Streptococcal

Zentralbl Bakteriol, 1991 Dec, 276(1), 68 - 72
Influence by staphylococcal lipase on granulocyte metabolism and killing of bacteria; Braconier JH et al.; Lipase purified from Staphylococcus aureus interferes with granulocyte phagocytic killing of S . aureus but not with killing of Streptococcus pneumoniae or Streptococcus agalactiae group B . Lipase treatment of granulocytes did not influence bacterial adherence to the cells.

J Antimicrob Chemother, 1991 Dec, 28 Suppl C, 65 - 71
Comparative pharmacokinetic disposition of fluoroquinolones in the lung; Wise R et al.; The problems associated with the study of the penetration of quinolones into the respiratory tract are discussed . New techniques allow the study of the penetration of these agents into bronchial mucosa, alveolar macrophages and epithelial lining fluid . In general quinolones are concentrated in bronchial mucosa approximately 1.5 times compared with serum . In alveolar macrophages, the agents are concentrated 14- to 18-fold compared with serum and the ratio of alveolar macrophage levels to those in epithelial lining fluid are 7.7 to 5.7:1 . The concentrations of temafloxacin and ciprofloxacin in these sites suggests that these agents will be efficacious in the therapy of respiratory infections caused by Streptococcus pneumoniae.

J Antimicrob Chemother, 1991 Dec, 28 Suppl C, 45 - 53
Comparative activity of fluorinated quinolones in acute and subacute Streptococcus pneumoniae pneumonia models: efficacy of temafloxacin; Azoulay-Dupuis E et al.; We have compared the efficacy of temafloxacin against Streptococcus pneumoniae in experimental murine pneumonia models with that of ofloxacin and ciprofloxacin . Erythromycin and amoxycillin were used as reference agents . Two different strains of mice were used: Swiss mice develop acute pneumonia and die within three to four days, while C57B1/6 mice develop subacute pneumonia and die within eight to ten days . In both cases all animals quickly become bacteraemic . Mice were infected with approximately 10(5) cfu of a virulent S . pneumoniae strain, serotype 3 (P4241), by the intra-tracheal per oral route . In Swiss mice, subcutaneous treatments were initiated early (18 h post-infection) and given every 12 h for 72 h . A 79% cumulative survival rate was obtained in temafloxacin-treated mice (50 mg/kg); a figure not significantly different from those for erythromycin and amoxycillin but far higher than those for ofloxacin and ciprofloxacin (7% survivors) . Pulmonary clearance of bacteria was consistent with the survival rates . Complete clearance of bacteria in the lungs and blood was achieved using temafloxacin (50 mg/kg), whereas mice remained bacteraemic even with increased dosages of ofloxacin and ciprofloxacin . In the subacute pneumonia C57B1/6-mice model, the superior efficacy of temafloxacin (compared to ofloxacin and ciprofloxacin) was also seen even when treatment was initiated at late stages of the disease (up to 96 h post-infection) . The pharmacokinetics of temafloxacin account for its better efficacy against S . pneumoniae pneumonia relative to the other quinolones.

J Antimicrob Chemother, 1991 Dec, 28 Suppl C, 39 - 44
Pharmacokinetics of four fluoroquinolones in an animal model of infected lung; Vallee E et al.; We studied the pharmacokinetic parameters of four fluoroquinolones--ofloxacin, ciprofloxacin, temafloxacin and sparfloxacin--in a mouse model of Streptococcus pneumoniae-infected lung . After a single subcutaneous injection, bioactivities were determined concomitantly in non-infected and infected animals, at a time at which pneumonia was well developed . Fluoroquinolones exhibited generally good activity at the site of infection . Infection did not affect the tissue distribution of either drug . However, the differences observed in non-infected controls (greater AUCs and longer half-lives of temafloxacin and sparfloxacin in lung and serum) were accentuated in infected mice, with probable trapping of temafloxacin and sparfloxacin at the site of infection and more persistent activity in the lung . These data suggest that the anti-pneumococcal activity of temafloxacin, and to a lesser extent sparfloxacin, were greatly favoured by their pharmacokinetic behaviour in the infected lung.

N Engl J Med, 1991 Nov 21, 325(21), 1453 - 60
The protective efficacy of polyvalent pneumococcal polysaccharide vaccine; Shapiro ED et al.; BACKGROUND . Although the protective efficacy of pneumococcal polysaccharide vaccine has been demonstrated in randomized trials in young African gold miners, there has been controversy about its efficacy in older Americans at risk for serious pneumococcal infections . To assess the vaccine's protective efficacy against invasive pneumococcal infections, we conducted a hospital-based case-control study of the efficacy of pneumococcal vaccine in adults with a condition recognized to be an indication for receiving the vaccine . METHODS . From 1984 to 1990, adults in whom Streptococcus pneumoniae was isolated from any normally sterile site were identified by prospective surveillance in the microbiology laboratories of 11 large hospitals; those with an indication for pneumococcal vaccine were enrolled as case patients . For each case patient, one control was matched according to age, underlying illness, and site of hospitalization . We contacted all providers of medical care to ascertain each subject's history of immunization with pneumococcal vaccine . Isolates of S . pneumoniae were serotyped by an investigator unaware of the subject's vaccination history . RESULTS . Thirteen percent of the 1,054 case patients and 20 percent of the 1,054 matched controls had received pneumococcal vaccine (P less than 0.001) . When vaccine was given in either its 14-valent or its 23-valent form, its aggregate protective efficacy (calculated as a percentage: 1 minus the odds ratio of having been vaccinated times 100) against infections caused by the serotypes represented in the vaccine was 56 percent (95 percent confidence interval, 42 percent to 67 percent; P less than 0.00001) for all 983 patients infected with a serotype represented in the vaccine, 61 percent for a subgroup of 808 immunocompetent patients (95 percent confidence interval, 47 percent to 72 percent; P less than 0.00001), and 21 percent for a subgroup of 175 immunocompromised patients (95 percent confidence interval, -55 percent to 60 percent; P = 0.48) . The vaccine was not efficacious against infections caused by serotypes not represented in the vaccine (protective efficacy, -73 percent; 95 percent confidence interval, -263 percent to 18 percent; P = 0.15) . CONCLUSIONS . Polyvalent pneumococcal vaccine is efficacious in preventing invasive pneumococcal infections in immunocompetent patients with indications for its administration . This vaccine should be used more widely.

J Immunol, 1991 Nov 15, 147(10), 3370 - 80
Characterization of streptococcal antigen-specific CD8+, MHC class I-restricted, T cell clones that down-regulate in vitro antibody synthesis; Walker PR et al.; T cell clones were generated from the peripheral blood of rhesus monkeys that had been immunized with a soluble Mr 185,000 Ag (SAI/II) derived from Streptococcus mutans . The clones were CD3+ CD8+ CD4- alpha beta TCR+ and were specifically stimulated to proliferate by SAI/II . The proliferative responses of the cloned cells were class I restricted, as demonstrated by reconstitution of the cloned T cells with APC matched at various MHC class I and II loci, as well as by inhibition with anti-class I and not anti-class II mAb . The function of the CD8+ cloned cells was examined in vitro for their effect on antibody synthesis by Ag-stimulated CD4+ cells and B cells from immunized animals . Indeed, four of the five clones suppressed SAI/II-specific IgG antibody synthesis when activated with SAI/II and the appropriate MHC-matched APC . Although activation of the suppressor clones was Ag specific, the effector function of the suppression of antibody synthesis was Ag nonspecific . The latter was probably mediated by lymphokines and, indeed, the culture supernatant generated by stimulating the cloned CD8+ cells with anti-CD3 mAb suppressed both the specific and nonspecific antibody synthesis . Cytotoxicity studies showed that all five CD8+ clones showed a low level of lectin-dependent cytotoxicity . However, because four of the five clones expressed significant suppression of antibody synthesis, the suppressor activity was unlikely to be a function of the weak cytotoxicity . The results suggest that immunization of rhesus monkeys with a soluble streptococcal Ag induced CD8+ alpha beta TCR+ T cell clones that show SAI/II-specific, MHC class I-restricted proliferative responses and nonspecific down-regulatory function of in vitro antibody synthesis.

Clin Ther, 1991 Nov-Dec, 13(6), 727 - 36
Ofloxacin versus cephalexin in the treatment of skin, skin structure, and soft-tissue infections in adults; Powers RD et al.; A multicenter study was conducted to compare the safety and efficacy of oral ofloxacin with that of cephalexin in microbiologic eradication of skin and skin-structure pathogens and the clinical treatment of skin and skin-structure infections . The subjects, 335 adult patients with acute localized infections of the skin, skin structure, or soft tissue, were randomly assigned to receive 400 mg of ofloxacin orally every 12 hours or 500 mg of cephalexin orally every six hours for 10 days . At admission, 398 aerobic pathogens were isolated, the most common being Staphylococcus aureus (160 isolates), Streptococcus pyogenes (49), coagulase-negative staphylococci (30), Staphylococcus epidermidis (25), and Pseudomonas aeruginosa (10) . Of 317 isolates tested against ofloxacin, 96% were susceptible, and of 325 tested against cephalexin, 85% were susceptible (P less than 0.001) . Microbiologic and clinical outcome were evaluated in 73 ofloxacin-treated patients and in 65 cephalexin-treated patients . The causative pathogens were eradicated in 95% of the ofloxacin group and in 92% of the cephalexin group . In the ofloxacin group, 75% were clinically cured and 23% improved, and in the cephalexin group, 74% and 23%, respectively . Drug-related adverse experiences were reported by 14% of the 161 ofloxacin-treated patients and by 11% of the 162 cephalexin-treated patients; gastrointestinal disturbances were reported by 8% and 7% and nervous system effects by 6% and 1%, respectively (P less than 0.05) . It is concluded that both ofloxacin and cephalexin are safe and effective in the treatment of skin and soft-tissue infections.

Fundam Appl Toxicol, 1991 Nov, 17(4), 723 - 32
Effects of CI-949, a novel antiallergy compound, on host resistance in mice; Bleavins MR et al.; The effect of CI-949, a novel inhibitor of allergic mediator release, on immune function was assessed with holistic mouse models of immunocompetence . Resistance to the bacterial pathogens Listeria monocytogenes and Streptococcus pneumoniae and the B16F10 melanoma cell line was used to evaluate the potential of CI-949 to affect immune function . CI-949 treatment of female B6C3F1 mice increased pulmonary tumor burden at 100 mg/kg/day in the B16F10 melanoma model, with a no effect level of at least 50 mg/kg/day . A correlation was seen between decreased clearance of the B16F10 cells and increased tumor burden . However, CI-949 produced this effect only at the maximum tolerated dose . No effect of the drug was seen in the S . pneumoniae model . Host resistance to L . monocytogenes was increased after CI-949 administration, with the no adverse effect level in this model being at least equivalent to the top dose of 100 mg/kg/day . Therefore, the immune system does not appear to be adversely affected or to be a specific target for CI-949 even at an overtly toxic dose.

J Ky Med Assoc, 1991 Nov, 89(11), 558 - 62
Thoracic empyema due to Streptococcus intermedius; Roy WJ Jr et al.; With improved laboratory identification procedures, Streptococcus milleri (intermedius) is becoming recognized as an important human pathogen with the potential to form abscesses in a wide range of organs . The occurrence of a rapidly progressive and toxic empyema due to this organism in an otherwise healthy young adult without a predisposing lower respiratory tract infection allows us to examine the possibility that this microbe may be a significant but frequently unrecognized cause of adult empyema.

J Biol Chem, 1991 Nov 5, 266(31), 20797 - 802
cDNA and deduced amino acid sequence of a mouse DNA repair enzyme (APEX nuclease) with significant homology to Escherichia coli exonuclease III; Seki S et al.; We purified a mouse DNA repair enzyme having apurinic/apyrimidinic endonuclease, DNA 3'-phosphatase, 3'-5'-exonuclease and DNA 3' repair diesterase activities, and designated the enzyme as APEX nuclease . A cDNA clone for the enzyme was isolated from a mouse spleen cDNA library using probes of degenerate oligonucleotides deduced from the N-terminal amino acid sequence of the enzyme . The complete nucleotide sequence of the cDNA (1.3 kilobases) was determined . Northern hybridization using this cDNA showed that the size of its mRNA is about 1.5 kilobases . The complete amino acid sequence for the enzyme predicted from the nucleotide sequence of the cDNA (APEX nuclease cDNA) indicates that the enzyme consists of 316 amino acids with a calculated molecular weight of 35,400 . The predicted sequence contains the partial amino acid sequences determined by a protein sequencer from the purified enzyme . The coding sequence of APEX nuclease was cloned into pUC18 SmaI and HindIII sites in the control frame of the lacZ promoter . The construct was introduced into BW2001 (xth-11, nfo-2) strain cells of Escherichia coli . The transformed cells expressed a 36.4-kDa polypeptide (the 316 amino acid sequence of APEX nuclease headed by the N-terminal decapeptide of beta-galactosidase) and were less sensitive to methyl methanesulfonate than the parent cells . The fusion product showed priming activity for DNA polymerase on bleomycin-damaged DNA and acid-depurinated DNA . The deduced amino acid sequence of mouse APEX nuclease exhibits a significant homology to those of exonuclease III of E . coli and ExoA protein of Streptococcus pneumoniae and an intensive homology with that of bovine AP endonuclease 1.

J Med Microbiol, 1991 Nov, 35(5), 304 - 6
Typing of Streptococcus pyogenes by pyrolysis mass spectrometry; Magee JT et al.; Strains of Streptococcus pyogenes from an outbreak in an oncology ward (13) and routine isolates from sporadic cases (6) were examined blind by pyrolysis mass spectrometry (Py-MS), extending previous work on epidemiological typing . This outbreak appeared more complex than one reported previously, but Py-MS and conventional typing results were in complete agreement . The results confirm the potential of Py-MS as a rapid method for identification at strain level in studies of cross infection.

J Exp Med, 1991 Nov 1, 174(5), 1271 - 4
Characterization and clonal distribution of four alleles of the speA gene encoding pyrogenic exotoxin A (scarlet fever toxin) in Streptococcus pyogenes; Nelson K et al.; Streptococcus pyogenes strains producing pyrogenic exotoxin A (scarlet fever toxin) have recently caused episodes of streptococcal toxic-shock-like syndrome (TSLS) . We exploited knowledge of genetic diversity and relationships among exotoxin A-producing patient strains provided by multilocus enzyme electrophoresis to select strains for comparative sequencing of toxin genes . Our analysis identified four alleles of speA in natural populations, one of which (speA1) occurs in many distinct clonal lineages and is probably old . Two other alleles (speA2 and speA3), characterized solely by single amino acid substitutions, were each identified in single clones that together have caused the majority of TSLS episodes . It is unlikely that these alleles have had a long association with S . pyogenes clones . A fourth allele (speA4) also is present in a single phylogenetic lineage and is 9% divergent from the other three toxin alleles . An absence of synonomous (silent) nucleotide changes in speA2 and speA3 is unusual and suggests that the allelic variation is not selectively neutral, which implies that the toxins are not functionally equivalent . These results may be important in helping to understand the recent increase in frequency and severity of disease caused by S . pyogenes.

J Bacteriol, 1991 Nov, 173(21), 6986 - 90
Five independent combinations of mutations can result in low-affinity penicillin-binding protein 2x of Streptococcus pneumoniae; Laible G et al.; Penicillin-binding protein 2x (PBP 2x) of Streptococcus pneumoniae is one of the high-molecular-weight PBPs involved in the development of intrinsic beta-lactam resistance . Point mutations in the PBP 2x genes (pbpX) have now been characterized in five independent spontaneous laboratory mutants in order to identify protein regions which are important for interaction with beta-lactam antibiotics . All mutant genes contained two to four mutations resulting in amino acid substitutions within the penicillin-binding domain of PBP 2x, and none of the mutants carried an identical set of mutations . For one particular mutant, C606, carrying four mutations in pbpX, the mutations at positions 601 and 597 conferred first- and second-level resistance when introduced into the susceptible parent strain S . pneumoniae R6 . However, the other two mutations, at amino acid positions 289 and 422, which were originally selected at the fifth and sixth isolation steps, did not contribute at all to resistance in similar experiments . This suggests that they are phenotypically expressed only in combination with mutations in other genes . Three PBP 2x regions were mutated in from two to all four mutants carrying a low-affinity PBP 2x . However, in a fifth mutant containing a PBP 2x with apparent zero affinity for beta-lactams, the three mutations in pbpX mapped at entirely different positions . This demonstrates that different mutational pathways exist for remodeling this PBP during resistance development.

Infect Immun, 1991 Nov, 59(11), 4103 - 9
Adherence of oral "Streptococcus milleri" cells to surfaces in broth cultures; Eifuku-Koreeda H et al.; Cells of representative strains of oral "Streptococcus milleri" firmly adhered to glass surfaces when grown in glucose broths as well as in fructose and sucrose broths . Cellular adherence occurred on saliva-coated glass surfaces as well as uncoated surfaces, but the cells of only a few (6 of 69) tested adherent strains agglutinated upon the addition of human whole-saliva supernatant . Thus, the firm adherence of growing "S . milleri" cells is independent of sucrose and salivary macromolecules . Two macroscopic forms of cell adherence were observed: one was a coarse-granule type and one was a tiny-granule type covered with a thin homogeneous membranous material . Scanning electron microscopy revealed that, in both types, a stringy substance interconnected the cells and connected the cells to glass surfaces, with amorphous flocklike materials present in the intercellular space . Of the 154 tested strains, 128 were adherent, of which 90 were firmly and extensively (+2 or +3) adherent . Most strains of the serovars f/F, g, h, i, j, g-, and gj- were extensively adherent . Generally, cells of the more strongly adherent strains were more hydrophobic and spontaneously aggregating . However, there also existed a few hydrophilic and nonaggregating but extensively adherent strains . The presence of trypsin or pronase completely inhibited the adherence of some strains (mostly nonaggregating) but did not at all inhibit that of others (mostly aggregating) . The adhering groups did not significantly differ in their cell surface hydrophobicities . Therefore, at least two factors, one proteinaceous and one nonproteinaceous, appear to be principally involved in the firm surface adherence of "S . milleri."

Infect Immun, 1991 Nov, 59(11), 4061 - 70
Distribution, persistence, and recall of serum and salivary antibody responses to peroral immunization with protein antigen I/II of Streptococcus mutans coupled to the cholera toxin B subunit; Russell MW et al.; After peroral immunization of mice with surface protein antigen (Ag) I/II of Streptococcus mutans conjugated to the cholera toxin B (CTB) subunit, cells actively secreting immunoglobulin A (IgA) antibodies specific for Ag I/II, but not for CT, were induced in the salivary glands; salivary IgA anti-Ag I/II antibodies and total salivary IgA were also elevated . The development of large numbers of IgA and IgG antibody-secreting cells in the mesenteric lymph nodes and spleen and high levels of serum IgA and IgG antibodies to Ag I/II and CT demonstrated that a response to both antigens occurred . At least two to three intragastric doses of 15 micrograms or more of Ag I/II-CTB conjugate, plus free CT as an adjuvant, were needed to induce the salivary IgA anti-Ag I/II response, which peaked at about 35 days and persisted at lower levels for 5 to 6 months . A single booster intragastric immunization did not induce enhanced salivary IgA anti-Ag I/II antibodies relative to the primary response, but serum IgA and IgG antibodies to both Ag I/II and CT showed evidence of marked anamnestic responses . The results indicated that relatively long-term mucosal IgA antibody responses could be induced by peroral immunization with small quantities of a CTB-conjugated protein . However, additional factors governed the distribution of cells secreting antibodies of different specificities, or capable of mounting anamnestic responses, between different compartments of the mucosal and circulatory immune systems.

Infect Immun, 1991 Nov, 59(11), 3930 - 4
DNA sequence and in vitro mutagenesis of the gene encoding the fructose-1,6-diphosphate-dependent L-(+)-lactate dehydrogenase of Streptococcus mutans; Duncan MJ et al.; Previously, the fructose-1,6-diphosphate-dependent L-(+)-lactate dehydrogenase gene of Streptococcus mutans JH1000 was cloned into Escherichia coli (J . D . Hillman, M . J . Duncan, and K . P . Stashenko, Infect . Immun . 58:1290-1295, 1990) . In the present study, the nucleotide sequence of 1.29 kb of S . mutans DNA which contained the promoter and protein-coding region of the gene was determined . In vitro disruption of the gene was achieved by deletion of the promoter and a major portion of the protein-coding sequence . Subsequently, a tetracycline resistance gene from S . mutans was inserted at the deletion site as a marker for selection . In addition, evidence from Southern hybridization showed that S . mutans JH1000 contained a single copy of the lactate dehydrogenase gene.

Obstet Gynecol, 1991 Nov, 78(5 Pt 2), 908 - 11
Transplacental passage of vancomycin during the second trimester of pregnancy; Bourget P et al.; Pharmacokinetics and drug monitoring of vancomycin were studied at mid-pregnancy in a patient with chorioamnionitis due to Streptococcus agalactiae . The terminal half-life remained in the normal range (4-6 hours) because of an equivalent increase in both volume of distribution and total plasma clearance . Transplacental passage of the drug was observed . Monitoring is mandatory for prolonged vancomycin therapy, and the results should be available within 24 hours . The therapeutic regimen of 15-20 mg/kg every 12 hours was sufficient for this patient's chorioamnionitis . Serum drug levels and renal function should be measured before increasing the vancomycin dosage.

Pediatr Dent, 1991 Nov-Dec, 13(6), 361 - 6
Influence of rampant caries in dams on caries activity in their offspring; O'Connell AC et al.; Available evidence indicates that infants, for the most part, acquire their oral flora, in particular Streptococcus mutans, from their mothers . The purpose of this study was to explore the effect of rampant caries in rat dams on subsequent caries activity in their offspring . Rampant caries was induced by surgical desalivation of four dams, and subsequent infection with Streptococcus sobrinus 6715 . Two intact dams served as controls . Desalivated dams, having rampant caries, reared litters that experienced significantly higher caries scores (P = 0.0001) on smooth and sulcal surfaces than litters from intact dams . Fluoride given to the dams did not affect caries scores of their pups . The results suggest that the magnitude and virulence of the maternal reservoir of S . sobrinus is a critical factor in the primary infection and caries activity in the offspring . Results support the concept that caries activity in mothers should be controlled in any program designed to prevent caries in infants and children.

Spec Care Dentist, 1991 Nov-Dec, 11(6), 248 - 51
Caries levels, Streptococcus mutans counts, salivary pH, and periodontal treatment needs of adult Down syndrome patients; Shapira J et al.; The prevalence of dental caries and periodontal treatment needs in an institutionalized Down syndrome (DS) population was examined as well as the relationship between caries prevalence, salivary pH and salivary levels of Streptococcus mutans . Twelve patients with DS, aged 20 to 48, were compared with two similar age and gender control groups: healthy, and non-Down institutionalized mentally retarded patients . The pH levels did not differ significantly among the three groups . As to periodontal needs expressed by the CPITN, the institutionalized groups had the highest needs compared with the healthy group . Down adults, who were cariesfree, had significantly lower S . mutans counts compared with the patients with caries . In addition, the cariesfree patients with DS had much lower CPITN scores compared with the patients with caries.

Eur J Clin Microbiol Infect Dis, 1991 Nov, 10(11), 949 - 53
Comparative study of clarithromycin and penicillin V in the treatment of streptococcal pharyngitis; Stein GE et al.; This study evaluated the safety and efficacy of clarithromycin in the treatment of patients with Group A beta-hemolytic streptococcal pharyngitis . Subjects were treated with either 250 mg clarithromycin twice daily or 250 mg penicillin V four times a day for 10 days and followed for approximately three weeks post-treatment . At the completion of therapy, 96% (45/47) of patients treated with clarithromycin and 89% (43/48) of patients treated with penicillin V were clinically cured or improved . Recurrence of symptoms occurred in 7 and 5 patients who were treated with clarithromycin and penicillin V respectively . Initial bacteriologic eradication was observed in all but one patient . Recurrence of Streptococcus pyogenes occurred in 5 (11%) patients who received clarithromycin and 7 (15%) patients who received penicillin V . The majority of adverse events reported during this study were mild and involved the gastrointestinal tract . Diarrhea was more frequent in patients who received clarithromycin . In this multicenter, randomized, double-blind trial, clarithromycin was as safe and effective as penicillin V in the treatment of Streptococcus pyogenes throat infections.

J Dent Res, 1991 Nov, 70(11), 1422 - 6
Chromosomal deletions in melibiose-negative isolates of Streptococcus mutans; Ushiro I et al.; Isolates from a collection of phenotypically melibiose-negative (Mel-) Streptococcus mutans from widely-scattered geographical locations were examined and found to lack the activities of the enzymes alpha-galactosidase and alpha-glucosidase, in addition to being unable to transport melibiose . Cloned fragments of S . mutans DNA from the region of the chromosome carrying the genes for alpha-galactosidase (aga), sucrose phosphorylase (gtfA), and dextran glucosidase (dexB), as well as the genes encoding components of the binding-protein-dependent uptake system for raffinose and melibiose, were used in hybridization studies for investigation of the genetic basis of the Mel-phenotype . A region of at least 12 kilobases, containing all the above genes, was found to be deleted from the chromosome of the Mel- strains . It appears that this region of the chromosome is not essential for survival of S . mutants in the oral cavity . The reason for the frequent occurrence of deletions, as opposed to other forms of mutational events, is unknown.

Infect Immun, 1991 Nov, 59(11), 4161 - 7
Oral passive immunization against dental caries in rats by use of hen egg yolk antibodies specific for cell-associated glucosyltransferase of Streptococcus mutans; Hamada S et al.; The effect of polyclonal egg yolk immunoglobulin G antibodies (yIgG) raised against whole cells, cell-free (CF) glucosyltransferase (GTase), or cell-associated (CA) GTase of serotype c Streptococcus mutans was examined in terms of in vitro inhibition of virulence-related factors of S . mutans and protection of S . mutans-infected rats against the development of dental caries . Hens (18 weeks old) were immunized with formalin-treated whole cells, purified CF-GTase, or CA-GTase together with Freund's complete adjuvant . In addition, yIgG to surface protein antigen was used in some in vitro experiments for comparison with other antibodies . yIgG was purified by ammonium sulfate precipitation followed by DEAE-Sephacel column chromatography or fractional precipitation with ethanol . Purified yIgG was found to be a 220-kDa protein, which was dissociated into heavy and light chains upon addition of 2-mercaptoethanol . yIgG to whole cells and surface protein antigen gave a heavy aggregation of S . mutans organisms, while yIgG to CF- and CA-GTase specifically inhibited the enzymatic activity of the respective GTase . yIgG to CA-GTase and whole cells was found to clearly suppress the adherence of S . mutans cells to a glass surface . Specific-pathogen-free Sprague-Dawley rats that had been infected heavily and repeatedly with S . mutans and fed diet no . 2000 developed severe dental caries, while rats fed diet 2000 containing greater than or equal to 0.1% yIgG to CA-GTase showed a statistically significant reduction in dental plaque accumulation and caries development . Administration of yIgG to CF-GTase and whole cells failed to protect against caries . These results clearly suggest that yIgG to S . mutants CA-GTase specifically inhibited a virulence factor of this organism, i.e., insoluble glucan-synthesizing CA-GTase, resulting in a significant reduction in the development of dental caries.

Am J Respir Cell Mol Biol, 1991 Nov, 5(5), 416 - 23
Pneumolysin induces the salient histologic features of pneumococcal infection in the rat lung in vivo; Feldman C et al.; Streptococcus pneumoniae infections are common, but how they cause host tissue injury and death is incompletely understood . Immunization with pneumolysin, a thiol-activated toxin produced by the pneumococcus, partially protects animals during subsequent infection . The mechanism by which pneumolysin contributes to disease is not known . The aim of the present investigation was to determine the histologic changes induced by recombinant pneumolysin in the rat lung and to compare them with the changes induced by live organisms . Injection of either toxin (200 or 800 ng) or bacteria into the apical lobe bronchus was associated with the development of a severe lobar pneumonia restricted to the apical lobe . The changes induced by the toxin were greater at the higher concentration, and changes were most severe in those animals in which there was partial ligation of the apical lobe bronchus . The pneumonitis was less severe following injection of a modified toxin with decreased hemolytic activity, generated by site-directed mutagenesis of the cloned pneumolysin gene, indicating that this property of the toxin was important in generating pulmonary inflammation . There was still considerable pneumonitis after injection of a modified toxin with decreased capacity to activate complement.

Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1991 Nov-Dec, 32(6), 391 - 5
{Streptococcus bovis meningitis and sepsis in neonates: report of two cases}; Chang YC et al.; Streptococcus bovis is a veterinary organism rarely previously reported in the neonatal infection . Two cases are presented of neonatal infection by this organism; one case manifested with meningitis and the other, with sepsis . Seizure and respiratory distress were the symptoms found in these two babies, respectively . Following adequate treatment, recovery was complete, and the infants enjoyed healthy lives post-discharge . S . bovis is always sensitive to penicillin, but resistant strain has been reported recently . It is reasonable to treat infant patients infected by this organism with a combined initial therapy of penicillin and aminoglycoside . After the minimal inhibitory concentration and minimal bactericidal concentration of antibiotic has been determined, penicillin or ampicillin can be used alone.

Pediatr Med Chir, 1991 Nov-Dec, 13(6), 645 - 7
{Empyema due to an anaerobic Streptococcus in childhood}; Sanna CM et al.; Anaerobic infections are quite rare in pediatric age, being that, they affect only neonates and immunodepressed patients . We think to be somewhat interesting to describe the case of our patient, a 9 year old boy, unaffected by any predisposing factor, came under our observation because of a severe respiratory distress . He showed evident clinical and radiological signs of pleural effusion in the right lung, together with a gas coil in the upper field and a left mediastinal shifting . A thoracentesis was then performed, giving rise to 600 ml of foul smelling purulent material; this procedure promptly improved his respiratory function . A permanent drainage trough the chest wall was set and an antibiotic therapy, based on the clinical picture and the character of the exudate, begun . In effect, the typical smell of the purulent material led us to suspect an anaerobic infection, and for this reason we employed the teicoplanin iv, a rarely used in the pediatric age drug . While blood cultures were negative for any organism, exudate cultures yielded Peptostreptococcus anaerobius; the last one resulted highly sensible following antibiogram to the previously chosen drug . The x-ray pattern and the rapid disappearing of the gas coil induced us to exclude further either congenital or acquired lung diseases . We conclude that, in absence of other proved sources of entry, the air presence in the pleural space was secondary to gas formation by the anaerobic micro-organism . The clinical course was very satisfactory allowing the patient to be dismissed on the 28th hospital day, with no need of further surgical therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Eur J Clin Microbiol Infect Dis, 1991 Nov, 10(11), 897 - 910
Pneumococcal polysaccharide vaccines: indications, efficacy and recommendations; Bruyn GA et al.; Streptococcus pneumoniae is the primary cause of community-acquired pneumonia, meningitis in adults and otitis media in infants and children and the third cause of meningitis in infants and children . Despite the availability of effective therapeutic agents against this pathogen, mortality has remained high, particularly for infections complicated by bacteremia . For many years, there has been a plea for vaccination . The first steps, using whole bacterial vaccines, were taken during the early decades of this century in the gold mining camps of South Africa, where pneumonia was endemic . The efficacy of purified pneumococcal polysaccharide vaccines has since been demonstrated in young adults, such as gold miners and military recruits, as well as for several other groups at risk, such as institutionalized elderly, patients with sickle cell anemia or those who have undergone a splenectomy, and elderly patients with underlying conditions such as chronic obstructive pulmonary disease and chronic cardiovascular disease, but not in infants and severely immunocompromised patients . Serological studies on the immune response to inoculation of pneumococcal polysaccharide antigens have demonstrated a severely impaired antibody response in the last two groups . Therefore, development of more highly immunogenic vaccines, e.g . by linking pneumococcal polysaccharides or parts of them to protein carriers, should be continued in an attempt to offer adequate protection to those who are insufficiently protected by the current 23-valent polysaccharide vaccine . Opportunities to immunize other patients who are at risk for pneumococcal infection and are capable of responding to the current vaccine should not be missed.

Kansenshogaku Zasshi, 1991 Nov, 65(11), 1419 - 29
{Studies on clinical significance of "Streptococcus milleri group" in respiratory infections}; Yamashiro T; "Streptococcus milleri group" are the part of the indigenous oral flora, and they are proposed to contain three distinct species: Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius . Though not included in the approved lists of bacterial names, "S . milleri group" are regarded as the causative organisms of suppurative infections, such as oral abscess, brain abscess, lung abscess and empyema . I have studied the clinical significance of the "S . milleri group" in respiratory infections . An investigation was performed to confirm the incidence of "S . milleri group" colonization in healthy 120 volunteers' (20 y/o-80 y/o) throats, and it was found that 11.7% (14/120) were positive . On the other hand, attention should be paid to the fact that the "S . milleri group" was highly isolated, 24 (24.7%) in 97 purulent respiratory specimens (94 sputa and 3 throat swabs) from which no other significant microorganism was recovered . I have measured the serum antibody titers of the "S . milleri group", employing the IFA technique, in 10 patients from whose specimens "S . milleri group" was predominantly isolated, and compared with those of 18 healthy volunteers . Whereas all of the titers of healthy volunteers reveal less than 1:256, those of the patients reveal more than 1:512 . And antibody titers to "S . milleri group" showed the highest in two weeks after "S . milleri group" isolation, and came down to healthy adult levels in six weeks or more . Thus far, about half of the causative organisms of acute pneumonia have been reported unknown . In this study I have suggested that the "S . milleri group" plays an important role as the causative organism in respiratory infections including pneumonia.

