Scand J Infect Dis, 1991, 23(1), 47 - 53 Rationality and cost-effectiveness of diagnosis and treatment of group A streptococci in primary care patients with pharyngitis; Makela M et al.; Rationality and cost-effectiveness of several strategies for diagnosing and treating sore throat patients were evaluated in primary care . In an empirical material of 2016 patients, 3 different bacteriological methods (traditional culture, slide culture, and latex agglutination test) for the detection of group A beta-hemolytic streptococci (GAS) were compared . Sensitivity analyses were done for several variables, including GAS test performance, testing frequencies, medication rates, and accuracy of clinical evaluation . The amounts of unnecessary medication varied from 19 to 33%, and there were 2.2-8.9% of untreated GAS infections . Strategies based on bacteriology achieved more rational and economic results than treating no one, treating all patients, or using clinical evaluation without bacteriology . The cost-effectiveness of the latex agglutination test depended on the sensitivity of the test . The results were further sensitive to sick leave lengths, cost of antibacterials, and clinical accuracy, but not to GAS test cost . Rapid tests for GAS detection can be recommended, if the sensitivity of the test in the actual working conditions is acceptable. Swed Dent J Suppl, 1991, 79, 1 - 103 Sorbitol transport and metabolism by oral streptococci; Svensater G; Sorbitol transport by oral streptococci was mediated by a phosphoenolpyruvate phosphotransferase system (PTS) . The transition of S . sanguis 160 from continuous growth on limiting glucose to limiting sorbitol resulted in induction of EIIsor of the sorbitol-PTS, as well as sorbitol-6-P dehydrogenase which converts sorbitol-6-P to fructose-6-P . Sorbitol transport activity required the presence of a soluble sorbitol-specific component of the PTS, tentatively identified as an enzyme III for sorbitol (IIIsor) . In addition, the results indicated that sorbitol transport can be mediated by the ELLglc, particularly in the presence of the sorbitol-specific component . S . sanguis 160 utilized sorbitol in a manner different from that reported for S mutans . Growth on glucose by S . sanguis 160 was inhibited by the presence of sorbitol in the growth medium and sorbitol was utilized in the presence of glucose . In addition, pulses of glucose added to cultures growing on sorbitol resulted in expulsion of sorbitol from the cell . Sorbitol was shown to interfere with glucose metabolism by S . sanguis 160 by inhibiting glucose transport by sorbitol-limited cells, but not by glucose-limited cells, and by inhibiting glycolytic activity with glucose as the substrate . Furthermore, sorbitol was an effective repressor of the glucose-PTS, exhibiting negative regulation over synthesis of both EIIglc and a soluble component of the glucose-PTS, presumably IIIglc . Oral streptococci metabolize sorbitol to large amounts of formate and ethanol in addition to smaller amounts of lactate and acetate . The metabolism of sorbitol by S . sanguis and S . gordonii was less sensitive to oxygen than that by S . mutans and S . mitis. Cah Anesthesiol, 1991, 39(3), 165 - 9 {Nosocomial pneumonia following surgery of esophageal tumors (apropos of 50 cases)}; Naudan P et al.; Esophagus cancer surgery often becomes complicated with fistulas and above all with infections . In 50 cases, the authors relate 7 fistulas and 60 nosocomial infections among which pneumonia takes the first place . The pneumonia diagnosis has been established on the criteria of the "National Nosocomial Infection Study" and on bacteriologic samples . Those mostly isolate Gram-bacilli and streptococci . The diagnosis and etiologic factors leading to prophylactic measures are studied. Vet Res Commun, 1991, 15(3), 163 - 76 The kinetics of inflammation and phagocytosis during bovine mastitis induced by Streptococcus agalactiae bearing the protein X; Rainard P et al.; The protein X of Streptococcus agalactiae is a surface antigen borne by a high proportion of strains isolated from bovine mastitis . We have tested the capacity of two strains of X-bearing Streptococcus agalactiae to induce mastitis in dairy cows . The reference X-strain (411.07) produced an intramammary infection with local clinical signs in the three inoculated quarters . Another X-bearing strain (443.31) of bovine origin produced infection in all 11 quarters