (range 3 to 8 days) . All infants had neutropenia by the criteria of Manroe et al., and the mean average bone marrow neutrophil storage pool ranged between 35% and 37% . There were no significant differences with respect to serum IgG, IgA, IgM, and total hemolytic complement values between treatment groups or between survivors and nonsurvivors . Clinical severity as defined by hypoxia, acidosis, and hypotension was similar between treatment groups . Group B streptococcus was the most common organism identified and accounted for almost 33% of all bacterial isolates . There was a significantly different survival rate in the group receiving polymorphonuclear leukocyte transfusions (100%, 21/21) compared with the group receiving IVIG infusions (64%, 9/14; p = less than 0.03) . There were no significant complications in either treatment group with respect to fluid overload, secondary infection, blood group sensitization, pulmonary complications, or graft-versus-host disease . This pilot study suggests a possible benefit of granulocyte transfusions compared with 'IVIG therapy in the adjuvant treatment of neonatal neutropenia and overwhelming bacterial sepsis.

Chest, 1992 Feb, 101(2), 566 - 7
Pneumococcal crepitant cellulitis caused by a bronchocutaneous fistula; Haubrich RH et al.; An elderly woman who had received radiation treatment for carcinoma of the lung presented with erythema, crepitus and pain over the scapular area . Streptococcus pneumoniae was isolated in pure culture from the subcutaneous tissues, and a bronchocutaneous fistula was demonstrated.

Int J Rad Appl Instrum B, 1992 Feb, 19(2), 183 - 90
The use of 2-{18F}fluoro-2-deoxy-D-glucose as a potential in vitro agent for labelling human granulocytes for clinical studies by positron emission tomography; Osman S et al.; In this study, 2-{18F}fluoro-2-deoxy-D-glucose, {( 18F}FDG) was used to radiolabel human granulocytes in vitro for possible clinical use by positron emission tomography (PET) . Uptake of {18F}FDG was dependent on the amount of glucose in the labelling medium, e.g . when 1 x 10(7) granulocytes were incubated with {18F}FDG containing 15 micrograms/mL glucose 80% of {18F}FDG was incorporated within 30 min, but in the presence of 1 mg/mL of glucose it was reduced to 2% . Increasing the cell concentration and activating the granulocytes with Streptococcus pneumoniae, opsonized zymosan or phorbol myristate acetate all increased the uptake of {18F}FDG . Retention of the {18F}FDG by the cells as {18F}FDG-6-phosphate was also dependent on the extracellular glucose concentration, 9% was released within 60 min in the absence of glucose, but 27% in the presence of 1 mg/mL glucose.

An Esp Pediatr, 1992 Feb, 36(2), 145 - 7
{Neonatal sepsis caused by Streptococcus pneumoniae . Report of two cases}; Balliu Badia PR et al.; Streptococcus pneumoniae is an unusual pathogen during the neonatal period . Two cases of neonatal early-onset sepsis, one of them associated with meningitis, are reported . Positive cultures for Strep . pneumoniae were obtained from both newborns and their mothers . Both newborns were full term with birth weights in the normal range . In one of them, amniorrexis occurred 18 hours before the delivery and the amniotic fluid was meconium stained . Significant clinical findings consisted in fever and respiratory distress . There was leucopenia and in one case the chest radiography was abnormal . Both neonates had an uneventful recovery after starting antibiotic treatment and no long term sequellae were detected . The incidence of neonatal sepsis caused by Strep . pneumoniae and its pathogenesis are reviewed.

Radiologe, 1992 Feb, 32(2), 73 - 4
{Percutaneous catheter drainage of a thyroid abscess under CT control}; Klose KC et al.; A large cervical abscess originating from the thyroid gland was treated by means of irrigational catheter drainage performed percutaneously with CT guidance . Culturing resulted in the growth of Streptococcus . Catheter drainage associated with appropriate antibiotic therapy resulted in healing of the abscess after only 3 days with no complications occurred . This case suggests that CT-guided percutaneous catheter drainage may be an effective and safe alternative to surgical therapy in the neck area as well as in other regions of the body.

Rev Clin Esp, 1992 Feb, 190(3), 131 - 3
{Peritoneal pneumococcal infections}; Garcia-Arenzana JM et al.; The clinical-microbiological characteristics of 13 patients iun whom Streptococcus pneumoniae (Pneumococcus) was isolated from the peritoneum over eight and a half years in a third grade hospital are reviewed . It is noteworthy the fact that only in 7 cases primary or spontaneous peritonitis were treated; the remaining cases were secondary to perforation or genital infection in females . The presence of antibiotic resistance in pneumococcus was high and global mortality was low.

Acta Ophthalmol (Copenh), 1992 Feb, 70(1), 19 - 25
Ophthalmia neonatorum in northern Norway . II . Microbiology with emphasis on Chlamydia trachomatis; Dannevig L et al.; In a population of 1928 neonates in Northern Norway, ophthalmia neonatorum was diagnosed in 18.9%, including mild and self-limiting cases . Sixteen out of 269 (6.0%) cultured cases were positive for Chlamydia trachomatis . No gonococcal ophthalmia was seen . In neonates whose symptoms began in the maternity wards, the distribution of the isolated microorganisms (mainly Staphylococcus aureus) was different from those in whom symptoms began after discharge (mainly S . aureus, Staphylococcus species (coagulase-negative), Streptococcus viridans and C . trachomatis) . Growth of C . trachomatis was significantly associated with the intensity of conjunctivitis (P less than 0.001) . However, no sequelae could be demonstrated in the eyes at the age of 6 months . 60% of the neonates with chlamydial ophthalmia also suffered from rhinitis . 31.4% of the neonates received silver nitrate instillation, which had no significant influence on the frequency of chlamydial ophthalmia . General practitioners are often faced with chlamydial ophthalmia . In cases of ophthalmia neonatorum, a microbiological examination is recommended, as a guide to appropriate antibiotic treatment . The result of microbiological examination may also indicate other infections in mother and child . In areas with a readily available health service, including an adequate microbiological laboratory service, prophylaxis in the eyes does not seem to be necessary.

Clin Infect Dis, 1992 Feb, 14(2), 427 - 35
Susceptibility of Streptococcus pneumoniae to penicillin: a prospective microbiological and clinical study; Garcia-Leoni ME et al.; We performed a prospective study of all infections with Streptococcus pneumoniae documented during a 22-month period at our hospital . A total of 163 clinically significant strains of S . pneumoniae were isolated from 139 patients whose ages ranged from 8 days to 91 years (mean +/- SD, 42.6 years +/- 26.8 years) . Twenty percent of the patients had cancer, and 18% were infected with the human immunodeficiency virus . Pneumococcal infection was nosocomially acquired in one-fourth of cases . One-third of patients had nonpneumonic disease . A wide range of serotypes were isolated, and 42.5% of all strains were nonsusceptible--i.e., showed either intermediate or high-level resistance--to penicillin . The rates of resistance to chloramphenicol, erythromycin, and tetracycline were 23%, 10.8%, and 48.2%, respectively . Twenty-two percent of the infected patients died, with a 15.8% mortality directly attributable to pneumococcal infection . Factors associated with infection by strains of S . pneumoniae not susceptible to penicillin included an age of less than or equal to 10 years, immunosuppression, the presence of a rapidly fatal underlying disease, previous antimicrobial therapy, and infection by serotypes 14 and 23 . All clinically significant isolates of S . pneumoniae should be submitted for antimicrobial susceptibility studies, and, whenever a high prevalence of resistance to penicillin and macrolides is detected, the use of these well-established empirical therapeutic regimens should be reconsidered.

Zentralbl Veterinarmed A, 1992 Feb, 39(1), 43 - 56
{The pathogenesis of the "endometritis-pyometra complex" in the female dog}; Schoon HA et al.; Based on investigations in 51 bitches (uteri and ovaries after ovariohysterectomy), suffering from "endometritis-pyometra-complex" (without, n = 38; with, n = 13, hormonal pretreatment), morphologic-functional endometrial characteristics (light microscopy, scanning electron microscopy, enzyme histochemistry, immunohistochemical estrogen receptor analysis) are correlated with ovarian findings, plasma estradiol and progesterone levels as well as microbiological results . The estrous phase of all cycling patients was determined as "diestrus" . Plasma estradiol and progesterone concentrations fluctuate within physiological variations . In all cases, not including those, pretreated with progestagen, histological signs of irregular hyperproliferation of uterine glands are obvious, closely related with enzyme histochemical aberrations and atypical endometrial estrogen receptor state . This is interpreted as indicative for prolonged periestrous estrogen induced effects, undergoing different stages of secretory transformation due to the species specific long lasting corpus luteum period . A comparable pathogenesis is supposed deriving from estrogen applications (e . a . after mismating) due to intensified hormonal stimulation and sensibilization of the endometrium, predisposing to ascendant infections by facultative pathogenic bacteria (e . a . E . coli, Streptococcus sp.) . Patients without ovarian cyclicity, resulting from progestagen application, exhibit findings, that indicate hormonal imbalances: secretory hypertrophy, irregular regeneration, fibrous atrophy and rigid secretion, resembling those possibly occurring in women after long administration of oral contraceptives.

Med Clin (Barc), 1992 Feb 1, 98(4), 137 - 8
{Septic arthritis due to Streptococcus bovis}; Calderon J et al.; A 47-year-old man presented with arthritis of the right shoulder and spondylodiscitis by Streptococcus bovis . This microorganism is a frequent cause of endocarditis and has been associated with gastrointestinal neoplasm, mainly carcinoma of the colon; however up to the present it had not been described as an causal agent of septic arthritis . The studies carried out on the patient permitted the exclusion of the existence of a digestive neoplasm and endocarditis . Despite a prolonged evolution prior to treatment with elevated doses of penicillin G and not requiring surgical drainage, the evolution was good and no destructive lesions were produced in the shoulder joint . Hematogenous infections (in this case septic arthritis) by Streptococcus bovis may present in patients without gastrointestinal diseases or endocarditis, possibly have a low damage to skeletal structures and respond adequately to conventional treatment with penicillin G.

J Periodontol, 1992 Feb, 63(2), 73 - 9
Minocycline slow-release formulation effect on subgingival bacteria; Okuda K et al.; The purpose of this study was to determine the microbiological efficacy of an adjunctive minocycline periodontal formulation delivered subgingivally . Subjects were systemically healthy but exhibited severe periodontitis; i.e., probing depths greater than 6 mm . The two study groups included individuals who received minocycline or a placebo periodontal formulation after root planing . Subgingival plaque samples were obtained at baseline; prior to treatment; and at 1, 3, and 6 months . Plaque was evaluated by darkfield microscopy and further analyzed for total dark-pigmented Bacteroides species, P . intermedia, P . gingivalis and Streptococcus, Actinomyces, Eikenella, Actinobacillus, Capnocytophaga, and Fusobacterium species using cultivable flora techniques . In addition, plaque was evaluated for yeast on a selective agar medium . When compared to the placebo, the minocycline group had significantly lower proportions of spirochetes at 1 and 3 months and lower proportions of motile rods at 3 months . Furthermore, when compared to the placebo group, the minocycline patients had lower mean proportions of dark-pigmented Bacteroides spp . and P . intermedia at 1 and 3 months as well as lower proportions of E . corrodens at 1 month . The minocycline group had significant decreases in proportions of spirochetes at 1 and 3 months, motile rods at 1 and 3 months, and increases in cocci at 1, 3, and 6 months when compared to baseline . In the placebo group, root planing was also effective at decreasing spirochetes at 1, 3, and 6 months, but with significant differences seen only at 3 and 6 months . However, the degree of reduction in spirochete proportions was greater in the minocycline group when compared with the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

J Am Osteopath Assoc, 1992 Feb, 92(2), 205, 209 - 12
Bacterial patterns found in surgery patients with chronic sinusitis; Hoyt WH 3rd; Aseptic samples of sinus mucosa or aspirates from maxillary sinuses were taken from 197 patients who underwent sinus surgery and were cultured for aerobic bacteria . Anaerobic cultures were also obtained from 143 of these patients . A total of 236 bacterial isolates from 174 patients were analyzed . No anaerobic organisms were isolated . The most commonly isolated organisms were Staphylococcus species (coagulase-negative), Staphylococcus aureus, gram-negative bacilli, and Streptococcus species . Penicillin G, erythromycin, tetracycline hydrochloride and, to a lesser degree, first-generation cephalosporins were found to be inferior to ciprofloxin, trimethoprim/sulfamethoxazole, and cefuroxime axetil when the susceptibilities of all the bacterial isolates to oral antibiotics used commonly in the empiric therapy of chronic sinusitis were compared.

J Clin Microbiol, 1992 Feb, 30(2), 517 - 9
Minimum number of pneumococci required for capsular antigen to be detectable by latex agglutination; Holloway Y et al.; Forty-eight strains of Streptococcus pneumoniae were tested in vitro to determine the minimum number required for pneumococcal capsular antigen to be detectable by latex agglutination . It was found that 10(6) to 10(7) microorganisms per ml were needed and that antigen remained detectable even when viable pneumococci could no longer be demonstrated.

J Clin Microbiol, 1992 Feb, 30(2), 318 - 22
Quantitation of pneumococcal C polysaccharide in sputum samples from patients with presumptive pneumococcal pneumonia by enzyme immunoassay; Parkinson AJ et al.; Although the Gram stain and culture of expectorated sputum are considered standard methods for the diagnosis of presumptive pneumococcal pneumonia, these methods remain relatively insensitive and nonspecific . We developed an enzyme immunoassay (EIA) for the quantitation of pneumococcal C polysaccharide (PnC) in the sputum of patients with presumptive pneumococcal pneumonia . Of 34 patient sputum samples collected within 24 h of the first radiographic report of pneumonia, 12 grew Streptococcus pneumoniae on culture . By using a cutoff point of 0.5 micrograms of PnC per ml of sputum, all 12 specimens were positive (sensitivity, 100%) by EIA . PnC levels ranged from 1.43 to 57.53 micrograms/ml . Blood samples from 18 of the 34 patients were cultured . S . pneumoniae grew in the culture of a blood sample from one patient, whose sputum also had the highest PnC level . Of 22 sputum samples from patients with pneumonia that did not grow S . pneumonia, two were positive by EIA (specificity, 90.1%) . Sputa from both patients had low levels of PnC (2.7 and 4.5 micrograms/ml), and both patients had received antibiotics before sputum collection . The positive predictive value of the quantitative EIA was 85.7% . Quantitation of PnC has the potential for improving the accuracy of sputum examination for S . pneumoniae, monitoring disease severity and the effectiveness of antibiotic therapy, and differentiating between those patients with invasive pneumococcal disease and those who are carriers of S . pneumoniae.

Infect Immun, 1992 Feb, 60(2), 360 - 5
Induction of a putative laminin-binding protein of Streptococcus gordonii in human infective endocarditis; Sommer P et al.; There is evidence to suggest that the virulence of Streptococcus strains in infective endocarditis might be due to the expression of binding sites for the extracellular matrix proteins of damaged valves . In this communication, we draw attention to one laminin-binding protein from a strain of Streptococcus gordonii isolated from a patient with human endocarditis . This 145-kDa protein was found on the cell wall of the bacterium . The level of expression of this binding protein might be regulated by the presence of extracellular matrix proteins: the protein was lacking after in vitro selection of laminin, collagen I, and fibronectin nonbinding variants, and it was recovered after growth of the variants when laminin or collagen I was added to the growth medium . It was also missing after 10 subcultures in minimal medium, indicating some positive control . Furthermore, the 145-kDa protein was recognized as a major antigen by sera from patients treated for streptococcal infective endocarditis, while sera from patients with valvulopathies gave only slight recognition, suggesting an increase of the expression of this protein during infective endocarditis . It was also shown that the 145-kDa protein carried a collagen I-like determinant detected with anti-human collagen I antibodies.

Oral Microbiol Immunol, 1992 Feb, 7(1), 14 - 8
Enumeration of subgingival species on primary isolation plates using colony lifts; Gunaratnam M et al.; This study evaluated the feasibility of using a colony lift method and DNA probes to enumerate bacterial species cultured on primary isolation plates . Fourteen digoxigenin-labeled whole chromosomal DNA probes representing 12 subgingival species were validated by hybridization with colony lifts prepared from 249 reference strains of 51 species grown on Trypticase soy agar plates supplemented with 5% sheep blood . Colonies of reference strains were lifted onto Nytran filters from plates and treated to lyse cells, remove cellular proteins, denature and fix microbial DNA to the filters . Positive reactions were detected with an anti-digoxigenin antibody conjugated to alkaline phosphatase and revealed by bromo-chloro-indolyl phosphate and nitroblue tetrazolium . Cross-reactions were not observed for 13/14 probes, but 2 strains of Streptococcus mitis reacted with the probe to Streptococcus sanguis II . Subgingival plaque samples were taken by means of a sterile curette from mesiobuccal surfaces of teeth present in each of 26 subjects with differing periodontal disease states . Samples were dispersed, diluted, plated and incubated anaerobically for 7 d at 35 degrees C . Colonies were lifted as described above . Filters were cut into sections and hybridized with the 14 digoxigenin-labeled DNA probes . The probes were used to enumerate the test species and the total number of isolates was determined in 711 plaque samples . The colony lift method and DNA probes provided a sensitive, economical and quantitative method for enumerating cultivable microbial species in subgingival plaque samples . In addition, the amplification provided by growing the organisms on agar plates facilitated determination of numbers of organisms in small plaque samples, such as those from healthy sites.

J Antimicrob Chemother, 1992 Feb, 29(2), 149 - 57
Surveillance of Streptococcus pneumoniae serotypes in Riyadh and their susceptibility to penicillin and other commonly prescribed antibiotics; Shibl AM et al.; A total of 358 recent distinct isolates of Streptococcus pneumoniae were recovered from clinical specimens of patients in various hospitals in Riyadh, Saudi Arabia . The commonest serotypes were Groups C, F, B and A . Using specific monosera for typing it was found that serotype 14 was the commonest followed by serotypes 3, 7, 1, 2, 19 and 8 respectively . The minimal inhibitory concentrations (MIC) of penicillin determined by an agar dilution method, showed that 81% were susceptible (MIC less than 0.1 mg/L), 18% were relatively resistant (MIC = 0.1-1 mg/L) and 1% showed increased resistance (MIC greater than or equal to 1.0 mg/L) . The use of a 1 microgram oxacillin disc distinguished between susceptible and relatively penicillin resistant pneumococci more reliably than did the use of a penicillin disc (1 or 10 micrograms) . Resistance of S . pneumoniae to tetracycline, co-trimoxazole, chloramphenicol, and erythromycin were 70%, 43%, 12% and 4% respectively . All isolates were susceptible to oral cephalosporins (cefadroxil, cephalexin, cefaclor, and cefuroxime axetil) with an MIC range of less than or equal to 0.03-2 mg/L . The selection of antimicrobial therapy and the efficiency of vaccines depend on the knowledge of the local isolates of S . pneumoniae . Clinical isolates should be routinely screened to detect susceptibility to penicillin . The relatively high incidence of resistance to multiple antibiotics indicates the need to perform antibiotic susceptibility testing in order to avoid possible therapeutic failure.

J Leukoc Biol, 1992 Feb, 51(2), 157 - 63
The up- and down-modulation of immunoglobulin G Fc receptors and complement receptors on activated human neutrophils depends on the nature of activator; Leino L et al.; Human neutrophils were activated with soluble stimuli, formyl-methionyl-leucyl-phenylalanine (fMLP) or ionophore A23187, and with opsonized particles, zymosan or Streptococcus pneumoniae bacteria . Monoclonal antibodies and flow cytometry were used to assess the expression of Fc-gamma receptors (FcRI, FcRII, FcRIII) and complement receptors (CR1, CR3) . The role of extracellular calcium and magnesium in the modulation of receptor expression was also examined . The low-level expression of FcRI was not affected by any activator tested . fMLP and A23187 did not alter the expression of FcRII, whereas a significant, Ca(2+)- and Mg(2+)-independent down-modulation was observed upon activation with opsonized particles . All activators clearly decreased the surface expression of FcRIII in the presence of Ca2+ and Mg2+, probably as a consequence of shedding of the phosphatidylinositol-glycan-anchored receptor protein . The removal of calcium and magnesium blocked the shedding of FcRIII caused by soluble stimuli, whereas it retarded but did not abolish the fall in FcRIII expression when cells were incubated with opsonized particles . This fall was likely due to internalization of the receptor molecules while the shedding was blocked . A rapid increase in CR1 and CR3 expression was seen upon activation with soluble stimuli . The change in CR1 expression was independent of extracellular Ca2+ and Mg2+ . The increase in CR3 number required an influx of divalent cations . No total up-modulation of complement receptors occurred when neutrophils were activated with opsonized particles . However, the kinetic analysis revealed a temporary up-modulation that was followed by a down-modulation . The results indicate that the expression of both Fc-gamma and complement receptors on human neutrophils is changed upon activation and that the up- and down-modulation of these receptors depends on the nature of activator . We also suggest that in neutrophils the FcRIII down-modulation is the result of both receptor shedding and internalization, while FcRII is down-modulated by receptor internalization.

Kansenshogaku Zasshi, 1992 Feb, 66(2), 225 - 31
{Detection of polymeric IgA antibody to herpes simplex virus by pretreatment of sera with Streptococcus pyogenes--its application to diagnosis of primary infection}; Hashido M et al.; In 17 patients of genital herpes virus infections, herpes simplex virus (HSV)-specific IgA antibody responses were analyzed using an enzyme-linked immunosorbent assay (ELISA) and the absorption of sera with Streptococcus pyogenes, AW43 and AR1, which bind monomeric IgA (m-IgA) and IgG antibodies, respectively . The ratio of polymeric IgA (p-IgA) to total IgA was calculated from the formula, the p-IgA index = IgA activity after absorption/IgA activity before absorption . In early-convalescent-phase sera from primary cases, the p-IgA indices were 0.5-0.9, whereas in recurrent or provoked cases, they were lower than 0.2 . There results indicate that the p-IgA index may be useful for rapid and simple differentiation of primary from non-primary HSV infections.

Endod Dent Traumatol, 1992 Feb, 8(1), 6 - 11
Efficacy of different irrigation methods and concentrations of root canal irrigation solutions on bacteria in the root canal; Briseno BM et al.; The effectiveness of two different root canal irrigating solutions, each in two different concentrations or formulations, with two different irrigation methods was compared in vitro by means of bacterial survival determinations . 75 human root canals were enlarged, sterilized and inoculated with a mixed culture of Escherichia coli and Streptococcus mutans . After inoculation, the root canals were irrigated either manually or with an ultrasonic device for equal times (20s) with the same amount (5 ml) of sodium hypochlorite (1% and 2%), Fokalhydran I and Fokalhydran II . Sodium hypochlorite (1% and 2%) was used in a 1:100 dilution . Fokalhydran I and II were used in a 1:10 dilution . In the sodium hypochlorite group, the 1% concentration applied with a syringe proved to be most effective against Escherichia coli and Streptococcus mutans . The least effective concentration and application method against both bacteria species was obtained with 2% NaOCL and ultrasonics . Against Escherichia coli and Streptococcus mutans, a significantly lower effectiveness was found with 2% NaOCL applied with ultrasonics with respect to the rest of the sodium hypochlorite group . Fokalhydran I was significantly better than Fokalhydran II against Escherichia coli . However, no significant differences could be seen against Streptococcus mutans within this group.