Appl Environ Microbiol, 1991 Nov, 57(11), 3383 - 4
Intracellular pH of acid-tolerant ruminal bacteria; Russell JB; Acid-tolerant ruminal bacteria (Bacteroides ruminicola B1(4), Selenomonas ruminantium HD4, Streptococcus bovis JB1, Megasphaera elsdenii B159, and strain F) allowed their intracellular pH to decline as a function of extracellular pH and did not generate a large pH gradient across the cell membrane until the extracellular pH was low (less than 5.2) . This decline in intracellular pH prevented an accumulation of volatile fatty acid anions inside the cells.

Mol Microbiol, 1991 Nov, 5(11), 2611 - 6
Structure and function of pneumolysin, the multifunctional, thiol-activated toxin of Streptococcus pneumoniae; Boulnois GJ et al.; Pneumolysin is a thiol-activated, membrane-damaging, multifunctional toxin and a known virulence factor of Streptococcus pneumoniae . The toxin can interfere with the functioning of both cellular and soluble components of the human immune system which protects against pneumococcal infection . Different amino acids within the toxin which are important in promoting oligomerization of the toxin in membranes and for the generation of functional lesions have been identified by site-directed mutagenesis . Pneumolysin can also activate the classical pathway of complement, and this appears to involve antibody binding (via Fc) by a region of the toxin homologous to C-reactive protein, a human acute-phase protein also capable of classical pathway activation and implicated in host defence against pneumococcal infection.

Equine Vet J, 1991 Nov, 23(6), 466 - 9
Influence of age on neutrophil function in foals; Wichtel MG et al.; Functional activities (phagocytosis and killing) of neutrophil leucocytes (NL) and immunoglobulin G concentrations were evaluated in six healthy foals from birth to 6 months of age . Peripheral blood NL were reacted with Streptococcus equisimilis in 20 per cent pooled equine serum for 30, 60 and 90 mins and functional activities of NL were determined using a fluorochrome microassay . Values for foal NL function were compared with those of healthy adult horses (n = 28) . Foal neutrophil function was influenced by age . Killing capacity of NL decreased, whereas phagocytic capacity increased, until 113 days of age, after which a reversal in trends became apparent . Immunoglobulin G concentrations changed significantly over time and were lowest at 29 to 56 days of age . All foal values for NL function fell within the range of normal values established for healthy adult horses.

S D J Med, 1991 Nov, 44(11), 317 - 20
Overwhelming postsplenectomy sepsis twenty-two years after operation risks management and prevention; White BP et al.; A new case of fatal postsplenectomy sepsis occurring 22 years after operation for splenic rupture is described . There are now 30 published cases in which this complication occurred 10 or more years after operation . The microorganism responsible for the vast majority of cases is Streptococcus pneumoniae . The causative pathogen identified in the present case was a Viridans Streptococcas, Strep . sanguis, an opportunistic, low virulence pathogen . The clinical presentation of this patient is characteristic of the syndrome of overwhelming postsplenectomy infection and exemplifies the dramatic suddenness with which it develops.

J Clin Microbiol, 1991 Nov, 29(11), 2651 - 2
Failure of Micro Media FOX Microdilution System to detect decreased susceptibility of Streptococcus pneumoniae to penicillin; Carroll K et al.; Twelve isolates of Streptococcus pneumoniae with decreased susceptibility by oxacillin screen were susceptible by the FOX panel (Micro Media Systems, Cleveland, Ohio), a commercial microdilution system designed for fastidious organisms . These organisms were found to be moderately susceptible or resistant by broth macrodilution and agar dilution methods . This discrepancy indicates that the FOX panel is not reliable for susceptibility testing of S . pneumoniae.

J Clin Microbiol, 1991 Nov, 29(11), 2590 - 4
Characterization of six new capsular types (23 through 28) of Streptococcus suis; Gottschalk M et al.; Six new capsular types of Streptococcus suis (types 23 to 28) are described . All reference strains were isolated from diseased pigs and were morphologically and biochemically similar to previously described capsular types 1 to 22 . Clear and specific reactions were obtained for each of the new capsular types with three different typing techniques; no cross-reactions were detected among them or with other S . suis capsular types . Their capsular material presented similar ultrastructural characteristics, as shown by electron microscopy, and fimbriae similar to those described for other capsular types of S . suis were observed . When untypeable field isolates were tested with antisera raised against the six new capsular types, capsular type 23 appeared to be the most prevalent, representing more than 50% of all these isolates . Most isolates were recovered from cases of pneumonia, septicemia, and meningitis . Presumptive biochemical identification described for S . suis capsular types 1 to 22 may also be used for capsular types 23 to 28.

Ann Vasc Surg, 1991 Nov, 5(6), 529 - 32
Mycotic aneurysm of the suprarenal aorta secondary to Streptococcus pneumoniae: an unusual pathogen; Gelabert HA et al.; Mycotic aneurysms of the suprarenal aorta are rare lesions, accounting for less than 1% of aortic reconstructions for aneurysmal disease . The bacteriology of these lesions differs from the infrarenal aneurysms and primarily consists of Gram-negative organisms . We report an unusual case of an 87-year-old man successfully treated for a ruptured mycotic suprarenal aortic aneurysm caused by Streptococcus pneumoniae . We have not seen a previously reported case where this pathogen has been associated with a suprarenal mycotic aneurysm . The unique bacteriology of these aneurysms is reviewed along with theories of etiology and their classification . The current management of these aneurysms is summarized.

Vet Microbiol, 1991 Nov, 29(3-4), 281 - 7
Preliminary observations of interaction between bacteriophages and Streptococcus bovis bacteria on ruminal epithelium primoculture; Styriak I et al.; Five Streptococcus bovis strains (47/3, 59/2, 4/1, 46/2 and 44/9) isolated from calf ruminal fluid samples were examined for the adherence to cultured ruminal epithelium cells . Four strains (47/3, 59/2, 4/1 and 46/2) were able to attach to the cultured epithelial cells . However, S . bovis 47/3 strain attached to the target cells in significantly greater numbers than the other strains . Strain 44/9 did not adhere to cells of ruminal epithelium . The adherent bacteria were observed on the surface of differentiated (mainly keratinized) cells of ruminal epithelium primoculture only . The different effect of F4, F5 and F6 bacteriophages was ascertained on S . bovis bacteria adhering to rumen epithelial primoculture . A significant decrease in the number of adherent bacteria was shown after cultivation of strains 47/3 and 4/1 with F6 bacteriophage and of 47/3 strain with F4 phage . The F5 bacteriophage had no significant effect on these bacteria.

J Dairy Res, 1991 Nov, 58(4), 383 - 8
Influence of milk flow rate and streak canal length on new intramammary infection in dairy cows; Grindal RJ et al.; Eighteen cows with a wide range of quarter peak flow rates (0.35-2.22 kg/min) were inoculated with Streptococcus agalactiae and Str . dysgalactiae 4 mm into each streak canal every 3 d for 12 d . Thirty of the 72 quarters developed intramammary infection . Mean peak flow rate and length of streak canal of those quarters that became infected were 1.26 +/- 0.08 kg/min (mean +/- SEM) and 11.47 +/- 0.41 mm respectively, compared with 1.01 +/- 0.05 kg/min and 12.05 +/- 0.35 mm for those that remained uninfected . Logistic regression analysis showed that the probability of infection increased significantly with the increase in peak flow rate (P = 0.01) . The influence of streak canal length on new infection, after allowing for the effect of peak flow rate, was not significant at the 5% level (P = 0.07), suggesting that there may be an inverse relationship between teat duct length and infection, but that it is of secondary importance to peak flow rate . If increased mass of milk distends the teat duct by raising intramammary pressure, then quarter susceptibility to infection is further compromised . These results strongly suggest that the benefits of reduced infection from mastitis control, achieved despite dramatic increases in milk flow rate and milk yield, are significantly underestimated.

J Infect, 1991 Nov, 23(3), 307 - 16
Group A streptococcus endocarditis: report of five cases and review of literature; Burkert T et al.; Group A streptococcus is an uncommon cause of infective endocarditis . We report five probable cases during a 10-year period (1980-1989) from a 750-bed community-teaching hospital . None of the patients were drug abusers . Group A streptococcus is the cause of infective endocarditis in between 0 and 5% cases in reported series . Since the introduction of penicillin 69 cases of group A streptococcus endocarditis have been reported in the literature . Clinical details of 14 patients, none of whom were drug abusers, are available . Included are our five cases . Eight patients had no underlying valve lesions . The overall mortality was 21% but only 15% for patients treated approximately . Among the 25 reported IV drugs abusers with group A streptococcus endocarditis and known valve involvement, right-sided heart valves were involved in 19 and left sided in six . The overall mortality was 9%.

Int J Cardiol, 1991 Nov, 33(2), 333 - 4
Endocarditis due to Streptococcus agalactiae presenting with myositis; Owen A; A case of endocarditis of the aortic valve due to Streptococcus agalactiae is described in which the patient presented with a myositis sparing the myocardium . The patient required emergency replacement of the valve, and made a good recovery.

Kansenshogaku Zasshi, 1991 Nov, 65(11), 1488 - 93
{A case of smoldering adult T-cell leukemia complicated by various pulmonary infections}; Yamakami Y et al.; A 46-year-old man was admitted to Oita Medical College Hospital on October 16, 1987, because of cough and sputum . Chest X-ray and chest CT films showed diffuse reticulonodular shadow . The specimens obtained by transbronchial lung biopsy revealed cysts of pneumocystis carinii . Abnormal lymphocytes with lobulated nuclei were found 2-7% of peripheral leucocytes . The anti HTLV-I antibody was positive . According to these data, we diagnosed the patient as smoldering adult T cell leukemia with pneumocystis carinii pneumonia . The abnormal shadow on chest X-ray disappeared after SMX-TMP and pentamidine treatment . After about 1 year, he was again admitted for high fever . Chest X-ray showed infiltration with cavity in right upper lobe . Streptococcus pneumoniae was isolated from the sputum . The infiltration shadow on chest X-ray disappeared after antibiotics treatment . However, multiple nodular shadow appeared on the chest X-ray and ATL cell infiltration was found in the specimens of transbronchial lung biopsy . ATL cells in peripheral blood also increased and serum LDH and Calcium levels were markedly high . According to these data, we diagnosed the patient as having a ATL crisis . Although chemotherapy for ATL was started, the ATL, cell infiltration shadow on the chest X-ray enlarged, and bilateral diffuse patchy shadows was appeared on the chest X-ray . He died of respiratory failure on April 26, 1989 . Cytomegalovirus pneumonia and ATL cell infiltration were revealed by necropsy.

Pediatr Infect Dis J, 1991 Nov, 10(11), 813 - 9
Bacterial infections in human immunodeficiency virus type 1-infected children: the impact of central venous catheters and antiretroviral agents; Roilides E et al.; We conducted a retrospective study to analyze the impact of central venous catheters (CVCs) and antiretroviral therapy on the frequency and the patterns of bacterial infections in children infected with human immunodeficiency virus during a 3-year period . Among 204 bacterial infections other than otitis media reviewed, soft tissue infection (n = 69), bacteremia (n = 57), pneumonia (n = 27) and sinusitis (n = 27) were encountered most frequently . Catheter-related staphylococcal infection was the most common infection in children with CVCs, particularly in those who were less than 6 years old . In children without CVCs, Streptococcus pneumoniae was the most frequent organism . Younger children had more CVC-related infections whereas children with lower CD4 counts had more CVC-related and CVC-unrelated infections . A lower frequency of CVC-unrelated infections was detected in patients who received antiretroviral therapy, especially those receiving a continuous infusion of zidovudine . These data suggest that increased frequency and altered patterns of bacterial infections are associated with the use of CVCs in these patients, but antiretroviral therapy may reduce the frequency of CVC-unrelated infections.

Nucleic Acids Res, 1991 Oct 25, 19(20), 5525 - 31
Uracil-DNA glycosylase affects mismatch repair efficiency in transformation and bisulfite-induced mutagenesis in Streptococcus pneumoniae; Mejean V et al.; The generalized mismatch repair system of Streptococcus pneumoniae (the Hex system) can eliminate base pair mismatches arising in heteroduplex DNA during transformation or by DNA polymerase errors during replication . Mismatch repair is most likely initiated at nicks or gaps . The present work was started to examine the hypothesis that strand discontinuities arising after removal of uracil by uracil DNA-glycosylase (Ung) can be utilised as strand discrimination signals . We show that mismatch repair efficiency is enhanced 3- to 6-fold when using uracil-containing DNA as donor in transformation . In order to assess the contribution of Ung to nascent strand discrimination for postreplication mismatch repair, we developed a positive selection procedure to isolate S . pneumoniae Ung- mutants . We succeeded in isolating Ung- mutants using this procedure based on chromosomal integration of uracil-containing hybrid DNA molecules . Cloning and characterization of the ung gene was achieved . Comparison of spontaneous mutation rates in strains either proficient or deficient in mismatch and/or uracil repair gave no support to the hypothesis that Ung plays a major role in targeting the Hex system to neosynthesized DNA strands . However Ung activity is responsible for the increased efficiency of mismatch repair observed in transformation with uracil-containing DNA . In addition Ung is involved in repair of bisulfite-treated transforming DNA.

J Immunol, 1991 Oct 15, 147(8), 2750 - 5
Repertoire diversity of antibody response to bacterial antigens in aged mice . II . Phosphorylcholine-antibody in young and aged mice differ in both VH/VL gene repertoire and in specificity; Nicoletti C et al.; Aging of mice is accompanied by both quantitative and qualitative changes in antibody responses to phosphorylcholine (PC), an immunodominant epitope of Streptococcus pneumoniae R36a strain (Pn) . In order to study these changes at the molecular level, we generated PC-specific hybridomas from young (3 to 4 mo) and aged (20 to 24 mo) mice of different strains after primary immunization with S . pneumoniae R36a strain . These mAb were tested for Ig VH and VL gene family utilization, idiotopic repertoire, and cross-reactivity with unrelated Ag . Hybridomas from young mice (BALB/c, C57BL/6, and D1.LP) uniformly expressed the VH-S107 and V kappa-22 genes as well as most idiotopes of the T15 family, which were identified with different anti-T15 mAb . In contrast, the PC-reactive mAb from aged mice were quite heterogeneous: only 2 out of 13 utilized VHS107, 1 of 13 used VH7183, and 3 of 13 used VHJ558 gene family . Moreover, none of these mAb used L chain encoded by V kappa 22(0/13), but surprisingly they frequently expressed some of the T15 idiotope . In addition, the PC-binding mAb from aged mice showed broad cross-reactivity with various mouse and foreign proteins, whereas the mAb from young mice did not . These results demonstrate the genetic shift in antibody response of aging mice to PC, which is accompanied by a change in the antibody specificity . Interestingly, the qualitative repertoire change appears to be unrelated to the magnitude of antibody response, for the aged BALB/c mice maintain a very high reactivity to PC.

Biochim Biophys Acta, 1991 Oct 11, 1080(1), 45 - 50
Horseradish peroxidase catalyzed oxidation of thiocyanate by hydrogen peroxide: comparison with lactoperoxidase-catalysed oxidation and role of distal histidine; Modi S et al.; Horseradish peroxidase-catalysed oxidation of thiocyanate by hydrogen peroxide has been studied by 15N-NMR and optical spectroscopy at different concentrations of thiocyanate and hydrogen peroxide and at different pH values . The extent of the oxidation and the identity of the oxidized product of the thiocyanate has been investigated in the SCN-/H2O2/HRP system and compared with the corresponding data on the SCN-/H2O2/LPO system . The NMR studies show that (SCN)2 is the oxidation product of thiocyanate in the SCN-/H2O2/HRP system, and its formation is maximum at pH less than or equal to 4 and that the oxidation does not take place at pH greater than or equal to 6 . Since thiocyanate does not bind to HRP at pH greater than or equal to 6 (Modi et al . (1989) J . Biol . Chem . 264, 19677-19684), the binding of thiocyanate to HRP is considered to be a prerequisite for the oxidation of thiocyanate . It is further observed that at {H2O2}/{SCN-} = 4, (SCN)2 decomposes very slowly back to thiocyanate . The oxidation product of thiocyanate in the SCN-/H2O2/LPO system has been shown to be HOSCN/OSCN- which shows maximum inhibition of uptake by Streptococcus cremoris 972 bacteria when hydrogen peroxide and thiocyanate are present in equimolar amounts (Modi et al . (1991) Biochemistry 30, 118-124) . However, in case of HRP no inhibition of oxygen uptake by this bacteria was observed . Since thiocyanate binds to LPO at the distal histidine while to HRP near 1- and 8-CH3 heme groups, the role of distal histidine in the activity of SCN-/H2O2/(LPO, HRP) systems is indicated.

Curr Opin Obstet Gynecol, 1991 Oct, 3(5), 707 - 14
Obstetric and neonatal infection; Dinsmoor MJ; Recent advances in prevention, diagnosis, and treatment of infection-associated preterm labor are discussed . This includes antepartum treatment of vaginal infections, amniocentesis for culture and glucose levels, and adjunctive antibiotic treatment of preterm labor and preterm premature rupture of the membranes . Risk factors for neonatal group B streptococcus sepsis are described and testing for rapid detection of maternal group B streptococcus colonization is discussed, as are recent prospective studies of pregnancy outcome following human parvovirus B19 infection . Studies quantifying the transmission of herpes simplex virus to neonates following vaginal delivery to mothers with recurrent infections are discussed, as well as the results of several studies using rapid detection kits for the virus.

Ann Rheum Dis, 1991 Oct, 50(10), 724 - 6
Pneumococcal septic arthritis after splenectomy in Felty's syndrome; Brzeski M et al.; A patient with Felty's syndrome who developed bilateral knee septic arthritis and septicaemia due to Streptococcus pneumoniae is described . She had had a previous splenectomy for symptomatic thrombocytopenia, having received pneumococcal vaccine before the operation . Measurement of antibody to the 23 vaccine serotypes showed protective concentrations before infection to just two . The infecting serotype was not represented in the vaccine, but a vigorous antibody response to this serotype occurred . The patient also developed glomerulonephritis due to immune complex deposition.

Arch Dis Child, 1991 Oct, 66(10), 1227 - 30
Retropharyngeal abscess; Coulthard M et al.; Of 31 children with retropharyngeal abscess treated at this hospital between 1954 and 1990, 17 (55%) were 12 months old or less and 10 (32%) less than 6 months . Three of these 10 children were neonates, only one of whom had a predisposing congenital lesion . Fourteen children (45%) had a preceding upper respiratory illness and four (13%) had a prior history of pharyngeal trauma or ingestion of a foreign body . In children less than 1 year old the clinical presentation was usually classical with fever, neck swelling, stridor, and pharyngeal swelling . Significantly fewer children over 1 year had neck swelling and no child over 3 years old had stridor . A lateral radiograph of the neck, when performed, had a sensitivity of 88% in diagnosis . Bacteria isolated included pure growths of Staphylococcus aureus (25%), klebsiella species (13%), group A streptococcus (8%), and a mixture of Gram negative and anaerobic organisms (38%) . There were two deaths . In six cases (24%) the abscess recurred necessitating further surgical drainage.

Am J Obstet Gynecol, 1991 Oct, 165(4 Pt 1), 955 - 61
Microbiologic causes and neonatal outcomes associated with chorioamnion infection; Hillier SL et al.; Chorioamnion infection is associated with histologic chorioamnionitis and prematurity, but the specific chorioamnion microorganisms associated with histologic chorioamnionitis, prematurity, and poor neonatal outcome have not been identified . Bacteria were recovered from the chorioamnion cultures of 32% of 112 placentas delivered at less than or equal to 34 weeks' gestation and from 19% of 156 placentas delivered at greater than 34 weeks' gestation (odds ratio 2.1; 95% confidence interval 1.1 to 3.8) . Chorioamnion bacteria most highly related to both prematurity and histologic chorioamnionitis were group B Streptococcus and Fusobacterium species . Chorioamnion infection with Peptostreptococcus was significantly related only to preterm delivery, and infection with Escherichia coli, Bacteroides, and Ureaplasma were significantly related to histologic chorioamnionitis . Among preterm infants, isolation of bacteria from the chorioamnion was related to an increased risk of neonatal death (rate ratio 3.8; 95% confidence interval 1.4 to 11.6) . Bacterial infection of the chorioamnion is related to preterm birth, histologic chorioamnionitis, and neonatal death.

Am J Obstet Gynecol, 1991 Oct, 165(4 Pt 1), 867 - 75
Adjunctive clindamycin therapy for preterm labor: results of a double-blind, placebo-controlled trial; McGregor JA et al.; A double-blind, placebo-controlled, randomized trial was conducted to evaluate the efficacy, safety, and tolerance of a course of clindamycin (administered for 3 days intravenously and 4 days orally) among hospitalized women with preterm labor at less than or equal to 34 weeks' gestation who were treated with tocolytics . One hundred three woman-perinate pairs were analyzed . Univariate analysis demonstrated that pregnancies were continued longer in women treated with clindamycin than in women who received placebo (clindamycin-treated group, 35 days; placebo-treated group, 25 days; p = 0.02) . Survival analysis showed that pregnancy continued at least 35.5 days in 50% of clindamycin-treated women versus 20 days for control women (p = 0.03) . Obstetric and microbiologic parameters associated with treatment outcomes were also sought . Women with bacterial vaginosis more often delivered preterm (p = 0.03; relative risk, 1.4; 95% confidence interval, 1.04 to 2.0) . Among women with bacterial vaginosis, trends for increased duration of pregnancy (clindamycin-treated group, 36 days; placebo-treated group, 19 days), increased birth weight (clindamycin-treated group, 2634 gm; placebo-treated group, 2256 gm), and increased mean gestational age at delivery (clindamycin-treated group, 35 weeks; placebo-treated group, 34 weeks) were associated with clindamycin treatment . Women with either group B streptococcus, Chlamydia trachomatis, Trichomonas vaginalis, or Staphylococcus aureus were more likely to have preterm premature rupture of membranes (p = 0.01) . Clindamycin treatment of these women reduced the incidence of preterm premature rupture of membranes to that of uninfected subjects . Stratification by gestational age at enrollment showed clindamycin treatment to be associated with an increased interval to delivery only among mothers enrolled before 33 weeks' gestation (clindamycin-treated group, 40 days; placebo-treated group, 28 days; p less than 0.05) . Treatment with clindamycin appeared safe and well tolerated, with benefits limited to women who were less than or equal to 32 weeks' gestation.

Epidemiol Infect, 1991 Oct, 107(2), 297 - 310
Antigenic and genetic homogeneity of Streptococcus uberis strains from the bovine udder; Groschup MH et al.; DNA- fingerprints (Hind III) of Streptococcus uberis field isolates from New York State and Europe showed substantial homogeneity, but were different to those of the type strain of the newly proposed psychrophilic species S . parauberis . S . uberis strains had major SDS-heat extracted antigens of molecular masses (Mr) less than 14, 40-41, 42-43, 59-61, 80-86 and 118-122 kDa following immunoblotting with rabbit hyperimmune sera . Bovine sera and milk reacted with the 40-41 and 118-122 kDa antigens . Variations in the Mr of particular bands were too unevenly distributed to permit formation of subgroups . Although cross reactive, the sizes of the antigens of S . parauberis strain NCDO 2020 were substantially different to those of S . uberis, the most prominent antigen having a Mr of 50 kDa . The antigenic and genetic data therefore strongly support the introduction of S . parauberis as a distinct species . S . uberis strains reacted with antiserum to Lancefield groups B, E, G and P, their grouping reactions showing no correlation with DNA and immunoblot fingerprints . Lancefield grouping of S . uberis therefore appears to have little value in identification.

Am J Pathol, 1991 Oct, 139(4), 921 - 31
Streptococcal cell wall-induced systemic disease . Beneficial effects of trans-bis(5-amidino-2-benzimidazolyl)ethene, a novel, macrophage-directed anti-inflammatory agent; Geratz JD et al.; Previously bis(5-amidino-2-benzimidazolyl)methane (BABIM) was identified as a strong inhibitor of the multisystem inflammatory disease induced in Lewis rats by injection of streptococcus group A cell wall-derived peptidoglycan polysaccharide (PG-APS) . A BABIM derivative, trans-bis(5-amidino-2-benzimidazolyl)ethene (BBE), has attracted attention because of striking qualitative and quantitative differences in its activities when compared with the parent compound . BBE could control destructive tibial osteitis and necrotizing granulomatous splenitis and hepatitis, regardless if given in a preventive or curative mode . The compound had little effect on synovitis, however . BABIM, on the other hand, was active against synovitis and osteitis, but not against splenic granuloma formation . To be effective, it needed to be applied in a preventive mode . BBE caused a characteristic enlargement of PG-APS-laden splenic and hepatic macrophages suggesting that those cells represent targets of the inhibitor . BBE may be a powerful tool for the study of granulomatous lesions.

Eur J Biochem, 1991 Oct 1, 201(1), 147 - 55
The polymerase domain of Streptococcus pneumoniae DNA polymerase I . High expression, purification and characterization; Pons ME et al.; The 3'-terminal two-thirds of the Streptococcus pneumoniae polA gene was cloned in an Escherichia coli genefusion vector with inducible expression . The resulting recombinant plasmid (pSM10) directs the hyperproduction of a polypeptide of 70.6 kDa corresponding to the C-terminal fragment of pneumococcal DNA polymerase I . Induced cells synthesized catalytically active protein to the extent of 7% of the total soluble protein in the cells . The polymerase fragment was purified to greater than 90% homogeneity with a yield of 1.5 mg pure protein/l culture . The protein has DNA polymerase activity, but no exonuclease activity . The enzyme requires a divalent cation (MgCl2 or MnCl2) for polymerization of DNA . Comparison of the mutant and wild-type pneumococcal polymerases shows that the construction did not affect the enzymatic affinity for the various substrates . The mutant protein, like its parent DNA polymerase I, exhibited an intermediate level of activity with primed single-stranded DNA . At high molar ratio of enzyme/DNA substrate, the polymerase fragment catalyzes strand displacement and switching after completing the replication of a primed single-stranded M13 DNA molecule.

Infect Immun, 1991 Oct, 59(10), 3434 - 8
Cloning of a Streptococcus sobrinus gtf gene that encodes a glucosyltransferase which produces a high-molecular-weight water-soluble glucan; Hanada N et al.; The gtf gene coding for glucosyltransferase (GTF), which produces a water-soluble glucan, was cloned from Streptococcus sobrinus OMZ176 (serotype d) into plasmid vector pBR322 . This gene was expressed in Escherichia coli, and the product was purified to near homogeneity . The antigenicity of recombinant GTF (rGTF) was examined with the antisera raised against purified GTF P1, P2, P3, and P4 obtained from S . sobrinus AHT (serotype g) . The rGTF reacted only with anti-GTF P1 serum in a Western blot (immunoblot) analysis . The rGTF closely resembled GTF P1 in its molecular mass, Km value for sucrose, optimal pH, primer dependency, and immunological properties . The high-molecular-weight, water-soluble glucan produced by the rGTF also resembled that of GTF P1, which is the most efficient primer donor for primer-dependent, water-insoluble glucan synthesis . Properties of the rGTF were also compared with those of rGTFS, which was purified from E . coli carrying the gtfS gene isolated from Streptococcus downei (previously S . sobrinus serotype h) MFe28 . Both rGTF and rGTFS synthesized water-soluble glucan from sucrose without primer dextran, but their characteristics in Km values for sucrose, optimal pHs, and polymer sizes of the glucan were different . Furthermore, the gtf gene did not hybridize with the gtfS gene in a Southern blot analysis . These results showed that rGTF is similar to S . sobrinus AHT GTF P1 but distinct from rGTFS that has been previously purified from E . coli carrying the gtfS gene.

Oral Microbiol Immunol, 1991 Oct, 6(5), 313 - 5
Chain formation and de-chaining in Streptococcus sobrinus SL-1; Thibodeau EA et al.; Regulation of chain length by chain-forming bacteria is believed to depend on wall-associated autolytic activity and environmental conditions . In this study, the chain length of Streptococcus sobrinus SL-1 was determined under various initial culture and pH conditions and NaF concentrations . Crude wall extracts were prepared by dilute alkali treatment of whole cells and were tested for de-chaining activity . The results indicate that S . sobrinus SL-1 grows primarily as short chains under alkaline growth conditions and at high (3.0 mM) medium fluoride levels, and growth as long chains occurs under acidic growth conditions . De-chaining activity was observed following incubation of the longer chain form of the organism with crude wall extracts . The evidence suggests that the chain length of S . sobrinus SL-1 depends on environmental conditions, including pH and fluoride, and that cell wall-associated factors may be active in regulating the chain length of the organism.

Oral Microbiol Immunol, 1991 Oct, 6(5), 299 - 304
Metabolism of intracellular polysaccharide in the cells of Streptococcus mutans under strictly anaerobic conditions; Takahashi N et al.; Streptococcus mutans, which had accumulated glycogen-like iodophilic intracellular polysaccharide (IPS), produced large amounts of formate, acetate and ethanol from the IPS by pyruvate formate-lyase (PFL) under strictly anaerobic conditions without exogenous sugar . Under aerobic conditions, the same S . mutans produced exclusively lactate and pyruvate from the IPS because of the inactivation of PFL by oxygen . The total amount of acid produced under anaerobic conditions was larger than that under aerobic conditions . The analysis of intracellular glycolytic intermediates revealed that levels of fructose 1,6-bisphosphate (lactate dehydrogenase (LDH) activator) and glyceraldehyde 3-phosphate and dihydroxyacetone phosphate (PFL inhibitors) were low when IPS was used as a glycolytic substrate, implying that PFL functions more efficiently than LDH in IPS metabolism . These findings suggest that the PFL pathway contributes to the acid production from IPS, and may explain partially why the acids in starved dental plaque are mainly acetate and formate.

Oral Microbiol Immunol, 1991 Oct, 6(5), 295 - 8
Carbohydrate antigen of serotype g "Streptococcus milleri": immunochemical characterization; Inoue M et al.; Cell wall carbohydrate antigen of the serotype g "Streptococcus milleri" was extracted with cold trichloroacetic acid from purified cell walls of the type strain K1K . The extracts were then purified by a DEAE-Sephadex A-25 column, followed by a Sephadex G-100 column . The immunoelectrophoresis revealed that the serotype g carbohydrate antigen preparation displayed a single precipitin band against the crude anti-K1K serum . The purified type g antigen consisted of rhamnose, galactose, glucose and galactosamine in a ratio of 1.3:3.8:1.0:2.5 . The quantitative precipitin inhibition test with various haptens indicated that galactosamine is a major immunodeterminant of the type g-specific antigen.

Oral Microbiol Immunol, 1991 Oct, 6(5), 288 - 91
Acidogenesis in relation to fluoride resistance of Streptococcus mutans; Van Loveren C et al.; The velocity of acid production (Vap) of Streptococcus mutans C180-2 and of 2 fluoride-resistant mutant strains S . mutans C180-2FR and S . mutans C180-2MFR was examined in vitro at pH values between 7.0 and 4.5 . The Vap of the fluoride-resistant mutants was lower than the Vap of the parent strain at pH greater than or equal to 6.0 . At pH 5.5 and 5.0, the Vap of the mutant strains was higher than the Vap of the parent strain, whereas at pH 4.5 no significant differences were observed between the Vap of the 3 strains . The fluoride sensitivity of all 3 strains was amplified by a low pH environment . The fluoride concentration necessary to inhibit the acid production of the parent strain completely was 27 mM at pH 7 and 0.1 mM at pH 4.5 . For the 2 mutants, the corresponding concentrations were 65 mM at pH 7 and 0.5-0.7 mM at pH 4.5 . The results suggest that, if S . mutans acquires fluoride resistance in vivo, the rate of acid production in dental plaque may be decreased at pH greater than or equal to 6, but increased at lower pH levels . Low concentrations of fluoride inhibit acid production less effectively.

Enferm Infecc Microbiol Clin, 1991 Oct, 9(8), 495 - 7
{Resistance of Streptococcus pneumoniae in Galicia}; Perez del Molino ML et al.; We studied the antibiotic sensitivity of 130 Streptococcus pneumonia strains isolated from respiratory samples (96 cases), blood (13 cases), CSF (6 cases), ocular secretions (5 cases) and other origins (10 cases) . High-level penicillin-resistance was found in 13.08% of strains, and intermediate-level penicillin resistance was also found in 22.3% of strains . A multiple-antibiotic resistance pattern was shown by 80.44% of all penicillin-resistant strains . Resistance rates found against antibiotics were as follows: tetracycline, 41.53%; chloramphenicol 17.69%; cotrimoxazole, 16.92% and erythromycin 6.92% . All isolated strains were sensitive to rifampin and vancomycin.

Acta Paediatr Jpn, 1991 Oct, 33(5), 613 - 6
Forty year review of bacterial endocarditis in infants and children; Saitoh M et al.; From 1950 through 1989 at Tokyo University's Department of Pediatrics, 25 children were treated for bacterial endocarditis . Twenty-two of these patients had previously been diagnosed as suffering from congenital heart disease . Twenty one of the 25 patients had positive blood cultures . Streptococcus viridans was the most common organism isolated, although the incidence of Streptococcus viridans infection has decreased in the last 20 years . In present series only a few post-surgical cases with congenital heart disease occurred . There were three deaths which all occurred prior to 1965.

Mikrobiyol Bul, 1991 Oct, 25(4), 373 - 80
{The use of plasmid profiles for the identification of Streptococcus lactis strains}; Akcelik M; In this study, the plasmid contents of Streptococcus lactis strains, isolated from whey of white pickled cheese samples which produced using without industrial starter culture, were searched . It is determined that strains containing plasmids at a range of 1-10 with the molecular weight between 1.8 and 41 kilobases (Kb) . Six of totally 28 Streptococcus lactis strains were classified into three groups according to their identical plasmid contents, and the others were identified as different strains.