inoculated with only 25 or 85 colony-forming units . In naive cows, strain 433.31 induced less exudation of plasma into the milk, shedding of bacteria, macroscopic alteration, and a lower somatic cell count (SCC) than did the reference strain . Only one quarter spontaneously eliminated the infection before antibiotic treatment 9 days after inoculation . The serum of all the cows contained naturally acquired or induced antibodies to the challenge strain (443.31) and possessed opsonic activity . Before inflammation occurred, the milk was almost devoid of antibody or opsonic activities . The early phase of infection was characterized by rapid multiplication of streptococci in the milk, followed by a sharp drop in bacterial counts concomitant with the onset of inflammation . Three cows immunized with protein X displayed higher SCC and bactericidal activity in milk from the inoculated quarter at the onset of inflammation than non-immunized cows . Two of the three immunized cows underwent an early and transient febrile episode and eliminated the infection. Caries Res, 1991, 25(3), 185 - 90 Interactions of sanguinarine and zinc on oral streptococci and Actinomyces species; Eisenberg AD et al.; Sanguinaria extract, which contains benzophenanthridine alkaloids, has been used as a folk medicine for many years . Minimum inhibitory and minimum bactericidal concentrations (MIC and MBC values) for sanguinarine were determined for common and etiologically important plaque bacteria . Because the efficacy of sanguinarine is believed to be enhanced by zinc, isobolograms were assessed to determine their mode(s) of interaction . Hydrogen ion concentration influenced the inhibitory activity of both sanguinarine and zinc . For sanguinarine, at the optimum pH (6.5), MIC values were 4 or 8 micrograms/ml for Streptococcus mutans, Streptococcus sobrinus, Streptococcus sanguis, Actinomyces viscosus and Actinomyces naeslundii . MIC values were 0.125-0.50 mmol Zn/ml . MBC values ranged from 1 to 8 mmol Zn/ml at pH 5.5 . Isobologram data revealed that sanguinarine and zinc interacted synergistically . Viadent oral rinse, which contained 300 micrograms sanguinaria extract/ml and 0.2% zinc chloride (14.9 mmol Zn/l), was inhibitory to all strains tested . MIC values were 1 or 2% (ml Viadent oral rinse/100 ml aqueous solution) for all strains except A . viscosus for which the MIC value was 12% (vol/vol). Caries Res, 1991, 25(3), 179 - 84 Effects of fluoride, lithium, and strontium on growth and acid production of mutants streptococci and Actinomyces viscosus; Eisenberg AD et al.; Eight strains of mutants streptococci and two strains of Actinomyces viscosus were studied to determine (1) their relative sensitivities to fluoride, lithium, and strontium and (2) whether lithium or strontium interact to enhance the known antimicrobial effects of fluoride . Analyses of variance of the data revealed a major inhibition of growth and acid production by fluoride, but not by lithium or strontium . Fluoride (5 mg/l) inhibited cell growth of all strains tested by a mean of 17% and total titratable acid production by a mean of 31% . However, there were marked differences between the strains . Mean total titratable acid was inhibited by fluoride least with the A . viscosus strains (15%) and most with the mutans streptococci (34%) . Although interactions among the elements were statistically significant, they were generally slight in magnitude. Swed Dent J, 1991, 15(3), 145 - 51 Salivary mutans streptococci and caries prevalence in 8-year-old Swedish schoolchildren; Twetman S et al.; The aim of this study was to obtain cross-sectional information about the quantitative distribution of salivary mutants streptococci assessed with a clinically applicable microbiological method and the relation to dental caries in young schoolchildren . A total of 355 8-year-old children were examined for the presence and number of mutants streptococci in saliva by a specially prepared strip, the "Strip-mutans" method, cultivated in a selective broth . The strips were first visually examined and grouped by aid of a templet provided by the manufacturer and thereafter transferred to a laboratory for enumeration of colony forming units (CFU) with aid of a stereomicroscope . Caries scores were obtained from the dental records . Mutans streptococci were identified in 70% of all children . 