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 we