Kansenshogaku Zasshi, 1991 Oct, 65(10), 1369 - 73
{A case of remarkable effect of clindamycin in nasal septum abscess caused by Streptococcus milleri}; Yamamura K et al.; We encountered a 14-year-old male patient with a destructive abscess of nasal septum, caused by Streptococcus milleri . He was successfully treated with Clindamycin in combination with surgical intervention . We emphasized the significance of Streptococcus milleri as a causative agent for abscess formation, and clindamycin should be considered as a first choice of antibiotics against Streptococcus milleri infection.

Can J Vet Res, 1991 Oct, 55(4), 325 - 31
Evaluation of a guarded bronchoscopic method for microbial sampling of the lower airways in foals; Hoffman AM et al.; A novel method to reduce contamination of the bronchoscope during microbial sampling of the lower airways of foals was evaluated . Methylene blue (MB) was used as a nasopharyngeal dye marker to assess the relative contamination from the upper airways of bronchoalveolar lavage (BAL) specimens obtained by standard bronchoscopy (SB) and a "guarded" bronchoscopic method (GB) . For GB, a clear sterile cellulose sheath was fitted over the bronchoscope in an effort to protect the endoscope tip and channel from contamination . Methylene blue was detected visually in seven of eight BAL samples from foals following SB, but in none of the samples recovered by GB (p less than 0.001) . Significantly less MB was detected in BAL by spectrophotometry in the GB group as well (p less than 0.02) . The GB was next employed to study the microbial flora in the lower airways of healthy weaned foals (n = 30) . Bacteria were isolated from 29 of 30 (97%) BAL samples, and in moderate or large numbers from 26 of 30 (87%) of the foals . Potential pathogens, including Bordetella bronchiseptica, Streptococcus zooepidemicus, Staphylococcus aureus, Mycoplasma felis and Streptococcus pneumoniae, were cultured from the lower airways of foals . In conclusion, the bronchoscope and bronchoalveolar lavage specimens were readily contaminated by a dye marker placed in the nasopharynx of foals, and the degree of contamination was significantly reduced by sheathing the endoscope . This contamination during bronchoscopy may obscure the interpretation of isolates from BAL specimens from foals, which may possess a bacterial flora in the lower airways without cytological evidence of inflammation.

Med Vet Entomol, 1991 Oct, 5(4), 421 - 9
Studies on the possible role of cattle nuisance flies, especially Hydrotaea irritans, in the transmission of summer mastitis in Denmark; Madsen M et al.; The summer mastitis pathogens Actinomyces pyogenes, Peptococcus indolicus, Bacteroides melaninogenicus ss . levii, Fusobacterium necrophorum and Streptococcus dysgalactiae were isolated from the polyphagous symbovine dipterans Hydrotaea irritans (Fallen) and Morellia sp . caught around dairy heifers on pasture, but not from the haematophagous species Haematobia irritans (L.), Haematobosca stimulans (Meigen), Culicoides sp . and Simulium sp . Secretions from clinical cases of summer mastitis proved to be sources of summer mastitis bacteria for more than 3 weeks despite antibiotic treatment and teat amputation . Taking into account the seasonal activity pattern of Hydrotaea irritans and its topographical distribution on grazing cattle, it appears evident that this fly may play a central role in the establishment and maintenance of the bacterial contamination with summer mastitis pathogens on the teats of healthy cattle . In the present study the survival of A.pyogenes and P.indolicus for 7 days in experimentally infected Hydrotaea irritans, as demonstrated by the recovery of these microorganisms from agar plates exposed to live infected flies, is described . However, experimental transmission of summer mastitis from sick to healthy heifers by Hydrotaea irritans proved unsuccessful.

Scand J Dent Res, 1991 Oct, 99(5), 390 - 6
Combined inhibitory effect of lactoferrin and lactoperoxidase system on the viability of Streptococcus mutans, serotype c; Soukka T et al.; We have studied the effects of iron-free lactoferrin (apo LF) and lactoperoxidase system (lactoperoxidase, LP/SCN-/H2O2), separately and together, on the viability of Streptococcus mutans (serotype c) in vitro . The bacteria were incubated in buffered KCl (pH 5.5) with and without the above components which were used at concentrations normally present in human saliva . Both apo LF and LP-system had a bactericidal effect against S . mutans at low pH . Together they showed an additive, but not a synergistic, antibacterial effect against S . mutans . Apo LF enhanced the LP enzyme activity but decreased the yield of the antimicrobial component, hypothiocyanite (HOSCN/OSCN-), when incorporated into the reaction mixtures . This decrease, which was most pronounced at low pH, was due to an LP-independent reaction between apo LF and HOSCN/OSCN- . Our study indicates that the LP-system and apo LF can be combined to combat oral S . mutans.

Appl Environ Microbiol, 1991 Oct, 57(10), 3037 - 9
Phenotypic characterization of CO2-requiring strains of Streptococcus bovis from koalas; Osawa R et al.; We examined phenotypic characteristics of six mannitol-fermenting strains of Streptococcus bovis, including two unusual CO2-requiring strains isolated from koala feces . These strains did not grow in air, but grew in air supplemented with CO2 and under reduced oxygen conditions . All six strains had the same biochemical characteristics, except that the CO2-requiring strains did not produce beta-N-acetylglucosaminidase.

Appl Environ Microbiol, 1991 Oct, 57(10), 3000 - 5
Selection and application of Streptococcus bovis as a silage inoculant; Jones BA et al.; Three strains of Streptococcus bovis, a homolactic bacterium capable of utilizing starch, were evaluated for growth kinetics and ability to decrease the pH of alfalfa silage . A selected strain was evaluated for its competitiveness as an inoculant with Enterococcus faecium, an organism used in inoculants, and for its ability to enhance the effect of a commercial inoculant . Testing was completed over three studies using wilted alfalfa (28 to 34% dry matter) ensiled into laboratory silos . Treatments were control, E . faecium, E . faecium and commercial inoculant, S . bovis, and S . bovis and commercial inoculant . Replicate silos were emptied and analyzed at 0.5, 1, 2, 4, 8, and 40 days for pH, fermentation products, and nitrogen fractions . S . bovis alone lowered the pH quicker and improved silage parameters early in the fermentation compared with E . faecium, the commercial inoculant, and control treatments . When combined with a commercial inoculant, S . bovis lowered pH more quickly than the commercial inoculant alone and E . faecium plus commercial inoculant . At 40 days, S . bovis combination had lower pH and ammonia nitrogen and acetate contents than the E . faecium combination . Starch in the silage was not utilized by S . bovis as had been anticipated . Results indicate that S . bovis was more effective than E . faecium as a silage inoculant and could enhance a commercial inoculant on low-dry-matter alfalfa.

Kokyu To Junkan, 1991 Oct, 39(10), 1049 - 53
{A case of ventricular septal defect associated with active infective endocarditis which was successfully treated by triple valve replacement and ventricular septal defect patch closure}; Ohyama Y et al.; A 47-year-old man was hospitalized in May, 1990, because of breathlessness and continuous fever which appeared about 4 weeks after he had had his periodontic tooth removed in December, 1989 . He had been diagnosed as having ventricular septal defect (VSD) at the age of 6 years . When he was hospitalized, he was in a condition of class IV by NYHA classification, with a white blood cell count of 17,300/mm3, an increase in CRP, a red blood cell sedimentation rate of 108 mm/hr, and positive alpha-streptococcus in blood culture . His cardiothoracic ratio was 64% with signs of pulmonary congestion on a chest X-ray film . Echocardiography revealed the presence of VSD and huge vegetations on the tricuspid, mitral and aortic valves . He was considered to have active infective endocarditis (AIE) which had presumably been provoked by VSD and the tooth removal . Penicillin G at a daily dose of 20 million units and gentamicin at a daily dose of 80 mg were intravenously administered to treat the alpha-streptococcus infection for about 4 weeks . Furosemide was used for congestive heart failure . Since, although his cardiac function appeared to have been improved, the signs and symptoms of the infection persisted, triple valve replacement for the tricuspid, mitral and aortic valves and patch closure of the VSD were performed 4 weeks after the hospitalization . The operation revealed inflammatory lesions extending from the endocardium of the right ventricle to the mitral valves through the VSD, and huge vegetations on the tricuspid, mitral and aortic valves . The operation was successful and the inflammatory areas gradually disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)

Clin Otolaryngol, 1991 Oct, 16(5), 498 - 500
Treatment of recurrent acute tonsillitis with clindamycin . An alternative to tonsillectomy?
Jensen JH, Larsen SB.
The failure of treatment with penicillin in patients suffering from acute beta-haemolytic streptococcus Group A tonsillitis, may be due to the presence of beta-lactamase-producing bacteria . Several studies indicate that treatment with clindamycin may prevent recurrence and thereby eliminate the need for tonsillectomy . In this prospective study, 54 patients with recurrent acute tonsillitis were investigated . 29 patients were treated with clindamycin, 150 mg 4 times daily for 10 days, while 25 patients received no antibiotic treatment and served as a control group . A significantly reduced number of episodes of acute tonsillitis (P less than 0.01) and of tonsillectomy (P less than 0.001) was found in the group of patients treated with clindamycin.

Int J Syst Bacteriol, 1991 Oct, 41(4), 543 - 7
Streptococcus crista sp . nov., a viridans streptococcus with tufted fibrils, isolated from the human oral cavity and throat; Handley P et al.; We studied strains of an unusual streptococcus that superficially resembles Streptococcus sanguis but has fibrils that are arranged in lateral tufts . These strains were originally isolated from human throats and oral cavities and have been referred to previously as "Streptococcus sanguis I," the "CR group," and the "tufted-fibril group." Until now, insufficient phenotypic data have been available to allow reliable differentiation of these strains from other viridans streptococcal species, particularly the species in the S . sanguis group . Recently, workers have proposed a scheme of phenetic tests that is based on 4-methylumbelliferyl-linked substrates and conventional biochemical tests and allows the tufted-fibril group to be differentiated; these organisms differ from other viridans species in being able to hydrolyze arginine but not esculin and in producing alpha-L-fucosidase but not beta-glucosidase or alkaline phosphatase . These data, together with the results of our DNA-DNA hybridization experiments and the unusual ultrastructure of the tufted-fibril strains as determined by electron microscopy, demonstrate that these organisms represent a new species, for which the name Streptococcus crista is proposed . The DNA base composition is 42.6 to 43.2 mol% G + C . The type strain is strain CR311 (= NCTC 12479).

Int J Syst Bacteriol, 1991 Oct, 41(4), 487 - 94
Intrageneric structure of Streptococcus based on comparative analysis of small-subunit rRNA sequences; Bentley RW et al.; The partial 16S rRNA sequences of 24 Streptococcus species were determined by reverse transcription . A comparative analysis of these sequences and the sequences of seven previously studied streptococcal species revealed the presence of several clusters within the genus . The clusters obtained from the sequence analysis agreed in general with the groups outlined on the basis of the results of nucleic acid hybridization studies, but there were some exceptions . The pyogenic group was extended to include Streptococcus agalactiae, S . parauberis, S . porcinus, and S . uberis . Four oral groups were discerned; these four groups centered on S . mutans, S . salivarius, S . anginosus, and S . oralis . Some species (e.g., S . suis and S . acidominimus) did not cluster with any particular group . Our findings are discussed in the context of data from other genetic and chemotaxonomic studies.

Infect Immun, 1991 Oct, 59(10), 3523 - 30
Sucrose-promoted accumulation of growing glucosyltransferase variants of Streptococcus gordonii on hydroxyapatite surfaces; Vickerman MM et al.; Streptococcus gordonii exhibits a phase variation involving expression of high (Spp+) or low (Spp-) glucosyltransferase activity . The related bacterial accumulation on hydroxyapatite (HA) and saliva-coated HA surfaces was examined and found to be significant . Spp+ cells growing anaerobically in a defined medium utilize about 30% of the glucose available from sucrose to make insoluble glucans . These glucans formed cohesive masses on HA beads, which contained 80 to 90% of the total bacteria . The bacterial polymer mass had a volume of about 40 microns3 and contained more than 5 x 10(10) viable cells per cm3 . In the absence of sucrose, the beads were saturated by 1 x 10(8) to 2 x 10(8) Spp+ cells . Spp- bacteria, which make 30-fold less glucan than do Spp+ bacteria, did not accumulate on surfaces in numbers significantly above the saturation level of 1 x 10(8) to 2 x 10(8) cells in the presence or absence of sucrose . Insoluble glucan synthesized by Spp+ cells from sucrose also enabled these bacteria to accumulate on saliva-coated HA seven times more effectively than the Spp- cells and 10 times more effectively than the Spp+ cells grown in medium without sucrose.

Eur J Clin Microbiol Infect Dis, 1991 Oct, 10(10), 821 - 7
The activity of azithromycin in animal models of infection; Pechere JC; High and prolonged tissue levels accompanied by low serum concentrations are a feature of azithromycin, an azalide antibiotic . It has a broad spectrum of activity against gram-positive and gram-negative microorganisms and several intracellular pathogens . A number of animal models of localised infection have been developed which demonstrate that the efficacy of azithromycin correlates with its extravascular pharmacokinetics and not with blood levels . In many instances, because of high tissue bioavailability, azithromycin has better in vivo efficacy than comparative agents, despite a similar or higher minimum inhibitory concentration . Additionally, the extravascular kinetics of azithromycin are associated with bactericidal activity against pathogens such as Staphylococcus aureus, Streptococcus pneumoniae and Escherichia coli . Intracellular pathogens are susceptible to azithromycin and it is believed that the agent penetrates and remains within host cells infected by organisms including Mycobacterium avium, Legionella pneumophila and Borrelia burgdorferi . This paper reviews the in vivo efficacy of azithromycin and standard agents in animal models of infection, especially those involving intracellular pathogens.

Carbohydr Res, 1991 Sep 30, 218, 201 - 9
Structural studies of amyloglucan and a soluble glucan produced from starch by Streptococcus sanguis 1 MC 204; Coogan MM et al.; Two alpha-D-glucans, produced from amylopectin by an oral isolate Streptococcus sanguis 1 MC 204, were shown to contain both (1----4) and (1----6) linkages . The first alpha-D-glucan (amyloglucan) was adherent and highly insoluble, and methylation analysis, i.r . spectroscopy, and enzymic analyses showed it to be similar to amylopectin but less branched with longer interior and exterior chains . The second polymer was a non-adherent soluble alpha-D-glucan that was similar to amyloglucan but with long exterior chains . These alpha-D-glucans were not synthesised de novo, but were the products of the modification of amylopectin.

Carbohydr Res, 1991 Sep 30, 218, 175 - 84
Location and quantitation of the sites of O-acetylation on the capsular polysaccharide from Streptococcus pneumoniae type 9V by 1H-n.m.r . spectroscopy: comparison with type 9A; Rutherford TJ et al.; The 1H-n.m.r . spectra of the Streptococcus pneumoniae type 9V (S68 in American nomenclature) capsular polysaccharide (PS) and its O-deacetylated derivative {which is structurally identical to the S . pneumoniae type 9A (S33) PS} were assigned using COSY, relayed-COSY, and 2D-NOESY experiments . The positions of the OAc groups in the alpha-GlcA, beta-ManNAc, and alpha-Glc residues of the native 9V PS were established using 2D-n.m.r . and chemical shift arguments, and the relative proportions of different O-acetylated species were estimated by integration of well-resolved 1H-n.m.r . signals . The locations of the OAc substituents differ from those previously reported . {formula: see text}.

N Z Med J, 1991 Sep 25, 104(920), 401 - 3
Evaluation of a rapid diagnostic test for group A beta-haemolytic streptococcus in general practice; Carey RD et al.; OBJECTIVE: to assess the efficacy of Abbott Testpack Strep A compared with throat culture for the diagnosis of group A beta-haemolytic streptococcus in general practice . METHODS: one hundred and fifty-four specimens were obtained from general practices in selected regions, and were tested for group A beta-haemolytic streptococcus using both Abbott Testpack Strep A and throat culture . RESULTS: sensitivity of the rapid diagnostic test was 79.4%, specificity 93.3% . The negative predictive value of the test was 94.1%; the positive predictive value 77.1% . CONCLUSION: maximum cost effectiveness is achieved, with respect to short term costs and benefits, by diagnosing and treating solely on the basis of Abbott Testpack Strep A results . When possible complications are taken into consideration, initial testing by Abbott Testpack Strep A, followed by confirmatory laboratory testing of negative Testpack results becomes a feasible alternative.

Carbohydr Res, 1991 Sep 18, 217, 171 - 80
The structure of the capsular polysaccharide from Streptococcus pneumoniae type 7B; Jansson PE et al.; The capsular polysaccharide elaborated by Streptococcus pneumoniae type 7B is composed of the following heptasaccharide repeating-units . {formula: see text} The identities and modes of linkage of the constituents were established using sugar, methylation, and phosphorus analysis, together with 1D- and 2D-n.m.r . spectroscopy . The sequence was established from inter-residue n.O.e . data . The structure was corroborated by n.m.r . spectroscopy, f.a.b.-m.s., and methylation analysis of the oligosaccharides isolated after partial acid hydrolysis of the polysaccharide with aqueous 48% hydrogen fluoride . It is suggested that the structural basis for the common antigenic formula in the group 7 serotypes of S . pneumoniae is the disaccharide element alpha-D-GlcpNAc-(1----2)-alpha-L-Rhap-(1----.

Am J Med, 1991 Sep 16, 91(3B), 329S - 333S
Recurrent group A streptococcal carriage in a health care worker associated with widely separated nosocomial outbreaks; Viglionese A et al.; Nine postpartum infections (five bacteremias, three cases of endometritis without bacteremia, and one infected episiotomy site) caused by an M-nontypable, T-28 strain of group A Streptococcus occurred during a 9-week period in 1987 . Seven cases were cared for by one obstetrician, who was also present in the delivery suite when the remaining patients delivered . This individual was found to be an anal carrier of group A Streptococcus with the same M and T types . During the cluster, the attack rate for vaginal deliveries performed by this individual was 18% (6 of 34 patients) . The individual was treated with penicillin V (500 mg four times a day for 10 days), rifampin (600 mg twice a day for 5 days), and hexachlorophene showers . Surveillance cultures of the physician were negative 1 week, 1 month, and 3 months after completion of therapy . No additional cases were identified among the next 210 vaginal deliveries performed by this individual . Fourteen months after therapy, four new cases occurred during 2 days . The physician was found to be heavily colonized once again with the original strain of group A Streptococcus and was treated with rifampin (600 mg twice a day) and oral vancomycin (250 mg four times a day) for 7 days . An open-ended regimen of penicillin V (250 mg/day) and periodic surveillance cultures was begun . During the next 19 months, this physician performed 275 vaginal deliveries, one of which resulted in an M-nontypable, T-28 group A streptococcal infection, at a time when the physician's surveillance cultures were negative . It is unclear how long a colonized health care worker who causes nosocomial group A streptococcal disease must be treated or monitored, but there is some risk after more than a year . Long-term surveillance or prophylaxis may be useful in some circumstances.

FEMS Microbiol Lett, 1991 Sep 15, 67(1), 69 - 71
The extension of alpha-D-1,3-branch linkages by 1,3-alpha-D-glucan synthase from Streptococcus sobrinus; Takehara T et al.; In the presence of an acceptor, 1,3-alpha-D-glucan synthase of Streptococcus sobrinus synthesizes water-insoluble glucans from sucrose . Under such conditions, 1,3-alpha-D-glucoside linkages were extended without any change in the glucose-residue number between the 1,3,6-branch points on the acceptor . From these results, the mechanisms of water-insoluble-glucan formation were proposed as follows: (i) the attachment of an acceptor to the glucan binding sites of 1,3-alpha-D-glucan synthase occurs during the initiation of the reaction, and concurrently determines the positions of the branched portions of 1,3,6 on the acceptor, and (ii) the 1,3-alpha-D-glucoside linkage extends from these positions.

Am J Med, 1991 Sep 12, 91(3A), 36S - 39S
Azithromycin compared with cephalexin in the treatment of skin and skin structure infections; Mallory SB; This randomized, third-party-blinded study compared short-course therapy of once-daily azithromycin (500 mg on day 1, followed by 250 mg/day on days 2-5) with cephalexin (500 mg twice daily for 10 days) in the treatment of patients with skin and skin structure infections . At 25 centers, a total of 361 patients were entered into the study and 148 were evaluable for efficacy . The main causative pathogens, Staphylococcus aureus and Streptococcus pyogenes, were responsible for approximately two thirds of the infections in the two treatment groups . Clinical cure and improvement rates for the two treatments were comparable; 99% with azithromycin and 96% with cephalexin . On completion of therapy, both treatments had eradicated approximately 98% of pathogens . In general, both agents were well-tolerated . The results of this study show that a 5-day course of once-daily treatment with azithromycin is as effective as a 10-day course of twice-daily treatment with cephalexin in the management of skin and skin structure infections.

Rev Infect Dis, 1991 Sep-Oct, 13(5), 997 - 8
Tricuspid valve group B streptococcal endocarditis following elective abortion; Vartian CV et al.; Streptococcus agalactiae, a group B streptococcus, has been a well-known cause of postpartum and postabortion endocarditis since the preantibiotic era . Streptococcus agalactiae is capable of infecting normal valves and usually produces left-sided disease . We describe a 30-year-old woman who developed tricuspid valve endocarditis due to S . agalactiae . Excision of the valve and a 4-week course of therapy with vancomycin resulted in cure.

Rev Infect Dis, 1991 Sep-Oct, 13(5), 896 - 7
Postmenopausal pneumococcal tubo-ovarian abscess; Rahav G et al.; Streptococcus pneumoniae is an uncommon cause of infection in the female genital tract . An unusual case of postmenopausal pneumococcal tubo-ovarian abscess is presented . The pathogenesis of this infection probably entailed the ascent of bacteria from the vagina to the internal genitalia; there was no evidence of infection of the bloodstream or gastrointestinal tract.

J Forensic Sci, 1991 Sep, 36(5), 1485 - 91
Sudden death due to streptococcal infection; Hartsough AB et al.; Sudden unexpected deaths form a large population of medical examiner caseloads . Presented are the clinical, pathologic, and virulence features of sudden death due to Group A beta-hemolytic streptococcus . Emphasis is placed on the importance of post-mortem cultures . Case histories are included to illustrate the sometimes unusual presentation of this disease . Recent publicity has led to a heightened public awareness of this unusually virulent entity.

Infect Dis Clin North Am, 1991 Sep, 5(3), 509 - 21
Pneumococcal pneumonia including diagnosis and therapy of infection caused by penicillin-resistant strains; Musher DM; Attempts to rank causative agents of pneumonia in adults have placed Streptococcus pneumoniae at the top of the list . Until 10 years ago, virtually all pneumococci isolated in the United States were susceptible to less than or equal to 0.02 micrograms/mL penicillin; however, the incidence of disease caused by moderately penicillin-resistant strains has increased in the United States in the past decade . This article reviews the role of S . pneumoniae in causing pneumonia, the best methods to make the diagnosis, and the appropriate means of treatment.

Infect Dis Clin North Am, 1991 Sep, 5(3), 453 - 66
Anaerobic disease of the lung; Hill MK et al.; Anaerobic pleuropulmonary infections present in various ways . Aspiration pneumonitis occurs first and may be quite difficult to distinguish from the acute bacterial pneumonia caused by Streptococcus pneumoniae and other organisms . Although aspiration pneumonitis may be self-limiting, sequelae such as lung abscess, necrotizing pneumonia, and empyema can develop . Empiric antimicrobial therapy is now acceptable . The initial choice of antimicrobial agents is based on which pathogens are likely to be involved.

Dtsch Tierarztl Wochenschr, 1991 Sep, 98(9), 330 - 4
The influence of colostral leukocytes on the immune system of the neonatal calf . III . Effects on phagocytosis; Riedel-Caspari G et al.; The influence of colostral leukocytes on the activity of phagocytic cells from the blood of calves, in particular the concentration of neutrophils (PMN) in blood, ingestion of Streptococcus agalactiae, reduction of NBT-dye and activity of lysozyme, was investigated for four weeks using four groups . The calves received either complete colostrum (COL+, n = 16), cell depleted colostrum (COL-, n = 16), cell-supplemented milk-substitute (MS+, n = 7) or pure milk-substitute (MS-, n = 6) . Calves of the COL+ group had a significantly lower PMN concentration in their blood on day 2 and a significantly higher activity of lysozyme during their first three weeks of life as compared to the COL- animals . A postnatal increase in number of ingested Streptococcus agalactiae test bacteria per 100 phagocytic cells occurred later in the COL+ calves than in the COL- . No difference between both COL groups in NBT-reduction was observed . The calves of the MS+ group showed higher lysozyme activity and a retarded increase in the ingestion of test bacteria during the first week of life as compared to the MS- . The MS+ group had a transient neutrophilia on the second day of life while the concentration of PMN was not altered in the MS- from the first to the second day.

Antimicrob Agents Chemother, 1991 Sep, 35(9), 1834 - 9
Pharmacodynamic effects of subinhibitory concentrations of beta-lactam antibiotics in vitro; Odenholt-Tornqvist I et al.; The pharmacodynamic effects of subinhibitory concentrations of different beta-lactam antibiotics were investigated . A postantibiotic effect (PAE) was induced for different bacterial species by exposure to 10x MIC of several beta-lactam antibiotics for 2 h in vitro . The antibiotic-bacterial combinations used in this study were imipenem-Pseudomonas aeruginosa, benzylpenicillin-Streptococcus pneumoniae and -Streptococcus pyogenes, cefcanel-S . pyogenes, ampicillin-Escherichia coli, and piperacillin-E . coli . After the induction of the PAE, the exposed cultures as well as the unexposed controls were washed and diluted . Thereafter, the cultures in the postantibiotic phase (PA phase) and the cultures not previously treated with antibiotics were exposed to 0.1, 0.2, and 0.3x MIC of the relevant drug and the growth curves were compared . When bacteria in the PA phase were exposed to sub-MICs, a substantial prolongation of the time before regrowth was demonstrated, especially in antibiotic-bacterial combinations for which a PAE was found . In contrast, sub-MICs on cultures not previously exposed to suprainhibitory antibiotic concentrations yielded only a slight reduction in growth rate compared with the controls . Thus, it seems important to distinguish the direct effects of sub-MICs on bacteria not previously exposed to suprainhibitory concentrations from the effects of sub-MICs on bacteria in the PA phase.

Wis Med J, 1991 Sep, 90(9), 525 - 9
Severe illness associated with group A-hemolytic streptococcal infections; Butler JC et al.; The Wisconsin Division of Health (DOH) began surveillance for severe illnesses associated with group A beta-hemolytic streptococcus (GABS) infections in late 1989 to describe the current epidemiologic features and clinical spectrum of these infections in the state . Severe illness was defined by the isolation of GABS from the blood or by the development of one or more of the following in a patient infected with GABS: shock, extensive tissue injury, desquamating rash, disseminated intravascular coagulation, renal failure, adult respiratory distress syndrome, or death . Case reports involving 28 patients with severe GABS-related illnesses with onset from November 1989 through October 1990 were received by the DOH . The majority of the case-patients had sepsis (57%), cellulitis (50%) or both . Nine (32%) cases were fatal . Those who died were older than those who survived (median age 74 years v 43 years, p = 0.002) and were more likely to have clinical diagnoses that included pneumonia (relative risk {RR} 3.0, 95% confidence interval {CI} 1.2, 7.3) or necrotizing fasciitis/myositis (RR 3.7, 95% CI 1.5, 9.0) . The median interval from illness onset to hospitalization was similar for fatal cases (1 day) and non-fatal cases (2 days), suggesting that early intervention after the appearance of clinical illness may not improve the outcome.

Cornea, 1991 Sep, 10(5), 381 - 6
Donor cornea bacterial contamination; Farrell PL et al.; The incidence of culture-positive cornea rims from 446 consecutive donor corneas cultured at the Doheny Eye Institute between 1986 and 1988 was determined . Both the identity and antibiotic sensitivities of the contaminating organisms were reviewed . Sixty-three (14.1%) of 446 cornea rims were culture-positive, but none of the 63 patients who received these contaminated donor corneas developed endophthalmitis . Streptococcus (26 of 63), Propionibacterium (15 of 63), Stphylococcus (14 of 63) species and diptheroids (8 of 63) were the most common cornea rim contaminants, and in most cases were resistant to gentamicin (i.e., 21 of 26 or 81%, 9 of 15 or 60%, 10 of 14 or 71%, 4 of 8 or 50%, respectively) . Virtually all of the gentamicin-resistant bacteria isolated from cornea rims were found to be sensitive to vancomycin . Eye banks should consider the addition of other antibiotics to storage media to reduce donor cornea contamination . Surgeons performing corneal transplantation should also consider these results when selecting antibiotics for use at the time of surgery and in the postoperative period.

J Dent Res, 1991 Sep, 70(9), 1235 - 8
Effects of salivary bicarbonate content and film velocity on pH changes in an artificial plaque containing Streptococcus oralis, after exposure to sucrose; Macpherson LM et al.; Chewing-gum stimulation of salivary flow (at the time of the pH minimum following exposure of plaque to carbohydrate) has been shown to cause a rapid increase in plaque pH . The objective of this study was to determine whether the rise in plaque pH is primarily due to the increased buffering capacity of stimulated saliva, or to the fact that an increased flow rate increases the concentration gradient for acid to diffuse from the plaque into the overlying salivary film, which will be moving at a higher velocity . This was investigated with an in vitro technique in which artificial plaque (0.5 or 1.5 mm deep) containing S . oralis cells was exposed to 10% sucrose for one min . The pH values at the proximal and distal undersurfaces of the plaque were then monitored during the passage of a 0.1-mm-thick film of a sucrose-free artificial saliva over the surface, at a range of film velocities (0.8-8 mm/min) that have been estimated to occur in vivo . When a minimum plaque pH had been achieved, the salivary film velocity was either (a) kept the same, with or without 15 mmol/L HCO3 (the concentration measured in chewing-gum-stimulated saliva), (b) increased to 86.2 mm/min, or (c) increased to 86.2 mm/min with 15 mmol/L HCO3 added to the artificial saliva . The findings suggest that after sucrose ingestion, the rapid rise from minimum plaque pH values, which can occur with gum-chewing stimulation of salivary flow, is due to the combined effects of the increase in salivary film velocity, and of a greater availability of bicarbonate.(ABSTRACT TRUNCATED AT 250 WORDS)

J Dent Res, 1991 Sep, 70(9), 1230 - 4
Effects of salivary film velocity on pH changes in an artificial plaque containing Streptococcus oralis, after exposure to sucrose; Macpherson LM et al.; Results from a computer model suggest that following exposure of dental plaque to sucrose, the rate of clearance of acids from plaque into the overlying salivary film will be greatly retarded at low film velocities . This was investigated with an in vitro technique in which artificial plaque containing S . oralis cells was exposed to 10% sucrose for one min . The pH at the proximal (P) and distal (D) undersurfaces of the plaque (0.5 or 1.5 mm thick) was then monitored during the passage of a 0.1-mm-thick film of a sucrose-free solution over the surface . Over the range of salivary film velocities that have been estimated to occur in vivo (0.8-8 mm/min), lower minimum pH values and increased times for the pH to recover toward neutrality occurred at the lower salivary film velocity . Lower pH values were also reached with the 0.5- than with the 1.5-mm-thick plaque . P/D pH gradients, with a lower pH distally, developed at film velocities of 0.8 and 8 mm/min, and the gradients were much more pronounced at the lower velocity . No P/D pH gradients developed when the film velocity was 86.2 mm/min . Incorporation of dead S . oralis cells into the plaque at percentages up to 57% reduced the extent of the pH fall and prolonged the recovery of the pH toward neutrality . The results support the prediction that, other factors being equal, plaque located in regions of the mouth with low salivary film velocity will achieve pH values lower than those of plaque of identical dimensions and microbial composition located in areas where salivary film velocity is high.

Crit Care Med, 1991 Sep, 19(9), 1172 - 6
Postsepsis bradycardia in children with leukemia; Tobias JD et al.; OBJECTIVE: We observed sinus bradycardia in a small number of children with hematologic malignancies who were recovering from sepsis . Our objective was to define this symptom complex and attempt to delineate its etiology . DESIGN: Retrospective chart review . SETTING: A pediatric ICU in a children's oncology hospital . PATIENTS: Children admitted to the ICU over a 24-month period who developed persistent bradycardia (heart rate less than 5% for age for greater than 1 hr) after an episode of sepsis . MEASUREMENTS AND MAIN RESULTS: Seven children developed postsepsis bradycardia . Six patients had a primary diagnosis of acute myelogenous leukemia and one patient had acute lymphocytic leukemia . All patients had positive blood cultures (Streptococcus mitis, n = 4; Escherichia coli, n = 2; and Klebsiella pneumoniae, n = 1) . All seven children were clinically recovering from sepsis when the bradycardia developed . Neither hypotension nor other symptom was associated with the bradycardia . No therapy was given for the bradycardia . Echocardiograms and ECGs were normal in all patients, except for the presence of bradycardia . Bradycardia persisted for 24 to 72 hrs . After that time, heart rates slowly increased to the normal range for age . CONCLUSIONS: We speculate that this syndrome may result from alterations in beta-adrenergic receptor function or an unidentified humoral factor produced by the invading organism or as part of the host's response to sepsis . Prior drug therapy or the underlying illness may predispose to this condition, since all the patients had acute leukemia . As the bradycardia was clinically insignificant, invasive therapeutic or diagnostic strategies were not indicated.