46% were free from the bacterium or harboured low levels (0-10 CFU) while high levels (greater than or equal to 500 CFU) were found only in 6% of the material . Strong positive correlations (p less than 0.001) were found between different levels of mutans streptococci infection and the caries experience in both the primary (dmfs) and the permanent (DMFS) dentition . A statistically significant correlation between the direct examination and the microscopic enumeration was disclosed (r = 0.84) . The bacterial culturing technique used in this study proved to be practical and reliable and thus useful in clinical routines of pediatric dentistry. Dtsch Zahn Mund Kieferheilkd Zentralbl, 1991, 79(2), 111 - 4 {The establishment efficiency of S . sobrinus OMZ 176 in a model caries experiment on the Osborne-Mendel rat}; Stosser L et al.; S . sobrinus OMZ 176 was inoculated in young OM rats during tooth eruption in two experiments and the microbial composition of dental plaque as well as the caries decay was estimated after 25 days on cariogenic sucrose rich diet . Germs were reproducibly established in the oral cavity by such way . The resulting caries decay correlated with the streptococci in the dental plaque . Due to this fact it seems to be necessary to identify not only the inoculated microorganisms at the end of each animal experiment but also to estimate the qualitative composition of the whole dental flora which may have an essential cariogenic effect. Br J Neurosurg, 1991, 5(2), 153 - 61 Multiple brain abscess: a review of fourteen cases; Kratimenos G et al.; The case notes of 14 consecutive patients with multiple brain abscesses presenting over a 14 year period were studied with respect to the incidence and presentation, the source of infection, the investigations, microbiology and the treatment and outcome . The incidence of multiple brain abscesses in non-immunocompromised patients is 13% of all intracranial abscesses . Computerized tomographic scanning is vital both in the detection of multiple abscesses and in the subsequent assessment of therapy . The source of infection in half of our patients was the teeth or the paranasal sinuses . Streptococci were isolated in 63% of the patients; staphylococci in 21% . This has obvious implications for the antibiotic policy . Intracranial surgery, with few exceptions, had a diagnostic and management role rather than a curative one; identification of the causative organism was its prime purpose . CSF, obtained by lumbar punctures, did not provide any positive cultures and should not be contemplated in view of the inherent hazards . The elimination of the primary focus of infection was a most important step in the management of this condition . Multiple brain abscesses represent a potentially curable condition, provided appropriate antibiotics are used, the primary septic focus is eliminated and the intracranial complications are anticipated by the use of frequently repeated CT scans. Zh Mikrobiol Epidemiol Immunobiol, 1991 Jan, (1), 24 - 7 {The pharyngeal beta-hemolytic streptococcal carrier state among blood donors}; Briko NI et al.; 459 blood donors aged 18-50 years were examined in 1987-1988 in Moscow . Among them, carrier state with respect to beta-hemolytic streptococci was detected in 107 donors (23.3%) . The number of carriers gradually decreased with the increase of age of the examined donors . Group C streptococci occurred least of all (6.9%) . Group A beta-hemolytic streptococci were isolated in 16.7% of the carriers . The isolation rate of streptococci from blood achieved its maximum in autumn and winter months and did not depend on preceding diseases, unhealthy working conditions, the rhesus factor and, with the exception of group A streptococci, the blood group . Among tonsillectomized donors carrier state with respect to beta-hemolytic streptococci occurred 2.2 times less frequently than among donors who had not undergone tonsillectomy . Carrier state with respect to beta-hemolytic streptococci was accompanied by higher levels of salivary sIgA antibodies to polysaccharide A, serum antibodies to polysaccharide A and circulating polysaccharide A . All beta-hemolytic streptococci were sensitive to erythromycin . All groups of streptococci showed the highest percentage of cultures resistant to gentamicin and tetracycline . In 100% of cases group A streptococci were sensitive to benzylpenicillin, methicillin, ampicillin, erythromycin and lincomycin. Recent Results Cancer Res, 1991, 121, 329 - 36 Spectrum