Oral Microbiol Immunol, 1992 Feb, 7(1), 53 - 6
Use of a replica-plate assay for the rapid assessment of salivary protein-bacteria interactions; Tseng CC et al.; A replica-plate assay was used to screen for the interaction of salivary molecules with dental plaque bacteria . Bacterial colonies cultured from supragingival plaque on sheep-blood (SB) agar were replica-plated onto nitrocellulose membranes overlaying SB or mitis-salivarius agar . Membranes with attached colonies were removed and incubated with 125I-amylase or 125I-proline-rich glycoprotein (PRG) . Positive interactions were detected by autoradiography . Only strains of Streptococcus gordonii and Actinomyces viscosus bound amylase, and strains of A . viscosus bound PRG . The results suggest that amylase and PRG bind to selected species of aerobic dental plaque bacteria.

Gynecol Oncol, 1992 Feb, 44(2), 137 - 46
Immunological modulation of lymphocyte subpopulation in cervical cancer tissue by sizofiran and OK-432; Gorai I et al.; The intimate correlation between marked lymphocyte infiltration in the cancer tissue and the superior clinical prognosis has been reported in human cancers . Sizofiran (SPG), a polysaccharide consisting of beta-1,3-D-glucopyranosyl linkage with beta-1,6-D-glucopyranosyl branches, or OK-432, a heat- and penicillin-treated, lyophilized preparation of the Su strain of Streptococcus pyogenes of human origin, was administered intratumorally to nine patients with advanced uterine cervical carcinoma before radical hysterectomy to assess their immunological modulating properties to tumor-infiltrating lymphocyte subpopulations immunohistochemically . The degree of infiltration of CD3- and CD5-positive cells increased moderately or markedly in the stroma surrounding the lesion in both SPG group and OK-432 group, as well as that of CD4- and CD8-positive cells, from that before administration . The density of infiltration of CD3-positive, CD4-positive, and CD8-positive cells in the lesion increased slightly or moderately in both groups after administration . As for CD16-positive cell infiltration, both SPG and OK-432 increased its degree in the stroma lining the lesion while SPG alone augmented its degree in the lesion . This augmentation of lymphocyte infiltration in situ induced by intratumoral administration of SPG and OK-432 is expected to lead to a favorable prognosis of patients with cervical cancer.

Infect Immun, 1992 Feb, 60(2), 623 - 9
Genetic control of immune responses in mice to synthetic peptides of a Streptococcus mutans surface protein antigen; Takahashi I et al.; The immune responses to a cell surface protein antigen (PAc) of Streptococcus mutans and a peptide corresponding to residues 301 to 319 of the protein antigen {PAc(301-319)} in various strains of mice were studied, with attention being given to the haplotype of major histocompatibility complex (MHC) class II genes . Subcutaneous immunization of mice carrying the MHC class II I-Ad gene {BALB/c, B10.D2, B10.GD, and (B10.D2 x B10.G)F1 mice} with the peptide induced strong serum immunoglobulin G (IgG) responses to recombinant PAc (rPAc) and the peptide . Subcutaneous immunization of mice carrying the haplotype k or b of the H-2 I-A gene (C3H/HeN, C57BL/6, B10.BR, B10.A, or B10 mice) with the peptide induced intermediate serum IgG responses to rPAc and the peptide, and subcutaneous immunization of mice carrying the haplotype s or q of the H-2 I-A gene (DBA/1, B10.S, or B10.G mice) induced weak serum IgG responses to rPAc and the peptide compared with the responses of mice carrying the I-Ad gene . PAc(301-319) strongly induced PAc(301-319)-specific T-cell proliferation in B10.D2 mice but not in B10.G mice . The T-cell proliferation in B10.D2 mice was inhibited by treatment of antigen-presenting cells with anti-I-Ad monoclonal antibody but not with anti-I-Ab monoclonal antibody . These results indicate that the immune responses to the peptide in mice are genetically restricted or dominated by the MHC class II gene (I-Ad) . To map antigenic epitopes in PAc(301-319) and PAc in mice bearing different H-2 haplotypes, 10 overlapping decapeptides covering PAc(301-319) and 153 decapeptides covering the entire mature PAc were synthesized . Of 10 decapeptides covering PAc(301-319), 6, 7, 1, and 1 decapeptides showed strong reactions with anti-PAc(301-319) sera from B10.D2 (H-2d), B10.GD (H-2g2), B10.BR (H-2k), and B10.A (H-2a) mice, respectively . None of these overlapping decapeptides reacted with anti-PAc(301-319) sera from B10.S (H-2s) and B10.G (H-2q) mice . Epitope-scanning analyses of the mature PAc molecule showed that antigenic epitopes scattered throughout the molecule and that antigenic epitope patterns differed in mice with different H-2 haplotypes . In addition, there was little overlap of immunogenic peptides among the mice with different haplotypes.

Cancer, 1992 Feb 1, 69(3), 636 - 42
Use of fibrinogen to enhance the antitumor effect of OK-432 . A new approach to immunotherapy for colorectal carcinoma; Monden T et al.; OK-432 (5 KE), an immunomodulatory agent prepared from an attenuated strain of Streptococcus pyogenes, was dissolved in 1 ml of aprotinin (1000 KIE) and mixed with 80 mg of fibrinogen containing Factor XIII . A single intratumoral injection of the mixture was performed preoperatively under endoscopy in 20 patients with colorectal carcinoma . Postoperative histopathologic examinations revealed the formation of fibrin fibers at the site of injection and marked infiltration of inflammatory cells into the tumor stroma on the day after injection; the formation of granulomas containing many giant cells after 4 to 7 days; and extensive regression of tumor tissue after 14 days . This study suggests that the high concentration of exogenous fibrinogen gelatinized enough to trap OK-432 in tumor stroma and that OK-432 induced granulomatous hypersensitivity to degenerate tumor stroma, thereby causing regression of the tumors.

Microb Pathog, 1992 Feb, 12(2), 87 - 93
Effect of insertional inactivation of the genes encoding pneumolysin and autolysin on the virulence of Streptococcus pneumoniae type 3; Berry AM et al.; Derivatives of Streptococcus pneumoniae type 3 deficient in production of either pneumolysin or autolysin were constructed . This was achieved by transformation of type 3 pneumococci with DNA from derivatives of a rough strain (Rx1), in which the respective genes had been interrupted by insertion-duplication mutagenesis using internal fragments of the cloned genes in the vector pVA891 . Southern blot analysis confirmed that the pneumolysin or autolysin genes in the respective transformants had been interrupted by insertion of the plasmid-derived sequences . Both the pneumolysin-negative and the autolysin-negative strains had significantly reduced (P less than 0.0001) virulence in mice, as judged by survival time after intraperitoneal challenge . The median survival time of mice challenged with type 3 pneumococci in which either pneumolysin or autolysin production had been reconstituted by back-transformation of the mutants with an intact copy of the respective cloned gene (with concomitant elimination of plasmid-derived sequences), was indistinguishable from that of mice challenged with the wild-type strain . These results establish the importance of both pneumolysin and autolysin to the virulence of type 3 pneumococci.

Microb Pathog, 1992 Feb, 12(2), 137 - 43
Comparative efficacy of autolysin and pneumolysin as immunogens protecting mice against infection by Streptococcus pneumoniae; Lock RA et al.; Previous studies on Streptococcus pneumoniae have established that the pneumococcal proteins autolysin (N-acetylmuramyl-L-alanine amidase) and pneumolysin both contribute significantly to the virulence of the organism . In the present work, autolysin and a defined toxoid derivative of pneumolysin were tested, individually and in combination, for efficacy in a mouse model as antigens protecting against challenge with virulent, wild-type S . pneumoniae . While each antigen alone provided significant protection, the degree of protection was not increased when the antigens were administered together . In an additional experiment, mice were challenged with a genetically-modified mutant strain of pneumococcus unable to express active pneumolysin . Pre-immunization of such mice with autolysin failed to provide any significant protection against the challenge . The results of this study suggest that the most important contribution made by autolysin to the virulence of S . pneumoniae may be its role in mediating the release of pneumolysin from the pneumococcal cytoplasm during infection.

Vet Microbiol, 1992 Feb, 30(2-3), 213 - 22
Conjugation of antibiotic resistance in Streptococcus suis; Stuart JG et al.; Forty-eight clinical isolates of Streptococcus suis were examined for antibiotic sensitivity and the presence of plasmid DNA . It was determined that isolates from this study showed a substantial increase in resistance to erythromycin (ery), clindamycin, and tetracycline (tet) compared to a similar study conducted five years earlier . Eleven of the 48 isolates contained plasmid DNA as revealed by DNA isolation and gel electrophoresis . Plasmid DNA from four strains resistant to the above three antibiotics was tested for the ability to transform an antibiotic sensitive recipient . No transformation of antibiotic resistance could be demonstrated . In other experiments, the above four strains, along with four plasmid-negative triply resistant strains were tested for the ability to transfer tet or ery resistance to tet and ery sensitive recipients by conjugation . In each mating, antibiotic resistance was transferred at frequencies averaging 2.4 x 10(-6) recombinants/recipient for ery and 3.4 x 10(-6) recombinants/recipient for tet resistance . DNA from each clinical specimen, as well as the recombinants mentioned above was probed with tn916 . Autoradiographs revealed that several clinical isolates and recombinants bound the probe . It is concluded that conjugation of antibiotic resistance in these clinical strains is possibly mediated by a transposon similar to tn916.

Pediatr Res, 1992 Feb, 31(2), 121 - 6
Hemodynamic effects of heat-killed group B beta-hemolytic streptococcus in newborn lambs: role of leukotriene D4; Schreiber MD et al.; Group B beta-hemolytic streptococcus (GBS) infection is an important cause of neonatal pneumonia and sepsis . GBS infection is frequently associated with persistent pulmonary hypertension of the newborn . To better understand the early pulmonary hypertension phase of GBS-induced acute lung injury in a conscious animal, we characterized the pulmonary and systemic hemodynamic response of spontaneously breathing, chronically instrumented newborn lambs to injections of heat-killed type Ib GBS, 0.1-9.0 x 10(9) colony forming units . Heat-killed GBS caused marked dose-dependent increases in mean pulmonary arterial pressure and calculated pulmonary vascular resistance, 190 and 370% at the maximum dose, respectively . Similarly, GBS caused dose-dependent increases in mean systemic arterial pressure and systemic vascular resistance (28.5 and 108% at the maximum dose, respectively) and a decrease in cardiac output (33.5%) . Arterial oxygen tension worsened at the higher doses . GBS-induced pulmonary hypertension was decreased by two structurally unrelated, putative leukotriene D4 receptor antagonists . Pretreatment with LY171883 blocked GBS-induced pulmonary hypertension by 95%, and WY48,252 attenuated this effect by 27% . Both drugs completely blocked the hemodynamic effects of exogenous leukotriene D4 . For comparison, several lambs received bolus injections of live GBS, either alone or after pretreatment with LY171883 . The hemodynamic response to live GBS and attenuation of that response by LY171883 were similar to those caused by similar doses of heat-killed GBS . Thus, bolus injections of heat-killed GBS provide a reproducible model of pulmonary hypertension in conscious newborn lambs . In addition, the sulfidopeptide leukotrienes appear to be important mediators of GBS-induced pulmonary hypertension in newborn lambs.

Cell Biophys, 1992 Feb, 20(1), 99 - 110
Depth profiling of the elemental surface composition of the oral microorganism S . salivarius HB and fibrillar mutants by X-ray photoelectron spectroscopy; van der Mei HC et al.; X-ray photoelectron spectroscopy (XPS) on microbial cell surfaces requires freeze-drying of cells, and as a result, the cell surface appendages flatten out on the cell surface and form a collapsed fibrillar mass . At present, it is unclear how the density, length and composition of these fibrils influence the elemental surface composition as probed by XPS . The sampling depth of XPS can be varied by changing the electron take-off angle . In this article, we made a depth profiling of the collapsed fibrillar mass of Streptococcus salivarius HB and fibril-deficient mutants by angle-dependent XPS . Methylamine tungstate negative staining and ruthenium red staining followed by sectioning revealed distinct classes of fibrils with various lengths on each of the strains . Interpretation of the angle dependence of the oxygen/carbon (O/C) and phosphorus/carbon (P/C) surface concentration ratios of these strains was difficult . However, the angle dependence of the nitrogen/carbon (N/C) surface concentration ratio could be fully interpreted: N/C did not vary with sampling depth on a bald strain, S . salivarius HBC12 and on S . salivarius HB7, a strain with a dense array of fibrils of uniform length . N/C decreased with sampling depth in case of a sparsely fibrillated strain, S . salivarius HBV51 and eventually reached the value observed for the bald strain, HBC12 . A high N/C at small sampling depth was observed for S . salivarius HB with protruding, protein rich fibrils . We conclude that elemental depth profiling of microbial cell surfaces by XPS can be interpreted to coincide with structural and biochemical information on the cell surface as obtained by electron microscopy and can therefore be considered as a useful technique to study structural features of cell surfaces in combination with electron microscopy.

J Biol Chem, 1992 Jan 25, 267(3), 1924 - 31
Cloning and expression of two different genes from Streptococcus dysgalactiae encoding fibronectin receptors; Lindgren PE et al.; Binding of bacteria to fibronectin has been implicated as a mechanism of bacterial adhesion to the host tissue . In this report we have analyzed the binding of a strain of Streptococcus dysgalactiae to fibronectin . The cells bind to a site in the NH2-terminal domain of the protein via trypsin-sensitive cell surface components . Furthermore, a lysate prepared by sonication of streptococcal cells contained fibronectin-binding proteins that inhibit the binding of the ligand to intact bacteria . When the proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, blotted to an Immobilon-P filter, and probed with 125I-labeled fibronectin, a 140-kDa fibronectin-binding protein was identified along with a number of smaller binding proteins . A genomic DNA library was constructed and screened for the expression of fibronectin-binding proteins . Two clones were isolated and shown to contain unrelated inserts by restriction mapping and cross-hybridization experiments . The two encoded proteins were also immunologically distinct although both bound to the same region of the fibronectin molecule, and both effectively inhibited the binding of 125I-fibronectin to bacterial cells . Immunological analyses showed that only one of the two proteins tentatively identified as fibronectin receptors was expressed in detectable quantities in the Streptococcus dysgalactiae strain under the culture conditions employed.

J Med Chem, 1992 Jan 24, 35(2), 361 - 7
New 8-(trifluoromethyl)-substituted quinolones . The benefits of the 8-fluoro group with reduced phototoxic risk; Sanchez JP et al.; A series of 8-(trifluoromethyl)-substituted quinolones has been prepared and evaluated for in vitro and in vivo antibacterial activity, and phototolerance in a mouse phototolerance assay . These analogues were compared to the corresponding series of 6,8-difluoro- and 6-fluoro-8H-quinolones (ciprofloxacin type) . Although their in vitro antibacterial activities are less than the 6,8-difluoro analogues, the 8-(trifluoromethyl)quinolones are generally equivalent to their 8H analogues . In vivo, they are comparable to the 6,8-difluoro series and show up to 10-fold improvement in efficacy when compared to their ciprofloxacin counterparts vs Streptococcus pyogenes and Streptococcus pneumonia . In the phototolerance model, the 8-(trifluoromethyl)quinolones are comparable to the 8H-quinolones . Both of these series display much higher no effect doses (greater tolerance) than the corresponding 6,8-difluoroquinolones.

J Theor Biol, 1992 Jan 21, 154(2), 205 - 17
Differences in the formation of poles of Enterococcus and Bacillus; Koch AL; The pole of Enterococcus hirae (Streptococcus faecium) is more pointed than that of Bacillus subtilis; i.e . the pole of the former is prolate and the latter is oblate . Both species form their poles by constructing annular additions on the inside surface . In both cases, the thick septum starts to split from the outside before the septum is complete . Physiochemical considerations dictate that the peptidoglycan must be unstretched as laid down . However, it later becomes stressed and may stretch to increase its surface area or to change its shape . Our earlier analysis for B . subtilis demonstrated that, without the addition of new peptidoglycan, the nascent wall is stretched after it is externalized to 1.51 times the original area . The wall of partially formed poles that is already exteriorized continues to deform with further development . For E . hirae, Higgins & Shockman's measurements showed that the completed pole has a surface area 2.18 times larger than a completed septal disk and the wall changes shape very little after exteriorization . A model is presented here for the streptococcus in which the septal wall does not increase its surface area on exteriorization either by expansion or by murein insertion . Instead, the septal wall as it is split and exteriorized twists to become oblique, increasing the inner radius of the incomplete septum . In consequence of this rotation, extra layers of peptidoglycan are added to the inside face of the developing septum . This additional murein forms the more pointed pole shape for E . hirae . This "split-and-splay" model thus refines and extends the surface stress theory of E . hirae developed a decade ago by proposing a source of the extra wall needed for the formation of its prolate, more pointed, pole.

Eur J Biochem, 1992 Jan 15, 203(1-2), 153 - 9
Immobilization and single-step purification of fusion proteins using DEAE-cellulose; Sanchez-Puelles JM et al.; We have developed a new single-step system, using a DEAE matrix, to immobilize and/or purify fusion proteins containing the choline-binding domain of the Streptococcus pneumoniae murein hydrolases . We have constructed a choline-binding-domain--beta-galactosidase chimera, which can be purified by this procedure and shows a high beta-galactosidase activity when immobilized in the column . A vector plasmid, pCUZ1, containing the lppp-5/lac promoter as well as 13 restriction sites, was constructed to facilitate the cloning and expression of gene fusions . This plasmid also allows the selection of recombinants by the well-known blue/white 5-bromo-4-chloro-3-indolyl-beta-D-galactoside procedure . A chimera between the choline-binding domain and the pneumococcal hemolysin was also constructed and purified using pCUZ1.

Arch Dis Child, 1992 Jan, 67(1), 126 - 30
Streptococcus associated toxic shock; Torres-Martinez C et al.; In the past few years, there appears to have been a change in the spectrum of disease caused by group A beta-haemolytic streptococcus (GABHS), and a toxic shock-like syndrome caused by this organism has recently been described in adults . We report four children with an acute illness characterised by rapid progression of shock, erythematous rash, multisystem organ involvement, electrolyte derangements, and desquamation who fulfil the previously established diagnostic criteria for toxic shock syndrome . Three of the children had extensive cutaneous and soft tissue infection and the fourth had peritonitis . All four developed bacteraemia . Treatment included aggressive cardiovascular resuscitation and antibiotic therapy . Although no patient died, they suffered multiple and severe complications requiring prolonged treatment and hospitalisation . Streptococcal toxic shock syndrome is a separate and clearly defined entity occurring in previously healthy children.

J Clin Microbiol, 1992 Jan, 30(1), 243 - 4
Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus (the Streptococcus milleri group): association with different body sites and clinical infections; Whiley RA et al.; The associations of Streptococcus intermedius, S . constellatus, and S . anginosus (the three species of the S . milleri group) with clinical infections and sites of isolation were investigated by using a simple biochemical scheme to identify a collection of 153 clinical isolates . S . intermedius was associated with abscesses of the brain and liver, while both S . anginosus and S . constellatus were isolated from a wider range of sites and infections . S . anginosus strains predominated in both genitourinary and gastrointestinal sources and exhibited a wider range of phenotypes, particularly in the ability to ferment mannitol and/or raffinose.

Laryngoscope, 1992 Jan, 102(1), 88 - 9
Changes in the microbial flora of airline headset devices after their use; Brook I et al.; The bacterial flora of 20 headset devices were evaluated before and after they were worn for 1 hour . Bacteria were recovered from all headsets, and their number increased from a mean (+/- standard deviation) of 60 +/- 5 organisms per device to 650 +/- 51 organisms per device (P less than .001) . The predominant organisms recovered were Staphylococcus spp, Streptococcus spp, Propionibacterium spp, and Peptostreptococcus spp . This study demonstrates the presence of potential pathogens in headset devices, as well as the increase in the number of these pathogens after the headsets have been worn for 1 hour.

Diagn Microbiol Infect Dis, 1992 Jan, 15(1), 81 - 4
Comparison of cefotaxime with ceftriaxone given intramuscularly 12-hourly for community-acquired pneumonia; Dansey RD et al.; Cefotaxime 1 g intramuscularly (i.m.) 12-hourly was compared with ceftriaxone 1 g i.m . 12-hourly in adult patients requiring hospitalization with uncomplicated community-acquired pneumonia . Fifty-two patients were enrolled and two were subsequently withdrawn, leaving 50 patients who completed the study; 23 received cefotaxime and 27 received ceftriaxone . Clinical cure was achieved in 49 of the 50 patients (98%) . One treatment failure occurred in a patient who received ceftriaxone . The only significant pathogen isolated from the pretreatment sputum cultures was Streptococcus pneumoniae (50%) . All isolates were sensitive to both drugs . Cefotaxime 1 g i.m . 12-hourly was as effective as ceftriaxone in the treatment of patients with uncomplicated community-acquired pneumonia requiring hospital admission.

J Clin Invest, 1992 Jan, 89(1), 203 - 9
Effects of chain length on the immunogenicity in rabbits of group B Streptococcus type III oligosaccharide-tetanus toxoid conjugates; Paoletti LC et al.; One method to improve the immunogenicity of polysaccharide antigens is the covalent coupling of the native polysaccharide or a derivative oligosaccharide to a carrier protein . In general, T cell-dependent properties are enhanced in conjugates of smaller saccharides, but a conformational epitope of the native polysaccharide may be better expressed in conjugates of larger saccharides . We have reported previously the synthesis and immunogenicity in animals of an oligosaccharide-tetanus toxoid conjugate vaccine against type III group B Streptococcus . In this study, we sought to determine the optimal size of group B Streptococcus type III oligosaccharide for use in a conjugate vaccine by evaluating the relative immunogenicity of conjugate vaccines containing oligosaccharides that were twofold smaller (7,000 Mr) or larger (27,000 Mr) than that reported previously (14,500 Mr) . All three type III oligosaccharide conjugate vaccines were immunogenic in rabbits, in contrast to native, uncoupled group B Streptococcus type III polysaccharide . However, with respect to eliciting specific antibodies that were protective in vivo, the vaccine containing the intermediate-size oligosaccharide was superior to the smaller or larger conjugate vaccine . Analysis of opsonic activity of vaccine-induced antibodies demonstrated a predominance of IgG antibodies, thought to reflect T cell dependence, in response to shorter chain length conjugates, while the conformational epitope of the native polysaccharide was maximally expressed on longer chain length conjugates . These opposing trends may account for the optimal immunogenicity of an intermediate-size group B Streptococcus type III oligosaccharide conjugate vaccine.