Infect Immun, 1991 Sep, 59(9), 3284 - 6
Inhibitory effects of human salivary histatins and lysozyme on coaggregation between Porphyromonas gingivalis and Streptococcus mitis; Murakami Y et al.; The effects of histatins on coaggregation between Porphyromonas gingivalis 381 and Streptococcus mitis ATCC 9811 were investigated by using a turbidimetric assay . The coaggregation activity was significantly inhibited by histatins 5 and 8 and strongly by lysozyme . Tritium-labeled histatin 8 bound to P . gingivalis cells but not to S . mitis cells.

Infect Immun, 1991 Sep, 59(9), 3156 - 62
Identification of two proteins associated with virulence of Streptococcus suis type 2; Vecht U et al.; The protein profiles of various cell fractions of 180 strains of Streptococcus suis type 2, which were isolated from diseased pigs, from healthy pigs when they were slaughtered, and from human patients, were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting . The isolates from diseased pigs contained two proteins that were absent in most of the isolates from healthy pigs . One of these proteins was a 136-kDa protein that was previously identified as the muramidase-released protein (MRP) . This protein was predominantly detected in protoplast supernatants and culture supernatants . The second protein was a 110-kDa protein that was detected only in culture supernatants and therefore was provisionally called extracellular factor (EF) . Three phenotypes of S . suis type 2 strains were recognized . Isolates from organs of diseased pigs mainly belonged to the MRP+ EF+ phenotype (77%), while isolates from tonsils of healthy pigs mainly had the MRP- EF- phenotype (86%) . Most of the isolates from human patients contained MRP (89%); 74% had the MRP+ EF- phenotype . These findings confirm the results of previous investigations which demonstrated that S . suis type 2 strains differ in virulence . Monoclonal antibodies raised against the 110-kDa EF recognized proteins with higher molecular weights in culture supernatants of all of the strains with the MRP+ EF- phenotype . However, none of the strains with the MRP+ EF+ phenotype produced these high-molecular-weight proteins . Our results demonstrate that MRP and EF are associated with virulence . This suggests that one or both of these proteins are virulence factors that play a role in the pathogenesis of S . suis type 2 infections in pigs and human patients.

Obstet Gynecol, 1991 Sep, 78(3 Pt 2), 549 - 51
Streptococcal toxic shock associated with septic abortion; Dotters DJ et al.; The group A streptococcus is capable of producing exotoxins that have been linked to a toxic shock-like syndrome . Streptococcal toxic shock is a rapidly progressive disease associated with injury to multiple organ systems and a 30-60% mortality rate . We present a case of a 40-year-old woman who developed group A streptococcal toxic shock following a spontaneous abortion . She required surgical debridement, pulmonary artery catheterization, mechanical ventilation, and massive transfusions . Clinicians must be aware of the presentation of this disease, as its incidence appears to be increasing.

J Infect Dis, 1991 Sep, 164(3), 595 - 8
Outbreak of group A streptococcal bacteremia in Sweden: an epidemiologic and clinical study; Stromberg A et al.; The nationwide incidence of group A streptococcal bacteremia in Sweden was 1.8 per 100,000 population in 1987 . During the winter season 1988-1989, the reported cases rate doubled and then declined to the previous level . The peak was due to a type T1/M1 Streptococcus pyogenes strain associated with an increased case fatality rate (33% vs . 15% for other T types) . The highest incidence rates were found in the age groups less than 12 months and greater than 70 years . Among a sample of 79 patients hospitalized in November or December 1988, a portal of entry, mainly cutaneous, was recognized in 89% of the patients and concomitant conditions in 67% . Among the clinical findings were signs of skin or soft tissue infection (41%), local or generalized pain (41%), vomiting or diarrhea (24%), cough (18%), and upper respiratory tract symptoms (12%) . A fatal outcome was associated with high age, lower respiratory tract or unknown focus, leukopenia on admission, start of antibiotic therapy greater than 6 h after the patient's initial contact with a physician, and a rapid clinical course including multiple organ failure . Renewed awareness of the many facets of fulminant streptococcal infection represents one approach to minimize the case fatality rate.

Infect Immun, 1991 Sep, 59(9), 3309 - 12
Complete nucleotide sequence of the gene for a surface protein antigen of Streptococcus sobrinus; Tokuda M et al.; The complete nucleotide sequence of the gene for a cell surface protein antigen (SpaA) of Streptococcus sobrinus MT3791 (serotype g) was determined . The spaA gene consisted of 4,698 bp and coded for a protein of 170,202 Da . A putative signal peptide was found in the amino-terminal end of the protein . A potential promoter sequence and a putative Shine-Dalgarno sequence preceded the open reading frame . Two internal repeating amino acid sequences were present in SpaA . One repeating region, located in the amino-terminal region, was rich in alanine, and the other, located in the central region, was rich in proline . The molecular structure of SpaA was very similar to that of the surface protein antigen of Streptococcus mutans.

Spec Care Dentist, 1991 Sep-Oct, 11(5), 203 - 8
Caries experience, periodontal treatment needs, salivary pH, and Streptococcus mutans counts in a preadolescent Down syndrome population; Stabholz A et al.; The prevalence of dental caries and periodontal treatment needs in an institutionalized population with Down syndrome was examined and the relationship between caries prevalence, salivary pH, and salivary levels of Streptococcus mutans was studied . Thirty-two children with Down syndrome, aged 8 to 13, were compared with two control groups of similar age ranges: healthy children and non-Down mentally retarded (MR) children living in the same institution as the Down syndrome population . The gender ratio mixtures in each group also matched the study sample . Caries experience as indicated by decayed, missing, and filled surfaces (DMF-S) showed significantly lower mean scores for the Down syndrome group compared with both control groups . A similar pattern was found when evaluating the mean numbers of decayed surfaces . Streptococcus mutans counts, expressed as number of colony-forming units on mitis salivarius agar plates among the Down syndrome group, were the lowest, although not statistically significant compared with the counts of the healthy children . Both groups had bacterial counts which were significantly lower than those of the MR group . Significant differences between the two institutionalized groups and the healthy group were recorded for the salivary pH levels . The periodontal treatment needs as evaluated by the Community Periodontal Index of Treatment Needs showed significant difference between the MR group versus both the healthy population and the Down syndrome group . On the whole, 84% of the Down syndrome children were cariesfree.

J Oral Rehabil, 1991 Sep, 18(5), 421 - 9
Streptococcal adherence to uncoated and saliva-coated restoratives; Satou J et al.; The adherence of Streptococcus sanguis and S . mutans to seven restoratives in the presence and absence of an artificial salivary pellicle has been investigated . The physiochemical surface characteristics of the bacteria and of the restoratives were also measured, together with the effect of salivary coating of restoratives . Zeta potential of uncoated restoratives showed a positive correlation with the number of adherent S . mutans cells and S . sanguis cells . S . sanguis showed a positive correlation with the hydrophobicity of uncoated restoratives . The surface hydrophobicity was decreased upon saliva coating, whereas the zeta potential was slightly increased . The contact angles or zeta potentials of saliva-coated restoratives were positively correlated with those of uncoated restoratives . The number of adherent cells of both S . sanguis and S . mutans to saliva-coated restoratives were decreased after the coating . Zeta potential of saliva-coated restoratives showed a positive correlation with the numbers of adherent S . mutans cells, suggesting that non-specific electrostatic interactions have an important role in the adherence of this species.

Biull Eksp Biol Med, 1991 Sep, 112(9), 267 - 9
{Comparison of the frequency of detection of autoantibodies to epidermal antigens with the level of antibodies to polysaccharide of group A Streptococcus and the number of T-suppressors in glomerulonephritis}; Evtushenko ES et al.; By the acute glomerulonephritis (GN) of streptococcal etiology, autoantibodies (AA) reacting with the basal layer of skin epithelium (BLSE) are discovered . The presence of this AA's correlate with the high level of antibodies to the streptococcal group A polysaccharide (A-PS) . In the control sera such AA's and the high level antibodies to A-PS are discovered very rarely . By the GN of non-streptococcal etiology, AA's to the BLSE apparently of other specificity are obtained in some cases, in spite of the absence of antibodies to A-PS . AA's reacting with the differentiated layers of skin epithelium are discovered in the high percent of cases by GN . The presence of these AA's do not correlate with the levels of antibodies to A-PS . The reduction of the number of T-lymphocyte suppressors is established in the blood by the presence of AA's to the BLSE by GN . This question is a subject of later investigations by the different autoimmune processes . Such data can apparently corroborate the previously expressed hypothesis, that AA's to BLSE, which as a rule react with endocrine thymus epithelium, are the cause of the beginning of immunoregulatory disorders, characteristic of autoimmune processes.

J Periodontal Res, 1991 Sep, 26(5), 395 - 401
Urea concentration in minor mucous gland secretions and the effect of salivary film velocity on urea metabolism by Streptococcus vestibularis in an artificial plaque; Macpherson LM et al.; Our purpose was to determine the urea concentration in minor mucous gland (MMG) secretions and the pH at proximal and distal aspects of the lower surface of artificial plaque in vitro during infusion of urea solutions over the surface, at different film velocities . Saliva is present in the mouth as a slowly moving film (ca . 0.1 mm thick) with an estimated velocity in the range of 0.8-8.0 mm/min . At low velocities, due to the accumulation of bacterial products, a progressive increase in their concentration may occur in both the plaque and the overlying salivary film at the distal edge (where the film leaves the plaque) . S . vestibularis, an oral micro-organism possessing ureolytic activity, was combined with 1% agarose, to give a urease Vmax similar to that of natural plaque . The artificial plaque was in the chamber (6.0 x 6.0 square and 0.5 or 1.5 mm deep) of a diffusion apparatus, and a urea-containing artificial saliva (3.3 or 13.2 mmol/l) was infused over the surface, as a film 0.1 mm deep, at velocities of 0.8, 8.2 and 86.2 mm/min . At the lower (physiologically normal) urea concentration and the two lower film velocities, most urea appeared to be metabolized at the proximal end of the plaque, which developed a higher pH . At the higher urea concentration, and a film velocity of 8 mm/min, a higher pH was found at the distal end . This was probably due to the combination of greater urea availability and a reduced rate of ammonia loss distally . At a film velocity of 86.2 mm/min, proximal/distal pH gradients did not develop.(ABSTRACT TRUNCATED AT 250 WORDS)

Infect Immun, 1991 Sep, 59(9), 3261 - 6
Activation of human monocytes by Streptococcus mutans serotype f polysaccharide: immunoglobulin G Fc receptor expression and tumor necrosis factor and interleukin-1 production; Benabdelmoumene S et al.; Streptococcus mutans serotype f polysaccharide (poly f) was prepared from S . mutans whole cells by autoclaving . The poly f was purified by chromatography on DEAE Trisacryl M and Bio-Gel P100, treated with insoluble pronase, and resubjected to chromatography on DEAE Trisacryl M . Normal human blood monocytes, stimulated in vitro with purified poly f, produced extracellular tumor necrosis factor alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) in a dose-dependent fashion as determined by a heterologous two-site sandwich enzyme-linked immunosorbent assay . Poly f also increased the expression of monocyte cell surface receptors for the Fc part of human immunoglobulin G, activity which is correlated with an increase of the phagocytic activity of the stimulated monocytes . Polymyxin B had no effect on TNF-alpha and IL-1 beta release . Neutralization assays with anti-recombinant human TNF-alpha and anti-recombinant human IL-1 beta immunoglobulin G confirmed the fact that the cytotoxic and mitogenic mediators released by the poly f-stimulated monocytes were mainly TNF-alpha and IL-1 beta.

J Dairy Sci, 1991 Sep, 74(9), 2982 - 8
Effect of milking without pulsation on teat duct colonization with Streptococcus agalactiae and penetrability to endotoxin; Bramley AJ et al.; Forty quarters of 10 cows were milked for a 9-d period with one of four treatments: 1) no liner pulsation, 2) conventional milking, 3) no pulsation for 4 d followed by conventional milking for 5 d, and 4) conventional milking for 4 d followed by milking without pulsation for 5 d . All teat orifices were inoculated with approximately .5 million cfu of Streptococcus agalactiae and Streptococcus dysgalactiae on d 1 and 5 . Recoveries of Strep . agalactiae from the teat end were increased for teats milked without pulsation . Recoveries of Strep . dysgalactiae were lower than those of Strep . agalactiae and not increased by milking without pulsation . In a second experiment, teats of 20 cows were milked for a 15-d period with or without liner pulsation . For 10 successive milkings, all teats were inoculated with 1.0 micrograms of Escherichia coli endotoxin either immediately or 2.5 h after each milking . The frequency of endotoxin penetration, measured by the Wisconsin Mastitis Test, in pulsated quarters and in nonpulsated quarters was similar . For quarters milked without pulsation but not for pulsated quarters, inoculation of endotoxin immediately after milking led to greater incidence of teat duct penetration than for inoculation 2.5 h after milking.

Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1991 Sep-Oct, 32(5), 265 - 71
Peritonitis in children with nephrotic syndrome; Fang LJ et al.; In a retrospective review of 300 children with nephrotic syndrome seen at National Taiwan University Hospital throughout the 12-year period from 1978 to 1990, 20 episodes of peritonitis were identified in 17 patients (7.4%) . Gram-negative bacilli (E . coli and Klebsiella pneumoniae) were the majority of pathogens, accounting for 55% of all the cases . Streptococcus pneumoniae were cultured from only 15% of the patients . An additional 15% had negative culture results, but were clinically responsive to penicillin . In 15% of cases the cause was unknown . Clinically, peritonitis was characterized by abdominal pain (100%), abdominal tenderness (100%), rebounding pain (85%), leukocytosis (85%), and fever (75%) . Based on this data, it seems reasonable to initiate antimicrobial therapy in nephrotic children with suspected peritonitis, using a combination of penicillin plus either an aminoglycoside or a broad-spectrum cephalosporin . This regimen should be continued until culture results are available.

Zentralbl Veterinarmed B, 1991 Sep, 38(7), 538 - 44
Growth of Staphylococcus aureus and Streptococcus species in bovine mammary secretions during the nonlactating and peripartum periods following intramammary infusion of lipopolysaccharide at cessation of milking; Oliver SP; The objective was to determine if induced mammary inflammation at cessation of milking influenced growth of gram-positive mastitis pathogens in mammary secretions, particularly during early involution . Growth of all mastitis pathogens evaluated was similar in cell-free fat-free mammary secretions from LPS-infused and control glands . These data indicate that intramammary infusion of LPS at cessation of milking did not alter growth of gram-positive mastitis pathogens in mammary secretion during the nonlactating period . Stage of lactation and the nonlactating period influenced bacterial growth and marked differences between bacteria and among strains of a bacterial species were observed . Staphylococcus aureus grew well in secretions collected during late lactation, but growth decreased during early- and mid-involution and increased again in secretions obtained near parturition . Streptococcus agalactiae and Strep . uberis grew better in mammary secretion obtained during involution than in secretions collected during late or early lactation . Streptococcus dysgalactiae grew well in mammary secretions at all time periods . These data demonstrate the variability of mastitis pathogen growth during physiologic transitions of the bovine udder.

J Clin Microbiol, 1991 Sep, 29(9), 1842 - 6
Protein X of Streptococcus agalactiae induces opsonic antibodies in cows; Rainard P et al.; Protein X of Streptococcus agalactiae is a surface protein frequently associated with strains isolated from cases of mastitis of dairy cows . By immunizing cows with purified protein X, we obtained an antibody response which was restricted to X-bearing strains of S . agalactiae in a whole-cell enzyme-linked immunosorbent assay . This response resulted in an increase in the opsonic activity of serum for strains bearing protein X, as assessed through the augmentation of the chemiluminescence response of phagocytosing polymorphonuclear cells and through an increased ingestion of bacteria, although the proportion of ingested bacteria which were killed (about 60%) remained unchanged . Protein X behaved as a target of opsonins and, as such, could be a protective antigen worth incorporating in a vaccine against S . agalactiae mastitis.

J Clin Microbiol, 1991 Sep, 29(9), 1789 - 94
Antibody levels and in vitro lymphoproliferative responses to Streptococcus pyogenes erythrogenic toxin A and mitogen of patients with rheumatic fever; Bahr GM et al.; We investigated the in vitro lymphoproliferative responses to a streptococcal mitogen and erythrogenic toxin A of children with acute rheumatic fever (ARF) and patients with chronic rheumatic heart disease (CRHD) . Antibody levels to the streptococcal products were also analyzed in the sera of those with ARF or chronic rheumatic heart disease as well as in the sera of children with streptococcal pharyngitis or poststreptococcal glomerulonephritis . Our results demonstrated that the individuals had depressed lymphoproliferative responses during the active stage of rheumatic fever . The depressed responses were not found either to be induced by time-sensitive mitogen-specific suppressor cells or to be related to a dose-response phenomenon . On the other hand, antibody levels to the extracellular mitogens were significantly elevated in the sera of children with ARF compared with the levels in the rest of the groups . The hyperresponsiveness noted among children with ARF was found to be at a quantitative level and was not due to recognition of more epitopes, as determined by Western blotting (immunoblotting) . The profile of immune responsiveness in children with ARF to the streptococcal extracellular mitogens is discussed in relation to the pathogenesis of disease.

J S Afr Vet Assoc, 1991 Sep, 62(3), 107 - 9
Arthritis in slaughter pigs; Turner GV et al.; Joints obtained from 192 pig carcases were examined by means of standard microbiological and macro- and histopathological procedures . Approximately 32% of the joints were considered normal; 35.5% showed lesions consistent with osteochondrosis and a non-specific synovitis was present in 24.4% . Only 6.1% of joints were arthritic and yielded either Staphylococcus aureus or Streptococcus spp . The remainder (2.3%) had periarticular lesions such as abscesses . The study emphasises that an accurate diagnosis and correct evaluation of pig carcases showing joint lesions, is absolutely essential if a high standard of meat inspection is to be obtained and unnecessary economic losses are to be avoided.

Mol Microbiol, 1991 Sep, 5(9), 2255 - 60
Horizontal transfer of multiple penicillin-binding protein genes, and capsular biosynthetic genes, in natural populations of Streptococcus pneumoniae; Coffey TJ et al.; Multiply antibiotic-resistant serotype 23F isolates of Streptococcus pneumoniae are prevalent in Spain and have also been recovered recently in the United Kingdom and the United States . Analysis of populations of these isolates by multilocus enzyme electrophoresis, and restriction endonuclease cleavage electrophoretic profiling of penicillin-binding protein (PBP) genes, has demonstrated that these isolates are a single clone (Munoz et al., 1991) . Here we report studies of non-serotype 23F penicillin-resistant pneumococci isolated in Spain and the United Kingdom . One of the isolates expressed serotype 19 capsule but was otherwise indistinguishable from the serotype 23F clone on the basis of multilocus enzyme electrophoresis, antibiotic resistance profiling, and restriction endonuclease patterns of genes encoding PBP1A, PBP2B and PBP2X, a result which suggests that horizontal transfer of capsular biosynthesis genes had occurred . These same techniques revealed that six other resistant isolates, all expressing serotype 9 polysaccharide capsule, represent a clone . Interestingly, the chromosomal lineage of this clone is not closely related to the 23F clone; however, the serotype 9 and 23F clones harbour apparently identical PBP1A, -2B and -2X genes . To explain these data, we favour the interpretation that horizontal gene transfer in natural populations has distributed genes encoding altered forms of PBP1A, -2B and -2X to distinct evolutionary lineages of S . pneumoniae.

Minerva Pediatr, 1991 Sep, 43(9), 601 - 3
{Perinatal listeriosis . A report of a case with a hydrocephalus outcome}; Paolillo F et al.; Perinatal listeriosis is a disease whose incidence has increased constantly in recent years . Like neonatal infection determined by B hemolyticus streptococcus, the disease appears in two forms: the first is the septicaemic form with early onset, the second form is meningoencephalitic with late onset . We describe a case of listeriosis with immediate onset in which, in spite of the prompt therapy and the normality of rachiocentesis, developed a purulent ventriculitis with outcome in hydrocephalus.

Scand J Prim Health Care, 1991 Sep, 9(3), 149 - 54
Streptococcal throat infection: calculation of test standards and a comparison between an antigen detection test and culture; Stillstrom J et al.; The standard minimum sensitivity (94%) and minimum specificity (89%) of a group A streptococcus (GAS) test were calculated, assuming that no more than 10% false positive and no more than 2% false negative test results should be allowed . The clinical judgement of the need for immediate antibiotic treatment in tonsillitis/pharyngitis was an unreliable indicator of a GAS aetiology, 20-29% of the results being false positive and 2-10% false negative . The rapid antigen detection test Tandem Icon Strep A was not sensitive enough to be used as a single test, though it was specific enough . The sensitivity of culture almost reached the standard demand . Two combinations of rapid test and culture (sequence testing) were superior to the rapid test, but were not significantly better than culture.

Semin Respir Infect, 1991 Sep, 6(3), 131 - 5
Fluoroquinolones in respiratory infections; Klein NC; The fluoroquinolones have excellent activity against a number of respiratory pathogens, especially gram-negative bacteria, including beta-lactamase-producing Hemophilus influenzae and Moraxella catarrhalis . Several studies have shown ciprofloxacin to be effective in the treatment of acute exacerbations of chronic bronchitis, some community-acquired and nosocomial pneumonia, and acute exacerbations of bronchopulmonary infections in cystic fibrosis . The fluoroquinolones have less activity against Streptococcus pneumoniae and limited anaerobic activity, which should limit the use of these drugs in empiric therapy of community-acquired pneumonia where the pneumococcus or anaerobes play a predominant role.

J Infect, 1991 Sep, 23(2), 195 - 6
Multiple brain abscesses caused by Streptococcus bovis; Leibovitch G et al.; A case of multiple brain abscesses caused by Streptococcus bovis in a 28-year-old man is described . Infected bronchiectasis is presumed to be the source of infection . Streptococcus bovis infection is a rare cause of brain abscess . The aetiology and manifestations of this infection are discussed.

P N G Med J, 1991 Sep, 34(3), 211 - 4
Immune function risk factors for acute lower respiratory tract infections; Witt CS et al.; The immune response of pneumonia patients and controls to Streptococcus pneumoniae was investigated by enzyme-linked immunosorbent assay (ELISA) . Patients less than 6 months of age had significantly lower levels of anti-pneumococcal polysaccharide antibodies than their age-matched controls . Patients and controls 6-14 months of age had lower antibody levels than the children 0-5 months of age . Adult patients and controls did not differ in their antibody status . However, patients and Papua New Guinean controls had depressed cell-mediated immunity and low T-cell numbers . Low levels of antibodies to pneumococcal polysaccharides in children less than 6 months of age appear to be an important risk factor for acute lower respiratory tract infections but other factors may be important in older infants and adultsPIP: The immune response of pneumonia patients and controls to Streptococcus pneumoniae was investigated by enzyme-linked immunosorbent assay (ELISA) . Patients under 6 months of age had significantly lower levels of anti-pneumococcal polysaccharide antibodies than their age-matched controls . Patients and controls ages 6-14 months had lower antibody levels than children ages 0-5 months . Adult patients and controls did not differ in their antibody status . However, patients and Papua New Guinean controls had depressed cell-mediated immunity and lower T-cell numbers . Low levels of antibodies to pneumococcal polysaccharides in children less than 6 months of age appear to be an important risk factor for acute lower respiratory tract infections but other factors may be important in older infants and adults . author's modified

J Vet Intern Med, 1991 Sep-Oct, 5(5), 263 - 7
Unusual patterns of serum antibodies to Streptococcus equi in two horses with purpura hemorrhagica; Heath SE et al.; An enzyme-linked immunosorbent assay (ELISA) was developed for use in horses to determine serum titers of antibodies of the immunoglobulin classes IgA, IgG, and IgM to Streptococcus equi M-like protein and culture supernatant protein antigens . Serum antibodies were determined in 28 adult horses, including 9 horses with recent S . equi infections, 17 horses without known exposure to S . equi, but without a history of respiratory disease in the preceding 4 months, and 2 horses with clinical purpura hemorrhagica . Serum IgA titers to culture supernatant protein antigen were highest in recently infected horses (P less than 0.001) . Serial determinations of antibody titers in the horses with purpura showed that IgG antibodies to both S . equi M-like protein and culture supernatant protein antigens were undetectable initially, but later rose coincidental with clinical recovery from the disease . Possible mechanisms for these findings are discussed.

J Gen Microbiol, 1991 Sep, 137 ( Pt 9), 2259 - 64
A survey of peptidase activity in rumen bacteria; Wallace RJ et al.; Twenty-nine strains of 14 species of rumen bacteria were screened for their ability to hydrolyse Ala2, Ala5, GlyArg-4-methoxy-2-naphthylamide (GlyArg-MNA) and Leu-MNA . Several species, notably Megasphaera elsdenii, were active against Ala2, and a smaller number, including Bacteroides ruminicola, Butyrivibrio fibrisolvens, Ruminococcus flavefaciens, Lachnospira multipara and Ruminobacter amylophilus, broke down Ala5 . Streptococcus bovis had an exceptionally high leucine arylamidase activity . However, only Ba . ruminicola hydrolysed GlyArg-MNA . Further investigation revealed that only Ba . ruminicola and Bu . fibrisolvens hydrolysed Ala5 to Ala3 and Ala2, with little ALa4 being produced, in a manner similar to rumen fluid . The activity of Ba . ruminicola against synthetic peptidase substrates, including GlyArg-MNA, LysAla-MNA, ArgArg-MNA, GlyPro-MNA, LeuVal-MNA, and Ala3-p-nitroanilide, was similar to that of rumen fluid, whereas the activity of Bu . fibrisolvens was quite different . Since the main mechanism by which peptides are broken down in the rumen is similar to dipeptidyl aminopeptidase type I, for which GlyArg-MNA is a diagnostic substrate, it was concluded that Ba . ruminicola was the most important single species in peptide breakdown in the rumen.

J Am Soc Echocardiogr, 1991 Sep-Oct, 4(5), 465 - 74
Prediction of rapid versus prolonged healing of infective endocarditis by monitoring vegetation size; Rohmann S et al.; The diagnostic value of transesophageal echocardiography in monitoring the clinical course has been evaluated in 83 patients with echocardiographic evidence of infective endocarditis . A total of 103 vegetations attached to the aortic or mitral valves were detected by use of the transesophageal approach . The patients were monitored for a mean of 74 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations . Group A included patients with increasing or remaining constant size of vegetation (8.2 +/- 1.5 to 11.2 mm, p less than 0.05) during 4 to 8 weeks of antimicrobial therapy, whereas group B was formed by patients with decreasing vegetation size (8.3 +/- 0.8 to 4.9 +/- 0.8 mm, p less than 0.05) . The incidences of complications after diagnosis and onset of therapy was higher in group A than in group B: valve replacement (45% versus 2%, p less than 0.05), embolic events (45% versus 17%, p less than 0.05), perivalvular abscess formation (13% versus 2%, p less than 0.05), and mortality (10% versus 0%, respectively, p less than 0.05) . Staphylococcus aureus was the most frequent organism isolated in group A (44% versus 11% in B, p less than 0.05) and Streptococcus viridans in group B (33% versus 18% in A, p less than 0.05) . Blood cultures were negative in nearly 50% of the patients in each group . There was no difference in the incidences of complications in patients with positive or negative blood cultures . We conclude that an increase in vegetation size during antibiotic therapy predicts a prolonged healing phase of infective endocarditis . This prolonged healing period is associated with a significantly increased risk of complications, independent of blood culture results . Monitoring vegetation size contributes important information concerning prognosis and stage of risk, and it aids in the choice of patient management in infective endocarditis . Because embolic events after diagnosis and onset of treatment are less frequent in rapid-healing endocarditis, surgery cannot be recommended to prevent further events taking into account the high risk of surgery.

J Gen Microbiol, 1991 Sep, 137 ( Pt 9), 2125 - 33
Protection against Streptococcus equi infection by monoclonal antibodies against an M-like protein; Jean-Francois MJ et al.; We have developed an in vivo passive transfer assay using mice to identify monoclonal antibodies (mAbs) which offer protection against Streptococcus equi infection . The assay was developed using serum antibodies collected from horses convalescing from strangles . In this study, we show that a preparation of M-like protein, acid-extracted from S . equi, affords 80% protection to mice immunized with it . A number of mouse mAbs directed against a preparation of M-like protein were then assessed for their ability to passively protect mice against challenge with a lethal dose of the bacteria . Two mAbs, 1D10 and 2A6, were shown to be highly protective . It was also demonstrated, by means of a competitive enzyme immunoassay, that these mAbs recognized different epitopes in the preparation . Examination of a dose-response curve for mAbs 1D10 and 2A6 revealed that optimal levels of protection were achieved using 1 mg of either 1D10 or 2A6, or 0.5 mg 1D10 and 0.5 mg 2A6 given together . Immunological reactivity of these mAbs with a preparation of M-like protein showed that the antigens they recognized were comparable in size to some of the antigens recognized by convalescent horse serum antibodies . The role of immunoglobulin isotype in conferring protection is discussed.

J Formos Med Assoc, 1991 Sep, 90(9), 857 - 9
Brain abscess following endoscopic injection sclerotherapy: report of a case; Tai DI et al.; A 33-year-old male patient with hepatitis B surface antigen positive cirrhosis, received 2 courses of endoscopic injection sclerotherapy for bleeding esophageal varices . A Streptococcus viridans brain abscess developed 2 weeks after the first sclerotherapy (or 1 week after the second sclerotherapy) . In cirrhotic patients, an increase in pulmonary vasodilatation and pulmonary arteriovenous shunting has been well recognized . Sclerosant as well as bacteria may pass through a pulmonary arteriovenous shunt and reach the brain, directly after an infection of esophageal varices . Brain ischemia and a bacterial infection may occur at the same time, this can accelerate the development of a pyogenic brain abscess . Careful observation for the early detection and treatment of infection following endoscopic sclerotherapy is essential.

J Infect Dis, 1991 Sep, 164(3), 527 - 32
Mechanism of killing of pneumococci by lysozyme; Coonrod JD et al.; Lysozyme is abundant in respiratory secretions and may play a role in lung host defenses . Mechanisms by which lysozyme killed Streptococcus pneumoniae, an important respiratory pathogen, were studied . Lysozyme caused optical clearing of pneumococcal suspensions and released fragments containing {3H}choline from their cell walls . Electron micrographs revealed wide-spread cell wall destruction and bacteriolysis . Breakdown of the cell wall appeared to be mediated mostly by the major pneumococcal autolysin, N-acetylmuramoyl-L-alanine amidase, because it was blocked by phosphorylcholine, a specific inhibitor of amidase, or by substitution of ethanolamine for choline in the cell wall . Blockade of amidase did not greatly increase survival of lysozyme-treated pneumococci on blood agar . Pneumococci in which amidase was blocked appeared intact immediately after treatment with lysozyme, but when they were reincubated at 37 degrees C in fresh culture medium they swelled and lysed . Thus, widespread triggering of the major pneumococcal autolysin is not essential for the bactericidal effect of lysozyme.

Vet Microbiol, 1991 Aug 30, 28(4), 335 - 42
Detection of Streptococcus suis type 2 in tonsils of slaughtered pigs using improved selective and differential media; Kataoka Y et al.; New selective and differential media were devised for the isolation and identification of Streptococcus suis type 2 . The selective medium (NNCC) agar) was Todd-Hewitt broth containing 1.5% Bactoagar and 5% defibrinated sheep blood with addition of sodium azide (50 micrograms/ml), nalidixic acid (25 micrograms/ml), colistin (12.5 micrograms/ml) and crystal violet (2 micrograms/ml) . The differential medium consisted of heart infusion agar and antiserum specific only for S . suis type 2 . In a total of 291 pigs tested by a combination of these media, S . suis type 2 was isolated and confirmed from 40 of them (13.7%).

JAMA, 1991 Aug 28, 266(8), 1112 - 4
Invasive group B streptococcal disease in adults . A population-based study in metropolitan Atlanta; Schwartz B et al.; OBJECTIVE: To define the incidence and clinical spectrum of group B streptococcus infection in adults . To characterize groups at increased risk for infection . DESIGN: Retrospective population-based surveillance of group B streptococcus infections occurring in adults . Patients were identified by review of microbiology records at all surveillance area hospital laboratories . Demographic and clinical data were abstracted from patient medical records . SETTING: Metropolitan Atlanta, Ga, 1982 through 1983 . PATIENTS: We identified 70 adult patients with invasive group B streptococcus infections; 14 infections occurred in pregnant women and 56 in nonpregnant adults . RESULTS: The annual incidence of group B streptococcus infection in men and nonpregnant women was 2.4 cases per 100,000 population . Incidence increased with age and was higher in blacks than in whites . The case-fatality rate was 32% . Group B streptococcus was most often isolated from blood (71%) and soft tissue (16%) . Common clinical presentations included skin and soft-tissue infection (36%), bacteremia without focus (34%), pneumonia (11%), arthritis (9%), and endocarditis (9%) . Compared with the general population's risk of infection, the risk of infection in persons with diabetes mellitus was increased 10.5-fold (95% confidence interval {CI}, 7.8 to 14.4); in persons with cancer, it was increased 16.4-fold (95% CI, 11.5 to 23.3) . CONCLUSIONS: Group B streptococcus infections cause serious disease in adults as well as in neonates, providing an additional rationale for vaccine development . Determining the incidence of adult disease and groups at greatest risk will help in focusing prevention efforts.