and treatment of bacterial infections in cancer patients with granulocytopenia; Calandra T; Bacterial infections remain a frequent cause of morbidity and mortality in cancer patients with granulocytopenia . In recent years the proportion of patients with gram-positive infections, caused mainly by coagulase-negative staphylococci and viridans streptococci, has increased markedly in many institutions . The precise reasons for this recent change in the epidemiology of infection in cancer patients are as yet not fully ascertained . Although less prevalent, gram-negative infections are still the major threat, since they are associated with higher mortality . What constitutes the optimal empirical antibiotic therapy remains a controversial issue . One should however recognize that the results of one particular study may not be relevant to other institutions where the predominant pathogens and the pattern of antibiotic resistance may be different . In addition, the results of studies using various antibiotic regimens should be compared with caution . However, with these limitations in mind, the results of the most recently published studies support the following recommendations: in patients with nonmicrobiologically documented infections, monotherapy with a third-generation cephalosporin or a carbapenem is a safe alternative to combination therapy . For gram-negative bacteremia, combined therapy with an extended-spectrum beta-lactam antibiotic and an aminoglycoside appears preferable . For gram-positive infections, a specific anti-gram-positive antibiotic is not needed in every patient and can safely be added upon identification of the pathogen in those patients not responding to empirical therapy. Prep Biochem, 1991, 21(1), 75 - 86 A simple preparative procedure to extract and purify protein G from group G streptococci; Faulmann EL et al.; A rapid method for the solubilization of the bacterial type III Fc binding protein, protein G, from a group G streptococcus is described . Treatment of intact bacteria with cyanogen bromide results in the solubilization of a homogeneous Mr approximately 50,000 protein which retains IgG and human serum albumin binding properties . The solubilized protein could be purified to homogeneity by molecular sieving chromatography and retained all of the functional properties of the native protein. Crit Rev Microbiol, 1991, 18(1), 15 - 45 Enterococci in milk and milk products; Garg SK et al.; Enterococci are widely distributed in nature . They gain entry into milk and milk products through the water supply, equipment, and insanitary and unhygienic conditions of production and handling . They have been incriminated as direct or indirect agents of disease . The evidence concerning their involvement is only circumstantial . These reports are also disputed as the disease symptoms have not been experimentally induced in animal models . However, there is sufficient evidence to indicate that prolific growth of enterococci in foods may lead to formation of clinically significant levels of pressor amines . These amines are very thermostable and therefore remain active even after heat processing, which eliminates all viable streptococci . These pressor amines may be involved in the onset of migraine attacks and produce hypersensitive crises in psychiatric patients who are being treated with monoamine oxidase inhibitors for depression. Schweiz Med Wochenschr Suppl, 1991, 35, 1 - 37 {Meningitis in adults in Geneva . Review of 257 cases}; Dufour JF et al.; We review the 257 patients hospitalized for meningitis in the Cantonal University Hospital, Geneva between 1st January 1980 and 31st December 1986 . 104 patients had acute bacterial meningitis (32 Str . pneumoniae, 21 N . meningitidis, 10 Listeria monocytogenes, 8 streptococci, 5 H . influenzae, 5 staphylococci, 4 gram negative bacilli and 19 without identified bacteria), 124 patients had viral meningitis and 29 meningitis of other etiologies (6 tuberculous meningitis, 2 fungal meningitis, 1 leptospiral meningitis, 5 neoplastic meningitis--one already counted because of a meningitis due to Staph . epidermidis--2 meningitis consecutive to a meningeal irritation, 4 already treated meningitis of undetermined etiology, 2 chronic meningitis and 8 meningoencephalitis) . The total mortality was 14.4% . It was zero in viral meningitis and 28% in bacterial meningitis (47% in cases of Str . pneumoniae, 5% in cases of N . meningitidis, 