Streptococci

Gene, 1992 Jul 1, 116(1), 35 - 42
In vivo inactivation of the Streptococcus mutans recA gene mediated by PCR amplification and cloning of a recA DNA fragment; Quivey RG Jr et al.; The inactivation of the RecA protein in pathogenic oral streptococci would facilitate genetic analysis of potential virulence factors in these strains . Comparison of recA nucleotide (nt) sequences from a number of bacteria has suggested that two regions of highly conserved RecA amino acid (aa) sequence could be used as a basis for synthesizing degenerate oligodeoxyribonucleotide primers with which to amplify recA homologues from the streptococci . Accordingly, primer mixtures were used to amplify a 693-bp fragment of the Streptococcus mutans chromosome by PCR . The amplified fragment was cloned and its identity confirmed via hybridization to an Escherichia coli recA gene probe and by nt sequence determination . The recA homologue fragment from S . mutans GS-5 was 63% and 75% homologous to the deduced aa sequences of the E . coli and Bacillus subtilis RecA enzymes, respectively . The S . mutans recA fragment was mutagenized in vitro via insertional inactivation and returned to the chromosome using allelic exchange . The resulting strains of S . mutans were shown to be substantially more sensitive to UV irradiation than the wild-type strain . Further, the ability to incorporate linear markers into the chromosome was abolished in putative S . mutans recA strains, thus indicating the functional inactivation of RecA in these microorganisms.

Lancet, 1992 Jul 11, 340(8811), 65 - 9
Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour . The Swedish Chlorhexidine Study Group; Burman LG et al.; Streptococcus agalactiae transmitted to infants from the vagina during birth is an important cause of invasive neonatal infection . We have done a prospective, randomised, double-blind, placebo-controlled, multi-centre study of chlorhexidine prophylaxis to prevent neonatal disease due to vaginal transmission of S agalactiae . On arrival in the delivery room, swabs were taken for culture from the vaginas of 4483 women who were expecting a full-term single birth . Vaginal flushing was then done with either 60 ml chlorhexidine diacetate (2 g/l) (2238 women) or saline placebo (2245) and this procedure was repeated every 6 h until delivery . The rate of admission of babies to special-care neonatal units within 48 h of delivery was the primary end point . For babies born to placebo-treated women, maternal carriage of S agalactiae was associated with a significant increase in the rate of admission compared with non-colonised mothers (5.4 vs 2.4%; RR 2.31, 95% CI 1.39-3.86; p = 0.002) . Chlorhexidine reduced the admission rate for infants born of carrier mothers to 2.8% (RR 1.95, 95% CI 0.94-4.03), and for infants born to all mothers to 2.0% (RR 1.48, 95% CI 1.01-2.16; p = 0.04) . Maternal S agalactiae colonisation is associated with excess early neonatal morbidity, apparently related to aspiration of the organism, that can be reduced with chlorhexidine disinfection of the vagina during labour.

Eur Heart J, 1992 Jul, 13(7), 872 - 7
Native valve infective endocarditis in the general population: a 10-year survey of the clinical picture during the 1980s; Nissen H et al.; In a population of 930,000 inhabitants all records of native valve infective endocarditis diagnosed in the decade 1980-89 were reviewed . Using strict case definitions 132 clinically well-defined or post-mortem diagnosed cases were found . Included were cases referred to the local department of cardiology, as well as cases treated in non-specialized departments . Of 132 cases found 23 were only diagnosed post mortem . The male/female ratio was 71/61 . The median prehospital duration of symptoms was 20 days (range 0-180 days) and the median in-hospital diagnostic delay was 5 days (range 0-54 days) . Known cardiac disease was found in 42% of cases, a possible portal of entry was found in 33%, but in 36% there were no predisposing factors . Remarkably, only two patients had known rheumatic heart disease and none had a known dental focus . During the clinical course 55% experienced cardiac failure and 17% embolic episodes . In 19 patients surgery was required . Of 111 culture-positive cases streptococci were found in 61 and staphylococci in 45 cases . Echocardiography was performed in 95 cases with echocardiographic signs of endocarditis in 65 patients . Overall mortality was 33% with a mortality in clinically diagnosed cases of 18% . Of 14 cases needing immediate surgical intervention, two died.

Am J Perinatol, 1992 Jul, 9(4), 304 - 8
Comparison of rapid tests for detection of group B streptococcal colonization; Walker CK et al.; Accurate rapid detection of maternal lower genital tract colonization with group B streptococci (GBS) in high-risk patients is essential for selective institution of intrapartum antibiotic treatment to reduce neonatal GBS infection . In this study, pure GBS isolates were used to evaluate five commercially available rapid tests in terms of speed, ease of use, and sensitivity . The products tested were Directigen, Equate, Bactigen, PathoDx, and Phadebact . Although each test could be performed relatively quickly, the ease of performance and level of sensitivity (10(5) to 10(8) CFU/ml) varied markedly . Quantitative cultures obtained from 17 known GBS carriers showed concentrations ranging from less than 10(2) to greater than 10(8) CFU/gm of vaginal material . Since only 40% of the women had greater than or equal to 10(5) CFU/gm of vaginal material, it appears that many colonized women would not be identified by these rapid tests.

Infect Immun, 1992 Jul, 60(7), 2636 - 40
Murine model of cutaneous infection with gram-positive cocci; Bunce C et al.; Staphylococcus aureus has remained an important cause of nosocomial wound infections, but standardized or reproducible systems for analyzing cutaneous infections caused by S . aureus do not exist . A variety of foreign materials, variable inocula, and skin traumas have been used to promote infection . To minimize these variables and ensure reproducibility, we chose a model using subcutaneous injections of a fixed quantity of dextran microbeads (Cytodex) as the foreign material added to standardized broth suspensions of S . aureus . Suspensions (0.2 ml) injected into an outbred strain of immunocompetent hairless mice generated reproducible, measurable lesions . With S . aureus Smith Diffuse, fluctuant, erythematous lesions with a peak diameter of 15 mm were observed; these lesions yielded purulent material containing gram-positive cocci and neutrophils and yielded growth of S . aureus on culture . Lesion size was proportional to the bacterial inoculum size . Histologic examination of excised lesions revealed typical abscesses . A second strain of S . aureus (SLC3) produced dermonecrosis instead of abscesses at an inoculum size of 10(7) CFU . Control injections with a sterile Cytodex suspension regularly produced nondraining, nonerythematous nodules with maximum diameters of less than or equal to 5 mm . Streptococcus pyogenes produced late-onset necrotic lesions and abscesses . Using a foreign substance, this model generates easily observed and reproducible cutaneous infection with S . aureus and streptococci that can potentially discriminate between inter- and intrastrain differences . Such a model could be used to test the pathogenicity of isogeneic strains of these bacterial species and to evaluate the efficacy of antimicrobial agents.

J Infect Dis, 1992 Jul, 166(1), 31 - 7
Aspects of pathogenesis of serious group A streptococcal infections in Sweden, 1988-1989; Holm SE et al.; Serotypes of serious, sometimes fatal, streptococcal infections in Sweden during 1988-1989 were analyzed . The T1M1 type totally dominated, representing almost 70% of all group A streptococci from serious and uncomplicated infections at the peak of the outbreak . Immunoblots of isolates from various patient groups showed that all isolates produced high amounts of erythrogenic toxin (ET) B and high amounts of ET-C, whereas ET-A was released only in small amounts and from few isolates . ELISAs showed high antibody levels to these toxins and to the M1 antigen in patients with uncomplicated infections . Low antibody levels against M1 were seen in patients with bacteremia and in fatal cases; the latter also had low antibody levels against ET-B . It seems likely that a combination of production of large amounts of toxin and low antibody titers to it and to the M antigen of the infecting isolate are determining factors for the outcome of the infection . No signs of primary immune deficiency were noted.

J Infect Dis, 1992 Jul, 166(1), 162 - 5
Oral erythromycin prophylaxis against Streptococcus pyogenes infection in penicillin-allergic military recruits: a randomized clinical trial; Fujikawa J et al.; Historically, military recruits have required benzathine penicillin G to prevent epidemics of Streptococcus pyogenes . In this randomized clinical trial, low-dose oral erythromycin was evaluated as an alternative for prophylaxis against group A beta-hemolytic streptococci in penicillin-allergic recruits . US Marine Corps recruits (186) reporting penicillin allergy were randomly given either oral erythromycin (250 mg twice a day) or a vitamin (one tablet daily) for 60 days . Evidence of infection was defined as a two-dilution rise in anti-streptolysin O titer . The erythromycin group had a significantly lower risk of S . pyogenes infection than did the vitamin group (relative risk 0.44; 95% confidence interval, 0.22-0.89) . There was no significant difference among the treatment groups in isolation of group A beta-hemolytic streptococci from throat cultures . Low-dose oral erythromycin appears as effective as benzanthine penicillin G in preventing S . pyogenes infection.

Mikrobiyol Bul, 1992 Jul, 26(3), 253 - 60
{Incidence of Mycoplasma and group B streptococci in the genitourinary system of pregnant women and their effect on pregnancy}; Shokouhizadeh S et al.; This study included 59 pregnant women and their mature infants born in term in order to establish the incidence of potential microorganisms that may transmit through the birth canal to infant and the evidence for vertical transmission in pregnancy . Using isolation studies based on selective methods, it was found that U.urealyticum had the highest incidence with 26 (44%) and Diphtheroid was isolated from 19 (32.2%), Staphylococcus from 17 (28.8%), M.hominis from 16 (27.1%), group B Streptococcus from 8 (13.6%) of genital canal specimens, respectively . It was also found that E.coli with a carriage rate of 6 (50%), M.hominis with 4 (25%) and Diphtheroid with 4 (21%) were transmitted through the birth canal to infant and colonized the conjunctiva and face of infant at birth.

Clin Ther, 1992 Jul-Aug, 14(4), 595 - 602
Intravenous fleroxacin versus ceftazidime for lower respiratory tract and skin and soft-tissue infections; Huston MJ et al.; Fleroxacin, a new quinolone antimicrobial agent, was evaluated as part of a multicenter, comparative, open-label, randomized trial with ceftazidime in the treatment of lower respiratory tract infections and skin and soft-tissue infections . After written informed consent was obtained, 20 patients were entered at our center . Twelve patients were assigned to the fleroxacin group; 6 in each infection category . Of these 12 patients, 2 with pneumonia and 3 with skin and soft-tissue infection were not clinically evaluable . The mean duration of therapy was 5.7 +/- 3.0 days in the fleroxacin group versus 7.9 +/- 2.0 days in the ceftazidime group . The gram-positive organisms responsible for those infections not evaluable were methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, and group F streptococcus, all of which were resistant to fleroxacin . In total, 6 gram-positive isolates were resistant to fleroxacin . All but 2 S aureus isolates were susceptible to ceftazidime . Adverse reactions in both groups were negligible . Fleroxacin was found to be as effective as ceftazidime against a variety of gram-negative pathogens, but local susceptibility patterns for quinolones should be checked before empiric use of fleroxacin against gram-positive pathogens such as streptococci.

Infection, 1992 Jul-Aug, 20(4), 213 - 20
Bacteremia caused by Stomatococcus mucilaginosus: report of seven cases and review of the literature; Kaufhold A et al.; During a three-year period eight patients with blood cultures positive for Stomatococcus mucilaginosus were identified at two university hospitals . One patient without any signs of infection had a central venous catheter that was colonized with this organism, two patients had transient bacteremia without definite relationship to underlying disease, whereas the remaining five patients suffered from clinically significant infections . Of these last five patients, one had undergone prior head and neck surgery and four had hematologic malignancy with mild to severe neutropenia; two of the latter patients developed the infection subsequent to dental surgery . Besides neutropenia and mucosal damage in the oropharynx, quinolone antibacterial prophylaxis may have been an additional risk factor for the development of S . mucilaginosus bacteremia in these patients . A thorough review of the literature revealed that in addition to our findings, endocarditis and foreign body infections are further typical clinical manifestations . Although the overall antibiotic susceptibility pattern of S . mucilaginosus resembles that of streptococci, it is suggested that penicillin G may not be the drug of choice for initial therapy of particularly severe infections . S . mucilaginosus can be easily differentiated from other gram-positive bacteria when certain key criteria (e.g . adherence to agar surfaces, poor growth on Mueller-Hinton agar, presence of a capsule) as well as an array of biochemical tests, including commercially available identification systems, are applied . Our own and published data emphasize that both microbiologists and clinicians should be increasingly aware of this opportunistic pathogen.

FEMS Microbiol Lett, 1992 Jul 1, 73(1-2), 139 - 42
PCR amplification of streptococcal DNA using crude cell lysates; Hynes WL et al.; Gram-positive organisms such as streptococci and enterococci are often difficult to lyse . Obtaining DNA for procedures such as PCR amplification usually requires a large scale isolation for each strain under investigation . We describe a simple procedure for small volumes of whole cells, involving pretreatment with detergent and proteinase that allows for efficient release of DNA for PCR amplification . This procedure is fast, reproducible, can be used with a large number of samples, and has been successfully applied to a variety of streptococcal and enterococcal strains.

Zentralbl Bakteriol, 1992 Jul, 277(2), 260 - 6
Serotyping and further characterization of group B streptococcal isolates from Indonesia; Wibawan IW et al.; Serotyping of 103 streptococci of serological group B isolated from human clinical specimens in Indonesia revealed mainly type pattern Ia/c and type patterns III and V, either alone or in combination with protein antigens c or R . Few cultures had serotype II and IV, none of the cultures had type antigen Ib or X . Extracts of one group B streptococcal culture reacted with antibodies specific to type antigens II, IV and R and one culture with antibodies specific to candidate type 7271 . Protein antigen c was present as c alpha, c alpha, beta but not as c beta component . Group B streptococci with type antigen R grew generally as a granular sediment with clear supernatant, formed compact colonies in soft agar and reacted positively in the salt aggregation test . Group B streptococci without surface antigen R grew mainly with a uniform turbidity of the growth media, formed diffuse colonies in soft agar and were negative in the salt aggregation test.

Arch Dis Child, 1992 Jul, 67(7 Spec No), 797 - 801
Development of cutaneous microflora in premature neonates; Keyworth N et al.; Coagulase-negative staphylococci (C-NS) are a frequent cause of bacteraemia in premature neonates . It is likely that the strains of C-NS causing bacterial sepsis in premature neonates have their origin on the patient's skin surface . We have studied the quantitative development of the skin microflora at eight sites on premature neonates . A swab wash method was used to sample and enumerate the cutaneous microflora of premature neonates admitted to an intensive care unit with respiratory distress syndrome . The numbers of bacteria present on the skin increased rapidly by 100-fold in the first week of life . The species of C-NS found on neonatal skin were similar to those found on adult skin . However, the bacterial population was 10(3) lower by comparison . There was considerable variation in numbers of bacteria and in the proportion resistant to antibiotics from day to day . There appeared to be no association between antibiotic usage and the proportion of isolates resistant to antibiotics, although the resident bacteria were in many cases resistant to a variety of antibiotics . C-NS were isolated from 92% of samples from which bacteria were isolated . Staphylococcus epidermidis was found at all sites and accounted for 82% of each colonial type of staphylococcus isolated . Other organisms isolated included Propionibacterium sp, alpha-haemolytic streptococci, aerobic spore-bearing bacilli, aerobic coryneforms, Candida albicans, Klebsiella oxytoca, Pityrosporum sp, Klebsiella pneumoniae, and Escherichia coli . The results of this study suggest that the skin of premature neonates is colonised with antibiotic resistant C-NS during the first week of life and that the chance of contamination of an intravascular catheter at insertion increases during this period.

Zentralbl Veterinarmed B, 1992 Jul, 39(5), 376 - 82
Relationship between group B streptococcal serotypes and cell surface hydrophobicity; Wibawan IW et al.; Cell surface hydrophobicities of streptococci of serological group B were determined by the adherence of the bacteria to hexadecane droplets . A significant adherence to hexadecane was observed with the group B streptococcal type reference strains Ib, V, Ic, R and X, but not with those of serotype Ia, II, III and IV . Cultivation of the bacteria in microcapsule-inducing media reduced the hexadecane adherence properties . The adherence to hexadecane was not related to fibrinogen binding properties of the cultures . Screening a large number of group B streptococci isolated from humans and bovines revealed that those with polysaccharide type antigen alone were generally hydrophilic, those with protein antigen alone or with protein antigen in combination with polysaccharide antigen were mostly hydrophobic . Cultivation of the bacteria under microaerobic conditions or after a single mouse passage enhanced microcapsule production and correspondingly reduced the hexadecane adherence values . Treatment of the bacteria by guanidinium chloride or by neuraminidase enhanced the hexadecane adherence . The hydrophobic component on group B streptococcal surface appeared to be partly inactivated by heat or proteolytic treatment of the bacteria.

J Antibiot (Tokyo), 1992 Jul, 45(7), 1125 - 32
Tirandalydigin, a novel tetramic acid of the tirandamycin-streptolydigin type . I . Taxonomy of the producing organism, fermentation and biological activity; Karwowski JP et al.; Tirandalydigin is a new tetramic acid antibiotic which was discovered in a screen designed to find compounds with activity against pathogenic anaerobic bacteria . It was named tirandalydigin because it possesses structural features that are common to both tirandamycin and streptolydigin . The producing culture, strain AB 1006A-9, is a Streptomyces and was compared to the streptomycetes that synthesize tirandamycin and streptolydigin . It is closely related to the former culture and was named Streptomyces tirandis subsp . umidus . Tirandalydigin has MICs in the range of 0.5 to 32 micrograms/ml against many pathogenic anaerobes, streptococci, enterococci and legionellae.

Gastrointest Endosc, 1992 Jul-Aug, 38(4), 444 - 9
Bacteremia following diagnostic and therapeutic ERCP; Kullman E et al.; The occurrence of bacteremia in association with diagnostic or therapeutic ERCP was studied in 180 patients undergoing a total of 194 examinations . Nineteen (15%) of 126 diagnostic procedures and 18 (27%) of 68 therapeutic procedures were associated with bacteremia (p less than 0.1) . Nine patients had polymicrobial bacteremia and a total of 16 species were detected . Different streptococci, mainly alpha-hemolytic, were the most common bacteria which were identified in 38% of the bacteremic patients . There were no significant differences with regard to the occurrence of fever, pancreatitis, or septic complications between the diagnostic and therapeutic groups of patients . Neither did the complication rate in patients with bacteremia differ from that in patients without bacteremia, whether the procedure was diagnostic or therapeutic . Complication rates did not differ between patients with and patients without pancreaticobiliary obstruction . However, the majority of patients with biliary stasis had drainage with relief of the obstruction at the time of the diagnostic ERCP . We conclude that general routine antibiotic prophylaxis is not indicated in patients undergoing diagnostic or therapeutic ERCP . The question whether such prophylaxis should be given with certain diagnoses or treatments, or in patients with valvular heart disease, remains to be answered in controlled randomized studies.

Immun Infekt, 1992 Jul, 20(3), 92 - 8
{Epidemiology and pathogenesis of streptococcal infection}; Kohler W; The appearance of the "streptococcal toxic shock-like syndrome" led to a growing interest in infections caused by Streptococcus pyogenes (group-A-streptococci) . Since 1987 some 800 cases with a lethality of 20% or more were observed . Contrary to toxic scarlet fever the site of primary infection are the lower respiratory tract or soft tissue infections . Erythrogenic toxins and low molecular weight mitogens, inducing cytokines (IL-2, IL-3, IL-6, TNF-alpha, IFN-gamma) seem to be involved in the pathogenesis of these severe infections . Morphologically and culturally the strains isolated from cases of toxic shock-like syndrome cannot be differentiated from isolates of epidemic scarlet fever or sporadic cases . At the same time, when in Scandinavia an epidemic by S.pyogenes type 1 with many cases of toxic shock was observed, the same type caused a scarlet fever epidemic without complications in eastern Germany . Erythrogenic toxin type A or its toxoid, respectively, can be used for successful immunizations of rabbits . Another--antibacterial-immunization can be done with the M-protein of S.pyogenes, which is limited by its type-specificity . Streptococcal vaccination is required especially for developing countries with a high incidence of rheumatic fever . Infections due to Streptococcus agalactiae (group-B streptococci) are often underestimated though they have a first position in septicemia and meningitis of newborns . Taxonomy and nomenclature of streptococci are often changing; a list of the presently known species is presented in table I.

Cent Afr J Med, 1992 Jul, 38(7), 263 - 81
The causes of perinatal mortality in Bulawayo, Zimbabwe; Aiken CG; The causes of all perinatal deaths at Mpilo Maternity Hospital were investigated over a 12-month period, during which there were a total of 466 stillbirths and 379 neonatal deaths, with a perinatal mortality rate of 36.0/1000 births in Bulawayo, Zimbabwe . The causes of death were in order of importance; congenital syphilis (20.5 pc), birth asphyxia (18.8 pc), unexplained stillbirths (11.8 pc), hyaline membrane disease (11.5 pc) neonatal septicaemia (10.8 pc), congenital malformations (7.7 pc), pregnancy induced hypertension (5.4 pc), placental abruption (4.9 pc), congenital infection (2.2 pc) and other causes (6.4 pc) . Eleven pc of mothers booking in antenatal clinics had positive syphilis serology . Most were successfully treated . But over 400 mothers with early syphilis escaped treatment usually because they booked late or failed to book at all at antenatal clinics (74 pc) and occasionally because they had false negative results or were infected after early booking (27 pc) . They delivered 101 stillbirths, most of whom died prematurely before labour and often had abdominal distension . There were 72 neonatal deaths, most of whom were preterm babies with respiratory distress and often hepatosplenomegaly . One half of the deaths from asphyxia were caused by prolonged obstructed labour and one quarter by prolapsed cord, stuck head in breech delivery and retained second twin . The incidence of both early and late onset neonatal septicaemia was very high with Group B Streptococci, Kliebsiella and Staphylococcus aureus the predominant pathogens . Improved antenatal, intrapartum and neonatal care could substantially reduce the perinatal mortality rate by preventing congenital syphilis and birth asphyxia and by treating hyaline membrane disease and neonatal septicaemia.

West J Med, 1992 Jul, 157(1), 55 - 9
Do we need an intravenous fluoroquinolone?
Maddix DS, Warner L.
Intravenous ciprofloxacin, the first parenteral fluoroquinolone available in this country, represents another class of antimicrobial agents from which physicians must choose when treating nosocomial infections . Fluoroquinolones are bactericidal antimicrobial agents that act by inhibiting DNA gyrase . They are active in vitro against most gram-negative bacteria and methicillin-susceptible staphylococci . Activity against anaerobic bacteria and streptococci is poor . The rapid development of bacterial resistance in centers with high quinolone usage is of great concern . Resistance develops most commonly in Pseudomonas aeruginosa and staphylococci . Resistance emerges most often when quinolones are used to treat chronic infections or in patients with poorly drained abscesses, necrotic tissue, or indwelling catheters . Clinical trials have shown ciprofloxacin to be as effective as ceftazidime in the treatment of infections caused by gram-negative bacteria . Although the overall frequency of side effects to fluoroquinolones is low, seizures and allergic reactions have been attributed to their use . Ciprofloxacin inhibits the metabolism of theophylline, and morbidity and death have been reported in patients taking the two drugs concomitantly . Parenteral fluoroquinolones should be reserved for the treatment of gram-negative bacterial infections in patients in whom standard agents cannot be used.

J Antimicrob Chemother, 1992 Jul, 30 Suppl A, 25 - 8
The in-vitro activity of RP 59500 against gram-positive cocci; Goto S et al.; RP 59500 was more potent than erythromycin, josamycin, amoxycillin and ciprofloxacin, and as potent as vancomycin, against staphylococci and enterococci . Against streptococci, the activity of RP 59500 was very similar to that of amoxycillin, but was superior to that of erythromycin, josamycin, vancomycin or ciprofloxacin . Compared with the other antimicrobial agents tested, RP 59500 was the most active against erythromycin-resistant Gram-positive cocci.

Gen Pharmacol, 1992 Jul, 23(4), 639 - 42
Cefaclor concentrations in human serum, gingiva, mandibular bone, and dental follicle following a single oral administration; Akimoto Y et al.; 1 . Cefaclor concentrations in human serum (n = 59), gingiva (n = 46), mandibular bone (n = 39), and dental follicle (n = 42) following a single oral administration of cefaclor (500 mg) were measured by the paper disk method . 2 . The peak times of serum, gingiva, mandibular bone, and dental follicle were 1.5, 2, 2, and 1.5 hr, respectively . 3 . The mean peak concentrations of serum, gingiva, mandibular bone, and dental follicle were 7.58 micrograms/ml, 3.71, 1.59 and 2.42 micrograms/g, respectively . 4 . The concentration ratios of gingiva/serum, mandibular bone/serum, and dental follicle/serum at peak times of the tissues were 0.49, 0.18, and 0.32, respectively . 5 . Mean cefaclor concentrations in gingiva, mandibular bone, and dental follicle at peak times exceeded MIC for 90% for clinically isolated strains of alpha-hemolytic Streptococci.

Int J Biochem, 1992 Jul, 24(7), 1073 - 9
Purification and characterization of streptolysin O from Streptococcus pyogenes; Canalias F et al.; 1 . Streptolysin O, an exotoxin produced by group A beta-hemolytic streptococci, has been purified from Streptococcus pyogenes culture supernatants . 2 . The isolation and purification procedure involved ammonium sulphate and polyethylene glycol precipitations, and ion-exchange chromatographies on CM-Sepharose and Mono Q . 3 . The proposed procedure introduces two ion-exchange chromatography steps making the purification process simpler and, especially, more reproducible than other described protocols . 4 . The purified streptolysin O was hemolytically active, had a specific activity of 415,000 HU/mg, an optimum pH of 7.0, a relative molecular mass of 60,100 and an isoelectric pH of 7.5.

J Hosp Infect, 1992 Jul, 21(3), 231 - 40
A study of 245 infected surgical wounds in Singapore; Esuvaranathan K et al.; The aims of the study were to correlate the laboratory detection rate of wound infections with the actual wound infection rate, and to analyse the bacteriology of these wounds to provide a rationale for antibiotic usage in prophylaxis and treatment of surgical wound infections . The wound infection rate in a general surgical unit was determined using the most comprehensive surveillance available to us and was correlated with the laboratory detection rate . A correlation coefficient of 0.8 was obtained, allowing a reasonable estimation of the actual wound infection rate from laboratory data . Review of the bacteriology of consecutive infected surgical wounds over a 4 year period in a university hospital, revealed that the commonest organisms cultured were Staphylococcus aureus, Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, enterococci and beta-haemolytic streptococci . Methicillin-resistant S . aureus (MRSA) caused 50% of all staphylococcal wound infections . All MRSA isolates were sensitive to fusidic acid and vancomycin . All the non-MRSA isolates of S . aureus were sensitive to cephalexin . Some 89% of E . coli were sensitive to gentamicin, with 93% and 100% sensitive to cefuroxime and ceftriaxone respectively . Klebsiella isolates have shown an increased resistance to aminoglycosides, with a new strain from one patient, isolated in 1990, resistant to penicillins, aminoglycosides and third generation cephalosporins . Pseudomonas spp., enterococci and beta-haemolytic streptococci did not show a change in resistance patterns over the same time period.

J Infect Dis, 1992 Jul, 166(1), 165 - 9
Streptococcal pyrogenic exotoxin A and streptolysin O enhance polymorphonuclear leukocyte binding to gelatin matrixes; Bryant AE et al.; Autopsy data from cases of streptococcal toxic shock demonstrate accumulation of polymorphonuclear leukocytes (PMNL) within lung and soft tissue microvasculature . Because of the increased prevalence of streptococcal pyrogenic exotoxin A (SPEA)-producing strains associated with streptococcal toxic shock syndrome, experiments were done to determine whether SPEA or streptolysin O (SLO, a thiol-activated cytolysin produced by all group A streptococci) could stimulate PMNL-dependent adherence mechanisms in vitro . SPEA (0.01-10 micrograms/5.5 x 10(6) PMNL) only modestly enhanced PMNL adherence over the entire range of concentrations tested . In contrast, SLO-induced PMNL binding was highly dose dependent (maximal binding, 55.1 +/- 1.6% at 0.5 hemolytic units/5.5 x 10(6) PMNL) and was mediated by CD11/CD18 adherence glycoprotein.

Mol Gen Mikrobiol Virusol, 1992 Jul-Aug, (7-8), 7 - 10
{Kasugamycin methylase modified by ribosomal RNA from group A streptococci}; Ravdonikas LE et al.; Kasugamycin sensitivity in Escherichia coli depends on the specific enzyme methylating rRNA . Native group A streptococci (GAS) were found to be sensitive to kasugamycin . After introduction of the erythromycin gene located on the transposon Tn916E into GAS some of the strains obtained kasugamycin resistance together with erythromycin resistance (erm) . One of these strains carrying the transposon in its chromosome was tested for methylase activity . It was demonstrated to be deficient in kasugamycin methylase (ksg) . The presented data proves the presence of ksg methylase in GAS . Evolutionary relationship between erm and ksg genes is discussed.

Roum Arch Microbiol Immunol, 1992 Jul-Sep, 51(3), 165 - 70
Group B streptococci implicated in the etiology of acute pneumopathies in neonates; Gulan L et al.; 111 neonates with acute respiratory insufficiency and/or severe pneumopathy (pneumonia, bronchopneumonia) occurring in the first 10 hours after birth were investigated during January 1990-September 1991 for the group B streptococci presence . 430 samples from these neonate cases: throat and nose exudates, necroptic material from died neonates (pulmonary, blood, bronchial secretion) and their mothers (lochia, vaginal and uterine secretion) were examined . 33% of the neonates and their mothers were positive with the same GBS . 65.30% from the GBS strains belonged to serotype Ia and 34.70% to Ib . 24.48% from the GBS strains were resistant to Penicillin G by diffusimetric method with a corresponding MIC of 0.1 UP/ml (22.12%) and 0.5 UP/ml (2.65%).

Presse Med, 1992 Jun 13, 21(22), 1022 - 4
{Deep venous thromboses in erysipelas of the leg . A prospective study of 40 cases}; Mahe A et al.; The treatment of lover limb erysipelas rests on antibiotic therapy directed against streptococci, but the necessity of prescribing a concomitant anticoagulant treatment has not yet been established . The incidence of deep vein thrombosis in patients with erysipelas of the leg in unknown . In a prospective study of 40 patients presenting with this type of skin disease, we looked for deep vein thrombosis, using systematically pulsed Doppler vein exploration combined with ultrasonography and, if necessary, a second Doppler examination and a phlebography . Six cases of deep vein thrombosis were diagnosed . This complication was observed in 5 patients at high risk for deep venous thrombosis; it had never been foreseen at clinical examination.

Pediatr Res, 1992 Jun, 31(6), 640 - 4
Oxygen free radicals and the cerebral arteriolar response to group B streptococci; McKnight AA et al.; We used a cranial window preparation to observe the effects of direct application of group B streptococci to the surface of the brain in the adult rat . Continuous exposure to group B streptococci at concentrations of 10(3) and 10(5) organisms/mL caused progressive dilation of surface (pial) cerebral arterioles that became statistically significant (p less than 0.05) after 2.5 h . These results were reproduced with heat-killed organisms at the same concentration, but not with a bacteria-free filtrate of the growth medium . In separate studies, we found that infusion of alkaline cerebrospinal fluid (pH = 7.8) into the window did not reverse vasodilation, suggesting that it was not due to progressive cerebrospinal fluid acidosis . A solution of nitroblue tetrazolium infused into the window at the end of a 3-h exposure to the organism was promptly reduced, suggesting the presence of oxygen free radicals . Treatment with i.v . polyethylene glycol-superoxide dismutase and polyethylene glycol-catalase in doses of 10,000 and 20,000 U/kg, respectively, was itself without effect on pial arterioles, but treatment with these compounds before exposure to group B streptococci eliminated the vasodilation . These data support a role for oxygen free radicals in the pathogenesis of pial arteriolar dysfunction induced by exposure to group B streptococci.

Arch Ophthalmol, 1992 Jun, 110(6), 798 - 801
Endophthalmitis caused by streptococcal species; Mao LK et al.; The medical records of 48 patients with culture-positive streptococcal endophthalmitis diagnosed between January 1977 and May 1990 were reviewed . The viridans group streptococci were isolated in 24 (50%) of the 48 cases, enterococci in 13 cases (27.1%), Streptococcus pneumoniae in six cases (12.5%), and beta-hemolytic streptococci in six (12.5%) of 48 cases . The clinical statuses of endophthalmitis cases by etiology were postoperative in 40 patients (83.3%), posttraumatic in six patients (12.5%), and miscellaneous in two patients (4.2%) . Overall, 15 (31.2%) patients achieved 20/400 or better visual acuity . The streptococcal isolates demonstrated a 32.6% in vitro resistance to gentamicin sulfate, whereas all isolates were sensitive to vancomycin hydrochloride . The enterococci were often resistant to the cephalosporins, whereas the other streptococcal species were not.

J Bacteriol, 1992 Jun, 174(11), 3739 - 49
Group B streptococcal opacity variants; Pincus SH et al.; Colony opacity variants were detected for type III group B streptococci (GBS) . Transparent colonies predominate in the parent GBS, with occasional colonies having opaque portions . Two stable opaque variants (1.1 and 1.5) were compared with three transparent clones (1.2, 1.3, and 1.4) . All grew well on blood agar and on GC medium, but variant 1.1 failed to grow on Todd-Hewitt medium . Scanning and transmission electron microscopy demonstrated that colony opacity correlated with bacterial aggregation status, with opaque variants forming longer and more organized chains . Opaque-transparent switches were observed in both directions for most variants, with transparent to opaque noted most frequently, but 1.5 did not switch at all . Switching of the opacity phenotype was observed both in vitro and in neonatal mice . Relationships between colony opacity and several cell surface phenomena were explored . (i) Opaque variant 1.1 had two surface proteins (46 and 75 kDa) that were either unique or greatly overexpressed . (ii) Variant 1.1 was deficient in type III polysaccharide, while 1.5 lacked group B antigen . Diminished capsular polysaccharide of variant 1.1 was reflected in reduced negative electrophoretic mobility and in increased buoyant density . (iii) Transparent variant colonies growing closest to a penicillin disk were opaque, but colonial variants did not differ in their sensitivity to penicillin . These data indicate that GBS can exist in both opaque and transparent forms, with opaque appearance occurring by multiple routes . Opaque variants grow poorly on Todd-Hewitt medium generally used for isolation of GBS, so any possible relationships between opacity variation and pathogenesis of GBS infection are unknown.

J Biol Buccale, 1992 Jun, 20(2), 85 - 90
Antimicrobial factors of saliva in relation to dental caries and salivary levels of mutans streptococci; Tenovuo J et al.; The possible association between salivary non-immunoglobulin (lysozyme, lactoferrin, hypothiocyanite, agglutinins) or immunoglobulin (total IgA, anti-Streptococcus mutans IgA) antimicrobial factors, and the prevalence of dental caries was studied in 59 young adults . These antimicrobial factors were also analysed in relation to the salivary levels of mutans streptococci (MS) . The amount of MS correlated significantly (+0.31, p less than 0.05) with the number of initial caries lesions (Di) but not with other caries indices (DMFT, DMFS, DS) . The group with no Di (N = 17) had significantly (p less than 0.05) more hypothiocyanite (HOSCN/OSCN-) and anti-S . mutans IgA antibodies in whole saliva than those with initial caries lesions (N = 42) . None of the antimicrobial factors alone showed any significant association with salivary MS counts . Our results suggest that HOSCN/OSCN- and anti-S . mutans IgA may be involved in the prevention of the early phases of dental caries.

Ann Hematol, 1992 Jun, 64(6), 260 - 5
Prevention of viridans-group streptococcal septicemia in oncohematologic patients: a controlled comparative study on the effect of penicillin G and cotrimoxazole; Guiot HF et al.; In a controlled randomized study among 48 patients undergoing 75 courses of aggressive antileukemic therapy, it was shown that cotrimoxazole was less effective than penicillin G in preventing septicemia due to viridans streptococci . Both antibiotics were given intravenously . During 35 episodes of chemotherapy in the group of patients on penicillin G only, one patient developed a streptococcal bacteremia; this contrasted with bacteremia and septicemia in seven patients during 40 episodes in the group on cotrimoxazole . In three of these seven patients, septicemia was associated with respiratory failure and it was the cause of death in one . Both aerobic gram-negative rods and streptococci which caused infection despite cotrimoxazole prophylaxis were resistant to cotrimoxazole . Side effects such as hypersensitivity and favorable or unfavorable interaction with the oral selective decontamination regimen were similar for the two drugs, with the exception of colonization with Candida spp, which occurred more often in patients on cotrimoxazole than in patients on penicillin.