J Bacteriol, 1992 Jan, 174(2), 610 - 8
Truncated forms of PspA that are secreted from Streptococcus pneumoniae and their use in functional studies and cloning of the pspA gene; Yother J et al.; Insertion-duplication mutagenesis was used to generate mutants of Streptococcus pneumoniae that produced truncated forms of PspA (pneumococcal surface protein A) . The truncated products, representing from 20 to 80% of the complete PspA molecule, were all secreted from the cell and could be detected in unconcentrated culture medium . Analysis of the truncated molecules showed that the antigenic variability known to be associated with PspA is located in the alpha-helical N-terminal half of the molecule . This region was also found to contain immunogenic and protection-eliciting epitopes and to define the maximum region of the molecule that is likely to be surface exposed . The apparent molecular weight variability seen for PspA molecules of different S . pneumoniae strains was localized to both the N- and C-terminal halves of the protein . Attachment of PspA to S . pneumoniae was found to require regions located carboxy to the fifth repeat unit in the C-terminal end of the molecule . From the insertion-duplication mutants, the complete pspA gene was cloned and expressed in Escherichia coli . Differences in apparent molecular weight were observed when the same cloned product was expressed in E . coli and S . pneumoniae, suggesting that PspA is modified differently in the two hosts.

Infect Immun, 1992 Jan, 60(1), 111 - 6
Strong association between capsular type and virulence for mice among human isolates of Streptococcus pneumoniae; Briles DE et al.; The relationship between capsular type and virulence for mice was examined with 69 fresh human isolates of Streptococcus pneumoniae . These isolates represented eight capsular types or groups . Serologic and molecular weight differences in PspA (pneumococcal surface protein A) indicated that the strains were clonally distinct . Mice were infected intravenously with washed bacteria of all 69 isolates in sterile salt solutions . Twenty-eight of the isolates were also injected intraperitoneally to permit comparisons between the intravenous and intraperitoneal routes . With a few exceptions, there was concordance between the ability of strains to cause fatal infections by the two routes . About 30% of the 69 isolates were virulent for mice . The abilities of the isolates to kill mice and the length of time between inoculation and death were strongly associated with capsular type . All type 4 isolates, 40% of type 3 isolates, and 60% of group 6 isolates were virulent for mice; type 1 isolates were marginally virulent; and all type or group 14, 19, and 23 isolates were avirulent . Times to death were generally longer for mice infected with group 6 or type 1 than for those infected with type 3 or 4 pneumococci . There was no relationship between clinical diagnosis or tissue source of the isolates and virulence for mice.

Chest, 1992 Jan, 101(1), 150 - 5
Pneumococcal bacteremia with pneumonia . Mortality in acquired immunodeficiency syndrome; Pesola GR et al.; OBJECTIVE: To compare mortality due to bacteremic pneumococcal pneumonia in patients with acquired immunodeficiency syndrome (AIDS) vs (control) patients without human immunodeficiency virus (HIV) infection . Non-AIDS patients with HIV infection were incidentally tabulated as a separate group . DESIGN: A two-year retrospective study . SETTING: Inpatients of St . Clare's Hospital, a community hospital in New York City . PATIENTS: Forty-nine patients had 50 separate episodes with at least one positive blood culture for Streptococcus pneumoniae (all were penicillin-sensitive) and pneumonia on chest roentgenogram . Twenty-four patients had no HIV infection, 14 patients had AIDS, and 11 patients with 12 bacteremic episodes were HIV-positive without AIDS . INTERVENTIONS: Treatment for pneumonia was determined by the patient's individual physician . MEASUREMENTS AND MAIN RESULTS: AIDS patients with pneumonia had a mortality of 57.1 percent (8/14), which was significantly higher than the 25 percent (6/24) seen in patients without HIV infection (p less than 0.025, two-sample test for independent proportions) . Septic shock, usually occurring within the first five days of hospitalization, was the primary cause of death, occurring in six of eight AIDS patients and six of six patients without HIV infection . If the mortality in the first five days of hospitalization was excluded, the mortality would drop to 33.3 percent in the AIDS population and 5.3 percent in patients without HIV infection . Eleven HIV-infected patients without AIDS survived 12 episodes of bacteremic pneumococcal pneumonia . CONCLUSIONS: Bacteremic pneumococcal pneumonia in the setting of AIDS has a survival rate of less than 50 percent with septic shock as the usual mode of death . This is the highest pneumococcal pneumonia mortality rate ever reported in a large subgroup of patients in the antibiotic era . On the other hand, HIV-infected patients without progression to AIDS have an excellent chance for survival . This may be related in part to young age, absence of many underlying diseases, and a better humoral immune system.

Clin Immunol Immunopathol, 1992 Jan, 62(1 Pt 2), S92 - 7
Directed immune globulin for the prevention or treatment of neonatal group B streptococcal infections: a review; Fischer GW et al.; Intravenous immune globulin (IVIG) is now used in many nurseries to prevent or treat neonatal infections . The most common cause of early-onset neonatal sepsis is the group B streptococcus (GBS) . Commercially available IVIG preparations have variable levels of specific antibody directed against GBS . Therefore, to ensure high levels of anti-GBS antibody, we developed a polyvalent IVIG directed against GBS (GBS-IVIG) by immunizing plasma donors . This GBS-IVIG was superior to standard IVIG both in vitro using opsonic studies and in vivo using a lethal suckling rat model of GBS sepsis . GBS-IVIG also protected neonatal rhesus monkeys in a GBS sepsis model . Safety and pharmacokinetic studies have been completed in 20 neonates with suspected sepsis . Fifteen infants were randomized to receive 500, 250, or 100 mg/kg of GBS-IVIG and were compared with 5 infants given 500 mg/kg of standard IVIG . No adverse effects of standard IVIG or GBS-IVIG were observed . While total serum IgG and IgG subclasses reflected the dose administered, the specific GBS antibody reflected both the dose and IVIG preparation utilized . At 500 mg/kg, the GBS-specific antibody rises more than fourfold above baseline in all babies that were observed for greater than 42 days postinfusion, while standard IVIG provided a fourfold rise in less than 20% of babies for less than 1 day . These studies suggest that GBS-IVIG can effectively and reliably elevate GBS-specific antibody levels in neonates . Clinical trials are needed to evaluate the efficacy of GBS-IVIG in preventing or treating neonatal GBS infections.

Ann Otol Rhinol Laryngol Suppl, 1992 Jan, 155, 51 - 7
Etiology and management of pharyngitis and pharyngotonsillitis in children: a current review; Paradise JL; Although viruses are the most common causes of childhood throat infections, interest in the etiology of these infections has primarily focused on whether an individual episode is caused by group A beta-hemolytic streptococcus (GABHS), particularly since the recent outbreaks of rheumatic fever in certain areas of the country . Penicillin remains the cornerstone of treatment in GABHS pharyngitis . Early treatment effects prompt clinical improvement and reduces the risk of transmission . Whether early treatment suppresses immunologic response and results in a higher recurrence rate than does delayed treatment is still unknown, but recent evidence suggests that it does not . The causes of persistent GABHS carriage, its clinical importance, and optimal methods of treatment are all still in question . When penicillin treatment does not eradicate carriage, other drugs may be efficacious . In children severely affected with recurrent throat infection, tonsillectomy is generally effective and is sometimes a desirable option.

Ann Otol Rhinol Laryngol Suppl, 1992 Jan, 155, 37 - 41
Sinusitis in infants and children; Wald ER; The major clinical problem in considering a diagnosis of sinusitis is differentiating uncomplicated upper respiratory tract infection from a secondary bacterial infection of the paranasal sinuses that may benefit from antimicrobial therapy . A diagnosis of sinusitis is suggested by presentation with protracted upper respiratory tract symptoms or a cold that is more severe than usual with fever and purulent nasal discharge . Confirmatory tests of sinus disease are transillumination (useful in adolescents if interpretation is confined to the extremes--normal or absent); radiographic findings of opacification, mucous membrane thickening, or an air-fluid level; and sinus aspiration (indicated for severe pain, clinical failures, or complicated disease) . When clinical signs and symptoms are accompanied by abnormal radiographic findings, bacteria in high colony count are recovered from the maxillary sinus aspirate in 70% of patients . The common bacterial species recovered from children with acute maxillary sinusitis are Streptococcus pneumoniae, Moraxella (Branhamella) catarrhalis, and Hemophilus influenzae.

Ann Otol Rhinol Laryngol, 1992 Jan, 101(1), 87 - 91
Effect of prior antibiotic treatment on middle ear disease in children; Faden H et al.; The effect of prior antibiotic treatment on the course of otitis media was assessed in a group of 62 children who experienced 83 episodes of ear infection during 3 years of observation . Bacterial quantitation in middle ear fluids demonstrated a significantly higher colony count in symptomatic children (3.9 x 10(4) +/- 12 bacteria per milliliter) compared to asymptomatic children (6.3 x 10(3) +/- 10 bacteria per milliliter; p = .05) . Bacterial counts similarly tended to be higher in children with Streptococcus pneumoniae (4.0 x 10(6) +/- 16 bacteria per milliliter) and Hemophilus influenzae (2.0 x 10(6) +/- 16 bacteria per milliliter), who were more often symptomatic (73% and 55%, respectively, versus 38%) than children with Moraxella catarrhalis (7.9 x 10(3) +/- 2) . Antibiotic therapy between 3 and 30 days prior to bacterial diagnosis was associated with a reduction in symptoms from 70% to 38% (p less than .025) . However, prior treatment did not statistically reduce bacterial colony counts, although S pneumoniae decreased 90% in the previously treated group . Resistance to ampicillin occurred in 0% of S pneumoniae, 39% of nontypeable H influenzae, and 80% of M catarrhalis subjects without prior treatment and in 0%, 46%, and 100%, respectively, of subjects previously treated (p less than .025) . These data suggest that prior treatment has a significant impact on the subsequent course of otitis media in children.

Arch Otolaryngol Head Neck Surg, 1992 Jan, 118(1), 53 - 7
Bacterial tympanogenic labyrinthitis, meningitis, and sensorineural damage; Schachern PA et al.; Pathologic changes (sensorineural hearing loss, labyrinthitis, meningitis) can follow otitis media . Various macromolecular substances demonstrably enter the inner ear via the round window membrane, but its permeability to bacteria is less known . We inoculated Streptococcus pneumoniae type 7F bilaterally into the middle ears of two groups of chinchillas, with and without grafted round window membranes . Inner ears of inoculated animals were observed by light and electron microscopy . None with continuous grafts had labyrinthitis . Bacteria penetrated all three layers of nongrafted round window membranes and into all cochlear turns, entering Schuknecht's channels and following neuronal pathways; nerves were often degenerated, hair cells were damaged or missing, and the stria vascularis was edematous and hemorrhagic . The neural damage suggests a mechanism for the hearing loss that can follow otitis media . Absence of labyrinthitis and meningitis in grafted animals suggests a tympanogenic pathway for the bacteria.

Arch Otolaryngol Head Neck Surg, 1992 Jan, 118(1), 49 - 52
Third-generation cephalosporins in the treatment of acute pneumococcal otitis media . An animal study; Rosenfeld RM et al.; There is concern that third-generation cephalosporins may not be effective in the treatment of acute otitis media due to Streptococcus pneumoniae . Using the chinchilla animal model, we compared two third-generation cephalosporins, cefixime (Suprax) and ceftibuten (investigational), with ampicillin and saline controls in an investigator-blinded, randomized trial . Whereas the saline controls performed worse than all other groups, no significant differences were detected among the three antibiotics regarding the time required to sterilize the middle ear cleft, or the prevalence of positive cultures after 10 days of therapy . The statistical power of the comparisons of cefixime and ceftibuten with ampicillin were 98% and 67%, respectively . The results of this in vivo animal study fail to support the contention that the two third-generation cephalosporins investigated are not effective in the treatment of pneumococcal acute otitis media . Caution is advised when extrapolating these results to the general clinical setting.

J Fr Ophtalmol, 1992, 15(2), 106 - 11
{Sterile corneal ulcers in dry eye . II . Treatment, complications and course}; Petroutsos G et al.; Over a period of 6 years, 23 patients (4 males and 19 females: mean age 56 years) who presented dry eyes developed 33 sterile corneal ulcers . Treatment included occlusion of the eyes or bandage soft contact lenses, prophylactic topical administration of antibiotics, punctal occlusions and currently available tear substitutes . Seventeen eyes healed completely without any corneal opacity and 10 eyes healed with opacity . Nine of the 33 eyes developed microbial keratitis . The causes of microbial keratitis were Staphylococcus aureus in 7 cases, beta-hemolytic Streptococcus in one and Pseudomonas aeruginosa in one case . The microbial keratitis was treated with intensive topical antibiotics . In 6 eyes, corneal perforation occurred . Rheumatoid arthritis coexisted in four cases.

Acta Otolaryngol Suppl, 1992, 492, 33 - 7
Cellular regeneration and recovery of the maxillary sinus mucosa . An experimental study in rabbits; Norlander T et al.; Unilateral maxillary sinusitis was induced in 30 New Zealand White rabbits with Streptococcus pneumoniae or Bacteroides fragilis . In another group of 15 rabbits without infection, the sinus mucosa was surgically removed in defined areas . In both series, the sinuses were serially sectioned for histological analysis of the cellular regenerative capacity . In maxillary sinusitis induced by Bacteroides fragilis, an inflammatory and also reparative process involving all mucosal layers including the underlying periosteum was seen . The more superficial trauma as found in pneumococcal sinusitis eventually led to restitution ad integrum . Following surgical removal, the denuded sinus-lining was reepithelized by a flattened ciliated epithelium on a lamina propria displaying fibrosis and lacking serous glands . The restoration of the rabbit maxillary sinus mucosa after surgical trauma thus leads to structural abnormalities of the epithelium as well as the lamina propria, and these changes are likely to interfere with the normal function of the sinus mucosa.

Ann Chir Gynaecol, 1992, 81(1), 25 - 7
Septic complications of endoscopic laser treatment of gastrointestinal diseases; Hiltunen KM et al.; This study was designated to establish the incidence of septic complications associated with Nd:YAG-laser treatment of varied gastrointestinal lesions . A total of 30 laser procedures were performed for 27 patients with both upper and lower gastrointestinal diseases . Thirty minutes after the completion of laser therapy, blood culture was obtained from each patient . Only one patient developed sepsis with fever, chills and positive blood culture, the organism isolated was Streptococcus mitis . All the other patients tolerated the treatment well and without signs of septic complications . According to this study, antibiotic prophylaxis is not necessary for gastrointestinal laser treatment . However, the conclusions must be cautious due to the small number of patients included in this study.

Vaccine, 1992, 10(7), 461 - 8
Intranasal immunization with bacterial polysaccharide containing liposomes enhances antigen-specific pulmonary secretory antibody response; Abraham E; Enhancement of bacterial antigen-specific secretory IgA (sIgA) titres in the lungs may enhance resistance to infections, such as pneumonia, occurring at this mucosal surface . To examine this issue, we intranasally administered liposomes containing bacterial polysaccharide antigens from Aerobacter levanicum, Pseudomonas aeruginosa and Streptococcus pneumoniae . In each case, increased titres of bacterial polysaccharide-specific sIgA could be achieved in the lungs following intranasal immunization with antigen encapsulated in liposomes . In comparison with oral immunization, which required high doses of polysaccharide antigen even when coadministered with adjuvant, intranasal administration of liposomes containing polysaccharide antigens achieved a similar pulmonary sIgA response with approximately 1/30 the amount of antigen necessary with oral immunization . In the case of P . aeruginosa, the magnitude of the sIgA response following intranasal immunization was sufficient to significantly reduce mortality from pneumonia produced by this organism . These results demonstrate that liposome-based mucosal immunization strategies can induce increased bacterial polysaccharide antigen-specific sIgA titres in the lung, and reduce susceptibility to pneumonia.

Rev Mal Respir, 1992, 9 Suppl 1, R39 - 43
{Changes in the sensitivity of pneumococci to antibiotics . Therapeutic consequences}; Geslin P et al.; Streptococcus pneumoniae has a prominent role in infectious bronchopulmonary diseases . This organism is normally sensitive to a vast number of antibiotics . However, in recent years, acquired resistance against tetracyclines, macrolides, and, more recently, penicillins, has emerged . Since 1987, there is indeed a regular increase in the frequency of strains that have a lower sensitivity to penicillin G (less than 1% before 1986; 12% in 1990) . However, this percentage of strains with a lower sensitivity is much more important among non-invasive as opposed to invasive organisms that are isolated from blood, pleural and spinal fluid cultures (3.3% in 1990) . Among strains with abnormal sensitivity to penicillin G, there are very selective serotypes or serogroups: 4 types or groups (23, 19, 6 and 14) represent 80% of these strains . More than 80% of the strains of MIC greater than 2 mg/l are among only one stereotype, 23F . This abnormal sensitivity to penicillin G implies a modification of sensitivity to all beta-lactams, but MIC increase to a variable extent depending on the antiinfectious agent . The most efficient agents against strains of lower sensitivity are amoxicillin, imipenem and parenteral third generation cephalosporins . On the other hand, for all oral first, second and third generation cephalosporins, MIC increase to levels for which seric levels that are reached hardly demonstrate convincing efficiency . Even if resistance levels are less marked as shown by strains isolated from pulmonary infections as compared to what is seen in ENT, the trend in the development of abnormal sensitivity of pneumococci to beta-lactam agents urges the clinician to take into account these data in the therapeutic coverage of bronchopulmonary infections.

Immunogenetics, 1992, 36(1), 28 - 32
Genetic control of streptococcus-induced hepatic granulomatous lesions in mice; Chen CY et al.; Hepatic granulomatous lesions were induced in mice by a single intraperitoneal injection of 3 mg of disrupted Streptococcus pyogenes cell-wall material . Mice carrying the H-2b or H-2k haplotypes were highly susceptible to the induction and three weeks after the injection produced numerous granulomas . In contrast, mice of the H-2d haplotype were resistant and produced only a few hepatic granulomas . Resistance was inherited as a dominant trait and in the backcross generation segregated together with the H-2d phenotype . Testing of the H-2-recombinant mice indicated that the putative gene(s) determining resistance/susceptibility is located to the right of the S and to the left of the D region . This location corresponds to the recently described gene cluster consisting of tumor necrosis factor (TNF) and lymphotoxin genes and several BAT sequences . The known effect of TNF on granuloma formation in mice is consistent with a possible effect of TNF genes, and their variants, on S . pyogenes-inducibility of hepatic granulomas in mice.

Perit Dial Int, 1992, 12(2), 214 - 5
Streptococcus peritonitis with urticaria; Edward A et al.; Peritonitis following urticaria on two occasions in a 46-year-old white female treated with CAPD for nine years is reported . On both occasions an episode of urticaria and pruritus occurred 24 hr before the dialysate became cloudy, and the patient experienced abdominal pain, nausea, and vomiting . The culture of the peritoneal dialysis effluent grew gamma Streptococcus with the first episode . To our knowledge this is the first report of CAPD peritonitis preceded by urticaria where the skin findings were most likely related to the peritoneal infection.

Int Arch Allergy Immunol, 1992, 97(2), 173 - 7
Oral immunization with polyvalent bacterial lysate and infection with Streptococcus pneumoniae: influence on interferon-gamma and PMN elastase concentrations in murine bronchoalveolar lavage fluid; van Daal GJ et al.; We recently demonstrated that oral immunization with a polyvalent bacterial lysate (Paspat oral) significantly reduces mortality rates in mice, infected with Streptococcus pneumoniae or influenza A virus . In this study it is demonstrated that oral immunization with the same bacterial lysate reduces the intrapulmonary inflammatory reaction to infection with S . pneumoniae, assessed by measurement of PMN elastase in bronchoalveolar lavage fluid . Furthermore, it is demonstrated that oral immunization with Paspat oral increases intrapulmonary IFN-gamma concentrations.

Intensive Care Med, 1992, 18(1), 56 - 8
Meningoencephalitis due to penicillin-resistant Streptococcus pneumoniae; Vassal T et al.; The case of a 68-year-old man suffering from pneumococcal meningoencephalitis is reported . Antibacterial susceptibility tests revealed a multiply resistant pneumococcal strain . High doses of cefotaxime were necessary to sterilize the cerebrospinal fluid despite the achievement of a satisfactory level of antibiotic in the cerebrospinal fluid with moderate dosage . In France, as well as in many countries, high doses of third-generation cephalosporins such as cefotaxime or ceftriaxone should be administered for the initial therapy of suspected pneumococcal meningitis.

Clin Infect Dis, 1992 Jan, 14(1), 251 - 62
Mechanisms of host defense against infection with Streptococcus pneumoniae; Bruyn GA et al.; Various aspects of the host's response to infection by Streptococcus pneumoniae are reviewed . First, the structure of the bacterium is described, with a focus on those elements that are related to its immunogenicity and pathogenicity . The epidemiology of the pneumococcal serotypes, which are differentiated by the molecular structure of the capsule, is considered briefly, and several key points are emphasized--for example, that some pneumococcal types are more pathogenic than others; that variations in biological behavior are based on differences in the chemical composition of the capsule, although the particular factors determining virulence are not known; and that cell wall peptidoglycan, a structure common to all pneumococci, plays an important role in the inflammatory reaction in the tissues . Next, current views on the pathogenesis of pneumococcal infections are discussed . Finally, the roles of type-specific antibodies to the capsular polysaccharide and of complement in the opsonization of pneumococci and the clearance of these bacteria from the bloodstream by the spleen and liver are reviewed.

Clin Infect Dis, 1992 Jan, 14(1), 247 - 50
Cellulitis due to Streptococcus pneumoniae: case report and review; Lawlor MT et al.; Although Streptococcus pneumoniae remains the most common cause of community-acquired bacterial pneumonia, its involvement in skin infection is notably infrequent . A review of the literature uncovered only 13 cases of pneumococcal cellulitis in adults . Distinguishing features of skin infection by S . pneumoniae included the presence of bullae, brawny erythema, and a violaceous hue in the affected skin area . Most patients with pneumococcal cellulitis had chronic illnesses or were immunocompromised because of drug or alcohol abuse . Even with appropriate antimicrobial therapy, many patients required prolonged hospitalizations and surgery for cure . We report a case of primary pneumococcal cellulitis with secondary bacteremia in an alcoholic patient who required extensive surgical therapy and whose course was additionally complicated by acute glomerulonephritis.