20% in cases of Listeria monocytogenes, 38% in cases of streptococci, 0% in cases of H . influenzae, 60% in cases of staphylococci, 50% in cases of gram negative bacilli, 16% in cases of unidentified bacteria) . The striking difference in mortality emphasizes the importance of recognizing a bacterial etiology in order to institute antibiotic therapy as soon as possible . The delay between admission and lumbar puncture averaged 15 hours (range 0.25-96 h) in patients with acute bacterial meningitis and 6.3 hours (0.5-80 h) in patients with viral meningitis . The delay between admission and institution of the antibiotics averaged 5.3 hours (1-48 h) in cases of acute bacterial meningitis and 4.8 hours (0.5-48 h) in cases of viral meningitis . A better clinical workup may provide a reliable diagnosis sooner . In the collective with bacterial and viral meningitis headaches, fever or nuchal rigidity were present in over 80% of the cases . The following features were significantly associated with a bacterial etiology: age over 30 years, alcoholism, concomitant neoplasm, cough, coma, pulmonary rales, new neurological signs or petechia . At least one of these 4 latter signs was present in more than 70% of the cases with acute bacterial meningitis compared to 6% in cases of viral meningitis . Thus the clinical presentation alone serves to recognize the meningitis and to differentiate between a bacterial or viral etiology, thus permitting an immediate therapeutic decision without waiting for complementary investigations . The 104 patients with acute bacterial meningitis were treated with antibiotics: 60 with penicillin, 17 with ampicillin and 26 with other antibiotics; one case did not receive antibiotics . More than the half of the cases with viral meningitis have got antibiotics (52%). Scand J Infect Dis, 1991, 23(2), 163 - 8 Incidence and clinical epidemiology of streptococcal septicemia during treatment of acute myeloid leukemia; van der Lelie H et al.; The incidence and outcome of streptococcal septicemia was analyzed in 76 consecutive patients with newly diagnosed and relapsed acute myeloid leukemia . They received 215 courses of remission induction or intensive consolidation treatment . There were 31 different episodes of streptococcal septicemia in 27 patients, making these microorganisms the most frequently encountered bacteria in blood cultures . This high incidence coincided with the introduction of selective intestinal decontamination . In 24 episodes (20 patients) there was a fast recovery, but 7 patients developed pulmonary symptoms resulting in death due to respiratory failure in 5 of them . The infections all occurred in the phase of maximum bone marrow suppression 1-3 weeks after the start of the chemotherapy . Streptococcal septicemia was not limited to patients treated with cytosine arabinoside but also occurred in patients treated with other regimens of intensive chemotherapy . In 28 episodes there were no focal signs of infection, but in half there were symptoms of treatment induced gastrointestinal toxicity . The streptococci probably invade through oral and gastrointestinal mucosa damaged by the chemotherapy . Selective decontamination may play a promoting role. Pediatrician, 1991, 18(3), 211 - 7 Atopic and seborrheic dermatitis: practical management; David TJ et al.; Atopic dermatitis is common and causes sleep loss, a disfiguring appearance, an unpleasant odour, teasing, short stature and restriction of career choice in severe cases . There are no drugs which control the scratching; distraction, keeping the nails short and smooth, and the use of mittens at night are all helpful . The sedative action of the older H1 antihistamines makes them useful if scratching prevents a child from falling asleep . Emollients are useful for the associated skin dryness . The least potent topical steroids should be used sparingly to avoid the main hazards of skin atrophy, systemic absorption and growth stunting . Bacterial skin infection with Staphylococcus aureus and sometimes beta-haemolytic streptococci is common and is best treated with oral antibiotics . Herpes simplex virus skin infection is also common; the initial infection occasionally causes a lethal (if untreated) illness . Allergy to house dust mites, pet animals, pollen and food can worsen dermatitis in some cases . There is no test however, which can be used to predict those patients who will respond to avoidance measures, so