Pediatr Res, 1992 Jun, 31(6), 596 - 600
Effects of pentoxifylline on the cardiovascular manifestations of group B streptococcal sepsis in the piglet; Del Moral T et al.; Pentoxifylline (PTXF) is a methylxanthine that modifies leukocyte function and inhibits cytokine release . To evaluate its effects on the cardiovascular manifestations of sepsis secondary to group B streptococci, 14 anesthetized, mechanically ventilated piglets were studied over a 240-min period . Animals were randomly assigned to a treatment group that received a PTXF bolus (20 mg/kg) followed by a continuous infusion of 5 mg/kg/h before and during group B streptococci (1 x 10(8) colony forming units/kg/min) administration and a control group that received saline as a placebo . Comparison of the hemodynamic measurements and arterial blood gases during the first 90 min of PTXF treatment with those of the control group resulted in the following 90 min values: systemic arterial blood pressure was significantly higher in the PTXF group (89 +/- 10 versus 56 +/- 30 mm Hg; p less than 0.005) as was cardiac output (0.18 +/- 0.04 versus 0.10 +/- 0.07 L/kg/min; p less than 0.005) . Pulmonary vascular resistance remained lower in the PTXF-treated animals (135 +/- 117 versus 248 +/- 119 mm Hg/L/min/kg; p less than 0.001), and these animals were less acidotic as measured by pH (7.07 +/- 0.2 versus 7.31 +/- 0.1; p less than 0.05) and base deficit (-15 +/- 9 versus -5 +/- 2 mmol/L; p less than 0.05) . Median survival time was significantly longer in the PTXF group (210 versus 90 min; p less than 0.002) . These data demonstrate that PTXF can ameliorate some of the deleterious hemodynamic manifestations of group B streptococci sepsis and result in improved survival in a young animal model.

Geburtshilfe Frauenheilkd, 1992 Jun, 52(6), 335 - 9
{B-streptococci in obstetrics--risks and consequences of maternal colonization and neonatal contamination}; Grischke EM et al.; 2,373 mothers and their newborn were studied during two years with respect to B streptococci colonisation or contamination . Bacteriological, vaginal and anal smears were taken from mothers at the beginning of parturition, as well as the amnion and the aspirated stomach contents of the newborn, employing, in each case, conventional culture methods and a latex agglutination test as a rapid testing method . Smears from the ears were also taken from the newborn for bacteriological examination . The vertical transmission and its possible influencing variables were examined in 1,328 mother/child pairs of the first observation year . Surface contamination of the newborn was confirmed in 10% in at least one smear . In the group of mothers with B streptococci colonisation, the amnion showed the highest rate of contamination (43%), followed by the aspirated stomach contents (26%) and the ear smears (taken from each side separately) with 28% and 30% respectively . Vertical transmission was decisively influenced by vaginal maternal colonisation (50% of the cases resulting in contamination of newborn), whereas anal colonisation, if it was the only site of colonisation, resulted in contamination of newborn in only 32% of the cases . The rate of contamination of newborn dropped significantly from 50% to 20% after intrapartal antibiotic prophylaxis, the latter appearing to be meaningful only after at least 6 hours of exposure . In this group, the surface contamination could be reduced from 61% to 8% . A group of newborn suffering from early onset of sepsis (0.4%), was compared with a group of 13 newborn at risk of infection (0.9%) with established surface contamination and clinical or laboratory chemistry confirmation of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Marrow Transplant, 1992 Jun, 9(6), 409 - 13
A scheme for daily monitoring of oral mucositis in allogeneic BMT recipients; Donnelly JP et al.; A system was developed for scoring oral mucositis in order to investigate its connection with fever and bacteraemia due to 'viridans' streptococci . A series of 42 allogeneic bone marrow transplant recipients given demethoxydaunorubicin and total body irradiation for conditioning therapy were monitored daily for the presence of lesions, erythema, oral oedema, pain and dysphagia, each of which was graded numerically at four levels . These values were added together to yield a daily mucositis score (DMS) with a scale of 0-15 . Mucositis developed shortly after transplant and progressed within a few days to grade III (WHO grade 3-4) in the majority of patients . Bacteraemia due to 'viridans' streptococci was documented in 64% of cases and the organisms were first detected as fever developed and mucositis approached its peak . The WHO scheme defined mucositis as either absent or grade 3-4 corresponding to a DMS of 4 or 5, whereas a grading system based on the most pronounced sign or symptom resulted in three grades of severity which corresponded to a DMS of less than or equal to 4, 5-9 and greater than or equal to 10 respectively . However, only the DMS permitted monitoring of mucositis through all its stages of development . The scheme therefore offers the potential for exploring causal relationships between mucosal damage, granulocytopenia, fever and bacteraemia and can be included as an independent measure in studies of prevention and therapy of complications related to mucositis.

J Dent, 1992 Jun, 20(3), 163 - 6
Mutans streptococci in margins of fillings and crowns; Wallman C et al.; A significant correlation was found between the number of mutans streptococci in saliva and the proportional distribution of these microorganisms in pooled plaque from the margins of all restorations . At high salivary numbers there was a tendency towards a higher porportion of mutans streptococci in plaque from the margins of separate restorations . At low and medium salivary numbers, plaque samples could, however, contain greater than 10 per cent mutans streptococci and even less than 1 per cent was found in plaque from margins of restorations at high salivary numbers . The reproducibility of the plaque sampling method was good . Plaque material collected on different occasions from the same margins did not vary significantly in terms of proportions of mutans streptococci . The numbers of mutants streptococci in plaque samples from different restorations of the same kind collected on the same occasion in the same mouth could, however, show a considerable variation . The observations made in this study, indicate that a low salivary number of mutans streptococci does not exclude a high proportion of these microorganisms in plaque from the margins of separate restorations . This has to be considered when efforts are made to reduce the risk of recurrent decay.

J Clin Pathol, 1992 Jun, 45(6), 475 - 8
Clinical comparison of Sentinel, a novel blood culture system, with radiometric Bactec 460 and Isolator 10 in the detection of streptococcal and anaerobic bacteraemias; Hutchinson NA et al.; AIMS: To compare the performance of the Sentinel blood culture system with two other systems for the recovery of streptococci and anaerobes . METHODS: Blood cultures were taken from 55 patients one to two minutes after dental extraction . The samples were tested by the radiometric Bactec 460; the Isolator 10, which works by lysis centrifugation; and Sentinel, a fully automated system, which detects bacterial growth by changes in the voltage between two electrodes in the media . Positive samples were subcultured and streptococci and anaerobes were further identified . Terminal subcultures were performed on all negative samples . RESULTS: Sentinel was comparable with Bactec, with Sentinel recovering 20 streptococci and 14 anaerobes; Bactec isolated 26 streptococci and 15 anaerobes . The recovery of Streptococcus sanguis was significantly better from Bactec than Sentinel . The Isolator 10 recovered significantly fewer streptococci and anaerobes than either Bactec or Sentinel . Sentinel was noticeably quicker in detecting anaerobes than Bactec 460 . However, there was no comparable difference with streptococci . Contaminants were recovered from 10% of Isolator 10, 2.7% of Bactec, and 7.2% of Sentinel bottles . CONCLUSIONS: Sentinel and Bactec 460 were broadly comparable in the detection of viridans streptococci and oral anaerobes, and both systems were significantly better than the Isolator 10 . However, the prototype Sentinel, was significantly poorer than Bactec for the recovery of S sanguis.

Clin Infect Dis, 1992 Jun, 14(6), 1251 - 3
Antimicrobial treatment of orthopedic implant-related infections with rifampin combinations; Widmer AF et al.; The purpose of this prospective clinical study is to evaluate the role of combination chemotherapy with rifampin in the treatment of orthopedic device-related infections in which the implant could not be removed . Eleven patients with orthopedic implant-related infections due to staphylococci or streptococci were treated with the implant in situ . Each antimicrobial regimen included rifampin in combination with a beta-lactam antibiotic or ciprofloxacin . The median duration of treatment with rifampin was 86 days (range, 15-336 days) with a median follow-up of greater than 24 months after cessation of therapy . Treatment was successful for 82% of patients . Failures were associated with documented inappropriate treatment . These preliminary clinical data are supported by data from in vitro studies and animal experiments . Combination therapy with rifampin, in particular rifampin and a quinolone, should be considered for patients with orthopedic implant-related infections if the implant cannot be removed.

Clin Infect Dis, 1992 Jun, 14(6), 1201 - 7
Septicemia and shock syndrome due to viridans streptococci: a case-control study of predisposing factors; Elting LS et al.; Between 1972 and 1989, the incidence of viridans streptococcal bacteremia at the University of Texas M . D . Anderson Cancer Center in Houston increased from one case per 10,000 admissions to 47 cases per 10,000 admissions (P less than .0001) . A shock syndrome characterized by hypotension, rash, palmar desquamation, adult respiratory distress syndrome, and occasionally death developed in 26% of cases of streptococcal septicemia but in only 4% of cases of septicemia involving other gram-positive bacteria (P = .0005) . The risk of streptococcal infection increased with the prophylactic administration of trimethoprim-sulfamethoxazole or a fluoroquinolone (P less than .0001) and with profound neutropenia (P less than .0001) . Treatment of chemotherapy-induced gastritis with antacids or with histamine type 2 (H2) antagonists was associated with a sevenfold increase in risk (P less than .001), while sucralfate therapy did not increase risk (P = .65) . Streptococcal infection may result from gastric overgrowth of organisms resistant to trimethoprim-sulfamethoxazole in an antacid- or H2 antagonist-induced alkaline environment, with the gastrointestinal tract ulceration caused by antineoplastic therapy providing a convenient portal of entry . In patients receiving chemotherapy, replacement of antacids or H2 antagonists by an acid-sparing regimen should be considered to preserve the natural acidic barrier to infection.

Mil Med, 1992 Jun, 157(6), 282 - 3
A new Streptococcus group A M-29 variant isolated during a suspected common-source epidemic; Gillis D et al.; In the summer of 1988, a large epidemic of acute pharyngitis occurred in an Israeli military base . The clinical features were those of acute pharyngitis . The epidemic curve was characteristic of a common-source outbreak, possibly food-borne . Throat swabs from a sample of cases were positive for group A streptococci . Nine isolates from the epidemic were further evaluated at the local reference laboratory and serotyping showed that all were of the same strain with a distinct M protein that is a hitherto undescribed variant of M-29 . We discuss the significance of unusual strains of beta-hemolytic Streptococcus appearing in food-borne outbreaks.

Clin Infect Dis, 1992 Jun, 14 Suppl 2, S224 - 30; discussion S231-2
Treatment of pharyngitis and tonsillitis with cefprozil: review of three multicenter trials; McCarty JM et al.; Cefprozil is a new oral cephalosporin with an in vitro spectrum of activity that includes group A beta-hemolytic streptococci (Streptococcus pyogenes) . Three multicenter, randomized trials were conducted for comparing the clinical efficacy and safety of cefprozil administered once or twice daily with that of cefaclor, penicillin, or erythromycin ethylsuccinate administered three or four times daily in the treatment of mild-to-moderate tonsillopharyngitis . In the cefprozil-cefaclor trial, the pathogen eradication rate for evaluable patients receiving cefprozil was 83%, which was significantly better than that for patients receiving cefaclor (76%) (P = .035) . The rate of satisfactory clinical response was similar with cefprozil (89%) and cefaclor (84%) . The overall response rate was significantly better with cefprozil (80%) than with cefaclor (72%, P = .018) . Differences in response rates were not noted when analyzing only patients 2-12 years of age . In the cefprozil-penicillin trial, the eradication rate of bacteriologic pathogens was similar in patients receiving cefprozil (91%) and in patients receiving penicillin (87%) . A satisfactory clinical response was seen in 95% of the evaluable cefprozil-treated patients, which was significantly better than the rate of satisfactory clinical response seen in the penicillin-treated patients (88%; P = .023) . In addition, during-therapy cultures for penicillin-treated patients yielded a significantly higher rate of beta-lactamase-producing Staphylococcus aureus than did those for the group of cefprozil-treated patients (13% vs . 4.5%, respectively; P = .046) . Significantly more clinically symptomatic bacteriologic failures occurred in the penicillin group (P = .037).(ABSTRACT TRUNCATED AT 250 WORDS)

Int J Cardiol, 1992 Jun, 35(3), 311 - 5
Optimum sampling time for detection of dental bacteraemia in children; Roberts GJ et al.; A total of 458 blood cultures were taken from 229 children aged 2 to 16 yr . Each 6 ml sample was taken starting at one of the following times after the extraction of a single tooth: 10 s, 30 s, 60 s, 90 s, 120 s, 180 s, 600 s and continuously over 2.5 min . The samples were cultured in the BACTEC radiometric culture system and when positive the bacteria isolated were speciated . At 30 s 56% of the samples were positive, the highest proportion, in contrast to only 38% of positive samples at 90 s and 28% at 600 s . Over 50% of the organisms found were Viridans streptococci.

APMIS, 1992 Jun, 100(6), 567 - 74
Role of streptococcal IgG Fc receptor in tissue deposition of IgG in rabbits immunized with Streptococcus pyogenes; Burova LA et al.; Induction of anti-IgG during hyperimmunization of rabbit with Streptococcus pyogenes (group A streptococci; GAS) was previously shown to require the presence of IgG Fc receptors (FcR) in the vaccine strain . In the present work, we examined whether streptococcal FcR activity might also be of importance for heart and kidney deposition of IgG, known to occur in poststreptococcal sequelae as well as during experimental immunization of animals . Each of three IgG-binding (GAS types M1, M12 and M22) and two non-binding (GAS type T27 and S . agalactiae (GBS) type Ia) streptococcal strains were used for intravenous immunization of rabbits during two periods of eight and six weeks, respectively, separated by an interval of one month . Before use, vaccine strains were treated with KSCN and carefully washed in order to remove any surface-bound immunoglobulins . No deaths occurred among injected rabbits . No tissue deposition was elicited by the GAS type T27 or the GBS strain . In contrast, the strains of types M1, M12 and M22 all induced deposits of IgG in kidney and heart tissue, beginning during the first immunization period . In two tested animals, receiving GAS of types M1 or M22, circulating immune complexes containing anti-IgG antibodies were also detected . Finally, serum autoantibodies reacting with preparations of heart and kidney, but not lung or liver, were demonstrated in each of six animals receiving M1 or M22, reaching maximum levels during reimmunization; such antibodies were not evoked by the two strains not binding IgG . Our results suggest that, in GAS with capacity for non-immune binding of IgG, triggering of anti-IgG acted to enhance tissue deposition of IgG or immune complexes in immunized rabbits . Furthermore tissue-specific antibodies were elicited only by the IgG-binding strains and occurred comparatively late during immunization, suggesting that those antibodies might have been triggered due to the exposition of hidden kidney and heart determinants.

Pediatr Infect Dis J, 1992 Jun, 11(6), 441 - 5
Complications of varicella requiring hospitalization in previously healthy children; Jackson MA et al.; Between January 1, 1981, and December 31, 1990, 83 previously well children and 20 with stable underlying conditions were hospitalized because of complications of varicella . The mean hospital stay was 4.5 days and one child with pneumonia died . Skin or soft tissue infections and pneumonia were the most common complications . Central nervous system complications (15), dehydration (8) and Reye's syndrome (6) accounted for 75% of the nonsuppurative complications . Cellulitis (7), pneumonia (3) and encephalitis (3) were the most common diagnoses among the 20 children hospitalized greater than or equal to 7 days . No cases of Reye's syndrome were diagnosed after 1984 . An increase in the number of soft tissue infections caused by Group A beta-hemolytic streptococci and involving an extremity was noted during the last 5 years . Chickenpox continues to cause significant morbidity in the pediatric population.

Crit Care Med, 1992 Jun, 20(6), 831 - 9
Relationship between oxygen delivery and metabolic acidosis during sepsis in piglets; Rudinsky BF et al.; OBJECTIVE: To determine if the preservation of oxygen delivery (DO2) ameliorates the development of metabolic acidosis during group B streptococcal infusion . METHODS: We examined 22 piglets (2 to 4 wks of age) that were anesthetized, intubated, and mechanically ventilated . Three groups of piglets were studied: group 1 (n = 6), in which DO2 was reduced progressively over 4 hrs by infusion of group B streptococci; group 2 piglets (n = 6) received a similar infusion of streptococci, but DO2 was preserved at presepsis levels by the infusion of dextran and exogenous porcine RBCs; group 3 piglets (n = 6) received no bacteria, but did receive a continuous infusion of 0.9% sodium chloride to maintain cardiac output, and thus, DO2, at baseline levels . To correlate arterial lactate concentrations with metabolic acidosis, four additional piglets received the continuous infusion of streptococci . RESULTS: DO2 decreased significantly in group 1 (14.2 to 5.7 mL oxygen/kg/min) but not in either group 2 or 3 . The arterial pH decreased significantly in both septic groups, groups 1 and 2 (7.47 to 7.20; 7.45 to 7.36, respectively), but not in the uninfected group 3 . The pH was significantly lower for group 1 vs . group 2 piglets at 210 and 240 mins of streptococcal infusion . Base excess decreased significantly for group 1 and group 2 piglets (+1.5 to -13.9; -0.1 to -5.8 mM/L, respectively) but not in group 3 . Base excess was significantly lower for group 1 vs . group 2 piglets at 210 and 240 mins of streptococcal infusion . Oxygen extraction increased significantly for only the low DO2 group 1 piglets (32% to 73%), and did not differ comparing group 2 vs . group 3 . In both groups of septic piglets, metabolic acidosis developed before any detectable reduction in oxygen consumption . The increase in circulating lactate concentration (1.0 to 4.6 mM/L) was correlated with the decrease in base excess (-1.0 to -9.7 mM/L) in the four additional piglets that received an infusion of streptococci . CONCLUSIONS: Maintaining DO2 at presepsis levels ameliorated the development of metabolic acidosis during streptococcal infusion . Nevertheless, a significant degree of metabolic acidosis developed despite the preservation of DO2.

J Gen Microbiol, 1992 Jun, 138 ( Pt 6), 1237 - 42
Role of hydrophobic surface proteins in mediating adherence of group B streptococci to epithelial cells; Wibawan IT et al.; Determination of the cell-surface hydrophobicity of group B streptococci by hydrophobic interaction chromatography on phenyl-Sepharose revealed that human and bovine group B streptococcal isolates with protein surface antigens, either alone or in combination with polysaccharide antigens, were mainly hydrophobic, whereas those with polysaccharide antigens alone were mainly hydrophilic . Removal of capsular neuraminic acid enhanced, and pronase treatment reduced, surface hydrophobicity . The hydrophobic surface proteins, solubilized by mutanolysin treatment of the bacteria and isolated by hydrophobic interaction chromatography, appeared in SDS-PAGE as numerous protein bands . Staphylococcal carrier cells loaded with antibodies produced against hydrophobic surface proteins agglutinated specifically with hydrophobic group B streptococci . No agglutination reaction was observed with hydrophilic cultures . Hydrophobic group B streptococci adhered to buccal epithelial cells in significantly higher numbers than did hydrophilic cultures . The adherence of group B streptococci to epithelial cells was inhibited in the presence of isolated hydrophobic proteins and in the presence of specific antibodies produced against hydrophobic proteins . The results of this study demonstrate a close relation between the occurrence of type-specific antigens, surface hydrophobicity and the adherence of group B streptococci to epithelial cells.

Eur J Clin Microbiol Infect Dis, 1992 Jun, 11(6), 543 - 6
In vitro antimicrobial susceptibility of viridans streptococci isolated from blood cultures; Potgieter E et al.; The susceptibility of 211 viridans streptococci isolated from blood cultures to eight antimicrobial agents was determined . All the isolates were susceptible to cefotaxime, ceftriaxone, imipenem and vancomycin . Thirty eight percent of the isolates were resistant to penicillin (MICs greater than or equal to 0.25 micrograms/ml) . Tetracycline resistance was found in 41% of the isolates and in 7% of these strains tetracycline resistance was combined with erythromycin resistance . Five Streptococcus mitis isolates exhibited increased (MIC 64 micrograms/ml and 128 micrograms/ml) or high-level (MIC greater than or equal to 500 micrograms/ml) resistance to gentamicin, kanamycin and tobramycin . Four of these isolates were also resistant to penicillin (MICs 16-32 micrograms/m) . In vitro synergy was not demonstrated for combinations of penicillin and gentamicin against three Streptococcus mitis isolates with gentamicin MICs of 1000, 128 and 64 micrograms/ml . Results of this study indicate the importance of monitoring antibiotic resistance trends in viridans streptococci particularly with respect to penicillin and aminoglycoside resistance.

Eur J Clin Microbiol Infect Dis, 1992 Jun, 11(6), 540 - 3
Production of pyrogenic exotoxins in group A streptococci isolated from patients in Zagreb, Croatia; Begovac J et al.; The pyrogenic exotoxin profiles were determined of group A streptococci isolated from patients in Zagreb, Croatia in the period 1989-1990 . A total of 12 strains were studied, five from patients with serious infections and seven from patients with uncomplicated infections . Serotypes M1 and M3 were found in seven (58%) patients . Seven strains produced exotoxin A and ten strains exotoxin B . The proportion of exotoxin A and B producing strains in patients with severe infections (3 patients respectively) was similar to that found in patients with uncomplicated infections (4 and 7 patients respectively).

Eur J Clin Microbiol Infect Dis, 1992 Jun, 11(6), 491 - 8
Streptococcus milleri group: renewed interest in an elusive pathogen; Piscitelli SC et al.; The following review examines the bacteriological characteristics, epidemiology, pathogenicity and antimicrobial susceptibility of the "Streptococcus milleri group" . "Streptococcus milleri group" is a term for a large group of streptococci which includes Streptococcus intermedius, Streptococcus constellatus and Streptococcus anginosus . Usually considered commensals, these organisms are often associated with various pyogenic infections including cardiac, abdominal, skin and central nervous system infections . Organisms of the "Streptococcus milleri group" are often unrecognized pathogens due to the lack of uniformity in classifications and difficulties in microbiological identification . Penicillin G, cephalosporins, clindamycin and vancomycin all possess activity against these streptococci . Use of agents with poor activity may promote infections with "Streptococcus milleri group" and allow it to exhibit its pathogenicity . An understanding of these organisms may aid in their recognition and proper treatment.

Rev Rhum Mal Osteoartic, 1992 Jun, 59(6), 401 - 7
{Infectious spondylodiscitis . Analysis of a series of 105 cases}; Bontoux D et al.; Among 105 cases of infectious spondylitis diagnosed and treated from 1971 through 1990, 23 were due to tuberculosis (TS) and 82 to other causes (NTS) . The annual number of cases of NTS rose over the study period, partly because of an increase in iatrogenic spondylitis, whereas the number of TS cases fell . In both groups, mean age of patients was higher than in earlier studies . The leading causative agents in NTS were staphylococci, followed by streptococci, then Escherichia coli . Diagnosis of spondylitis was dependent on the imaging techniques used; among available methods, the most reliable was magnetic resonance imaging which improved diagnostic performance by detecting early, specific changes . Except in patients with positive blood cultures and in TS patients with Koch bacilli recovered from other visceral foci, bacteriologic diagnosis rested on studies of samples taken from the spinal infection site . Half the subjects underwent discovertebral needle biopsy, with a success rate of 47.5%, a figure comparable with those reported in other studies . In 30% of patients, bacteriologic documentation of the infection was not obtained and diagnosis rested on a set of clinical, biological, and radiological criteria.

Oral Microbiol Immunol, 1992 Jun, 7(3), 177 - 81
DNA probes for detection of cariogenic Streptococcus mutans; Smorawinska M et al.; Streptococcus mutans has been identified as the principal etiological agent in human dental caries . Therefore, the specificity and sensitivity of 3 potential gene probes derived from S . mutans GS5 have been examined as potential reagents for detecting the cariogenic bacteria . The gene probes derived from the cloned gtfB, gtfD and ftf genes were examined in Southern blots with a panel of representative oral bacteria . The gtfB and ftf genes were apparently specific for S . mutans under high-stringency hybridization conditions . However, the gtfD gene fragment did cross-hybridize with the DNA from other mutans streptococci . These results suggest that gtfB and ftf gene fragments may be used as specific probes for S . mutans.

Oral Microbiol Immunol, 1992 Jun, 7(3), 148 - 54
Purification and properties of sorbitol-6-phosphate dehydrogenase from oral streptococci; Svensater G et al.; The activity of sorbitol-6-phosphate (S6P) dehydrogenase (S6PDH) and the sorbitol transport system were studied in strains of the oral streptococci Streptococcus gordonii, Streptococcus mitis, Streptococcus sanguis and Streptococcus mutans . Genetically transformed (to ferment sorbitol) strains and their DNA donors were included . S6PDH was purified by anion exchange chromatography and gel filtration . The purity of the enzyme was confirmed by polyacrylamide gel electrophoresis . The purified enzyme from all the strains exhibited Michaelis-Menton saturation kinetics . The Km values for nicotinamide-adenine dinucleotide (NAD) and S6P ranged between 0.03 and 0.21 mM and 0.07 and 0.20 mM respectively . The relative molecular weights of the native enzyme were 229,000 for one donor-transformant pair (S . sanguis and S . gordonii), 107,000 for the other pair (S . mitis and S . gordonii) and 129,000 for S . mutans . The molecular weights of the S6PDH subunits ranged from 26,000 to 28,000 . The pH optima (greater than 8.5) and the amino acid composition (15 amino acids examined) were similar for the S6PDH from the different strains . However, the chromatographic and electrophoretic patterns as well as the Km values for NAD and S6P were the same only between the S6PDHs from the strains within each donor-transformant pair . Purified S6PDH from S . mutans also exhibited low mannitol-1-phosphate dehydrogenase activity . Sorbitol-grown decryptified cells of all the strains phosphorylated sorbitol in the presence of phosphoenolpyruvate but not in the presence of adenosine triphosphate (ATP) . ATP-mediated phosphorylation of glucose was observed with the same strains when grown on glucose . No evidence for a non-phosphotransferase transport system was found for sorbitol in any of the strains.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral Microbiol Immunol, 1992 Jun, 7(3), 137 - 41
Chronic peroral immunization of conventional laboratory rats with mutans streptococci leads to stable acquired suppression of salivary antibodies; Riviere GR et al.; Prior investigations have demonstrated that salivary antibody responses to mutans streptococci are dose-dependent and temporary . The purpose of this study was to evaluate the stability of antibody suppression established by mutans streptococci . Streptococcus mutans 6715-15 was provided in food to conventional rats for 18 weeks . Antigen was withdrawn for 10 weeks and then resumed for an additional 6 weeks . Saliva and serum from nonimmunized controls and from experimental rats were tested with a quantitative enzyme-linked immunosorbent assay for IgA and IgG antibodies to whole bacterial cells and to soluble antigen . Results show that salivary antibodies were stimulated by primary peroral immunization, that IgA was the dominant isotype and that IgA antibodies were primarily directed against soluble antigen . This study also shows that immunity is not maintained, even while challenge continues, and that once suppression is established, immunized animals do not recover their ability to respond, even if exposure is stopped for 10 weeks before re-exposure.

Cesk Epidemiol Mikrobiol Imunol, 1992 Jun, 41(2), 109 - 17
{Use of the Streptotest for identification of enterococci and viridans-type streptococci}; Pakrova E et al.; The new identification system STREPTOtest (fy . Lachema, Brno) was evaluated . A total 118 well-known strains of genus Enterococcus, Streptococcus, Aerococcus, Stomatococcus and Gemella were tested . The STREPTOtest system rapidly and reliably distinguished genus Enterococcus from genus Streptococcus . This method identified correctly to the species level 65.9% of enterococci strains and 52.5% of streptococci strains . The STREPTOtest was used for identification of A . viridans and S . mucilaginosus and it was possible to separate these strains from similar ones . A new differentiation chart for identification of all 13 recently described enterococcal species was proposed.

Int J Gynaecol Obstet, 1992 Jun, 38(2), 131 - 9
Antimicrobial therapy for gynecologic infections . ACOG Technical Bulletin Number 153--March 1991; Comparative in vitro activity of PD 127391 et al.; Center for Infectious Diseases, University of Texas Medical School, Houston 77030We examined the in vitro activity of PD 127391, an investigational fluoroquinolone antibacterial agent, against staphylococci (including methicillin-resistant Staphylococcus aureus), enterococci (including beta-lactamase-producing and highly gentamicin-resistant isolates), and streptococci . The compound was active against all organisms tested and compared favorably with antimicrobial agents routinely used to treat infections with these organisms . On the basis of MICs for 90% of the strains tested, PD 127391 was 32-fold more active against all staphylococci, 16-fold more active against methicillin-resistant S . aureus, 8-fold more active against all streptococci, and 4-fold more active against all enterococci than ciprofloxacin . PD 127391 was shown to be more active than sparfloxacin, which in turn was shown to be more active than ciprofloxacin, against these gram-positive cocci . PD 127391 shows promise for the treatment of infections with gram-positive cocci, including organisms which are resistant to other commonly used antimicrobial agents.

J Immunol, 1992 May 15, 148(10), 3238 - 43
Protein Arp and protein H from group A streptococci . Ig binding and dimerization are regulated by temperature; Akerstrom B et al.; Cell surface proteins that bind to the Fc part of Ig are expressed by many strains of group A streptococci, an important human pathogen . Two such bacterial strains, AP4 and AP1, were shown to bind IgA and IgG, respectively, in a temperature-dependent manner . The binding of radiolabeled Ig to the bacterial cells was lower at 37 degrees C than at 22 and 4 degrees C . Similarly, protein Arp, the IgA-binding protein isolated from strain AP4, and protein H, the IgG-binding protein isolated from strain AP1, displayed a strong Ig-binding at 22 degrees C and lower temperatures, and virtually no binding at all at 37 degrees C . The effect was reversible: lowering of the temperature restored the binding and vice versa . A gradual shift between binding and nonbinding took place between 27 and 37 degrees C . Gel chromatography and velocity sedimentation centrifugation showed that protein Arp and protein H appeared as noncovalently associated dimers at 10 and 22 degrees C, and as monomers at 37 degrees C . These results strongly suggest that the dimerization of protein Arp and protein H, rather than the low temperature itself, yielded the strong Ig-binding of the proteins at 10 and 22 degrees C . Indeed, after covalent cross-linking of the dimers at 10 degrees C by incubation with low concentrations of glutaraldehyde, full Ig-binding was achieved even at 37 degrees C . A carboxyl-terminal proteolytic fragment of protein Arp, which completely lacked the IgA-binding capacity at any temperature, showed the same temperature-dependent dimerization as intact protein Arp, suggesting that the Ig-binding part of the protein is not required for dimerization . The implications of these results for the function of Ig-binding group A streptococcal proteins, and their role in the host-parasite relationship are discussed.

J Immunol, 1992 May 15, 148(10), 3174 - 82
Identification of two type IIa IgG-binding proteins expressed by a single group A streptococcus; Otten RA et al.; Functional heterogeneity associated with Ig-binding proteins expressed by group A streptococci is well documented . In this study we have demonstrated that treatment of group A streptococcal isolate 64/14 with CNBr resulted in the solubilization of two different sized proteins that displayed identical functional reactivity with human IgG1, IgG2, and IgG4 (characteristics of a type IIa binding protein) . Monospecific polyclonal antibodies to each form of type IIa molecule were prepared and no antigenic cross-reactivity between the two m.w . forms of type IIa binding protein could be detected . The smaller m.w . protein was shown to be identical or closely related to the recombinant type IIa protein cloned from strain CS110 . These studies provide further evidence for the heterogeneity of type II Ig-binding proteins expressed by pathogenic group A streptococci.

J Immunol, 1992 May 15, 148(10), 3110 - 6
Role of a streptococcal antigen in the pathogenesis of acute poststreptococcal glomerulonephritis . Characterization of the antigen and a proposed mechanism for the disease; Yoshizawa N et al.; We studied the significance of a streptococcal protein (preabsorbing Ag) (PA-Ag) in the pathogenesis of acute poststreptococcal glomerulonephritis (APSGN) . This protein was isolated from nephritogenic streptococci . Purification of PA-Ag was achieved by chromatography, followed by Sephadex IEF . A single protein band at pH 4.7 was identified as PA-Ag . The m.w . was 43,000 . Rabbit antisera against PA-Ag and sera of patients with APSGN showed identical precipitation lines by immunodiffusion . Antibodies to PA-Ag were found to be present in 30 of 31 patients with APSGN, in 1 of 36 patients with uncomplicated group A streptococcal upper respiratory tract infections, and in 1 of 36 normal adults . By using immunoelectrophoresis, it was found that PA-Ag activates the alternate pathway of C . Other water-soluble streptococcal fractions, used as controls, did not activate the C system . The demonstration that PA-Ag is present in the glomeruli in the early phase of APSGN and its ability to activate C3 and factor B suggest that PA-Ag may be involved in the pathogenesis of APSGN, via in situ C activation.

J Immunol, 1992 May 15, 148(10), 3249 - 55
Epitope mapping of Streptococcus mutans SR protein and human IgG cross-reactive determinants, by using recombinant proteins and synthetic peptides; Gangloff S et al.; alpha-Hemolytic oral streptococci are known to possess a family of cell surface cross-reactive proteins termed Ag I/II, having a molecular mass of approximately 180 to 210 kDa . These proteins are implicated in bacterial adherence to various oral tissues, and we showed recently that the SR protein, an I/II Ag-related protein, from Streptococcus mutans OMZ 175 serogroup f possesses Ag mimicry with human IgG . In this study, regions of the SR protein encoding the cross-reactive epitope(s) were analyzed by expressing selected restriction fragments from the cloned sr gene . The three SR-derived polypeptides reacted in ELISA with anti-SR rabbit IgG, whereas only the two polypeptides located along the carboxyl-terminal two thirds of the SR protein reacted with anti-human IgG rabbit IgG . In order to locate more precisely the human IgG-cross-reactive region, we synthesized six peptides, on the basis of the recently determined complete nucleotide sequence of the sr gene . Among these peptides, peptide 2, corresponding to the alanine-rich repeating amino-terminal region, peptide 3, located in the three tandem proline-rich regions, and peptide 6, located near the cell wall-spanning region, were the most interesting in term of antigenicity and immunogenicity . Anti-peptide 2, 3, and 6 rabbit IgG reacted with free SR and with cell wall-associated SR . Peptide 1, located near the amino terminus, was poorly immunogenic . Peptides 4 and 5, located in the putative human IgG-cross-reactive region, were immunogenic; however, anti-peptide 4 rabbit IgG reacted only weakly with SR or human IgG, whereas anti-peptide 5 rabbit IgG reacted strongly with SR and human IgG, and peptide 5 was recognized by anti-SR and anti-human IgG rabbit IgG . These results confirm the cell surface accessibility of this epitope and its potential participation in eliciting, in rabbits, anti-SR IgG cross-reactive with human IgG.

Infection, 1992 May-Jun, 20(3), 118 - 21
Childhood meningitis caused by enterococci and viridans streptococci; Koorevaar CT et al.; Selected clinical and laboratory parameters were studied respectively in patients with meningitis caused by enterococci and viridans streptococci in an academic children's hospital . During a nine-year period (1981-1989), enterococci or viridans streptococci were isolated from the cerobrospinal fluid (CSF) of 48 patients . In nine of these 48 patients, enterococci or viridans streptococci were the causative agents of meningitis . These nine children constituted 2.0% of 450 patients with bacterial meningitis in this period . All nine children suffered from underlying diseases; neurosurgical procedures were performed in six of these patients, of whom four had ventricular drains . A head trauma preceded the development of meningitis in another patient . Drainage of the lacrimal duct was associated with the development of meningitis in another patients . One child concurrently suffered from severe gastroenteritis . CSF leukocyte count and CSF protein levels were moderately elevated, whereas CSF glucose levels were either slightly decreased or within the normal range . Meningitis due to enterococci or viridans streptococci is seen predominantly in children under the age of one year . Predisposing factors, including neurosurgical procedures, head trauma and severe gastroenteritis, are usually present in these patients . The prognosis for recovery is generally good.

Rev Clin Esp, 1992 May, 190(9), 458 - 9
{Acute suppurative thyroiditis and Klebsiella pneumoniae sepsis . A case report and review of the literature}; Echevarria Villegas MP et al.; The acute suppurative thyroiditis is a rare infection . It affects specially patients with preexisting thyroid gland pathology and its frequency is higher in women . In childhood it's linked to local anatomic defects . The infection used to be located in left thyroid lobe and it's much less usual in right lobe, in both or in isthmus . The most important causal microorganisms are staphylococci (Staphylococcus aureus overcoat) and streptococci (usually Streptococcus pyogenes and Streptococcus pneumoniae), with frequent isolation of mixed flora and anaerobes in the last reported cases . We present the case of a male patient, without previous thyroid disease, who suffered an acute suppurative thyroiditis and Sepsis due to Klebsiella pneumoniae, with right lobe abscess and secondary septic focus formation (kidneys, spleen, lungs), with fatal course despite of medical treatment, favoured or precipitated by the development of serious alcoholic abstinence.