Clin Infect Dis, 1992 Jan, 14(1), 2 - 11
Invasive group A streptococcus infections; Stevens DL; The late 1980s have witnessed the emergence of severe group A streptococcus (GAS) infection; shock, bacteremia, and acute respiratory distress syndrome are common features, and death has been associated with this infection in 30% of patients . Such infections have now been described in all parts of the United States, Europe, and Australia and have occurred predominantly in otherwise healthy adolescents and adults . The characteristic clinical and laboratory features of the streptococcal toxic shock syndrome include deep-seated infection associated with shock and multiorgan failure . Strains of GAS isolated from patients with invasive disease have been predominantly M types 1 and 3, which produce pyrogenic exotoxin A or B or both . In this report, the clinical and demographic features of streptococcal bacteremia, myositis, and necrotizing fasciitis will be presented and compared with those of streptococcal toxic shock syndrome . Current concepts of the pathogenesis of invasive streptococcal infection will also be presented in terms of the interaction between virulence factors of GAS and host defense mechanisms . Finally, new concepts for future treatment of serious streptococcal infections will be proposed.

Clin Infect Dis, 1992 Jan, 14(1), 192 - 9
Unusual manifestations of pneumococcal infection in human immunodeficiency virus-infected individuals: the past revisited; Rodriguez Barradas MC et al.; Although AIDS was largely recognized and defined because of the increased presence of diseases that reflect deficiencies in cell-mediated immunity, susceptibility to common extracellular bacterial pathogens has also been shown to be increased . To our knowledge, adults with concurrent infection due to human immunodeficiency virus (HIV) and Streptococcus pneumoniae whose cases have been described to date have all had pneumococcal pneumonia and/or bacteremia . We describe five cases of HIV-infected patients who had unusual manifestations of pneumococcal infection, which include recurrent exudative pleural effusion, pyopneumothorax, purpura fulminans, mediastinitis with chest wall abscess, and multiple brain abscesses . Such complications of pneumococcal infection occurred more or less commonly in the preantibiotic era, but on the basis of our experience and an exhaustive literature search, these complications have been exceedingly rare in the past few decades . In four of our five patients, the unusual, complicated pneumococcal disease preceded and prompted a search for HIV infection . Because concurrent HIV infection increases the susceptibility to pneumococcal disease, other such cases are likely to be seen.

Res Exp Med (Berl), 1992, 192(1), 41 - 7
Intracranial pressure and cerebral perfusion pressure in experimental streptococcus pneumoniae meningitis; Goitein KJ et al.; Clinical studies have demonstrated the prognostic importance of increased intracranial pressure in central nervous system infections . To delineate development of intracranial pressure in meningitis experiments were carried out in rabbits . Meningitis was induced by injecting streptococcus pneumoniae bacteria into the cisterna magna and blood, and intracranial pressures were continuously recorded . In the experimental model, three stages were seen: incubation period (0-8 h)--in which CSF becomes positive for the infecting organism and biochemical changes occur, but there are no hemodynamic or intracranial pressure changes; stage of slowly increasing intracranial pressure - because blood pressure remains normal, cerebral perfusion pressure is maintained adequate for cerebral metabolic need (9-24 h); terminal stage (greater than 25 h)--with hemodynamic collapse, critical reduction of cerebral perfusion pressure, cerebral ischemia, and death of the experimental animals . It is suggested that a similar sequence occurs in human disease . The clinical implication stresses the need for early recognition and treatment of intracranial hypertension as an important adjunct to antibiotic treatment of the infecting organism.

J Gen Microbiol, 1992 Jan, 138 ( Pt 1), 77 - 84
Calcium regulation of growth and differentiation in Streptococcus pneumoniae; Trombe MC et al.; Streptococcus pneumoniae requires 0.15 mM-Ca2+ in the medium for optimal growth . Increasing the Ca2+ concentration to 1 mM triggers either a differentiative state, competence for genetic transformation during exponential growth, or partial lysis as soon as the cultures enter stationary phase . Genetic and physiological data both suggest that these responses are under the control of activator(s), excreted in the presence of high Ca2+ concentrations . 45Ca2+ transport is also stimulated by the activator(s) . The amiloride derivative 2',4'-dimethylbenzamil (DMB) inhibits 45Ca2+ transport and prevents lysis and competence development . This provides evidence in favour of the involvement of Ca2+ transport in competence and culture lysis . On the other hand, addition of DNA to a competent culture prevents lysis of wild-type bacteria while a mutant, defective for DNA uptake, is not protected from lysis by exogenous DNA . An hypothesis is proposed for competence induction as a global metabolic response to Ca2+, under the control of competence factor.

J Vet Diagn Invest, 1992 Jan, 4(1), 28 - 30
An investigation of bacterial causes of arthritis in slaughter hogs; Hariharan H et al.; Joints from 153 arthritic and 80 normal slaughter hogs were examined by culture for presence of bacteria . Although none of the normal joints yielded bacteria, 37% of the disease joints were positive for bacterial growth . Of 67 bacterial isolates obtained, 45% were Erysipelothrix rhusiopathiae . Occurrence of other bacteria in order of their frequency was Streptococcus suis (16%), Actinomyces pyogenes (10%), Mycoplasma spp . including 3 M . hyorhinis isolates (7%), staphylococci (7%), Streptococcus spp . (6%), and organisms of uncertain significance (7%).

Pharmacotherapy, 1992, 12(1), 23 - 7
Toxic shock-like syndrome; Erstad BL et al.; Invasive group A streptococcal infection has important diagnostic and therapeutic implications in patients with necrotizing fasciitis . We cared for a man with the full-blown syndrome in whom many features of toxic shock syndrome were present, including profound hypotension and renal failure . The diagnostic similarities of toxic shock syndrome and the toxic shock-like syndrome caused by group A Streptococcus could have led to inappropriate treatment . Successful therapy in our patient included high doses initially of broad-spectrum antibiotics, repeated operative debridement of the lower leg (the affected limb), and ultimately, reconstructive surgery consisting primarily of split-thickness skin grafts . The reemergence of invasive streptococcal infections may relate to changes either in virulence factors of the causative streptococcus or in exotoxins elaborated by this microorganism . A causative relationship between an exotoxin produced by group A Streptococcus and the toxic shock-like syndrome has not yet been established.

J Surg Res, 1992 Jan, 52(1), 79 - 84
Establishment of animal liver metastatic model for C-1300 murine neuroblastoma and immunotherapy for it using OK-432, streptococcus preparation; Naito H et al.; Intrasplenic administration of 1 x 10(6) C-1300 murine neuroblastoma cells induced spleen tumor in 78.6% of mice and liver metastasis in 64.3% . When mice were pretreated with carrageenan, an antimacrophage agent, the incidence of spleen and liver tumors in this system was lower, possibly due to the rebound increase in macrophage activity following the disappearance of the carrageenan effect . Continuous daily intraabdominal injection of 1 KE of OK-432 streptococcus preparation markedly reduced the appearance of liver metastasis (P less than 0.01), whereas the spleen mass was not reduced to such an extent . However, the survival rate of the OK-432-treated group did not differ greatly from that of the nontreated group . These results demonstrate the usefulness of the model of liver metastasis induced by intrasplenic administration of tumor cells and the effectiveness of OK-432 against liver metastasis formation.

Biotherapy, 1992, 4(1), 53 - 63
Polyclonal activation of human lymphocytes and induction of cytotoxic lymphocytes by streptococcal preparations; Sato T et al.; Polyclonal activation of human peripheral blood lymphocytes (PBLs) in vitro by preparations of Streptococcus pyogenes Su strain (OK-432) and other heat-killed strains was investigated . The streptococcal preparations tested induce a proliferative response of PBLs via interleukin-2 (IL-2)-independent pathways . The proliferative response is accompanied by the generation of lymphoblastic cells (LBCs), which consist of heterologous lymphocyte populations: CD4+ helper type of T cells, and CD4-CD8- double-negative (DN) lymphocytes, including both CD3+ TcR gamma + T cells and CD2+CD3- immature type of T or non-T cell type of lymphocytes . Almost all the LBCs express Leu19, TfR (transferrin receptor), LFA-1 and CD38 (OKT10) antigens, which are expressed on activated T cells, NK cells and some other lymphocytes . The proliferative response of human PBLs is also accompanied by the generation of potent cytotoxic activity against NK-sensitive and -resistant targets . C-dependent cytolysis and cell sorting experiments of OK-432-activated LBCs revealed that both CD3+ and CD3- types of CD4-CD8- DN lymphocytes, but not CD4+ helper T cells, may be major populations responsible for the cytotoxicity induced . On the other hand, CD4-CD8- T cells may be required for the proliferation of PBLs and generation of cytotoxic effector cells . These results suggest that the OK-432 and other streptococcal preparations stimulate the human PBLs in vitro to induce the proliferation/activation of CD4+ T cells, mediating the following generation of DN cytotoxic effector lymphocytes.

Appl Environ Microbiol, 1992 Jan, 58(1), 48 - 54
Interaction of ruminal bacteria in the production and utilization of maltooligosaccharides from starch; Cotta MA; The degradation and utilization of starch by three amylolytic and one nonamylolytic species of ruminal bacteria were studied . Pure cultures of Streptococcus bovis JB1, Butyrivibrio fibrisolvens 49, and Bacteroides ruminicola D31d rapidly hydrolyzed starch and maltooligosaccharides accumulated . The major starch hydrolytic products detected in S . bovis cultures were glucose, maltose, maltotriose, and maltotetraose . In addition to these oligosaccharides, B . fibrisolvens cultures produced maltopentaose . The products of starch hydrolysis by B . ruminicola were even more complex, yielding glucose through maltotetraose, maltohexaose, and maltoheptaose but little maltopentaose . Selenomonas ruminantium HD4 grew poorly on starch, digested only a small portion of the available substrate, and generated no detectable oligosaccharides as a result of cultivation in starch containing medium . S . ruminantium was able to grow on a mixture of maltooligosaccharides and utilize those of lower degree (less than 10) of polymerization . A coculture system containing S . ruminantium as a dextrin-utilizing species and each of the three amylolytic bacteria was developed to test whether the products of starch hydrolysis were available for crossfeeding to another ruminal bacterium . Cocultures of S . ruminantium and S . bovis contained large numbers of S . bovis but relatively few S . ruminantium and exhibited little change in the pattern of maltooligosaccharides observed for pure cultures of S . bovis . In contrast, S . ruminantium was able to compete with B . fibrisolvens and B . ruminicola for these growth substrates . When grown with B . fibrisolvens, S . ruminantium grew to high numbers and maltooligosaccharides accumulated to a much lesser degree than in cultures of B . fibrisolvens alone . S . ruminantium-B . ruminicola cultures contained large numbers of both species, and maltooligosaccharides never accumulated in these cocultures.(ABSTRACT TRUNCATED AT 250 WORDS)

J Appl Physiol, 1992 Jan, 72(1), 272 - 7
Group B Streptococcus-induced acidosis in newborn swine: regional oxygen transport and lactate flux; Barefield ES et al.; To investigate the mechanism of metabolic acidosis resulting from group B streptococcal sepsis, oxygen metabolism and lactate flux of the cerebrum, hindlimb, liver, splanchnic organs, and systemic vascular bed as a whole were examined . Nine 3- to 5-day-old awake and spontaneously breathing piglets were studied before and after 3, 4, and 5 h of continuous live group B Streptococcus infusion . After 5 h, oxygen delivery was decreased to all organs and to the whole systemic vascular bed . Increased oxygen extraction compensated for reduced oxygen delivery in the liver and splanchnic organs; however, it only partially offset reduced oxygen delivery to the hindlimb and systemic vascular bed . Cerebral oxygen extraction did not increase . As a result, oxygen uptake was reduced in the cerebrum, hindlimb, and systemic vascular bed . At 5 h of bacterial infusion, arterial lactate concentration was increased with regional lactate efflux from the cerebrum and hindlimb and influx to the liver (P less than 0.05 vs . zero or no net flux) . We conclude that group B Streptococcus-induced metabolic acidosis is associated with regional lactate efflux from vascular beds in which oxygen uptake is reduced . We speculate that the quantity of net lactate efflux from vascular beds with insufficient oxygen uptake exceeds the net influx into organs such as the liver, resulting in metabolic acidosis.

Vet Microbiol, 1992 Jan, 30(1), 59 - 71
Production and characterization of two Streptococcus suis capsular type 2 mutants; Gottschalk M et al.; Two avirulent mutants of Streptococcus suis capsular type 2 (M2 and M42) were produced from a highly virulent strain . Mutant M2, obtained after serial subcultures of the parent strain in the presence of rabbit anti-capsular type 2 serum, no longer possessed the type-specific capsular antigen, as demonstrated by serotyping methods and immunoelectron microscopy . The Lancefield group D antigen could not be detected on the cell surface of this mutant using the immunogold labelling technique . SDS-PAGE of lysozyme treated cells demonstrated that a 44 kDa protein which was present in the parent strain, was absent in mutant M2 . Immunoblotting using rabbit whole cell homologous anti-serum revealed that the protein was strongly immunogenic . Mutant M2 was totally avirulent in mice, and the homologous antiserum completely failed to protect mice against challenge with the parent strain . However, mutant M42, obtained after passages of the parent strain at 42 degrees C, remained capsulated but lacked the same 44 kDa protein as mutant M2 . The quantity of sialic acid present in the capsule was similar to that of the parent strain . Despite the presence of antibodies against the capsule, antiserum prepared against M42 only partially protected mice against a challenge with the parent strain . The 44 kDa cell wall protein could act as a virulence factor as well as an important immunogen of S . suis capsular type 2.

Microbiol Immunol, 1992, 36(6), 643 - 7
Characterization of an exo-beta-D-fructosidase from Streptococcus mutans Ingbritt; Igarashi T et al.; An extracellular enzyme beta-D-fructosidase was purified from the culture supernatant of Streptococcus mutans Ingbritt and characterized . The molecular weight of the enzyme was 127,000 as determined by SDS-polyacrylamide gel electrophoresis . The enzyme was specific for levan which mainly consists of beta-(2,6)-linked D-fructose and was also able to hydrolyze inulin, sucrose and raffinose at the activities of 13, 9 and 5% of that hydrolyzing levan, respectively . The pH optima for levan, inulin and sucrose were approximately 5.5, 6.0 and 5.0, respectively . The enzyme was optimally reactive at 55 C for levan . The enzyme was inhibited by Fe3+, Hg2+ and Zn2+ and not by either anionic or non-ionic detergents . Paper chromatographic analysis revealed that the enzyme attacked levan by an exo-type mechanism.

Caries Res, 1992, 26(2), 98 - 103
Limitations in the intraoral demineralization of bovine enamel; Kashket S et al.; A model system was used to examine the relation between the duration of plaque pH fall and enamel demineralization following the intake of dietary carbohydrate in humans . Subjects wore palatal appliances containing blocks of bovine enamel covered with Streptococcus mutans IB 1600, and rinsed with 5 or 10% sucrose . Changes in iodide penetrability (delta Ip) of the enamel, and the pH and extracellular calcium and inorganic phosphate (Pi) concentrations of the streptococcal plaque were determined . Following rinses with 5% sucrose, delta Ip increased with time and reached a maximum (11.2 +/- 2.2 units) at 45-60 min although the S . mutans plaque remained acidic (pH = 4.8 +/- 0.6) . After 10% sucrose, the maximum (14.7 +/- 3.1 units) was reached while the plaque pH was 4.0 +/- 0.3 . Second rinses with sucrose increased delta Ip at most by 30% . Thus, demineralization did not persist throughout the period of low plaque pH, but occurred primarily during the early phase of plaque acidogenesis . Enamel demineralization appeared to be limited by factors other than the pH of the streptococcal plaque . Calcium concentrations in the S . mutans plaque rose to a maximum of 10.9 +/- 2.8 mEq/l at 30 min after the 5% sucrose rinses, then fell; Pi reached a stable level of 12.2 +/- 2.3 mEq/l by 60 min . Calculations showed that conditions approached saturation with respect to enamel and dicalcium phosphate dihydrate as demineralization reached a maximum . Demineralization appeared to be limited at low plaque pH, therefore, by the accumulation of high levels of mineral ions in the streptococcal plaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Caries Res, 1992, 26(2), 110 - 6
Purification, characterization and inhibition by fluoride of enolase from Streptococcus mutans DSM 320523; Kaufmann M et al.; Enolase from Streptococcus mutans has been purified to homogeneity by a three-step procedure . As shown by analytical ultracentrifugation and polyacrylamide gel electrophoresis under denaturing conditions, the purified enzyme is an octamer with molecular weight Mr = 360 kDa, composed of eight identical subunits with Mr = 45 kDa . The kinetic parameters of S . mutans enolase in the presence of 1 mM Mg2+ are Aspec = 130 IU x mg-1 and KM = 0.44 mM as determined by steady-state experiments in the D-glycerate 2-phosphate to enolpyruvate phosphate reaction . Enzymatic activity is inhibited noncompetitively by fluoride in the range between 0 and 10 mM NaF yielding Ki = Kii = 1.39 mM, but inhibition characteristics become competitive when tested above 10 mM . In the presence of only small amounts of phosphate (0.5 mM) the inhibitory effect of fluoride is enhanced dramatically yielding Ki = 0.26 mM . Inhibition by NaPO3F is competitive with Ki = 0.9 mM, indicating that free fluoride ions in combination with phosphate are more effective in inhibiting S . mutans enolase . It can be concluded that inhibition of enolase by fluoride in combination with phosphate can influence glycolysis in S . mutans and so reduce acid production or even growth rate, thereby leading to potential anticariogenic effects.

Proc Finn Dent Soc, 1992, 88 Suppl 1, 313 - 20
Odontoblast-mediated regulation of the progression of dentinal caries; Larmas M et al.; Osteoblasts and odontoblasts are both derived from the same mesenchymal cell line . Our aim was to investigate whether the processes of bone destruction and dentinal caries are biologically similar . The working hypothesis was that after the initiation of caries in the enamel, its rate of progression in the dentine is regulated by cell-mediated factors . Experimental caries was induced in the rat with a high sucrose diet combined with Streptococcus sobrinus infection . Both destruction of dentine and its apposition in the pulp under the carious lesions were measured after vital staining with tetracycline . Caries progression and dentine apposition were higher in developing teeth prior to apex "closure" than in adult, fully-formed teeth . Rats placed on a cariogenic diet during tooth development had an increased rate of caries progression . Fluoride administration via the drinking water was associated with decreased dentine apposition and little progression of dentine caries during the developmental stages . Dentine apposition was enhanced in adult rats placed on fluoride administration, while caries progression was reduced, whereas in animals subjected to metabolic acidosis dentine caries progression was enhanced, with reduced dentine apposition . In contrast, alkalotic animals had less dentinal lesions and smaller ones than the controls . Three theories are advanced to explain the observed changes: (i) They may be associated with changes in alkaline phosphatase activity in the pulpo-dentinal complex, (ii) they may be mediated by ionic changes in the dentinal fluid, or (iii) they may reflect the liberation of growth factors from dentinal matrix.

Enferm Infecc Microbiol Clin, 1992 Jan, 10(1), 11 - 6
{Pneumonia caused by non-opportunistic bacteria in patients infected with HIV . Incidence and evaluation of a non-invasive approach}; Teira R et al.; BACKGROUND: Pneumonia due to pathogenic bacteria is common in HIV infected patients . However, a global overview has not been yet performed and also the effectiveness of a non-invasive approach has not been tested . PATIENTS AND METHODS: An open study was conducted in 1989 including all HIV infected patients with a presumptive or definite diagnosis of bacterial pneumonia . Fiberoptic bronchoscopy procedures were used only in patients with a difficult diagnosis and/or problems in their clinical evolution . Clinical and biological data were compared among different etiologic groups, and their evolution was also recorded in relation with the use of non-invasive procedures . RESULTS: Among a total of 302 admissions of HIV infected patients, 113 developed a primary or secondary respiratory tract infection . Forty-three of those were bacterial pneumonia episodes . Etiologic diagnosis was achieved with non invasive methods in 18 cases (42%) . Blood cultures were the most effective method used . Streptococcus pneumoniae was the most frequently identified microorganisms (9 cases, 21%) . The identification of other bacteria was linked with more severe forms of disease regarding immunologic (leukopenia, p less than 0.001; T4 lymphopenia, p less than 0.05), and respiratory parameters (hypoxemia, p less than 0.05) . Two deaths were directly related with pneumonia of known etiology . CONCLUSIONS: Bacterial pneumonia is the most frequent respiratory infection in HIV infected patients . An initial non-invasive approach yields a reasonable percentage of etiologic diagnosis and is not related with a poorer outcome.

Vet Res Commun, 1992, 16(2), 87 - 96
Adherence and colonization by bacterial pathogens in explant cultures of bovine mammary tissue; Thomas LH et al.; Explant cultures of bovine mammary tissue taken from virgin heifers were used to examine adherence, colonization and cytopathogenesis of Streptococcus uberis, Streptococcus agalactiae, Streptococcus dysgalactiae, Staphylococcus aureus and Escherichia coli in the putative target tissue . None of the five bacteria was able to adhere to healthy ductular epithelium but all showed a marked tropism for exposed connective tissue . S . aureus and E . coli induced a marked cytopathic effect in ductular epithelium after 6 hours in culture but the bacteria were not in close association with the affected tissue . No evidence could be found to support the hypothesis that adherence to epithelium might be the first stage in the pathogenesis of mastitis caused by these organisms.

Lasers Surg Med, 1992, 12(4), 450 - 8
Dye-mediated bactericidal effect of He-Ne laser irradiation on oral microorganisms; Okamoto H et al.; Little attention has been given to the bactericidal effect of laser irradiation, particularly using low-power energy lasers . It has been demonstrated that He-Ne laser light has an inhibitory action on dental plaque . The purpose of this study was to investigate the bactericidal effect of He-Ne laser irradiation on cariogenic microorganisms . The bactericidal effect was determined by the formation of a growth-inhibitory zone or by the counting of viable bacterial colonies . Streptococcus sobrinus AHT that is a Gram-positive microorganism was sensitive to He-Ne laser light, but Escherichia coli, a Gram-negative microorganism, was resistant . The effect of several dyes necessary to instigate a bactericidal action was also examined . A growth-inhibitory zone was observed using 10 kinds of blue, purple, or green dyes, which were mainly phenylmethane dyes . The leakage of potassium from S . sobrinus AHT following laser irradiation was determined using an atomic absorption spectrophotometer . The leakage began to increase following irradiation for 2 min, and reached a plateau following irradiation for 30-60 min . Moreover, to examine some changes in the dye itself following laser irradiation in the absence of bacteria, ultraviolet-visible absorption spectra and 1H NMR spectra were recorded . In this study, it was indicated that the bactericidal effect on cariogenic bacteria by He-Ne laser irradiation was efficient only in the presence of specific dyes . It is suggested that this laser may be suitable for clinical applications in preventive dentistry.