Nucleic Acids Res, 1991 Aug 25, 19(16), 4523 - 9
Cloning and characterization of Rrp1, the gene encoding Drosophila strand transferase: carboxy-terminal homology to DNA repair endo/exonucleases; Sander M et al.; We previously reported the purification of a protein from Drosophila embryo extracts that carries out the strand transfer step in homologous recombination (Lowenhaupt, K., Sander, M., Hauser, C . and A . Rich, 1989, J . Biol . Chem . 264, 20568) . We report here the isolation of the gene encoding this protein . Partial amino acid sequence from a tryptic digest of gel purified strand transfer protein was used to design a pair of degenerate oligonucleotide primers which amplified a 635 bp region of Drosophila genomic DNA . Recombinant bacteriophage were isolated from genomic and embryo cDNA libraries by screening with the amplified DNA fragment . These bacteriophage clones identify a single copy gene that expresses a single mRNA transcript in early embryos and in embryo-derived tissue culture cells . The cDNA nucleotide sequence contains an open reading frame of 679 amino acids within which are found 5 tryptic peptides from the strand transfer protein . Expression of this cDNA in E . coli produces a polypeptide with the same electrophoretic mobility as the purified protein . The deduced protein sequence has two distinct regions . The first 427 residues are basic, rich in glutamic acid and lysine residues and unrelated to known proteins . The carboxy-terminal 252 residues are average in amino acid composition and are homologous to the DNA repair proteins, Escherichia coli exonuclease III and Streptococcus pneumoniae exonuclease A . This protein, which we name Rrp1 (Recombination Repair Protein 1), may facilitate recombinational repair of DNA damage.

Carbohydr Res, 1991 Aug 12, 215(1), 59 - 65
An h.p.l.c . method for determining chain-length distribution in some glycogens; Cheetham NW et al.; Human, oyster, Streptococcus mitis, and phyto-glycogen samples were debranched using Pseudomonas amylodermosa isoamylase (EC 3.2.1.68) . The distribution of chain lengths was studied by high-performance liquid chromatography on reversed-phase columns, with water as eluent . Quantitative data was obtained over the degree of polymerisation range three to eighteen (d.p . 3-18), and oligosaccharides up to d.p . 26 were detected . No single column was found suitable for the resolution of the complete range of oligosaccharides, two columns being necessary for the quantitative analysis . The resulting "fingerprints" of chain lengths are characteristic of the glycogen source and should be useful for both comparison purposes among glycogens and for monitoring procedures of glycogen isolation.

Nucleic Acids Res, 1991 Aug 11, 19(15), 4189 - 92
Identification and sequence analysis of a methylase gene in Porphyromonas gingivalis; Banas JA et al.; A gene from the periodontal organism Porphyromonas gingivalis has been identified as encoding a DNA methylase . The gene, referred to as pgiIM, has been sequenced and found to contain a reading frame of 864 basepairs . The putative amino acid sequence of the encoded methylase was 288 amino acids, and shared 47% and 31% homology with the Streptococcus pneumoniae DpnII and E . coli Dam methylases, respectively . The activity and specificity of the pgi methylase (M.PgiI) was confirmed by cloning the gene into a dam- strain of E . coli (JM110) and performing a restriction analysis on the isolated DNA with enzymes whose activities depended upon the methylation state of the DNA . The data indicated that M.PgiI, like DpnII and Dam, methylated the adenine residue within the sequence 5'-GATC-3'.

Science, 1991 Aug 9, 253(5020), 657 - 61
A novel, highly stable fold of the immunoglobulin binding domain of streptococcal protein G; Gronenborn AM et al.; The high-resolution three-dimensional structure of a single immunoglobulin binding domain (B1, which comprises 56 residues including the NH2-terminal Met) of protein G from group G Streptococcus has been determined in solution by nuclear magnetic resonance spectroscopy on the basis of 1058 experimental restraints . The average atomic root-mean-square distribution about the mean coordinate positions is 0.27 angstrom (A) for the backbone atoms, 0.65 A for all atoms, and 0.39 A for atoms excluding disordered surface side chains . The structure has no disulfide bridges and is composed of a four-stranded beta sheet, on top of which lies a long helix . The central two strands (beta 1 and beta 4), comprising the NH2- and COOH-termini, are parallel, and the outer two strands (beta 2 and beta 3) are connected by the helix in a +3x crossover . This novel topology (-1, +3x, -1), coupled with an extensive hydrogen-bonding network and a tightly packed and buried hydrophobic core, is probably responsible for the extreme thermal stability of this small domain (reversible melting at 87 degrees C).

Can J Microbiol, 1991 Aug, 37(8), 609 - 12
Thermal susceptibility of Streptococcus faecium strains isolated from frankfurters; Gordon CL et al.; The heat resistance of nine strains of Streptococcus faecium isolated from frankfurters was determined at 63 and 68 degrees C in brain heart infusion broth . Exponential-phase cultures (approximately 10(7) colonies/mL) were used as inoculants . The heat resistance of S . faecium DP2181, a moderately resistant isolate, was further examined in broth (55, 63, and 68 degrees C) and frankfurter emulsion (63 and 68 degrees C) . The decimal reduction times (D values) were determined by regression . In broth, both time-temperature combinations resulted in a 3-4 log decline in bacterial numbers for the nine S . faecium strains tested . For S . faecium DP2181, the survivor curves deviated from the logarithmic order of death at all three heating temperatures . An initial slow period of death was evident at 55 degrees C and a resistant tail of organisms was observed at 55, 63, and 68 degrees C . The D55D63, and, D68 values for the logarithmic portion of the corresponding survivor curves were 105.6, 9.36, and 3.34 min, respectively . The survival of DP2181 was enhanced by the frankfurter emulsion . The results indicate that populations of S . faecium existed that were very heat resistant and could survive normal frankfurter processing if initially present in high numbers.

FEMS Microbiol Lett, 1991 Aug 1, 66(2), 219 - 24
Electrotransformation of Streptococcus pyogenes with plasmid and linear DNA; Simon D et al.; Electrotransformation was used to introduce both plasmid and linear DNA into Streptococcus pyogenes . The method was optimized using strain NZ131, for which transformation frequencies up to 10(7) per micrograms of plasmid DNA were obtained . A linear fragment of DNA, containing the streptokinase gene (ska) in which an internal fragment had been replaced with an erythromycin resistance gene (erm), was transformed into strain NZ131 with a frequency of 10(3) per micrograms DNA . The introduction of linear DNA into S . pyogenes by electrotransformation should be useful for future genetic analyses as well as targeted gene replacement.

Ear Nose Throat J, 1991 Aug, 70(8), 508, 513 - 9
Sensori-neural hearing loss in acute otitis media due to beta-hemolytic streptococcus successfully treated with penicillin and prednisone; Fearrington SJ et al.; This article reports a case of a 21-year-old woman with acute otitis media with effusion secondary to a virulent group A beta-hemolytic streptococcus infection that led to rapidly deteriorating hearing in an only hearing ear . This deterioration continued despite middle ear ventilation and high-dose intravenous cefazolin and subsequent high-dose aqueous penicillin . The addition of prednisone to her therapeutic regimen led to rapid hearing improvement and decrease in effusion production . A historical perspective on the use of steroids in treating otitis media and several theories for this reversal in clinical course are presented.

Arch Fr Pediatr, 1991 Aug-Sep, 48(7), 491 - 2
{Palpebral edema with fever and Streptococcus sanguis septicemia}; Zelinsky-Gurung A et al.; A case of facial cellulitis complicated by regional thrombophlebitis and septicemia is reported in a 6 year-old girl . Streptococcus sanguis, a bacterial agent, unusually responsible for cellulitis, was isolated from 5 blood cultures . This child had no immunosuppression or endocarditis or dental infection . She had been previously given a non-steroidal anti-inflammatory agent, which was potentially responsible for the diffusion of infection.

Wis Med J, 1991 Aug, 90(8), 465 - 7
Pyomyositis secondary to group A beta hemolytic streptococcus; Unger MJ et al.; Pyomyositis is a primary bacterial infection of skeletal muscle not formed by local extension from superficial tissues . It is relatively frequently seen in tropical climates but reportedly rarely seen in temperate climates such as North America . In this report, we present a 67-year-old man with a primary Group A beta hemolytic Streptococcal infection of the quadriceps muscle of the left leg.

J Periodontol, 1991 Aug, 62(8), 510 - 23
Prevention of infective endocarditis: a review of the medical and dental literature; Barco CT; This paper is a review of what is presently known about the cause and prevention of infective endocarditis . Systemic antibiotics alone are not always enough for an effective prevention of infective endocarditis . Non-streptococcus bacteria frequently found in the periodontal pocket are now reported as causing infective endocarditis; these bacteria are not uniformly susceptible to the antibiotics recommended for prophylaxis . Animal studies indicate that periodontal disease does increase the incidence of infective endocarditis and that the number of microbes entering the blood stream may not be as important in the production of infective endocarditis as other qualities, such as the microbe's ability to adhere . Antibiotics may affect the ability of a microorganism to adhere to tissues of the heart, but this association is yet unclear and may vary with the antibiotic and species of bacteria . Reduction of inflammation of the periodontal tissues is of the utmost importance in the prevention of infective endocarditis; however, mouthrinses have a very limited effect in a periodontal pocket of more than 3 mm in depth and irrigation of a periodontal pocket may create a dangerous bacteremia . Nevertheless, in addition to systemic antibiotics, local antimicrobial agents followed by routine dental treatment and maintenance show promise as an effective means for the prevention of infective endocarditis . Future research in the prevention of infective endocarditis should include placement of antimicrobials in the periodontal pocket and systemic agents that reduce platelet adhesion . The suggestions presented in this review are only recommendations for further research and are not to be construed as a substitute for the current guidelines.

J Pediatr Surg, 1991 Aug, 26(8), 908 - 13
Infectious complications of pediatric liver transplantation; Saint-Vil D et al.; Twenty-five pediatric orthotopic liver transplantations (OLTs) performed in 22 patients at Sainte-Justine Hospital were reviewed for infections complications . One patient died within 12 hours posttransplantation and is excluded . The patients had an average age of 6.1 years (range, 1.25 to 19 years) and an average weight of 20.4 kg (range, 11 to 55 kg) . Two patients (9%) were cytomegalovirus (CMV) seropositive and 9 of 19 patients (48%) were Epstein-Barr virus (EBV) seropositive preoperatively . Five of the donors (20%) were CMV seropositive . The most common indications for OLT were biliary atresia (8) and tyrosinemia (7) . There were 4 deaths, for an overall mortality rate of 19% . In 3 patients, deaths were related to infection (CMV hepatitis and duodenitis with aortoduodenal fistula, adult respiratory distress syndrome {ARDS} with Streptococcus viridans pneumonia, Escherichia coli cholangitis with progressive hepatic failure) . Fifteen patients (72%) had 41 major infections, most of them bacterial, during the first month posttransplantation . These include pneumonia (25%), line sepsis (17%), cholangitis (14%), and tracheitis (14%) . There was only one major viral infection, a CMV hepatitis that occurred in the first month posttransplantation . Three patients had fungal infections (8%) associated with hepatic artery thrombosis and recurrent cholangitis . All three patients required retransplantation . There was only one protozoal infection (Pneumocystis carinii pneumonia) causing life-threatening respiratory failure, from which patient recovered without sequelae . Infection still remains a serious complication of OLT . Bacterial infection is common and is usually associated with technical complications . The low rate of CMV infection is related to low incidence of CMV in the donor pool and the minimal use of strong immunosuppressants.

J Clin Gastroenterol, 1991 Aug, 13(4), 448 - 51
Infectious endocarditis after fiberoptic sigmoidoscopy . With a literature review; Norfleet RG; Infectious endocarditis is a feared complication of procedures causing bacteremia . Gastrointestinal procedures cause bacteremia, but are seldom followed by infectious endocarditis . Of nine cases found in the English literature, only five have convincing evidence that endocarditis resulted from the gastrointestinal procedure . I present a new case of endocarditis due to Streptococcus sanguis type II after fiberoptic sigmoidoscopy.

Ann Otol Rhinol Laryngol, 1991 Aug, 100(8), 612 - 5
Nasopharyngeal flora in the first three years of life in normal and otitis-prone children; Faden H et al.; Nasopharyngeal carriage of the three major middle ear pathogens (Streptococcus pneumoniae, nontypeable Hemophilus influenzae, and Moraxella catarrhalis) was evaluated prospectively in a group of 110 children followed up for the first 3 years of life . The findings suggested that nasopharyngeal carriage of middle ear pathogens increases significantly during respiratory illness among the general population of young children; however, otitis-prone children demonstrated a tendency to carry nontypeable H influenzae at an unusually high rate even during health . This propensity to carry nontypeable H influenzae might explain why nontypeable H influenzae is a major cause of recurrent or chronic otitis media.

Arch Otolaryngol Head Neck Surg, 1991 Aug, 117(8), 889 - 94
Oral vaccine therapy for pneumococcal otitis media in an animal model; Yoshimura H et al.; We investigated whether mucosal IgA response in the middle ear cavity against Streptococcus pneumoniae type 19F is enhanced by use of enteric capsules, and whether the resulting mucosal immunity can prevent pneumococcal otitis media . Adult Hartley guinea pigs were employed . With intratympanic inoculation of 10(5) and 10(6) live S pneumoniae, the occurrence of pneumococcal otitis media significantly decreased in guinea pigs that received intraduodenal and intragastric immunization by enteric capsules . In these guinea pigs, the values of salivary IgA antibody titers against S pneumoniae were significantly greater, and histologic changes of the middle ear mucosa were also slighter than those of control guinea pigs . These findings indicate that oral vaccination by enteric capsules elicits mucosal IgA responses, as well as intraduodenal immunization, to prevent pneumococcal otitis media . These results suggest the possibility of clinical application of oral vaccination by enteric capsules for the prevention of middle ear infection.

Obstet Gynecol Surv, 1991 Aug, 46(8), 499 - 508
Group B streptococcus: the effectiveness of screening and chemoprophylaxis; Greenspoon JS et al.; Although antepartum screening for Group B Streptococcus is not ideal, it may be the most practical approach until rapid tests are proven to be useful in this clinical setting . The efficacy has been established for intrapartum chemoprophylaxis with a penicillin antibiotic of patients with a positive antepartum culture . There is evidence that supports the concept for selective intrapartum chemoprophylaxis in some populations . Intrapartum chemoprophylaxis prevents maternal morbidity . Rapid tests for intrapartum diagnosis of Group B streptococcus colonization appear promising, providing results are available in time for therapy to be administered before delivery.

South Med J, 1991 Aug, 84(8), 1058 - 9
Streptococcus salivarius meningitis and colonic carcinoma; Legier JF; Streptococcus salivarius caused fulminant meningitis in an elderly patient . A gastrointestinal diagnostic workup revealed an asymptomatic colonic adenocarcinoma . This first reported instance of S salivarius sepsis associated with a colonic neoplasm is not unexpected, since the organism is bacteriologically similar to S bovis, the prime bacterial indicator of occult malignancy . Exact speciation of streptococcal strains is fraught with technical difficulties, and gastrointestinal investigation may be warranted in an expanded variety of streptococcal infections.

Epidemiol Infect, 1991 Aug, 107(1), 119 - 26
A longitudinal study of natural infection of piglets with Streptococcus suis types 1 and 2; Robertson ID et al.; Streptococcus suis types 1 and 2 were detected in nasal swabs taken from five litters of piglets sampled twice weekly from birth . The two types had been detected in all pigs by the time they were 38 and 25 days old respectively with mean ages of first detectable infection being 13.5 and 8.5 days . The prevalence of infection was not affected by housing conditions or the population density of pigs . Piglets originating from a sow with vaginal swabs positive for S . suis type 2 were infected earlier than piglets from non-vaginal carriers . It is concluded that infection of piglets with S . suis type 2 may occur during the birth process.

Clin Exp Immunol, 1991 Aug, 85(2), 265 - 9
Anti-IgG antibodies in rheumatic diseases cross-react with Streptococcus mutans SR antigen; Ackermans F et al.; We have previously shown that SR protein, a S . mutans major cell wall protein, as well as the recombinant protein SR (rSR) share common epitopes with human IgG . Since this antigenic mimicry could play a role in the induction of anti IgG, we have examined, in k-ELISA, the presence of antibodies reacting with S . mutans SR proteins and S . mutans whole cells in sera from 36 patients with rheumatic diseases . The majority of the 36 sera showed a high reactivity with rSR when compared with control sera . Eight highly positive sera were further purified on rSR and human IgG sorbents and tested against both rSR and IgG in ELISA and Western blotting . The affinity-purified antibodies reacted strongly with rSR, IgG and IgG Fab fragments but failed to react with IgG Fc fragment . In Western blotting the addition of unlabelled IgG abolished the reactivity of affinity-purified biotinylated antibodies with all antigens, confirming the existence of a common epitope shared by rSR and human IgG heavy chain . We show the existence in rheumatic diseases of high titres of anti-human IgG antibodies cross-reactive with S . mutans SR proteins . Those antibodies are principally IgG and react with the Fd part of the Fab fragment . We can hypothesize from the above data that this antigenic mimicry existing between S . mutans SR-related antigens and human IgG could play a role in the synthesis of at least a part of the anti-IgG antibodies present in rheumatic diseases sera.

J Bacteriol, 1991 Aug, 173(16), 5105 - 9
Analysis of Streptococcus pneumoniae sequences cloned into Escherichia coli: effect of promoter strength and transcription terminators; Dillard JP et al.; Difficulties encountered in the cloning of DNA from Streptococcus pneumoniae and other AT-rich organisms into ColE1-type Escherichia coli vectors have been proposed to be due to the presence of a large number of strong promoter-acting sequences in the donor DNA . The use of transcription terminators has been advocated as a means of reducing instability resulting from disruption of plasmid replication caused by strong promoters . However, neither the existence of promoter-acting sequences of sufficient strength and number to explain the reported cloning difficulties nor their role as a source of instability has been proven . As a direct test of the "strong promoter" hypothesis, we cloned random fragments from S . pneumoniae into an E . coli vector containing transcription terminators, identified strong promoter-acting sequences, and subsequently removed the transcription terminators . We observed that terminator removal resulted in reduced copy numbers for the strongest promoter-acting sequences but not in reduced promoter strengths or altered plasmid stabilities . Our results indicate that promoters strong enough to require transcription terminators for plasmid stability are probably rare in S . pneumoniae DNA.

Am Rev Respir Dis, 1991 Aug, 144(2), 312 - 8
Severe community-acquired pneumonia . Epidemiology and prognostic factors; Torres A et al.; Over a period of 4 consecutive yr, 92 nonimmunosuppressed patients (21 women and 71 men aged 53 +/- 16 yr, means = SD) with critical acute respiratory failure (PaO2/FiO2, 209 +/- 9 mm Hg) caused by severe community-acquired pneumonia were admitted to the respiratory intensive care unit (RICU) of a general hospital . The most frequent underlying clinical condition was chronic obstructive pulmonary disease (44 patients, 48%) . A total of 56 patients (61%) required mechanical ventilation for a mean period of 10.7 +/- 12.5 days, 29 of them (52%) needing PEEP (9.9 +/- 3.8 cm H2O) . A group of 23 (25%) patients had criteria of adult respiratory distress syndrome (ARDS) . A causal microorganism was identified in 48 patients (52%), the two most frequent etiologies being Streptococcus pneumoniae (14, 15%) and Legionella pneumophila (13, 14%) . Pseudomonas aeruginosa (5, 5%) was always associated with bronchiectasis . Mortality due to severe community-acquired pneumonia was 22% (20 patients) . According to univariate analysis, mortality was associated with anticipated death within 4 to 5 yr, inadequate antibiotic treatment before RICU admission, mechanical ventilation requirements, use of PEEP, FIO2 greater than 0.6, coexistence of ARDS, radiographic spread of the pneumonia during RICU admission, septic shock, bacteremia, and P . aeruginosa as the cause of the pneumonia . Further, recursive partitioning analysis selected two factors significantly related to the prognosis: the radiographic spread of the pneumonia during RICU admission and the presence of septic shock.(ABSTRACT TRUNCATED AT 250 WORDS)

J Infect Dis, 1991 Aug, 164(2), 313 - 9
Antigenic variation of penicillin-binding proteins from penicillin-resistant clinical strains of Streptococcus pneumoniae; Hakenbeck R et al.; Penicillin-resistant strains of Streptococcus pneumoniae that are isolated with increasing frequency worldwide contain low-affinity penicillin-binding proteins (PBPs) . The relatedness of PBPs from 55 resistant strains isolated on three continents was investigated by testing the reactivity of antibodies specific for PBP 1a or 2b and by comparing the PBP patterns . Seventeen patterns of antibody reactivity could be distinguished, 12 of which were specific to one isolate . Most strains, including all German and South African strains, had a unique PBP profile . A few groups of Spanish and Finnish isolates were identified where the strains within each group shared the same PBP profile, the same antigenic variants of PBPs 1a and 2b, and the same serogroup, suggesting that they represent different clones of S . pneumoniae . The results demonstrated highly variable pathways of resistance development and confirmed that resistant strains have emerged independently in different locations.

J Infect Dis, 1991 Aug, 164(2), 307 - 12
Variability of penicillin-binding proteins from penicillin-sensitive Streptococcus pneumoniae; Hakenbeck R et al.; Penicillin-binding proteins (PBPs) from penicillin-susceptible strains of Streptococcus pneumoniae are believed to be fairly similar in contrast to PBPs occurring in resistant isolates . The antigenic variation of PBPs 1a and 2b in 65 penicillin-susceptible strains from different geographic areas and a wide variety of isolation sites was analyzed using a set of specific antisera and monoclonal antibodies . Three strains contained different antigenic variants of PBP 1a, and 50 strains contained one of three antigenic variants found in PBP 2b . Seven patterns of antibody reactivity could be defined; all but one were distinct from those found recently in resistant strains . In addition, electrophoretic mobilities of all six PBPs, compared after conventional SDS-PAGE and fluorography, revealed an unexpected variation of PBP-profiles even for strains of one sero-group . Few strains appeared identical to each other or to the laboratory reference strain R6.

J Infect Dis, 1991 Aug, 164(2), 302 - 6
Intercontinental spread of a multiresistant clone of serotype 23F Streptococcus pneumoniae; Munoz R et al.; Isolates of serotype 23F Streptococcus pneumoniae with high levels of resistance of penicillin have been commonly recovered in Spain for more than a decade . Recently penicillin-resistant serotype 23F S . pneumoniae strains were also isolated from children attending a day-care center in Cleveland . A number of Spanish and Cleveland isolates were compared by electrophoretic analysis of penicillin-binding protein (PBP) profiles and DNA restriction endonuclease cleavage profiles of the PBP 2X and 2B genes amplified with the polymerase chain reaction and by multilocus enzyme electrophoresis . All strains were identical by these criteria . The findings demonstrate that the Spanish and Cleveland isolates are clonally related and suggest that this antibiotic resistant clone of serotype 23F S . pneumoniae has spread intercontinentally from Spain to the United States.

Infect Immun, 1991 Aug, 59(8), 2856 - 8
Streptococcus pneumoniae produces at least two distinct enzymes with neuraminidase activity: cloning and expression of a second neuraminidase gene in Escherichia coli; Camara M et al.; A gene from Streptococcus pneumoniae was cloned in lambda EMBL301 and then expressed in Escherichia coli, which cleaved the fluorogenic neuraminidase substrate 2'-(4-methylumbelliferyl)-alpha-d-N-acetylneuraminic acid . The cloned gene therefore encodes an enzyme with neuraminidase activity . On the basis of restriction mapping and DNA hybridization studies, this gene could be distinguished from another pneumococcal neuraminidase gene cloned previously (A . M . Berry, J . C . Paton, E . M . Glare, D . Hansman, and D . E . A . Catcheside, Gene 71:299-305, 1988) . Both neuraminidase genes were found in each of five isolates, covering at least three serotypes, of pneumococci tested.

Infect Immun, 1991 Aug, 59(8), 2677 - 85
Sequence and structural analysis of surface protein antigen I/II (SpaA) of Streptococcus sobrinus; LaPolla RJ et al.; Streptococcal antigen I/II or the surface protein antigen A (SpaA) of Streptococcus sobrinus is an adhesin which mediates binding of the organism to tooth surfaces . The complete sequence of the gene which encodes SpaA has been determined . The gene consists of 4,584 bp and encodes a protein of 1,528 amino acid residues . The deduced amino acid sequence shows extensive homology with those of the cell surface adhesins from Streptococcus mutans serotypes c and f and from Streptococcus sanguis . Structural analysis of the N-terminal region (residues 50 to 550), which is rich in alanine and includes four tandem repeats of an 82-residue sequence, suggests that it adopts an alpha-helical coiled-coil conformation . Cell surface hydrophobicity may be associated with this region . The C-terminal region is more conserved and includes two tandem repeats of a 39-residue proline-rich sequence . A further proline-rich sequence in this region is predicted to span the cell wall . Although a hydrophobic sequence is present in the C-terminal region, it appears to be too short to span the cell membrane . Anchoring of SpaA in the cell membrane may therefore require some form of posttranslational modification or association with another membrane protein.

Enferm Infecc Microbiol Clin, 1991 Aug-Sep, 9(7), 413 - 5
{Lower respiratory infections caused by beta hemolytic group A Streptococcus}; Gutierrez J et al.; Three patients with beta-hemolytic group A streptococcal pneumonia were described . We emphasize the opportunistic pathogenic ability of the microorganism in the lower respiratory tract, and we describe the possible pathogenic mechanisms as well as the more frequent symptoms and complications.

Mol Gen Mikrobiol Virusol, 1991 Aug, (8), 11 - 3
{Cloning of the gene and immunochemical specificity of recombinant immunoglobulin binding protein V7 from Streptococcus valente (group G)}; Spirina GV et al.; The fragment of the structural gene coding for the Fc-receptor of Streptococcus Valente (G group) has been cloned . The resulting recombinant plasmid pPGSV1 contains the O, kb HindIII fragment of streptococcal chromosomal DNA inserted into the vector plasmid pUC19 and determines the expression of the 31 kD protein in Escherichia coli cells . The protein binds the immunoglobulins of human, rabbit, guinea pig origin, but in contrast to the G protein of another G group streptococcus it is nonreactive with mouse, pig and sheep IgG.

Scand J Dent Res, 1991 Aug, 99(4), 301 - 9
Combined effects of Zn(2+)-chlorhexidine and Zn(2+)-cetylpyridinium chloride on caries incidence in partially desalivated rats; Giertsen E et al.; The effects of Zn2+ combined with either chlorhexidine or cetylpyridinium chloride (CPC) on caries incidence in partially desalivated rats were investigated . Seven groups of 12 animals each received topical applications for 20 s with a saturated swab (0.2 ml) of the following aqueous solutions twice daily on weekdays (10 a.m . and 3 p.m.) and once daily during weekends (12 a.m.) for 5 wk: deionized water (placebo); 40 mM zinc acetate; 2.2 mM chlorhexidine diacetate; 4.4 mM CPC; 40 mM zinc acetate and 2.2 mM chlorhexidine diacetate; 40 mM zinc acetate and 4.4 mM CPC; and 20 mM NaF (positive control) . Coronal caries was scored by the method of Keyes . All treatments except CPC alone resulted in significantly (P less than 0.05, ANOVA) less smooth-surface caries than did the placebo . NaF treatment resulted in significantly less smooth-surface caries than did Zn2+, chlorhexidine, CPC, and Zn(2+)-CPC . The inclusion of zinc ions did not significantly increase the caries-inhibitory efficacy of chlorhexidine (CH) . The combination of Zn(2+)-CPC decreased smooth-surface scores significantly more than did CPC alone . Significant differences in sulcal-surface caries were not observed among the groups . Zn(2+)-CPC suppressed the Streptococcus sobrinus counts significantly more than did the separate agents . Animals treated with Zn(2+)-CH harbored the lowest populations of S . sobrinus.

An Med Interna, 1991 Aug, 8(8), 391 - 2
{Austrian's syndrome and infection with human immunodeficiency virus}; Carrasco R et al.; A case of a patient diagnosed of Austrian' syndrome associated to HIV infection is presented . Our aim is to highlight the frequent but not enough described association to pneumonia, endocarditis and meningitis caused by Streptococcus pneumonia to increased its knowledge and permit a correct and early treatment, improving the bad prognosis of this association.

J Clin Microbiol, 1991 Aug, 29(8), 1625 - 8
Application of a monoclonal antibody-based enzyme-linked immunosorbent assay for detection of an inflammatory response antigen in subclinical mastitic milk samples; Ball HJ et al.; A monoclonal antibody to a 23.5-kDa bovine inflammatory antigen present in high levels in mastitic milk has been used in an antigen-capture enzyme-linked immunosorbent assay (ELISA) to screen milk samples from herds of cattle for subclinical mastitis . The results from 20 herds with a total of 2,612 quarter samples are presented . Good correlation was observed between the ELISA level and the milk cell count (MCC) . The results demonstrated an average of 5% false negatives (1.8% associated with isolates of Staphylococcus aureus and/or Streptococcus spp.) and 7.7% false positives for each herd in relation to mastitic (greater than 400,000 cells per ml) or nonmastitic (less than 400,000 cells per ml) MCCs.

Antibiot Khimioter, 1991 Aug, 36(8), 28 - 31
{Immunological study of lysates from the cell wall of group A Streptococcus}; Shmakova ZF et al.; The chemical composition and presence of immunogenic components in the lysates of the cell walls of group A Streptococcus, type M29, were studied . The lysates were prepared with the use of muramidase . Fc-Receptors were detected in the lysates . Within the first 30 minutes of cell wall lysis by muramidase, 4 times higher amounts of the protein reacting with fibrinogen excreted than in the subsequent 4 hours . The lysates contained immunogenic proteins . Fraction III isolated by chromatography of the 30-minute lysate on DEAE-trisacryl formed a single precipitation band with lysate antiserum . The lysate Fraction IV forming three precipitation bands contained a protein not specific of the type . The protein was identical to the protein antigen from Triton X-100 extracts of group A Streptococcus, types M1, M12 and M29 . The group-specific polysaccharide was detected in the lysate Fraction I and Fraction II of the 4-hour lysate.

Arch Ophthalmol, 1991 Aug, 109(8), 1147 - 51
Characterization of infectious crystalline keratitis caused by a human isolate of Streptococcus mitis; McDonnell PJ et al.; Streptococcus mitis isolated from a human with infectious crystalline keratitis was injected intrastromally into corneas of adult New Zealand white rabbits that were treated with tetracycline hydrochloride, methylprednisolone acetate, or a combination of tetracycline and methylprednisolone . Animals were followed up for up to 44 days; untreated corneas and those treated with tetracycline developed no disease or "fluffy" stromal infiltrates with overlying epithelial defects representing an abscess . Corneas treated with the combination of tetracycline and corticosteroid usually developed crystalline stromal opacities that on histopathologic examination were shown to be intrastromal aggregates of cocci . Transmission electron microscopy of crystalline lesions within 10 days of infection revealed typical cocci intermixed with a fibrillar material having periodicity characteristic of fibrinogen or fibrin, and immunoperoxidase staining for fibrinogen was positive . By 1 month, electron microscopy revealed aggregates of degenerated bacteria that were surrounded by cellular processes of activated keratocytes . Our studies demonstrate a model for crystalline keratitis in which organisms are seen to reside within the stroma for up to 44 days without an inflammatory response . Periocular corticosteroids appear to be necessary to create this model . It is possible that the organisms are isolated from the host response by fibrin or by keratocytes.

Proc Natl Acad Sci U S A, 1991 Aug 1, 88(15), 6780 - 4
Drosophila Rrp1 protein: an apurinic endonuclease with homologous recombination activities; Sander M et al.; A protein previously purified from Drosophila embryo extracts by a DNA strand transfer assay, Rrp1 (recombination repair protein 1), has an N-terminal 427-amino acid region unrelated to known proteins, and a 252-amino acid C-terminal region with sequence homology to two DNA repair nucleases, Escherichia coli exonuclease III and Streptococcus pneumoniae exonuclease A, which are known to be active as apurinic endonucleases and as double-stranded DNA 3' exonucleases . We demonstrate here that purified Rrp1 has apurinic endonuclease and double-stranded DNA 3' exonuclease, activities and carries out single-stranded DNA renaturation in a Mg(2+)-dependent manner . Strand transfer, 3' exonuclease, and single-stranded DNA renaturation activities comigrate during column chromatography . The properties of Rrp1 suggest that it could promote homologous recombination at sites of DNA damage.

Kansenshogaku Zasshi, 1991 Aug, 65(8), 1009 - 13
{Severe infections due to Streptococcus milleri in children}; Sasaki H et al.; Streptococcus milleri (S . milleri) is found in healthy individuals in the mouth, nasopharynx, throat, vagina and in feces, and has been reported to be isolated from several infectious diseases in man, particularly from abscess in various parts of the body . We report two cases of severe infections due to S . milleri isolated from subdural abscess and pleural empyema . {Case 1} 13 year old boy who had been healthy until he was noticed to have meningeal signs and was diagnosed as left subdural abscess with siagonantritis by cranial CT scans . S . milleri was isolated from subdural abscess and maxillary sinus . {Case 2} 10 year old boy who had encephalitis and severe mental retardation after measles at 6 months of age . He had a fever, dyspnea and chest X-ray abnormalities and was diagnosed as right pleural empyema . Three strains of organism, S milleri, Bacteroides spp . and Fusobacterium nucleatum were isolated from the pleural effusion.

J Investig Allergol Clin Immunol, 1991 Aug, 1(4), 235 - 8
Cellular immunity in splenectomized patients; Balsalobre B et al.; Delayed hypersensitivity and lymphocyte subsets in a group of adult splenectomized patients after abdominal trauma without associated disease have been studied . The results were compared with those observed in healthy individuals . The results show a decreased cutaneous reaction against extracts of Streptococcus and diphtheria antigens . Moreover, an increase in the number of lymphocytes and monocytes was observed, but the T4/T8 ratio was not affected . The impaired cutaneous response against Streptococcus could be related to post-splenectomy sepsis.