Diagn Microbiol Infect Dis, 1992 May-Jun, 15(4), 281 - 5
Genetic heterogeneity among nutritionally deficient streptococci; Stein DS et al.; The nutritionally deficient (variant) streptococci (NDS) share the auxotrophic characteristic of requiring pyridoxal or thiol group supplementation for growth . The deoxyribonucleic acid relatedness of these organisms among themselves is unknown . Improved speciation of NDS would lead to a better knowledge of their pathogenesis and possible insight into improved clinical management . Therefore, DNA-DNA hybridization and biotyping of 23 nutritionally deficient streptococci were performed . Biochemical testing using the API Rapid Strept Identification method revealed that the organisms in this study were characterized among three broad biotype groups . Only one strain was nontypeable . DNA-DNA hybridization among the nutritionally deficient streptococci that we compared revealed genetic heterogeneity . Only four (17%) of 23 isolates were highly homologous; all were of biotypes 2 and 3 . Reference viridans streptococcal strains had minimal homology to the NDS strains . The data indicate that the NDS are genetically heterogeneous.

Clin Investig, 1992 May, 70(5), 441 - 3
Spontaneous gas-forming bacterial myonecrosis caused by group B streptococci and peptostreptococci; Overkamp D et al.; We present the case of a patient who spontaneously developed a severe gas-forming infection involving the voluntary muscles of both thighs . The organisms responsible were group B beta-haemolytic streptococci together with peptostreptococci . Following surgical and medical treatment, the patient fully recovered . No predisposing factors, in particular no disease causing immunocompromise, could be identified.

J Dairy Sci, 1992 May, 75(5), 1241 - 52
Managerial determinants of intramammary coliform and environmental streptococci infections in Ohio dairy herds; Bartlett PC et al.; Forty-eight dairy herds in Ohio were selected as a stratified random sample for participation in a disease monitoring study to relate the prevalence of IMI with coliform and environmental streptococci to herd management and environmental conditions . Management and environmental conditions were assessed by farm inspection and by an interview with the dairy producers . A separate analysis for each independent variable identified many potential disease determinants . A multivariable analysis of a covariance model to predict the prevalence of coliforms had 6 model df (R2 = .47) . Increased prevalence of coliform infection was associated with an increased amount of milk remaining in the udder after milking, use of free stalls, regular use of a running water wash, increased person hours per cow spent milking, and poor sanitation . The multivariable model for environmental streptococci used 5 model df (R2 = .51) . Increased prevalence of environmental streptococci was associated with poor sanitation, increased number of days dry, use of tie stalls, no use of a shared wash cloth, and no use of an individual dry cloth.

Mol Microbiol, 1992 May, 6(9), 1185 - 94
Many group A streptococcal strains express two different immunoglobulin-binding proteins, encoded by closely linked genes: characterization of the proteins expressed by four strains of different M-type; Stenberg L et al.; Most group A streptococcal strains are able to bind immunoglobulin (Ig) in a non-immune manner, and the majority of these strains bind both IgA and IgG . Using molecular cloning and immunochemical techniques, we have purified and characterized the Ig Fc-receptors expressed by four such strains . Two of the strains express a novel type of receptor, designated protein Sir, which binds IgA and IgG of all subclasses, and therefore has broader reactivity than any Fc-receptor previously described . The other two strains express protein Arp, a receptor that binds IgA of both subclasses, and also binds polyclonal IgG weakly . Characterization of the weak IgG-binding ability of protein Arp shows that it binds only some monoclonal IgG proteins, in particular those of the IgG3 subclass . The four strains studied here were unexpectedly found to also express a second Ig-receptor, called protein Mrp, encoded by a gene closely linked to the gene for the first receptor . The Mrp protein does not bind IgA, but it binds IgG molecules of the IgG1, IgG2 and IgG4 subclasses, and it also binds fibrinogen . Binding of fibrinogen has been reported to be a characteristic property of streptococcal M proteins, which suggests that the Mrp protein may be an M protein that also binds Ig . Taken together, all available evidence now indicates that most strains of group A streptococci express two different Ig-binding proteins, encoded by closely linked genes.

J Exp Med, 1992 May 1, 175(5), 1291 - 9
Molecular characterization of a locus required for hyaluronic acid capsule production in group A streptococci; Dougherty BA et al.; To characterize the production of hyaluronate capsule by the membrane-associated enzyme hyaluronate synthase (HAS), group A streptococci from a recent outbreak of acute rheumatic fever were mutagenized via Tn916 insertion . Acapsular transconjugants harboring multiple, nontandem copies of the transposon were identified and found to lack HAS activity (less than 1% of wild-type levels) . Generalized transduction was then performed to determine which Tn916 insertion was responsible for the HAS- phenotype . These marker exchange experiments resulted in the isolation of two distinct classes of acapsular transductants, designated WF61 and WF62 . Both transductants also lacked significant HAS activity, and excision of the transposon from WF62 restored capsular hyaluronate production . Southern analysis of WF61 DNA demonstrated a large deletion of genomic DNA adjacent to the Tn916 insertion . This deletion event is presumably responsible for the observed stability of the acapsular phenotype of WF61 . Further analyses of transductant whole-cell DNA indicated that the transposon insertions of WF61 and WF62 were separated by 2.5 kb . These studies define a locus required for hyaluronate capsule production in group A streptococci . Further genetic analysis of this locus has identified a gene required for HAS activity which wasd inactivated by TN916 in WF62 and deleted in WF61.

Obstet Gynecol, 1992 May, 79(5 ( Pt 2)), 894 - 6
Life-threatening puerperal infection due to group A streptococci; Silver RM et al.; We describe two patients with life-threatening puerperal infection due to group A beta-hemolytic streptococcus . Each patient had bacteremia, shock, and multi-organ involvement . Both cases were compatible with a recently described streptococcal toxic shock-like illness . Both women failed to improve despite vigorous medical and antibiotic therapies, and each required hysterectomy . Obstetricians should be alert to the importance of early diagnosis and treatment of this potentially lethal infection.

Infect Immun, 1992 May, 60(5), 1902 - 7
Delivery and expression of a heterologous antigen on the surface of streptococci; Pozzi G et al.; We have developed a system in which a foreign antigen replaces nearly all of the surface-exposed region of the fibrillar M protein from Streptococcus pyogenes and is fused to the C-terminal attachment motif of the M molecule . The fusion protein is thus expressed on the surface of Streptococcus gordonii, a commensal organism of the oral cavity . The antigen chosen to be expressed within the context of the M6 molecule was the E7 protein (98 amino acids) of human papillomavirus type 16 . Stable recombinant streptococci were obtained by integrating genetic constructs into the chromosome, exploiting in vivo homologous recombination . The M6-E7 fusion protein expressed on the S . gordonii surface was shown to be immunogenic in mice . This is the first step in the construction of recombinant live vaccines in which nonpathogenic streptococci as well as other gram-positive bacteria may be used as vectors to deliver heterologous antigens to the immune system.

Infect Immun, 1992 May, 60(5), 1890 - 3
Evidence consistent with horizontal transfer of the gene (emm12) encoding serotype M12 protein between group A and group G pathogenic streptococci; Simpson WJ et al.; Human isolates of Lancefield group G streptococci harbor sequences homologous with the structural gene (emm) encoding M protein, a major virulence factor in Streptococcus pyogenes (a group A Streptococcus species) . We used DNA-DNA hybridization, restriction endonuclease chromosomal profiling, and multilocus enzyme electrophoresis to examine genetic relationships between group A and group G streptococcal strains expressing homologous serologic type 12 M (M12) protein . All M12 group A strains studied had very similar restriction endonuclease genomic profiles and multilocus enzyme genotypes . In contrast, the restriction enzyme genomic profile and multilocus enzyme genotype of the M12 group G strain CS140 were strikingly different from those characterizing the M12 group A organisms . DNA-DNA hybridization studies revealed, on average, 57% genomic similarity between the M12 group A and group G strains . Taken together, our data demonstrate that a gene encoding M12 protein occurs in two highly divergent chromosomal backgrounds, a result suggesting that an episode of horizontal gene transfer and recombination has occurred between two streptococcal lineages.

Indian J Med Res, 1992 May, 95, 130 - 5
Biological characterisation of group F streptococci causing human infections; Krishna RM et al.; Fifty five strains of group F streptococci (GFS) isolated from clinical samples of 53 patients with diverse diseases, were characterised by a battery of physiological tests . Among them 37 (67%) were Streptococcus anginosus F, 14 (25%) were Strep . intermedius, two of which were mannitol positive and 4 (7%) were Strep . constellatus . Determination of minimum inhibitory concentrations of penicillin, erythromycin, ampicillin, gentamicin and cefazolin showed that despite their biochemical heterogeneity, all strains were uniformly susceptible to these antibiotics . Except for bacteraemia, other diseases due to GFS responded well to surgical drainage and/or antibiotics.

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1992 May, 25(2), 91 - 100
{Morphologic and biochemical characteristics of viridans streptococci isolated from dental plaque}; Lu JR et al.; The purposes of this study were to give the characteristics of viridans streptococci isolated from dental plaque, and the relationships with dental caries . We stained 69 patients' teeth on supragingival plaques (Plaque Index = 1) with the Pfiffer's reagent or FD&C RED#28 dye, then isolated 80 strains of oral streptococci from 69 patients . Cultures were grown in TSB, MS, and MSB media . A total of 80 fresh-isolated plaque streptococci, including strains of S . salivarius, S . sanguis, S . mitis, and S . mutans were identified on the basis of morphologic, dark field, SEM, and biochemical characteristics . All of the oral plaque streptococci were to be found in significant percentages in dental plaque . Patients who had caries harboured S . mutans more often (37/40) than patients without caries (7/29) . S . mutans comprised the greatest percentage (37/69) of microorganisms encountered in caries' plaque, and there was an association between high counts of S . mutans and the presence of dental caries . Cultural and biochemical methods were used for the isolation and identification of the different species of S . mutans . The result indicated that biotype I were the most predominant species (50%) in dental plaque . Thus, it is possible to isolate, screen and identify unknown strains through the morphologic, darkfield, SEM, and biochemical characteristics of viridans streptococci isolated from human dental plaque . By means of the present methods for identification, we hold considerable promises for contributing to the prevention and diagnosis of dental diseases.

J R Soc Med, 1992 May, 85(5), 262 - 6
Infective endocarditis in a district general hospital; Manford M et al.; Thirty-three cases of infective endocarditis presenting during a 6.5 year period to a district general hospital were analysed retrospectively . The annual incidence was 22 cases per million population . Twenty-two cases had pre-existing cardiac disease, mainly valvular disease-usually rheumatic (nine cases) and prosthetic valves (10 cases) . Recognizable precipitants such as recent surgery were uncommon . Two cases presented after deliberate drug overdose possibly due to depression exacerbated by systemic disease . Symptoms were usually non-specific . All but two cases had murmurs and most were pyrexial . Splinter haemorrhages and clubbing were seen in about 20% of cases . Viridans-type streptococci were the commonest infecting organisms (14 cases) . Staphylococcal infection (six cases) was confined to intravenous drug abusers and patients with prosthetic valves . Five cases were culture negative . Cardiac failure was present in 13 cases at presentation and developed in seven others during treatment . Acute valve replacement was necessary in eight cases, and late replacement in three . Renal impairment (plasma urea > 8 mmol/l and/or plasma creatinine > 120 mumol/l) occurred in 19 cases during the course of their illness . Embolic phenomena occurred in 12 patients and mostly involved the central nervous system . In the 8 fatal cases, the cause of death was cardiac failure in six, cerebrovascular accident in one, and myocardial infarction in one . Four of the six patients who subsequently died of cardiac failure had been referred for surgery . Both those who were not referred had coexisting medical problems . Factors associated with increased mortality were age, male sex, cardiac failure (P < 0.01), renal impairment (P < 0.05), and embolic phenomena (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Eur J Clin Microbiol Infect Dis, 1992 May, 11(5), 416 - 26
Spectrum of disease in bacteraemic patients during a Streptococcus pyogenes serotype M-1 epidemic in Norway in 1988; Bucher A et al.; All 87 known cases of bacteraemia due to Streptococcus pyogenes (beta-haemolytic group A streptococci) occurring during the peak of a nationwide outbreak in Norway (population 4.2 million) between January and June 1988 were reviewed . Clinical features varied widely and appeared largely to be dependent on the patients' age . The case fatality rate ranged from 11% in the age group under 30 years to 44% in patients over 60 years . Clinical complications such as shock, severe renal or respiratory failure or serious local infection occurred particularly in 30-to 59-year old individuals . Shock was manifest in 32% of the patients and carried a 68% case fatality rate . Chronic heart disease in the elderly and pneumonia seemed to be associated with a fatal outcome . In the 25 patients (29%) who died the disease showed a fulminant course, 80% dying within 48 hours after admission . However, 56% of the patients had experienced symptoms for more than two days before admission, suggesting that early diagnosis and treatment might possibly have prevented the development of a serious disease . This study revealed a wide spectrum of clinical manifestations in bacteraemia cases in a unique epidemiological situation caused largely by a single serotype of Streptococcus pyogenes; 89% of the 27 preserved bacteraemia strains carried the M-1 antigen . The observations call attention to the ability of these organisms to cause fulminant clinical illness, indicating a probable increase in both invasiveness and toxicity of group A streptococci responsible for the epidemic.

Enferm Infecc Microbiol Clin, 1992 May, 10(5), 290 - 2
{Comparison of the new Granada medium and the ICON-strep B test in the detection of group B streptococci in pregnant patients}; de Cueto M et al.; The detection of group B streptococci by the ICON Strep-B test an enzyme immunoassay, and culture in new Granada Medium was compared in tubes and plates in a total of 200 vaginal specimens from pregnant women . The group B streptococci were cultured in new Granada medium from 33 of these specimens (incidence of 16.5%) . Compared with culture in new Granada medium, the sensitivity and specificity of the ICON-Strep B test were 66.6 and 100%, respectively . Because of their poor sensitivity, we do not recommend the use of these rapid test as the only basis for GBS detection.

Pathol Biol (Paris), 1992 May, 40(5), 461 - 5
{In vitro activity of vancomycin and teicoplanin against gram-positive cocci}; Bezian MC et al.; The activities of vancomycin and teicoplanin against 148 strains of Gram-positive cocci were tested using agar diffusion and liquid microdilution MIC determination . Tested strains included 84 staphylococci, 32 S . aureus, 52 coagulase-negative staphylococci (CNS), 52 enterococci, and 12 streptococci . Most strains (136) were susceptible to both agents, with inhibition diameters of 17 mm or more . MRSA strains exhibited lower geometric MIC means with teicoplanin (0.90 micrograms/ml) than with vancomycin (1.79 micrograms/ml); this difference was found for methicillin-susceptible S . aureus strains (1.07 and 1.38 micrograms/ml for teicoplanin and vancomycin, respectively) . In contrast, methicillin-susceptible and methicillin-resistant strains of CNS exhibited similar MICs (1.60 micrograms/ml approximately) . Enterococci were more susceptible to teicoplanin (MIC 0.25 micrograms/ml) than to vancomycin (MIC 1.35 micrograms/ml) . Both vancomycin and teicoplanin were thus found to be consistently effective against Gram-positive cocci; however, teicoplanin proved more effective than vancomycin against enterococci and methicillin-resistant S . aureus strains and may therefore be a valuable therapeutic alternative for these multiresistant organisms.

Drugs, 1992 May, 43(5), 700 - 12
Treatment options for the pharmacological therapy of neonatal meningitis; Paap CM et al.; Neonatal bacterial meningitis has a relatively low incidence in developed countries, but continues to cause morbidity and mortality despite advances in antimicrobial therapy . Bacterial pathogens commonly associated with neonatal meningitis include Group B streptococci, Escherichia coli K1 and other coliforms, Listeria monocytogenes and staphylococci . As it can be difficult to differentiate meningitis from septicaemia in neonates, empirical antibiotic therapy should be effective for both . Selection of an empirical antibiotic regimen should be based on: (a) bacterial prevalence and susceptibility; (b) drug characteristics; (c) postnatal age at the onset of disease; and (d) patient-specific factors . A penicillin in combination with an aminoglycoside or cefotaxime is commonly used in empirical therapies . The increased risk of staphylococcal infection in older neonates requires consideration of an antistaphylococcal antibiotic in the empirical therapy regimen . Once a causative organism has been identified, antimicrobial therapy should be directed towards that pathogen . Duration of therapy remains empirical, but should be at least 7 days for documented bacterial meningitis . Viral meningitis continues to have a high mortality despite the availability of antiviral agents . Adjunctive therapies may further reduce the morbidity and mortality of meningitis . While most of these therapeutic options have not been investigated in neonates, they may prove to be of benefit in the future . Anti-inflammatory agents, such as glucocorticoids, nonsteroidal anti-inflammatory agents and immunoglobulin, may modulate the inflammatory response of a meningeal infection . Other possible therapies in neonatal meningitis include cerebral blood flow modulators and disease prevention with maternal vaccines and perinatal antibiotics . Practical aspects of drug therapy such as route of administration and serum drug concentration monitoring can improve both drug therapy and patient outcome . While antibiotics have greatly improved the treatment outcome of neonatal meningitis, it is clear that additional intervention will be required to increase cure rates and reduce sequelae.

J Dent Res, 1992 May, 71(5), 1182 - 8
Restriction endonuclease-fragment polymorphisms of oral viridans streptococci, compared by conventional and field-inversion gel electrophoresis; Rudney JD et al.; Oral streptococci formerly classified as Streptococcus sanguis or Streptococcus mitis have recently been divided into four species . Two additional species have also been proposed for this group . Each species is genetically distinct, but they have many traits in common, which makes it difficult for clinical isolates to be identified by phenotypic tests . Genotypic comparison may provide an alternative approach . This study used DNA fingerprint analysis for comparison of genotypes of 21 reference strains--classified as Streptococcus gordonii, Streptococcus sanguis, Streptococcus oralis, "Streptococcus parasanguis", or "Streptococcus crista" in previous DNA hybridization studies--and 17 clinical and laboratory strains placed in those groups on the basis of phenotypic tests . HinDIII and PvuII digests were run in conventional horizontal agarose gels . SfiI digests of reference strains and two laboratory strains were run in field-inversion gels . Fingerprint patterns were compared by visual examination, cluster analysis of densitometric traces, and lane-matching software . Only two "S . crista" strains and two parent mutant lineages showed fingerprint patterns that were identical by visual examination . Fingerprint patterns of all other strains were unique . Cluster analysis results could not be considered valid, since replicate lanes in different gels were not grouped together . HinDIII and PvuII digests contained too many bands for correct matching by lane-matching software . SfiI digests were correctly matched by computer, with the same results as visual examination . Results indicate that the diversity of strains within these streptococcal species was too great to permit species identification by DNA fingerprint patterns . This genotypic diversity suggests that isolates from unrelated hosts may have been separate for long periods of time.(ABSTRACT TRUNCATED AT 250 WORDS)

Carbohydr Res, 1992 Apr 27, 228(2), 399 - 414
Convergent synthesis of higher-order oligosaccharides corresponding to the cell-wall polysaccharide of the beta-hemolytic Streptococci group A . A branched hexasaccharide hapten; Reimer KB et al.; A convergent synthesis of a hexasaccharide corresponding to the cell-wall polysaccharide of the beta-hemolytic Streptococci Group A is described . The strategy relies on the preparation of a key branched trisaccharide unit alpha-L-Rhap-(1----2)-{beta-D-GlcpNAc-(1----3)}-alpha-L-Rhap which functions both as a glycosyl acceptor and donor . The hexasaccharide is obtained after only three glycosylation reactions . This fully functionalized unit can serve, in turn, as a glycosyl acceptor or donor for the synthesis of higher-order structures . Deprotection gives a hexasaccharide for use as a hapten in immunochemical studies . The characterization of all compounds by high resolution 1H- and 13C-n.m.r . spectroscopy is also described.

J Immunol, 1992 Apr 15, 148(8), 2469 - 74
Human monoclonal antibody homodimers . Effect of valency on in vitro and in vivo antibacterial activity; Wolff EA et al.; Human IgG1 mAb dimers specific for either group B streptococci or Escherichia coli K1 bacteria were formed using chemical cross-linkers . The effect of antibody valency on biologic efficacy was investigated by comparing the IgG dimers against the corresponding IgG monomers . Binding activity and relative avidity were assessed using Ag binding and competition ELISA, and functional activity was analyzed using opsonophagocytic assays . These in vitro assays revealed that the dimers were greater than or equal to 50-fold more active than the monomers . A neonatal rat infection model showed the in vivo protective efficacy of the dimers was greater than or equal to 20-fold greater than that of the monomers . Enhancing the activity of mAb by chemical cross-linking may be a useful strategy for salvaging low affinity IgG mAb that possess poor functional properties.

FEMS Microbiol Lett, 1992 Apr 15, 71(2), 193 - 7
Enzymic activity of salivary amylase when bound to the surface of oral streptococci; Douglas CW et al.; The enzymatic activity of salivary amylase bound to the surface of several species of oral streptococci was determined by the production of acid from starch and by the degradation of maltotetraose to glucose in a coupled, spectrophotometric assay . Most strains able to bind amylase exhibited functional enzyme on their surface and produced acid from the products of amylolytic degradation . These strains were unable to utilise starch in the absence of salivary amylase . Two strains failed to produce acid from starch, despite the presence of functional salivary amylase, because they could not utilise maltose . Strains that could not bind salivary amylase failed to produce acid from starch . In no case was all the bound salivary amylase active, and two strains of Streptococcus mitis which bound amylase did not exhibit any enzyme activity on their cell surface . The ability to bind amylase may confer a survival advantage on oral bacteria which inhabit hosts that consume diets containing starch.

Clin Infect Dis, 1992 Apr, 14(4), 852 - 62
Operative intervention in active endocarditis in children: report of a series of cases and review; Tolan RW Jr et al.; We describe in detail 14 children (age, less than or equal to 19 years) who underwent operative intervention during active infection of the heart and/or great vessels . The series included five children less than 6 years old, who constitute 10% of all such cases reported in this age group to date . We also review the 132 published reports in which children underwent operative intervention during active endocarditis . We found the following: (1) The survival rate for all cases was 77% . (2) Persistent infection, embolic phenomena, and increasing congestive heart failure were the most frequent indications for operative intervention . (3) Survival rates were independent of the duration of preoperative antibiotic treatment . (4) Survival rates were independent of positive results of cultures of blood or tissue obtained at operation . (5) The perioperative mortality in our series was 14% . (6) Only 67% of patients had conditions thought to predispose to endocarditis . (7) Except for removal of catheter-associated cardiac masses from neonates, operative intervention in active endocarditis was uncommon among children less than 4 years old . (8) Staphylococcus aureus and viridans streptococci were the etiologic agents in the majority of cases of endocarditis requiring operation during active infection in children.

Ther Umsch, 1992 Apr, 49(4), 222 - 6
{Group A streptococci 1992--a challenge for general practice, hospital and research}; Schaad UB; Group A streptococci continue to frequently cause a wide array of infectious diseases . Prompt and reliable diagnosis of such patients and their adequate management are often complex and require substantial degree of both knowledge and suspicion . Modern aspects concerning acute streptococcal pharyngitis, invasive infections, and rheumatic fever represent important challenges for medical doctors working in private praxis, hospital and research . Major achievements in better understanding streptococcal infection include the complex pathogenicity of M-proteins, the perplexing results of uncritically performed throat cultures, the questionable therapeutic dominance of penicillin, and the prospect for active immunization . These changes certainly imply relevant adaption in managing group A streptococcal infections.

Ther Umsch, 1992 Apr, 49(4), 211 - 5
{Common cold: diagnostic steps? Antibiotics?}; Auckenthaler R; The common cold is caused by more than 100 virus types . However, the clinical manifestation is always similar with rhinorrhea, stuffiness, sneezing, pharyngitis, laryngitis and cough . The local inflammatory reactions are not due to the presence of virus but caused by locally produced inflammatory mediators . Bacterial superinfections may cause otitis or sinusitis . Bacterial nasopharyngitis has been described in children . This entity possibly exists also in adults . Traditional viral cultures are rarely positive and are not recommended in the daily routine . In children, antigen detection for adenovirus, respiratory syncytial virus, parainfluenza and influenza virus are recommended to confirm the viral etiology or for epidemiological surveillance . The presence of group-A streptococci must be proven by culture or antigen detection before treatment with penicillin . Antiviral treatment is limited to interferon or ribavirin . New antiviral substances are in development . Today, treatment of common cold is limited to symptomatic measures, and antibiotic treatment is not justified.

APMIS, 1992 Apr, 100(4), 353 - 9
Adherence of Streptococcus pyogenes M type 5 to pharyngeal and buccal cells of patients with rheumatic fever and rheumatic heart disease during a one-year follow-up; Nanda Kumar KS et al.; In vitro adherence of Streptococcus pyogenes M type 5 to isolated pharyngeal and buccal epithelial cells was studied in patients with acute recurrent rheumatic fever (n = 21), chronic rheumatic heart disease (n = 33), streptococcal pharyngitis (n = 12), and in normal controls . Patients were investigated at admission and one, six and 12 months later . Streptococci adhered significantly more to the pharyngeal cells of patients with rheumatic fever and rheumatic heart disease than to the pharyngeal cells of controls . Adherence of streptococci to pharyngeal cells of patients with pharyngitis was not different from age-matched controls . The adherence of streptococci to the pharyngeal cells of patients with acute rheumatic fever fell during follow-up but even after one year remained significantly higher than in the control group . These findings suggest that host factor(s) controlling streptococcal adhesion and colonization at the pharyngeal mucosa may be important in the pathogenesis of acute rheumatic fever.

Clin Infect Dis, 1992 Apr, 14(4), 947 - 8
Streptococcus salivarius bacteremia and meningitis following upper gastrointestinal endoscopy and cauterization for gastric bleeding; Carley NH; Streptococcus salivarius is a normal inhabitant of the oral cavity . When isolated from blood cultures, this viridans streptococcus is often disregarded as a contaminant . Viridans streptococci, although a common cause of endocarditis, are rarely associated with bacterial meningitis and account for less than 1% of all cases of purulent meningitis . We report a case of bacteremia and meningitis due to S . salivarius that occurred in a patient who underwent upper gastrointestinal endoscopy and cauterization for control of gastric bleeding . Although bacteremia following gastrointestinal procedures has been well documented, its incidence is low (ranging from 2% to 10%), and its course is usually transient without major clinical sequelae . This case is unique with respect to the pathogen isolated, the length of bacteremia, and the meningitis that subsequently developed following a gastroesophageal procedure.

Scand J Dent Res, 1992 Apr, 100(2), 98 - 103
Retention of streptococci to defined solid surfaces in the presence of saliva secretions; Christersson CE et al.; The initial surface retention of Streptococcus sanguis (G9B and ATCC 10556) and Streptococcus salivarius (ATCC 9758 and ATCC 13419) was examined using a well defined flow cell system . The microorganisms, known to be recovered from hard vs . soft tissue surfaces, respectively, were suspended in either Ringer solution, human parotid saliva (HPS), human submandibular and sublingual saliva (HSMSL), or mixed saliva . Microbial retention was evaluated on germanium prisms of low (20-25 mNm-1) and medium (30-35 mNm-1) critical surface tensions following distilled water rinse at 1 ml/min for 15 min . When suspended in only Ringer solution, the tested microorganisms showed patterns of generally high retention, that reflected the influence of both bacterial and substratum surface properties . However, in the saliva suspensions an overall reduction of retention was found with preferential retention to surfaces of medium critical surface tension for all bacteria . When comparing HPS and HSMSL as the suspending medium, a statistically significant observation was that smaller numbers of retained bacteria were recorded in the presence of HSMSL . The most frequently observed relationship between the tested salivas and numbers of retained cells was HSMSL less than MIXED less than HPS.

J Clin Microbiol, 1992 Apr, 30(4), 1019 - 21
New Granada Medium for detection and identification of group B streptococci; de la Rosa M et al.; A methotrexate-containing medium for the detection of beta-hemolytic group B streptococci from clinical specimens on the basis of detection of pigment is described . The medium contained peptone, starch, serum, MgSO4, glucose, pyruvate, methotrexate (as pigment enhancer), phosphate-morpholine-propanesulfonic acid buffer, and selective agents . The recovery of beta-hemolytic group B streptococci was comparable to that obtained with selective broth.

J Trop Pediatr, 1992 Apr, 38(2), 74 - 7
Microbiological evaluation of malted wheat, chickpea, and weaning food based on them; Livingstone AS et al.; The changes in the microbial load during steeping, germination, drying, kilning, and debranning of wheat and chickpea were studied, and the microflora of a weaning food formulation based on 48-hours germinated wheat and 24-hours germinated chickpea was also assayed . Total bacterial count (TBC) of control wheat and chickpea were 5 x 10(4)/g and 110 x 10(4)/g, respectively . The microbial load increased 9000-fold in wheat on 48-hours germination of wheat and 870-fold on 24-hours of germination of chickpea . The microbial counts decreased substantially on drying, kilning, and debranning, and the TBC of wheat and chickpea malt flours were 3 x 10(4)/g and 9 x 10(4)/g, respectively . Some of the spoilage microflora of health significance, viz . coliforms, E . coli, Streptococci, Staphylococci, yeast, and mould were assayed in raw materials and in the weaning foods based on malting (MWF), popping (PWF), and roller drying (RDF) of wheat and chickpea . The levels of these spoilage microflora were considerably high in raw materials and also in uncooked weaning foods, the load being high in MWF, moderate in PWF and low in RDF . Cooking the weaning foods slurry for 5 minutes at about 95 degrees C reduced the TBC and other spoilage microflora to safe limits, and counts were well within the prescribed values for the cereal-based weaning foods.

Otolaryngol Head Neck Surg, 1992 Apr, 106(4), 339 - 44
Necrotizing fasciitis of the eyelids; Overholt EM et al.; Necrotizing fasciitis is a destructive soft tissue infection that rarely involves the eyelids . Three cases of necrotizing fasciitis of the eyelids are described . Necrotizing fasciitis was preceded by minor forehead soft tissue trauma in two cases and occurred spontaneously in one . In two patients necrotizing fasciitis was bilateral and involved both the upper and lower eyelids . Review of these cases, in addition to 18 cases previously reported in the English literature, reveals a predominance in females, preceding minor local soft tissue trauma, frequent bilateral involvement, and an association with alcohol abuse and diabetes . In all of the patients, group A beta-hemolytic streptococci were cultured from the wound . Early recognition of the disease process, prompt surgical debridement of the necrotic tissue, aggressive antimicrobial therapy, and delayed skin grafting combine to minimize morbidity.

Arch Intern Med, 1992 Apr, 152(4), 853 - 5
Food-borne outbreak of group A beta-hemolytic streptococcal pharyngitis; Lossos IS et al.; An outbreak of pharyngitis due to group A beta-hemolytic streptococci type T 12 occurred at a military base . An epidemiologic investigation indicated that the outbreak was food borne . Consumption of boiled egg salad at lunch was significantly associated with the illness . Immediate institution of antibiotic therapy and isolation of the patients prevented secondary respiratory spread of the infection . No cases of poststreptococcal suppurative and nonsuppurative complications were found during a 6-week period after the outbreak . Medical personnel should be aware of the possibility of food-borne streptococcal pharyngitis . Regular health surveillance of food handlers and food preparation processes are important for prevention of such outbreaks.

Pediatrics, 1992 Apr, 89(4 Pt 2), 743 - 6
Suppurative group A beta-hemolytic streptococcal infections in children; Rathore MH et al.; Group A beta-hemolytic streptococci (GABHS) have once again become an important cause of serious suppurative disease in children . A 100% increase in the rate of GABHS bacteremia and an increased frequency in GABHS bacteremia in previously healthy children were observed in 1989 through 1990 compared with 1984 to 1988 . Streptococcal isolates were characterized and patient demographic data were tabulated from children hospitalized with GABHS suppurative infections in 1989 through 1990 . The differences in clinical manifestations and strains of GABHS were examined in patients with bacteremia, with or without focal site of infection, and in those with focal infections without bacteremia . Bacteremic children were significantly younger and had higher white blood cell counts at admission . No patient had a toxic shock-like syndrome . Although no specific strain was associated with suppurative infections, serum opacity reaction-negative organisms were more frequently associated with focal infections without bacteremia . The data suggest that GABHS may have become more virulent . Physicians should consider GABHS as an important cause of serious suppurative infection in children.

Infect Immun, 1992 Apr, 60(4), 1598 - 602
Murine monoclonal antibodies to type Ib polysaccharide of group B streptococci bind to human milk oligosaccharides; Pritchard DG et al.; The chemical structures of the repeating units of the type Ib polysaccharide of group B streptococci and of the desialylated form of this antigen are almost identical to those of some oligosaccharides in human milk and certain fetal antigens . The structural similarities suggested that the molecules may be immunologically cross-reactive . Mouse monoclonal antibodies to the sialylated and nonsialylated forms of the type Ib polysaccharide were produced and tested for their ability to bind to immobilized human milk oligosaccharides . One antibody, SMB19, reacted specifically with the sialylated form of the type Ib polysaccharide and was also bound by an affinity column containing immobilized sialyllacto-N-tetraose a . The antibody was eluted from the affinity column with EDTA, since its binding to the antigen was calcium dependent . A second monoclonal antibody . SIbD2, bound specifically to the nonsialylated form of the type Ib polysaccharide and also to immobilized lacto-N-tetraose . The antibody was eluted from the affinity column at an acidic pH and retained immunologic activity . These results further extend our previous observations that certain antibodies raised against group B streptococci can also react with normal human glycoconjugates.

Aten Primaria, 1992 Apr, 9(5), 245 - 9
{Evaluation of a rapid technique for detecting the type A Streptococcus antigen (Test Pack Strep A)}; Diaz-Berenguer JA et al.; OBJECTIVE . To test a rapid technique of Antigen Detection (TAD) of Type A Betahemolitic Streptococci (BHSA) in Acute Tonsillitis (AT), comparing it with and using as a point of reference traditional Blood Agar Cultivation (BAC) . Additionally, the use of Clinical Data as a method of supposed Diagnosis was studied . DESIGN . Prospective observational study . SITE . Health Primary Care (Maspalomas Health Centre) . PATIENTS AND OTHER PARTICIPANTS . 118 patients between the ages of 1 and 71 affected by AT . MEASUREMENTS AND MAIN RESULTS . There was a proportion of 13.56% BHSA in the AT of our sample, with a Confidence Interval (CI) of 95% (7.38-19.74) using the BAC; and 17.80% with a CI of 95% (10.90-24.70) using the TAD . The following values were obtained for the TAD: Sensitivity (S) of 93.75%, Specificity (Sp) of 94.12%, Positive Predictive Value (PPV) of 71.43% and Negative Predictive Value (NPV) of 98.9% . Of the clinical variables studied, only the presence/absence of Exudate and Adenopathies were linked to the presence of BHSA in the Cultivations (p less than 0.05 and p less than 0.01 respectively); with, however, inconclusive S, Sp, PPV and PNV values . CONCLUSIONS . We found insufficient correlation between clinical findings and the presence of BHSA to consider it a valid method of supposed diagnosis . There was however a statistical link between the presence of Exudate and local Adenopathies, and a positive result in the cultivation . The TAD is shown to be a rapid method, easy to use, and highly reliable for the discovery of the presence of BHSA in AT.

Zh Mikrobiol Epidemiol Immunobiol, 1992 Apr, (4), 40 - 2
{The characteristics of a Russian-made kit for the serological identification of streptococci groups A, B and C}; Khodyrev AP et al.; The first Soviet kits for the serological identification of streptococci, groups A, B, and C, on the basis of the coagglutination test were developed . Each kit was intended for 35-40 determinations . The optimum concentration of streptococci during their identification by means of the reagents making up the kit was about 1.6 x 10(9) cells/ml . The specificity of the reagents in comparison with the results of the identification of streptococci by reference methods was 97.3 +/- 0.9% . The reagents making up the kits can be presumably used for solving a number of practical problems in the epidemiological surveillance of streptococcal infection.