Eur Arch Otorhinolaryngol, 1992, 249(7), 374 - 9
Pneumococcal antigens and serum antibody responses in experimentally induced sinusitis; Westrin KM et al.; Maxillary sinusitis was induced in New Zealand White rabbits with Streptococcus pneumoniae serotype 3 and the serum antibody response was recorded by enzyme immunoassay . Activity of the three major immunoglobulin classes, viz . IgG, IgA and IgM, against the type-specific capsular polysaccharide, the cell wall C-polysaccharide as well as its subunit phosphorylcholine was analyzed . A pronounced increase in immunoglobulins reactive to the specific capsular antigen was observed throughout the study period, with the rise being particularly noticeable during the first 2 weeks . An increase in anti-C-polysaccharide antibodies was also evident, but no reaction to phosphorylcholine could be detected . Although the histological findings at 3 and 4 weeks varied in spite of similar serum antibody responses, a correlation appeared to exist between a more rapidly increasing anti-capsular IgG production and the prevalence of a purulent sinus secretion.

Zh Mikrobiol Epidemiol Immunobiol, 1992, (9-10), 26 - 9
{The virulence of Streptococcus pneumoniae strains--the causative agents of pneumococcal infection at different sites}; Vishniakova LA et al.; A total of 256 S . pneumoniae strains, the causative agents of infectious processes with different localization, were studied for their virulence (in experiments on mice), neuraminidase and aldolase-protease activity (APA) . In pneumococcal strains isolated 18-20 hours after intraperitoneal infection their virulence for mice increased, on the average, 1,000-fold and the average level of extracellular and cellular neuraminidase and APA increased 2- to 5-fold in comparison with the initial values . Pneumococcal strains causing acute pneumococcal infections with different localization, or the aggravation of such infections, exhibited higher virulence for mice and higher levels of neuraminidase and APA, while the inflammatory process at the period of clinical remissions was mainly maintained by S . pneumoniae cultures with low virulence.

Microbios, 1992, 72(290), 35 - 45
Extracellular dextranase from Streptococcus oralis; Johnson IH; A human dental plaque organism, Streptococcus oralis (S . mitior), was cultivated in a dextran-free, dialysed medium, and dextranase activity was isolated from the cell-free, culture supernatant . The lyophilized, crude enzyme preparation, optimum pH 6, was subjected sequentially to anion exchange and gel filtration fast protein liquid chromatography (FPLC) . The dextranolytic fraction from gel filtration FPLC produced a symmetrical, baseline resolved peak . The dextranolytic enzyme was purified 1,126-fold with a yield of 2.4% . Amino acid analysis revealed a large proportion of alanine and an abundance of acidic amino acids . This extracellular enzyme isolated from S . oralis is constitutive and has a relative molecular mass of 45 kD . Further investigation of the possible structural and biochemical effects of endogenous bacterial glucanases in human dental plaques is necessary.

Caries Res, 1992, 26(5), 402 - 7
Models for coronal caries and root fragments in an elderly population; Drake CW et al.; A random sample of 809 dentate, home-dwelling people 65 years of age or older participated in a study to determine the prevalence of dental diseases in the elderly . Part of the study investigated the determinants of coronal caries and root fragments in these older adults . Using a wide array of potentially explanatory variables available, logistic regression models were developed to identify relationships between these variables and coronal caries and root fragments . The variables with the most explanatory power in the coronal caries model were the presence of decayed root surfaces, lower salivary flow rate, lack of regular dental care and an interaction variable including race and a perception of financial well-being . When a subsequent model was created that did not include decayed root surfaces or root fragments as potential explanatory variables, an additional variable relating to self-perception of mouth appearance emerged . The strongest variables in the model for root fragments were episodic (vs . regular) dental visits, presence of root caries, lack of replacement for lost teeth, high levels of Streptococcus mutans and number of teeth present in the mouth.

Caries Res, 1992, 26(5), 363 - 6
Evaluation of the cariogenic potential of the intense natural sweeteners stevioside and rebaudioside A; Das S et al.; Stevioside and rebaudioside A, two intense natural sweeteners, that are constituents of the South American plant Stevia rebaudiana, were tested for cariogenicity in albino Sprague-Dawley rats . Sixty rat pups colonized with Streptococcus sobrinus were divided into four groups and fed stevioside, rebaudioside A or sucrose added to basal diet 2000 as follows: group 1, 30% sucrose; group 2, 0.5% stevioside; group 3, 0.5% rebaudioside A, and group 4, no addition . All four groups were sacrificed after 5 weeks . S . sobrinus counts were made and caries was evaluated according to Keyes' technique . There were no differences in food and water intake and weight gains between the four groups . There were significant differences in sulcal caries scores (p < 0.02) and S . sobrinus counts (p < 0.05) between group 1 and the other three groups . There were no significant differences between the stevioside, rebaudioside A and no-addition groups . It was concluded that neither stevioside nor rebaudioside A is cariogenic under the conditions of this study.

Scand J Infect Dis, 1992, 24(5), 647 - 55
Pneumonia--a clinical or radiographic diagnosis? Etiology and clinical features of lower respiratory tract infection in adults in general practice; Melbye H et al.; Etiology and clinical manifestations have been studied in 153 adult patients with lower respiratory tract infection, and the results are presented according to clinical and radiographic diagnosis . Laboratory investigations revealed that bacterial infection, mycoplasma and chlamydia included, occurred as often in 22 patients whose clinical diagnoses of pneumonia were not evident radiographically, as in 20 patients with radiographic pneumonia . In the latter group significantly higher values of erythrocyte sedimentation rate and C-reactive protein were demonstrated . The most common pathogen was influenzavirus A, followed by respiratory syncytial virus, Streptococcus pneumoniae, and Mycoplasma pneumoniae . Chlamydia pneumoniae infection was found in 3 patients with radiographic pneumonia . The study supports the traditional view that patients with a positive chest radiograph as a rule present more serious manifestations of lower respiratory tract pathology than patients with a normal radiograph . However, as only 1/9 patients with pneumococcal infection and 2/7 with mycoplasmal infection had radiographic evidence of pneumonia, radiography alone did not seem to offer sufficient information for selecting patients for antibacterial therapy.

Neurol Croat, 1992, 41(3), 131 - 9
Pneumococcal meningitis in the elderly; Barsic B et al.; The authors reviewed 70 cases of Streptococcus pneumoniae meningitis occurring over a 5-years period (1985-1989) . Clinical features, outcome and laboratory findings in elderly patients (> 60 years of age, 21 patients) were compared with those in younger patients (< 59 years of age, 49 patients) . Mortality rate was 57% in elderly group vs . 20% in younger . Admission to the hospital was delayed in the elderly . Only 67.6% of them were admitted on the first two days of the illness vs . 81.6% of younger patients . Nearly 62% of them were deeply soporous or comatose on admission (Mathew-Lawson grade 3 and 4), while in the control group only 31% of patients had such severely altered mental status . Although glucose cerebrospinal fluid (CSF)/blood ratio tended to be lower in the elderly (0.09 vs 0.17) the difference did not reach statistical significance . Thrombocytes in the peripheral blood were lower in the elderly (113 x 10(9)/L vs . 148 x 10(9)/L, p < 0.05) . When we compared laboratory findings in survivors and nonsurvivors from both groups, nonsurvivors had significantly lower glucose CSF/blood ratio (0.054 vs . 0.174, p = 0.008), and higher bilirubin levels in serum (27.9 vs 14.7, p = 0.003), but differences were more obvious in younger group of patients . Our results suggest that there is increased risk of death among elderly patients . It can be at least partially attributed to their later admittance to the hospital and because of that delayed start of the appropriate therapy and more severe conscious disturbances . All these factors contribute to the greater case-fatality ratio observed in elderly patients with pneumococcal meningitis.

Microbiol Immunol, 1992, 36(9), 969 - 76
Characterization of the dextranase purified from Streptococcus mutans Ingbritt; Igarashi T et al.; We purified dextranase from the culture supernatant of Streptococcus mutans Ingbritt by procedures including ammonium sulfate precipitation, ion-exchange chromatography, and gel filtration . The molecular weight of the enzyme was estimated as 78 kDa by SDS-PAGE . The enzyme degraded dextran at the optimum pH of 5.5, but not other glucans and fructans at all . Paper chromatographic analysis revealed that the enzyme cleaved dextran by an endo-type mechanism . The enzyme was inhibited by Hg2+, Fe3+, Zn2+, and anionic detergents SDS and deoxycholic acid, but not inhibited by non-ionic detergents Triton X-100, Lubrol PX, Nonidet P-40, and Tween 80 . SDS-blue dextran-PAGE analysis of the culture supernatant revealed that the enzyme activity detected in the 96 kDa band shifted gradually to the 78 kDa band during handling the supernatant . This shift was inhibited by phenylmethylsulfonyl fluoride, suggesting that the shift of the molecular size is due to proteolytic degradation of the enzyme by serine protease.

Microbiol Immunol, 1992, 36(9), 923 - 33
Temperature-sensitive immunoglobulin A-binding and dimerization of C-terminus-impaired protein Arp4 produced in Escherichia coli; Nakatani T et al.; A gene for protein Arp4, an IgA receptor protein derived from Streptococcus pyogenes AP4, was expressed in Escherichia coli . The product was demonstrated to be accumulated in a periplasmic space as a polypeptide with an apparent molecular weight of 40 kDa with the deleted C-terminal membrane anchor portion of protein Arp4 . This 40-kDa peptide of the C-terminus-impaired recombinant protein Arp4 produced in E . coli, designated ir-protein Arp4, was purified from a periplasmic fraction of transformants and its IgA-binding activity was analyzed . The IgA binding of ir-protein Arp4 was temperature-sensitive, that is, ir-protein Arp4 bound IgA at 4 and 25 C, but did not at 37 C . In addition, the dimerization of ir-protein Arp4 was also temperature-sensitive in parallel with temperature-dependent binding activity, suggesting that the dimerization of ir-protein Arp4 may be required for its active binding to IgA . In contrast, ir-protein Arp4 immobilized on Sepharose 4B did bind to IgA even at 37 C as well as 4 and 25 C . The immobilized ir-protein Arp4 might acquire the temperature-resistant IgA binding activity in part through the formation of a stable dimerized ir-protein Arp4 on the solid support.

Vaccine, 1992, 10(12), 833 - 40
Immunogenicity of a Streptococcus pneumoniae type 4 polysaccharide--protein conjugate vaccine is decreased by admixture of high doses of free saccharide; Peeters CC et al.; In this study we report that the priming capacity of a Streptococcus pneumoniae type 4 polysaccharide-protein conjugate to booster immunizations with the native capsular polysaccharide is dose dependent . Furthermore, it is shown by admixture experiments that simultaneous administration of high doses of free saccharide (0.5-25 micrograms) of different chain lengths (varying from M(r) 1.6-120 kDa) decreases the anti-polysaccharide antibody response . Presence of low doses of saccharide (up to 10%), which are usually present in conjugates prepared by the carbodiimide coupling procedure, did not influence the anti-polysaccharide antibody response in adult and neonatal mice.

Ter Arkh, 1992, 64(5), 69 - 72
{The serum neopterin level in acute rheumatic fever}; Samsonov MIu et al.; Acute rheumatic fever (ARF) is a systemic inflammatory disease etiologically related to infection with group A streptococcus characterized by a broad spectrum of disorders of cellular and humoral immunity . To estimate the activity of the immunopathological process and to forecast myocardial derangement in ARF patients, measurements were made of neopterin in the serum of ARF patients . Nine men with ARF serving in the armed forces were examined . The control group comprised 24 donors . The reference group included 13 patients with dilated cardiomyopathy and 14 with chronic myocarditis . The mean level of neopterin in ARF patients was equal to 14.5 +/- 12.2 nM/l and was significantly higher than in the donors (5.0 +/- 2.0 nM/l) . In patients with dilated cardiomyopathy and chronic myocarditis, it was 9 +/- 6 and 16 +/- 11 nM/l, respectively . On more careful clinical analysis the highest level of neopterin was recorded in 3 patients with impairment of the valvular apparatus of the heart . That level was observable during the whole period of the follow-up of the patients . In other patients, no impairment of the valves was detected, whereas the concentration of neopterin fell to normal . Therefore, the rise of the level of neopterin was described for the first time in patients with ARF . Besides, a relationship was found between the high level of neopterin and impairment of the valvular apparatus of the heart.

Microbios, 1992, 71(287), 125 - 34
Susceptibility of sixty-five non-oral clinical isolates of the Streptococcus milleri group to seven antimicrobial agents; Horton WA et al.; Antimicrobial susceptibilities of sixty-five non-oral Streptococcus milleri group clinical isolates to penicillin, gentamicin, lincomycin, ampicillin, chloramphenicol, tetracycline and erythromycin were determined by an agar dilution method . All strains were penicillin-sensitive (MIC < or = 0.031 microgram/ml) and the majority (64/65) were susceptible to erythromycin (MIC < or = 0.125 microgram/ml) . Low-level resistance to gentamicin was observed, and the majority of strains possessed an MIC of 8 micrograms/ml . Lincomycin and ampicillin at 0.5 microgram/ml inhibited 52/65 and 61/65 strains, respectively . Of the isolates 92% were inhibited by chloramphenicol at < or = 2 micrograms/ml . Twenty-two S . milleri group strains (of which thirteen were vaginal isolates) were resistant to tetracycline (MIC > or = 8 micrograms/ml).

Arch Microbiol, 1992, 158(1), 54 - 8
The effect of pH on the heat production and membrane resistance of Streptococcus bovis; Russell JB; Non-growing cultures of Streptococcus bovis JB1 which were incubated in 2-{N-moropholino} ethane-sulfonic acid (MES)-phosphate buffer (pH 6.8) and glucose (2 g/l) produced heat at a rate of 0.17 mW/mg protein, and this rate was proportional to the enthalpy change of the homolactic fermentation . Since the growth-independent heat production could be eliminated by dicyclohexylcarbodiimide (DCCD), an inhibitor of F1F0 ATPases, it appeared that virtually all of the energy was being used to counteract proton flux through the cell membrane . When the pH was decreased from 6.8 to 5.8, heat production and glucose consumption increased, the electrical potential (delta psi) declined, the chemical gradient of protons (Z delta pH) increased, and there was a small increase in total protonmotive force (delta p) . Further decreases in pH (5.8 to 4.5) caused a marked decrease in heat production and glucose consumption even though there was only a small decline in membrane voltage . Based on the enthalpy of ATP (4 kcal or 16.8 kJ/mol), it appeared that 38% of the wattage was passing through the cell membrane . The relationship between membrane voltage and membrane wattage or glucose consumption was non-linear (non-ohmic), and it appeared that the resistance of the membrane to current flow was not constant . Based on the electrical formula, resistance = voltage2/wattage and resistance = voltage/amperage, there was a marked increase in membrane resistance when the pH was less than 6.0 . The increase in membrane resistance at low pH allowed S . bovis to maintain its membrane potential and expend less energy when its ability to ferment glucose was impaired.

Ter Arkh, 1992, 64(6), 57 - 60
{Antistreptococcal antibodies in the blood serum of glomerulonephritis patients}; Nanchikeeva ML et al.; To study humoral antistreptococcal immunity, 29 patients with acute glomerulonephritis (AGN), 211 patients with chronic glomerulonephritis (CGN) and 30 healthy donors were examined . According to EIA, blood sera of the indicated groups demonstrated antibodies (AB) to structural components of Streptococcus--A-polysaccharide (A-ps) and hyaluronic acid (HA) and to its extracellular products--streptokinase (SK) and streptolysin-O (ASLO) . It has been shown that in the blood of AGN patients, the levels of AB to A-ps, SK and ASLO were high . The highest level of AB and SK was detected in 55% of the patients with the disease standing of up to half a year . In patients of all the clinical groups of CGN, the levels of AB to A-ps, SK and HA were elevated . The degree of the rise of the levels of all AB depended on the disease activity . Of prognostic importance in the chronicity of AGN and progression of CGN are high titers of AB and SK . The etiological role of streptococcus in glomerulonephritis and its importance in CGN exacerbation and prognosis are under discussion.

Rev Chir Orthop Reparatrice Appar Mot, 1992, 78(3), 205 - 11
{Necrotizing fasciitis of the upper limb: a case}; Berlemont M et al.; Necrotizing fasciitis is a rare form of anaerobic infection, quite different from gas forming gangrene: it affects the skin, the cellular tissue, the fascia; it doesn't diffuse in depth to the muscles and doesn't produce gas . Its microbic agents vary from haemolytic streptococcus to anaerobic bacteria in synergy . It rapidly spreads into a massive necrosis and can in a week's time lead to death by toxic shock . It spreads locally to large cutaneous areas eventually leading to the necessity of amputations . A joint treatment must be started with extreme urgency: extensive surgical excisions of all necrotic teguments, and medical treatment consisting of correcting metabolic troubles and antibiotherapy . This difficult treatment can save the patient, but it involves great loss of cutaneous and subcutaneous substance leading to local problems which are similar to serious burns, then to problems of reconstruction . An open fracture of the elbow led to an observation . A review of the literature sets out the different forms and complications.

Gig Tr Prof Zabol, 1992, (2), 12 - 3
{The allergologic status of vegetable growers in hothouses}; Fedotova EV; Studies of the main factors causing allergic diseases, level and structure of allergic morbidity proved the prevalence of contact allergic dermatitis and urticaria among hot-house plant workers . Opportunistic bacteria and Streptococcus pyogenes were found to play an important role in sensitization of vegetable growers . The rational employment of subjects suffering from allergic diseases is recommended.

Caries Res, 1992, 26(4), 281 - 5
Effect of delmopinol on the viscosity of extracellular glucans produced by Streptococcus mutans; Rundegren J et al.; The surfactant delmopinol, which is a new antiplaque agent with a low anti-microbial profile, was tested for its effects on the viscosity of bacterial extracellular glucans . Glucans were isolated from Streptococcus mutans broth supernatants incubated with 0.15 M sucrose in 50 mM sodium phosphate buffer at pH 6 . The viscosity was measured in a shear rate range from 15 to 230 reciprocal seconds . The viscosity of the water-soluble glucan was found to be independent of shear rate whereas the water-insoluble glucan showed a strong shear thinning . The addition of delmopinol to preformed glucans did not affect the viscosity nor the shear rate dependence of the glucans . However, when present during synthesis of the polysaccharides, delmopinol was found to reduce the viscosity of both water-soluble and water-insoluble glucans by approximately 50% at the shear rates investigated . The reduction in viscosity for the water-soluble glucans was obtained at a delmopinol concentration of 0.32 mM (0.01%) and for the water-insoluble glucans at 3.2 mM delmopinol . The observed reduction of viscosity of glucans indicates that the in vivo stability of plaque matrix after delmopinol treatment would be lowered, which may lead to a reduction of plaque cohesion and thus facilitate mechanical plaque removal.

Urol Int, 1992, 48(4), 439 - 40
Abscess of corpus cavernosum; Moskovitz B et al.; A rare case of abscess of the corpus cavernosum is described . Culture of the abscess yielded beta-hemolytic streptococcus . Ultrasound scan and cavernosography confirmed the physical examination findings of involvement of the corpus cavernosum . The patient was treated successfully by percutaneous ultrasound-guided aspiration drainage and systemic antibiotic therapy.

Rheumatol Int, 1992, 12(2), 61 - 3
Rheumatic manifestations of infective endocarditis; Roberts-Thomson PJ et al.; Rheumatic manifestations are common and varied in infective endocarditis . We performed a retrospective case analysis on 87 patients with 93 episodes of infective endocarditis admitted to Flinders Medical Centre over an 11 year period (1980-1990) . Disabling musculoskeletal symptoms and signs were documented in 22 (25%) of the patients . Thirteen patients developed severe or moderately severe low back pain during their illness, two with radiological evidence of a septic discitis or vertebral osteomyelitis . Two patients developed polyarthralgia/arthritis, four had septic arthritis (all with acute Staphylococcus aureus endocarditis), three developed severe loin pain, two acute gout, two had severe buttock pain and sacroiliac joint tenderness and two each developed disabling jaw/facial pain, neck/scapular pain and flank pain respectively . Five patients presented initially to the orthopaedic or rheumatological unit for management of their musculoskeletal symptoms . Four of seven patients with Streptococcus bovis endocarditis demonstrated prominent low back pain supporting a previously noted association between this organism and back symptoms . Furthermore, in one patient who had three separate episodes of endocarditis involving three different organisms, florid back symptoms were only seen in the infective episode involving Streptococcus bovis.

Postgrad Med J, 1992, 68 Suppl 1, S21 - 3
The carditis/cardiomyopathy of rheumatic fever: relationship to pathogenesis; Kaplan EL; Although the relationship between group A streptococcal upper respiratory tract infection and the development of acute rheumatic fever has been known for many years, the pathogenetic mechanism(s) have never been defined . Thus, the mechanism of damage to the valves and to the myocardium in patients with rheumatic fever remains unexplained . Traditionally, emphasis has been placed on the valvular damage in rheumatic heart disease, but there is considerable evidence for myocardial involvement . An abnormal immune response to some as yet unrecognized somatic or extracellular antigen of the group A streptococcus is probably related to the cardiomyopathy . This abnormal immune response is supported by considerable clinical and experimental evidence . Recent studies have suggested other mechanism to explain the myocardial damage including the influx of lymphocytes into the area as well as the possibility of damage relating to generation of oxygen-free radicals . As more sophisticated molecular biological studies of the group A streptococcus become available, perhaps the mystery of this very unique and common cardiomyopathy can be resolved.

Pediatriia, 1992, (4-6), 12 - 6
{The role of Pneumococcus in the development of acute bronchitis in young children}; Kobruseva LV et al.; To study the etiological role of Streptococcus pneumoniae in bronchial inflammation, 49 children with acute bronchitis and 21 children with acute nasopharyngitis were examined . The given patients' groups manifested no significant differences in the microflora of the upper respiratory tract, serotype landscape of pneumococcus, the level and dynamics of the immunologic characteristics . The growth of the titer of pneumococcal antibodies in the saliva in the early times of the disease as well as the lack of its changes in blood serum suggest that interaction of pneumococcus with the host is restricted in the given case by the bronchial lumen.