Antimicrob Agents Chemother, 1991 Aug, 35(8), 1657 - 60
Nucleotide sequences specific for Tn1545-like conjugative transposons in pneumococci and staphylococci resistant to tetracycline; Poyart-Salmeron C et al.; The distributions of tet(M) and conjugative transposons related to Tn1545 were studied by hybridization in 47 clinical isolates of Streptococcus pneumoniae resistant to tetracycline . Resistance to tetracycline was always associated with resistance to minocycline and was due to the presence of the tet(M) gene . Association of tet(M) with int-Tn, the gene encoding the protein required for the movements of Tn1545-like transposons, was found in all but one strain of S . pneumoniae . In contrast, int-Tn was detected in only 2 of 37 strains of Staphylococcus spp . harboring tet(M).

Gene, 1991 Jul 31, 104(1), 11 - 7
Sequential cloning by a vector walking along the chromosome; Lacks SA et al.; A procedure was devised for sequential cloning of chromosomal DNA by cyclical integration and excision of a plasmid vector so that slightly overlapping chromosomal segments are successively cloned . The method depends on circular integration of the vector into the chromosome of a host nonpermissive for its replication, and on excision and reduction of a recombinant plasmid by use of an appropriately designed set of restriction enzyme sites in the vector . A vector suitable for cloning in Escherichia coli was constructed by combining a segment of pBR322 with a gene encoding chloramphenicol resistance expressible in many species . Sequential cloning was demonstrated in Streptococcus pneumoniae by extending a previously cloned segment of the region of the chromosome encoding maltosaccharide utilization by 8 kb in three cycles of cloning . Accuracy of the method was confirmed by hybridization of cloned DNA with chromosomal restriction fragments . It is pointed out that the similarity of the requisite genetic processes in bacteria and yeasts should allow use of the method for sequential cloning of yeast chromosomal DNA and of human or other mammalian DNA in artificial chromosomes of yeast.

JAMA, 1991 Jul 24-31, 266(4), 533 - 7
Outbreak of group A streptococcus septicemia in children . Clinical, epidemiologic, and microbiological correlates; Wheeler MC et al.; OBJECTIVE . To determine the epidemiologic, clinical, and microbiological features of group A streptococcus septicemia in children . DESIGN . A descriptive series of 34 cases over an 11-year period from 1980 through 1990 . SETTING . An academically affiliated tertiary-care pediatric hospital, the principal referral center for the state of Colorado and surrounding states . PARTICIPANTS . Thirty-four patients with positive blood cultures for group A streptococcus (33 medical records were available) . MAIN OUTCOME MEASURES . Yearly incidence and clinical features of cases; microbiological features of isolated organisms . RESULTS . There was a significant increase (P = .01) in the incidence of group A streptococcus bacteremia over an 11-year period, with 14 (41%) of these cases occurring in 1989 and 1990 . Patients had a rapidly progressing illness, usually without preceding pharyngitis . The prominent M and T types were 1 (4) and 12 (4) . Eleven (73%) of the 15 strains produced pyrogenic exotoxin B that significantly correlated with production of proteinase . CONCLUSION . There appears to be an increase in group A streptococcus bacteremia in children that is associated with a strain phenotype that suggests a change in organism virulence.

Cancer, 1991 Jul 15, 68(2), 259 - 63
Intrapericardial OK-432 instillation for the management of malignant pericardial effusion; Imamura T et al.; Ten patients with malignant pericardial effusion were treated with intrapericardial injection of OK-432 (penicillin-treated and heat-treated lyophilized powder of the substrain of Streptococcus pyogenes A3) . After intrapericardial insertion of a catheter, a maximal volume of pericardial fluid was withdrawn with cytologic confirmation of malignancy . Five or 10 Klinische Einheit (KE) (KE is a unit used to express the strength of a preparation) of OK-432 diluted in 20 ml of saline was injected into the pericardial space in seven and three patients, respectively . It was repeated in case of reaccumulation . Seven patients were treated only once and the remaining three required a second treatment . Complete control of pericardial effusion was achieved in all patients for an average of 329 days (range, 54 to 790 days) . Fever and chest pain were experienced in six and five patients, respectively, but were controlled with antipyretics . Two of three patients who received 10 KE of OK-432 experienced hypotension that was successfully controlled with vasopressor drugs with or without reaspiration of pericardial fluid . Rapid reactive reaccumulation of the pericardial fluid was thought to be a cause of hypotension . A follow-up computed tomography (CT) scan was performed in seven patients and a thickened pericardium was noticed in five; no patients had constrictive pericarditis . These results suggest that intrapericardial administration of 5 KE of OK-432 is an effective and safe treatment for malignant pericardial effusion.

J Am Vet Med Assoc, 1991 Jul 15, 199(2), 190 - 6
Costs associated with selected preventive practices and with episodes of clinical mastitis in nine herds with low somatic cell counts; Hoblet KH et al.; Nine dairy herds (mean size, 149 cows) with bulk-tank milk somatic cell counts of less than 300,000 cells/ml and greater than 80% of cows with Dairy Herd Improvement Association linear somatic cell counts less than or equal to 4 were selected for study . Each herd was monitored for 12 consecutive months . Duplicate quarter-milk specimens were collected from each cow for bacteriologic culturing at beginning of lactation, cessation of lactation, and at the time of each clinical episode of mastitis . Streptococcus agalactiae was never isolated and Staphylococcus aureus was isolated from less than 1% of all quarters . There were 554 episodes of clinical mastitis . During the year of study, the incidence rate of clinical mastitis varied from 15.6 to 63.7% of cows among the 9 herds . Mean costs per cow per year in herd for mastitis prevention were: $10 for paper towels, $3 for nonlactating cow treatment, and $10 for teat disinfectants . Mean cost associated with clinical mastitis was $107/episode . Approximately 84% ($90) of the costs attributed to a clinical episode were associated with decreased milk production and nonsalable milk . Costs of medication and professional veterinary fees per clinical episode varied significantly among the 9 herds . Three of the herds did not have a veterinarian treat a clinical episode of mastitis during the year of study even though 2 of these herds had the first and third highest incidence rates of clinical mastitis . When calculated on a per cow in herd basis, mean costs of $40/cow/year were attributed to clinical mastitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral Surg Oral Med Oral Pathol, 1991 Jul, 72(1), 101 - 4
The comparative antimicrobial effect of calcium hydroxide; Stuart KG et al.; The antimicrobial effectiveness of calcium hydroxide, camphorated paramonochlorophenol, and formocresol in root canals of extracted human teeth was compared . Canals in single-rooted teeth were enlarged and inoculated with Streptococcus mutans, Actinomyces viscosus, and Bacteroides gingivalis or Bacteroides fragilis . After treatment with a test agent and sealing and incubation for 1 hour, the canal contents were analyzed for the number of viable test bacteria and compared with that of inoculated teeth not treated with test agents . All test agents exhibited antimicrobial activity against all bacteria, with percent reductions in viable bacteria ranging from 64.3% to 100% . The combined data for Pulpdent paste and calcium hydroxide showed significantly higher antimicrobial activity than the combined data for camphorated paramonochlorophenol and formocresol for S . mutans and B . gingivalis or B . fragilis but showed no difference for A . viscosus.

N Engl J Med, 1991 Jul 11, 325(2), 92 - 7
Hyperendemic Streptococcus pyogenes infection despite prophylaxis with penicillin G benzathine; Gray GC et al.; BACKGROUND . In closely confined populations, in which epidemics of Streptococcus pyogenes infection are common, penicillin G benzathine has long been used prophylactically to reduce morbidity from this pathogen . We report on our investigations of the effectiveness of penicillin G benzathine prophylaxis at a military recruit camp . METHODS . We prospectively studied the rates of pharyngeal colonization and infection by S . pyogenes among 736 male U.S . Marine Corps recruits from January through March 1989 . Throat swabs for culture, clinical data, and questionnaire data were obtained during six examinations at intervals of two weeks . Serum samples obtained before training, after training, and from acutely ill recruits were analyzed with use of an antistreptolysin O microtitration technique . RESULTS . Although 93 percent of the recruits received prophylaxis with two intramuscular injections of 1.2 million units of penicillin G benzathine each (administered 30 to 39 days apart), 33 percent of the recruits were colonized by S . pyogenes, and 42 percent had infection (as defined by a two-dilution increase in the antistreptolysin O titer) . Thirty-seven percent of 265 recruits who reported a sore throat and were infected with S . pyogenes did not seek medical attention . The recruits who were allergic to penicillin (7 percent of the total), who received no prophylaxis, were more likely to be colonized; an increased risk of colonization and infection among the nonallergic recruits was associated with the presence of a higher percentage of allergic recruits in the platoon . After the study was completed, all recruits who were allergic to penicillin were prescribed 250 mg of oral erythromycin twice daily (a total daily dose of 500 mg) for 60 days . Subsequently, the average weekly rate of clinically evident S . pyogenes pharyngitis fell by more than 75 percent . CONCLUSIONS . If the prevention of S . pyogenes infection is to be effective in closely confined populations such as military recruits, prophylactic antibiotics must be administered to all members of the population . Exempting those who are allergic to penicillin may create a bacterial reservoir from which infection can be transmitted to nonallergic members of the population.

J Med Microbiol, 1991 Jul, 35(1), 60 - 3
Detection of nephritis strain-associated streptokinase by monoclonal antibodies; Ohkuni H et al.; Monoclonal antibodies (MAbs) N-59 and RU-1 were produced by immunisation of mice with streptokinase secreted by Streptococcus group A, type 12, strain A374 isolated from a patient with post-streptococcal glomerulonephritis (PSGN) and were characterised by Western blot analysis . MAb N-59 recognised antigenic determinants shared by both nephritis strain-associated streptokinase (NSA-SKase) and streptokinase of Streptococcus group C (C-SKase); MAb RU-1 reacted only with NSA-SKase . All nephritis-associated group A streptococcal strains tested reacted with MAb N-59; 87.5% of these strains reacted with MAb RU-1 . MAb N-59 reacted with SKase produced by group G streptococcal strains isolated from patients with PSGN, and MAb RU-1 recognised SKase in two out of three of these strains.

Am J Orthod Dentofacial Orthop, 1991 Jul, 100(1), 35 - 7
Salivary Streptococcus mutans levels in patients before, during, and after orthodontic treatment; Rosenbloom RG et al.; The purpose of this study was to evaluate salivary Streptococcus mutans levels in patients before, during, and after orthodontic treatment . S . mutans levels were significantly elevated during active treatment . However, when sampled 6 to 15 weeks into the retention phase of treatment, the microbial levels decreased significantly to levels comparable to age-matched untreated controls . In addition, patients who were no longer wearing any retention appliances had S . mutans levels similar to those subjects sampled in the retention phase of treatment as well as to subjects in age-matched control groups . The findings of the study suggest that orthodontic treatment does not result in any long-term elevations of S . mutans levels.

Ann Otol Rhinol Laryngol, 1991 Jul, 100(7), 593 - 6
Middle ear fluid lysozyme source in experimental pneumococcal otitis media; Nonomura N et al.; Middle ear infection with Streptococcus pneumoniae is important in the pathogenesis of acute and chronic otitis media, and lysozyme in middle ear fluid (MEF) is an important inflammatory mediator in this disease . To determine the source of lysozyme during the early period of acute pneumococcal otitis media, chinchillas were irradiated to induce neutropenia, and their middle ears were inoculated with heat-killed, encapsulated pneumococci . The number of inflammatory cells and concentration of lysozyme were measured in MEF between 6 and 72 hours after inoculation . In pneumococcus-inoculated ears, the mean number of inflammatory cells but not lysozyme was significantly lower in MEF from irradiated animals than that from nonirradiated animals at 6 hours . Since lysozyme accumulated in MEF before the influx of inflammatory cells in irradiated animals, the initial release of this inflammatory mediator is most likely not from inflammatory cells; and mucosal epithelial cells, the only other known source of lysozyme in the middle ear environment, were the probable source induced by the direct stimulation of pneumococci . Inflammatory cells may contribute lysozyme later in the inflammatory response, since cellular and lysozyme concentrations in irradiated and nonirradiated animals were similar between 24 and 72 hours . These results suggest that future therapeutic interventions to limit middle ear inflammation in acute otitis media may need to recognize the direct action of pneumococcal cells or their envelope components on middle ear epithelium.

Pediatrics, 1991 Jul, 88(1), 154 - 6
Group A beta-hemolytic streptococcal balanitis: it may be more common than you think; Kyriazi NC et al.; Group A beta-hemolytic Streptococcus can cause balanitis in prepubertal males, and its incidence is probably greater than previously reported in the pediatric literature . We suggest the routine inclusion of a GABHS-selective culture in any case where a discharge or irritation is present on the glans or foreskin, especially if a recent streptococcal infection has been documented, whether or not sexual abuse is being considered . Finally, we hope to stimulate interest for further in-depth study of balanitis caused by GABHS.

Infect Immun, 1991 Jul, 59(7), 2297 - 304
Purification and immunogenicity of genetically obtained pneumolysin toxoids and their conjugation to Streptococcus pneumoniae type 19F polysaccharide; Paton JC et al.; As part of an ongoing study concerned with improving human vaccines against Streptococcus pneumoniae, the genes for two defined pneumolysin (PL) toxoids (pneumolysoids), Pd-A (PL with a Cys----Gly substitution at amino acid 428) and Pd-B (PL with a Trp----Phe substitution at position 433), were inserted into the high-expression vector pKK233-2 in Escherichia coli and the pneumolysoids were purified . Groups of mice which had been immunized with either Pd-A, Pd-B, or native PL purified from S . pneumoniae were then challenged either intranasally or intraperitoneally with virulent pneumococci . Mice in all immunized groups survived significantly longer than sham-immunized controls . Both pneumolysoids were more effective than PL as protective immunogens . Pneumolysoid Pd-B was conjugated covalently with pneumococcal type 19F capsular polysaccharide (19F PS), and the immunogenicities of both the protein and the PS moieties of the conjugate in mice were determined . Significant anti-PL titers were obtained, and the immunogenicity of the 19F PS moiety was markedly enhanced compared with that of unconjugated PS . Conjugation also appears to have converted the 19F PS into an antigen capable of inducing a booster effect . These results support the notion that the efficacy of human, PS-based antipneumococcal vaccines might be improved by supplementation with pneumolysoid in the form of a covalent pneumolysoid-PS conjugate.

Minerva Pediatr, 1991 Jul-Aug, 43(7-8), 481 - 92
{Rheumatic fever in childhood--today}; Calvani M; Acute rheumatic fever in the young: a review of historical land marks and the current status of rheumatic fever are discussed . The follows are presented here: prevent-day epidemiology; the role of group A streptococcus and the reappearance of "rheumatogenic" serotypes; the host's susceptibility and the tantalizing possibility of a genetic basis; the basis of autoimmune pathogenesis (so-called molecular mimicry); the increasing diagnostic difficulties and the critical review of Jones criteria; the reassessment of primary prevention and the couvent possibility of a streptococcal vaccine.

Clin Ther, 1991 Jul-Aug, 13(4), 460 - 6
Ofloxacin in the treatment of lower respiratory tract infections: report of a prospective, comparative trial; Khajotia RR et al.; The subjects were 241 patients with lower respiratory tract infections treated at two medical centers in Austria; 161 of the patients were evaluated clinically and, of these, 69 were evaluated bacteriologically . The patients were randomly assigned to receive ofloxacin (n = 101) or a comparison drug (doxycycline {n = 27} or amoxicillin-clavulanate {n = 33}) . The mean age of patients in the ofloxacin group was 61 years; that of patients in the comparison groups was 64 years . The mean duration of treatment was nine days; most patients received the study drug intravenously for three days and then orally for four to seven days . In most patients, the doses were 200 mg of ofloxacin twice daily; 100 mg of doxycycline twice daily; or 2,200 mg of amoxicillin-clavulanate intravenously two or three times daily, followed by 625 mg orally two to four times daily . The clinical response was rated satisfactory (all pretreatment symptoms disappeared) in 28% of the ofloxacin-treated patients and in 22% of the other two groups; improved (all except one symptom improved) in 70% and 65%, respectively; and unsatisfactory in 2% and 13%, respectively . The bacteriologic response was rated satisfactory in 59% of the 39 evaluable ofloxacin-treated patients and in 50% of the 30 patients in the other two groups . Most of the unsatisfactory responses were associated with persistent strains of Streptococcus pneumoniae . Transient side effects of mild to moderate severity were noted in nine of the 101 ofloxacin-treated patients and in seven of the 60 patients in the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Minerva Med, 1991 Jul-Aug, 82(7-8), 495 - 500
{Streptococcus mitis endocarditis . Description of a clinical case}; Marolda A et al.; The diagnostic iter of a case of Streptococcus mitis endocarditis is reported . Bacterial endocarditis was diagnosed in a 32-year-old patient following ultrasound cardiography and microbiological tests . The paper stresses the importance of ultrasound cardiography in the diagnosis of bacterial endocarditis.

Thorax, 1991 Jul, 46(7), 508 - 11
Aetiology of community acquired pneumonia in Valencia, Spain: a multicentre prospective study; Blanquer J et al.; A year long multicentre prospective study was carried out in the Valencia region of Spain, to determine the cause of community acquired pneumonia . The study was based on 510 of 833 patients with pneumonia . Of these, 462 were admitted to hospital, where 31 patients died . A cause was established in only 281 cases--208 of bacterial, 60 of viral, and 13 of mixed infection . The most common microorganisms were Streptococcus pneumoniae (14.5%), Legionella sp (14%), Influenza virus (8%), and Mycoplasma pneumoniae (4%) . There was a higher incidence of Legionella sp than in other studies.

Kokyu To Junkan, 1991 Jul, 39(7), 725 - 8
{A case of mitral stenosis developing infective endocarditis 18 months after PTMC}; Tada Y et al.; We presented here a case of mitral stenosis developing infective endocarditis 18 months after PTMC . A 33-year-old male was admitted to our hospital for the evaluation of mitral stenosis with signs of congestive heart failure . The use of PTMC was adequately indicated based on the data of previous cardiac catheterization and was successfully performed . The post-operative clinical course was good leaving only slight mitral regurgitation demonstrated by post-valvuloplasty LVG . About 18 months after PTMC, the patient developed a high fever and erythema with tenderness on his leg, so he was admitted again . Blood culture was positive for streptococcus viridans . Moreover, echocardiogram revealed valvular vegetation on the anterior mitral leaflet, which is the characteristic finding of infective endocarditis . Antibiotics were so effective that his clinical course was relatively good with minor cerebral infarction during chemotherapy . Little is known about the prognosis and late complication of PTMC . However, our reported case may suggest that prophylactic chemotherapy might be recommended at least in some cases showing mitral regurgitation after PTMC.

Ophthalmic Surg, 1991 Jul, 22(7), 412 - 3
Infectious crystalline keratopathy occurring in an eye subsequent to glaucoma filtering surgery with postoperative subconjunctival 5-fluorouracil; Patitsas C et al.; We present a case of infectious crystalline keratopathy occurring after 5-fluorouracil filtering surgery . The patient had discrete, branching, white crystalline lesions in the anterior corneal stroma . Cultures grew Streptococcus viridans, and gram-positive cocci were demonstrated in corneal tissue biopsy specimens . Toxic and immunosuppressive properties of 5-fluorouracil may have participated in the pathogenesis of the infectious crystalline keratitis.

Cornea, 1991 Jul, 10(4), 341 - 5
Scleritis and Streptococcus pneumoniae; Altman AJ et al.; We retrospectively review our experience with four patients with Streptococcus pneumoniae scleritis . Two of the patients had been exposed to beta irradiation after pterygium removal 4 and 13 years previously . One patient had a 3-year history of chronic anterior nodular scleritis, and one patient had severe rheumatoid arthritis . All were treated with intensive i.v . and topical fortified antibiotics . In two of the cases, the infection was controlled and visual acuity returned to 20/30 and 20/60 . In one patient, infectious scleritis progressed to endophthalmitis . This eye ultimately became phthisical and required enucleation because of chronic pain . In the remaining patient, infectious scleritis led to perforation, which required a corneal-scleral patch graft . This patient had a final visual acuity of counting fingers . An infectious etiology should be suspected in cases of necrotizing scleritis associated with a purulent discharge, and appropriate smears and cultures should be obtained . Infectious scleritis can be caused by streptococcal organisms . Appropriate topical and intravenous antibiotic treatment is effective in some cases.

Diagn Microbiol Infect Dis, 1991 Jul-Aug, 14(4), 281 - 5
Evaluation of the modified Visuwell Strep-A enzyme immunoassay for detection of group-A Streptococcus from throat swabs; Drulak M et al.; The modified Visuwell Strep-A enzyme immunoassay (EIA) was compared with culture for detection of group-A Streptococcus from throat swabs . Throat swabs in modified Stuarts medium obtained after culture at two institutions were tested in Visuwell . Cumulative results were n = 417, sensitivity 87.8%, specificity 89.9% predictive value positive (PVP) 67.9%, predictive value negative (PVN) 96.8%, and accuracy 89.5% . At another site, swabs were delivered to the laboratory without transport medium, cultured, and subsequently tested by Visuwell (n = 202, sensitivity 79.6%, specificity 84.5%, PVP 65.2%, PVN 91.9%, accuracy 83.2%) . When 1+ culture-positive specimens were considered negative, the sensitivity and PVN increased from 79.6% to 90.2% and 91.9% to 97.1% respectively . Overall performance of the modified Visuwell was comparable with that of the initial assay for throat swabs transported with or without modified Stuarts medium . Cross reaction with organisms other than group-A Streptococcus normally found in the oropharynx was negligible in Visuwell and the limit of detection of group-A Streptococcus was 5 x 10(4) colony-forming units.

Can J Vet Res, 1991 Jul, 55(3), 302 - 4
Adherence of Streptococcus suis capsular type 2 to porcine lung sections; Gottschalk M et al.; The present study was undertaken to evaluate the ability of 33 Streptococcus suis capsular type 2 isolates to adhere to frozen sections of porcine lung . Twenty isolates originated from diseased pigs and 13 from the nasal cavities of clinically healthy pigs . All isolates from diseased animals adhered to lung sections; isolates from pneumonia adhered, in general, in greater numbers than isolates from meningitis . Only four isolates from clinically healthy animals showed a weak adherence to lung sections . Hydrophobic surface properties were also evaluated . All isolates tested appeared to possess a hydrophilic cell surface . The thickness of the capsular material correlated well with the degree of adherence . However, when the adherence capacity of a noncapsulated mutant was compared with that of the parent strain, it was found that the mutant strain had at least the same adherence capacity as the capsulated parent strain . The data suggest that S . suis capsular type 2 isolates involved in pathological conditions can adhere to porcine lung tissue . The adherence activity does not seem to involve hydrophobic interactions . The amount of capsular material seems to influence the adherence activity, but is probably not the only mechanism involved.

Pediatr Dent, 1991 Jul-Aug, 13(4), 217 - 20
Aspartame and dental caries in the rat; Das S et al.; Aspartame (NutraSweet--The NutraSweet Co., Deerfield, IL) an artificial intense sweetener, was tested for its cariogenicity alone and in the presence of sucrose . Sprague-Dawley rat pups (Charles River Laboratories, Bloomington, MA) inoculated with Streptococcus mutans were fed basal diet 2000 with one of the following added: 50% sucrose; 30% sucrose; 30% sucrose + 0.15% aspartame; 0.30% aspartame; 0.15% aspartame and no addition . The animals were sacrificed after eight weeks . Caries was evaluated using Keyes' technique . It was found that the addition of 0.15% aspartame to 30% sucrose diet significantly reduced caries in comparison to rats fed only 30% sucrose diet . In animals fed aspartame only, there was no caries . The S . mutans counts were high in the animals receiving sucrose diets with and without aspartame . The animals receiving only aspartame had very low S . mutans counts.

Ugeskr Laeger, 1991 Jul 1, 153(27), 1924 - 6
{Autotransplantation of splenic tissue after splenectomy in adults}; Becker NA; Splenectomy involves a risk of development of postsplenectomy sepsis, PSS . An assessment of the incidence of PSS is made on the basis of a review of the literature . Experimental studies on animals suggest that splenic autotransplantation exerts a protective effect following nasal exposure to Streptococcus pneumoniae . Where other routes of exposure are concerned, the results are contradictory, but no general effect has been found . Clinical data is limited and the effect cannot be assessed as yet . The technique of autotransplantation and the commonest complications are summarised . On this basis, several guidelines are presented . It is concluded that splenic autotransplantation is a potentially beneficial alternative to total splenectomy but that it involves a certain risk . The procedure should, therefore, only be carried out under clinically controlled conditions.

Rev Chil Pediatr, 1991 Jul-Aug, 62(4), 256 - 9
{Total gastrectomy in newborn infant}; Barrera F et al.; Total gastrectomy is rarely indicated in childhood and when necessary it involves multiple ulterior therapeutic problems, mainly nutritional, which need a meticulous physiological approach to avoid further complications, as illustrated by the following patient who, at age 15 months, was submitted to total gastric resection, Y en Roux esophagojejunal anastomosis and splenectomy, because of peritonitis secondary to dehiscence of a recent esophagogastric anastomosis for partial gastric resection due to gastric volvulus and necrosis, which in turn were associated to diaphragmatic relaxation . The patient was admitted to our hospital one month later with signs of acute calorie-protein malnutrition (W/A 60% and W/H 68%, NCHS standards) requiring combined parenteral and enteral nutritional support (via central venous catheter and jejunostomy tube for 15 and 35 days respectively) together with intramuscular vitamin B 12, oral iron and oral vitamin supplements before it became possible to fed him only by mouth . Prophylaxis against Streptococcus pneumonia infections with monthly benzatin penicillin was also instituted . Mean daily weight increases of 16 g, W/A 68% and W/H 74% were thus achieved before hospital discharge, without evidence of dumping syndrome nor alkaline reflux.

Clin Oral Implants Res, 1991 Jul-Sep, 2(3), 121 - 7
Clinical and microbiological findings on newly inserted hydroxyapatite-coated and pure titanium human dental implants; Rams TE et al.; The clinical and microbiologic features of 30 hydroxyapatite-coated root-form endosseous dental implants (Tri-Stage) were compared to 10 similar pure titanium implants without hydroxyapatite coatings . In 7 of 9 partially edentulous patients studied, pure titanium fixtures were placed adjacent to hydroxyapatite-coated implants . Implants in the maxilla were submerged beneath mucosal tissues after implant placement for a minimum of 6 months, and in the mandible for at least 4 months . All patients were prescribed short-term beta-lactam antibiotic therapy after fixture placement, and 8 of 9 used chlorhexidine mouthrinses after fixture exposure . Clinical and microbiological examination was carried out 7-10 months after fixed prosthetic loading of the implants . Clinical measurements included the gingival index, plaque index, bleeding on probing and peri-implant probing depths determined with the Florida Probe system . Subgingival microbial samples were collected with paper points and transported in VMGA III . Specimens were examined by direct phase-contrast microscopy and were plated onto nonselective and selective culture media for anaerobic and aerobic incubation . No significant mean clinical or microbiological differences were found between the implant types, although one hydroxyapatite-coated implant exhibited deep probing depths, bleeding on probing and marked radiographic crestal bone loss . Streptococcus sanguis and Streptococcus mitis were the most predominant organisms recovered from clinically stable implants, whereas high proportions of Fusobacterium species and Peptostreptococcus prevotii were isolated from the ailing hydroxyapatite-coated implant . One or more implants in 8 of the study subjects yielded enteric rods, pseudomonads, enterococci or staphylococci . The prognosis of implants with varying early microbiotas needs to be established in longitudinal studies.

Arq Gastroenterol, 1991 Jul-Sep, 28(3), 79 - 85
{Spontaneous bacterial peritonitis: occurrence in chronic liver disease patients in Recife}; Andrade-Lima R et al.; A prospective research was made on spontaneous bacterial peritonitis (SBP) in chronic liver disease patients presenting with ascites . Forty clinical cases, of 37 patients, were analysed . All subjects were submitted to clinical and laboratory evaluation and diagnostic paracentesis, and the material was obtained for biochemical dosages, pH determination, cytology and bacterial cultures . Thirty cases of sterile ascites and 10 of SBP (25%) were detected . In 5 (50%) with SBP, the clinical findings were characteristic, with fever, abdominal pain and rebound tenderness . In 2 patients (20%) the presentation was atypical, without the complete triad described above . Finally in 3 (30%) SBP was silent, without any suggestive clinical manifestations of infection . In 7 cases (70%) cultures were positives; Streptococcus pneumoniae (3 cases), Streptococcus pyogenes, Staphylococcus negative coagulase, Staphylococcus aureus and Klebsiella pneumoniae (one case each) . In 7 (70%) SBP cases, the patients were admitted already infected in the hospital . Lethality in the SBP group was 30% and in the sterile ascites was 13.3% . We concluded that SBP is a frequent cause of morbid-lethality in patients with ascites and chronic hepatopathy, presenting itself often in a typical clinical manifestations.

Med J Aust, 1991 Jul 1, 155(1), 14 - 7
Spinal epidural abscess: presentation and treatment . A report of 21 cases; McGee-Collett M et al.; OBJECTIVE: To examine the presentation, investigative findings, treatment and outcome in patients with spinal epidural abscess . DESIGN AND SETTING: The study was a retrospective analysis of all patients with this condition presenting to the Neurosurgical Units at the Royal Prince Alfred Hospital and Westmead Hospital, Sydney, during the period September 1984 to September 1987 . PATIENTS: There was a total of 21 patients with an age range from 7-87 years (mean 47 years) . Eleven cases were acute and ten chronic . The causative organism was Staphylococcus aureus in 15 of the 21 cases, the other organisms involved were Mycobacterium tuberculosis, Escherichia coli, Streptococcus and Pseudomonas aeruginosa . INTERVENTIONS: All patients were treated with a combination of surgery (decompression with or without fusion) and prolonged antibiotic administration . RESULTS: Of the 21 patients 11 had a good to excellent outcome while 10 had a poor outcome . CONCLUSION: The main determinant of outcome was the neurological state at presentation emphasising the importance of early diagnosis and prompt treatment.

Infect Immun, 1991 Jul, 59(7), 2316 - 23
Cariogenicity of Streptococcus mutans V403 glucosyltransferase and fructosyltransferase mutants constructed by allelic exchange; Munro C et al.; Streptococcus mutans produces several enzymes which metabolize sucrose . Three glucosyltransferase genes (gtfB, gtfC, and gtfD) and a single fructosyltransferase gene (ftf) encode enzymes which are important in formation of exopolysaccharides . Mutants of S . mutans V403 carrying single and multiple mutations of the gtfB, gtfC, gtfD, and ftf genes recently have been constructed by allelic exchange in our laboratory . Using selected strains from this panel of mutants, we examined the importance of water-insoluble glucan, water-soluble glucan, and fructan production in cariogenicity while controlling for the effects of strain and species variability . Genetic and biochemical characterization of mutants and assays of glucosyltransferase and fructosyltransferase activities were performed to ensure that the phenotypes of strains coincided with deficiencies predicted by genotype . The young gnotobiotic rat model of cariogenicity was used to assess virulence of the wild-type strain and isogenic mutants . Mutant strains were less virulent than the wild type in almost every location examined for caries on tooth surfaces and level of involvement of lesions (depth and severity) . Inactivation of either gtfB and gtfC or ftf dramatically reduced virulence; the subsequent inactivation of gtfD did not enhance the effect of reduced virulence.

Rev Argent Microbiol, 1991 Jul-Sep, 23(3), 138 - 45
{Incidence of Streptococcus mutans and changes in the concentration of serum immunoglobulins and SIgA in allergic children with caries}; Maldonado AM et al.; The incidence of Streptococcus mutans in dental plaque and the relationship between dental caries and the levels of serum Igs and IgAS was investigated in allergic children . The relationship between IgAS mean levels and a) cariogenic diet, b) fluoride concentration in consumption water and c) different frequency in brush-washing was also studied . Direct examination of specimens obtained from either dental plaque or caries was performed . Cultures in tryptone soy agar and blood agar base were carried out . Catalase and nitrate reductase tests and biochemical tests for the identification of Streptococcus mutans were also done . Seric Igs and IgAS from saliva secretion were measured by radial immunodiffusion technique . Streptococcus mutans were found in 25/45 samples from allergic children, in 3/16 non allergic, in 25/43 children with caries and 3/18 children without caries . IgM reached higher levels in children with caries . Seric IgA average levels were lower in allergic children and were significantly increased in the non-allergic with caries . Most allergic children with caries showed very low IgAS values . Cariogenic diet, fluoride water ingestion and frequent brush-washing had no effect on IgAS concentration . Allergic children with caries showed low levels of seric IgA and Streptococcus mutans were frequently found in dental plaque . In these patients the specific class IgA response against the potentially cariogenic microorganisms was diminished . Allergic as well as non-allergic children with dental caries showed low IgAS levels suggesting that this may be an important factor in caries development.

Dent Mater, 1991 Jul, 7(3), 155 - 60
In vivo and in vitro studies on soft denture materials: microbial adhesion and tests for antibacterial activity; Okita N et al.; The microbiological properties of four tissue conditioners, one soft liner, and one acrylic resin were studied . The tissue conditioners showed no or negligible antimicrobial effects toward salivary microorganisms by two different in vitro tests . In in vitro adhesion experiments, more Streptococcus mutans and Candida albicans adhered to the tissue conditioners and the soft liner in comparison with conventional acrylic resin used for denture-base fabrication . No difference in bacterial adhesion was found among the tissue conditioners . The microbial colonization of two tissue conditioners lined on maxillary dentures in three volunteers was followed for 14 days . No difference among the materials was found, but a tendency for subject-dependence in plaque formation on the materials was noted.

J Pharm Belg, 1991 Jul-Aug, 46(4), 236 - 40
{Synthesis and antimicrobial activity of substituted fluorobenzyl benzylidenethiazolidinediones and imidazolidinediones}; Goes AJ et al.; The synthesis of six benzylidene thiazolidine-diones and three benzylidene imidazolidine-diones is described . In order to investigate their antimicrobial activity, they are evaluated against micro-organism such as Staphylococcus aureus, Streptococcus feacalis, Mycobacterium smegmatis and Neurospora crassa.