J Immunol, 1992 Mar 15, 148(6), 1879 - 84
Comparison of the opsonic and complement triggering activity of human monoclonal IgG1 and IgM antibody against group B streptococci; Shyur SD et al.; We have compared the opsonic and complement-triggering activity of transfectoma-derived, class-switched human IgG1 and IgM mAb (HumAb) against types Ia, II and III group B streptococci (GBS) . These antibodies appear to be directed against the common group B cell wall Ag of these organisms . The HumAb IgM promotes uptake of type Ia and II GBS at concentrations as low as 37 ng/ml and type III GBS at concentrations of 150 ng/ml in the presence of human neonatal complement . In contrast, the IgG1 GBS HumAB showed no detectable opsonic activity in concentrations up to 600 ng/ml . When the concentration of HumAb IgG1 is raised to 2.5 micrograms/ml, significant opsonic activity against GBS is detected and when the concentration is approximately 40 micrograms/ml, the opsonic activity peaked at a slightly higher level than that with the HumAb IgM . Thus, approximately 100- fold higher concentrations of the IgG1 than the IgM HumAb are required for optimal opsonization . The opsonic activity of the IgM and IgG1 HumAb are closely related to their ability to consume complement and deposit C3 on the surface of type Ia, II, and III GBS (r = 0.959) . We believe that the marked opsonic and protective activity of the IgM GBS HumAb is due to its enhanced avidity and ability to trigger the complement system . Further studies are indicated to determine the feasibility of employing human IgM antibody preparations in the immunotherapy of neonatal GBS disease.

Obstet Gynecol, 1992 Mar, 79(3), 358 - 63
Assessment of a rapid latex agglutination test for group B streptococcal colonization of the genital tract; Clark P et al.; OBJECTIVE: The purpose of this study was to determine the reliability of a rapid enzyme extraction-latex agglutination test in detecting intrapartum colonization of the maternal genital tract by group B streptococci . METHODS: Swabs of vaginal secretions were obtained from 314 patients in labor with either ruptured or intact membranes . Four tests were performed on each specimen: 1) qualitative culture on blood agar, 2) semiquantitative culture on blood agar, 3) culture in selective Todd-Hewitt broth, and 4) latex agglutination preceded by enzyme extraction . RESULTS: The prevalence of positive cultures was 29% . When compared with culture in Todd-Hewitt broth, the latex agglutination test had a sensitivity of 30%, specificity 93%, positive predictive value 64%, and negative predictive value 76% . In patients with heavy colonization the test had a sensitivity of 76%, compared with 17% in patients with light growth (P less than .001) . The lower limit of sensitivity of the test was 4 x 10(5) cfu/mL . The performance of the test was not affected by rupture of the membranes . CONCLUSION: Although the latex agglutination test is reasonably sensitive in detecting heavy colonization, low overall performance combined with technical difficulties in assessment of particle agglutination make the test unsuitable for general screening.

Eur J Epidemiol, 1992 Mar, 8(2), 292 - 7
An outbreak of group A food-borne streptococcal pharyngitis; Gallo G et al.; A food-borne outbreak of pharyngitis from group A streptococcus developed in people attending wedding banquets in the same restaurant on July 5-8, 1986 . Of the 300 people interviewed, 179 reported illness; pharyngeal swabs were taken from 115 ill people; from 63 (53%) of them group A streptococci, belonging to serotype T28, M28, were isolated . Statistical analysis performed using chi-square and Cochran's test showed that a prawn hors-d'oeuvre served on July 5 and squills or/and custard cake served on July 7 could have been a possible source of infection . Six people on the staff, 5 of whom belonged to the family of the restaurant manager, and the manager's three young daughters were colonized by the same group A serotype . A possible previous diffusion of the strain among the staff followed by contamination of the food was suspected.

J Chir (Paris), 1992 Mar, 129(3), 169 - 71
{Necrotizing fasciitis: a medical and surgical emergency . Apropos of a case}; Cornu E et al.; We report about a 66-years-old obese and diabetic female patient, treated with anti-inflammatories for osteoarthritis of the hip and operated for varices of the lower limbs by a bilateral stripping of the internal saphenous veins, who presented with a mortal necrotizing fasciitis during the postoperative period . Necrotizing fasciitis is a severe, infrequent disease jeopardizing the vital prognosis, in which an appropriate and early treatment (medical, using antibiotics, and surgical by extensive debridement) can prevent a fatal outcome . The most often involved germs are streptococci (45%) . The association of anaerobic and aerobic germs sometimes causes mixed cellulitis . The vital prognosis is always threatened by postoperative fasciitis . The mortality rate ranges from 50 to 75%, the main causes of death being a septic shock or pulmonary embolism . The functional prognosis of the surviving patients depends on the extent and quality of surgery.

Kansenshogaku Zasshi, 1992 Mar, 66(3), 314 - 8
Seroepidemiology status of Nepalese against hemolytic streptococcal infection in Katmandu; Shibata H et al.; Immune status of apparently healthy Nepalese against hemolytic streptococci was studied by measuring antibodies to various streptococcal antigens such as streptolysin-O (SO), streptokinase (SK), deoxyribonuclease-B (DN-B) and streptococcal polysaccharide (SP) . The normal range of anti-streptolysin-O (ASO), anti-streptokinase (ASK), anti-deoxyribonuclease-B (ADN-B) and anti-Streptococcus polysaccharide (ASP) was 60-480 (T.U.), 40-1024 (titer), 60-1280 (titer) and less than 2-128 (Unit), respectively . No difference was observed between the two sexes . ASO and ADN-B were measured by the neutralization method . Passive hemagglutination (PHA) was used to measure ASK and ASP . These values were 2-3 fold higher than those obtained on the Japanese subjects.

Microb Pathog, 1992 Mar, 12(3), 199 - 208
Lipoteichoic acid and M protein: dual adhesins of group A streptococci; Courtney HS et al.; The roles of lipoteichoic acid (LTA) and M protein in the adherence of group A streptococci to human cells were investigated . Both M+ and M- streptococci bound to pharyngeal and buccal epithelial cells in similar numbers . Streptococcal attachment was inhibited by LTA, but not by the pepsin-extracted, amino-terminal half of M protein (pep M), suggesting that M protein does not mediate attachment to these cells . However, a purified, recombinant, intact M protein did block attachment of streptococci to buccal cells . Using synthetic peptides, the inhibitory domain was localized to a region of intact M protein that is within or near the bacterial cell wall . Evidence is presented to suggest that on the surface of streptococci this region of the M protein is probably not accessible for interactions with host cell receptors and that M protein does not mediate attachment to buccal or pharyngeal cells . In contrast, approximately 10-times more M+ streptococci bound to Hep-2 cells than did M- streptococci and pep M protein blocked binding of streptococci to Hep-2 cells . The data suggest that at least two streptococcal adhesins, LTA and M protein, are involved in the adherence of streptococci to certain cells and that the relative contributions of these adhesins to the attachment process depends on the type of host cells used to study adherence.

Mil Med, 1992 Mar, 157(3), 111 - 3
Effect of povidone-iodine irrigation on the preoperative chemical preparation of the eye; Grimes SR et al.; Preoperative eyes which had been treated with gentamicin for one-half day were subjected to one of two povidone-iodine (PI) preparations . The control eye was prepared using a previously described 5% PI one-drop technique, while the paired eye was irrigated with a 0.02% PI solution . Aerobic and anaerobic bacterial cultures were taken of each eye before and after PI applications . Statistical analysis of the data indicates that both techniques were equally effective in reducing surface colonization of the anaerobic cocci and bacilli, the viridans streptococci and micrococci . Both methods were also equally ineffective in reducing the numbers of coagulase-negative staphylococci from the surface of the eye . With the apparent emergence of gentamicin-resistant coagulase-negative staphylococci the potential for staphylococcal endophthalmitis is increasing.

Helv Chir Acta, 1992 Mar, 58(5), 663 - 6
{Prospective analysis of infections of the upper extremity}; Leupi W et al.; In a prospective investigation infections of the upper extremity are examined with respect to incidence, bacterial pathogens, operative or conservative treatment, and duration of disability for work . A total of 255 patients (pts) (170 men, 85 women; mean age 37 years, range 16-85) were entered into the study . In a 12-month period 163 (64%) were treated as outpatients, the condition of 92 pts (36%) required hospitalisation . Conservative and operative treatment was performed in 82 (32%) and 173 (68%) pts, respectively . Conservative treatment included fixation by cast as well as antibiotics (penicillinase resistant penicillin), usually given by the oral route for a mean of 4 days . Surgical procedures consisted of excision and debridement . Intraoperatively intravenous antibiotics were instituted for a mean of 3 days, followed by oral application for another 4 days . In 135 of 173 pts who underwent surgery, sufficient material for bacterial culture was obtained . There was a polymicrobial infection in 50% of pts . Most common isolated pathogens were Staphylococcus aureus, beta-hemolytical streptococci group A, and indigenous skin flora in 34%, 21%, and 11%, respectively . Among the 255 pts there were 26 HIV-positive iv drug abusers, who suffered from abscesses at injection sites . The infections in these immunocompromised HIV-positive pts did not reveal differences with respect to number and species of isolated pathogens as compared to immunocompetent pts . Resistant bacteria were not found . Response to treatment was satisfactory usually within a few days in all but 12 pts (4.7%) in which the failure could be attributed to inadequate primary debridement.

Infection, 1992 Mar-Apr, 20(2), 86 - 8
Microbial flora and its significance in pathology of sickle cell disease leg ulcers; Sehgal SC et al.; The microflora and its significance was investigated in 82 leg ulcers in patients with sickle cell disease . Staphylococcus aureus, Pseudomonas aeruginosa and group A streptococci were the most common isolates . The majority of ulcers which yielded these organisms showed signs of local inflammation, regional lymphadenopathy and healed slowly as compared with ulcers which did not show these organisms . Repeat culture swabs demonstrated persistence of these organisms . A topical spray containing neomycin, polymyxin B and bacitracin helped to eradicate these organisms and hastened the healing process of ulcers . Coliforms and anaerobes were also isolated but were transient in nature and of no significance in the pathology of such ulcers.

Infect Dis Clin North Am, 1992 Mar, 6(1), 41 - 55
Prevention of group B streptococcal infection; Noya FJ et al.; Group B streptococci continue to be major perinatal pathogens, both for mothers and their infants, and are associated with significant morbidity, mortality, and its attendant cost to society . Approaches to prevention are directed toward either eliminating exposure to the organism or enhancing host resistance, that is, chemoprophylaxis and immunoprophylaxis . Intrapartum chemoprophylaxis has been shown to effectively interrupt vertical transmission of group B streptococci from the genitally colonized mother to the infant and to decrease the incidence of both maternal and early-onset neonatal group B streptococcal disease . To avoid unnecessarily exposing large numbers of colonized women to antibiotics, only those with defined risk factors should be selected for intrapartum chemoprophylaxis . This regimen is ampicillin given intravenously, 2 g initially at onset of labor or rupture of membranes, followed by 1 g every 4 hours until delivery . Risk factors include premature onset of labor or rupture of membranes before 37 weeks' gestation, rupture of membranes of more than 12 hours, intrapartum fever, group B streptococcal bacteriuria, or having previously delivered an infant with group B streptococcal disease . Detection of anogenital colonization is accomplished either by culture late in the second or early in the third trimester or by intrapartum group B streptococcal antigen testing of vaginal swabs from those previously culture-negative or not cultured . Although this approach combines the advantages of several proposed strategies, it will still miss those cases of group B streptococcal disease developing in the absence of discernible risk factors . Intrapartum prophylaxis does not prevent late-onset group B streptococcal disease . Prenatal and postnatal chemoprophylaxis have not been shown to be effective . Symptomatic infants born to mothers given chemoprophylaxis should be evaluated for neonatal sepsis and treated accordingly . This approach is also suggested for asymptomatic premature infants, those whose mothers have not received adequate prophylaxis or have previously delivered infants with group B streptococcal disease, and for twin siblings of infants developing group B streptococcal disease . Successful implementation of this approach may be limited by the availability and sensitivity of the rapid antigen test used . Immunoprophylaxis, and active immunization in particular, is the most promising method of preventing perinatal group B streptococcal disease in mothers and their infants, including late-onset disease . Immunization of pregnant women with type III polysaccharide vaccine has resulted in adequate provision of functional antibody to the infants born to responders.(ABSTRACT TRUNCATED AT 400 WORDS)

J Dent Res, 1992 Mar, 71(3), 491 - 500
Adhesion of mutants streptococci to glass with and without a salivary coating as studied in a parallel-plate flow chamber; Busscher HJ et al.; Deposition and adhesion to glass with and without a salivary coating in a parallel-plate flow chamber were studied with four strains of mutans streptococci . Stationary-state adhesion of the strains to uncoated glass ranged from 0.3 x 10(6) cm-2 (Streptococcus rattus HG218) to 12.7 x 10(6) cm-2 (Streptococcus sobrinus HG1025) and generally decreased after saliva coating of the glass . The poor adhesion found for S . rattus HG218 to both uncoated and saliva-coated glass could be due to its relatively high negative surface-charge . Deposition efficiencies of all strains were greater than or equal to 1 for uncoated glass and decreased greatly after saliva coating of the glass . Possibly, adhesion to a saliva coating is less efficient and more time-consuming than that to uncoated glass, because stereochemical groups in the pellicle and on the cell surfaces may have to re-arrange before an effective interaction can occur . Desorption rates, measured 1000 s and 5000 s after the start of an experiment, decreased by a factor of ten upon a five-fold increase in contact time, indicative of a two-phase adhesion process . Of the four strains studied, only Streptococcus cricetus HG737 showed a minor positive cooperativity on saliva-coated glass, possibly mediated by surface appendages observed by transmission electron microscopy on negatively-stained cells . Retention of adhering bacteria was strain-dependent on uncoated glass, but was identical for all strains on saliva-coated glass, which suggests that the structure and composition of the pellicle may be more important with respect to the retention of adhering cells than the cell-surface properties themselves.

Int J STD AIDS, 1992 Mar-Apr, 3(2), 128 - 9
Balanitis (balanoposthitis) in patients attending a department of genitourinary medicine; Abdullah AN et al.; Eighty-six patients with balanitis/balanoposthitis who presented at the department of genitourinary medicine in Coventry between October 1989 and August 1990 were investigated . While 34 (41%) cases had no specific aetiological factor Candida spp . accounted for 26 cases (30%), and group B beta haemolytic streptococci for 11 cases (13%) (one patient, a diabetic, was culture positive for both Candida spp . and group B beta haemolytic streptococci) . The remaining 14 patients had other miscellaneous causes of balanitis/balanoposthitis.

Nippon Jibiinkoka Gakkai Kaiho, 1992 Mar, 95(3), 400 - 8
{Incidence of alpha-streptococcus having inhibitory activity against beta-streptococcus in patients with tonsillitis}; Fujimori I et al.; Inhibitory activity against the proliferation of group A beta-streptococci by alpha-streptococci, part of the normal flora of the oral cavity and throat, plays a role in host defense against infection . We speculated that there might be some relationship between alteration of oral flora and the presence of recurring tonsillitis . Accordingly, 141 cases of tonsillitis have been investigated for the detection of inhibitory alpha-streptococci . In patients scheduled for tonsillectomy, the mean number of inhibitory alpha-streptococci was preoperatively decreased and postoperatively increased . In patients in whom beta-streptococcus had been detected (including patients scheduled for tonsillectomy), the mean number of inhibitory alpha-streptococci was markedly decreased, indicating a high incidence of beta-streptococci in patients with tonsillitis . As inhibitory strains of alpha-streptococcus are sensitive to almost all antibiotics, it is suggested that chemotherapy may disrupt the normal flora of the throat . In summary, investigation of the oral cavity and the throat for the detection of inhibitory alpha-streptococcus appear to be useful in the management of group A beta-streptococcal infection.

West Indian Med J, 1992 Mar, 41(1), 27 - 30
Soft tissue infection in children in south Trinidad; Anatol TI; A review of 391 children in the first decade of life admitted to a surgical ward with soft tissue infections revealed predisposing factors in 38.4% of cases, mainly trauma and adjacent skin sepsis . Superficial abscess formation occurred in 90% of cases, muscle abscesses in 9.5%, and necrotizing fasciitis in less than 1% . The most frequent organism isolated was the staphylococcus aureus which was found in 52.8% of the available cultures . Coliform organisms were found in 14.6%, and haemolytic streptococci in just over 10% . A study of the culture and sensitivity profiles obtained made it possible to formulate a programme for the empirical treatment of soft tissue infections based on the region of the body involved.

J Clin Pathol, 1992 Mar, 45(3), 232 - 4
Differentiation of species in human beta-haemolytic group G streptococci using immunoglobulin Fc fragment receptor; Cimolai N et al.; AIMS: To assess the ability of human immunoglobulin Fc fragment binding activity to differentiate human biotype large colony group G streptococci from the group G "Streptococcus milleri group" . METHODS: Fifty two isolates of large colony group G streptococci and 30 group G "S milleri group" strains were tested for their ability to bind fluorescein conjugated human IgG Fc fragments after acetone fixation . Immunoblotting with peroxidase labelled human Fc fragments after resolution of bacterial polypeptides by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) was performed for six large colony strains . RESULTS: All large colony group G streptococci showed positive Fc fragment binding whereas all "S milleri group" bacteria failed to bind Fc fragments when viewed by fluorescence microscopy . All six large colony strains showed similar immunoblot binding patterns . CONCLUSION: Immunoglobulin Fc fragment receptor content distinguishes the large colony group G streptococci from the group G "S milleri group" and mayhave a role in the rapid laboratory diagnosis of pharyngeal pathogens.

J Clin Microbiol, 1992 Mar, 30(3), 716 - 8
Latex agglutination testing directly from throat swabs for rapid detection of beta-hemolytic streptococci from Lancefield serogroup C; Hayden GF et al.; A latex agglutination method for the rapid detection of beta-hemolytic streptococci from Lancefield serogroup C in throat swabs from 403 university students with symptomatic pharyngitis was evaluated . Compared with culture, the rapid test was poorly sensitive (34.4%) but very specific (98.4%) in detecting group C beta-hemolytic streptococci . The sensitivity of the rapid test improved with an increasing quantity of growth on culture.

Infect Immun, 1992 Mar, 60(3), 749 - 53
Defective production of interleukin-6 in very small premature infants in response to bacterial pathogens; Yachie A et al.; In the present study, a whole-blood culture was employed to examine the ability of preterm and term newborn infants to produce interleukin-6 (IL-6) in response to major bacterial pathogens such as group B streptococci, Escherichia coli, Listeria monocytogenes, and Streptococcus pneumoniae . Similarly, in response to stimulation with lipopolysaccharide, a potent stimulant for monocyte cytokine production, appreciable levels of IL-6 activity in the stimulated whole blood from term newborns as well as adults was effectively induced by all of these pathogens . In contrast to that of term infants, the bacteria-induced IL-6 production of preterm infants, especially those born before 30 weeks of gestation, was somewhat decreased (P less than 0.01 for each pathogen) . It was also demonstrated that IL-6 responses to lipopolysaccharide stimulation were reduced in preterm newborns (for term versus preterm newborns less than 30 weeks of gestation, P was less than 0.01) . These findings imply some inherent abnormality of monocytes in preterm babies . The diminished IL-6 production may be partly responsible for the susceptibility of preterm newborn infants to bacterial infections.

Infect Immun, 1992 Mar, 60(3), 1178 - 86
Characterization of Veillonella atypica PK1910 adhesin-mediated coaggregation with oral Streptococcus spp; Hughes CV et al.; The gram-negative human oral bacterium Veillonella atypica PK1910 exhibits both lactose-inhibitable and lactose-noninhibitable coaggregations with certain human oral streptococci . A mild sonication procedure was used to obtain a veillonella surface protein preparation against which antisera were prepared . To characterize the lactose-inhibitable coaggregation, coaggregation-defective (COG-) mutants unable to exhibit this kind of coaggregation (class 1 mutants) were used to absorb the antisera . Only the lactose-inhibitable coaggregations were blocked by these absorbed antisera . The absorbed antiserum also reacted with a 45-kDa protein found in the parent and in class 2 COG- mutants that exhibited lactose-inhibitable coaggregation . This protein was not detected in surface protein preparations of class 1 COG- mutants . Two affinity protocols, involving agarose-lactose beads and the streptococcal coaggregation partner cells, were used to bind surface proteins from V . atypica PK1910 . In each protocol, the 45-kDa protein was eluted by a solution containing 100 mM lactose . Antiserum was prepared against agarose-lactose beads with bound 45-kDa protein . When absorbed with class 1 COG- mutants, the antiserum blocked lactose-inhibitable coaggregation and reacted with the 45-kDa protein in immunoblots . When the same antiserum was absorbed with class 2 COG- mutant cells, it lost both properties, suggesting that the 45-kDa protein is an adhesin that mediates coaggregation with streptococci . The proposed adhesin does not seem to be the structural subunit of veillonella fimbriae, since no differences in fimbriae were observed by electron microscopy of the parent and all three classes of mutants.

Infect Immun, 1992 Mar, 60(3), 1114 - 21
Opsonin-independent phagocytosis of group B streptococci: role of complement receptor type three; Antal JM et al.; The role of complement receptor type 3 (CR3) in nonopsonic recognition of group B streptococci (GBS) by macrophages was investigated . Monoclonal anti-CR3 (anti-Mac-1) inhibited phagocytosis of GBS strains by as much as 50% in serum-free cultures of both mouse peritoneal macrophages and the macrophage cell line PU5-1.8 . GBS uptake was unaffected by the presence of anti-C3 or salicylhydroxamate, an inhibitor of the covalent binding reaction of C3 . Soluble antibodies to LFA-1 or to the common beta-chain (CD18) of the LFA-1/CR3/p150,95 family of cell adhesion molecules did not inhibit GBS uptake . Down-modulation of surface Mac-1 on macrophages following adherence to anti-Mac-1- or anti-CD18-coated surfaces also inhibited uptake of GBS . Further evidence for GBS interaction with CR3 was demonstrated by reduction of EC3bi rosette formation in macrophages adherent to GBS-coated plates . These studies suggest that GBS can interact with macrophage CR3, promoting phagocytosis in a C3-independent fashion . In the absence of specific immunity in neonates, this recognition mechanism may be a significant virulence determinant for GBS which poorly activate the alternate complement pathway.

Infect Immun, 1992 Mar, 60(3), 1008 - 17
Differentiation of salivary agglutinin-mediated adherence and aggregation of mutans streptococci by use of monoclonal antibodies against the major surface adhesin P1; Brady LJ et al.; The ability to adhere to salivary agglutinin-coated hydroxyapatite beads and to aggregate in the presence of fluid-phase salivary agglutinin was tested by using 25 isolates of mutants streptococci representing eight serotypes . Both adherence and aggregation activity correlated with expression of the Mr-185,000 cell surface antigen P1 on Streptococcus mutans serotype c, e, and f strains . In addition, it was shown that the P1 molecule itself served as the adhesin of S . mutans serotype c, since adherence was significantly inhibited by the presence of recombinant-specified Mr-150,000 P1 . The ability of S . sobrinus strains to adhere or aggregate did not correlate with expression of the P1 cross-reactive antigen SpaA . There was also evidence for interaction with salivary agglutinin, as manifested by aggregation but not adherence of S . rattus serotype b, which does not express a P1 cross-reactive antigen . To understand the interaction of P1 with salivary agglutinin at the molecular level, a panel of 11 anti-P1 monoclonal antibodies was tested for inhibitory activity in adherence and aggregation inhibition assays . Overlapping, but not identical, subsets of monoclonal antibodies were found to inhibit adherence and aggregation, indicating that the interactions of P1 with salivary agglutinin which mediate these two phenomena are different . The localization of functional domains of P1 which may mediate the aggregation and adherence reactions is discussed.

Biotechniques, 1992 Mar, 12(3), 424 - 9
Purification of streptokinase by affinity chromatography on immobilized acylated human plasminogen; Rodriguez P et al.; Streptokinase is an extracellular protein produced by several strains of streptococci . It functions in the species-specific conversion of plasminogen to plasmin . In this paper we describe the purification of streptokinase by affinity chromatography on human plasminogen acylated with p'-nitrophenyl p-guanidinobenzoate . The acylated and non-acylated plasminogen and plasmin were coupled to cyanogen bromide-activated Sepharose 4B and evaluated for streptokinase purification . These results show that a homogeneous preparation of streptokinase with high specific activity and high yield can be obtained using acylated plasminogen . This method permits the binding of one milligram of streptokinase per milliliter of swollen gel.

Infect Immun, 1992 Mar, 60(3), 778 - 83
Natural transmission of Streptococcus sobrinus in rats: saliva and serum antibody responses to colonization; Cole MF et al.; One hundred and twenty weanling rats fed diet NIH 2000 that were free of Streptococcus sobrinus and other mutans streptococci were employed in this study . Sixty rats were inoculated orally with S . sobrinus 6715 . Each infected rat (donor) was paired and housed with an uninfected recipient . Saliva and serum samples were collected from 24 (12 donor and 12 recipient) rats at the baseline (day 0) and from groups of 12 recipients sacrificed on days 10, 24, 38, and 52, and the level of infection with S . sobrinus was monitored . Salivary immunoglobulin A (IgA) and IgG and serum IgM and IgG antibodies reactive with whole cells (WC), glucosyltransferase (GTF), and the serotype carbohydrate (g) of S . sobrinus were measured by an indirect enzyme-linked immunosorbent assay . Although the rats were free of S . sobrinus and other mutans streptococci at baseline, they exhibited salivary IgA and serum IgM antibodies reactive with S . sobrinus WC, GTF, and g and serum IgG antibodies reactive with WC and GTF . Infection of recipients with S . sobrinus did not induce salivary antibodies reactive with WC, GTF, or g . In contrast, increases in serum IgM and IgG antibodies reactive with WC and serum IgM antibodies reactive with g were observed.

Infect Immun, 1992 Mar, 60(3), 1229 - 31
Gamma interferon and interleukin 2, but not interleukin 4, are detectable in gamma/delta T-cell cultures after activation with bacteria; Follows GA et al.; Mycobacterium tuberculosis- or group A streptococcus-activated gamma/delta T cells from normal healthy individuals were negatively sorted and restimulated in vitro from 48 h . Significant amounts of gamma interferon were detected after restimulation with M . tuberculosis, group A streptococci, or Listeria monocytogenes . In contrast, interleukin 4 was undetectable in the culture supernatants . Our findings provide indirect evidence for the involvement of gamma/delta T cells in immunity against tubercle bacilli and probably other bacteria.

Med Lab Sci, 1992 Mar, 49(1), 16 - 9
High level gentamicin resistance in enterococcal and streptococcal isolates from blood culture; Stevens PJ et al.; The combination of an aminoglycoside with a cell wall active agent is often necessary for the satisfactory management of serious enterococcal and streptococcal infections . High level gentamicin resistance (MIC > 1000 micrograms/ml) eradicates the synergy between these two classes of antibiotics and treatment of these infections becomes difficult . Over a four year period we assessed the susceptibility of blood culture isolates of enterococci, Streptococcus agalactiae (group B), and clinically significant viridans-type streptococci . The susceptibility of the organisms to gentamicin could be determined utilizing high content aminoglycoside discs . We report an increasing prevalence of high level gentamicin resistance in enterococci in South London, with 44% of isolates being resistant in the first quarter of 1991 . None of the streptococcal isolates demonstrated high level gentamicin resistance . We recommend screening for high level gentamicin resistance in all enterococcal and streptococcal cases where aminoglycoside-penicillin synergy is desired.

J Hosp Infect, 1992 Mar, 20(3), 153 - 62
A clinical evaluation of glove washing and re-use in dental practice; Adams D et al.; This study has assessed the durability of four brands of latex gloves, Ansell Medical 'Medi-Grip', Regent 'Biogel D', Surgikos 'Microtouch' and the London Rubber Company 'Supreme', under conditions of repeated washing and re-use in a clinical dental setting . The microbiological effectiveness of 'Hibiscrub' as a decontaminating washing agent was examined simultaneously . Examination by an electrical test for micropunctures in 200 unused gloves of each brand revealed such defects in 6(3%) of Ansell 'Medi-Grip', 3(1.5%) of 'Biogel D', 14(7%) of Surgikos 'Microtouch' and 2(1%) of LRC 'Supreme' gloves . Following repeated clinical use, micropunctures were detected in 18% of Ansell 'Medi-Grip', 10% of 'Biogel D', 75% of Surgikos 'Microtouch' and 56% of LRC 'Supreme' . Microorganisms were isolated from the glove surfaces after 45% of the occasions on which the gloves were washed for 1 min in 'Hibiscrub' (ICI Dental) . Eighty-five per cent of these isolates were environmental organisms, but oral streptococci were isolated from 8.4% of the pairs of gloves examined . The high rate of micropuncture development following repeated washing and re-use of latex gloves indicates that they cannot effectively perform their barrier function under such conditions . The microbiological data have also revealed the potential for cross-infection between patients through inadequate decontamination of glove surfaces . For operative dental surgery, the results suggest that heavier, surgical type gloves are to be preferred, and that multiple use of any glove type should be discouraged.

Pediatr Dent, 1992 Mar-Apr, 14(2), 86 - 91
Salivary antimicrobial proteins and mutans streptococci in tonsillectomized children; Lenander-Lumikari M et al.; Whole saliva from 53 children who had been tonsillectomized when they were younger than 4 years old was analyzed for selected antimicrobial proteins and oral mutans streptococci 3-4 years after the operation . The results were compared with those from age- and gender-matched control children with no history of tonsillectomy . The salivary analyses comprised both immune (total IgA, IgG and IgM) and selected nonimmune (lactoferrin, myeloperoxidase, salivary peroxidase) antimicrobial proteins . Specific IgA and IgG antibodies against viral antigens (adeno-, cytomegalo-, respiratory syncytial- and Epstein-Barr-viruses) and against Streptococcus mutans cells were quantitated in both groups . The tonsillectomized children had statistically significantly higher concentrations of all immunoglobulin isotypes (P 0.001) as well as of lactoferrin (P less than 0.005), and myeloperoxidase (P less than 0.001) in saliva . However, no differences were found in the numbers of cariogenic mutans streptococci or in the total oral aerobic flora . In line with the streptococcal counts, no differences existed in anti-S . mutans IgA or IgG titers between the groups . Most antibodies against viruses, especially of IgG isotype, were significantly (P less than 0.001) higher in saliva of tonsillectomized children than in that of the controls . The results suggest that, within a long run, the humoral immune status of human saliva is not weakened by tonsillectomy . Also, mainly serum-derived antimicrobial proteins (myeloperoxidase, lactoferrin, IgG) exist in high concentrations in whole saliva after tonsillectomy.

Med J Aust, 1992 Feb 17, 156(4), 240 - 3
Survey of neonatal meningitis in Australia: 1987-1989; Francis BM et al.; OBJECTIVE: To identify incidence, bacterial aetiology, outcome after treatment and risk factors for poor outcome of neonatal meningitis . DESIGN: Retrospective survey of neonatal meningitis occurring in Australia between January 1987 and December 1989 . Data were obtained from Medical Records and Microbiology Departments of hospitals with neonatal nurseries . SETTING: Neonatal nurseries throughout Australia . PATIENTS: 116 infants under 6 weeks of age with bacterial or fungal meningitis . RESULTS: The minimum incidence was 0.17 per 1000 live births . Traditional neonatal pathogens were responsible for 60% of cases (group B streptococci, 35%; Escherichia coli, 22%), childhood meningeal pathogens for 10% and opportunistic pathogens for 30% . Risk factors for meningitis, including prematurity, were more common among those with meningitis due to E . coli or opportunistic pathogens than among those with infections due to group B streptococci, Listeria monocytogenes or the childhood pathogens (46/60 v . 11/55; P less than 0.0001) . Meningitis was more likely to be due to Gram-negative bacteria in premature infants (less than 36 weeks gestation) than in full-term infants (19/30 v . 20/86; P = 0.0002) . The mortality overall was 26% but was higher in extremely premature infants (less than 29 weeks) (6/9 v . 24/107; P = 0.009) and among 13 patients who were judged to have had inappropriate initial therapy (7/13 v . 21/97; P = 0.04) . Long-term sequelae occurred in at least 23% of survivors, but were more common in those with Gram-negative meningitis (6/10 v . 13/76; P = 0.012) . CONCLUSIONS: Initial therapy with penicillin or amoxycillin plus cefotaxime is appropriate for most infants with bacterial meningitis . Since some less common Gram-negative bacteria isolated in this survey were resistant to cefotaxime, an aminoglycoside should be added, initially, in Gram-negative meningitis.

Rofo, 1992 Feb, 156(2), 172 - 7
{Gas-forming infections of the extremities}; Oberstein A et al.; A variety of cases of gas-forming infections has been collected and the radiological appearances due to the gas formation are described . In the context of the clinical situation the development of gas gangrene can be distinguished from other gas-forming infections which are mostly due to B . coli or cellulitis due to anaerobic streptococci . In addition to describing the pathology and clinical course, the possible forms of treatment are discussed.

Schweiz Med Wochenschr, 1992 Feb 1, 122(5), 153 - 7
{Toxic shock syndrome in infection due to Streptococcus pyogenes}; Bombeli T et al.; Acute infections with group A beta-hemolytic streptococcus normally take a favourable course under therapy with penicillin . Only in a few cases has a completely different manifestation been described with multisystem failure similar to toxic shock syndrome induced by Staphylococcus aureus . We report on 4 patients (1990/91) who showed this manifestation in spite of immediate antibiotic therapy . In 3 patients the suspected portal of entry was the skin, in 1 patient it was unknown . Group A streptococci were grown from blood cultures from all 4 patients . Without an underlying immune deficiency all 4 patients (age 22, 24, 38 and 51) went into septic shock with high fever, hepatic and renal impairment, diarrhea, DIC and cerebral confusion . 2 patients died within a few days after developing acute respiratory distress syndrome and cerebral edema . All strains isolated from the patients were penicillin-sensitive, group A streptococci . 3 of them were M-type 1, which are known to be more invasive . The bacteremia by itself is not sufficient to explain all complications and the high mortality rate . It is probable that streptococcal toxins, such as pyrogenic exotoxin A, streptolysin O, or a new unknown one, play a decisive role.

J Infect Dis, 1992 Feb, 165(2), 315 - 21
Bacterial evasion of the antibody response: human IgG antibodies neutralize soluble but not bacteria-associated group B streptococcal C5a-ase; Bohnsack JF et al.; Most strains of group B streptococci (GBS) possess an enzyme that inactivates the human anaphylatoxin C5a by cleaving a heptapeptide from the carboxyl terminus of C5a . This enzyme, called GBS C5a-ase, has been purified to homogeneity and cleaves and inactivates C5a in physiologic buffer . The enzymatic activity of soluble C5a-ase is completely inhibited, however, in the presence of plasma or serum from normal human adults . The neutralization of soluble C5a-ase by plasma and serum results largely from naturally occurring IgG antibodies directed against C5a-ase . IgG does not neutralize C5a-ase present on intact encapsulated type III GBS but does neutralize the C5a-ase activity associated with a transposon-induced mutant strain of type III GBS that lacks capsule . The location of GBS C5a-ase on the surface of encapsulated type III GBS permits the C5a-ase to inactivate C5a while evading neutralization by IgG antibodies.

J Infect Dis, 1992 Feb, 165(2), 306 - 14
The effect of type-specific polysaccharide capsule on the clearance of group B streptococci from the lungs of infant and adult rats; Martin TR et al.; To study the importance of the type-specific polysaccharide capsule of group B streptococci (GBS) in the pathogenesis of lung infections, bacterial clearance rates and lung cellular responses to encapsulated and unencapsulated variants of types III and Ia GBS strains were investigated in rats . Bacteria were instilled by direct intratracheal inoculation to simulate aspiration during parturition . Neonates failed to eliminate encapsulated or unencapsulated GBS strains within 6 h of inoculation, whereas adults cleared greater than 90% of each strain within 6 h . Neutrophils accumulated rapidly in the lungs of neonates and adults in response to all GBS strains . Immediately after inoculation, neonatal alveolar macrophages contained fewer encapsulated GBS than did adult alveolar macrophages and fewer encapsulated than unencapsulated GBS, suggesting that the capsule impairs the initial phagocytosis of GBS in the lungs of neonates . Animal age was a more important determinant of bacterial elimination from the lung than the type-specific GBS capsule . However, both age and the bacterial capsule were important determinants of systemic dissemination.

Infect Immun, 1992 Feb, 60(2), 550 - 6
Virulence of Streptococcus suis type 2 strains in newborn germfree pigs depends on phenotype; Vecht U et al.; To determine whether the virulence of Streptococcus suis type 2 is associated with the phenotype of the strain, we infected newborn germfree pigs with 10 strains of S . suis type 2 categorized by three phenotypes . In an earlier study, the phenotypes were distinguished by the presence or absence of the muramidase-released protein (MRP) and an extracellular factor (EF) and were designated MRP+ EF+, MRP+ EF- and MRP- EF- . Pigs were first inoculated with Bordetella bronchiseptica to predispose them to infection and were then intranasally inoculated with the streptococci . Strains of the MRP+ EF+ phenotype induced fever and increased the number of polymorphonuclear leukocytes in blood . Specific clinical signs of disease such as nervous disorders and lameness were also observed . At necropsy bacteriologic and pathologic examination disclosed meningoencephalitis, polyserositis, and polyarthritis . Strains of the MRP+ EF- phenotype induced only nonspecific clinical signs of disease such as recumbency, lack of appetite, and fever; only slight pathologic changes were detected in the serosae . The four strains of the MRP- EF- phenotype induced no signs of disease . These findings indicate that the 110-kDa EF and, to a lesser degree, the 136-kDa MRP may be associated with the virulence of the bacterium . The results demonstrated that S . suis type 2 strains producing both MRP and EF are pathogenic for pigs.