Microbios, 1992, 71(286), 33 - 46
Photosensitizing activity of water- and lipid-soluble phthalocyanines on prokaryotic and eukaryotic microbial cells; Bertoloni G et al.; The photosensitizing activity of lipophilic zinc-phthalocyanine (Zn-Pc) and its water-soluble sulphonated derivative (Zn-PcS) towards Streptococcus faecium and Candida albicans was studied and correlated with the amount of cell-bound photosensitizer . With both micro-organisms Zn-PcS was more tightly bound in larger amounts than Zn-Pc in the protoplasts of the cytoplasmic membrane . As a consequence, the photoinduced damage in S . faecium initially involved membrane proteins, while DNA was modified only upon prolonged irradiation . For C . albicans only Zn-PcS showed a preferential affinity for the spheroplasts and the decrease in cell survival was not accompanied by detectable modifications of the electrophoretic pattern of membrane proteins . The photoinduced ultrastructural alteration of both micro-organisms suggests damage at membrane level . This would indicate the involvement of different targets in bacteria and yeast for phthalocyanine photosensitization.

Periodontal Clin Investig, 1992 Spring, 14(1), 21 - 7
An augmented regenerative technique for severe osseous defects; Iacono VJ et al.; Techniques for new attachment using the principle of guided tissue regeneration with barrier membranes have become accepted as a method for treating teeth with severe osseous defects and furcation involvement . After an evaluation of existing membranes and techniques, a procedure was developed using an expanded polytetrafluoroethylene soft tissue patch, 1 mm thick (W . L . Gore and Assoc., Flagstaff, AZ), in conjunction with an alloplast hydroxylapatite bone substitute (HA-500, 40-60 mesh) (Orthomatrix, Minneapolis, MN), to maintain a space for the maturation of the blood clot . An in vitro study of microbial adherence to the soft tissue patch indicated that the number of attached Streptococcus sanguis (gordonii) G9B, and Actinomyces viscosus T14 (V) cells was significantly lower (P < .005 and P < .025, respectively) than the number of bacteria that attached to Gore-Tex Periodontal Material . Two case reports are presented to demonstrate the successful use of the soft tissue patch augmented with hydroxylapatite in patients exhibiting furcation involvement and severe vertical osseous defects.

Arch Microbiol, 1992, 157(3), 201 - 4
Cloning and expression of an amylase gene from Streptococcus bovis in Escherichia coli; Clark RG et al.; An amylase gene was identified in a Streptococcus bovis 033 lambda gtWES lambda B genomic library . Using a starch overlay and a Congo red-iodine staining procedure, amylase positive clones could be identified by zones of clearing . Ten amylase positive clones were identified using this procedure . The clone chosen for further study, lambda SBA105, contained an insert of approximately 7.5 kb . The insert was mapped, and subcloning localized the amylase gene to a region of approximately 3.1 kb . Cloning of the 3.1 kb amylase fragment into pUC18 in both orientations revealed that the amylase gene was transcribed from its own promoter . Amylase activity was expressed by the Escherichia coli subclones and was found to be largely associated with the cytoplasmic fraction . Southern hybridization of genomic DNA from the amylolytic strains, S . bovis 033, S . bovis 077, Butyrivibrio fibrisolvens 194 and 195 revealed a single hybridizing band in S . bovis 033 DNA only . This indicates that the amylase gene from S . bovis may differ from the amylases of these other amylolytic bacteria.

Arch Pathol Lab Med, 1992 Jan, 116(1), 71 - 5
Hepatic pathology of chronic granulomatous disease of childhood; Nakhleh RE et al.; We reviewed the hepatic pathology of seven cases of chronic granulomatous disease of childhood . All patients were male, with an age range of 5 to 41 years . Hepatic biopsy with drainage or wedge resection was performed in five cases to remove abscesses . Autopsy was performed in three cases . Presentation was typical of infection (fever, leukocytosis) with an elevated serum alkaline phosphatase level . Histologically, the most consistent feature was the presence of foamy macrophages that contained a finely granular golden brown pigment, seen in all seven cases . These were present as small collections predominantly in the portal tracts but were also found in the lobules . Palisading granulomas with central necrosis and associated giant cells were seen in four cases, one of which also had occasional lobular epithelioid granulomas . One case showed hyalinized portal and lobular granulomas . Four cases that showed palisading granulomas cultured positive for Staphylococcus aureus . One case cultured Pseudomonas cepacia, and one case cultured Streptococcus intermedius . Although palisading granulomas are typical of chronic granulomatous disease, they are not seen in all cases . These granulomas are similar to granulomas that are seen with Candida and other fungal infections and therefore are not specific for chronic granulomatous disease of childhood . The pigmented macrophages appear to be a consequence of the primary defect of the disease and are not secondary to infection and associated inflammation.

Infect Immun, 1992 Jan, 60(1), 278 - 83
Immunochemical studies and complete amino acid sequence of the streptokinase from Streptococcus pyogenes (group A) M type 12 strain A374; Ohkuni H et al.; The complete amino acid sequence of the streptokinase (SKase) of Streptococcus pyogenes M type 12 strain A374, isolated from a patient with poststreptococcal glomerulonephritis (PSGN), was determined . The epitope domain for the monoclonal antibody N-59, which cross-reacts with SKases of both the PSGN-associated strain and S . equisimilis H46A (a non-PSGN-associated strain), was predicted to be localized in residues 370 to 374 . The epitope domain specific for monoclonal antibody RU-1, which reacts only with the PSGN-associated SKase, was localized to residues 164 to 236.

Bioseparation, 1992, 3(1), 63 - 71
Amplified expression and large-scale purification of protein G'; Murphy JP et al.; PCR was used to isolate the gene fragment coding for Protein G' (SpG'), a truncated bacterial cell surface protein from Streptococcus G148 which binds to the Fc region of IgG and expressed in E . coli {Goward et al . (1990) Biochem . J . 267: 171-177} . The PCR primer was designed to change the TTG initiation triplet to ATG and to incorporate it into an NdeI restriction site (CATATG), allowing the gene to be cloned in frame into an NdeI restriction site immediately downstream of a trp promoter . Expression of SpG' was estimated as about 30% total soluble cell protein which compares very favourably to the less than 1% total soluble cell protein obtained from the original system {Goward, et al . (1990) Biochem . J . 267: 171-177} . Homogeneous SpG' was recovered by a single anion-exchange chromatography step on Q-Sepharose FF in a process which avoided use of an affinity adsorbent . Even though SpG' consists of almost identical repetitive domains from amino acid sequence analysis, different proteolytic sensitivity of each domain was observed indicating their structural dissimilarity.

Biosci Biotechnol Biochem, 1992 Jan, 56(1), 94 - 8
Purification and characterization of an antibiotic substance produced from Rhizopus oligosporus IFO 8631; Kobayasi S et al.; We obtained a purified antibiotic protein from the submerged cultivation broth of Rhizopus oligosporus IFO 8631 by using CM-Cellulofine chromatography and HPLC . The antibiotic did not show a broad spectrum of activity, but it was very active against some of the Bacillus species, especially against Bacillus subtillis (B . natto) at a very low concentration (less than 1 ppm) . It also showed activity against other gram-positive bacteria, including Staphylococcus aureus and Streptococcus cremoris . The purified antibiotic was a simple protein of about 5,500 in molecular weight, the amino acid component being characteristically high in cystine content . This high cystine content contributed to the stability of the antibiotic over a wide pH range and against strong heating (50% of the activity remained after boiling for 1 hr).

J Infect Dis, 1992 Jan, 165(1), 147 - 50
Mother-to-infant vertical transmission and cross-colonization of Streptococcus pyogenes confirmed by DNA restriction fragment length polymorphism analysis; Bingen E et al.; Restriction fragment length polymorphism (RFLP) analysis of total DNA and of ribosomal DNA (rDNA) regions (ribotyping) were used to document Streptococcus pyogenes vertical mother-to-infant transmission and to investigate the spread of S . pyogenes in an obstetric unit . Two isolates from a newborn, two isolates from his mother (patient 1), and two isolates from two other mothers (patients 2 and 3) were studied . RFLP of total DNA, both after HindIII and PvuII digestions and ethidium bromide staining, gave indistinguishable patterns for the strains isolated from the neonate, his mother, and patient 2 . Strains from patient 3 and six unrelated strains studied for comparison showed different patterns . In our system, ribotyping was less discriminative than total DNA RFLP analysis . DNA RFLP analysis therefore provides a valuable molecular tool for studying S . pyogenes epidemiology.

Med Pregl, 1992, 45(9-10), 341 - 4
{Pneumococcal meningitis from 1974 to 1984}; Vukadinov J et al.; We examined a group of 22 patients presented with the acute infective meningeal syndrome . Lumbar punction confirmed diagnosed purulent meningitis--meningoencephalitis, and bacteriologic liquor culture identified Streptococcus pneumoniae as a cause of the disease . Patients were mostly aged over 30 . Clinical picture revealed signs of general infection and the meningeal syndrome . The severity of the disease was assessed on the basis of apparent signs of general infection, state of consciousness and endotoxic shock symptoms . Severe consciousness disorders were present in 16 (72.72%) patients . In our patients possible pneumococcus infection foci were: sinusitis, otitis media, pneumonia, mastoiditis and adnexitis . Lethal outcome occurred in 5 (22.72%) patients . In the therapy we used penicillin, chloramphenicol and ampicillin along with corticosteroid administration.

Acta Clin Belg, 1992, 47(5), 303 - 7
Isolation of Arcanobacterium haemolyticum from patients with pharyngitis in Belgium; Cambier M et al.; During a 40 months period, 49 Arcanobacterium haemolyticum strains were isolated from 12,000 throat swabs of patients with pharyngitis originating from 5 belgian provinces . All strains were recovered on sheep blood Columbia agar plates, supplemented by nalidixic acid and colistin . In two thirds of the cases, pharyngitis was associated with a rash . Half of the cases occurred in the age group between 10 and 20 years and isolates were twice more frequent in females than in males . Streptococcus pyogenes was isolated 23.2 times more frequently than Arcanobacterium haemolyticum.

Caries Res, 1992, 26(2), 132 - 8
Invasion of Streptococcus mutans, Streptococcus intermedius and Propionibacterium acnes into the teeth of gnotobiotic rats; Kobayashi Y et al.; Germ-free rats, fed a modified cariogenic diet 2000 with a reduced sucrose content of 25%, were inoculated with a strain of Streptococcus mutans, Streptococcus intermedius or Propionibacterium acnes, respectively . After 100 days on the diet, the rats were sacrificed . Microscopic examination of stained decalcified tooth sections revealed marked destruction of the outer zones of the dentin infected with S . mutans . The destruction was closely associated with the formation of glucan-mediated large aggregates of S . mutans . The aggregates, however, were rarely formed in the deep zones of the infected dentin . Inoculation with S . intermedius and P . acnes had little effect on the microscopic outline of the decalcified tooth sections . However, the staining behavior of the sections with Mallory's method, Alcian blue-PAS and silver was like that of the tooth sections infected with S . mutans, even in the central and inner zones of the dentin . The histochemical alterations of the deep zones of the dentin induced by the three infected bacteria appeared to be due to their proteolytic rather than to their acidogenic activities.

Arch Inst Pasteur Alger, 1992, 58, 103 - 16
{Post-streptococcal immunity in the child in acute articular rheumatism (R.A.A.) or recurrent sore throats}; Merad B et al.; It concerns comparative studies between two children groups: One group who had previous RAA . A second group who had anginas only . This work shows the interest to associate two streptococcal serologic tests (ASLO, ASD) in order to increase the number of recent diagnostic streptococcal infectious . The remaining immunity is missing in children less than 5 years old; more than 50% of above 10 years an antistreptococcal answer although they have not streptococcus infections presently.

Trans Assoc Am Physicians, 1992, 105, 110 - 22
Isolation and characterization of a novel streptococcal superantigen; Mollick JA et al.; The involvement of S . pyogenes (group A Streptococcus) in severe invasive disease, toxic-shock-like syndrome, and episodes of rheumatic fever led us to explore the possibility that these strains produce a novel superantigen . By using a superantigen-specific assay, we purified a 28-kDa protein from culture supernatants that stimulated T cells in an MHC class II-dependent, V beta-specific manner and designated it SSA, streptococcal superantigen . The amino terminus of SSA showed striking resemblance to SEB, SEC1, and SEC3 . The structural homology exhibited by SSA to SEB was reflected functionally in that both of these superantigens bound the same class II isotypes . In contrast, SSA differed from SEB and other known bacterial superantigens with respect to its pattern of V beta-specific T-cell activation . SSA stimulated human T cells that expressed V beta 1, 3, 15, and perhaps V beta 5.2 . Using SSA-specific antibodies in an immunoblot assay, we screened 26 strains of Lancefield group A Streptococcus and 16 strains of group B, C, and G Streptococcus . We found that SSA was expressed with high frequency in group A strains, but was absent from all other groups tested . These data establish SSA as a novel superantigen secreted by S . pyogenes . Further study of the structure and expression of SSA may reveal a role for this molecule in current episodes of severe streptococcal diseases.

Dev Pharmacol Ther, 1992, 19(1), 40 - 9
Delayed thromboxane synthesis inhibition, but not cholinergic blockade, reverses group B streptococcus-induced pulmonary hypertension; Li JX et al.; Anisodamine, an anticholinergic drug, is widely used in China for treatment of infants with septic shock and has been reported to inhibit thromboxane synthesis in cultured cells . Thromboxane A2 plays an important role in the early pulmonary hypertension in sepsis; however, the role of thromboxane A2 later in sepsis is unclear . We tested the hypothesis that thromboxane A2 synthesis inhibition with dazmegrel, and cholinergic blockade with anisodamine, would attenuate the later phase of pulmonary hypertension induced by 4 h of group B streptococcus (GBS) infusion . 1 mg/kg of dazmegrel reversed the pulmonary hypertension and slightly increased cardiac output; these hemodynamic improvements persisted for 30-60 min . Plasma thromboxane B2 levels returned toward pre-GBS baseline values after dazmegrel treatment . Thus, thromboxane A2 is still a major mediator of pulmonary hypertension in piglets after 4 h of continuous GBS infusion . 0.5 mg/kg of anisodamine had no significant hemodynamic effect . 2 and 4 mg/kg of anisodamine each caused transient, dose-related decreases in systemic artery pressure; cardiac output also fell after the highest anisodamine dose . Pulmonary hypertension was not alleviated by anisodamine . All hemodynamic changes induced by anisodamine were short-lived and returned to preanisodamine values within 10 min . Anisodamine did not ameliorate thromboxane-mediated pulmonary hypertension in this animal model, and therefore may not inhibit thromboxane synthesis in vivo . The results of this study do not support the use of anticholinergic therapy to improve hemodynamics in GBS sepsis, but do suggest that thromboxane synthesis inhibition may be a clinically useful therapy in advanced GBS sepsis.

Rev Belge Med Dent, 1992, 47(3), 67 - 92
{Chewing gum and dental health . Literature review}; Toors FA; Clinical studies have demonstrated the caries promoting effects of sugar based gum when compared with non sugar chewing controls . Sucrose gum has been shown to stimulate plaque growth and increase its adhesivity . Acid produced in plaque and mixed saliva whilst chewing sugar gum is counteracted by the buffering action of mastication induced saliva . However the vast majority of studies measuring plaque pH has demonstrated acidification of plaque during use of sugar gum into the decalcifying zone (pH < or = 5.5), or after the gum is taken out . Sugar gum causes a more pronounced fall in plaque pH in individuals with an increased caries risk compared to the pH drop in more caries resistant individuals . Sorbitol, by itself or in combination with mannitol is slowly converted to acids by the plaque microorganisms . Chewing gums sweetened with these sugar alcohols do not cause a critical acidification of the plaque and appear not to promote caries in the clinical trial . Twelve weeks use of sorbitol chewing gum has been shown to induce a plaque more adapted to form acids from this sugar alcohol . This adaptation has been shown to persist for up to twelve weeks after cessation of the use of the sorbitol gum . Xylitol has generally been considered non-cariogenic because of its non-fermentability by most important plaque microorganisms . Plaque pH and pH of mixed saliva is increased during and following the use of xylitol based chewing gum . Prolonged use of xylitol or xylitol containing chewing gum reduces Streptococcus mutans counts in plaque and saliva, at the same time fostering remineralization of early caries lesions . Regular use of xylitol reduces the acidogenic potential of the plaque as well as its adhesiveness, at the same time increasing its mineral content . No adaptive changes in plaque metabolism resulting in the fermentation of xylitol have been reported, not even after long term, intense use . Xylitol chewing gum therefore is eminently suited to be used as part of a caries preventive regimen notably for high caries risk patients and those suffering from xerostomia . Adding mineral salts to sugar based chewing gum has been demonstrated to significantly inhibit caries development . Possible additional caries preventive benefits of mineral compounds added to sugar-free chewing gum have, so far not been reported . Sugar-free chewing gum has been shown to be an excellent vehicle for Fluoride . The plaque-growth retarding properties of Chlorhexidine-containing chewing gum have been shown to equal that of a Chlorhexidine mouthwash . Ureum added to a sugar-free chewing gum helps to neutralize plaque acids by liberating basic ammonia.

Rev Med Chil, 1992 Jan, 120(1), 62 - 8
{Fatal infectious endocarditis in a patient with annulo-aortic ectasia and predominant bicuspid valve aortic stenosis . Anatomoclinical case}; Oyonarte M et al.; A 25 year old female with bicuspid aortic valve and aortic stenosis developed infectious endocarditis due to beta hemolytic streptococcus . Specific antibiotic therapy was not successful, the patient developed multiple embolic episodes and platelet dysfunction that prevented surgery . The patient died 5 weeks after admission . Necropsy showed aortic annulo-ectasia, cystic medial necrosis and localized dissection of the proximal aorta . There were multiple aortic valve vegetations and evidence of inflammatory myocardial involvement, coronary embolization and myocardial infarction . Aortic annulo-ectasia should be investigated in patients with aortic valve endocarditis and early surgery would be advised to prevent aortic dissection.

J Fr Ophtalmol, 1992, 15(12), 669 - 78
{Bacterial endophthalmitis . Ophthalmological results of a national multicenter prospective survey}; Salvanet-Bouccara A et al.; Under the aegis of the GEEP (Groupement d'Etudes Epidemiologiques et Prophylactiques) a prospective multicentre study concerning bacterial endophthalmitis was carried out over a period of one year long with the contribution of 64 metropolitan ophthalmologic hospital departments . During this survey 143 cases of post surgical endophthalmitis were recorded: 111 of them were secondary to elective surgery, 32 developed after a perforating eye injury . Twenty-four cases of endophthalmitis developed in the absence of surgery were therefore called "medical" endophthalmitis . The frequency of endophthalmitis after elective surgery was 0.32%, and 2.8% after penetrating eye injury . Intraocular samples were obtained in 61.5% of the cases of post surgical endophthalmitis . 53 bacteria were isolated from 50 cases of endophthalmitis . The bacterial nature of the endophthalmitis was proved in 35% of these cases of post surgical endophthalmitis . Bacteria isolated from these cases of post surgical endophthalmitis were gram positive in 86.7%, and gram negative in 13.3% of cases . 20 bacteria were isolated from pseudophakic eyes: 10 of them were Staphylococcus epidermidis . The visual prognosis of endophthalmitis depends on the strain: visual acuity was more than 1/10 in 68% of cases of Staphylococcus endophthalmitis infection, but in only in 7% of cases of Streptococcus endophthalmitis infection . Intraocular injections of antibiotics both in the anterior chamber and in the vitreous, and vitrectomy increased the quality of the visual result . Three months after post surgical endophthalmitis, 35% of those eyes who received systemic and periocular antibiotic therapy, combined with intraocular antibiotics, with or without vitrectomy, recovered a visual acuity of 4/10 or more, instead of only 18% in the group without any intraocular therapy.

Med Dosw Mikrobiol, 1992, 44(1-2), 5 - 11
{Problems encountered in identification of penicillin binding proteins with pneumococcus used as an example}; Markiewicz Z; Whole cells or isolated membranes of Streptococcus pneumoniae were treated with labelled benzyl penicillin and the penicillin binding proteins (PBPs) were visualized by fluorography after SDS-PAGE electrophoresis . The PBP profiles obtained for strains sensitive and resistant to penicillin strongly differed depending not only on the concentrations of acrylamide and bis-acrylamide used in the separating gel but also on the batch used (different manufacturers) . The latter was also true for sodium dodecyl sulfate.

Med Dosw Mikrobiol, 1992, 44(1-2), 1 - 4
{Evaluation of usefulness of the PYR-Wellcome test for identifying microorganisms from the genus enterococcus}; Zareba T et al.; The study was aimed at evaluation of usefulness of PYR-Wellcome test in bacteriological diagnostic . Results of identification of enterococcal strains by application of the above test were performed on 157 strains of Enterococcus spp., 15 strains of Streptococcus pyogenes and 12 of Streptococcus bovis . Application of test for PYR-ase production results in shortening of diagnostic procedure . Basing on morphological features, including type of hemolysis, lack of catalase production and presence in the bacterial cell of a peptidase hydrolyzing L-pirrolidonyl-beta-naphthylamide, it is possible to classify with high probability the investigated microorganism to the Enterococcus spp . The Shortened procedure is satisfactory for routine identification of enterococcal strains in diagnostic laboratories.

Caries Res, 1992, 26(6), 434 - 8
Effect of different glass ionomers on the acid production and electrolyte metabolism of Streptococcus mutans Ingbritt; Seppa L et al.; In order to study the effects of different glass ionomers on the metabolism of Streptococcus mutans, test slabs of freshly mixed conventional glass ionomer (Fuji), silver glass ionomer (Ketac-Silver), composite (Silux), and 2-week-old Fuji were fitted into the bottom of a test tube . A plaque-like layer of S . mutans strain Ingbritt was centrifuged onto the test slabs, and the samples were incubated for 20 h in 1.7% (w/v) sucrose solution . For freshly mixed Fuji and Ketac-Silver, the pH fall was significantly smaller than for old Fuji and composite . These materials also released the largest amount of fluoride into the fluid phase . Incubation with glass ionomer materials led to an increase in the cellular concentration of fluoride in bacteria, but intracellular fluoride did not correlate with the fall in pH . The lowest pH was associated with the lowest cellular magnesium content . Ketac-Silver released large amounts of calcium in the fluid phase, and the cellular calcium content was doubled in this group . The results show that freshly mixed glass ionomers affect acid production and electrolyte metabolism of S . mutans in vitro . The effect of conventional glass ionomer, however, seems to disappear after a few weeks . The effects of calcium and silver released by cermet glass ionomer deserve further study.