J Gen Microbiol, 1991 Jul, 137 ( Pt 7), 1603 - 9
Immunological relationships between glucosyltransferases synthesizing insoluble glucan from Streptococcus cricetus, Streptococcus sobrinus and Streptococcus downei; Tsumori H; The Mr values and isoelectric points of glucosyltransferases synthesizing insoluble glucan (GTF-Is) were determined, and the immunological relationships between them studied . The GTF-I enzymes were from Streptococcus cricetus (mutans group serotype a), Streptococcus sobrinus (mutans group serotypes d and g) and Streptococcus downei (mutans group serotype h) . By double immunodiffusion tests, the GTF-I enzymes from the three species possessed a common antigenic determinant; in addition, the GTF-I enzymes of serotypes d, g and h shared a further determinant . The S . sobrinus serotypes d and g GTF-I enzymes were immunologically identical . The GTF-I enzymes of S . sobrinus serotypes d and g, and of S . downei, had an Mr of 161,000 and isoelectric points of 4.8-4.9, while S . cricetus GTF-I had a lower Mr (150,000) and a higher isoelectric point (5.2) . This suggests that the S . cricetus GTF-I enzyme may lack a sequence of amino acids which include the determinant shared by S . sobrinus and S . downei GTF-I enzymes . Antibodies specific to the determinant shared by all four serotypes inhibited the homologous and heterologous enzymes by 94-100%.

Am J Dis Child, 1991 Jul, 145(7), 808 - 12
Neutropenia in an extremely premature infant treated with recombinant human granulocyte colony-stimulating factor; Roberts RL et al.; Neutropenia in the newborn is often associated with sepsis, maternal hypertension, or prematurity . We describe a 654-g infant born at 30 weeks' gestation by cesarean section due to severe maternal hypertension . His course was complicated by five episodes of sepsis, including three with group B streptococcus . The results of hematologic and immunologic studies were normal except that absolute neutrophil counts were low (less than 1 x 10(9)/L) with intermittent increases during sepsis . Human recombinant granulocyte colony-stimulating factor administered subcutaneously (10 micrograms/kg per day initially) resulted in an absolute neutrophil count of greater than 30 x 10(9)/L within 2 weeks . The dosage was lowered and the absolute neutrophil counts were maintained at 8 to 12 x 10(9)/L with no further septic episodes . The human recombinant granulocyte colony-stimulating factor therapy was discontinued after 7 months, and the patient remained healthy with an absolute neutrophil count of greater than 2 x 10(9)/L . Thus, treatment with human recombinant granulocyte colony-stimulating factor may be useful as a temporary measure for neonatal neutropenia associated with sepsis . A controlled, clinical trial is warranted.

Rev Infect Dis, 1991 Jul-Aug, 13(4), 559 - 63
Spinal sepsis due to Streptococcus milleri: two cases and review; Gelfand MS et al.; We have recently cared for two patients with spinal sepsis secondary to infection with Streptococcus milleri . One patient had a spinal epidural abscess and the other had meningitis as well as a spinal subdural empyema . A review of the English-language literature revealed only two previously reported cases of spinal epidural abscess due to S . milleri and no cases of spinal subdural empyema due to S . milleri . We report two cases of spinal sepsis due to S . milleri and discuss pertinent literature.

Schweiz Med Wochenschr, 1991 Jun 22, 121(25), 932 - 7
{Therapy and prognosis of bacterial arthritis: a retrospective analysis}; Misteli M et al.; Antibiotic therapy and immediate drainage of the infected joint are established practice in the treatment of septic arthritis . The best method of drainage (repeated puncture, arthroscopy or surgical discharge) remains controversial . We analyze 34 patients with septic arthritis admitted to our hospital from 1984 to 1988 . The pathogen was Staphylococcus aureus in 19 cases (56%), streptococcus in 6 (18%), pneumococcus in 2 (6%), other bacteria in (9%) and unknown in 4 (12%) . In 62% the infection was blood-borne . The knee was affected in 12 cases (35%) and the shoulder in 10 (30%) . A preceding joint puncture was the main source of infection . In 24 patients (70%) the initial joint drainage was by repeated puncture, while in 10 cases (30%) surgical drainage was the initial treatment . In 11 of the 24 patients initially treated by repeated puncture, surgical drainage was needed in the course of treatment because of persistent local infection of the joint . In only 13 (39%) was "medical" treatment alone effective . 5 patients died (14.7), 3 (8.8%) due to the infection . All deaths occurred in the "medical" group . 21 patients were asked about symptoms in the affected joint . In 71% there were no problems or only minimal ones, while in 29% there were distinct problems . 5 of the 6 patients with severe symptoms had been treated by repeated puncture . We conclude that surgical drainage of an infected joint is prescribed too rarely in departments of rheumatology and internal medicine . Arthroscopic or surgical drainage is indicated in cases of coxarthritis, omarthritis, in cases where symptoms last longer than 7 days and in patients with severe sepsis.

Am J Ophthalmol, 1991 Jun 15, 111(6), 686 - 9
An in vitro study of the potency and stability of fortified ophthalmic antibiotic preparations; Bowe BE et al.; We studied the potency of fortified ophthalmic antibiotic preparations of cefazolin sodium (50 mg/ml) and tobramycin sulfate (15 mg/ml), as measured by the minimum inhibitory concentration, against Streptococcus pneumoniae and Pseudomonas aeruginosa, respectively . We also examined absorbance spectra, pH, and the effect of storage temperature on these fortified solutions to determine their stability over a four-week period . Cefazolin and tobramycin maintained a constant potency throughout the experiment . There was no difference in potency if the fortified solutions were stored at 4 C or 24 C . Cefazolin stored at 24 C exhibited changes in both its absorbance spectra and pH after seven days . Cefazolin stored at 4 C and tobramycin stored at 24 C and 4 C remained stable throughout the four-week period.

Biochemistry, 1991 Jun 4, 30(22), 5335 - 40
Sequential 1H NMR assignments and secondary structure of an IgG-binding domain from protein G; Lian LY et al.; Protein G is a member of a class of cell surface bacterial proteins from Streptococcus that bind IgG with high affinity . A fragment of molecular mass 6988, which retains IgG-binding activity, has been generated by proteolytic digestion and analyzed by 1H NMR . Two-dimensional DQF-COSY, TOCSY, and NOESY spectra have been employed to assign the 1H NMR spectrum of the peptide . Elements of regular secondary structure have been identified by using nuclear Overhauser enhancement, coupling constant, and amide proton exchange data . The secondary structure consists of a central alpha-helix (Ala28-Val44), flanked by two portions of beta-sheet (Val5-Val26 and Asp45-Lys62) . This is a fundamentally different arrangement of secondary structure from that of protein A, which is made up of three consecutive alpha-helices in free solution (Torigoe et al., 1990) . We conclude that the molecular mechanisms underlying the association of protein A and protein G with IgG are different.

Oral Surg Oral Med Oral Pathol, 1991 Jun, 71(6), 737 - 42
Acute pulpal-alveolar cellulitis syndrome V . Apical closure of immature teeth by infection control: case report and a possible microbial-immunologic etiology . Part 1; Matusow RJ; Das with Matusow and Goodall previously noted the rapid clinical apexogenesis of nonvital immature permanent teeth that are involved with an acute endodontic cellulitis . This apexogenesis was achieved by control of infection and by nonspecific intracanal medication without the use of calcium hydroxide . The case report confirms the clinical observations . The experimental canine endodontic cellulitis in a Cebus primate was induced as an immunologic pulp infection with a facultative Streptococcus species . The noted epithelial proliferation and organization into lacelike strands and bilaminar loops, similar to Hertwig's epithelial root sheath in root development, appear to be immunologic and genetic in origin, with an acceleration of the root maturation process.

Ann Otol Rhinol Laryngol, 1991 Jun, 100(6), 455 - 8
Inhibition of bacterial adherence by nasopharyngeal secretions; Kurono Y et al.; The role of secretory immunoglobulin (Ig) A in nasopharyngeal secretions in the adherence of Streptococcus pneumoniae and Hemophilus influenzae to nasopharyngeal epithelial cells was investigated in vitro . The adherence was remarkably reduced by treating bacteria with nasopharyngeal secretions, and the antiadhesive activity was significantly greater in nasopharyngeal secretions having secretory IgA antibody activity against bacteria than in those having no activity . Noticeable changes were not observed in the antiadhesive activity caused by absorption of IgG from nasopharyngeal secretions . Results suggest that secretory IgA in nasopharyngeal secretions is related to bacterial adherence and adds to the prevention of nasopharyngeal infections.

Epidemiol Infect, 1991 Jun, 106(3), 459 - 65
Streptococcus pyogenes vulvovaginitis in children in Nottingham; Donald FE et al.; Isolates of Streptococcus pyogenes from vaginal swabs of children with vulvovaginitis received at Nottingham Public Health Laboratory during 1986-9 were studied . A total of 159 isolates was made during the 4 years, increasing from 17 in 1986 to 64 in 1989 and accounting for 11% of all vaginal swabs received from children . The numbers of throat swabs yielding S . pyogenes also showed an increase from 974 in 1986 to 1519 in 1989 . A winter peak of isolates was noted for both vaginal swabs and throat swabs . A total of 98 strains from vaginal swabs were serotyped: 22 different types were identified, 61% of which were the common types M4, M6, R28 and M12 . Erythromycin sensitivity was done on 89 strains; 84% were highly sensitive (MIC less than 0.03 mg/l) . There are no other reports of such large numbers in the literature; the reason for seeing this increase in Nottingham is unclear.

J Infect Dis, 1991 Jun, 163(6), 1273 - 8
Antimicrobial resistance of Streptococcus pneumoniae in the United States, 1979-1987 . The Pneumococcal Surveillance Working Group; Spika JS et al.; The increasing number of Streptococcus pneumoniae isolates identified as relatively or fully resistant to penicillin or fully resistant to other antimicrobials in the United States supports the need to monitor for this resistance . Thus, 5459 S . pneumoniae isolates submitted to the Centers for Disease Control in 1979-1987 by 35 hospitals in a hospital-based pneumococcal surveillance system were evaluated . The MIC to penicillin or ampicillin was greater than or equal to 0.1 micrograms/ml for 274 (5%) isolates; 1 had an MIC of 4.0 micrograms/ml to penicillin . Seventeen (0.3%) were resistant to erythromycin (MIC, greater than or equal to 8 micrograms/ml), 157 (2.9%) were resistant to tetracycline (MIC, greater than or equal to 16 micrograms/ml), and 34 (0.6%) were resistant to sulfamethoxazole/trimethoprim (MIC, greater than or equal to 76 and 4 micrograms/ml) . Isolates relatively resistant to penicillin represented 1.8% of isolates in 1979, 8% in 1982, and 3.6% in 1987 . Sixty-five multiply resistant isolates were identified . Pneumococci from the southwestern United States (region 4) were more likely to be relatively resistant to penicillin . Using logistic regression analysis, serotypes 14 and 19A, isolates from region 4, and isolates from middle ear fluid were associated with penicillin resistance (P less than or equal to .008, chi 2 . These data confirm that antimicrobial resistance among pneumococcal isolates remained at low levels in the United States through 1987.

Infect Immun, 1991 Jun, 59(6), 2219 - 21
Lack of cleavage of immunoglobulin A (IgA) from rhesus monkeys by bacterial IgA1 proteases; Reinholdt J et al.; Bacterial immunoglobulin A1 (IgA1) proteases cleaving IgA1 and secretory IgA1 molecules in the hinge region are believed to be important virulence factors . Previous studies have indicated that IgA of humans, gorillas, and chimpanzees are the exclusive substrates of these enzymes . In a recent study, IgA from the rhesus monkey was found to be susceptible to the IgA1 protease activity of Streptococcus pneumoniae . In an attempt to reproduce this observation, we found that neither five isolates of S . pneumoniae nor other IgA1 protease-producing bacteria representing different cleavage specificities caused cleavage of rhesus monkey IgA . Hence, the rhesus monkey does not appear to be a suitable animal model for studies of IgA1 proteases as virulence factors.

Minerva Cardioangiol, 1991 Jun, 39(6), 245 - 9
{Destructive endocarditis caused by Streptococcus sanguis on normal valves after gastroduodenoscopy}; Pentimone F et al.; In recent years, epidemiological and clinical patterns in infective endocarditis are changed: mean age of patients, sex, underlying cardiac diseases, source of bacteremia, availability of better diagnostic methods--specially two-dimensional and doppler echocardiography--and surgical options . The Authors report a paradigmatic case of a young man without cardiac disease, who developed a destructive endocarditis complicated by refractory congestive heart failure; the cause was an organism of low pathogenicity, Streptococcus sanguis, that entered the bloodstream after gastroduodenoscopy.

Oral Microbiol Immunol, 1991 Jun, 6(3), 169 - 76
Selective effects of histidine-rich polypeptides on the aggregation and viability of Streptococcus mutans and Streptococcus sanguis; Payne JB et al.; Enriched preparations of histidine-rich polypeptides (HRPs) and isolated HRP pairs (1-2, 3-4 and 5-6) degrade in the presence of fresh autologous whole saliva to a series of low-molecular-weight cationic peptides (HRPs 6a-c and 7) . Analysis of the HRPs during degradation indicates that: HRP 1 is not the parent molecule of the HRPs; the HRP pairs do not convert to each other in a cascade-like sequence in saliva; and the HRPs can be separated into 2 groups consisting of HRPs 1-2 and 3-7 . Preparations containing HRPs 1-7, 1-2, and 3-7 were obtained by fractionation and separation on Bio-Rex 70, and tested for aggregating and antibacterial effects against Streptococcus mutans BHT, S . mutans GS-5 and Streptococcus sanguis G9B . HRPs 1-2 had significant aggregating effects on all 3 strains but the other HRPs had little to no agglutinating ability . The HRPs did not inhibit the growth of S . sanguis, and HRPs 1-2 enhanced its growth . No growth enhancement by the HRPs was observed for the 2 S . mutans strains . However, significant bacterial inhibition of the S . mutans strains was noted after incubation with HRPs 3-7 . The data suggest that the dissimilar effects of HRPs 1-2 and 3-7 may be of importance in the colonization and growth of S . mutans and S . sanguis in vivo.

Oral Microbiol Immunol, 1991 Jun, 6(3), 160 - 8
Sorbitol transport by Streptococcus sanguis 160; Svensater G et al.; Sorbitol metabolism was examined with a sorbitol-fermenting strain (160) of Streptococcus sanguis isolated from the dental plaque of a subject using sorbitol-containing chewing-gum for 4 years . S . sanguis 160 was grown in continuous culture (pH, 7.0; dilution rate, 0.1 h-1) with glucose, sorbitol and nitrogen (sorbitol-excess) limitations . Cells grown with a glucose limitation exhibited low, but detectable, uptake of {14C}-sorbitol and transition to medium limiting in sorbitol resulted in a 5-fold increase in sorbitol uptake . Kinetic data revealed that both glucose and sorbitol-limited cells possessed 2 transport systems for sorbitol (Ks = 3.3-6.7 and 36-64 microM), but continued growth of the organism on limiting sorbitol resulted in the loss of the high-affinity system . Decryptified, sorbitol-limited cells phosphorylated sorbitol in the presence of phosphoenolpyruvate (PEP), but not with ATP, indicating sorbitol transport solely via the PEP phosphotransferase (PTS) system . PEP-dependent activity in glucose-limited and sorbitol-excess cells was 6- and 4-fold lower than that of the sorbitol-limited cells . Uptake of {14C}-sorbitol and activity for Ell for sorbitol {Ellsor} of the PTS in cells in transition from a glucose to sorbitol limitation confirmed the induction of the sorbitol-PTS and the repression of the glucose-PTS in the presence of sorbitol . Cells grown with an excess of sorbitol exhibited very low Ellsor activity . A crossover experiment with membranes and soluble fractions from glucose-, sorbitol- and nitrogen-limited cells of S . sanguis 160 demonstrated the induction of a soluble PTS component in sorbitol-limited cells essential for sorbitol transport via the PTS.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral Microbiol Immunol, 1991 Jun, 6(3), 151 - 9
Sorbitol inhibition of glucose metabolism by Streptococcus sanguis 160; Hamilton IR et al.; Clinical studies in Sweden have shown that the proportion of sorbitol-utilizing strains of Streptococcus sanguis increases in dental plaque from individuals using sorbitol-containing products for prolonged periods . We have undertaken to study the metabolism of glucose and sorbitol by S . sanguis 160, isolated from a subject consuming sorbitol-containing chewing-gum 4 times a day for 4 years . Growth on glucose was inhibited by the presence of sorbitol in the growth medium and sorbitol was utilized in the presence of glucose, albeit, at a slower rate than glucose . In addition, pulses of glucose added to cultures growing on sorbitol resulted in the expulsion of sorbitol from the cell . In order to examine further the relationship of sorbitol and glucose, uptake assays were carried out with S . sanguis 160 grown in continuous culture (pH 7.0, dilution rate = 0.1 h-1) with glucose, sorbitol or nitrogen (sorbitol excess) limitations . The uptake of {14C}-glucose by sorbitol-limited cells, but not by glucose-limited cells, was inhibited by sorbitol, as was glycolysis . Kinetic experiments with glucose-limited cells showed 2 transport systems for glucose with Ks values of 5.2 and 40 microM, and glucose phosphorylation activity by decryptified cells indicated transport by the P-enolpyruvate (PEP) phosphotransferase system (PTS) with lesser activity for an ATP-dependent transport process . Transition from glucose-limited growth to sorbitol-limited growth revealed repression of total {14C}-glucose uptake by intact cells and activity for Enzyme II for glucose (Ellglc) of the PTS measured in membrane preparations in the presence of an excess of the soluble PTS proteins in crude cell-free supernatant fractions.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral Microbiol Immunol, 1991 Jun, 6(3), 146 - 50
Antimicrobial susceptibility of 1042 strains of Streptococcus mutans and Streptococcus sobrinus: comparison from 1985 to 1989; Liebana J et al.; A total of 1042 strains of Streptococcus mutans and Streptococcus sobrinus isolated between 1985 and 1989 were tested to study the evolution of their sensitivity to penicillin, amoxycillin, amoxycillin/clavulanic acid, cefuroxime, tetracycline, erythromycin, spiramycin, acetyl spiramycin, lincomycin and clindamycin . The strains were taken from stock cultures and isolated from human saliva and dental plaque . The minimal inhibitory concentration (MIC) was determined by an agar dilution method . Except for spiramycin and acetyl spiramycin, all the antibiotics inhibited 100% of the strains with concentrations less than or equal to 2 micrograms/ml . Microorganisms from both species underwent a slow progressive loss of sensitivity to all the antibiotics over a 5-year period of study, showing statistically significant results in most cases.

Mol Gen Mikrobiol Virusol, 1991 Jun, (6), 25 - 9
{Structure of the beta-galactosidase gene from Streptococcus diacetylactis 144 and its expression in Escherichia coli and Streptococcus diacetylactis cells}; Molotov SV et al.; The ability of industrial strains of mesophylic Streptococcus diacetylactis to synthesize the enzyme beta-galactosidase has been studied . Among the 22 studied strains 8 were found to synthesize the enzyme . Plasmid DNA was isolated from the Streptococcus diacetylactis strain 144 possessing the highest level of beta-galactosidase activity . The cells of the strain harbour the 35, 40 and 60 kb plasmids . The alpha-galactosidase genes from this strain was cloned in Escherichia coli cells . The gene is located on the BglIII DNA fragment of the total plasmid DNA from Streptococcus diacetylactis the size of 2.8 kb . Following the Sau3A restriction endonuclease digestion the gene was subcloned on a birepliconed vector plasmid pCB20 . The latter is capable of replication in the Gram-negative as well as Gram-positive microorganisms . The pCB20 derivatives carrying the different length fragments with the beta-galactosidase gene were isolated . DNA of an obtained plasmid was used for transformation of Streptococcus diacetylactis cells . The presence of the recombinant plasmid in streptococcus strain 144 results in the 1.8 fold increase in beta-galactosidase production.

Mol Gen Mikrobiol Virusol, 1991 Jun, (6), 19 - 21
{Cloning the alpha-amylase gene of Streptococcus bovis and its expression in Bacillus subtilis cells}; Iakorski P et al.; The gene coding for alpha-amylase from the ruminant bacterium Streptococcus bovis was cloned on the plasmid pMX39 in Bacillus subtilis cells . An alpha-amylase positive colony was isolated in the initial screening of 3900 colonies on the medium containing insoluble starch . The size of the insert was approximately 2.8 kb . The recombinant plasmid was stably maintained in Bacillus subtilis cells under the nonselective conditions.

J Biol Buccale, 1991 Jun, 19(2), 167 - 72
Toothbrushing with the root of Euclea natalensis; Stander I et al.; The custom of cleaning teeth and the gums with a chewed root of the tree Euclea natalensis, in the belief that it benefits oral health, is practised in South Africa by married women of an African Zanzibari community . The root of E . natalensis contains naphthoquinones which are bactericidal and, as they are also pigments, the mouths of the root users are stained bright orange . Samples of fresh root were tested against Streptococcus mutans and organisms in saliva and from deep periodontal pockets . Aerobic as well as anaerobic bacterial growth was suppressed in all instances . In addition we compared the plaque index (Silness et Loe), the periodontal index (CPITN), the DMFT and the state of the oral mucosa of root users and non-users . No significant differences were recorded in any of the variables . Although the beneficial effects claimed for this custom may have scientific validity, it is concluded that the daily practice is too limited to have a demonstrable beneficial effect.

Chem Pharm Bull (Tokyo), 1991 Jun, 39(6), 1578 - 80
Synthesis of cobalt(II) and nickel(II) complexes of Ceclor (cefaclor) and preliminary experiments on their antibacterial character; Chohan ZH; Cobalt(II) and nickel(II) complexes of the antibacterial drug Ceclor have been synthesized and characterized on the basis of their elemental analysis, molar conductance, magnetic moment and electronic and infrared spectral data . These complex have been, then subjected to screening for their antibacterial properties against bacterial species such as Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus aureus and Escherichia coli . In comparison to uncomplexed Ceclor, the metal complexes have been shown to be more antibacterial.

Chem Pharm Bull (Tokyo), 1991 Jun, 39(6), 1480 - 3
New polyphenolic 5'-nucleotidase inhibitors isolated from the wine grape "Koshu" and their biological effects; Toukairin T et al.; New 5'-nucleotidase inhibitors designated as NPF-88BU-IA, NPF-88BU-IB, NPF-88BU-IIA and NPF-88BU-IIB, respectively, were isolated from the seeds and skin of the wine grape "Koshu" . They were purified by solvent extraction, dialysis, and reversed-phase high performance liquid chromatography (HPLC) . Their physico-chemical properties revealed these compounds to be polyphenolic substances . The average relative molecular masses of the four were estimated by gel permeation chromatography (GPC) analysis to be 7850, 5950, 11900, and 11300, respectively . They strongly inhibited 5'-nucleotidase activities from snake venom and rat liver membrane, and displayed significant therapeutic activity against Ehrlich ascites carcinoma . They also showed inhibitory effects on the growth of Streptococcus mutans MT8148(c), a primary cariogenic bacterium . Furthermore, these 5'-nucleotidase inhibitors inhibited the glucan formation from sucrose . These results suggest that the 5'-nucleotidase inhibitors can prevent the cause of caries of tooth.

Enferm Infecc Microbiol Clin, 1991 Jun-Jul, 9(6), 354 - 6
{Bacteremia caused by Streptococcus agalactiae in adults . Presentation of 6 cases}; Ferez A et al.; The incidence of Streptococcus agalactiae (SA) bacteremia in adults has increased in recent years, particularly in patients with severe underlying diseases . However SA is still an unusual pathogen in adults . We report 6 cases of SA bacteremia in adults, seen during 18 months . The microorganism was only isolated from the blood in 3 cases, and from blood and other locations in the remaining three cases . The age of the patients ranged from 35 to 70 years . Both sex were affected in the same proportion . In all cases except in one there was a previous underlying disease.

J Rheumatol, 1991 Jun, 18(6), 904 - 7
Group G streptococcus septic arthritis and osteomyelitis: report and literature review; Burkert T et al.; Beta hemolytic streptococcus group G is increasingly being recognized as a cause of serious infections . We describe a patient with group G streptococcus septic arthritis of the right knee and osteomyelitis of the proximal tibia . Clinical details of 46 patients including 13 patients with infected prosthetic joints reported in the literature were reviewed: 42% had multiple joint involvement . Almost all patients had underlying conditions . Almost one-half were treated with antibiotics alone without therapeutic drainage procedures . Patients with infected prosthetic joints did well without removal of infected prosthesis . There have been 11 cases of group G streptococcus osteomyelitis reported including 3 cases with concomitant septic arthritis.

Eur Respir J, 1991 Jun, 4(6), 761 - 3
Streptococcus group A pneumonia in an intravenous drug misuser (IVDM); McWhinney PH et al.; Streptococcus pyogenes appears to have become an uncommon cause of pneumonia . In view of the recent increase in S . pyogenes infections this situation is likely to change . An intravenous drug user presented with acute onset of fever and chills . At presentation pleuritic chest pain was a prominent symptom, and later he developed pulmonary abscesses and an empyema . The patient had a good response to benzyl penicillin, and his pulmonary lesions resolved completely . Although his clinical picture was characteristic of S . pyogenes pneumonia, it could easily be mistaken for Staphylococcus aureus septicaemia.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Jun, (6), 9 - 11
{A comparative study of 2 substances produced by the Streptococcus sp . Thom-1606 strain}; Golshmid VK et al.; Among the substances secreted by Streptococcus sp . Thom-1606 {correction of TOM-1606}, two substances exhibiting opposite biological action have been detected . Their antigenic structure, as indicated by the data of immunoprecipitation in agar, are not identical . The compounds contained in the substance with antibacterial action have molecular weight below 10 KD, Stokes' radium equal to 1.10 +/- 0.15 nm and electrophoretic mobility approximating that of d1-fraction of human blood serum . The compounds contained in the substance inhibiting the antibacterial activity of the preparation have molecular weight within the range 70-100 KD, Stokes' radius equal to 3.52 +/- 0.25 nm and electrophoretic mobility approximating to that of gamma-globulin of human blood serum . The removal of the inhibiting substance by ultrafiltration and chromatographic techniques enhanced the antibacterial activity of the commercial preparation tomicide.

Tierarztl Prax, 1991 Jun, 19(3), 320 - 3
{The neuropathology of martens}; Geisel O et al.; The present knowledge about the neuropathologic findings and postmortem investigation methods in neurologic diseases of martens is reviewed . Following diseases are discussed: encephalitis due to viruses (rabies, distemper), bacteria (streptococcus, staphylococcus), and parasites (toxoplasmosis, hepatozoonosis, nematodes); furthermore, metabolic disorders (amyloidosis, congophilic angiopathy, calcinosis), and congenital malformations.

J Am Vet Med Assoc, 1991 Jun 1, 198(11), 1953 - 6
Two-dimensional echocardiographically guided pericardiocentesis in a horse with traumatic pericarditis; Voros K et al.; Two-dimensional echocardiographic (2DE) examination was performed on a horse with clinical signs of pericardial effusion . Thickening of the pericardium, excess amount of pericardial fluid, elevation of the cardiac apex, and right ventricular compression, characteristic of cardiac tamponade, could be seen on 2DE recordings . Fibrinous pericarditis was suspected by observation of fibrinous strands in the pericardial fluid and epicardial fibrin deposits . Echocardiographically guided pericardiocentesis was performed, and 4 L of fluid was removed from the pericardial sac . Streptococcus zooepidemicus was isolated from the fluid . Pericardiocentesis was repeated for 3 days, and medication was administered . Despite temporary improvement in cardiac function, the horse's condition deteriorated gradually, and euthanasia was performed on the ninth day of hospitalization . Necropsy revealed chronic serofibrinous pericarditis of traumatic origin, attributable to an intercostal stab wound entering the pericardium and the apical portion of the myocardium.

J Am Vet Med Assoc, 1991 Jun 1, 198(11), 1950 - 2
Adherent gram-positive cocci on the intestinal villi of two dogs with gastrointestinal disease; Jergens AE et al.; Two dogs were examined for clinical signs of chronic gastrointestinal disease . Duodenal mucosal biopsy specimens, obtained endoscopically, revealed histologic lesions of adherent gram-positive cocci on the villus epithelium of both dogs . The positive gram stain and morphologic features of the adherent cocci were suggestive of Streptococcus organisms . Indirect tests for intestinal bacterial overgrowth were not diagnostic, suggesting that the adherent cocci were a primary lesion . Rapid clinical response following dietary manipulation and the initiation of medical management was observed in both dogs . The dogs of this report draw similarities to Streptococcus durans infection previously reported in pigs, foals, and a single pup . The pathogenesis of enteric disease associated with adherent gram-positive cocci in dogs remains ill-defined.

FEMS Microbiol Lett, 1991 Jun 1, 65(1), 117 - 21
Incorporation of fatty acids by Streptococcus mutans; Sato M et al.; In a series of investigations into the cariogenicity of Streptococcus mutans, we studied the incorporation of exogenous fatty acids with reference to glucosyltransferase secretion and membrane fatty acid changes . When cells were grown with different fatty acids, both saturated and unsaturated fatty acids were readily incorporated into the membrane lipids and were biotransformed and elongated preferentially to the longer 16- and 18-carbon-chain fatty acids . This incorporation and chain-elongation led to significant changes in fatty acids composition . By adding fatty acids to the medium, it was possible to appropriately modify the degree of unsaturation and the relative ratio between specific fatty acids in the membrane lipids of S . mutans.

Infect Dis Clin North Am, 1991 Jun, 5(2), 319 - 36
Acute respiratory infections; Berman S; During the past decade, recognition of the significance of pneumonia for childhood mortality has greatly increased . Etiologic studies have clarified the role of Streptococcus pneumoniae and H . influenzae as the pathogens most responsible for childhood pneumonia in developing countries . Case management intervention strategies using community health workers to identify cases of pneumonia by counting respiratory rate and observing chest indrawing have been shown to reduce ARI-related mortality . Although research is underway to develop more effective vaccines against Streptococcus pneumoniae and non-type b H . influenzae, effective case management will remain the most realistic method of reducing mortality in the next decade . Important gaps remain in our understanding of the pathogenesis, etiology, and epidemiology of acute respiratory infections . Our understanding is complicated by the multiplicity of viral and bacterial agents and their interrelationships, by an abundance of interacting host risk factors, and by diverse social, cultural, and environmental factors . However, sufficient knowledge is available to support the implementation of the WHO case management intervention strategies, which will save the lives of the many children now dying because of pneumonia.

Ophthalmology, 1991 Jun, 98(6), 863 - 9
Antimicrobial efficacy and corneal endothelial toxicity of DexSol corneal storage medium supplemented with vancomycin; Garcia-Ferrer FJ et al.; Despite the presence of gentamicin in corneal storage medium, postoperative endophthalmitis may result from the transmission of bacteria via contaminated corneal tissue . The authors evaluated the antimicrobial activity and endothelial toxicity of vancomycin (10 micrograms/ml) in combination with gentamicin (100 micrograms/ml) in DexSol corneal storage medium . When tested against a panel of common ocular pathogens, vancomycin combined with gentamicin proved more effective than gentamicin alone for inhibiting the growth of Streptococcus pneumoniae at 4 degrees C after 1- and 5-day incubation periods . Ultrastructural and morphometric analyses of paired human corneas stored for 5 days in either DexSol supplemented with vancomycin combined with gentamicin or DexSol with gentamicin alone did not show a significant difference in endothelial toxicity between the two groups . These results suggest that vancomycin combined with gentamicin has superior antimicrobial effect and similar corneal toxicity when compared with media supplemented with gentamicin alone.

Yan Ke Xue Bao, 1991 Jun, 7(2), 110 - 2
{Survey of fungi and bacterinum of the conjunctival sac in Guangzhou area}; Gong X et al.; This paper presents the results of fungal culture from healthy conjunctival sac in 178 eyes . The rate of positive culture of the fungi was 25% in farmers, 11.1% in cleaners, and 8.8% in city residents respectively . Culture for aerobic was carried out in the samples from conjunctival sacs of 137 eyes . The rate of positive culture was 71.9% in farmers, 80.6% in cleaners, and 23.2% in city residents respectively . On the other hand, the rate of fungal positive culture was 9.7% and that of aerobic was 30% in the patients managed with steroid eyedrops for more than one month . The aspergillus and penicillium were the most commonly seen species among the isolated fungal strain, whereas the staphylococci and streptococcus pneumonia were the most common among the isolated aerobic . The results run parallel to the fact that the main pathogens of ocular infection seen clinically are fungi and aerobics . The authors emphasize that the conjunctival sac should be disinfected to prevent infections caused by opportunistic pathogens.

FEMS Microbiol Lett, 1991 Jun 1, 65(1), 107 - 10
The carboxyl terminal domain of Streptococcus mutans glucosyltransferases prevents secretion in Escherichia coli; Kato C et al.; The extracellular glucosyltransferases (GTFs) of Streptococcus mutans are not secreted into the periplasmic space of Escherichia coli when the corresponding gtf genes are isolated in the latter organism . The utilization of both deletion analysis and gtfB: phoA fusions indicate that the signal sequences of the GTFs are functional in E . coli . However, these results further suggest that amino acid sequences present in the carboxyl terminus of the GTFs inhibit secretion through the cytoplasmic membrane in E . coli.