that management tends to be based on empirical trials of antigen avoidance . Seborrheic dermatitis is a common disorder that usually occurs in the first months of infancy . Findings consist of greasy yellow scales on the scalp (most simply treated with an emollient) and well-demarcated erythematous patches in the diaper area that spread to other areas such as the axillae and neck (usually requiring topical steroids) . Some cases go on to develop atopic dermatitis, but many others, although florid, resolve spontaneously. Eur J Cancer, 1991, 27(4), 409 - 11 Viridans streptococcal bacteraemia in patients with haematological and solid malignancies; Burden AD et al.; Thirty-three episodes of septicaemia caused by viridans streptococci are reported in 32 adults under treatment for malignant diseases . The underlying diseases were acute leukaemia (17), lymphoma (4), myeloma (1), small cell carcinoma of the bronchus (6), carcinoma of the breast (2) and carcinoma of the stomach (2) . Important predisposing factors included severe neutropenia and oral mucositis due to intensive chemotherapeutic regimens . There was a poor response to standard empirical antibiotics and a mortality of 12% . A role for prophylactic penicillin in high risk groups is suggested. Diagn Microbiol Infect Dis, 1991 Jan-Feb, 14(1), 29 - 31 Comparative in vitro activity of teicoplanin and vancomycin against United States teicoplanin clinical trial isolates of gram-positive cocci; Kenny MT et al.; In this study, the in vitro activity of teicoplanin and vancomycin was directly compared against 503 Gram-positive cocci isolated during the U.S . teicoplanin clinical trials . Both antibiotics were equally active against oxacillin-sensitive Staphylococcus aureus, oxacillin-sensitive and oxacillin-resistant Staphylococcus epidermidis, and other coagulase-negative staphylococci, except Staphylococcus haemolyticus . Teicoplanin was fourfold more active than vancomycin against oxacillin-resistant S . aureus (MIC90, 0.5 vs . 2.0 micrograms/ml), whereas vancomycin was more active than teicoplanin (MIC90, 2.0 vs . 8.0 micrograms/ml) against oxacillin-resistant S . haemolyticus . Teicoplanin was two- to eightfold more active than vancomycin against the streptococci and enterococci tested. Caries Res, 1991, 25(6), 454 - 8 Fluoride and mutans streptococci in plaque grown on glass ionomer and composite; Forss H et al.; The aim of this study was to compare the levels of fluoride and mutans streptococci in plaque grown on glass ionomer (Ketac-Fil) and composite (Silar) restorations in vivo . From tunnels left under the brackets bonded either with glass ionomer or composite, 14-day-old plaque samples were collected 14, 28, and 42 days after bonding . For glass ionomer the mean counts of mutans streptococci in plaque were 0.5 x 10(3), 6.7 x 10(3), and 8.8 x 10(3) CFU at the first, second, and third collection, respectively, whereas for composite restorations the corresponding values were 32.1 x 10(3), 14.6 x 10(3), and 120.6 x 10(3) CFU . For glass ionomer the mean concentrations of fluoride were 19,985, 5,788, and 5,019 ppm at first, second, and third collections of 14-day-old plaque samples, respectively, whereas for composite restorations the mean concentrations of fluoride were about 200 ppm throughout the study . The results show that the fluoride level in plaque growing on glass ionomer is much higher than that on composite restorations which seems to affect the level of mutans streptococci in dental plaque. Caries Res, 1991, 25(6), 449 - 53 Effect of dentifrices containing either xylitol and glycerol or sorbitol on mutans streptococci in saliva; Svanberg M et al.; In 76 adults, randomly distributed between two groups, a comparison was made of the effect on the level of mutans streptococci in saliva between two dentifrices containing: (1) xylitol (9.9%) and glycerol (20%) or (2) sorbitol (28%) as humectants . After the use of the dentifrices twice daily for 3 months, the levels of mutans streptococci had not changed significantly in the sorbitol-treated group, whereas a significant reduction (p less than 0.0005) was found in subjects using the xylitol/glycerol dentifrice . The difference between the two dentifrice groups based on the changes observed during the 3-month period was also significant (p less than 0.02). Caries Res, 1991, 25(6), 444 - 8 Dental caries and mutans streptococci in the proximal areas of molars affected by the