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 t