Rev Clin Esp, 1991 Jun, 189(2), 82 - 5
{Current status of the antipneumococcal vaccine: a pending issue}; de Ramon y Casado AM et al.; In spite of antibiotic treatment, mortality due to pneumonia caused by Streptococcus pneumoniae is still considerable and it is related to the presence of bacteremia . Prophylaxis with 23-polyvalent anti-pneumococcus vaccine would prevent severe processes in high risk populations . We present in this work the current status of our knowledge about this vaccine, regarding its efficacy in preventing bacteremia, economic cost, and secondary effects, we point out the indications of this vaccine according to IPAC (Immunization Practices Advisory Committee) and those special situations which modify prophylaxis (pregnancy, revaccination and massive immunizations) are discussed.

FEMS Microbiol Immunol, 1991 Jun, 3(3), 177 - 83
Isolation of a human T cell line specific for a streptococcal cell surface antigen; Brookes RH et al.; A streptococcal cell surface antigen of Mr 185,000 (SAI/II) expressed by Streptococcus mutans has previously been well characterised . A T cell line specific for native SAI/II has been isolated from peripheral blood mononuclear cells (PBMC) of a naturally sensitised normal individual . This line has been maintained in culture for several months and was shown to be highly specific, not only for different preparations of native antigen but also for recombinant SAI/II protein . It did not respond to a homologous antigen SpaA (Mr 210,000), extracted from Strep . sobrinus . The phenotype of the line was CD3+ CD4+ CD8- TcR alpha beta + . HLA typing and inhibition studies showed that the response was restricted by both DR and DP encoded class II.

J Formos Med Assoc, 1991 Jun, 90(6), 565 - 71
Inhibitory effect of stannous fluoride and other commonly used antimicrobial agents on oral bacteria; Tseng CC et al.; The purposes of this investigation were to evaluate and compare the antimicrobial effect of stannous fluoride (SnF2) gel and other commonly used oral antimicrobial agents/products . The antibacterial inhibitory effect of the various agents was evaluated by their effect against oral plaque bacteria including strains of Streptococcus sanguis, Streptococcus sobrinus, Actinomyces viscosus, Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius . A lawn of the specific bacteria to be tested was placed onto blood agar plates . Wells were then punched into the agar and each well was filled with 75 microliters of one of the antimicrobial products or control solutions . A positive control was a 0.12% chlorhexidine solution and a negative control was physiological saline . Agar plates were incubated in an anaerobic chamber at 37 degrees C for 5-7 days . Zones of inhibition in the lawn of bacteria were measured by a boley gauge . Each experiment was performed in duplicate and mean zones of bacterial inhibition were determined . Only 0.4% SnF2 and 0.12% chlorhexidine were consistently more effective in inhibiting oral bacteria when compared with other commercial mouth rinses/agents which had any one of a variety of antimicrobial agents as ingredients (alpha = 0.05) . This in vitro study demonstrates that stannous fluoride gel is as effective as chlorhexidine in inhibiting the growth of bacteria often found in dental plaque.

Acta Paediatr Jpn, 1991 Jun, 33(3), 292 - 9
Possible role of Streptococcus pyogenes in mucocutaneous lymph node syndrome . XI . Immunoelectron microscopic observation of protoplast-like "spherical bodies" detected in peripheral blood of MCLS patients; Akiyama T et al.; Protoplast-like "spherical bodies" averaging 0.5-1.5 microns in diameter and devoid of cell walls were first detected by Ueno et al, in the buffy coat of heparinized venous blood from patients with mucocutaneous lymph node syndrome (MCLS) . But the nature of the "bodies" has yet to be clarified because of the absence of convincing evidence pointing to their antigenic characteristics . The present investigations were designed solely to provide a serological identification of the "bodies" by the use of immunoelectron microscopy, with the following results . First, "spherical bodies" bearing a striking resemblance to those observed by the above-mentioned authors were detected in biopsy specimens from challenge sites in mice infected with Streptococcus pyogenes as well as in the buffy coat of peripheral blood from MCLS patients . Second, the "bodies" detected were stained distinctly in both cases by an immunohistochemical technique using, as the primary antibody, a rabbit antiserum raised toward S . pyogenes-derived protoplasts, which was then absorbed with protoplasts from Staphylococcus aureus and Escherichia coli . Third, the absorbed sera were proved to be not faultless, because complete specificity toward protoplasts from S . pyogenes was not attained due to the presence of a large amount of cross-reactive antigens between protoplasts from the immunizing and absorbing strains of bacteria . The implications of these findings are discussed, particularly in relation to the evaluation of the present serological test for the "spherical bodies".

Lab Anim Sci, 1991 Jun, 41(3), 251 - 4
Cervical lymphadenitis in guinea pigs: infection via intact ocular and nasal mucosa by Streptococcus zooepidemicus; Murphy JC et al.; The traditional view regarding the pathogenesis of cervical lymphadenitis in guinea pigs is that Lancefield Group C Streptococcus gains access to cervical lymph nodes via an abraded oral mucosa . In this study, it is established that inoculation of intact nasal and conjunctival mucous membranes with Streptococcus zooepidemicus (Lancefield Group C) also can produce the disease . Weanling (SPF) guinea pigs (Cavia porcellus) were divided into two experimental groups of 10 and two control groups of four each . Guinea pigs from each group were individually housed in separate cubicles . Group I was inoculated with 0.05 ml of culture containing 2.8 x 10(7) CFU/ml of S . zooepidemicus into the conjunctiva of the left eye . Group II received a similar inoculum into the left nares . Control groups received 0.05 ml of TSB broth in the same sites . Five of ten guinea pigs in Group II died four to nine days postinoculation . Surviving guinea pigs were euthanatized at intervals between days 4-13 postinoculation . All guinea pigs were necropsied, cultured and examined for evidence of infection . S . zooepidemicus was recovered from 30/50 and 39/46 sites cultured from Groups I and II, respectively . Lymphadenitis was found in cervical lymph nodes from 8/10 guinea pigs in Group I and 10/10 in Group II . The conjunctival and nasal mucosa, therefore, represent potential sites of entry resulting in cervical lymphadenitis in guinea pigs.

Zentralbl Bakteriol, 1991 Jun, 275(2), 179 - 84
Molecular cloning and nucleotide sequence of the group B streptococcal hemolysin; Conrads G et al.; Genomic DNA from a Streptococcus agalactiae strain and pUC8 were used to clone the genetic determinant of the group B streptococcal hemolysin . The smallest recombinant plasmid, which enables its E . coli hosts to express beta-hemolysis on sheep blood agar or in blood broth, was found to contain a 3.9 kb insert of streptococcal DNA . A restriction endonuclease map was established for the enzymes Cla I, EcoRI, Hind II, Hind III and Sau I . Transposon mutagenesis experiments with Tn5 extinguished hemolytic activity when Tn5 was inserted at 1.7 kb or 1.9 kb downstream the 5' end of the streptococcal fragment between the Hind II and EcoRI sites . The complete 3.9 kb fragment was sequenced on both strands by the dideoxy method of Sanger . It was shown to contain 4 open reading frames; one of 690 bp, including the area of transposon insertion mentioned above, has a potential promoter region upstream . The deduced amino acid sequence of 230 residues shows a hydrophobic signal sequence of 19 amino acids at its N-terminus.

Antimicrob Agents Chemother, 1991 Jun, 35(6), 1024 - 8
Prophylactic and therapeutic activities of azithromycin in a mouse model of pneumococcal pneumonia; Azoulay-Dupuis E et al.; Azithromycin is a new acid-stable 15-membered-ring macrolide that exhibits an extended half-life and excellent tissue distribution, including distribution in the lung . We compared its in vivo activity with that of erythromycin using two models of Streptococcus pneumoniae pneumonia, namely, a model of acute infection in Swiss mice and a model of subacute infection in C57BL/6j mice . Female mice were infected by oral delivery into the trachea of 10(5) CFU of a virulent serotype 3 strain of S . pneumoniae (P 4241) . Prophylactic and therapeutic treatments were given orally (p.o.) or subcutaneously (s.c.) by various regimens . In the model of subacute infection, a single dose of azithromycin, 25 mg/kg, given p.o . 7 h before infection protected 92% of the mice, while erythromycin was completely ineffective . In the model of acute infection, a single dose of azithromycin, 50 mg/kg, given s.c . 24 h prior to challenge protected 80% of the mice, whereas only 35% of the mice survived with erythromycin, 50 mg/kg, 1 h before challenge . Therapy, which was studied exclusively in the model of subacute infection, was initiated 48 h postinfection . Two doses of 12.5 mg/kg given p.o . 12 h apart resulted in 80% survival of mice treated with azithromycin versus 7% survival of mice treated with erythromycin . Pulmonary clearance of bacteria was consistent with the survival rates . Two doses (25 mg/kg) of azithromycin given s.c . at 48 and 65 h after infection led to complete clearance of bacteria from the lungs and blood, whereas erythromycin-treated mice remained bacteremic . The pharmacokinetics of azithromycin account for its superior efficacy against S . pneumoniae pneumonia relative to the efficacy of erythromycin.

Am J Obstet Gynecol, 1991 Jun, 164(6 Pt 1), 1609 - 14; discussion 1614-6
Vulvar vestibulitis: prevalence and historic features in a general gynecologic practice population; Goetsch MF; All gynecologic patients seen by the author during a 6-month period were questioned and examined by means of a swab test to determine the prevalence of vulvar vestibulitis and the normal variation in sensitivity of vestibular skin . Of 210 patients, 78 (37%) had some degree of positive testing . A total of 31 patients (15%) were found to fulfill the definition of vulvar vestibulitis . A questionnaire was administered to these patients as well as to seven patients in whom vestibulitis had been previously diagnosed . A total of 50% had always had pain, most since their teenage years . Their history was not suggestive of a cyclic or remittent pattern of symptoms . Those with secondary dyspareunia or resolution of pain were usually either in a post partum phase or had group B streptococcus or human papillomavirus . The two most severe cases of vestibulitis occurred after use of fluoroucil cream . A total of 32% had some female relative with dyspareunia or tampon intolerance, raising the issue of a genetic predisposition.

Rev Prat, 1991 May 21, 41(15), 1360 - 2
{Antibiotherapy of maternal-fetal infections}; Putet G; The initial antibiotic therapy of neonatal infections must be aimed at Streptococcus B, E . coli and Listeria which are the most frequent responsible pathogens . It must be initiated promptly and be effective against a possible meningeal infection . The first-line therapy with amoxicillin, amikacin and cefotaxime, which in theory should cover all the micro-organisms involved, must be short and rapidly replaced by an antibiotic proved to be active against the isolated pathogen . If aminoglycosides are administered for a long time, serum level assays are recommended for optimal safety.

Rev Prat, 1991 May 21, 41(15), 1354 - 9
{Acute bacterial and fungal neonatal meningitis}; Lequien P et al.; Neonatal meningitis has two closely related features: the mechanism of infection and the nature of the pathogen . When transmitted from mother to foetus, the infection is mainly caused by one of three microorganisms: Streptococcus group B, Escherichia coli or Listeria monocytogenes . It may occur before birth, in which case meningitis is of early onset and has a rather poor prognosis . When it occurs later, the infection is a pathological consequence of physiological bacterial colonization, and its symptoms and prognosis are those of post-natal meningitis . Post-natal infections are facilitated by a pre-existing pathology or by prematurity . The responsible organisms (Gram-positive or Gram-negative bacteria, or yeasts) are often multiresistant . Advances in biology provide increasingly clearer explanation of the cerebral complications that determine the medium- and long-term prognosis . The variety of organisms and their frequent resistance to antibacterials make it necessary to use antibiotics that possess an exceptionally broad spectrum.

J Immunol Methods, 1991 May 17, 139(1), 31 - 40
An appropriate in vitro culture condition for the induction of human TCR gamma delta + cells by heat-killed bacteria; Seki S et al.; TCR gamma delta + cells proliferated when MNC were stimulated with various heat-killed bacteria . We investigated here the culture conditions for their maximum proliferation . MNC were cultured for 6 days with Streptococcus pyogenes, and for 3 days with T cell mitogens, PHA and anti-CD3 mAb, in medium supplemented with various concentrations (0.05-50%) of human sera . TCR gamma delta + and TCR gamma delta- CD2+3- double negative cells induced by Str . pyogenes required high concentrations of sera (greater than 6%) for their proliferation . Moreover, increased sera (up to 50%) greatly augmented their proliferation . On the other hand, TCR alpha beta + cell proliferation induced by T cell mitogens was supported by a small concentration (even 0.1%) of the sera, and the addition of high concentrations of sera (greater than 6%) somewhat suppressed responses . Similar serum requirement patterns were evident for the induction of cytotoxic cells . These results clearly demonstrated the existence of an appropriate culture condition for the proliferation of TCR gamma delta + cells induced in vitro.

FEMS Microbiol Lett, 1991 May 15, 64(2-3), 289 - 94
Teichoic acid choline esterase, a novel hydrolytic activity in Streptococcus oralis; Ronda C et al.; Streptococcus oralis contains an enzyme that can remove a limited amount of choline residues when tested on purified cell walls . This activity has been identified as an esterase that exhibits some biochemical properties similar to those previously found for several lytic enzymes of S . pneumoniae and its bacteriophages.

FEMS Microbiol Lett, 1991 May 15, 64(2-3), 155 - 9
Phage resistance and altered growth habit in a strain of Streptococcus bovis; Klieve AV et al.; Bacteriophage (phi Sb01) of Streptococcus bovis, isolated from pooled rumen fluid of cattle, was a small siphovirus of morphotype B1 . It contained double-stranded DNA of length 30.9 kb, which was digested by the restriction endonucleases, EcoRI, HindIII, and PvuII . Bacteria which survived phi Sb01 infection (strain 2BAr) grew in long chains (100-200 cells), ultimately forming large clumps of cells . This growth habit was in distinct contrast to that of the parent host strain which grew predominantly in the form of single cells or diplococci . Strain 2BAr was genetically stable, resistant to phi Sb01 attack, and the observed differences in the growth characteristics of the parent strain and 2BAr indicated that cells of 2BAr were more adherent . In the rumen ecosystem, the selection of phage-resistant bacteria with altered growth characteristics may be a factor in modifying bacterial phenotypes, and thus increasing variability among bacteria which are closely related genetically.

J Biol Chem, 1991 May 15, 266(14), 8916 - 22
Isolation and sequence of an active-site peptide containing a catalytic aspartic acid from two Streptococcus sobrinus alpha-glucosyltransferases; Mooser G et al.; An active-site peptide containing an aspartic acid implicated in catalysis has been isolated and sequenced from two Streptococcus sobrinus extracellular glucosyltransferases: sucrose:1,3-alpha-D-glucan 3-alpha-D-glucosyltransferase (GTase-I) and sucrose:1,6-alpha-D-glucan 6-alpha-D-glucosyltransferase (GTase-S) . The sequenced peptides, tagged with radiolabeled glucose, were isolated from a pepsin digest of a stabilized glucosylenzyme complex prepared by rapidly denaturing a reaction of enzyme and radiolabeled sucrose . The glucosyl linkage had previously been characterized as a beta-anomer bound to an active-site carboxyl group . Purified GTase-I and GTase-S glucosyl-peptides had the following similar but not identical sequences: GTase-I, Asp-Ser-Ile-Arg-Val-Asp-Ala-Val-Asp; and GTase-S, Asp-Gly-Val-Arg-Val-Asp-Ala-Val-Asp . Each has 3 aspartic acids as potential sites of glucose conjugation, but the relevant residue was not identified in sequence analysis because the highly base-labile glucosyl bond was cleaved in the first sequence cycle . As an alternative, the GTase-I glucosyl-peptide was partially digested at the N terminus with cathepsin C and at the C terminus with carboxypeptidase P . Analysis of the truncated products by fast atom bombardment mass spectrometry localized the glucosyl group to Asp-6 i the GTase-I peptide . In the native enzyme, this sequence is found near the N terminus, well-removed from the glucan-binding site located on a 60-kDa domain at the C terminus . The catalysis-dependent method of incorporating a glucosyl label implicates the aspartic acid as the residue involved in stabilizing an oxocarbonium ion transition state . The peptide segment is highly conserved and homologous to a peptide from sucrase-isomaltase labeled by site-directed irreversible inhibition and peptide segments common to a broad array of alpha-glucosidases and related transferases.

Br Dent J, 1991 May 11, 170(9), 331 - 5
Evaluation of a hygiene monitor for detection of contamination in dental surgeries; Douglas CW et al.; Routines for disinfecting working surfaces in dental surgeries are difficult to monitor without time-consuming and labour-intensive microbiological techniques, yet effective monitoring is a vital part of cross-infection control . Easy to use, on-site methods would be valuable in this context . This study evaluates a portable monitor, the Biotrace Hygiene Monitor, which uses bioluminescence to measure adenosine triphosphate (ATP) on surfaces . Under laboratory conditions, the ability of the monitor to detect whole saliva and Streptococcus sanguis was determined and, in the general practice environment, the level of ATP on surfaces in five dental surgeries was assessed . The minimum amount of saliva detectable was 0.5 microliters and in surgeries, the monitor readily identified numerous surfaces with fairly high levels of ATP . Routine cleaning methods sometimes left ATP on surfaces at levels which represented a cross-infection risk, if it is assumed that the ATP derived from patients' saliva . Modification of cleaning methods resulted in a reduction of ATP levels to within that which could be considered reasonably practicably safe . It is concluded that the Biotrace Hygiene Monitor offers a simple and valuable means of monitoring dental practice cleaning routines.

J Clin Periodontol, 1991 May, 18(5), 291 - 9
Clinical, microbiological and immunological characteristics of subjects with "refractory" periodontal disease; Magnusson I et al.; The aim of the present study was to analyze the relationship between attachment loss and clinical, microbiological, and immunological parameters in a group of 21 human subjects exhibiting poor response to previous periodontal therapy . All had been treated with periodontal surgery, tetracycline, and subsequent maintenance recalls to periodontists who, upon detection of disease progression, referred the subjects to our clinic . In our clinic, each subject received oral hygiene instruction and a thorough subgingival scaling and root planing utilizing as many appointments as necessary . Clinical indices, including gingival index, bleeding on probing, suppuration, plaque index, pocket depth, and duplicate measurements of attachment level from an acrylic stent, were collected at monthly intervals . Probing measurements were performed using the Florida Probe . When significant attachment loss (0.8-1.2 mm) was detected in at least 1 site, a bacterial sample was taken from that site and from a comparably deep, but non-progressing, control site . Microbial samples were enumerated by darkfield microscopy, on selective and non-selective media, and by predominant cultivable technique . Blood samples were also collected to determine antibody levels against potential pathogens . There was no difference in the amount of plaque present in sites gaining or losing attachment, but losing sites exhibited more bleeding and suppuration . 20 of the 21 subjects were tested; of these, 17 exhibited elevated serum antibody against one or more of the following microorganisms: Actinobacillus actinomycetemcomitans, Bacteroides, gingivalis, and Eikenella corrodens . However, few, if any, of the "classical" pathogens were detected in the plaque samples obtained at the time progressive disease was diagnosed . The only exception was Streptococcus intermedius, which occurred in slightly higher numbers in active sites.

J Can Dent Assoc, 1991 May, 57(5), 403 - 5
Invasion of bacteria in enamel carious lesions; McCabe RP et al.; A review of recent findings concerning enamel carious lesions is presented . This lesion represents the initial phase of dental caries and is characterized by a demineralization of the subsurface enamel caused by acids of the plaque bacteria . Streptococcus mutans has been described as the etiologic agent of the dental caries and the most acidogenic plaque bacteria . Morphological studies have shown an invasion of microorganisms inside the enamel carious lesion . Unfortunately, several technical problems are associated with such studies . The identification of the invading bacteria has not yet been achieved . The future identification of bacteria inside the subsurface enamel lesions will represent an important step in the prevention of the carious progression.

Br J Dermatol, 1991 May, 124(5), 433 - 8
Acute infectious erythemas in children: a clinico-microbiological study; Goodyear HM et al.; One-hundred children with an acute illness comprising fever and widespread erythematous rash were prospectively studied to determine whether clinical presentations are helpful in defining the causative agent and to identify the most appropriate microbiological specimens . An infectious agent was identified in 65 children; 72% were viruses, 20% were bacteria, 5% were Mycoplasma pneumoniae and in 3% both viruses and bacteria were detected . The most common infectious agents were picornaviruses, an atypical presentation of measles and Group A beta-haemolytic Streptococcus . Different patterns of rash occurred with each of these infections . The clinical presentation of a child with an acute febrile illness and rash was unhelpful in defining the causative agent . Routine management should include a throat swab for bacterial investigation and in selected cases a blood sample for IgM viral titres.

Am J Clin Pathol, 1991 May, 95(5), 719 - 24
Rapid diagnosis of Legionella infection by a nonisotopic in situ hybridization method; Fain JS et al.; The authors report a nonradioactive adaptation of DNA hybridization technology for the direct detection of Legionella organisms in situ in routinely processed histologic specimens . The probe used consisted of synthetic oligodeoxynucleotides, complementary to the ribosomal RNA of all clinically relevant Legionella species, labeled with biotinylated dUTP at their 3' ends . By in situ DNA hybridization and detection with an avidin-alkaline phosphatase complex . Legionella was visualized by light microscopy within the alveoli of lung specimens in 9 of 13 direct fluorescent antibody- or culture-positive cases of Legionnaires' disease . No cross-hybridization was observed in lung specimens infected with Pseudomonas aeruginosa, Klebsiella pneumoniae, Streptococcus pneumoniae, or other pathogens . The authors' results illustrate a novel adaptation of in situ DNA hybridization techniques, usually used for viruses, to the detection of a bacterial organism . The method enables direct visualization of bacterial nucleic acid in infected tissues and may facilitate early diagnosis and treatment of legionellosis.

Infect Immun, 1991 May, 59(5), 1620 - 6
A 40-kilodalton cell wall protein-coding sequence upstream of the sr gene of Streptococcus mutans OMZ175 (serotype f); Ogier JA et al.; Streptococcus mutans surface proteins may be important in immunization against dental caries . We report the existence of an open reading frame of 1,005 bp that lies 1,162 bases upstream of the S . mutans OMZ175 sr gene and that encodes a cell wall-associated protein . This open reading frame codes for 335 amino acid residues . The first 18-amino acid region is predominantly hydrophobic and resembles a signal peptide, and the hydrophobic C-terminal region may function as an anchor to the bacterial cell wall . On the basis of the predicted antigenic determinants of the deduced amino acid sequence, a 16-residue synthetic peptide corresponding to the middle hydrophilic coiled region was synthesized . Antibodies raised against this synthetic peptide reacted with a protein with an apparent Mr of 40,000 that was identified by Western immunoblotting in a cell wall extract from S . mutans OMZ175 . The high reactivity in an enzyme-linked immunosorbent assay of the antibodies with whole S . mutans OMZ175 cells showed that this protein was located on the bacterial cell surface . Furthermore, the antipeptide immunoglobulin G recognized an identical determinant on the cell surface of other members of the S . mutans group . However, the function of this protein is not yet known.

Am J Emerg Med, 1991 May, 9(3), 243 - 5
Pneumococcal bacterial tracheitis; Orenstein JB et al.; Bacterial tracheitis is an uncommon cause of acute respiratory distress in children . The authors present a case of bacterial tracheitis in a 6-year-old girl caused by an unusual pathogen, Streptococcus pneumoniae . Her clinical presentation and radiographic findings are typical for an older child . Management of this case involved endotracheal intubation, although a review of the literature suggests that airway management can vary with age and size of the tracheal lumen . The microbiology of bacterial tracheitis shows a predominance of Staphylococcus and Streptococcus reported previously, with only three prior reported cases of Pneumococcus.

J Clin Oncol, 1991 May, 9(5), 865 - 70
Prevention of gram-positive infections after bone marrow transplantation by systemic vancomycin: a prospective, randomized trial; Attal M et al.; Gram-positive bacteria are the most commonly isolated organisms after bone marrow transplantation (BMT) and severe streptococcus septicemia has been reported . In order to evaluate the benefit of a gram-positive prophylaxis after BMT, we conducted a prospective, randomized trial of systemic vancomycin among 60 patients undergoing BMT for hematologic malignancies . Patients were randomized to receive (n = 30) or not receive (n = 30) prophylactic vancomycin 15 mg/kg every 12 hours from day -2 until resolution of neutropenia or until the first episode of fever . All patients were treated in laminar air-flow rooms, received sterile diet, total gut decontamination, and had central venous catheters placed surgically . Vancomycin was found to be highly effective in preventing gram-positive infections that occurred in 11 of 30 patients in the control group versus zero of 30 in the vancomycin group (P less than .002) . All gram-positive infections occurring in the control group were symptomatic (nine septicemia and two local infections), and one patient with Streptococcus septicemia died with pneumonia . Thus, gram-positive prophylaxis was found to decrease infection morbidity after BMT . Moreover, the number of days with fever (P less than .001), and empiric antibiotic therapy (P less than .01) was reduced without added toxicity or cost . This study confirmed the high prevalence of gram-positive infections after BMT and emphasized the clinical benefits of an adapted prophylaxis.

Enferm Infecc Microbiol Clin, 1991 May, 9(5), 268 - 71
{Bacteremia caused by Streptococcus pneumoniae and HIV infection}; Roca V et al.; We analyze seven patients with HIV infection that developed community-acquired bacteremic pneumonia due to Streptococcus pneumoniae . Six patients were drug addicts and one was a male homosexual . Five patients have been previously diagnosed of having AIDS . All patients had fever with respiratory tract symptoms and abnormal X-ray films of the chest, in five cases the lesions were located in both lungs . Only four patients showed a pattern of consolidation . The remaining cases showed an interstitial pattern . All but one patient have a CD4 lymphocyte count equal or less than 50 cells/mm3 . Clinical evolution was good with antibiotic treatment . In two cases a relapse occur . No deaths were seen directly related to pneumococcal infection . We want to highlight the relative lack of severity of this infection and we suggest the use of antibiotic treatment for at least 14 days.

Aust N Z J Obstet Gynaecol, 1991 May, 31(2), 119 - 22
Group B streptococcus (GBS) and neonatal infections: the case for intrapartum chemoprophylaxis; Garland SM et al.; At the Royal Women's Hospital, Melbourne over an 8-year period (1981-1988) all public antenatal patients were screened at 32 weeks' gestation for group B streptococcus (GBS) . In a total of 30,197 livebirths there were no early onset neonatal GBS infections in infants of treated asymptomatic carrier mothers . By contrast there were 27 infections with 8 deaths in an unscreened control group of private patients (total livebirths 26,915) . It is recommended that GBS screening occur antenatally at 28 weeks and that intrapartum chemoprophylaxis be offered at least to those carriers with obstetric risk factors.

Aust N Z J Obstet Gynaecol, 1991 May, 31(2), 117 - 8
Early onset neonatal group B streptococcus (GBS) infection: associated obstetric risk factors; Garland SM; An analysis of all early onset neonatal Group B streptococcal (GBS) infections at the Royal Women's Hospital, Melbourne was made for the 10-year period 1979-1988 . There were 104 cases with 29 neonatal deaths (28%) . One or more predisposing perinatal risk factors was evident in 82% of cases (premature labour 79%, prolonged membrane rupture (greater than 12 hours) 57%, premature rupture of the membranes 69%, maternal sepsis 29%) . Overall, 88% of GBS infections were evident within 24 hours of birth, suggesting an intrapartum pathogenesis for infection.

Chem Pharm Bull (Tokyo), 1991 May, 39(5), 1323 - 4
The growth inhibition of Streptococcus mutans by 5'-nucleotidase inhibitors from Areca catechu L; Iwamoto M et al.; New 5'-nucleotidase inhibitors named NF-86I, NF-86II were recently isolated from the seeds of Areca catechu L . NF-86I and NF86II showed inhibitory effects on the growth of Streptococcus mutans MT8148(c) and Streptococcus mutans MT6715(g), respectively . In addition, these inhibitors could inhibit insoluble glucan formation from sucrose . NF-86I and NF-86II were found to be polyphenolic substances . Some polyphenols such as tannic acid bind non-specifically to proteins (tannic activity) . The 5'-nucleotidase inhibitors that we isolated did not show any such activity . However, the growth inhibitory activity and the inhibitory effect on water-insoluble glucan production were equal to tannic acid . It is therefore considered that these inhibitors bind specifically to the bacterial cell surface . Our findings suggest that the 5'-nucleotidase inhibitors NF-86I and NF-86II may be useful anti-plaque preventing agents.

Spec Care Dentist, 1991 May-Jun, 11(3), 101 - 3
Effects of a 1% chlorhexidine gel on the cariogenic bacteria in high-risk elders: a pilot study; Clark DC et al.; Root caries in dentate elderly patients is a problem which may be controlled with chlorhexidine . The purpose of this pilot study was to establish the extent and duration of the antimicrobial effects from an intensive regimen of a 1% chlorhexidine gel in institutionalized elders who had experienced high caries activity in the previous year . Stimulated saliva samples from all subjects before treatment produced more than 105 colony forming units/milliliters of Streptococcus mutans (mean: 2.0 x 10(7); s.d.: 2.0 x 10(7)) when diluted and cultured on Mitus Salivarius-bacitracin agar for 48 hours . Findings suggest that daily treatments for 1 week with a 1% chlorhexidine gel can reduce the number of cariogenic bacteria in elderly people for approximately 3 weeks after treatment.

J Antimicrob Chemother, 1991 May, 27(5), 669 - 76
Clinical evaluation of ticarcillin, with clavulanic acid, and gentamicin in the treatment of febrile episodes in neutropenic children; Bolton-Maggs PH et al.; To assess the clinical efficacy of ticarcillin, with clavulanic acid, and gentamicin, we conducted a prospective one year study of febrile episodes in neutropenic children . Seventy-five episodes were evaluated in 42 children . The response rate was 32% during persistent neutropenia, whilst another third of episodes responded with neutrophil recovery . Positive blood cultures occurred in 21 episodes and 20 of 24 micro-organisms belonged to the 'community' flora, i.e . organisms carried by healthy people (Streptococcus pneumoniae, Staphylococcus aureus, Branhamella catarrhalis and Escherichia coli) . The route of pathogenesis was endogenous in 76% of the patients . There was a substantial superinfection-related morbidity (14%) and mortality (7%), related to emergence of resistance during and after parenteral antibiotic administration . The poor clinical response, combined with emergence of resistance, lead to the conclusion that this combination is of limited value as a first line regimen for neutropenic patients.

Zh Mikrobiol Epidemiol Immunobiol, 1991 May, (5), 19 - 21
{A comparison of their virulence for mice and the enzymatic activity of Streptococcus pneumoniae strains}; Vishniakova LA et al.; In most cases no correlation between the virulence of S . pneumoniae and their enzymatic activity was registered in 101 S . pneumoniae strains isolated in pneumococcal infections of different localization . Pneumococcal strains belonging to different serotypes and characterized by their low virulence for mice (LD50 = 10(6) colony-forming units) had the highest neuraminidase and protease-alzolase activity in comparison with highly virulent cultures of these bacteria . In pneumococcal cultures in the R-form avirulence for mice occurred mainly in combination with low enzymatic activity.

J Dairy Sci, 1991 May, 74(5), 1521 - 6
Evaluation of methods for the diagnosis of Streptococcus agalactiae intramammary infections in dairy cattle; Dinsmore RP et al.; The sensitivity, specificity, and positive and negative predictive values were compared for six methods of collecting or culturing milk samples for the diagnosis of chronic Streptococcus agalactiae intramammary infection . Cows in four dairy herds were cultured three times in 2 wk to determine infection status . At the second sample period, individual quarter and composite milk samples were taken before and immediately after milking, and two volumes of milk from the composite samples were streaked on culture plates . The sensitivity, specificity, and predictive values for these cultures ranged between 95 and 100% for all diagnostic methods, and no significant differences were found between methods . The results indicate that when either quarter or composite samples are collected before or immediately after milking, 95 to 100% of S . agalactiae culture-positive cows will be infected with S . agalactiae in herds with a prevalence of S . agalactiae between 35 and 55% . A similar proportion of culture-negative cows will be uninfected.

Antimicrob Agents Chemother, 1991 May, 35(5), 831 - 6
Comparative efficacies of ciprofloxacin, amoxicillin, amoxicillin-clavulanic acid, and cefaclor against experimental Streptococcus pneumoniae respiratory infections in mice; Gisby J et al.; Experimental respiratory infections were established in mice by intranasal inoculation of Streptococcus pneumoniae . Inoculation of 10(7) CFU of either S . pneumoniae 1629 or S . pneumoniae 7 produced a fatal pneumonia in nontreated mice 2 to 3 days after infection . Oral therapy was commenced 1 h after infection and was continued three times a day for 2 days . The doses used in mice produced peak concentrations in serum and lung tissue similar to those measured in humans . Ciprofloxacin failed to eliminate either strain of pneumococcus from mouse lungs at any of the doses tested (40, 80, or 160 mg/kg of body weight) by the end of therapy (33 h) . Mice that received ciprofloxacin at 160 mg/kg were clear of S . pneumoniae 7 5 days later, whereas persistence and regrowth of S . pneumoniae 1629 resulted in the death of 20% of animals treated with ciprofloxacin . Therapy with cefaclor (20 mg/kg) produced an effect similar to that of ciprofloxacin . In contrast, amoxicillin (10 and 20 mg/kg) and amoxicillin-clavulanic acid (10/5 and 20/10 mg/kg) were significantly (P less than 0.05) more effective in eliminating both strains of S . pneumoniae from the lungs by the end of therapy and, by 168 h, had prevented mortality in 80 to 100% of treated animals . The efficacy of ciprofloxacin against these experimental pneumococcal respiratory infections was poor, despite good penetration into lung tissue, and is a reflection of the low in vitro activity of the quinolone against S . pneumoniae, one of the most common pathogens in community-acquired pneumonia.

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