habitual use of xylitol chewing gum; Isokangas P et al.; The relationship between the caries status and the microbiological status {mutans streptococci (MS)} in the proximal areas of lower right and upper left molars was investigated in subjects of the Ylivieska xylitol study in Finland (1982-1985) in a cross-sectional follow-up in 1988 . Those children who had used xylitol chewing gum regularly since 1982 showed significantly lower caries indices in 1988, including the proximal caries scores . The presence of MS (expressed in log10 colony-forming units) in the proximal areas studied was significantly lower in habitual xylitol consumers . Carious interproximal areas of all subjects had significantly higher total levels of MS than clinically and radiographically sound interproximal areas . The present study supports the idea of a close association between MS and dental caries, and shows that the total level of MS in the human dentition can be influenced by xylitol . It is likely that the long-term (between 1982 and 1988) habitual xylitol consumption had decreased the prevalence of MS in the interproximal areas of the present subjects and, subsequently, decreased the proximal and overall caries indices. Caries Res, 1991, 25(6), 415 - 23 Comparison of the physicochemical surface properties of Streptococcus rattus with those of other mutans streptococcal species; van der Mei HC et al.; Mutans streptococci comprise a group of seven closely related, yet distinct species . The distinction between the four species used in this study, namely Streptococcus sobrinus, Streptococcus cricetus, Streptococcus rattus, and Streptococcus mutans, has been made only recently on the basis of DNA homologies . In order to determine if there is a difference in the physicochemical surface properties of these species, strains were characterized by contact angles, zeta potentials and isoelectric points (IEP), elemental surface compositions by X-ray photoelectron spectroscopy, and molecular moieties by infrared spectroscopy . Contact angles, particularly when measured with water, can be considered a measure of cell surface hydrophobicity; zeta potentials reflect the charge of the outermost cell surface; X-ray photoelectron spectroscopy yields the relative abundance of carbon, oxygen, nitrogen, and phosphorus over the outer 5 nm of the bacterial cell surface; infrared spectroscopy enables a molecular characterization in terms of proteins, phosphates, and polysaccharides . All four species were homogeneous with regard to their physicochemical surface properties . However, the S . rattus species were clearly different from the others on the basis of the low water contact angle (21 +/- 2 vs . 26-31 degrees), highly negative zeta potential and lack of IEP, and high oxygen/carbon (0.50 +/- 0.02 vs . 0.41-0.43) and phosphorus/carbon (0.016 +/- 0.001 vs . 0.006-0.008) surface concentration ratios . Amongst the other differences observed, each species had a characteristic pH dependence of their zeta potential measured in phosphate buffer, yielding an IEP of 1.7, 2.1, and 2.5 for S . cricetus, S . sobrinus, and S . mutans, respectively . However, a cluster analysis on the zeta potential data showed only an isolated cluster for the S . rattus species . Thus it is likely that the higher cariogenicity of S . sobrinus with respect to S . cricetus and S . mutans is, in addition to a higher acidogenicity, due to the smaller negative surface charge, giving an increased adhesion to negatively charged tooth surfaces . S . rattus is expected to be the least adherent strain in the oral cavity as it carries a relatively high negative surface charge. Microbiol Immunol, 1991, 35(12), 1029 - 40 Surface hydrophobicity of "rheumatogenic" and "nephritogenic" strains of group A streptococci and the ultrastructural surface feature of pharyngeal cells exposed to group A streptococci; Kumar KS et al.; The present study was carried out to determine the surface hydrophobicity of group A streptococcal strains responsible for rheumatic fever (RF), "rheumatogenic" strains (RG strains) and strains causing glomerulonephritis, "nephritogenic" strains (NG strains) in relation to their adhesion to human pharyngeal cells . Scanning electronmicroscopic (SEM) studies were carried out to the difference, if any, in the adherence of group A streptococci (M type 5) to pharyngeal and buccal cells (PEC and BEC) . By employing two techniques for hydrophobicity