J Oral Implantol, 1992, 18(3), 236 - 42
Radiofrequency gas plasma (glow discharge) disinfection of dental operative instruments, including handpieces; Baier RE et al.; The radiofrequency-stimulated argon gas plasma (glow discharge) technique, already well-known for surface cleaning and activation of adhesion, was investigated for determination of its separate potential for rapid disinfection of dental operative instruments . Disinfection effectiveness was judged from diminished post-treatment recovery of viable organisms from the instruments agitated in saline . Streptococcus salivarius, Bacillus stearothermophilus, and Escherichia coli were used as primary contaminant organisms, dried from gelatin-thickened laboratory cultures onto the instruments and not subjected to any preliminary cleaning steps . Significant disinfection was obtained, with no sensible temperature increases, in under 10 minutes in laboratory apparatus consuming fewer than 5 Watts of power per cycle . Also, clinically used and deliberately-saliva-contaminated high-speed handpieces were gas-discharge-treated, with their resultant rapid disinfection noted by complete suppression of the viability of any transferred natural contaminant organisms within two minutes . With regard to preservation of instrument quality, it was also shown that this low-temperature gas-discharge method provides the noted substantial disinfection without deterioration of sharp edges . Work now in progress suggests that the method can provide cool, rapid, and complete sterilization when hydrogen peroxide vapors are present in the gas plasma used for treatment of instruments first given the normally recommended thorough pre-cleaning.

Scand J Infect Dis, 1992, 24(6), 821 - 3
Increased rate of survival in Streptococcus pneumoniae-infected rats treated with the new immunomodulator Pidotimod; di Marco R et al.; Wistar rats infected with Streptococcus pneumoniae (type III ATCC) rapidly develop an acute form of experimental lobar pneumonia (ELP) with death of 80-90% of the animals by 6 days after the infection . Prophylactic treatment of these animals with the novel immunomodulator Pidotimod, at the dose of 25 mg/kg bw, significantly increased their rate of survival as compared to the control group (50 vs . 90% respectively) . Recovery from the infection appeared definitive since all the Pidotimod-treated survivors were alive and in good condition at the end of the observation period (45 days post infection) . Prophylactic treatment with higher or lower doses of the drug was ineffective . Therapy with Pidotimod was not effective . This preliminary study suggests that Pidotimod may have contributed to activation of specific and non-specific immune effectors involved in the host response to S . pneumoniae infection.

Scand J Infect Dis, 1992, 24(6), 765 - 72
Lactic acid isomers and fatty acids in sinus secretion: a longitudinal study of bacterial and leukocyte metabolism in experimental sinusitis; Westrin KM et al.; Concentrations of the two optic isomers of lactate (D- and L-form) as well as glucose, succinate, acetate, butyrate, isovalerate and valerate were examined in purulent sinus secretions . The samples were obtained from rabbit maxillary sinuses, experimentally infected with Streptococcus pneumoniae or Bacteroides fragilis . More soluble acids such as acetate displayed relatively low levels in the secretion, despite a high microbial production . A substantial increase in D-lactate concentration was found in secretions only the first day after induction of pneumococcal sinusitis, and not in bacteroides sinusitis . L-lactate levels were particularly high in secretions of a marked purulent character, and this isomer can be considered as indicator of anaerobic glycolysis in the leukocytes . Less diffusible fatty acids such as butyrate and isovalerate accumulated in the secretion, in spite of a relatively lower production rate, and are thus more reliable indicators of bacterial metabolism.

Am J Med, 1991 Dec 30, 91(6A), 3S - 11S
Current trends in bacterial respiratory pathogens; Facklam RR et al.; The relationship of virulence and antimicrobial susceptibility with morbidity due to bacterial respiratory pathogens is complex and evolving . Ultimately, decreasing the incidence of pneumonia due to bacterial pathogens will be dependent on successful preparation and distribution of effective vaccines . Until effective vaccines are widely available, control of a majority of respiratory infections will depend on promotion of rational therapeutic strategies . Though limited to a few specific serotypes and strains, changes in virulence of bacterial respiratory pathogens have been noted . Co-infections due to multiple respiratory pathogens may increase morbidity; however, the epidemiology of co-infections is not clear . Relationships between respiratory viruses and bacteria may exist that increase virulence of both agents, but information regarding these relationships awaits further investigation . Resistance of respiratory pathogens to the more commonly used antimicrobials, such as penicillin, erythromycin, chloramphenicol, and cotrimoxazole, is being documented globally with increasing frequency . The evolution of antimicrobic resistance, especially among strains of Streptococcus pneumoniae, the most common and deadly agent of lower respiratory tract infections, provides impetus to develop and promote effective pneumococcal vaccines and to search for new and effective antimicrobials.

Am J Med, 1991 Dec 30, 91(6A), 93S - 100S
Use of quinolones for the treatment of acute exacerbations of chronic bronchitis; Chodosh S; The availability of a new generation of quinolones expands the choices of antimicrobials for therapy of acute exacerbations of chronic bronchitis . These agents have broad antimicrobial activity, including good in vitro activity against respiratory pathogens, and advantageous pharmacokinetic characteristics, including bronchial tissue penetration . Ciprofloxacin, enoxacin, ofloxacin, and temafloxacin have been evaluated in a number of clinical trials, compared to the reference agents ampicillin, amoxicillin (with and without clavulanate), cefaclor, doxycycline, and erythromycin . Ciprofloxacin, ofloxacin, and temafloxacin have generally demonstrated greater clinical success than enoxacin . While these agents are effective against many respiratory pathogens, Streptococcus pneumoniae and Pseudomonas aeruginosa infections appear to pose problems . Temafloxacin and ciprofloxacin have been compared; temafloxacin eradicated S . pneumoniae more efficiently and did not interact with theophylline . Fluoroquinolones are an important addition to the agents useful for bacterial exacerbations of chronic bronchitis.

Am J Med, 1991 Dec 30, 91(6A), 67S - 70S
Comparative penetration of selected fluoroquinolones into respiratory tract fluids and tissues; Wise R; Sputum samples are easy to obtain; however, their use in therapeutic decision making is not without problems . Today, with the availability of more sophisticated endoscopic procedures, it is possible to determine antimicrobial concentrations at various sites within the respiratory tract . Fiber-optic bronchoscopy makes it possible to obtain samples of bronchial mucosa, bronchial epithelial lining fluid (ELF), and alveolar macrophages (AMs) . Antimicrobial concentration measurements from the bronchial mucosa, ELF, and AM may be better predictors of successful antimicrobial therapy than sputum samples . In general, fluoroquinolones penetrate well into lung tissue, including bronchial mucosa, ELF, and AM, resulting in concentrations higher than corresponding serum levels . Temafloxacin, a new fluoroquinolone, attains high bronchial concentrations that are well above the 90% minimal inhibitory concentration (MIC90) for many of the common respiratory pathogens, including Streptococcus pneumoniae (MIC90 = 0.5 micrograms/mL) . Early clinical trials confirm the clinical efficacy and safety of temafloxacin in the treatment of many common respiratory tract infections . The penetration of temafloxacin into the bronchial mucosa, AM, and ELF along with its antimicrobial spectrum supports the use of temafloxacin against common respiratory pathogens, including S . pneumoniae.

Am J Med, 1991 Dec 30, 91(6A), 31S - 34S
Evaluation of the bactericidal activity of temafloxacin; Jacobs MR; Although the fluoroquinolones share many properties, these agents differ in their ability to kill the same bacterial strain . The bactericidal activity of temafloxacin against a number of pathogens has been compared with that of other fluoroquinolones by determination of minimal bactericidal concentration, time-kill kinetics, and postantibiotic effect . Studies have demonstrated that temafloxacin has equivalent or superior ability to kill when compared with other fluoroquinolones . Temafloxacin, ciprofloxacin, and PD 117558 were more active than other fluoroquinolones against Mycobacterium avium complex, with 90% minimal bactericidal concentrations (MBC90S; 8-16 micrograms/mL) four- to eightfold greater than 90% minimal inhibitory concentrations (MIC90S; 2 micrograms/mL) . Against Chlamydia trachomatis the MIC90 and MBC90 of temafloxacin were both 0.25 microgram/mL; ciprofloxacin was less active (MBC90 twice the MIC90), and norfloxacin was least active . Temafloxacin demonstrated more rapid killing kinetics than did ciprofloxacin or ofloxacin at all concentrations tested against Streptococcus pyogenes . Findings were similar against Streptococcus pneumoniae at antibiotic concentrations of 1-2 micrograms/mL . Similar time-kill curves against Escherichia coli were observed for temafloxacin, ciprofloxacin, and difloxacin . Time-kill kinetics of temafloxacin against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S . aureus (MSSA) were superior to those of ciprofloxacin and ofloxacin . Postantibiotic effect with temafloxacin against Legionella pneumophila showed a considerable delay in regrowth, and temafloxacin delayed regrowth of MRSA and MSSA to a greater extent than did ciprofloxacin or ofloxacin . By the three methods used in the studies to assess bactericidal activity that are currently published, temafloxacin had equivalent or superior activity to the comparative fluoroquinolones tested . Other organisms remain to be tested and the significance of these findings determined in clinical studies.

Am J Med, 1991 Dec 30, 91(6A), 106S - 110S
Systemic management of cutaneous bacterial infections; Parish LC et al.; Cutaneous bacterial infections can be treated by a variety of modalities, although systemic antimicrobial agents usually provide the most efficacious and efficient means for treatment . Oral administration allows outpatient management, thus decreasing the overall cost of treatment . Although gram-negative organisms are increasingly implicated in dermatologic infections, the bacteria that are commonly found in skin infections include group A beta-hemolytic Streptococcus and Staphylococcus aureus, which cause many types of pyoderma or impetigo . Not every patient exhibits the common signs of bacterial skin infection, which can include redness, crusting, induration, increased local temperature, serous exudate, a purulent discharge, pustules, bullae, or a foul-smelling odor, as well as such symptoms as malaise, pain, and tenderness . Bacterial confirmation may also be difficult . Beta-lactam antibiotics, tetracycline, and erythromycin have proven useful in this setting; however, increasing resistance is problematic . The management of bacterial infections of the skin and skin structure has been expanded during the past decade with the introduction of the new fluoroquinolones--agents with a wide spectrum of antimicrobial activity and good pharmacokinetic characteristics . While the clinical efficacy of each agent must be considered in the light of risk of adverse events and potential drug interactions, ciprofloxacin, enoxacin, ofloxacin, and temafloxacin appear to be most useful for cutaneous bacterial infections.

Carbohydr Res, 1991 Dec 16, 221, 95 - 121
N.m.r . and conformational analysis of the capsular polysaccharide from Streptococcus pneumoniae type 4; Jones C et al.; The 1H- and 13C-n.m.r . data on the capsular polysaccharide (1) produced by Streptococcus pneumoniae type 4, the depyruvated polysaccharide (2), and a tetrasaccharide (3a) derived by Smith degradation of 2 were used as constraints on a computer-generated model of the conformation of 1 and to assess the effects of the pyruvic acetal substituent on the conformation . The dynamics of the polysaccharide systems and the influence of the pyruvic acetal were investigated using 13C-n.m.r . relaxation measurements.

J Immunol Methods, 1991 Dec 15, 145(1-2), 93 - 103
The immune response in the rat to Streptococcus pneumoniae type 3 and type 4 capsular polysaccharide . Detection by double immunocytochemical staining of antibody-containing cells in situ and ELISA; van den Dobbelsteen GP et al.; Two different methods have been used to study immune responses in the rat to Streptococcus pneumoniae type 3 and type 4 capsular polysaccharides (PPS) . First, for simultaneous detection of the specificity and isotype of anti-PPS antibody-containing cells (ACC) in cryostat sections of lymphoid tissue, a double immunocytochemical method was developed . This method is a combination of a three-step immunoperoxidase method to demonstrate specific anti-PPS ACC as bright red cells and a two-step immunophosphatase method to detect the isotype of ACC as blue cells . Double positive cells appear violet . Using this staining procedure, the detection of antigen was also possible . Second, to study the anti-PPS response in serum, an ELISA procedure was modified . In this ELISA, polyvinylchloride microtiter plates are coated directly with type-specific pneumococcal polysaccharide . After intraperitoneal (i.p.) immunization of rats with PPS-3 or PPS-4, both antigen (PPS) and specific ACC could be detected . Specific ACC were found in the spleen and mesenteric lymph nodes . In the spleen, the specific ACC were found in the red pulp, marginal zone, outer PALS, and follicles . Most of these ACC were IgM-positive and to a lesser extent IgG-positive and IgA-positive . However, specific ACC in mesenteric lymph nodes were predominantly of the IgA isotype, with only few IgM or IgG positive cells . The anti-PPS response in serum, as measured by the ELISA, consisted mainly of IgM antibodies with small amounts of IgG and IgA . Both methods were found to be valuable in studies of immune responses against bacterial polysaccharides.

Proc Natl Acad Sci U S A, 1991 Dec 15, 88(24), 11450 - 4
Cloning and expression of APE, the cDNA encoding the major human apurinic endonuclease: definition of a family of DNA repair enzymes; Demple B et al.; Abasic (AP) sites are common, potentially mutagenic DNA damages that are attacked by AP endonucleases . The biological roles of these enzymes in metazoans have not been tested . We have cloned the human cDNA (APE) that encodes the main nuclear AP endonuclease . The predicted Ape protein, which contains likely nuclear transport signals, is a member of a family of DNA repair enzymes that includes two bacterial AP endonucleases (ExoA protein of Streptococcus pneumoniae and exonuclease III of Escherichia coli) and Rrp1 protein of Drosophila melanogaster . Purified Ape protein lacks the 3'-exonuclease activity against undamaged DNA that is found in the bacterial and Drosophila enzymes, but the lack of obvious amino acid changes to account for this difference suggests that the various enzyme functions evolved by fine tuning a conserved active site . Expression of the active human enzyme in AP endonuclease-deficient E . coli conferred significant resistance to killing by the DNA-alkylating agent methyl methanesulfonate . The APE cDNA provides a molecular tool for analyzing the role of this central enzyme in maintaining genetic stability in humans.

FEMS Microbiol Lett, 1991 Dec 15, 69(1), 19 - 22
Inhibition of adhesion-promoting activity of a human salivary protein which promotes adhesion of Streptococcus mutans JBP to hydroxyapatite; Kishimoto E et al.; The adhesion-promoting proteins (APP) (molecular mass approx . 300 kDa), which promote adhesion of Streptococcus mutans JBP (serotype c) to hydroxyapatite, were isolated from human submandibular-sublingual (SMSL) saliva by gel filtration on a Trisacryl GP2000 M column . The effects of hexoses, pentoses, methyl-pentoses, hexosamines, N-acetylhexosamines, a basic amino acid, polyamines and ammonium chloride on the bacterial adhesion-promoting activity of the APP were examined . Galactosamine, mannosamine, L-lysine, spermine, putrescine, and ammonium chloride inhibited the adhesion-promoting activities of the APP . The other sugars, including the N-acetylhexosamines, were without effect . Thus, compounds containing a primary amino-group appear to have a specific inhibitory effect on adhesion of S . mutans JBP to APP adsorbed onto hydroxyapatite, an activity which is lost if the amino-group is acetylated.

J Infect Dis, 1991 Dec, 164(6), 1207 - 9
Hematogenous pneumococcal meningitis in the infant rat: description of a model; Rodriguez AF et al.; Sensorineural deafness occurs in 20%-30% of children after Streptococcus pneumoniae meningitis . An infant rat model of S . pneumoniae meningitis was developed to study the pathogenesis of inner ear invasion by S . pneumoniae . S . pneumoniae type 6 was administered intraperitoneally (inoculum: 1-10 x 10(8) cfu) every 24 h for 3 days to 5-day-old rats . Bacteremia (12 {50%} of 24) and meningitis (11 {46%} of 24) were detected most frequently 4 days after the three doses . The mean cerebrospinal fluid (CSF) white blood count for rats with positive CSF cultures was 7271/mm3 (range, 81-20,475) . Hematoxylin-eosin-stained brain tissue from the 11 rats with positive CSF cultures showed inflammation in the meninges and scala tympani in 9 each (82%), and scala vestibuli in 6 (55%), but none in the scala media . Gram's-stained brain and inner ear sections from the same 11 rats showed organisms in the meninges in 5 (45%) and scala tympani or vestibuli in 2 (18%) . Perilymphatic inflammation occurred significantly (P less than .001) more than did endolymphatic inflammation.

J Clin Microbiol, 1991 Dec, 29(12), 2774 - 8
Differentiation of Streptococcus uberis from Streptococcus parauberis by polymerase chain reaction and restriction fragment length polymorphism analysis of 16S ribosomal DNA; Jayarao BM et al.; Streptococcus uberis type II has been proposed recently as a separate species designated Streptococcus parauberis (A . M . Williams and M . D . Collins, J . Appl . Bacteriol . 68:485-490, 1990) . Differentiation of S . parauberis from S . uberis has been possible only by DNA-DNA hybridization or 16S rRNA sequencing, since the biochemical and serological characteristics of the two species are indistinguishable . A simple and reliable technique was developed for differentiating S . parauberis (S . uberis type II {ATCC 13386}) from S . uberis (S . uberis type I {ATCC 9927, ATCC 13387, and ATCC 27958}) by restriction fragment length polymorphism (RFLP) analysis of 1.4-kb 16S ribosomal DNA (rDNA) . Oligonucleotide primers complementary to 16S rRNA genes were used to amplify 16S ribosomal gene fragments from genomic DNA by polymerase chain reaction . The 1.4-kb 16S rDNA fragment was digested with ScaI, NspI, DdeI, and AvaII restriction endonucleases . Restriction fragments produced by all four restriction endonucleases were characteristic for each species . RFLP analysis of 16S rDNA from 24 "S . uberis" isolates obtained from mammary secretions of dairy cows indicated that all 24 isolates were indeed S . uberis.

Clin Orthop, 1991 Dec, (273), 105 - 12
Implant salvage in infected total knee arthroplasty; Burger RR et al.; In a retrospective study of 60 infected total knee arthroplasties (TKAs), attempted implant salvage of 39 knees was performed with surgical debridement and antibiotic therapy . In seven of the 39 knees (17.9%), infection was successfully eradicated, with a mean follow-up examination of 4.1 years . In comparing knees with successful salvage to those with persistent infection, the following factors strongly correlated with successful salvage: (1) short duration of symptoms of infection (less than 2 weeks); (2) susceptible gram-positive organism (Streptococcus or Methicillin-sensitive Staphylococcus aureus); (3) absence of prolonged postoperative drainage or the development of a sinus tract; and (4) no prosthetic loosening or roentgenographic evidence of infection . Only five knees in this series satisfied all these criteria, and in each case, implant salvage with eradication of infection and maintenance of good knee function was achieved . Although a higher salvage rate was obtained with the less-constrained prostheses, an infected hinge prosthesis did not preclude successful implant salvage . No patient with a draining sinus tract (0/17), infection with a virulent organism (0/9), or earlier revision arthroplasty (0/9) had successful salvage of the infected implant . Of the 22 knees with postoperative drainage for longer than two weeks or failure of primary wound healing at the time of TKA, only two were successfully salvaged and both required a local muscle flap . Therefore, early aggressive management of persistently draining wounds after TKA is imperative . In TKA complicated by infection, implant salvage with aggressive surgical debridement and antibiotic therapy should be strongly considered, provided that these strict criteria for attempted salvage are adhered.

J Bacteriol, 1991 Dec, 173(23), 7423 - 8
Molecular cloning of the extracellular endodextranase of Streptococcus salivarius; Lawman P et al.; We report the cloning in Escherichia coli of the gene encoding an extracellular endodextranase (alpha-1,6-glucanhydrolase, EC 3.2.1.11) from Streptococcus salivarius PC-1 . Recombinants from a S . salivarius PC-1-Lambda ZAP II genomic library specifying dextranase activity were identified as plaques surrounded by zones of clearing on blue dextran agar . One such clone, PD1, had a 6.3-kb EcoRI fragment insert which encoded a 190-kDa protein with dextranase activity . The recombinant strain also produced two lower-molecular-mass polypeptides (90 and 70 kDa) that had dextranase activity . Native dextranase was recovered from concentrated culture fluids of S . salivarius as a single 110-kDa polypeptide . PD1 phage lysate and PC-1 culture supernatant fluid extract were used to measure substrate specificity of the recombinant and native forms of dextranase, respectively . Analysis of these reaction products by thin-layer chromatography revealed the expected isomaltosaccharide products yielded by the recombinant-specified enzyme but was unable to resolve the larger polysaccharide products of the native enzyme . Furthermore, S . salivarius utilized neither the substrates nor the products of dextran hydrolysis for growth.

Infect Immun, 1991 Dec, 59(12), 4606 - 9
Role of a cell surface-associated protein in adherence and dental caries; Bowen WH et al.; Insertional inactivation of the Streptococcus mutans spaP gene was used to construct an isogenic mutant (834) of strain NG8 (serotype c) which lacked the major cell surface-associated protein referred to as P1 (15) . Results of several studies suggest that P1 is involved in the adherence of S . mutans to saliva-coated apatite surfaces . With an in vitro model system of hydroxyapatite (HA) beads coated with parotid saliva (PS) and additional HA surfaces coated with PS and in situ-formed glucan, it was observed that mutant 834 adhered poorly to the PS/HA surfaces . In contrast, both parent and mutant strains bound to the PS-glucan/HA surface . Groups of intact and desalivated rats were infected with each strain to determine relative capacities to induce dental caries . Rats were fed a highly cariogenic diet containing 56% sucrose for 3 to 5 weeks . Each strain colonized the rodent model and caused similar levels of smooth-surface caries under these dietary conditions . It was concluded that P1 influences the ability of organisms to adhere to saliva-coated surfaces and possibly affects primary colonization of the oral cavity in the absence of a glucan surface but has no effect on glucan-mediated adherence in vitro or in vivo.

Appl Environ Microbiol, 1991 Dec, 57(12), 3648 - 51
Ecological implications of glucosyltransferase phase variation in Streptococcus gordonii; Vickerman MM et al.; When sucrose is provided as a substrate for glucosyltransferase (GTF), Spp+ cells of the oral bacteria Streptococcus gordonii grow embedded in an insoluble glucan mass associated with surfaces . Spp- phase variants with lower GTF activity, which either arise from or are grown with Spp+ cells, segregate preferentially as unattached cells in the culture supernatants . Conversely, Spp+ revertants preferentially accumulate on surfaces . GTF phase variation, therefore, may facilitate the dispersion of S . gordonii cells throughout the oral cavity.