Arch Oral Biol, 1992 Feb, 37(2), 99 - 104
Latex agglutination test for detection of mutans streptococci in relation to dental caries in children; Takei T et al.; A simple and rapid system based on a latex agglutination (LA) reaction was devised for the detection of mutans streptococci in dental plaque . Latex particles were sensitized with antibodies against whole cells of Streptococcus mutans strains MT8148 (serotype c), MT703R (e) and OMZ175 (f) and Strep . sobrinus strains B13 (d) and 6715 (g) . These sensitized particles were agglutinated within a few minutes after addition of 1.0-10 ng serotype-specific antigen from the homologous organisms or the nitrous acid extract of whole cells at 10(5)-10(6) c.f.u . The LA test specifically differentiated not only mutans streptococci from the other oral streptococci but also Strep . sobrinus from Strep . mutans . The LA test was also applicable to extracts of plaque from 206 human subjects who harboured mutans streptococci . In clinical trials, the outcome of the LA test correlated significantly with the number of mutans streptococci found in plaque (p less than 0.0001), which was quantified by the selective cultivation of mutans streptococci . Furthermore, the LA test discriminated between Strep . mutans and Strep . sobrinus from human dental plaque . The sensitivity and the specificity of the LA test for detection of mutans streptococci were 78.9 and 100% . The degree of reactivity in the LA test correlated significantly with the number of decayed tooth surfaces (p less than 0.0001) and decayed and filled tooth surfaces (p less than 0.0001) . These results suggest that the LA test could be useful clinically for the detection of mutans streptococci in dental plaque as well as serving as a caries-activity test.

Rev Prat, 1992 Feb 1, 42(3), 303 - 7
{Treatment of acute pharyngitis}; Chavanet P et al.; The treatment of acute pharyngitis is mainly aimed at the prevention of complications, particularly rheumatic fever . To reach this objective group A beta-haemolytic streptococci must be eradicated . To be effective, antibiotics must penetrate into the pharyngeal and tonsillar tissues and be active against streptococci . Penicillin is effective if administered by intramuscular injection or administered orally for not less than 10 days . In practice, however, compliance with this treatment is insufficient, resulting in numerous bacteriological failures . A possible improvement in the effectiveness of treatment consists in the use of a first-generation cephalosporin with a prolonged half-life, taken daily for 10 days . Acute pharyngitis is an excellent indication for macrolides . In order to improve compliance, short treatments are being tested with promising results, but until studies on new therapeutic approaches have been completed, and in the present absence of rheumatic fever epidemics in France, acute pharyngitis must be treated systematically.

Rev Prat, 1992 Feb 1, 42(3), 289 - 91
{Acute pharyngitis: value of the bacteriological diagnosis}; Fleurette J; The aetiological diagnosis of acute pharyngitis relies upon laboratory examinations, but these are difficult to obtain in routine general practice . While taking throat swabs is mandatory in some clinical situations (membranous or ulcerous pharyngitis, special investigations in some patients) where it provides essential diagnostic data, it is in fact seldom performed in patients with common acute pharyngitis . Penicillin is systematically administered for fear of the severe sequelae of group A streptococci pharyngitis, but this type of infection occurs in only 10 to 20% of the cases so that on statistical grounds routine antibiotic therapy is not fully justified . For this reason, rapid diagnostic tests without cultures and feasible at the patient's bedside have been devised . These tests have excellent specificity, but their sensitivity is not so good . In addition, their use by general practitioners raises a problem of medical responsibility, and they are not reimbursed by the french Securite sociale . The future of these fast methods will depend on the solution of these two problems.

FEMS Microbiol Immunol, 1992 Feb, 4(3), 155 - 64
Metabolically active antigen presenting cells are required for human T cell proliferation in response to the superantigen streptococcal M protein; Tomai MA et al.; M protein from type 5 group A streptococci has been identified as a member of the family of polyclonal T cell activators termed superantigens because it preferentially stimulates T cells bearing specific V beta elements of the T cell receptor (TCR) . In this study the molecular and cellular requirements for presentation of this protein to T cells were investigated . Only accessory cells (AC) expressing class II major histocompatibility complex (MHC) molecules were capable of supporting T cell activation in response to a 22 kDa fragment of M protein (pep M) . Despite the need for class II elements, processing of pep M5 by the antigen-presenting cells (APC) was not required for T cell proliferation induced by pep M5 . Fixation of APC by paraformaldehyde (PF) treatment impaired their ability to induce optimal T cell proliferation in response to pep M5 without significantly affecting interleukin (IL-2) production . In contrast, PF-fixation of cells from the B cell lymphoma line, Raji, did not affect their ability to present pep M5 to human T cells . Addition of rIL-1 and IL-6 to PF-treated APC restored pep M5-induced blastogenesis . Our data suggest that pep M5 directly associates with HLA class II molecules forming a complex that can induce IL-2 production but not optimal proliferation by T cells . Additional signals provided by the AC are required to trigger optimal T cell proliferation in response to this superantigen.

Diagn Microbiol Infect Dis, 1992 Feb, 15(2), 151 - 5
Group-C beta-hemolytic streptococcal bacteremia; Berenguer J et al.; Group-C beta-hemolytic streptococci (GCBHS) is an uncommon cause of bacteremia . In a 5-year period, GCBHS accounted for 0.28% of positive blood cultures and 0.35% of bacteremias documented at our hospital . The incidence of GCBHS bacteremia was 0.05 episodes per 1000 admissions . We were able to analyze clinical data of 10 of the 13 patients with GCBHS bacteremias . All but one were adults with significant underlying diseases, and seven episodes were community acquired . The skin was the portal of entry in only one case . Clinical syndromes included primary bacteremia (four cases), pneumonia (two cases), endocarditis (two cases), and meningitis, intraabdominal infection, and metastatic suppurative pericarditis (one episode each) . Of 13 isolates, 12 were identified to species level: six, Streptococcus equisimilis; three S . equi; two S . dysgalactiae; and one S . zooepidemicus . Resistance to penicillin was detected in one isolate and none of our isolates displayed penicillin tolerance, Four patients died (40%) despite appropriate antimicrobial therapy.

J Gen Microbiol, 1992 Feb, 138 ( Pt 2), 269 - 74
Purification and properties of extracellular mutacin, a bacteriocin from Streptococcus sobrinus; Loyola-Rodriguez JP et al.; Mutacin MT6223, a cell-free bacteriocin produced by Streptococcus sobrinus MT6223, was purified by ammonium sulphate precipitation, chromatofocusing with PBE 94 and column chromatography on SP Sephadex C-25 . The specific activity of the purified mutacin was increased 1950-fold with a recovery of 9.7% . The molecular mass of the purified mutacin preparation was estimated to be 6.5 kDa . The mutacin activity was stable from pH 2-7, and was resistant to treatment at 100 degrees C for 20 min . It was inactivated by papain or ficin digestion, and was partially inhibited by alpha-chymotrypsin . The mutacin was found to be active against strains of serotypes c, e and f of Streptococcus mutans and the addition of purified mutacin MT6223 to growing cells of S . mutans MT8148 resulted in a rapid inhibition of incorporation of {3H}thymidine, {3H}uracil or L-{3H}glutamic acid into DNA, RNA or protein, respectively . Specific pathogen-free Fischer rats fed diet 2000 and infected with S . mutans MT8148R showed significantly fewer caries and lower plaque scores when mutacin was administered through drinking water . The present study demonstrates that mutacin MT6223 inhibited the growth of mutans streptococci . Thus, mutacin MT6223 may be a candidate for use in dental caries prevention.

Int Dent J, 1992 Feb, 42(1), 31 - 6
WHO pathfinder caries survey in Beijing extended with data for prevalence of mutans streptococci; Shi Y et al.; A pathfinder caries survey was carried out in Beijing, People's Republic of China, using WHO standard methodologies, in order to estimate the trend by comparing the results with the 1981 caries survey, performed in the same area . Simultaneously, the levels of mutans streptococci in the group were estimated in order to define the proportion of children with high and low mutans levels . Twelve-year-old children were randomly selected from schools in five districts within the city limits . Examinations for caries were performed according to 'WHO Oral Health Surveys' by two calibrated examiners . A total of 178 children were examined for caries and 156 of them were randomly selected for saliva sampling of mutans streptococci, using the 'Strip mutans' method . The number of colonies adhering to the strips were compared with a chart, supplied by the manufacturer, and given a score between 0 and 3, indicating low to very high saliva mutans counts, respectively . The results showed a mean DMFT of 1.87 (1.61-0.06-0.20, for decayed, missing and filled teeth respectively); 66.3 per cent of the children were affected . Fourteen per cent had mutans class 0, 28 per cent class 1, 35 per cent class 2 and 23 per cent class 3 . The mean DFT, for each mutans class was 0.82, 1.48, 2.09 and 2.69, respectively . The differences were statistically significant (P = 0.0015) . In the lowest mutans class, 50 per cent had caries and the mean number of teeth requiring conservative care was 0.68 . For the high mutans group, the corresponding values were 72 per cent and 2.11 teeth.(ABSTRACT TRUNCATED AT 250 WORDS)

Clin Infect Dis, 1992 Feb, 14(2), 418 - 21
Group A streptococcal meningitis; Chow JW et al.; Meningitis due to group A streptococci occurs uncommonly . We report two cases, one in a patient with otitis media and the other in a patient with bullous pemphigoid . Nineteen cases in the English-language literature from the past decade plus our two cases are reviewed . In 17 patients, an associated illness was present, most often otitis media or pharyngitis . When performed, gram staining of the cerebrospinal fluid and cultures of blood usually yielded organisms . Cerebrospinal fluid was acellular in two patients . Of 21 patients, 20 survived . Antibiotic therapy, which consisted of penicillin for most patients, was effective . Ceftriaxone may be an alternative agent . Neurologic sequelae occurred more often in children than in adults.

J Am Osteopath Assoc, 1992 Feb, 92(2), 231 - 3
Group A Streptococcus detection: office versus reference laboratory; Burdash N et al.; Clinical differentiation between a virus and beta-hemolytic streptococci as a cause of pharyngitis remains difficult . In the physician's laboratory, more rapid procedures using immunologic methods have replaced culture methods, traditionally requiring 2 to 3 days for identification of beta-hemolytic streptococci . Attention to the diagnostic sensitivity and specificity of these procedures will guide appropriate use.

Curr Opin Rheumatol, 1992 Feb, 4(1), 35 - 8
Infections that cause vasculitis; Mader R et al.; An infectious cause has long been suspected for most forms of vasculitis . In most cases vascular damage has been ascribed to immune-mediated mechanisms rather than direct microbial toxicity . Evidence cited in this review provides further support for a causal role of infection in the vasculitides by strengthening the link between group A streptococci and hepatitis B virus with polyarteritis nodosa and Kawasaki syndrome . It is anticipated that the application of new molecular technology will provide definitive evidence for the role of infection in the etiopathogenesis of the vasculitides.

J Clin Microbiol, 1992 Feb, 30(2), 506 - 8
Liquid medium for rapid presumptive identification of group B streptococci; Teixeira LA et al.; A suitable test was developed for distinguishing group B streptococci from other beta-hemolytic streptococci during growth in liquid medium . One hundred and sixty of 161 human group B strains tested yielded positive reactions within a 5 h incubation . The dye medium tested is a reliable substitute for more expensive serological procedures.

Eur J Pediatr, 1992 Feb, 151(2), 98 - 102
Isotype composition of antibodies to streptococcus group B type III polysaccharide and to tetanus toxoid in maternal, cord blood sera and in breast milk; Lagergard T et al.; Neonates are protected against group B streptococcal (GBS) infections and tetanus by transplacentally transferred serum antibodies . Antibodies of the immunoglobulin (Ig) G, IgM and IgA classes and IgG subclasses to the capsular polysaccharide (CPS) of type III group B streptococci (GBS III) and to tetanus toxoid (TT) were measured in sera from healthy women of fertile age and in paired maternal and cord blood sera from term and preterm pregnancies . GBS III CPS antibodies of the IgG class were found in sera from 97 out of 100 women of fertile age, but only 15 of them had antibodies above the proposed protective level (greater than or equal to 2 micrograms/ml) . TT IgG antibodies above the protective level (0.01 units/ml) were found in all sera . The IgG antibodies against GBS III CPS were mainly composed of the IgG2 subclass and to a lesser extent of IgG1 . Almost all women had IgG1 antibodies against TT and 40% had IgG4 antibodies . Total IgG and IgG1 antibodies against GBS III CPS were higher in cord blood sera from 37 term neonates than in sera from their mothers whereas IgG2 antibody levels were similar . Total IgG and IgG1 antibodies against TT were also higher in the 20 term neonates tested than in their mothers . In contrast, total IgG and IgG1 to both GBS III CPS and TT and IgG2 to GBS III CPS were lower in cord blood sera from preterm neonates than in sera from their mothers . IgA antibodies to GBS III CPS were detected in 63% of breast milk samples while IgA antibodies against TT were detected in only 4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Antimicrob Agents Chemother, 1992 Feb, 36(2), 446 - 52
Antimicrobial activity of MDL 62,873, a semisynthetic derivative of teicoplanin, in vitro and in experimental infections; Berti M et al.; MDL 62,873 is an amide derivative of teicoplanin A2-2 . Like those of natural glycopeptides, its antibacterial activity is mediated by inhibition of cell wall peptidoglycan synthesis . Against streptococci and enterococci, the in vitro activity of MDL 62,873 was similar to that of teicoplanin and greater than that of vancomycin . Against staphylococci, it has activity similar to that of vancomycin, and it was significantly more active than teicoplanin against coagulase-negative isolates . Like teicoplanin and vancomycin, MDL 62,873 had slow but significant bactericidal activity (99 to 99.9% killing in 24 h) against staphylococci at concentrations near the MIC . In murine septicemia studies with Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae, the 50% effective doses were lower than those of vancomycin . In staphylococcal endocarditis in rats, MDL 62,873 at 20 mg/kg of body weight and vancomycin at 40 mg/kg, both doses given intravenously twice daily, had similar efficacies in reducing the heart bacterial load . These results probably reflect the longer half-life of MDL 62,873, which has a pharmacokinetic profile in rats similar to that of teicoplanin.

J Antimicrob Chemother, 1992 Feb, 29(2), 141 - 7
In-vitro activities of 14-, 15- and 16-membered macrolides against gram-positive cocci; Hamilton-Miller JM; The in-vitro activities of the 14-membered macrolides erythromycin, dirithromycin, roxithromycin, clarithromycin, the 15-membered compound azithromycin and the 16-membered macrolides (16 MM) josamycin, spiramycin and midecamycin acetate (MOM) have been compared against staphylococci, enterococci and streptococci . Results have been analysed separately according to the sensitivity status of the tested strains to erythromycin, namely sensitive (S), inducibly resistant (IR) or constitutively resistant (CR) . 14- and 15-membered macrolides were active only against S strains; the order of potency in vitro was clarithromycin = erythromycin greater than azithromycin = roxithromycin greater than dirithromycin . The 16 MM were slightly less active against S strains than were the 14- and 15-membered compounds, and inhibited most IR strains; MOM and josamycin were about twice as potent as spiramycin . IR and S Staphylococcus aureus strains were equally sensitive to 16 MM, while IR strains of coagulase-negative staphylococci were less sensitive than were S strains . All CR strains of S . aureus were resistant to 16 MM, as were most of the other CR strains . However, 5/21 CR coagulase-negative staphylococci and 2/20 CR enterococci tested were sensitive to 16 MM . The seven CR strains showing anomalous sensitivity to the 16 MM (five Staphylococcus haemolyticus and two enterococci) were only 'moderately resistant' to erythromycin (MIC 8-64 mg/L), while all the other CR strains were 'highly resistant' (MIC greater than 128 mg/L) . These results indicate that it may be difficult to predict the sensitivity of Gram-positive cocci to 16 MM, and therefore individual sensitivity testing to specific compounds is essential.

East Afr Med J, 1992 Feb, 69(2), 74 - 7
Bacteraemia in febrile out-patient children; Ghiorghis B et al.; In order to study the occurrence of bacteraemia, 634 consecutively febrile children aged less than or equal to 14 years with Initial rectal temperature or 39 degrees C and above were evaluated . The overall frequency of bacteraemia was 7.7% (49 cases) . Salmonellae, Streptococci and Staphylococci accounted for 57%, 16% and 14% respectively . No statistically significant difference was noted between cases and controls with regard to the nutritional status mean age in months +/- SD (55.9 +/- 49.1 vs 39 +/- 41), and haemoglobin levels in g/dl +/- SD (11.1 +/- 1.5 vs 11.1 +/- 1.5) (P greater than 0.05) . None of the parameters studied was a strong predictor of bacteraemia and systemic bacterial infection did not strongly correlate with the magnitude of the clinical illness.

J Fam Pract, 1992 Feb, 34(2), 149 - 59
Management of children with acute pharyngitis: a decision analysis; Dippel DW et al.; BACKGROUND . Although the incidence of acute rheumatic fever has declined in the last decades, a few outbreaks have recently been reported . A rapid latex agglutination test for group A streptococci seems reasonably accurate, and early treatment of acute pharyngitis seems to influence the pharyngitis itself . These factors have promoted uncertainty concerning the current best management of patients with sore throat . METHODS . Clinical decision analysis is used to compare the risks and benefits of symptomatic treatment, and oral and intramuscular penicillin as therapeutic options, and the throat culture and the rapid latex agglutination test as diagnostic strategies . Best estimates of the risk of streptococcal pharyngitis, its complications, the carrier rate, the accuracy of diagnostic tests, the efficacy of antibiotic treatment, allergic reactions, medication compliance, and health outcomes are combined into a management advisory . All results are subjected to a sensitivity analysis in order to check their strength against plausible changes in assumptions . Quality adjusted life days (QALD) lost are used as an outcome measure . RESULTS . The agglutination test combined with oral penicillin yielded the lowest expected loss (.50) of QALD for a typical child with a risk of harboring streptococci of .60 . The other strategies, however, yielded losses that were only several hundredths of QALD higher . CONCLUSIONS . For children with at least a 40% chance of harboring streptococci and a duration of complaints of less than 2 days before starting treatment, diagnostic testing and prescription of oral penicillin appear to be the best choice of initial management . The rapid latex agglutination test is more effective than the throat culture, because prompt penicillin treatment after a positive test result may shorten the duration of pharyngitis in infected children . High rates of acute rheumatic fever (over 5 X 10(-4} and low medication compliance change the best strategy to agglutination test with intramuscular administration of penicillin.

Hybridoma, 1992 Feb, 11(1), 13 - 22
Specificity and protective activity of murine monoclonal antibodies directed against the capsular polysaccharide of type III group B streptococci; Teti G et al.; We have obtained 41 monoclonal antibodies directed against type III group B streptococci by immunizing Balb/c mice with formalin-killed bacteria . All of these antibodies reacted with purified type-specific carbohydrate by enzyme-linked immunosorbent assay and immunoprecipitation tests . The epitope recognized by all of these antibodies was associated with terminal sialic acid residues, as indicated by abrogation of immune reactions by treatment of the type-specific carbohydrate with neuraminidase . Two purified monoclonal antibodies (the IgM P9D8 and the IgG3 P4F12) were further characterized for their protective activity in a neonatal rat model of infection . P9D8 and P4F12 antibodies were significantly protective when administered in a dose of 0.5 and 2.5 mg/kg, respectively, at the same time as 3 x 10(5) colony forming units of type III streptococci . Protection was still observed when the antibodies were given up to 9 h after challenge . No protection was afforded against infections with type Ia/c and II streptococci . Similarly, both antibodies effectively opsonized type III, but not Ia, Ib or II bacteria, in an in vitro assay . These and similar, previously described, monoclonal antibodies may be useful, possibly after "humanization" by genetic engineering, for the therapy of neonatal group B streptococcal infections.

J Immunol, 1992 Feb 1, 148(3), 888 - 93
Epitopes of group A streptococcal M protein that evoke cross-protective local immune responses; Bronze MS et al.; The present studies were undertaken to identify conserved epitopes of group A streptococcal M proteins that evoke cross-protective mucosal immune responses . Two synthetic peptides copying conserved regions of type 5 M protein, designated SM5(235-264)C and SM5(265-291)C, were covalently linked to carrier molecules and their immunogenicity was tested in laboratory animals . Rabbit antisera against both peptides cross-reacted with multiple serotypes of group A streptococci, indicating that the peptides contained broadly cross-reactive, surface exposed M protein epitopes . Serum antipeptide antibodies adsorbed to the surface of heterologous type 24 streptococci passively protected mice against intranasal challenge infections . Mice that were actively immunized intranasally with each synthetic peptide covalently linked to the B subunit of cholera toxin were protected against colonization and death after intranasal challenge infections with type 24 streptococci in the absence of serum opsonic antibodies . These data confirm and extend previous observations that conserved M protein epitopes evoke cross-protective local immunity and may serve as the basis for broadly cross-protective M protein vaccines.

J Immunol, 1992 Feb 1, 148(3), 760 - 5
Expression of a monocyte chemotactic cytokine by human mononuclear phagocytes; Colotta F et al.; The present study was designed to investigate the capacity of human mononuclear phagocytes to produce a cytokine chemotactic for monocytes (monocyte chemotactic protein (MCP), alternative acronyms JE, monocyte chemotactic and activating factor, MCP-1, and tumor-derived chemotactic factor) . Human PBMC exposed in vitro to bacterial LPS expressed high levels of MCP transcripts . Monocyte-depleted lymphoid cells were not induced to express MCP by LPS . Percoll-gradient purified monocytes were able to express high levels of MCP transcripts . In an effort to exclude a role of contaminating non-monocytic cells, mononuclear phagocytes were separated by flow cytometry and sorting: CD14+ cells exposed to LPS showed high levels of MCP mRNA . LPS-stimulated monocytes released chemotactic activity for monocytes that could be inhibited by absorption with anti-MCP antibodies . IL-1, TNF, IFN-gamma, granulocyte-macrophage-CSF and, to a lesser extent, macrophage-CSF, as well as inactivated streptococci, also induced MCP gene expression . Actinomycin D experiments indicated that induction of MCP in monocytes was gene transcription-dependent . The protein synthesis inhibitor cycloheximide (Cy) blocked IL-1-, TNF-, or LPS-induced MCP gene expression in monocytes . In contrast, expression of the structurally related chemotactic cytokine IL-8 was superinduced by Cy . Moreover, Cy superinduced MCP gene expression in cells other than monocytes, including endothelial cells, smooth muscle cell and fibrosarcoma cells, indicating different mechanisms of regulation in mononuclear phagocytes vs cells of other lineages . The capacity of cells of the monocyte-macrophage lineage to produce a cytokine that recruits and activates circulating monocytes may be of considerable importance in inflammatory and immunologic reactions . Thus, the mononuclear phagocyte system can autonomously regulate the extravasation and activation of immature elements of the same lineage, a key event in inflammation and immunity.

FEMS Microbiol Lett, 1992 Feb 1, 70(1), 85 - 9
Clonal differences within M-types of the group A Streptococcus revealed by pulsed field gel electrophoresis; Single LA et al.; Digestion of chromosomal DNA with the rare cutting restriction enzyme SfiI in association with pulsed field gel electrophoresis was used to observe restriction fragment length polymorphisms (RFLP) among isolates of group A Streptococcus . Streptococci examined included isolates belonging to the same M-type (epidemiologically related and unrelated), and isolates from other M-types . RFLP patterns were quite distinct between all serotypes tested . More importantly, isolates from within a serotype could be differentiated by this technique.

Infect Immun, 1992 Feb, 60(2), 392 - 400
Identification of a genetic locus essential for capsule sialylation in type III group B streptococci; Wessels MR et al.; The type III capsular polysaccharide of group B streptococci (GBS) consists of a linear backbone with short side chains ending in residues of N-acetylneuraminic acid, or sialic acid . The presence of sialic acid on the surface of the organism inhibits activation of the alternative pathway of complement and is thought to be an important element in the virulence function of the capsule . We showed previously that a mutant strain of GBS that expressed a sialic acid-deficient, or asialo, form of the type III polysaccharide was avirulent, supporting a virulence function for capsular sialic acid . We now report the derivation of an asialo capsule mutant from a highly encapsulated wild-type strain of type III GBS, strain COH1, by insertional mutagenesis with transposon Tn916 delta E . In contrast to the wild-type strain, the asialo mutant strain COH1-11 was sensitive to phagocytic killing by human leukocytes in vitro and was relatively avirulent in a neonatal rat model of GBS infection . The asialo mutant accumulated free intracellular sialic acid, suggesting a defect subsequent to sialic acid synthesis in the biosynthetic pathway leading to capsule sialylation . The specific biosynthetic defect in mutant strain COH1-11 was found to be in the activation of free sialic acid to CMP-sialic acid: CMP-sialic acid synthetase activity was present in the wild-type strain COH1 but was not detected in the asialo mutant strain COH1-11 . One of the two transposon insertions in the asialo mutant COH1-11 mapped to the same chromosomal location as one of the two Tn916 insertions in the previously reported asialo mutant COH31-21, identifying this site as a genetic locus necessary for expression of CMP-sialic acid synthetase activity . These studies demonstrate that the enzymatic synthesis of CMP-sialic acid by GBS is an essential step in sialylation of the type III capsular polysaccharide.

Cell Biophys, 1992 Feb, 20(1), 17 - 32
Physicochemical characterization of Escherichia coli . A comparison with gram-positive bacteria; Harkes G et al.; Eight Escherichia coli strains were characterized by determining their adhesion to xylene, surface free energy, zeta potential, relative surface charge, and their chemical composition . The latter was done by applying X-ray photoelectron spectroscopy (XPS) and infrared spectroscopy (IR) . No relationship between the adhesion to xylene and the water contact angles of these strains was found . Three strains had significantly lower surface free energies than the other strains . Surface free energies were either obtained from polar and dispersion parts or from Lifshitz-van der Waals and acid/base parts of the surface free energy . A correlation (r = 0.97) between the polar parts and the electron-donor contributions to the acid/base part of the surface free energy was found . The zeta potentials of all strains, measured as a function of pH (2-11), were negative . Depending on the zeta potential as a function of pH, three groups were recognized among the strains tested . A relationship (r = 0.84) was found between the acid/base component of the surface free energy and the zeta potential measured at pH = 7.4 . There was no correlation between results of XPS and IR studies . Data from the literature of XPS and IR studies of the gram-positive staphylococci and streptococci were compared with data from the gram-negative E . coli used in this study . It appeared that in these three groups of bacteria, the polysaccharide content detected by IR corresponded well with the oxygen-to-carbon ratio detected by XPS.

N Engl J Med, 1992 Jan 30, 326(5), 292 - 7
Resistance to erythromycin in group A streptococci; Seppala H et al.; BACKGROUND . The use of erythromycin in Finland nearly tripled from 1979 to 1989 . In 1988, we observed an unusually high frequency of resistance to erythromycin in group A streptococci in one geographic region . Because routine testing does not detect the sensitivity of these organisms to antibiotics, we initiated a national study to evaluate the extent of this resistance . METHODS . We studied 272 isolates of group A streptococci obtained from blood cultures from 1988 through 1990 . In 1990 we collected from six regional laboratories 3087 consecutive isolates from throat swabs and 1349 isolates from pus samples . Resistance was indicated by growth on blood agar containing 2 micrograms of erythromycin per milliliter after incubation in 5 percent carbon dioxide . We also evaluated the clinical importance of erythromycin resistance in a retrospective study of consecutive patients with pharyngitis . RESULTS . The frequency of resistance to erythromycin in group A streptococci from blood cultures increased from 4 percent in 1988 to 24 percent in 1990 . From January to December 1990, the frequency of resistance in isolates from throat swabs increased from 7 percent to 20 percent, and resistance in isolates from pus increased from 11 percent to 31 percent . In four communities within 50 km of each other, the frequency of erythromycin resistance ranged from 2 to 5 percent to 26 to 44 percent . Several distinct DNA restriction profiles and serotypes were found among resistant isolates from the same area, suggesting a multiclonal origin . The treatment of pharyngitis with erythromycin failed in 9 of 19 patients infected with erythromycin-resistant group A streptococci, as compared with 1 of 26 patients with erythromycin-susceptible isolates (47 percent vs . 4 percent, P = 0.008) . CONCLUSIONS . In Finland since 1988 there has been a rapid and substantial increase in resistance to erythromycin in group A streptococci . The extent of this resistance is particularly serious since there are only a few alternative antibiotics available for peroral treatment of group A streptococcal infections.

FEMS Microbiol Lett, 1992 Jan 15, 69(3), 259 - 62
Synergistic degradation of bovine serum albumin by mutans streptococci and other dental plaque bacteria; Homer KA et al.; Mutans streptococci (Streptococcus mutans and Streptococcus sobrinus) exhibited low levels of proteolytic activity against the model protein substrate, FITC-labelled bovine serum albumin, when incubated alone . Inclusion of other members of the dental plaque microflora in the assay usually resulted in marked increases in the degree of proteolysis and a high level of synergy . Interactions between mutans streptococci and either Streptococcus oralis or Fusobacterium nucleatum gave rise to the greatest degree of synergistic proteolytic degradation.

J Dent Res, 1992 Jan, 71(1), 32 - 5
The effect of chlorhexidine varnish treatment on salivary mutans streptococcal levels in child orthodontic patients; Sandham HJ et al.; A chlorhexidine dental varnish was applied to the teeth of 26 children, ten to 17 years of age, in an attempt to limit the increase in colonization by mutans streptococci that normally accompanies the placement of fixed orthodontic appliances and to assess the acceptance of the application procedure . Despite the insertion of the appliances in the month following the varnish application, the numbers of detectable salivary mutans streptococci in the children were found to remain significantly lower than baseline values for seven months (p less than 0.01) . Among the 26 children, 16 exhibited high counts (greater than 2.5 x 10(5) cfu/mL saliva) at baseline, but none exhibited such counts until three months post-treatment, when one child did . By seven months, eight children had high counts . No significant difference in effectiveness was observed between varnish formulations containing 10% or 20% chlorhexidine acetate, or between children of different ages or past caries experience . The lack of drop-outs and the results of a questionnaire indicated that acceptance of the treatment by the children was excellent . The study indicates that chlorhexidine varnish therapy was acceptable to the children and was effective in suppressing oral mutans streptococcal levels for long periods, even when used prior to the placement of fixed orthodontic appliances.

Arch Dermatol, 1992 Jan, 128(1), 39 - 42
The role of streptococcal infection in the initiation of guttate psoriasis; Telfer NR et al.; BACKGROUND AND DESIGN--Although the association between streptococcal infection and guttate psoriasis is well known, to date there has been little information on whether only limited groups and/or serotypes of beta-hemolytic streptococci are involved . One hundred eleven patients with a sudden onset or deterioration of psoriasis were investigated for evidence of streptococcal infection . Of these patients, 34 had acute guttate psoriasis, 30 had a guttate flare of chronic psoriasis, 37 had chronic plaque psoriasis, and 10 had other types of psoriasis . RESULTS--Serologic evidence of recent streptococcal infection was present in 19 (58%) of 33 patients with acute guttate psoriasis compared with seven (26%) of 27 patients with guttate exacerbations of chronic psoriasis . Streptococcus pyogenes was isolated from 19 (17%) of all 111 patients (9 {26%} of 34 with acute guttate psoriasis, four {13%} of 30 with guttate exacerbations of chronic psoriasis, and five {14%} of 37 patients with chronic psoriasis) compared with seven (7%) of 101 of a control population of patients being seen for treatment of viral warts . Other beta-hemolytic streptococci were found with equal frequency in the study and control populations . Thirteen isolates of 10 different streptococcal serotypes were obtained from the 64 patients with guttate psoriasis . These serotypes were similar in distribution and prevalence to those present in the local community . CONCLUSIONS--This study confirms the strong association between prior infection with S pyogenes and guttate psoriasis but suggests that the ability to trigger guttate psoriasis is not serotype specific.

J Clin Microbiol, 1992 Jan, 30(1), 138 - 42
Rapid detection of group A streptococci: comparative performance by nurses and laboratory technologists in pediatric satellite laboratories using three test kits; Donatelli J et al.; Rapid tests for detecting group A streptococci in throat swabs are often performed outside hospitals or commercial laboratories by individuals with little or no technical training . We compared the abilities of nurses and technologists to perform and interpret three commercial kits (Directigen 1-2-3, ICON Strep A, and Culturette Brand 10-Minute Strep A ID) in three hospital satellite locations (the emergency department, a walk-in emergency clinic, and a general pediatric clinic) . When the three tests were compared with culture, the sensitivities of the tests as performed by nurses and technologists, respectively, were 39 versus 44% for Directigen, 55 versus 51% for Culturette, and 72 versus 39% for ICON . A significant difference in sensitivity was found only with ICON tests . This result was largely explained by the tendency of technologists to test moist swabs, while nurses generally processed dry swabs; ICON test sensitivity was significantly greater with dry swabs . The specificities of Directigen and ICON tests performed by nurses and technologists were high (97 to 100%) . The difference in the specificities of the Culturette test as determined from results obtained by nurses and technologists (80 versus 98%) was due to the tendency of one nurse to overinterpret the latex agglutination reaction . Analysis of the accuracies of the tests during practice periods compared with the accuracies of the tests during the study periods revealed statistically significant improvement in test performance . We conclude that these tests are specific but not sensitive when performed by nurses and technologists in satellite laboratories . With one exception, nurses and technologists performed the tests with comparable accuracy after brief training periods.

Crit Rev Oral Biol Med, 1992, 3(1-2), 109 - 33
Ontogeny of immunity to oral microbiota in humans; Smith DJ et al.; This article reviews the ontogeny of immune systems in the human oral cavity that may influence the colonization, accumulation, or pathogenesis of oral microbiota . The prenatal development of cellular components associated with the secretory immune system reveals that the initial organization of tissue into Peyer's patches can first be detected immunohistologically at 11 weeks gestation . Epithelial cells positive for secretory component and immunocytes positive for IgM can be detected in salivary gland tissue by 19 to 20 weeks and continue to predominate during gestation . After birth, immunocytes containing IgA begin to dominate . Essentially, no IgA can be detected in saliva at birth . However, salivary IgA and IgM often appear soon thereafter, presumably in response to environmental antigenic and mitogenic challenges . Salivary IgA in young infants has molecular characteristics of secretory IgA and becomes the quantitatively predominate Ig in saliva . Both IgA subclasses are present in proportions characteristic of adult pure glandular salivas in many 1- to 2-month-old infants, although the appearance of IgA2 is delayed in some subjects . Many innate, antibody, and cellular immune components are found in maternal colostrum and breast milk . The antibacterial properties of these maternal factors are diverse and can exert multifaceted protective effects on the infant's alimentary tract . The infant apparently can mount mucosal immune responses quite early in life . For example, salivary antibody activity to organisms that originally colonize the gut (e.g., E . coli) or the oral cavity (e.g., S . mitis, S . salivarius) can be detected by 1 to 2 months of age . Most of this antibody activity has characteristics of secretory IgA, although some IgM antibody can also be initially detected . Salivary IgA1 and IgA2 antibody specificities to S . mitis and S . salivarius components increase qualitatively and quantitatively during the first few years of life . Salivary IgA antibody to components of streptococci that require hard surfaces for colonization (e.g., S . sanguis and mutans streptococci) generally appear after tooth eruption . The loss of placentally derived maternal IgG antibody specificities to these microbiota in the circulation is replaced by de novo synthesis, presumably as a result of the teething process . These IgG antibodies can enter the oral cavity in the gingival crevicular fluid and by the process of teething.(ABSTRACT TRUNCATED AT 400 WORDS)

Infect Immun, 1992 Jan, 60(1), 31 - 8
Adherence of oral streptococci to salivary glycoproteins; Murray PA et al.; We used an overlay method to study the ability of human salivary glycoproteins to serve as receptors for several strains of streptococci that colonize the oral cavity . Parotid and submandibular-sublingual salivas were collected as ductal secretions, separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and transferred to nitrocellulose membranes . The resulting blots were overlaid with {35S}methionine-labeled bacteria, and salivary components to which the bacteria bound were detected by autoradiography . Potential glycoprotein receptors were identified for 8 of the 16 strains tested . In three cases (Streptococcus sanguis 72-40 and 804 and Streptococcus sobrinus OMZ176), highly specific interactions with a single salivary component were detected . Removal of sialic acid residues from the low-molecular-weight salivary mucin prevented adherence of one of these strains (S . sanguis 72-40), suggesting that this saccharide either mediates binding or is a critical component of the receptor site . In the remaining five strains (Streptococcus gordonii G9B and 10558, S . sanguis 10556, and Streptococcus oralis 10557 and 72-41), interactions with multiple salivary components, including the low-molecular-weight salivary mucin, highly glycosylated proline-rich glycoproteins, and alpha-amylase, were detected . These results suggest that some oral streptococci can bind specifically to certain of the salivary glycoproteins . The interactions identified may play an important role in governing bacterial adherence and clearance within the oral cavity.

