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