Enferm Infecc Microbiol Clin, 1991 Dec, 9(10), 613 - 8
{Resistance to erythromycin in Streptococcus pneumoniae}; Garcia-Arenzana JM et al.; A total of 640 S . pneumoniae isolates from different clinical samples obtained from patients (not including carriers) over a 10 years period were studied . Global resistance to erythromycin (MIC greater than or equal to 1 microgram/ml) was 9.1% (8.1% with MIC greater than or equal to 8 micrograms/ml) . Resistance was more prevalent in serotypes 6, 14, and 19, either in absolute number or in relation to the total number of strains in each serotype . A total of 16% of strains isolated from ear fluid specimens and bronchial secretions were resistant, but only a 4.5% of blood culture isolates showed also resistance to erythromycin . Resistance was found more frequently on pediatric patients . Although the highest resistance rate was found during the last year (15% of all 1990 isolated strains or 13.9% if the period also includes the first 1991 quarter) we did not find a gradual increase over time . Most of the resistant strains showed also resistance to tetracycline and other antimicrobial agents . Overall, 94.8% of strains showed multiple resistance (combined resistance to at least 2 other different antibiotics, not including clindamycin resistance, which always matches erythromycin resistance), and 60.3% showed resistance to penicillin . The multiply-resistant pattern and the similarity of isolated strains suggest an epidemiologic behaviour that not necessarily has to be linked to higher erythromycin use.

J Anim Sci, 1991 Dec, 69(12), 4967 - 73
Effect of growth conditions on the Streptococcus bovis phosphoenolpyruvate glucose phosphotransferase system; Moore GA et al.; Four strains of the ruminal bacterium Streptococcus bovis were surveyed for phosphoenolpyruvate (PEP) and ATP-dependent phosphorylation of glucose and the nonmetabolizable glucose analog 2-deoxyglucose . All four strains had high rates of glucose phosphorylation with either phosphoryl donor, but 2-deoxyglucose activity was much higher in the presence of PEP . These results provide evidence for a PEP-dependent glucose phosphotransferase system in these bacteria . Mannose and 2-deoxyglucose inhibited PEP-dependent phosphorylation of glucose by S . bovis JB1 by 50 and 38%, respectively, whereas alpha-methylglucoside had little effect . Mannose was a competitive inhibitor of PEP-dependent phosphorylation of glucose with an inhibition constant of 2.8 mM, and PEP-dependent activity in cells grown in batch culture was optimal at pH 7.2 . When S . bovis JB1 was grown in continuous culture, PEP-dependent phosphorylation of glucose and 2-deoxyglucose was highest in cells grown at a dilution rate of .10/h and at low glucose concentrations . Phosphoenolpyruvate-dependent activity was optimum at a growth pH of 5.0 for cells grown in medium that contained less than 6.0 g/liter of glucose . These data indicate that PEP-dependent glucose phosphotransferase system activity can be influenced depending on the growth conditions used to culture S . bovis . Furthermore, these results suggest that environmental conditions within the rumen will affect how glucose is transported by S . bovis.

Pathol Biol (Paris), 1991 Dec, 39(10), 984 - 90
{Relationship between virulence and resistance to antibiotics in pneumococci . Contribution of experimental data obtained in an animal model}; Bedos JP et al.; Epidemiologic data show that the organ affinity of Streptococcus pneumoniae varies across serotypes . As a result of this heterogeneous distribution, exposure to antimicrobials is greater for serotypes 6, 14, 19 and 23 . Most strains with resistance to antimicrobials are found among these four serotypes . Virulence of the various serotypes of pneumococci varies with adhesion, enzyme secretion, and resistance to phagocytosis . In a mouse model of experimental septicemia, neither the origin of strains nor the acquisition of a resistant phenotype modified virulence, which appeared as an intrinsic feature specific to each phenotype . Strains belonging to serotypes 6, 14, 19 and 23 with or without resistance to antimicrobials were only very rarely virulent in the experimental model used . As an indirect result, resistance to antimicrobials and virulence were inversely related among the strains of S . pneumoniae tested.

Pathol Biol (Paris), 1991 Dec, 39(10), 972 - 7
{Bactericidal effect of cefadroxil, amoxicillin alone or in combination with clavulanic acid in sera of healthy volunteers}; Etesse-Carsenti H et al.; Determination of minimal inhibitory concentrations (MICs) provides data on the susceptibility or resistance of a bacteria; however, in susceptible bacteria this parameter is not predictive of effectiveness of the antimicrobial agent . Bactericidal activities of cefadroxil, of amoxicillin, and of the amoxicillin-clavulanic acid combination on bacteria commonly found in ENT and lower respiratory tract disease were studied comparatively . The antibiotics were given by the oral route to six healthy volunteers . With beta-lactamase-producing and non-beta-lactamase-producing strains of Escherichia coli, amoxicillin produced MICs consistent with susceptibility but failed to exhibit a bactericidal effect, whereas cefadroxil was bactericidal . Combination of amoxicillin with an inhibitor did not modify this activity on E . coli and failed to produce a bactericidal effect on Klebsiella pneumoniae similar to that seen with cefadroxil . Amoxicillin with and without clavulanic acid exhibited comparable effectiveness on Streptococcus pyogenes and S . Pneumoniae . The bactericidal effect of cefadroxil on S . pneumoniae was of similar magnitude but shorter duration than that of amoxicillin . Cefadroxil and the amoxicillin-clavulanic acid combination had similar bactericidal effects against Staphylococcus aureus . These antibiotics exhibited a time-dependent effect on Gram positive microorganisms . These pharmacodynamic data, together with measures of bactericidal activity, may be very helpful for selecting the appropriate antibiotic and dosage.

Zentralbl Veterinarmed B, 1991 Dec, 38(10), 737 - 42
Biochemical and serological properties of Streptococcus uberis; Lammler C; The Strep-Zym identification system, a combination of 23 enzymatic tests, allowed a rapid biochemical characterization of Streptococcus uberis . The biochemical profiles of the S . uberis cultures clearly differed from those of S . agalactiae and S . dysgalactiae . Serological grouping of S . uberis revealed polysaccharide antigens of groups E, G, P and U . Some cultures of S . uberis demonstrated CAMP-like synergistic hemolytic activities on sheep blood agar and reacted specifically with the lectins of Helix pomatia and Dolichos biflorus . The occurrence of group polysaccharides, CAMP-like reactivities, and the lectin agglutination reactions were obviously not related to each other or to any of the biochemical properties . These reactions, possibly of importance as virulence factors, might serve as epidemiological markers.

J Vet Med Sci, 1991 Dec, 53(6), 1043 - 9
Experimental infections of mice and pigs with Streptococcus suis type 2; Kataoka Y et al.; Five inbred strains of mice were tested for their susceptibility to Streptococcus suis type 2 including the type strain, two isolates from meningitis in pigs and two isolates from tonsils of clinically healthy pigs . C57BL/6, ICR and ddY strain mice showed lower susceptibility to all strains of S . suis type 2 than BALB/c and SS strain mice . The type strain and the isolates from diseased pigs produced septicaemia and meningitis in BALB/c and SS mice inoculated with 10(8) colony forming unit of the bacteria and 60 to 100% of these infected mice died . On the other hand, mice inoculated with the isolates from healthy pigs showed mild clinical signs but none of them died . In BALB/c mice which died or developed nervous signs, the purulent meningo-encephalitis, myocarditis, ophthalmitis, labyrinthitis and otitis media were observed . S . suis type 2 antigen was demonstrated in these lesions by immunoperoxidase staining using rabbit S . suis type 2 antiserum . These results were similar to those in the experimentally infected pigs with these virulent and avirulent strains against mice . These results indicate that BALB/c and SS strains of mice are useful as an experimental model of S . suis type 2 infections in pigs, and that there are virulent and avirulent strains against mice and pigs among the strains of S . suis type 2.

J Dairy Sci, 1991 Dec, 74(12), 4183 - 8
Microbiological results from milk samples obtained premilking and postmilking for the diagnosis of bovine intramammary infections; Sears PM et al.; Bacteriological culture results were compared between 336 pairs of quarter milk samples collected premilking and postmilking . Using a positive result on either premilking or postmilking samples as the definitive diagnosis, premilking sampling sensitivity was 91% for Staphylococcus aureus, 91% for coagulase-negative staphylococci, and 97% for Streptococcus other than agalactiae . Postmilking sampling sensitivities were 81, 45, and 58%, respectively, for the same pathogens . Requiring both premilking and postmilking samples for the definitive diagnosis, specificities were 92, 86, and 95% for premilking sampling alone and 96, 98, and 99% for postmilking sampling alone . Such differences in specificity would result in major differences in predictive value of a positive culture for herds with a low prevalence . Multiple isolates were significantly more common from premilking samples.

J Antimicrob Chemother, 1991 Dec, 28 Suppl C, 31 - 8
A review of antibiotic resistance patterns of Streptococcus pneumoniae in Europe; Baquero F et al.; Streptococcus pneumoniae no longer has predictable antibiotic susceptibility . There are two areas of high prevalence of resistance (over 25%) to beta-lactam antibiotics in the South-West and North-East of Europe . In Spain, a close relationship has been found between the yearly rate of aminopenicillin consumption and penicillin resistance . High level resistance (MIC greater than or equal to 1 mg/L) has developed against a previous background of low level resistance . The serotypes involved in penicillin resistance in Spain are widespread in other countries . Macrolide resistance is high in France (over 15%) and is also increasing in other countries . All these resistant isolates remain susceptible to the most recent fluoroquinolones, such as temafloxacin . Prospective surveillance, more rational use of antibiotics and a diversification of antibiotic use in respiratory tract infections may serve to limit the threat of antibiotic resistance in S . pneumoniae.

Kansenshogaku Zasshi, 1991 Dec, 65(12), 1583 - 92
{Analysis of 98 cases of thoracic empyema}; Miyazaki T et al.; Ninety-eight cases of empyema thoracis admitted to Juntendo University Hospital between 1979 and 1990 were reviewed . Males accounted for 78 cases and females 20 cases . Thirteen pediatric patients ranged in age from 17 days to 4 years, while the 85 adult cases ranged from 16 to 89 years (mean: 58.4 years) . The mortality rate increased with age . Fifty-three cases of community-acquired empyema thoracis consisted of 24 with no underlying disease (including 13 pediatric cases), and 29 with diabetes mellitus, alcoholic liver damage or chronic obstructive bronchopulmonary disease . Forty-five nosocomial empyema cases occurred after chest operation or thoracocentesis, or due to a subdiaphragmatic pathogenic condition or congestive heart failure complicated with aspiration pneumonia . In this series, 63 patients (64.3%) had para- or post-pneumonic empyema . Compared with the community-acquired infection cases, the mortality rate of the nosocomial infection cases was very high . Seventy-eight cases were culture-positive, including 3 positive for Mycobacterium tuberculosis . The remaining 20 cases were culture-negative . In 75 cases of culture-positive pleural fluid, aerobic bacteria were isolated from 31 cases (mortality rate: 22.6%), anaerobes mixed with aerobes from 21 cases (mortality rate: 52.4%), and anaerobes only from 23 cases (mortality rate: 21.7%) . Thus, the mortality rate of mixed infected cases was highest . Anaerobes were frequently isolated from the community-acquired empyema cases, and were often found in para- or postpneumonic lesions, including aspiration pneumonia . The most commonly encountered aerobe was Staphylococcus aureus . Among the anaerobes, Bacteroides spp., microaerophilic streptococcus, Peptostreptococcus and Fusobacterium spp . were most common . A single organism was isolated in pure culture from 39 cases . Single organisms isolated from fluids were more frequently aerobes (25) than anaerobes (14) . The cases harboring Bacteroides spp . showed the worst outcome, with 11 deaths in 25 such cases.

Nippon Ganka Gakkai Zasshi, 1991 Dec, 95(12), 1261 - 7
{Close association of Streptococcus sanguis and Behçet's disease}; Yoshikawa K et al.; The oral flora of patients with Behcet's disease was investigated and compared to that of controls . The proportion of Streptococcus (S.) sanguis in the flora of patients with this disease was always higher than that of healthy controls . It is noteworthy that serotypes of S . sanguis in the oral flora of patients were different from controls . Immune responses against S . sanguis were also examined in the patients . Antibody titers against S . sanguis were higher in patients than in controls . Furthermore, the patients showed significantly increased skin reactivity to S . sanguis . These results suggest that uncommon serotypes of S . sanguis play an important role in the pathogenesis of Behcet's disease.

J Otolaryngol, 1991 Dec, 20(6), 376 - 8
Experimental sinusitis in rabbits induced by aerobic and anaerobic bacteria: models for research in sinusitis; Stierna P et al.; Experimental acute sinusitis can be induced in New Zealand white rabbits by Streptococcus pneumoniae serotype 3, or the anaerobe Bacteroides fragilis, after blocking of the sinus ostium . Histological examination of the sinus mucosa in both models reveals edema, dilated venules, leukocytic infiltration, goblet cell formation, as well as localized epithelial lesions . In comparison the bacteroides sinusitis enhances a more pronounced and long-lasting tissue reaction, including periosteal thickening and new bone formation . The sinus mucosal blood flow as measured with microspheres Sn113 is increased as compared to control side in pneumococcal sinusitis . An increased lactate concentration of sinus secretions as well as in the pathological sinus mucosa indicates an anaerobic metabolism . Furthermore, a decreased ATP-content of the sinus mucosa suggests an energy depletion which could impair epithelial function . The anaerobic milieu of the sinus secretion is probably created by the leukocytes as analyzed by the separation of the D- and L-form of lactate.

J Dent Res, 1991 Dec, 70(12), 1508 - 15
Studies on the subcellular localization of protease and arylaminopeptidase activities in Streptococcus sanguis ATCC 10556; Cowman RA et al.; Intact cells of Streptococcus sanguis ATCC 10556 possessed arylaminopeptidases exhibiting activity toward the nitroanilide (NA) derivatives of leucine, alanine, methionine, arginine, or lysine . Weak hydrolytic activity was observed in assays with the NA derivatives of valine, proline, glycine, or glutamic acid . Subcellular localization studies revealed that arylaminopeptidase activities were located in both the cell membrane and cytoplasm . Arylaminopeptidases exhibiting activity toward the leucine, alanine, or methionine NA substrates appeared to be more predominantly associated with the membrane, whereas enzymes exhibiting activity toward arginyl-NA or lysyl-NA were more prevalently located in the cytoplasm . Several results from this study suggest that the membrane-assocaited arginyl and lysyl arylaminopeptidases were located in such a way that their expression was restricted in the intact cell . The addition of 0.5 mol/L NaCl to protoplast preparations derived from mutanolysin-treated cells resulted in an almost complete solubilization of membrane-associated arylaminopeptidase activities . These observations support the conclusion that the association of arylaminopeptidases with the cell membrane may involve hydrophobic or electrostatic interactions, or both . S . sanguis ATCC 10556 also possessed at least one caseinolytic endopeptidase activity . This activity is most likely located near the membrane surface, as no association with the cell wall was evident . The location of membrane-associated endopeptidase and arylaminopeptidase activities, together with intracellular peptidases, is suggested to provide an efficient mechanism for the hydrolysis and subsequent utilization of polypeptide and oligopeptide substrates as sources of amino acids for growth by this microorganism.

Genitourin Med, 1991 Dec, 67(6), 469 - 74
The vagina of women infected with Trichomonas vaginalis has numerous proteinases and antibody to trichomonad proteinases; Alderete JF et al.; BACKGROUND--Patients with trichomoniasis have serum antibody to numerous T . vaginalis cysteine proteinases, indicating that the proteinases are expressed in vivo . It was important, therefore, to examine for the presence of soluble trichomonad proteinases and/or antibody to the proteinases in the vagina of infected women . METHODS--Vaginal washes (VWs) from 20 women were examined for the presence of proteinases by electrophoresis using acrylamide co-polymerised with gelatin as the indicator system . Antibody to proteinases in VWs was detected by an immunoprecipitation assay involving protein A-bearing Staphylococcus aureus first coated with anti-human immunoglobulin G (IgG) antibody, which was then added to VWs . For VWs having soluble proteinases, the bacteria were used to determine whether immune complexes between antibody and proteinases were present . VWs without soluble proteinases were incubated with the anti-human IgG treated bacteria before adding to detergent extracts of T . vaginalis . Individual isolates from the patients examined in this study were also analysed by one- and two-dimensional electrophoresis for their proteinase content . Finally, VWs were from patients without any history of other sexually transmitted diseases (STDs) as well as from individuals having numerous other STDs, including yeast, group B streptococcus, chlamydia, and syphilis . RESULTS--Approximately one-third of patients had soluble proteinases in the VWs; the remaining two-thirds (70%) of patients and normal women had no detectable proteinases in VWs . Half of the patients without soluble proteinases had IgG which, when bound to S . aureus, immunoprecipitated many proteinases from a detergent extract of T . vaginalis . All soluble proteinases and those precipitated from trichomonal extracts were inhibited by inhibitors of cysteine proteinases . Finally, patients having trichomoniasis in addition to numerous other STD agents, including yeast, group B streptococcus, chlamydia, and syphilis did not have soluble proteinases in VWs . Equally noteworthy, some patients with soluble proteinases in VWs did not have other detectable STD agents . CONCLUSIONS--Proteinases were detected in the vagina of some patients with trichomoniasis, and in most cases the proteinases were complexed with IgG, which was precipitated by S . aureus . Patients without soluble proteinases in VWs also had antibody specifically to trichomonad proteinases, again demonstrating both the expression and immunogenic nature of the proteinases in vivo . The absence of soluble proteinases in normal women and in patients having other STD agents as well as the presence of proteinases in VWs of patients without other detectable STD pathogens reinforced the idea that the proteinases were of T . vaginalis parasite origin . The findings of this study indicate that proteinases may be important to the T . vaginalis-host interrelationship.

Can J Ophthalmol, 1991 Dec, 26(7), 386 - 90
Streptococcal lid necrosis in previously healthy children; Stone L et al.; Fulminant preseptal eyelid cellulitis developed in two previously healthy children, aged 17 months and 8 years, following minor trauma . Despite appropriate intravenous antibiotic therapy, lid necrosis with ulceration developed in both patients . In both cases group A beta-hemolytic Streptococcus was the causative agent . Spontaneous granulation of the ulcerated areas resulted in cicatricial defects, which in one case may require surgical correction . Neither child had a past history of susceptibility to infection . Group A beta-hemolytic Streptococcus has been known to cause lid gangrene, but almost all previously documented cases occurred in debilitated or elderly patients.

Scand J Dent Res, 1991 Dec, 99(6), 498 - 504
Interactions between and within Streptococcus mutans and Streptococcus sobrinus isolated from humans harboring both species; Lindquist B et al.; The prevalence of Streptococcus mutans and Streptococcus sobrinus was examined in plaque samples from small discrete areas of the buccal tooth surfaces of seven subjects . Strains of S . mutans and S . sobrinus were isolated and tested for bacteriocin-mediated interactions between and within the two species, using the stab inoculation technique . S . mutans and S . sobrinus did not colonize each tooth surface uniformly and, in plaque from small discrete sites, S . mutans and S . sobrinus were either undetected or present in different interspecies proportions . Within the same subject, there were no bacteriocin-mediated interactions between strains of the same mutans species and no difference in bacteriocin activity was found between the strains of S . mutans and S . sobrinus from different sites . When bacteriocin interactions were tested between isolated strains from all seven subjects a somewhat higher inhibition ability was found for producer strains isolated from plaque compared with those isolated from saliva . S . mutans appeared to be more bacteriocinogenic than S . sobrinus . Replacing the glucose in the medium with sucrose enhanced the bacteriocin activity of S . mutans towards other S . mutans strains but reduced the inhibitory interaction towards strains of S . sobrinus.

Scand J Dent Res, 1991 Dec, 99(6), 484 - 8
Effect of whole saliva on the rheologic behavior of extracellular water-soluble glucan produced by Streptococcus mutans; Rundegren J et al.; The viscosity of mixtures of Streptococcus mutans water-soluble glucan and stimulated whole saliva or buffer was measured at pH 5, 6, 7, and 8 . The viscosity was measured as a function of shear rate in the range 15 s-1-230 s-1 . Though the centrifuged saliva had a viscosity close to that of water it increased the viscosity of the glucan up to 65% at pH 6 and 55% at pH 7 and at a shear rate of 20 s-1, indicating an interaction between saliva components and glucan that could be an important part of the cohesive forces of plaque matrix . The interaction between saliva and glucan was less pronounced at pH 5 and 8, which indicates a charge-dependent interaction . The viscosity increase at pH 6 and 7 was higher at low than at high shear rates, suggesting a higher contribution to plaque stability when weak as opposed to high mechanical forces are exerted on the plaque.

Epidemiol Infect, 1991 Dec, 107(3), 543 - 55
Genotypic and phenotypic analysis of Streptococcus uberis isolated from bovine mammary secretions; Jayarao BM et al.; Genotypic and phenotypic analysis of 42 strains of Streptococcus uberis isolated from mammary secretions of 17 cows collected at different periods of the lactation cycle and from episodes of clinical mastitis were performed . Seventeen restriction endonuclease fingerprint (REF) patterns and 12 bacteriocin-like inhibitory substance (BLIS) fingerprints were observed . REF identified and differentiated closely related strains of S . uberis isolated from mammary secretions collected from the same cow at different periods of the lactation cycle and from episodes of clinical mastitis . BLIS fingerprinting of S . uberis complemented REF results . REF and BLIS fingerprinting provided evidence concerning persistence of infection in the same quarter or different quarters of the mammary gland over different periods of the lactation cycle, and occurrence of infection with similar and dissimilar strains of S . uberis . Biochemical profiles could not identify closely related strains nor did they complement REF results . Antibiotic resistance patterns alone were of little value in differentiating closely related strains, but were identical with isolates having same REF pattern . None of the S . uberis strains was found to carry plasmids . REF and BLIS fingerprinting can be utilized effectively to differentiate closely related and unrelated strains of S . uberis isolated from bovine mammary secretions.

Am Surg, 1991 Dec, 57(12), 769 - 74
Adjunctive antimicrobials in surgery of soft tissue infections: evaluation of cephalosporins and carbapenems; Lami JL et al.; The authors report three trials of B-lactams and carbapenems for soft tissue infections treated on a surgical service: 1) cefmetazole versus cefoperazone, n = 44; 2) cefotetan versus cefoxitin, n = 24; and 3) meropenem versus imipenem, n = 44 . A total of 138 hospitalized patients were enrolled with 112 meeting evaluability criteria . Four hundred twenty-three isolates were cultured (mean, three/patient) of which 67 per cent were aerobes and 33 per cent anaerobes . Cure rates for each trial were: 1) 93 per cent; 2) 92 per cent; 3) 100 per cent . Failures were caused by resistant organisms (Streptococcus group D, Bacteroides fragilis and Pseudomonas) appearing in incompletely drained infection sites . Three patients receiving meropenem had adverse effects (headache, nausea) and one receiving cefoxitin (truncal rash) . Operative drainage and debridement remain the critical elements in therapy . Agents with longer half lives allowing twice daily dosing (cefmetazole and cefotetan) were as effective and less expensive than multiple doses of short-acting agents . The extended spectrum carbapenems are most useful for severe infections or resistant organisms.

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