Chest, 1992 Jan, 101(1), 37 - 41
Late prosthetic valve endocarditis . Immediate and long-term prognosis; Tornos P et al.; From 1975 to 1989, 307 consecutive episodes of infective endocarditis were diagnosed in our hospital . Of those, 35 were cases of late prosthetic valve endocarditis, defined as those occurring after 12 months of valvular replacement . Blood cultures grew streptococci in 15 patients (43 percent), staphylococci in seven (20 percent), enterococci in five (14 percent), Gram-negative bacilli of HACEK group in four (11.5 percent), and Candida in one . Blood cultures were negative in three cases (prosthetic infection was confirmed at surgery) . Heart failure due to prosthetic dysfunction occurred in seven patients (20 percent) and emboli in 12 (34 percent) . Early valvular replacement was performed in six patients (17 percent) . Complications and mortality were dependent on the infective agent . Overall mortality was 23 percent, no death occurred from streptococcal infection, whereas mortality with endocarditis by organisms of the HACEK group and Staphylococcus was 50 percent and 43 percent, respectively . During a mean follow-up of five years, 11 patients (those with prosthetic leaks diagnosed during the active infection and patients with biologic prostheses) required surgery . There was one relapse in a patient with staphylococcal endocarditis and one recurrence, six years after the initial episode . We conclude that immediate prognosis of late prosthetic valve endocarditis depends on the infective agent . Although the immediate prognosis of streptococcal infections is good, the need for early reoperation during follow-up due to progressive perivalvular leak is high . Also, it appears that deterioration of bioprostheses proceeds swiftly after the cure of infection.

Am J Clin Pathol, 1992 Jan, 97(1), 114 - 6
Aspergillus terreus as a cause of septic olecranon bursitis; Ornvold K et al.; A 72-year-old, non-insulin-dependent diabetic man with a 2-month history of painful right olecranon bursitis was examined after a fall on the sidewalk that resulted in some abrasion of the skin overlying the elbow . Fluid aspirated from the bursa showed growth of Aspergillus terreus, as did tissue from a bursectomy performed 1 week later . Septic bursitis is an uncommon disease that is nearly always caused by Staphylococcus aureus or hemolytic streptococci . Mycotic bursitis is very rare and this is the first reported instance of any Aspergillus species causing septic bursitis.

Intensive Care Med, 1992, 18(3), 175 - 6
Streptococcal toxic shock syndrome in children; Floret D et al.; Two children with toxic shock-like syndrome due to streptococcal infection are reported . In both cases (one fatal) the site of infection was in the soft tissues . Both strains of group A hemolytic streptococci isolated from blood culture produced large amounts of erythrogenic toxin B (ET B) small amounts of ET C but no ET A . This report confirms the implication of Streptococcus pyogenes in toxic shock like syndromes . When ET A seems to be responsible for most cases observed in the USA, our cases and others observed in Europe could be related to strains producing large amounts of ET B.

Acta Otolaryngol Suppl, 1992, 492, 68 - 71
Penicillin tolerance in group A streptococci and treatment failure in streptococcal tonsillitis; Stjernquist-Desatnik A et al.; Penicillin tolerance in Streptococcus pyogenes has been suggested as a possible cause of therapeutic failure in streptococcal phryngitis treated with penicillin . In 144 patients with acute group A streptococcal tonsillitis treated with phenoxymethyl penicillin 12.5 mg per kg body weight b.i.d . for 10 days the same T-type was recovered after treatment in 21% . The recovery rate was higher for non-tolerant strains, 23%, than for tolerant strains, 10% (p greater than 0.05) . Of patients with a non-tolerant strain 17% had both clinical and bacterial treatment failure in comparison with 5% infected with a tolerant strain (p greater than 0.05) . Reinfection with a new serotype occurred in altogether 3% . The present data did not indicate that penicillin tolerance in group A streptococci is of significance in acute tonsillitis treated with phenoxymethylpenicillin for 10 days.

Dtsch Zahn Mund Kieferheilkd Zentralbl, 1992, 80(1), 7 - 12
{Individual plaque flora determination in periodontal diseases . Methods and standardization}; Paul B et al.; The dental plaque of 15 patients with gingivitis and of 15 patients with marginal periodontitis was won by means of two different methods of isolation and sampling . Either the plaque was sampled by a scaler with and without covering the crown . The estimation of plaque-microflora was done by microscopical and cultural bacteriological methods . Differences in the composition of plaque-microflora could be found in dependence of method used in isolation and sampling . Also differences in bacterial colonisation of different regions were found using the same technique of sampling . The subgingival plaque in marginal periodontitis was different of the plaque in gingivitis . In plaque-microflora of periodontitis the percentage of gram-positive cocci and rods was decreasing, the percentage of gram-negative and mobile bacteria was increasing compared with the bacterial flora in gingivitis . In the subgingival plaque in gingivitis streptococci and actinomyces were the predominant bacteria.

Pediatriia, 1992, (1), 64 - 8
{Clinical and diagnostic value of complex examination of the bronchoalveolar lavage fluid in nonspecific inflammatory lung diseases in children}; Gaidashev EA et al.; A study was made of the results of cytological, cytochemical (determination of the ratio of ethidium bromide extinction and NTB test) and microbiological studies of bronchoalveolar lavage fluid in 125 children with acute pneumonia and 347 with chronic nonspecific inflammatory pulmonary diseases . It has been revealed that all-round studies permit defining the type and activity of endobronchitis together with the status of the ventilated alveolar tissue . Acute pneumonia is marked by catarrhal process with highly active inflammation of bacterial nature, whereas chronic nonspecific inflammatory diseases by purulent endobronchitis . In localized forms of nonspecific inflammatory pulmonary diseases, streptococci and pneumococci may be regarded as the dominant microflora.

Schweiz Monatsschr Zahnmed, 1992, 102(3), 286 - 91
Mutans streptococci and their specific oral target . New implications to prevent dental caries?
Suhonen J.
Over the past 25 years collection and analysis of clinical, dietary and microbiological data have led to the conclusion that caries is a bacterial infection, initiated by mutans streptococci which can be transmitted within a family by saliva . Bacteria attach themselves selectively to various oral surfaces . In order to inhabit the mouth mutans streptococci require the presence of teeth . The targets of the odontopathogens (tooth hard substances and gingival sulcus) appear into the oral cavity on a "peculiar" way: these surfaces and tissues are not exposed to bacterial colonization from birth as skin and mucosa . Teething starts 8 +/- 2 months after birth at which age the infant's antibody-dependent defence system is physiologically weak . Teeth erupt slowly during the night, at a period of least intraoral activity . Theoretically, streptococcal colonization can begin as soon as a few mm2 of incisal edges of primary teeth become visible . The earlier the establishment of mutans streptococci in the plaque of the primary teeth, the earlier and more extensive is the caries development . These aspects might open new possibilities for the prevention of the dental diseases, provided that means are found by which the primary colonization can be hindered or postponed.

Pediatr Res, 1992 Jan, 31(1), 14 - 7
Impact of prostaglandin and thromboxane synthesis blockade on disposition of group B streptococcus in lung and liver of intact piglet; Pauly TH et al.; Group B streptococci (GBS) localizing in the lungs of infant piglets is killed in part by an oxygen radical-dependent mechanism (Bowdy BD, Marple SL, Pauly TH, Coonrod JD, Gillespie MN: Am Rev Respir Dis 141:648-653, 1990) . The source of bactericidal oxygen radicals is unknown, but cyclooxygenation of arachidonic acid, an initial event in prostanoid synthesis, is accompanied by substantial oxygen radical generation . Because blockade of prostaglandin H synthase (cyclooxygenase) with indomethacin prevents GBS-induced pulmonary hypertension, we reasoned that the salutary effect of indomethacin might be associated with a reduction in the efficacy of bactericidal activity directed against GBS . To address this possibility, the distribution and viability of 111In-labeled GBS (10(8) colony forming units/kg/min i.v . for 15 min) were assessed in lungs and livers of control piglets, piglets treated with indomethacin (1 mg/kg), and piglets treated with OKY-046 (10 mg/kg), an inhibitor of thromboxane synthase that also forestalls GBS-induced pulmonary hypertension . Relative to control animals, indomethacin treatment increased pulmonary GBS uptake with no change in bacterial distribution into the liver . OKY-046 failed to influence pulmonary bacterial uptake but promoted a substantial increase in GBS depositing in the liver . In contrast to its effects on pulmonary bacterial deposition, indomethacin failed to increase lung bacterial viability relative to control animals . Indomethacin also was without effect on hepatic bacterial viability . OKY-046 failed to influence pulmonary bacterial viability but markedly augmented hepatic GBS viability to the extent that significant bacterial proliferation occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Microbios, 1992, 69(278), 17 - 27
Effects of haemolysins of groups A and B streptococci on cardiovascular system; Griffiths BB et al.; Anaesthetized New Zealand white rabbits and rats were either injected or infused with streptolysin S and group B streptococcal haemolysins in order to observe the haemodynamic actions of these haemolysins . Results showed that streptolysin S had little or no effect . In contrast, group B streptococcal haemolysin showed significant hypotensive action as manifested in rapid reduction of systolic, mean, diastolic and pulse pressures, and a limited number of deaths due to shock.

Clin Infect Dis, 1992 Jan, 14(1), 92 - 7
Meningitis due to beta-hemolytic non-A, non-D streptococci among adults at a cancer hospital: report of four cases and review; Sepkowitz KA et al.; Four cases of meningitis due to beta-hemolytic non-A, non-D streptococci among adult patients with neoplastic disease are reported . All four patients had head or neck tumors for greater than or equal to 4 years, and all had undergone surgery for these tumors . Three of four patients had received local radiation therapy . None of the patients were neutropenic . One patient died . A review of the literature revealed that most patients with non-A, non-D streptococcal meningitis had disruption of the normal barrier protecting the CNS due to trauma, surgery, or the presence of a tumor, or had extensive exposure to animals or an underlying medical disease . Infection with non-A, non-D streptococci should be considered in any patient with meningitis who has a tumor of the head or neck and who has undergone surgery and/or radiation therapy.

Infection, 1992 Jan-Feb, 20(1), 30 - 3
Skin concentrations of phenoxymethylpenicillin in patients with erysipelas; Sjoblom AC et al.; In 45 patients hospitalized with febrile erysipelas that had been treated with oral penicillin, punch biopsies of infected skin were performed and analysed for phenoxymethylpenicillin (pcV) concentrations . The curves for the concurrent serum and tissue levels followed the same course, indicating a rapid diffusion of pcV from serum into tissue . Penicillin concentrations in infected skin exceeded the minimal inhibitory concentrations (MIC) of the streptococci isolated for the first 4 h after tablet ingestion . Venous insufficiency was highly prevalent and pcV concentrations in affected patients were slightly but not significantly higher . A theoretical basis for the successful treatment of erysipelas with oral penicillin is therefore at hand.

FEMS Microbiol Immunol, 1992 Jan, 4(2), 111 - 22
Effects of protein intake on immune parameters in mice surviving streptococcal infection; Ota F et al.; Groups of mice were fed for 2 weeks on isocaloric diets containing 5, 7, 20 and 40% (w/w) casein, respectively, then injected intraperitoneally with group B streptococci, and observed for their survival rates . The mice fed 7% or 20% casein had lower mortalities than those fed 5% or 40% casein . In order to explain the different survival rates, other groups of mice were fed on the experimental diets and examined for the number of leukocytes in the blood, of spleen cells and thymocytes, for IgG and IgM antibody titres to the streptococci, for haemolytic titres of sera, the amount of complement component 3 (C3), for chemiluminescence and opsonic activity of peritoneal exudate cells (PEC) and spleen cells (SP), production of superoxide anion from PEC and SP, and production of immunoglobulins from cultured SP . After 2 weeks on a 7 or 20% casein diet mice showed increased serum levels of IgM antibodies reactive with the whole bacterial cells on days 3-5 when they were immunised with a sublethal dose of group B streptococci . The mice fed on the 7% casein diet also showed a higher C3 titre than the other diet groups when assayed by enzyme immunoassay . Furthermore, opsonophagocytic activity was highest when PEC or SP taken from mice on the 20% case in diet were incubated with radiolabelled microorganisms in the presence of fresh serum taken from the 7% casein group . The production of superoxide anions from PEC and SP was lowest in the mice fed on 5% casein when activity was expressed as nano-mol per animal . It is suggested from these results that the greater activity of phagocytic cells in the presence of increased amounts of C3 and IgM explains the heightened resistance in the mice fed on a 7% casein diet, and that suppressed opsonophagocytic activity resulting from the decreased number of leukocytes in the blood and other phagocytic cells explains the lowest resistance in the 5% casein group . However, mice fed on a 40% casein diet showed all these immunological parameters untouched, and their lowered resistance could not be explained . Different factors seem to be operative in them.

J Dairy Sci, 1992 Jan, 75(1), 96 - 104
The influence of intensively managed rotational grazing, traditional continuous grazing, and confinement housing on bulk tank milk quality and udder health; Goldberg JJ et al.; Monthly bulk tank milk samples and veterinary records were analyzed for 1 yr on 15 Vermont dairy farms . Data were evaluated using ANOVA to compare effects of grazing management systems on milk quality and udder health . Systems evaluated were intensively managed rotational grazing, traditional continuous grazing, and confinement housing . Bulk tank samples were evaluated for standard plate count, bacterial type counts on tryptose-blood-esculin agar, and SCC . Veterinary records were evaluated for incidence of clinical mastitis, udder edema, and teat injuries . Within- and between-treatment group analyses were conducted by season, herd size, and udder sanitation systems . Mean standard plate counts were lower in rotationally grazed herds than counts of confined herds during the grazing season . Similarly, rotationally grazed herds with fewer than 60 cows had lower standard plate counts than confined herds of similar size . Mean bulk tank counts of streptococci other than Streptococcus agalactiae during the grazing season differed among treatments . The lowest counts occurred in rotationally grazed herds . Among herd using predip products recognized as efficacious, fewer streptococci other than S . agalactiae were isolated from bulk tank milk of rotationally grazed herds than confined herds . Rotationally grazed herds using postdips recognized as efficacious had lower SCC than those using unrecognized postdips . No udder health differences were observed among grazing treatments.

APMIS, 1992 Jan, 100(1), 57 - 62
Characterization of the alpha antigen of the c proteins of group B streptococci (GBS) using a murine monoclonal antibody; Bevanger L et al.; A murine monoclonal antibody raised against the alpha antigen of the group B streptococcal c proteins was analysed by immunofluorescence and whole-cell ELISA against a collection of 22 c protein-producing GBS . All the strains showing fluorescence and reactivity in ELISA turned out to be alpha antigen-carrying strains as defined by polyclonal rabbit antisera, while none of the strains producing only the beta antigen was positive . Western blot analyses of the alpha antigen released into the culture medium of growing bacteria suggest that the alpha antigen is present as distinct proteins of variable molecular weights . The upper limit of the molecular weights varies considerably from one strain to another, from approximately 200 kD to 70 kD . With all strains, the bands seen by the MAb occurred at regularly spaced intervals of about 10 kD throughout the gel . Some strains gave rise to 15-16 bands, while others gave rise to only one or two bands . The present investigation suggests that alpha antigens include several, probably identical, repeating subunits of approximately 10 kD . The epitope recognized by the MAb seems to be located on a 10-kD fragment, and in addition, it appears to be surface located, making the MAb a suitable tool in serodiagnostic work.

Caries Res, 1992, 26(1), 33 - 7
Noncariogenicity of maltitol in specific pathogen-free rats infected with mutans streptococci; Ooshima T et al.; The effect of maltitol on caries development was examined in an experimental caries system employing specific pathogen-free (SPF) Sprague-Dawley rats . Fourteen strains of oral streptococci, including mutans streptococci, did not utilize the maltitol nor produce sufficient acid to demineralize tooth enamel . Furthermore, maltitol did not serve as a substrate for glucosyltransferases of either Streptococcus mutans MT8148R or Streptococcus sobrinus 6715 to synthesize water-insoluble glucan . Maltitol induced no significant dental caries in SPF rats infected with these mutans streptococci, and replacement of the dietary sucrose content with maltitol resulted in a trend towards caries reduction in SPF rats.

Infect Immun, 1992 Jan, 60(1), 284 - 95
Glucans synthesized in situ in experimental salivary pellicle function as specific binding sites for Streptococcus mutans; Schilling KM et al.; Many researchers have suggested that the role of glucan-mediated interactions in the adherence of Streptococcus mutans is restricted to accumulation of this cariogenic bacterium following its sucrose (i.e., glucan)-independent binding to saliva-coated tooth surfaces . However, the presence of enzymatically active glucosyltransferase in salivary pellicle suggests that glucans could also promote the initial adherence of S . mutans to the teeth . In the present study, the commonly used hydroxyapatite adherence assay was modified to include the incorporation of glucosyltransferase and the synthesis of glucans in situ on saliva-coated hydroxyapatite beads . Several laboratory strains and clinical isolates of S . mutans were examined for their ability to adhere to experimental pellicles, either with or without the prior formation of glucans in situ . Results showed that most strains of S . mutans bound stereospecifically to glucans synthesized in pellicle . Inhibition studies with various polysaccharides and fungal dextranase indicated that alpha 1,6-linked glucose residues were of primary importance in the glucan binding observed . Scanning electron microscopic analysis showed direct binding of S . mutans to hydroxyapatite surface-associated polysaccharide and revealed no evidence of trapping or cell-to-cell binding . S . mutans strains also attached to host-derived structures in experimental pellicles, and the data suggest that the bacterial adhesins which recognize salivary binding sites were distinct from glucan-binding adhesins . Furthermore, glucans formed in experimental pellicles appeared to mask the host-derived components . These results support the concept that glucans synthesized in salivary pellicle can promote the selective adherence of the cariogenic streptococci which colonize human teeth.

Cancer Immunol Immunother, 1992, 35(4), 277 - 82
Effect of picibanil (OK432) on neutrophil-mediated antitumor activity: implication of monocyte-derived neutrophil-activating factors; Yang KD et al.; Picibanil (OK432), an extract from streptococci, has been widely utilized to treat malignant ascites and pleural effusions . The antitumor mechanism is believed to include complement-mediated neutrophil activation . Employing a flow-cytometric analysis of actin polymerization as an indicator of cell activation as well as a tumor proliferation assay, we have found that monocyte-derived neutrophil-activating factors were involved in OK432-induced neutrophil activation as well as antitumor activity . OK432-stimulated (0.1 KE/ml; 0.01 mg/ml) monocyte supernatants (OKMS) induced neutrophil actin polymerization and chemotaxis . OKMS were responsible for neutrophil-mediated inhibition of human leukemic (CEM) cell proliferation and stimulated neutrophils to produce superoxide in the presence of CEM leukemic cells at an effector/target ratio higher than 20/1 . In contrast, OK432 alone, OK432-stimulated lymphocyte supernatants, or OK432-stimulated neutrophil supernatants had no effect on neutrophil activation or suppression of tumor cell proliferation . OK432 in combination with mononuclear cells also had no effect on the inhibition of CEM cell proliferation . Pretreatment of OKMS at 56 degrees C for 30 min did not affect its ability to activate neutrophils, implying that complement activation is not responsible for the neutrophil activation . Supernatants from OK432-stimulated mononuclear cells, as determined by enzyme-linked immunosorbent assays and radioimmunoassays, contained high levels of interleukin-8 (IL-8; 1567 +/- 145 pg/ml) and tumor necrosis factor (TNF alpha; 2105 +/- 152 pg/ml), low levels of leukotriene B4 (800 +/- 45 pg/ml) and IL-1 beta (180 +/- 22 pg/ml), but interferon gamma was not detectable . IL-1 beta, IL-8, and TNF alpha transcripts, undetectable in untreated monocytes, increased significantly after 30-60 min exposure to OK432 . These results suggest that neutrophil-activating factors from monocytes or resident macrophages may play an important role in the OK432-induced neutrophil activation and antitumor activity.

J Immunoassay, 1992, 13(3), 441 - 55
Rapid antibody capture assay for detection of group-A streptococci using monoclonal antibody and colloidal gold-monospecific polyvalent antibody conjugate; Gupta R et al.; A rapid one step, sensitive and specific antibody capture assay for detection of group-A streptococci from the throat swabs of children is described . Monoclonal antibody either MA-106 or MA-107 specific for group-A streptococci polysaccharide (APS) was used as the capture antibody on nitrocellulose paper and rabbit monospecific polyvalent antibody conjugated with colloidal gold to detect the presence of antigen . The lower detection limit of this assay is 15.6ng APS/ml . The assay is specific for APS and failed to recognize polysaccharides obtained from group-B,-C,-G streptococci as well as Staphylococcus aureus . Antigen extracted from throat swabs of children who were positive for beta-hemolytic plaques (other than group-A streptococci) as seen on blood agar culture gave negative readings, thereby confirming the specificity of the assay for APS.

Eye, 1992, 6 ( Pt 4), 396 - 9
Septicaemic infection with group B streptococci presenting with endophthalmitis in adults; O'Brart DP et al.; Metastatic bacterial endophthalmitis is an uncommon and serious infection, that can be caused by a variety of bacteria . Group B streptococci have rarely been implicated . We report four cases of metastatic endophthalmitis in adults caused by group B streptococci . The organisms were isolated from the eyes and blood in each case.

Microbiol Immunol, 1992, 36(8), 815 - 22
Antibody response to oral streptococci in Behçet's disease; Yokota K et al.; The serum antibody titers against oral streptococci were studied by enzyme-linked immunosorbent assay (ELISA) both in patients with Behcet's disease (BD) and control groups . The patients with BD showed significantly higher antibody titers to S . sanguis strains 113-20, 114-23, and 118-1 which were isolated from patients with BD, in comparison with control groups . Also, the reactions of high-titered sera to the crude cell wall and soluble (or membrane) fractions of the 113-20 strain were observed by western blot test . The sera of the patients with BD demonstrated strong bands of approximately 36 kDa, 82 kDa, and 87 kDa in the crude cell wall fractions, and many bands of 80 kDa to 150 kDa in the membrane fractions, indicating that these proteins are the ones leading the high antibody titers to this bacterium in the sera of patients with BD.

Caries Res, 1992, 26(5), 358 - 62
Noncariogenicity of erythritol as a substrate; Kawanabe J et al.; Erythritol is a sugar alcohol produced by Aureobasidium sp . from glucose . It is 75-80% as sweet as sucrose and is also nonhygroscopic . The aim of this study was to evaluate this sugar substitute from a cariological point of view . Erythritol was neither utilized as a substrate for the lactic acid production nor for plaque formation of mutans streptococci (serotypes a-h) and certain oral microorganisms . It was not utilized for water-insoluble glucan synthesis or cellular adherence by glucosyltransferase from Streptococcus mutans PS-14 (c) and Streptococcus sobrinus 6715 (g) . Finally, a significantly lower caries score (3.1 +/- 0.5; mean +/- SEM) was observed in specific pathogen-free rats infected with S . sobrinus 6715 and fed with a diet containing 26% erythritol, as compared to control rats fed with a diet containing 26% sucrose (60.5 +/- 2.0) . Also, rats provided a diet containing 56% erythritol chocolate (23.8% erythritol) and challenged with S . mutans PS-14 exhibited a significantly lower caries score (6.7 +/- 0.8) compared to the sucrose chocolate group (82.8 +/- 2.8) . The main conclusion from this study is therefore that erythritol is a promising sugar substitute from a cariological point of view.

Scand J Infect Dis, 1992, 24(5), 661 - 5
Streptococcal myositis; Jahnson L et al.; Streptococcal myositis (SM), is a very serious condition with a high mortality rate . The port of entry of the infection is often unknown . We present here a case report concerning a 68-year-old patient with fulminant SM preceded by symptoms of an upper respiratory tract infection . Haemolytic streptococci of group A were found in the blood, muscle tissue and throat . The patient survived after massive therapeutic interventions including intensive care with intravenous antibiotics, fasciotomy, plasma exchange, controlled respiratory ventilation and exarticulation through the shoulder . The patient's wife fell ill at the same time with a sore throat and the same type of streptococci (T-type 3) was found in both patients.

Scand J Infect Dis, 1992, 24(5), 589 - 97
Septic shock induced by group A streptococcal infection: clinical and therapeutic aspects; Stegmayr B et al.; During 1988 and 1989 > 500 cases of serious group A streptococcal infections were reported in Sweden, many with a fatal outcome . We report here on 11 consecutive patients with septic preshock/shock and multiorgan failure, including acute renal failure . 10 had verified group A streptococci (GAS) serotype T1M1 infections while 1 patient was culture negative but with clinical signs of severe infection and serological evidence of GAS infection . Presenting symptoms were high fever, relative bradycardia, edema and renal failure . In all patients the condition deteriorated despite conventional treatment including volume substitution and antibiotics . Systolic blood pressure was transiently < 80 mmHg in 10 patients and 9 of them needed infusion of inotropic agents to avoid fatal circulatory shock . In 9 patients respiratory aid was instituted and 7 were dialysed . Plasma exchange was performed in 7, while the remaining 4 received transfusions with blood and plasma without plasma exchange . 10 patients improved and were discharged within 8 weeks . One woman died within 2 days after admission to the hospital . Renal function recovered in all survivors, with a follow-up serum creatinine < 80 mumol/l . The complicated clinical picture in these patients with many simultaneous therapeutic events confounds the interpretation of the effect of single actions . The favourable outcome in these severely ill patients suggests that potent inotropic agents, immunoglobulin therapy and plasma exchange might be beneficial in severe streptococcal disease when conventional treatment fails.

Arch Toxicol, 1992, 66(6), 423 - 9
Acute infection of mice with highly virulent group B streptococci as a host resistance model for immunotoxicity assessment; Barnes DB et al.; This report describes a unique model for immunotoxicity evaluation in mice . The model is adapted from previously described mouse models for group B streptococcus (GBS) infections in human neonates . In this disease as well as a number of human diseases caused by highly virulent pathogens, the mechanisms of innate immunity are unable to protect the host, and survival is strictly dependent on acquired immunity . Unlike other host resistance models widely used in immunotoxicity studies, the GBS model utilizes bacteria that are highly virulent for mice (LD50 = 5-17 colony forming units) . GBS is not virulent for adult humans and can be safely handled with typical precautions . Acquired immunity in the GBS model is induced during a 2 week period by two injections of heat-killed GBS . The immunizing doses are the minimum which will allow survival of 80-100% of mice in response to challenge with an otherwise lethal dose of live GBS (100 bacteria) . Administration of the immunotoxic agents cyclophosphamide, carrageenan, or cobra venom factor during the immunization period and/or shortly before challenge significantly suppressed host resistance . For example, the composite mortality rate for unimmunized mice was 98% and the rate for immunized mice was 8.5% . For all groups treated with cyclophosphamide (one 75 mg/kg dose 48 h before each immunization) the mean mortality was 41 +/- 18% . The consistency of the model was evaluated by repetition of several treatments in independent experiments, and the model's consistency is comparable to that of other host resistance models.(ABSTRACT TRUNCATED AT 250 WORDS)

Acta Vet Scand, 1992, 33(3), 205 - 10
Mycoplasma hyosynoviae in joints with arthritis in abattoir baconers; Friis NF et al.; The occurrence of Mycoplasma hyosynoviae in synovial fluid of baconers with chronic arthritis was studied at an abattoir . Cultural examination of synovial fluid samples from diseased tarsal joints of 50 animals from 42 herds yielded M . hyosynoviae in 10 cases from 8 herds . Streptococci were found in 6 cases from 6 other herds . M . hyosynoviae antigen was found in 1 of 47 of the samples, and antibody to the mycoplasma was found in 14 of 40 of the samples by ELISA test . The presence of M . hyosynoviae in a joint was usually accompanied by the corresponding antibody . In joints with streptococcal infection antibody to M . hyosynoviae could not be found.

Respiration, 1992, 59 Suppl 3, 3 - 13
Mucosal immunology of the upper respiratory tract; Bernstein JM; The palatine tonsils and nasopharyngeal adenoids represent the predominant immunocompetent tissue of the upper respiratory tract . Its major function is as a first line of defense against viral, bacterial, and food antigens that enter the upper aerodigestive system . Another major function of the tonsils and adenoids is to supply the local mucosal immune system of the upper respiratory tract with dimeric IgA-producing B cells . Secretory IgA has particular hydrophilic properties and is capable of preventing adsorption and penetration of bacteria and/or viruses into the upper respiratory tract mucosa . In addition, the role of the indigenous flora of the upper respiratory tract, particularly the viridans streptococci has been emphasized as providing a valuable source of bacterial interference to the colonization of potential pathogens.

Med Microbiol Immunol (Berl), 1992, 181(4), 227 - 40
Ubiquitous occurrence of virR and scpA genes in group A streptococci; Podbielski A; Until now a few serotypes of M-class I group A streptococci (GAS) have been shown to encode VirR, a positive regulatory factor for the coordinate expression of the M protein (emm) and C5a peptidase (scpA) genes . The polymerase chain reaction technique has been applied to the genomic template of 36 GAS serotypes to demonstrate the general presence of VirR (virR) genes and scpA in GAS of both M classes . A virR gene region conserved in size was demonstrated for every strain investigated . Differences between virR genes from GAS of the two M classes were mainly confined to the 3' end of the gene and a region upstream of the gene's promoter . Every M-class II strain and some M-class I isolates were shown to possess a scpA gene of 4.6 kb, the rest of the M-class I GAS harbors a 3.5-kb scpA gene . The additional segment of 1.1 kb in the large-size scpA genes was located within a region of direct repeats at the 3' end of the gene . Among the serotypes encoding a large-size scpA gene a minority exhibits additional sequence variation downstream of the region of direct repeats.

Caries Res, 1992, 26(4), 275 - 80
Effects of chlorhexidine-fluoride gel treatments in mothers on the establishment of mutans streptococci in primary teeth and the development of dental caries in children; Tenovuo J et al.; In a longitudinal 3-year study, 151 children were followed for the colonization of the primary dentition by mutans streptococci (MS) and for the development of dental caries . At the age of 1 year, the child-mother pairs were divided into three groups on the basis of the levels of MS in maternal saliva . In the experimental group, the mothers had MS levels higher than 10(5) CFU/ml, and they were given chlorhexidine (1%)-sodium fluoride (0.2%) gel treatments twice a year for 3 years . Two control groups were formed . In control group 1, the mothers also had high levels of MS, but no gel was given . In control group 2, the mothers had low (< 10(5) CFU/ml) baseline levels of salivary MS, and no chlorhexidine-fluoride gel was used . In the total study population, 16, 42, and 54% of the children were colonized by MS by the age of 2, 3, and 4 years, respectively . Most children harbored only Streptococcus mutans, but 2 had both S . mutans and Streptococcus sobrinus, and 2 had only S . sobrinus . Twenty-eight percent of the MS-positive children developed caries by the age of 4 years, whereas 4 out of 27 children with dental caries did not have any detectable MS in their plaque samples . Both the colonization by MS and the caries incidence were highest in control group 1 and lower in the experimental group and in control group 2 . These observations suggest that the reduction of maternal salivary MS at the time of tooth emergence may delay, or perhaps even prevent, the colonization of MS in the children's primary dentition with a concomitant decline in caries incidence, even in a population with an already low prevalence of dental caries.

Bull World Health Organ, 1992, 70(4), 433 - 7
A comparison of group A streptococcal serotypes isolated from the upper respiratory tract in the USA and Thailand: implications; Kaplan EL et al.; Characterization of group A beta-haemolytic streptococci in upper respiratory tract isolates from the USA and Thailand revealed that whereas 80% of the U.S . isolates could be M or opacity factor (OF) typed, less than 20% of the Thai isolates could be characterized with the available typing sera (P less than 0.001) . There was also a statistically significant difference observed in the percentage of strains that could be characterized by the T-agglutination pattern (93% in the USA vs 61% in Thailand, P less than 0.001) . Even among the identifiable strains, marked differences in the distribution of the recovered serotypes were noted between the two countries . These results show that there are a significant number of as yet unidentified group A streptococcal strains in parts of the world where streptococcal infections and their sequelae are important public health problems . They further imply that such findings must be taken into consideration in the future when designing possible streptococcal vaccines for worldwide use.

Eur J Surg Suppl, 1992, (567), 31 - 2
Antibiotic prophylaxis in clean surgical cases and the role of community surveillance; Karran SJ et al.; In an ongoing prospective study of clean surgical procedures, patients have been examined by specialist research nurses on a minimum of three occasions during the postoperative period to determine the incidence of wound complications . Whereas a previous retrospective audit suggested a wound infection rate of 2%, this community surveillance programme revealed the true rate as at least fourfold greater (p less than 0.001) . Of these complications, more than 70% were detected only by the surveillance programme . Immediate benefit was obtained by a reduction in all complications . Despite these improvements, a core of postoperative sepsis remained, particularly in high-risk cases . Thus, a prospective, controlled, prophylactic antibiotic trial has been undertaken, in an attempt to reduce the infection rate still further . An antibiotic regimen of teicoplanin, 400 mg i.v., given as a single dose, was chosen because of the excellent activity of this agent against staphylococci and streptococci, and also because of the long half-life which renders it suitable for single-dose administration.

APMIS, 1992 Jan, 100(1), 21 - 8
Two types of receptors for human plasminogen on group G streptococci; Ullberg M et al.; To investigate the nature of plasminogen binding to streptococci, strains selected for high reactivity with human plasminogen were examined for binding pattern against a panel of plasminogen fragments . The strains included human isolates of groups A, C and G as well as bovine isolates of group G . All strains reacted substantially with the plasminogen fragment kringle 1-3 . Using the miniplasminogen fragment (kringle 5 and the B chain) a small but reproducible uptake was detected for human group G strains but not for group A or C strains . The group G strains of bovine origin on the other hand demonstrated high uptake of miniplasminogen, suggesting the possibility of an alternative plasminogen receptor for this species . This interpretation was supported by blocking experiments with the lysine analogue EACA where low concentrations (1 mM) completely blocked plasminogen binding to human streptococci, whereas a 100-fold higher concentration was needed for bovine group G strains . Scatchard plots with human isolates resulted in straight lines and Kd values were generally in the range of 20-80 nM . The number of receptors was estimated to be 45,000 for a selected group A strain and about 10,000 for the selected group C and G strains . Scatchard analysis with bovine group G isolates on the other hand revealed a two phase interaction, supporting the assumption of two different receptor structures on these strains . Kd for the first phase was estimated to be about 20 nM (10,000-20,000 receptors per bacterium), which was similar to the human strains, whereas the second phase was in the range of 400-500 nM (50,000 and 150,000 receptors per bacterium with two selected strains) . Scatchard plots with the miniplasminogen fragment as ligand mimicked the phase two reaction with plasminogen, supporting the concept that this reaction represents a new and not previously described receptor . Both the receptor reacting with the kringle 1-3 portion and the one reacting with the miniplasminogen portion bound plasmin and plasminogen with similar affinity.

Infect Immun, 1992 Jan, 60(1), 196 - 201
Tissue-type plasminogen activator-mediated activation of plasminogen on the surface of group A, C, and G streptococci; Kuusela P et al.; The interaction of Glu-plasminogen with group A, C, and G streptococci and subsequent formation of surface-associated plasminogen by tissue-type plasminogen activator (t-PA) were studied . Binding of 125I-Glu-plasminogen to streptococci greatly facilitated its activation to 125I-Glu-plasmin by exogenous t-PA, whereas activation in the absence of bacteria took place only slowly . Glu-plasmin formed on the streptococcal surface was further converted to the Lys form . Similar activation and modification took place also in the presence of plasminogen-depleted plasma, containing functional t-PA and plasmin inhibitors, indicating that the surface-associated enzymes were protected against these inhibitors . Lys-plasminogen was 10- to 30-fold more potent than Glu-plasminogen or Glu-plasmin in inhibiting the binding of 125I-Glu-plasminogen to streptococci . This indicated a higher affinity of the Lys form towards plasminogen-binding molecule(s) on the streptococcal surface . The surface-associated plasmin was also enzymically active as judged by digestion of chromogenic substrate S-2251 . Surface-associated plasmin activity was observed only when the incubations were carried out in the presence of t-PA and Glu-plasminogen or human plasma as the source of plasminogen . Under these conditions, soluble enzymatic activity was also recovered in the supernatant of group A streptococci . This favors the idea that plasmin can be released from the bacterial surface . The findings provide a mechanism for streptococci to adopt proteolytic activity by binding a host-derived enzyme zymogen on their surface, where the subsequent activation then takes place . The results suggest a role for surface-associated plasmin activity in tissue tropism and tissue invasiveness of streptococci.

Infect Immun, 1992 Jan, 60(1), 124 - 35
Nucleotide sequences of two adjacent M or M-like protein genes of group A streptococci: different RNA transcript levels and identification of a unique immunoglobulin A-binding protein; Bessen DE et al.; M protein is a key virulence factor present on the surface of group A streptococci . M protein is defined by its antiphagocytic function, whereas M-like proteins, while structurally related to M proteins, lack an established antiphagocytic function . Group A streptococci can be divided into two main groups (class I and II) on the basis of the presence or absence of certain antigenic epitopes within the M and M-like molecules, and importantly, the two classes correlate with the disease-causing potential of group A streptococci . In an effort to better understand this family of molecules, a 2.8-kb region containing the two M protein-like genes from a class II isolate (serotype 2) was cloned and sequenced . The two genes lie adjacent to one another on the chromosome, separated by 211 bp, and have many structural features in common . The emmL2.1-derived product (ML2.1 protein) is immunoreactive with type-specific antiserum, a property associated with M proteins . The cloned product of the downstream gene, emmL2.2 (ML2.2 protein), is an immunoglobulin A (IgA)-binding protein, binding human myeloma IgA . Interestingly, the RNA transcript levels of emmL2.1 exceed that of emmL2.2 by at least 32-fold . Northern (RNA) hybridization and primer extension studies suggest that the RNA transcripts of emmL2.1 and emmL2.2 are monocistronic . The ML2.1 and ML2.2 proteins exhibit 53% amino acid sequence identity and differ primarily in their amino termini and peptidoglycan-spanning domains and in a Glu-Gln-rich region present only in the ML2.1 protein . However, the previously described M-like, IgA-binding protein from a serotype 4 isolate (Arp4) displays a higher level of amino acid sequence homology with the ML2.1 molecule than with the IgA-binding ML2.2 protein . Amino acid sequence alignments between all M and M-like proteins characterized to date suggest the existence of two fundamental M or M-like gene subclasses within class II organisms, represented by emmL2.1 and emmL2.2 . In addition, IgA-binding activity can be found within both types of molecules.

Acta Derm Venereol, 1992, 72(2), 128 - 30
Group G streptococcal infections on a dermatological ward; Nohlgard C et al.; Groups A, B, C and G streptococci were cultured from 63 consecutive in-patients recruited between November 1987 and April 1988 and monitored until the end of July 1988 . Chronic leg ulcers were present in 34 patients . Group G was found in 34 patients, 25 of whom had pyoderma and 3 had sepsis . Six of the patients had no signs of clinical infection, and treatment with antibiotics was therefore withheld . Recurrent phlegmon or erysipelas developed in 2 of 28 patients with clinical Group G infections . Erysipelas developed some 1-7 months later in 3 of the 6 patients who were not initially treated . No significant difference in severity or additional medical conditions was found between the patients with either Group G or Group A streptococci . In comparison, data on all streptococcal cultures at the Department indicated that Group G was isolated 2.6 times as often as Group A streptococci for the in-patients, compared with 1.1 for all patients seen . It is concluded that Group G streptococcal skin infections must be regarded with the same clinical vigilance as Group A infections.

Acta Derm Venereol, 1992, 72(1), 50 - 1
Bullous impetigo caused by group A streptococci . A case report; Helsing P et al.; Bullous impetigo is considered to be a staphylococcal disease . Staphylococcus aureus, phage type 71, produces an epidermolytic toxin, assumed to be the cause of bullous formation in the skin . We present a case of bullous impetigo . Microbiological tests suggested beta-hemolytic streptococci, group A, M-type 3, as the etiological agent . Group A streptococci were isolated from the throat of the patient's mother and brother . The strains were shown to be identical, by means of DNA-'fingerprinting' and M-typing.

Chirurgie, 1992, 118(3), 177 - 82
{Problems posed by the association of streptococcus D infectious endocarditis and colorectal tumor}; Leborgne J et al.; The problems arising from the discovery of a colorectal tumor during an infectious endocarditis caused by Streptococci D have rarely been mentioned in the surgical literature . The frequency of association of an asymptomatic colorectal tumor and of a Streptococcus bovi endocarditis is now undisputed . This notion implies the systematic search for an intestinal lesion (adenoma or carcinoma) in case of endocarditis or septicemia without involvement of the valves, caused by a streptococcus of group D . The authors report about 3 cases of enterococcal (1 case) and S . bovis (2 cases) infectious endocarditis revealing a colic adenocarcinoma (2 cases) and a villous adenoma (1 case), all being perfectly latent . The specific therapeutic problems arising from this association are outlined, including the antibiotic therapy, the role of the anticoagulant treatment and the priority given to valve surgery in case of hemodynamic instability.

Arch Vet Pol, 1992, 32(3-4), 65 - 77
Concentrations of antibiotics in alveolar milk after intramammary inlocation of their different doses together with glucose, acetylsalicylic acid or chlormethine; Malinowski E; After intramammary introduction of penicillin (600 th . i.u.), streptomycin (0.5 g), cloxacillin (0.5 g), neomycin (0.5 g), erythromycin (0.5 g) and cefoperazone (0.25 g) in 100 ml of 5% glucose solution the antibiotics' concentrations in the alveolar milk remained for 24 hours or longer on the level higher than MIC in relation to staphylococci and streptococci isolated from cows mastitis . In the first 24 hours the growth of antibiotic activity was little influenced by chlormethine supplement . While addition of ASA increased concentration and prolonged the time of antibiotics remaining on the therapeutic level.

Caries Res, 1992, 26(5), 371 - 8
Viability of Streptococcus mutans and Streptococcus sobrinus in whole saliva with varying concentrations of indigenous antimicrobial agents; Lenander-Lumikari M et al.; We have studied the possible relationship between indigenous salivary antimicrobial agents, indigenous mutans streptococci and the capability of added mutans streptococci to grow in saliva . Stimulated whole saliva was collected from 19 healthy donors . Saliva samples were sterilized, supplemented with glucose and inoculated with Streptococcus mutans or Streptococcus sobrinus . The mixtures were incubated for 20 h followed by counting of viable cells . Saliva samples were analysed, both before and after sterilization, for indigenous antimicrobial agents and the bacterial flora . The subjects could be divided into two groups: those (n = 9) whose saliva promoted and those (n = 10) whose saliva inhibited the growth of the inoculated streptococci . A statistically significant correlation (+0.82, p < 0.001) was found between the numbers of viable cells of S . mutans and S . sobrinus after incubation in saliva . The sterilization procedure reduced the content of all antimicrobial proteins . Salivary antimicrobial factors, or levels of indigenous mutans streptococci, did not differ between the two groups . We conclude that none of the individual salivary antimicrobial factors alone can explain the large individual differences in growth-promoting or growth-inhibiting patterns of saliva on S . mutans and S . sobrinus . Inter-individually, saliva either supports or inhibits the growth of mutans streptococci, indicating a similar response of these two species in relation to the properties of saliva.

Acta Obstet Gynecol Scand, 1992 Jan, 71(1), 72 - 3
Two cases of neonatal pneumococcal septicemia; Johnsson H et al.; Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia . An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted . Two recent cases that occurred within a short period of time are described . They were found to exhibit most clinical characteristics, previously described, of Group B Streptococci (GBS) septicemia with an early onset, but appear to have a graver prognosis.

Acta Obstet Gynecol Scand, 1992 Jan, 71(1), 6 - 11
Neonatal septicemia caused by pneumococci; Johnsson H et al.; Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia . An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted . On the basis of two cases of our own and a review of 40 recently published case reports, the clinical characteristics of pneumococcal septicemia are described and the pathogenesis is discussed . The presenting clinical picture in early-onset pneumococcal septicemia is dominated by respiratory distress, frequently accompanied by leukopenia, and is indistinguishable from that seen in septicemia caused by Group B Streptococci (GBS) . The onset is preceded by prelabor rupture of the fetal membranes in almost half of the instances . The mortality is 50%, twice the figure given in recent GBS reports.

J Bacteriol, 1992 Jan, 174(2), 349 - 54
Characterization of the Streptococcus adjacens group antigen structure; Sieling PA et al.; Serological classification of bacteria requires the presence of an antigen unique to the organism of interest . Streptococci are serologically differentiated by group antigens, many of which are carbohydrates, although some are amphiphiles . This report describes the chemical characterization of the Streptococcus adjacens group antigen structure . Previous studies demonstrated that the amphiphile contained phosphorus, ribitol, galactose, galactosamine, alanine, and fatty acids . Phosphodiester bonds present in the purified group antigen were identified as part of a poly(ribitol phosphate), since ribitol phosphate was the only organic phosphate detected after acid hydrolysis . Hydrofluoric acid cleavage of the phosphodiester bonds generated oligosaccharide repeating units . Gas chromatography-mass spectrometric analysis of the methylated, acetylated oligosaccharide suggested that the repeating unit is a trisaccharide of Galp beta 1-3Galp beta 1-4GalNac with N-acetylgalactosamine attached in beta-linkage to either the number two or the number four carbon of ribitol . The lipid- and carbohydrate-substituted poly(ribitol phosphate) of the S . adjacens group antigen therefore is a unique amphiphile structure, differing in its repeating-unit structure from the polyglycerophosphate structure of the more common gram-positive amphiphile lipoteichoic acid.

Ginekol Pol, 1992 Jan, 63(1), 1 - 5
{Colonization with group B streptococcus in pregnant women taken into the care of unit K and hospitalized in the department of obstetric pathology}; Szponar M et al.; Colonization with group B streptococci (GBS) in 714 pregnant women was investigated . Among 232 were hospitalised in department of pathological pregnancy and 512 were under ambulatory control . In 13.4% of hospitalised patients and 2.8% healthy pregnant women the colonization of vagina or throat with GBS was stated . The greatest percentage of vagina colonization was found in patients hospitalised in connection with gestosis or because of abortions, premature delivery and inanimate fetus . No correlation was found between range of GBS colonization and trimester of pregnancy . Almost all GBS strains proved to be susceptible for commonly used antibiotics but resistant to biseptol (88.2%) . Patients of hospitalised group were more often colonized not only GBS but also other potentially pathogenic microorganisms.

Braz Dent J, 1992, 3(1), 3 - 9
The influence of gross caries removal and temporary filling of dental caries with a zinc oxide eugenol cement on the level of mutans streptococci in saliva; Souki BQ et al.; The influence of gross caries removal and temporary filling of dental caries with a zinc oxide eugenol cement on the salivary level of mutans streptococci (MS) was studied in 14 children, 6 to 8 years of age . Forty-eight hours after filling all cavities, there was a significant decrease in the level of these cariogenic microorganisms . However, after 30 days, the salivary level of mutans streptococci was similar to that detected initially.

Zh Mikrobiol Epidemiol Immunobiol, 1992, (11-12), 16 - 9
{The dynamics of detecting group-A streptococci in an infectious disease clinic}; Pavlova EB et al.; The study revealed that the isolation rate of group A streptococci in scarlet fever patients at the time of hospitalization did not exceed 68% . The isolation rate of these streptococci was greatly influenced by antibacterial therapy carried out before hospitalization . Under clinical conditions with intensive penicillin therapy group A streptococci were eliminated from the larynx on days 3-4 . In 13% of children repeated streptococcal infection was observed 0.5-3 months after discharge from hospital.

Proc Finn Dent Soc, 1992, 88(3-4), 155 - 61
Dental caries in the future: a global view; Newbrun E; Although the prevalence of caries has decreased markedly in children, adolescents, and young adults in most industrialized countries, caries continues to be the main reason for tooth loss, particularly among the high risk segment of the population . In many developing countries, where traditional dietary patterns have changed to include sugar-containing foods and beverages, caries prevalence has increased and will continue to do so in the immediate future . Accordingly, it would be a serious mistake to be complacent about caries prevention . In future industrialized countries will see computers playing a significant role in cariology, finding applications not only in research and practice administration but directly in clinical practice as well . They will be used in every operatory in the assessment of caries risk, the recording of caries prevalence, the direct storing of radiographic information, and the restoration of carious teeth, assisted by computer-aided design and computer-aided manufacture (CAD/CAM) technology . Fluoride therapy, both systemic and topical, will continue to be the basis of caries prevention . Dental sealants, which are highly effective in protecting pits and fissures when applied soon after the teeth erupt, will be more widely used in the future when insurance plans will pay for prevention . Substitution of sucrose and syrups by non-fermentable sweetening agents can also reduce caries increments, but most agents are more expensive than sucrose and require consumer education to pay for the additional cost . Caries, as an infectious and transmissible disease, is amenable to prevention by interfering with the chain of transmission or by suppressing the putative pathogens, the mutans streptococci, in infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Proc Finn Dent Soc, 1992, 88(3-4), 147 - 53
Chlorhexidine solutions, gels and varnishes in caries prevention; Luoma H; To combat dental caries, a chemical has been sought that possesses stronger antimicrobial properties than fluoride in support of its physicochemical tooth-protecting properties . These searches have led to several agents, of which chlorhexidine (CH) appears most effective . To reduce local side effects of the well-known 0.2% CH mouthwash, a 0.05% CH gluconate + 0.04% NaF solution, pH 5.9, has been developed . Use of this combination over a 2-year period resulted in a 53% reduction in caries increment and a 75% reduction in gingival bleeding, i.e . a clear duality of prevention of oral disease (Luoma et al . 1978) . Staining of teeth was minimal and easily removable in about one third of the subjects . To lessen the contribution of patients, chlorhexidine gels, without but more especially with fluoride have been professionally administered . Reductions in salivary mutans streptococci after short periods of gel applications have been found to persist longer than reductions after brief periods of mouthwashing . Reductions of approximal caries increment by about 50% in children, and root surface caries in adults have been obtained through use of CH gels . The effect on root surface caries in adults was equal to that obtained through use of local fluoride applications . Dental CH varnish seems promising, especially because a very short contact time with a tooth may be sufficient to reduce mutans streptococci . No simultaneous effects against caries and gingivitis of CH gels or varnishes has been reported . Comparisons of CH solutions, gels and varnishes, with or without fluoride, in relation to their potentials for preventing oral disease in subjects at risk remain to be accomplished.

Adv Exp Med Biol, 1992, 327, 229 - 41
Molecular, immunological and functional characterization of the major surface adhesin of Streptococcus mutans; Bleiweis AS et al.; In the 15 years since the last major NIH conference that dealt with anti-caries vaccines, we have learned much . Certainly, whole bacteria or bacterial fractions may not be proper immunogens due to the possibility of inducing tissue cross-reactivity . Our own experience (van de Rijn et al., 1976) illustrates that pitfall . But even in the era of genetically engineered vaccines, we first must understand the biological functions of our chosen immunogen before employing that pure protein in a vaccine . Our recent work (Brady et al., 1991c) indicates that antigen P1, a ubiquitous protein found on several oral streptococci, may possess different, but possibly overlapping, functional domains influencing reactions with fluid-phase salivary agglutinin (aggregation) versus fixed agglutinin (adherence) . A proper vaccine would induce antibodies against the latter domain(s) thereby retarding colonization . An improper vaccine that induces antibodies against aggregation-related domains on P1 would lessen the host's ability to clear those bacteria from the oral cavity . After carefully identifying appropriate functional domains and obtaining sub-clones of the larger gene that yield truncated polypeptides typical of adherence-specific regions that are also immunogenic, we may be in a position to create the most effective vaccine . In studies employing the polymerase chain reaction (PCR) and standard cloning procedures, we have already begun to produce such polypeptides . Once a library of polypeptides is assembled, they may be tested for functional activity and for lack of induction of cross-reactivity with nonpathogenic streptococci (i.e., S . gordonii) . Certain of these recombinant-specified polypeptides could serve as the basis for an anti-caries vaccine . Alternatively, peptides may be synthesized that resemble these sub-molecular regions for use in a vaccine or as competitive inhibitors of adherence but not aggregation . Clearly, a vaccine against dental caries remains a real possibility for the future.

Adv Exp Med Biol, 1992, 327, 151 - 63
A mechanism of passive immunization with monoclonal antibodies to a 185,000 M(r) streptococcal antigen; Lehner T et al.; The cell surface streptococcal antigen (SA) I/II of 185,000 M(r) is an immunodominant molecule that expresses one or more adhesion determinants . A series of 14 monoclonal antibodies (MAb) to defined parts of SA I/II were generated and some of these were used in passive immunization of macaques . Topical administration of selected MAb to the teeth of macaques prevented colonization of endogenous or implanted exogenous Streptococcus mutans for a period of 1 year . Significant reduction of both smooth surface and fissure caries was found in macaques who had MAb (Guy's 1) applied to their teeth, as compared with saline-treated animals . A series of in vivo passive immunization experiments was then carried out in 57 human subjects . Topical application of MAb to SA I/II prevented colonization of both artificially implanted exogenous strains of S . mutans, as well as natural recolonization by indigenous S . mutans . The properties of the protective MAb were then investigated and the epitope specificity within the SA I/II molecule was found to be essential but not the isotype specificity of the immunoglobulin (Ig) . The requirement for complement activating and the phagocyte binding sites of the Fc fragment of MAb was not essential, as the F(ab')2 fragment of the MAb was as protective as the intact IgG, but the Fab fragment failed to prevent recolonization of S . mutans . Prevention of recolonization was specifically restricted to S . mutans, as the proportion of other organisms, such as S . sanguis, failed to show a significant change . The surprising feature of these experiments was that protection of re-colonization of S . mutans lasted up to 2 years, although MAb was applied for only 3 weeks and functional MAb was detected on the teeth only 3 days following application of the MAb . The long-term protection could therefore not be accounted for by a persistence of MAb on the teeth, but may be due to a shift in the microbial balance in which other bacteria occupy the ecological niche vacated by S . mutans, resulting in colonization resistance to S . mutans . Gene cloning and sequencing the SA from S . mutans, S . sobrinus and S . sanguis identified a conserved region (residues 955-1213) which on Southern hybridization and partial DNA sequence analysis was also found in 19 alpha-haemolytic oral streptococci . The results suggest that the SA molecule may constitute a family of adhesins in oral alpha haemolytic streptococci.(ABSTRACT TRUNCATED AT 400 WORDS)

Australas J Dermatol, 1992, 33(2), 75 - 80
The effect of bacterial colonization on venous ulcer healing; Halbert AR et al.; To determine the effect of bacterial colonization on venous ulcer healing, 82 patients with 100 venous ulcerated limbs were each studied prospectively for six months . Despite bacteriological swab results, topical or systemic antibiotics were not administered unless cellulitis supervened . Initial ulcer size, length of ulcer history and time to complete healing of colonized and uncolonized ulcers were determined and compared . Organisms were cultured from 83 limbs prior to commencement of treatment, the commonest isolates being Staphylococcus aureaus (48%), mixed coliforms (28%), Pseudomonas aeruginosa (21%) and anaerobes (17%) . When compared with ulcers with no bacterial growth, colonized ulcers were of longer duration (p {symbol: see text} 0.01), had a larger initial size (p {symbol: see text} 0.001) and had significantly longer healing time (p {symbol: see text} 0.001) . When analysed individually beta-haemolytic streptococci, anaerobes, Staphylococcus aureus and coliforms were associated with delayed healing . Delayed healing was not found with Pseudomonas aeruginosa, although pseudomonas-colonized ulcers were significantly larger and of longer duration than uncolonized ulcers . Bacterial colonization is associated with delayed venous ulcer healing . To further clarify the pathogenicity of colonizing bacteria, however, the effect of their eradiction on healing of venous ulcers needs to be established.

Chemotherapy, 1992, 38(6), 395 - 8
Antibacterial activity of citreamicin-alpha (LL-E 19085 alpha) against gram-positive cocci; Qadri SM et al.; In vitro antibacterial activity of 429 clinical isolates of gram-positive cocci was tested against citreamicin-alpha (LL-E 19085-alpha) by the agar dilution method . The microorganisms consisted of 313 isolates of staphylococci and 116 strains of streptococci . In vitro activity of citreamicin-alpha was compared with ampicillin, augmentin, cephalothin, erythromycin and vancomycin . MICs of citreamicin-alpha for staphylococci ranged between 0.12-4.0 micrograms/ml and 0.03-0.12 micrograms/ml for Streptococcus pyogenes . Enterococci, however, were relatively more resistant, requiring 2.0 micrograms/ml of this drug to inhibit 64% of the 62 isolates tested . In vitro activity of this antibacterial agent was far superior to that of ampicillin, augmentin, cephalothin and erythromycin, but equal to or slightly inferior to that of vancomycin.

Med Microbiol Immunol (Berl), 1992, 181(6), 351 - 7
Lack of activity of transferrins towards Streptococcus spp; von Hunolstein C et al.; Clinically relevant Streptococcus spp . were tested for their susceptibility towards human serum transferrin (TR) and lactoferrin (LF) . Neither clinical isolates or type strains were inhibited by transferrins (5 mg/ml) . All species tested were shown to be able to grow under iron-limiting conditions (< 0.1 microM) and this might account for the lack of TR or LF activity towards streptococci . Even if not sensitive to LF and TR, some species were shown to bind LF in the apo-form.

Chemotherapy, 1992, 38(5), 330 - 4
In vitro activity of meropenem and other agents against oral bacteria; Wade WG et al.; The susceptibility of 106 oral bacteria to meropenem, a new carbapenem antimicrobial, penicillin V, tetracycline and metronidazole was assessed by an agar dilution method . Meropenem was the most effective of the antimicrobials, with all strains tested being inhibited at < or = 1 mg/l . A number of strains were resistant to penicillin V, particularly Bacteroides gracilis, and tetracycline resistance was widespread amongst the streptococci tested . Metronidazole was extremely effective against obligate anaerobes . The results of this study suggest that meropenem has potential for use in the treatment of serious head and neck infections.

Zh Mikrobiol Epidemiol Immunobiol, 1992, (11-12), 2 - 5
{Biochemical and immunochemical analyses of the protein components of the cell wall in group-A streptococci isolated by a sparing chemical method}; Blinnikova EI et al.; To study the protein components of the cell wall of group A streptococci, type M 29, a special preparative method was developed (extraction with 1 M hydroxylamine solution, pH 6.0, and subsequent purification) . Altogether six protein fractions were obtained . The isolated proteins were found to be a heterogeneous group of molecules, consisting of 25-40 individual proteins with molecular weights ranging between 13 and 94 kD . The study of the protein fractions thus obtained in the immunodiffusion test with rabbit antiserum to the initial protein preparation revealed that these proteins contained type-specific components, 3-6 type-nonspecific protein antigens common with protein antigens of M 1 and M 12, as well as one protein antigen common with type M 1 . Fc receptor was shown to be absent . The detected type-nonspecific protein antigens were partially separated by ion-exchange chromatography and some of them could be purified from the admixtures of nucleic acids and group-specific polysaccharide.

Microbios, 1992, 71(288-289), 179 - 92
Comparative studies on binding of vitronectin and fibronectin to groups A and C streptococci; Kostrzynska M et al.; Binding of 125I-labelled fibronectin and vitronectin to streptococci of group A (S . pyogenes), group B (S . agalactiae) and group C (S . dysgalactiae and S . zooepidemicus) isolated from various human infections and bovine mastitis, and S . uberis bovine isolates, was studied . Binding of vitronectin and fibronectin was common among both human groups A and C, and bovine group C streptococci . S . agalactiae strains of human and bovine origin as well as S . uberis bovine isolates bound low levels of both proteins . The binding of radiolabelled fibronectin and vitronectin to selected groups A and C streptococcal strains was specific, time-dependent and occurred with both live and heat-killed (80 degrees C for 15 min) cells . Binding declined rapidly after treatment of cells with trypsin or proteinase K, while pepsin digestion at pH 5.5 affected vitronectin but not fibronectin binding.

Am J Med, 1991 Dec 30, 91(6A), 12S - 14S
Activity of temafloxacin and other fluoroquinolones against typical and atypical community-acquired respiratory tract pathogens; Hardy DJ; The microbiologic activities of temafloxacin, ciprofloxacin, and ofloxacin against community-acquired respiratory tract pathogens are reviewed . The 90% minimal inhibitory concentrations (MIC90s) of these fluoroquinolones for gram-negative pathogens were generally comparable, that is, less than 0.06 micrograms/mL . Overall, the agents were less active against gram-positive pathogens, although temafloxacin was two- to fourfold more active than the other agents against staphylococci and streptococci . For strains of Mycoplasma pneumoniae and Chlamydia pneumoniae, temafloxacin was generally inhibitory at concentrations of 0.5-2 micrograms/mL . This microbiologic activity, combined with its pharmacokinetic profile, should make temafloxacin a useful antimicrobial agent for treating community-acquired respiratory tract infections.

Am J Med, 1991 Dec 30, 91(6A), 111S - 114S
Double-blind randomized study of oral temafloxacin and cefadroxil in patients with mild to moderately severe bacterial skin infections; Neldner KH; A randomized, double-blind, multicenter study was conducted in 374 patients to evaluate the safety and efficacy of a 7-10-day regimen of oral temafloxacin (600 mg b.i.d.) or oral cefadroxil (500 mg b.i.d.) in the treatment of mild to moderate staphylococcal or streptococcal infection of the skin or skin structure . Specimens from the infected skin lesion were obtained for culture . A dermatologic assessment was made within 48 hours of starting therapy, 0-48 hours post-treatment, and once during the 5-9 days following the last dose of study drug . The most common diagnoses were abscess, superficial skin infection, cellulitis, and infection of the hair follicle/sweat gland . Clinical response rates exceeded 95% in both the temafloxacin and cefadroxil groups . A higher bacterial eradication rate was demonstrated in the temafloxacin-treated patients (91%) than in those receiving cefadroxil (84%) . This was statistically significant in the subset of infections caused by Staphylococcus epidermidis (100% versus 81%, respectively; p = 0.032) . Both regimens were well tolerated . These results indicate that temafloxacin is useful in the treatment of mild to moderate skin and skin structure infections caused by staphylococci or streptococci.

FEMS Microbiol Lett, 1991 Dec 15, 69(1), 35 - 42
Relatedness between Streptococcus pneumoniae and viridans streptococci: transfer of penicillin resistance determinants and immunological similarities of penicillin-binding proteins; Chalkley L et al.; The occurrence of highly variable penicillin-binding proteins (PBPs) in penicillin-resistant Streptococcus pneumoniae suggested that transfer of homologous genes from related species may be involved in resistance development . Antiserum and monoclonal antibodies raised against PBPs 1a and 2b from the susceptible S . pneumoniae R6 strain were used to identify related PBPs in 41 S . mitis, S . sanguis I and S . sanguis II strains mostly isolated in South Africa with MIC values ranging from less than 0.15 to 16 mg/ml . Furthermore, the possibility of genetic exchange was examined with 30 penicillin-resistant strains of this collection (MIC greater than 0.06 mg/ml) as donors using S . pneumoniae R6 as recipient in transformation experiments . The majority of S . mitis and S . sanguis II strains but none of the S . sanguis I strains could transform penicillin resistance genes into S . pneumoniae R6 . All positive donor strains and all susceptible isolates of S . mitis and S . sanguis II strains contained PBPs which cross-reacted with the anti-PBP 1a and/or anti-PBP 2b antibodies . On the other hand, only five of the 14 S . sanguis I strains contained a PBP that reacted with one of the antibodies . This strongly suggested the presence of genes homologous to the pneumococcal PBP 1a and 2b genes in viridans streptococci, and documents that penicillin resistance determinants can be transformed from viridans streptococci into the pneumococcus.

J Infect Dis, 1991 Dec, 164(6), 1210 - 1
Stability of streptococcal pyrogenic exotoxin production with laboratory manipulation of group A streptococci; Kaplan EL et al.; Because of reported differences in the production of streptococcal pyrogenic exotoxins by group A strains associated with severe streptococcal infections, the stability of exotoxin production by specific strains was examined by passing group A streptococci on blood agar culture plates daily for 20 days . No changes were detected in either exotoxin genes or in exotoxin production during this time, suggesting that these reported differences are due to other explanations such as differences in the strains collected from various geographic areas or to laboratory methodologic differences.

Infect Immun, 1991 Dec, 59(12), 4425 - 35
Identification of monoclonal antibody-binding domains within antigen P1 of Streptococcus mutans and cross-reactivity with related surface antigens of oral streptococci; Brady LJ et al.; Eleven monoclonal antibodies (MAbs) specific for P1, the major protein surface antigen of Streptococcus mutans serotype c, were characterized by Western blot (immunoblot) analysis and by radioimmunoassay using whole bacterial cells . The approximate binding domains of the MAbs were determined by using full-length and truncated P1 polypeptides . The accessibility of these binding sites on the surfaces of intact bacteria was determined by radioimmunoassay . The ability of each MAb to cross-react with related proteins from strains of S . mutans serotypes e and f, S . sanguis, and S . sobrinus serotype g is also reported.

Cardiologia, 1991 Dec, 36(12 Suppl 1), 395 - 402
{Thrombolytic drugs in acute myocardial infarct}; Ambrosioni E et al.; Thrombolytic therapy has a primary role in modifying evolving acute myocardial infarction by restoration of patency of infarct-related artery . All thrombolytic agents convert plasminogen to plasmin; 3 of them (streptokinase, urokinase and anisoylated human plasminogen streptokinase activator complex-APSAC) are not specific for fibrin and 2 (rt-PA, scu-PA) are relatively clot-specific and have limited systemic fibrinolytic activity . To date, the largest experience has been with streptokinase, which is derived from streptococci and therefore has the potential to cause allergic reactions, more frequent with repeat doses of the drug . Streptokinase is not clot-selective; despite significant systemic fibrinolysis, which is an usual consequence, major bleeding complications are uncommon . Another problem with streptokinase is hypotension, which depends on infusion rate . APSAC differs from the parent streptokinase-plasminogen complex with kinetics well suited to a sustained thrombolytic effect . Although it was expected to have clot selectivity, this feature is missed at the dose needed in the treatment of acute myocardial infarction . rt-PA is a natural occurring serum protease which presents important clot specificity with limited systemic fibrinolytic activity . However, the risk of major bleeding is not less than that observed with thrombolytic agents without clot selectivity . Of considerable interest is the potential for urokinase and prourokinase to act synergistically with other thrombolytic agents, with hypothetic improvement in efficacy and safety of thrombolytic therapy . Despite some different features among various thrombolytic agents, they are equally safe and effective in salvaging myocardium and in assuring survival benefit after acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiologia, 1991 Dec, 36(12 Suppl 1), 125 - 36
{Infective endocarditis in valve prostheses}; Sanguinetti M; Prosthetic valve endocarditis (PVE) has existed for about 30 years . Its incidence and mortality have decreased compared to the '60s, but they are still remarkable . The distinction between early and late forms of PVE is still justified, only if considered critically . At present the incidence of early PVE is 1% or less . It is caused mainly by staphylococci, Gram-negative bacilli, and fungi, which infect the prosthesis during or immediately after surgery; it carries a mortality of 30-60% . The incidence of late PVE is approximately 1% per year; pathogenesis and clinical features are similar to infective endocarditis (IE) on native valves . Streptococci are the most frequent causative organisms and current mortality is 25-35% . The diagnosis of PVE can be difficult; a strong clinical suspicion, blood cultures, and echocardiography are the most valuable tools . The antibiotic treatment follows the general indications for IE, but in PVE the associations of 2 or more antibiotics are the rule and need to be used according to established protocols . The occurrence of prosthetic dysfunction, para-annular abscesses, and embolism is frequent in PVE and makes prognosis worse . In all cases of complicated PVE or in those due to resistant organisms, an early reintervention must be associated to medical therapy . The surgical treatment of PVE often implies difficult and complex procedures, but early and long-term results are better than those obtained with medical treatment alone . Pharmacological prevention of embolism remains an unsolved problem . The prophylaxis of early PVE has made remarkable progress in the last 20 years and present results appear hard to improve . The prophylaxis of late PVE requires a more widespread awareness of this problem even outside the setting of cardiology and cardiac surgery.

Infect Immun, 1991 Dec, 59(12), 4436 - 42
Pro- and anti-inflammatory roles of interleukin-1 in recurrence of bacterial cell wall-induced arthritis in rats; Schwab JH et al.; A specific interleukin-1 (IL-1) receptor antagonist (IL-1ra) was used to examine the roles of IL-1 in an experimental model designed to analyze the reactivation phase of erosive arthritis, induced in rats with peptidoglycan-polysaccharide polymers (PG-APS) isolated from cell walls of group A streptococci . Monoarticular arthritis was initiated by injection of a small dose of PG-APS into an ankle joint, and reactivation was induced by intravenous injection of PG-APS 20 days later . Human recombinant IL-1ra given at a dose of 2 to 3 mg/kg at the time of reactivation of arthritis and at 6-h intervals inhibits the increase in joint swelling by at least 60% . Joint swelling is suppressed 30 to 50% when the initial treatment with IL-1ra is delayed until 6 h after reactivation . IL-1ra is not effective when the initial injection is delayed 12 or 24 h . With an injection schedule of IL-1ra given at the time of reactivation and every 6 h, treatment can be stopped at 24 h and the suppression of swelling is no different from that in rats for which injections are continued for 4 days . The results indicate that IL-1 has a prominent, although not exclusive, role in initiating inflammation in this model and is involved in the amplifying processes in progressive inflammation and chronic erosive disease . An anti-inflammatory function of IL-1 is also indicated from data showing that IL-1ra treatment limited to 6 h or less after the induction of reactivation enhances joint swelling, whereas intravenous injection of human recombinant IL-1 beta 24 h before reactivation suppresses the reactivation of arthritis.

Indian Pediatr, 1991 Dec, 28(12), 1503 - 8
Epidemiology of streptococcal infection with reference to rheumatic fever; Bhave SY et al.; Antistreptolysin antibodies were estimated in 787 normal children and young adults by latex test . This test detects titres of 200 IU/ml and above, which is the western cut off point, for diagnosis . Children below one year showed no antibodies . Unlike western studies where no antibodies are detected below the age of 3 years, our study revealed that 7.9% children between 1-3 years had significantly elevated antibodies . This epidemiological pattern is well reflected in the different clinical profile of younger children developing rheumatic heart disease in our country . Antibodies progressively increased with age--11.8% in 4-8 years group to 15.8% in 9-12 years age group . All these were from the lower socio-economic group . ASO was positive in 16.7% of young adults from lower socio-economic status while it was positive only in 9.2% in the upper socio-economic status . A total of 522 patients of rheumatic carditis were studied . Only 23.4% had no antibodies or less than 200 IU/ml, and 77% were positive (26.9% had greater than 400 IU/ml and 49.7% had 200 IU/ml) . Throat swab culture and ASO antibodies were done simultaneously in 76 outdoor patients, clinically diagnosed as acute bacterial pharyngitis . Group A beta hemolytic streptococci were isolated in 64% and significant antistreptolysin antibodies were seen in 62% . School health records were scanned in more than 50,000 school children . Point prevalence of rheumatic heart disease was estimated to be 0.17% in lower and 0.05% in upper socio-economic groups . Age and socio-economic factors are important variables in epidemiology of streptococcal infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Mol Microbiol, 1991 Dec, 5(12), 2947 - 52
Genetic diversity among the T-protein genes of group A streptococci; Jones KF et al.; T protein is a trypsin- and pepsin-resistant molecule on the surface of group A streptococci used as a serological tool to differentiate streptococci of this group . The purpose of this study was to determine the relatedness among the T protein genes of the 25 known T serotypes . DNA probes were constructed which represented various regions of the structural gene for the T6 protein, tee6 . The probes were assayed for their ability to hybridize HindIII digests of chromosomal DNA from the 25 different T serotypes . Probe pTEE6.3, coding for the entire T6 protein, and pTEE6(1-299), coding for the amino-terminal half of T6, displayed the highest amount of homology, each binding to 10 of 25 T serotypes . Probes coding for sequences in the carboxy-terminal half of T6 showed considerably less homology among T serotypes with one probe hybridizing with only three out of 25 . A synthetic oligonucleotide coding for the carboxy-terminal hydrophobic domain of T6, an area conserved to some degree among several bacterial surface proteins, showed homology with only seven out of 25 T serotypes . Hybridization with sequences outside the tee6 coding area provided additional information on the relatedness of certain sets of T serotypes according to restriction-fragment size heterogeneity . Clearly, there is considerable diversity among T-serotype genes . The data suggest that two or more families of structurally variant T proteins exist, which share only the property of proteolytic resistance and/or, perhaps, some biological function.

Neuropathol Appl Neurobiol, 1991 Dec, 17(6), 485 - 93
The site of the lesion causing hearing loss in bacterial meningitis: a study of experimental streptococcal meningitis in guinea-pigs; Kay R; The pathological basis of hearing loss in bacterial meningitis was investigated using an animal model of Streptococcus suis meningitis . Forty guinea-pigs were infected after their hearing had been assessed by brain stem auditory evoked potentials . In 17 animals, it was possible to repeat the procedure at the onset of meningitis; this included one animal with subclinical disease . Fifteen animals showed evidence of hearing loss, which on subsequent histological examination was found to be associated invariably with suppurative labyrinthitis . The remaining two animals without hearing loss had normal cochleas . It is suggested that cochlear sepsis rather than eighth cranial nerve involvement by meningeal sepsis is primarily responsible for hearing loss in bacterial meningitis, and that bacteria enter the cochlea via the cochlear aqueduct and not the internal auditory canal . The tissue within the lumen of the cochlear aqueduct may act as a barrier against invasion by micro-organisms, and haemolytic streptococci could cause lysis of this barrier by the exotoxins they produce.

East Afr Med J, 1991 Dec, 68(12), 944 - 7
Sinusitis in Sudanese patients: a clinical review; Yagi H; A retrospective study was carried out to show the pattern of sinusitis in Sudanese patients . Patients with sinusitis were 32% of all patients with nasal diseases . Sinusitis affected males more than females . The highest incidence of the disease was at ages 21-30 years . The maxillary sinuses were the most affected by sinusitis followed by the ethmoid and frontal sinuses respectively . The disease was rare in the sphenoid sinuses . Bacteriological review showed that Staphylococci, Streptococci and E . coli were the commonest causative organisms isolated in culture . Medical treatment by the appropriate antibiotics, antihistamines and local decongestants cured the majority of patients.

Zentralbl Veterinarmed B, 1991 Dec, 38(10), 731 - 6
Antibiotic resistance patterns and pigment production of streptococci of serological group B isolated from bovines and humans; Wibawan IW et al.; All 127 streptococci of serological group B isolated from bovines and humans were resistant to bacitracin (0.04 U) and gentamicin and susceptible to penicillin . Of the bovine isolates examined 10%, 8%, 22%, 2% and 30% were resistant to bacitracin (10 U), cefoxitin, clindamycin, erythromycin and tetracycline respectively . Of the human isolates 52%, 21%, 38%, 3% and 65% were resistant to bacitracin (10 U), cefoxitin, clindamycin, erythromycin and tetracycline respectively . Most of the bovine strains were susceptible, most of the human strains were resistant to bacitracin and tetracycline . A relation of tetracycline resistance to group B streptococcal microcapsule was proposed . Pigmentation studies revealed generally a weak pigmentation of bovine and a strong pigmentation of human group B streptococci . Antibiotic resistance patterns together with the ability to form a yellow to orange-red pigment might be used for characterization of individual cultures of group B streptococci.

Kokubyo Gakkai Zasshi, 1991 Dec, 58(4), 692 - 5
{Studies on caries of Ishibashi rat--II . Streptococcus mutans population in oral cavity}; Ozaki F et al.; Previously, it was demonstrated that extensive carious lesions occurred in the Ishibashi rats (ISR) while they were bred with conventional diets . In this study, specimens from the oral cavity of the ISR were examined for the presence of Streptococcus mutans, and its occurrence and population were compared with those of the Wistar rats . The results were as follows: 1 . S . mutans was first found in the mouth of the ISR when the first molars erupt . 2 . The number of S . mutans (CFU on the gelatin agar) and its mean percentage of the total streptococci (CFU on the gelatin agar/CFU on the M-S agar) in the mouth of the ISR increased rapidly during the few days after weaning, and this increment was comparable to that of the Wistar rats fed caries-producing diets, 6PMV, after weaning . However, the population of the S . mutans remained low in the mouth of the Wistar rats fed conventional diets . 3 . In the aged ISR, the number of S . mutans and its mean percentage of total streptococci were also much higher than in the aged Wistar rats . These data suggested that the ISR harboured increased the number of S . mutans strains in the oral cavity when compared with the Wistar rats.

J Gen Microbiol, 1991 Dec, 137 ( Pt 12), 2721 - 5
Influence of capsular neuraminic acid on properties of streptococci of serological group B; Wibawan IW et al.; Neuraminic acid is thought to be a critical virulence factor of group B streptococci . The present study was designed to further characterize a previously described type III group B streptococcus and its transposon-mutagenized asialo capsular mutant . The wild-type group B streptococcus grew as short chains with a uniform turbidity and had diffuse colonies in soft agar media . In contrast, the asialo mutant grew in fluid media as a granular sediment, formed significantly longer chains and had compact colonies in soft agar . These differences, possibly related to the surface charge of the bacteria, could also be demonstrated in salt aggregation tests and hexadecane adherence studies . The wild-type group B streptococcus showed hydrophilic, and the asialo mutant hydrophobic surface properties . Removal of neuraminic acid from the wild-type strain changed the surface properties from hydrophilic to hydrophobic . A similar masking effect of capsular neuraminic acid could be observed in adherence and phagocytosis experiments . In contrast to the wild-type strain, the asialo mutant adhered significantly more to buccal epithelial cells and was phagocytosed more by polymorphonuclear leucocytes . These altered properties might possibly be of importance for group B streptococcal pathogenicity.

Rev Rhum Mal Osteoartic, 1991 Dec, 58(12), 839 - 46
{Role of iatrogenic spondylodiscitis among pyogenic spondylodiscitis . 136 cases observed between 1980 and 1989}; Meys E et al.; The authors report 136 cases of spondylodiscitis due to ordinary organisms seen between 1980 and 1989 and note the increasing incidence of iatrogenic forms which during the past three years accounted for 50 per cent of cases . 60 per cent of these cases of iatrogenic spondylodiscitis complicated a medical of surgical procedure involving the spine (form by direct inoculation) . In 40 per cent of cases, the organism came from a site of infection located at a distance (from by blood-borne spread) . The clinical picture in cases of primary spondylodiscitis and of iatrogenic disease by blood-borne spread is essentially similar . That of iatrogenic forms by direct inoculation is different: most often young subjects, virtually exclusive involvement of the lumbar spine, fever and inflammatory syndrome less common . Escherichia coli and Staphylococcus aureus were the organisms most often responsible for primary spondylodiscitis (23 and 21.7 per cent of case respectively) . Streptococci were in third position only (15.6 per cent of cases) . Staphylococcus aureus remained predominant in iatrogenic spondylodiscitis (34 per cent of cases), while Escherichia coli and streptococci were significantly rarer than in primary forms and there was the appearance of Pseudomonas aeruginosa and Staphylococcus albus . No organism was found in 23 per cent of cases of primary spondylodiscitis . This figure reached 44% of iatrogenic forms by direct inoculation . Because of their increasing incidence, these cases of apparently aseptic spondylodiscitis, frequently complicating a procedure involving the spine, are modifying the picture of infectious spondylodiscitis . No doubt worthy of separate identification, they raise the problem of the significance of the concept of aseptic spondylodiscitis.

Biull Eksp Biol Med, 1991 Dec, 112(12), 624 - 7
{Level of antibodies to different determinants of Streptococcus group A polysaccharide and autoantibodies to basal layer of the skin epithelium in rheumatism}; Borodiuk NA et al.; Direct dependence was established between the presence of autoantibodies reacting with the basal layer of the skin epithelium (BLSE) and the high level of antibodies to the streptococcal group A polysaccharide (APS) . By the primary active rheumatic fever (PARF) autoantibodies to the BLSE are revealed . By the recurrent active rheumatic fever (RARF) and in the control sera, autoantibodies reacting with the BLES, apparently, are directed to the rhamnose determinants of APS . These data confirm: different level of antibodies to the GS and to the rhamnose determinants of APS by PARF, RARF and in the control sera; the experiments of the autoantibody inhibition, reacting with the BLSE by the APS or the polysaccharide of streptococci A-variant, containing only the rhamnose determinants.

J Dent Res, 1991 Dec, 70(12), 1503 - 7
Mutans streptococci and non-mutans streptococci acidogenic at low pH, and in vitro acidogenic potential of dental plaque in two different areas of the human dentition; Van Houte J et al.; Samples of human dental plaque were obtained from sound tooth surfaces in the lower anterior and upper posterior areas of each of 11 subjects with various degrees of caries experience . Both types of plaque were compared for: (1) their pH-lowering potential {pH at 10 and 60 min after sugar addition and the pH drop between 0 and 10 min (delta pH)} with an in vitro method involving dispersed plaque suspensions and excess glucose supply; (2) the proportions of mutans streptococci; and (3) the distribution of the predominant non-mutans streptococci according to their final pH in glucose broth . Compared with plaque from the lower anterior area, plaque from the upper posterior area exhibited a significantly higher pH-lowering potential, i.e., a lower pH at 10 and 60 min and a greater delta pH and significantly higher levels of mutans streptococci . The final pH values for the non-mutans streptococci exhibited a wide range from about 4.4 to over 5.0 . The proportions of such organisms designated as capable of acidogenesis at low pH (final pH less than 4.6), whether expressed as a percentage of the total non-mutans streptococci or of the total plaque flora, were significantly increased in plaque from the upper posterior area . The proportions of non-mutans streptococci capable of acidogenesis at low pH in plaque from the upper posterior area were also significantly increased, with decreasing pH values at 10 and 60 min.(ABSTRACT TRUNCATED AT 250 WORDS)

J Dent Res, 1991 Dec, 70(12), 1491 - 6
In vitro demineralization of enamel by F-sensitive and F-resistant mutans streptococci in the presence of 0, 0.05, or 0.5 mmol/L NaF; Van Loveren C et al.; Lactate production and accompanying enamel demineralization by fluoride-sensitive and fluoride-resistant mutans streptococci were studied in an in vitro demineralization model in the presence of 0, 0.05, or 0.5 mmol/L NaF . The fluoride-resistant strains were derived from laboratory strains or were recently isolated strains from xerostomic patients on high-dose fluoride therapy . The demineralization model was composed of a cell suspension in a glucose-agarose gel overlying a bovine enamel block . Lactate and calcium content of the agarose were determined after 22-hour incubations at 37 degrees C . Fluoride-resistant variants of Streptococcus sobrinus 6715-15 produced less lactate and caused less demineralization than did the parent strain even in the presence of fluoride . On the other hand, fluoride-resistant variants of Streptococcus mutans C180-2 and of S . mutans GS-5 produced more acid and caused greater demineralization than did their respective parent strains, both in the absence and presence of fluoride . Two recently isolated fluoride-resistant S . mutans strains produced more lactate and demineralized enamel more than did two recently isolated S . mutans strains from normal human subjects, both in the presence of 0 and 0.05 mmol/L NaF . It is concluded that adaptation to fluoride resistance does not invariably reduce the cariogenicity of mutans streptococci nor the effectiveness of fluoride in preventing demineralization.

Scand J Dent Res, 1991 Dec, 99(6), 489 - 97
Oral implantation in man of Streptococcus mutans in relation to salivary IgA activity; Olsson J et al.; Oral implantations of and salivary IgA activity against a freshly isolated Streptococcus mutans strain and a repeatedly subcultured variant strain were studied in 20 subjects . The variant strain was eliminated at a higher rate than the parent strain . Both strains were eliminated at a lower rate in subjects with high oral levels of indigenous mutans streptococci than in subjects with low levels of these microorganisms . Subjects with high respectively low IgA activity against the parent strain also had high respectively low IgA activity against the variant strain (P less than 0.01) . The correlation between IgA activity and clearance rate of implanted bacteria was not statistically significant . However, following both implantations, median values of IgA activity were consistently higher in subjects who had eliminated the implanted strain than in subjects who had not.

J Clin Microbiol, 1991 Dec, 29(12), 2720 - 3
Group G streptococcal lymphadenitis in rats; Corning BF et al.; Group G streptococci which have been isolated from the oral flora of rats are also normal inhabitants of the human skin, oropharynx, gastrointestinal tract, and female genital tract . This group of streptococci can cause a wide variety of clinical diseases in humans, including septicemia, pharyngitis, endocarditis, pneumonia, and meningitis . Ten days after oral gavage with 7,12-dimethylbenz{a}anthracene, 12 of 22 two-month-old, female, outbred, viral-antibody-free rats presented with red ocular and nasal discharges and marked swelling of the cervical region . Various degrees of firm, nonpitting edema in the region of the cervical lymph nodes and salivary glands as well as pale mucous membranes and dehydration were observed . Pure cultures of beta-hemolytic streptococci were obtained from the cervical lymph nodes of three rats that were necropsied . A rapid latex test system identified the isolates to have group G-specific antigen . These streptococcal isolates fermented trehalose and lactose but not sorbitol and inulin and did not hydrolize sodium hippurate or bile esculin . A Voges-Proskauer test was negative for all six isolates . Serologic tests to detect the presence of immunoglobulin G antibody to rat viral pathogens and Mycoplasma pulmonis were negative . Histopathologic changes included acute necrotizing inflammation of the cervical lymph nodes with multiple large colonies of coccoid bacteria at the perimeter of the necrotiz zone . To our knowledge, this is the first report of naturally occurring disease attributed to group G streptococci in rats.

Mol Gen Genet, 1991 Dec, 231(1), 161 - 8
Molecular characterization of new group A streptococcal bacteriophages containing the gene for streptococcal erythrogenic toxin A (speA); Yu CE et al.; Bacteriophage T12 is the prototype phage carrying the streptococcal erythrogenic toxin A (speA) gene . To examine more closely the phages involved in lysogenic conversion, we examined 300 group A streptococcal strains, and identified and isolated two new phages that carry the speA gene . The molecular sizes of these phage genomes were between 32 and 40 kb, similar to that of phage T12 (35 kb) . However, as ascertained by restriction analysis, the physical maps of the new phage genomes were different from phage T12 and from each other . Hybridization analysis also showed that all of these phages were only partially related to one another and the speA gene was always located close to the phage attachment site . Additionally, colony hybridization showed that whereas phage T12 or one of its close relatives is the most common phage associated with the group A streptococci, phage 49 has a much stronger association with the speA gene . A defective phage was also found following pulsed field gel electrophoresis of total phage DNA . This phage appears to be a resident of strain T25(3)c and is found only following induction of a T25(3)c lysogen . Restriction enzyme analysis of the isolated defective phage DNA suggests that it is the source of the submolar amounts of DNA previously found in association with phage T12 digestion patterns . Additionally, the defective phage may serve as the site of integration of the speA gene-carrying phages described above.

J Med Microbiol, 1991 Dec, 35(6), 367 - 72
A scheme for the identification of viridans streptococci; Beighton D et al.; A collection of strains representing all the currently recognised species of oral or viridans streptococci (Streptococcus sanguis, S . parasanguis, S . gordonii, S . oralis, S . mitis, S . salivarius, S . vestibularis, S . anginosus, S . constellatus, s . intermedius, S . mutans and S . sobrinus) were tested for the production of a range of glycosidase activities with 4-methylumbelliferyl-linked fluorogenic substrates, and for reactions in a range of conventional fermentation and hydrolytic tests . The resulting biochemical scheme, consisting of 14 tests, enabled the differentiation of all these species and distinguished three biotypes within S . sanguis . The scheme reported here represents an improvement over currently available schemes for the identification of viridans streptococci.

Tijdschr Diergeneeskd, 1991 Dec 1, 116(23), 1168 - 74
{Changed health problems in a changing pig-farming concern in The Netherlands until 1980}; Akkermans JP; In 1905 Poels published 'Disease of swine in the Netherlands' . This book dealt predominantly with swine fever, erysipelas, tuberculosis and 'pneumonia' . Between 1920 and 1940 others reported on streptococci, lobular haemmorrhagic pneumonia, bordetellosis, Aujeszky's disease and postweaning diarrhoea . After the second world war, particularly after 1960, the Dutch pig-farming industry developed at a tremendous rate . As a consequence, the health problems changed . Certain diseases became less important: tuberculosis, erysipelas, Leptospira tarrasovi, enteroviruses . Yet other diseases including postweaning diarrhoea, atrophic rhinitis and Aujeszky's disease became problems of increasing importance . At the end of the seventies the knowledge of E . coli toxin types was substantial . On the other hand, information concerning the pathogenesis and pathophysiology was very limited . Bordetella bronchiseptica was still considered to be the most important agent in AR, zootechnical factors being predisposing . However, one was aware of missing links . Aujeszky's disease was obscure until the late fifties . Until 1972 only occasional reports were made . In that year, an epidemic occurred in the Gelderse Vallei . Another epidemic occurred in 1974 in the provinces of Brabant and Limburg . By 1980 proper vaccines were available and Aujeszky's disease was not yet a political problem.

Am J Clin Pathol, 1991 Dec, 96(6), 759 - 61
TestPack Strep A kit for the rapid detection of group A streptococci on 11,088 throat swabs in a clinical pathology laboratory; Tenjarla G et al.; Results obtained with Abbott Laboratories' TestPack Strep A, a rapid test kit to detect group A streptococcal antigen on throat swabs, were compared with the culture results . All tests were performed by American Society of Clinical Pathology-registered technologists in a large clinical laboratory . A total of 11,088 throat swabs were tested; 9,161 belonged to pediatric patients and 1,927 to adults . For TestPack Strep A, the study demonstrated a sensitivity value of 0.91 and a specificity value of 0.96; positive predictive value and negative predictive values were 0.82 and 0.98, respectively . These data indicate that even when performed by experienced technologists, in a laboratory setting, approximately 1 of 10 patients with group A streptococcal tonsillopharyngitis will be missed if physicians rely solely on this direct antigen test . A backup culture on all patients who are negative by a rapid antigen detection test is recommended.

Lancet, 1991 Nov 30, 338(8779), 1373 - 6
Epidemiology of infective endophthalmitis in France . The French Collaborative Study Group on Endophthalmitis; Fisch A et al.; Data from retrospective studies of endophthalmitis vary widely with respect to incidence and to the pathogens implicated . To see whether we could provide more accurate data, we have done a prospective multicentre national survey of endophthalmitis over one year in France . Records of 36,241 operations and 1148 cases of ocular trauma from 64 centres specialising in eye surgery were analysed . There were 167 cases of endophthalmitis; incidence of postoperative endophthalmitis was 0.31 per 100 operations, and the risk after penetrating ocular trauma was 2.8% . In contrast with most previous studies, Staphylococcus epidermidis was the most frequently isolated organism, with gram-negative organisms accounting for only a small proportion of cases . Patients infected with streptococci had the least favourable outcome . The survey confirms data from retrospective studies showing that the incidence of postoperative or post-injury endophthalmitis is low . The low frequency means that large numbers of patients would be required for a trial of antibiotic efficacy, but such a trial is worthwhile because there are now antibiotics with good ocular bioavailability that are effective against most of the bacteria that cause endophthalmitis.

Wis Med J, 1991 Nov, 90(11), 632 - 4
Diagnostic dilemma for the 1990s: Lyme disease versus rheumatic fever; Dlesk A et al.; A 15-year-old boy developed an annular erythematous skin rash, fever, knee pain, syncope, and was found to be in complete heart block requiring temporary transvenous pacing . His recovery was complete following therapy with high dose steroids, aspirin, and IV ceftriaxone followed by oral penicillin . Serologic tests documented diagnostic levels of antibodies to Borrelia burgdorferi as well as to Group A streptococcal DNase B . Diagnoses of both Lyme disease and rheumatic fever are based on clinical presentation and serologic confirmation . Our patient had a clinical presentation compatible with either diagnosis and serologic test results suggestive of infection by both B burgdorferi and Group A streptococci . The patient's management was aimed at preventing complications of both diseases, since clinicians involved with the patient's case could not agree on the most likely diagnosis . We present this case to emphasize the following: both rheumatic fever and Lyme disease should be considered in patients presenting with annular skin rashes and complete heart block; serologic studies may be confusing in both Lyme disease and rheumatic fever since neither is entirely sensitive nor specific and efforts should be made to document the causative organism by appropriate cultures, biopsies, and stains when possible; and improved immunoserologic testing for Lyme disease, in particular, is highly needed.

J Dent Res, 1991 Nov, 70(11), 1401 - 8
Clinical trial in adults of an antimicrobial varnish for reducing mutans streptococci; Sandham HJ et al.; An abbreviated treatment with a chlorhexidine-containing varnish was compared with a similar treatment with a placebo varnish and with a prophylaxis alone for its effects on the numbers of detectable salivary mutants streptococci in 51 adults . The varnishes, applied once weekly for four weeks, were held in place with a covering layer of either of two polyurethane sealants (FluorProtector or Adhesit) . On the first appointment, the varnish-sealant combination was applied to all tooth surfaces, but on succeeding appointments only the occlusal and approximal surfaces were covered . The chlorhexidine varnish, covered with either sealant, reduced the salivary mutans streptococci by an average of 3 logs (99.9%) in all of the 20 subjects treated, and below detectable levels for at least four weeks in nine of them . In the groups receiving placebo varnish-sealant combinations, the mean log number of mutans streptococci of the subjects was reduced only by approximately 0.5 log (32%), and none of the subjects experienced loss of their detectable mutans streptococci for four weeks, although one subject did so for three weeks . No significant difference between the effects of the two polyurethane sealants was observed . Treatment with a single prophylaxis had no effect on mutans streptococcus levels . Subjects treated with chlorhexidine varnish also experienced an increase in S . sanguis and a small decrease in yeasts . Loss of detectable mutans streptococci did not cause changes in the numbers of other micro-organisms examined, beyond those observed with chlorhexidine varnish treatment alone.

APMIS, 1991 Nov, 99(11), 1058 - 60
Evaluation of monoclonal antibodies in serovar classification of group B streptococci (GBS) . Brief report; Naess AI et al.; We have produced murine MAbs against the c protein from GBS and selected one anti-c alpha and one anti-c beta MAb for serovar classification of c-protein-producing strains . A total of 61 GBS isolates, classified by serotype-specific rabbit antisera, were tested in an immunofluorescent assay and whole-cell ELISA . The MAbs permitted classification of the isolates into 13 serovars . A total of 34 strains contained the c alpha antigen, seven strains the c beta antigen, and 20 strains both the c alpha and the c beta antigen . The distribution of GBS with regard to c-protein serovars was identical to that recorded when rabbit anti-c alpha and -c beta sera were used . The results show that the MAbs are directed against common epitopes on c alpha and beta, respectively . The MAbs will be useful in the serovar determination of clinical GBS isolates and in the study of the structure and immunobiology of c proteins.

Clin Immunol Immunopathol, 1991 Nov, 61(2 Pt 1), 131 - 42
Rheumatogenic streptococci and autoimmunity; Stollerman GH; The uniqueness of the group A streptococcus in initiating a cardiodestructive disease in a limited segment of the human species, regardless of race or ethnic group, makes the quest for a unique host response to a specific streptococcal antigen an intriguing and persisting challenge for clinical investigators, particularly for those investigators interested in autoimmunity . New methodology is making possible more incisive research approaches . The defined streptococcal antigens that turn out to be epitopes identical with host tissues, such as the M protein/cardiac myosin model or the hyaluronate in the capsule of mucoid rheumatogenic strains, offer the opportunity for more incisive clinical investigations . The isolation and cultivation of cardiotoxic T cell clones directed against such epitopes shared by host and parasite may eventually be possible . We may then learn more about whether autoimmunity is indeed a factor in the pathogenesis of rheumatic heart disease.

J Gen Microbiol, 1991 Nov, 137 ( Pt 11), 2577 - 93
Molecular characterization of a cluster of at least two glucosyltransferase genes in Streptococcus salivarius ATCC 25975; Giffard PM et al.; The oral micro-organism Streptococcus salivarius ATCC 25975 synthesizes extracellular glucosyltransferases (GTFs) which polymerize the glucose moiety of sucrose into glucan polymers . Two separate genes encoding the activities of a GTF-I (a GTF that synthesizes an insoluble product) and a GTF-S (a GTF that synthesizes soluble product) were cloned into bacteriophage lambda L47.1 . The inserts in the lambda-clones were characterized by restriction mapping and Southern hybridization and were found to overlap, implying that the two genes lay very close to one another on the S . salivarius chromosome . Both genes were subcloned into phagemid vector pIBI30 where they were expressed at a high level . The GTF-I-encoding gene was named gtfJ and the GTF-S-encoding gene, gtfK . Nucleotide sequencing showed that gtfJ and most probably gtfK were closely related to the gtf genes of the mutans streptococci . Sequence alignment also indicated that gtfK lay very close to and downstream from gtfJ, and that both were transcribed in the same direction.

Rinsho Shinkeigaku, 1991 Nov, 31(11), 1224 - 8
{A case of chorea as a sole presentation of primary anti-phospholipid antibody syndrome}; Sugiyama Y et al.; An 11-year-old boy developed florid choreic movements in his right extremities after having had an episode of febrile illness . He was evaluated at our hospital where MRI disclosed a honeycomb-like low signal intensity area rimmed by a thin Gd-enhanced layer in the left putamen . Arteriography revealed the lenticulostriate arteries being segmentally narrowed and a "ground glass" staining was observed in the left putamen in late venous phase . Sydenham's chorea, that had been the initial impression, was not substantiated because of negative pharyngeal culture for streptococci, negative ASLO/ASK titers and because of lack of clinical stigmata of rheumatic fever . However, prothrombin time was prolonged, and activated partial thromboplastin time (APTT), that had been also prolonged, was not normalized by adding healthy serum, indicating the presence of lupus anticoagulant . VDRL was false positive and anticardiolipin antibodies, both IgM and IgG classes, were also detected . However, systemic lupus erythematosus was unlikely in view of negative antinuclear antibody and LE phenomenon . He deteriorated rapidly due to development of severe bilateral chorea, thereby he was unable to walk or feed himself . He received a 3-day course of mega-dose intravenous methylprednisolone, that temporarily lessened the chorea, but soon it became worse . A second course of mega-dose methylprednisolone was given, followed by daily maintenance dose of prednisolone . His chorea gradually improved in severity and after 2 months only a trace of choreic movements was detected in his hands . He has been followed at our outpatient clinic where he no longer shows chorea and the APTT has improved to nearly normal time.(ABSTRACT TRUNCATED AT 250 WORDS)

Biochimie, 1991 Nov, 73(11), 1427 - 30
HPr polymorphism in oral streptococci is caused by the partial removal of the N-terminal methionine; Vadeboncoeur C et al.; HPr is a small phosphocarrier protein of the bacterial phosphoenolpyruvate:sugar phosphotransferase system involved in the transport and phosphorylation of sugars . It has recently been reported that streptococci possess two forms of HPr having identical biochemical properties . In this communication, we show by N-terminal amino-acid sequencing and by ion-spray mass spectroscopy that these two forms differ by the presence or the absence of the N-terminal methionine.

Klin Monatsbl Augenheilkd, 1991 Nov, 199(5), 330 - 2
{Differences in the pathogen spectrum of the conjunctival sac before and after irrigation of the lacrimal apparatus}; Amon M et al.; The microbial flora in the conjunctival sac of 30 patients was investigated . Qualitative and quantitative differences before and after irrigation of the lacrimal system were found . In some cases a quantitative increase was registered . In 12 cases conjunctival samples before and after irrigation changed . Negative results before and bacterial growth of coagulase-negative staphylococci after irrigation were found in 4 cases . In 3 cases unfavourable changes were seen . Pseudomonas, Klebsiella and beta-hemolytic streptococci were isolated after irrigation in these cases . In the other cases differences were insignificant . The sense of preoperative irrigation of the lacrimal system is discussed and questioned.

Dtsch Tierarztl Wochenschr, 1991 Nov, 98(11), 410 - 1
{Examination of the udder quarters of the first calving for Streptococcus group B of breeding cow market management of the Rhinish Association for the Schwartzbund cattle breed (RVS)}; Rottscheidt W et al.; Quarter milk samples from 344 heifers were examined on group-B-streptococci . In none of the 1376 milk-samples Streptococcus agalactiae could be detected . The problem of examination of B-streptococci is discussed and proposals from the examination on udders of heifers are given.

J Dairy Sci, 1991 Nov, 74(11), 3775 - 81
Effects of supplemental vitamin A or beta-carotene during the dry period and early lactation on udder health; Oldham ER et al.; Effects of vitamin A or beta-carotene supplementation during the dry period and early lactation on the frequency of new intramammary infection and clinical mastitis and on SCC and milk yield were examined . Eighty-two Holstein cows were randomly assigned to one of three groups: 1) 50,000 IU/d of vitamin A per cow (approximately equivalent to 1978 NRC recommended daily intake for dairy cows); 2) 170,000 IU/d of vitamin A per cow; or 3) 50,000 IU/d of vitamin A plus 300 mg of beta-carotene per cow . Cows were supplemented during the 2 wk before drying off, throughout the dry period, and for the first 6 wk of lactation . Concentrations of serum vitamin A did not differ among treatment groups but tended to decrease for all treatment groups from 14 d before drying off to calving . After calving, serum vitamin A tended to increase in all groups through wk 6 of lactation . Serum beta-carotene tended to be higher in beta-carotene-supplemented cows at dry-off, in the early dry period, and again during lactation . Serum beta-carotene decreased sharply in all groups during the prepartum period . The frequency of clinical mastitis and of new intramammary infection during the dry period, near parturition, and for the first 6 wk of lactation did not differ among treatment groups . The percentage of quarters newly infected over the entire trial was 26.8 in the control, 25.0 in the high vitamin A, and 30.6 in the beta-carotene group . Pathogens isolated most frequently were coagulase-negative staphylococci, streptococci other than Streptococcus agalactiae, and coliforms.(ABSTRACT TRUNCATED AT 250 WORDS)

Ann Pediatr (Paris), 1991 Nov, 38(9), 637 - 41
{Prevention of neonatal conjunctivitis . A comparative clinical and bacteriologic study of 2 eyedrops: silver nitrate and oxytetracycline chlorhydrate}; Brussieux J et al.; This study carried out at the Saint-Germain-en-Laye Hospital maternity ward included all the neonates delivered between February and September 1989 who exhibited no abnormal manifestations during their stay in the ward, except for ocular symptoms in some subjects . Nine hundred neonates were enrolled . Each day, one of two eyedrop preparations for the prevention of neonatal ocular infections was selected at random . Investigators were blinded to the preparation used . Study subjects were evaluated twice, between D1 and D7 (900 infants) and between D15 and D30 (407 infants) . Ocular findings were classified as follows: normal, minimally abnormal (isolated swelling of the eyelids, clear discharge), or frankly abnormal (conjunctivitis, purulent discharge) . A bacteriologic study was performed in all patients with minimally abnormal or abnormal findings . Between D1 and D7, ocular symptoms were significantly (p less than 0.05) more prevalent in neonates treated with silver nitrate than in neonates treated with oxytetracycline hydrochloride . This difference was no longer present between D15 and D30 . Bacteriologic studies recovered no gonococci . One enfant in the oxytetracycline group had bacteriologically confirmed Chlamydia trachomatis ocular infection . The other organisms recovered were mainly Staphylococcus aureus and non-hemolytic streptococci . In inclusion, no currently available eyedrop preparation offers complete protection against C . trachomatis but tolerance is considerably better with oxytetracycline hydrochlorate than with silver nitrate.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Nov, (11), 56 - 9
{The enhancement of the immunogenicity of streptococcal group-A M protein by conjugation with a synthetic polyelectrolyte}; Semenova EN et al.; Immunization with the polypeptide fragment of group A streptococcal protein M conjugated with the copolymer of acrylic acid and N-vinylpyrrolidone in complete Freund's adjuvant has been found to lead to a sharp increase in the level of antibodies to the type-specific determinants of protein M, detected in the enzyme immunoassay (EIA) . The possibility of the application of such sera to preliminary typing of streptococci in EIA with the use of whole microbial cells as antigens has been shown . The data on high activity of the sera thus obtained in the bactericidal test with streptococci of the homologous type are presented . Recommendations on the use of sera obtained by the above method for highly precise typing of the virulent cultures of group A streptococci in the bactericidal test are given.

Br J Dermatol, 1991 Nov, 125(5), 443 - 7
Cross-reactivity between streptococcal M surface antigen and human skin; McFadden J et al.; Psoriasis can be triggered by haemolytic streptococcal infections . As M protein is a major pathogenic surface antigen in these streptococci, the cross-reactivity between streptococcal M protein surface antigens and human epidermis was investigated . The conserved component common to the few M proteins investigated consists of an alpha-helical 'coiled-coil' configuration, similar to sub-units of human keratin . The amino acid sequence of protein M6, one of the M proteins that has been fully sequenced, was compared with that of 4721 ubiquitous peptides, by computer-assisted analysis using a protein-sequence data bank . Of all human proteins in the data bank 50-kDa keratin type 1 showed the closest homology with protein M6 . Further evaluation revealed that this homology mainly involved the heptapeptide repeat patterns, which form the alpha-helical 'coiled-coil' structure, in both M6 and 50-kDa keratin . Cryostat sections of normal, involved and uninvolved psoriatic skin were studied for cross-reactivity with rabbit antisera raised against 10 different M proteins . All these antisera reacted with the stratum corneum of normal and psoriatic epidermis to a variable extent . Staining of keratinocyte cytoplasm was also observed, but this tended to be more prominent in lesional than in uninvolved and normal skin . Some of the M antisera also stained dendritic cells in the upper dermis as well as endothelium and smooth muscle . These cross-reactivities might be relevant to the pathogenesis of post-streptococcal psoriasis.

Eur J Immunol, 1991 Nov, 21(11), 2727 - 33
Induction of antigen-specific CD8+ cytolytic T cells by the exogenous bacterial antigen streptolysin O in rhesus monkeys; Chizzolini C et al.; We have characterized the T cell responses induced by streptolysin O (SLO), a sulfhydryl-activated hemolysin secreted by streptococci, by applying long-term in vitro culture and cloning rhesus monkey (Macaca mulatta) T cells . T cell lines specific for SLO were obtained from three rhesus monkeys . These T cell lines required autologous antigen-presenting cells (APC) to proliferate in response to SLO and did not respond to purified protein derivative . Phenotypic analysis showed that the cells from two of three SLO-specific T cell lines were more than 85% CD3+CD4-CD8+ after prolonged in vitro culture . The rh 1842 CD8+ T cell line proliferative response to SLO was inhibited by the addition of anti-major histocompatibility complex (MHC) class I and anti-CD8 but not of anti-MHC class II and anti-CD4 monoclonal antibody (mAb) . This cell line was able to lyse P815 target cells in the presence of anti-CD3 mAb and did not show natural killer activity . Moreover, specific lysis of autologous but not allogeneic non-rosetting E- cell targets pulsed with SLO was observed . Such lysis was inhibited by the addition of anti-MHC class I mAb . In the attempt to identify the restriction elements involved in SLO presentation APC from six unrelated rhesus monkeys and three humans were used . A CD4+ rh 1842 T cell clone responded when SLO was presented by one of six, and a CD8+ rh 1842 T cell clone by four of six rhesus monkeys APC . Both CD4+ and CD8+ T cell clones did not respond when SLO was presented by human APC . However, both clones responded when APC from all donors were used in conjunction with anti-CD3 mb . Furthermore, SLO required active processing to be presented to CD4+ and CD8+ T cell clones as glutaraldehyde fixation of APC before but not after antigen pulsing inhibited T cell proliferation . The SLO-specific CD8+ cytolytic T cells described here could play a role in the regulation of the immune response occurring during streptococcal infections and/or could participate in the pathogenesis of poststreptococcal nonsuppurative sequelae.

Lijec Vjesn, 1991 Nov-Dec, 113(11-12), 405 - 10
{Bacteremia caused by beta-hemolytic group A streptococci}; Begovac J et al.; The epidemiological, clinical and laboratory characteristic of group A beta-hemolytic streptococcal (GABHS) bacteremia in patients treated at the University Hospital of Infectious Diseases in Zagreb were analyzed . Of 51 cases of bacteremia due to GABHS seen over the past 15 years, 15 (29%) have been registered since 1987 . The mean age of our patients was 25 years (range, 5 months to 87 years); and 29 (57%) were under 18 . Ten (19%) patients died, 6 being less than 18 years of age . Forty-seven (92%) cases were community-acquired and 16 (32%) had underlying disease . Primary foci of infection, defined as a sites of inflammation that precedes bacteremia, included pharyngitis in 15 and erysipelas/cellulitis in 16 patients . Six patients had no focus of infection . Shock was recorded in 4 patients, all of whom died . Seven patients had a rash, in 5 the rash was typical of scarlet fever . Of the 6 children who died 4 were previously healthy and they all died within 24 hours following admission, and were sick at least 48 hours before admission to our hospital . Our experience suggests that serious GABHS infections may appear in children, that it requires prompt recognition and treatment and that a worldwide change in the virulence of GABHS may have occurred.

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