determination, salt aggregation titre (SAT) and n-hexadecane binding technique, it was observed that RG strains (M5, M1 and M6) were more hydrophobic than NG strain, M49 . However, NG strain M12 was almost equally as hydrophobic as RG strains . The adherence of RG strains, except M1 and M24, to PEC was greater in number than that of NG strains . Although M1 strain was hydrophobic, its adherence to PEC was less . Pepsin and trypsin treatment with streptococci reduced the hydrophobicity and adherence of RG and NG strains to PEC . SEM studies revealed firmly adhered indigenous bacteria on PEC and BEC . Streptococci (M5) adhered more to PEC than to BEC . SEM studies also showed that PEC had a peculiar ultrastructural surface feature to which streptococci adhered . These findings suggest that streptococcal hydrophobicity alone does not determine their adhesion to PEC . The surface nature of PEC might be a characteristic feature of the epithelial cells that allows streptococci to adhere and colonize or it might be a consequence of streptococcal adhesion. Dtsch Zahn Mund Kieferheilkd Zentralbl, 1991, 79(8), 631 - 9 {Biocompatibility studies of periodontal dressings}; Sachse RE et al.; Periodontal packs have to be considered medications due to their direct contact to the gums and wound surfaces . For this reason a high cell biological compatibility has to be considered as one of their most important properties . For this reason, the cytotoxicity of all periodontal packs commonly used in Germany was examined, using the "Erlangen Ciliate Test" . This method, which is commonly used to determine the cytotoxic and cytostatic properties of a wide variety of different materials and substances, is based on liquid cultures of the eucaryotic organism "Tetrahymena piriformis", using an excellent correlation with mammalian or human tissue cultures as well as the LD50 . A significant toxicity of up to 50% could be shown in all but one periodontal pack . In addition, the antibacterial properties of the same materials were examined, using liquid cultures of Staphylococcus aureus and hemolyzing streptococci group A . However, using this method, no significant antibacterial effects could be shown. Biomed Sci, 1991, 2(4), 410 - 4 Immunogenicity of a polypeptide fragment of the streptococcal group A M protein conjugated with an acrylic acid N-vinylpyrrolidone copolymer; Lyampert IM et al.; Immunization of animals with a polypeptide fragment of the streptococcal group A M protein (pep M) conjugated with a synthetic copolymer caused a significant increase in the titres of bactericidal type-specific antibodies . In some cases bactericidal antibodies to streptococci of other types were also induced. Biol Neonate, 1991, 60(5), 320 - 6 Bilirubin as an antioxidant: effect on group B streptococci-induced pulmonary hypertension in infant piglets; Pauly TH et al.; Bilirubin scavenges toxic oxygen radicals in vitro, but it is not known whether this potential salutary effect can be extended to the intact animal . Accordingly, the present experiments tested the hypothesis that bilirubin protects against oxygen radical-dependent pulmonary hypertension and arterial hypoxemia in piglets infected with group B streptococci (GBS) . Piglets ranging in age and weight from 7 to 14 days and 1.5 to 2.0 kg, respectively, were infused for 60 min with 108 cfu GBS/kg/min . One group of 7 animals was pretreated with a bolus infusion of 15 mg/kg of bilirubin followed by a continuous bilirubin infusion . A second group of 7 animals was given the vehicle . While plasma bilirubin levels in control animals were negligible, administration of exogenous bilirubin was associated with plasma levels of 13.0 +/- 0.74 mg% . Piglets treated with exogenous bilirubin exhibited GBS-induced increases in pulmonary arterial pressure and decreases in PaO2 of 16.1 +/- 2.0 and 46.5 +/- 4.3 torr, respectively . In control animals, GBS increased pulmonary arterial pressure and decreased PaO2 by 17.5 +/- 1.6 and 47.9 +/- 3.2 torr, respectively . Neither the peak changes in pulmonary arterial pressure or PaO2 nor the time courses of these alterations differed between treatment groups . These observations indicate that bilirubin fails to prevent GBS-induced pulmonary hypertension and arterial hypoxemia in infant piglets and suggests that in this particular model bilirubin does not exhibit appreciable oxygen radical scavenging activity. Shoni Shikagaku Zasshi, 1991, 29(1), 95 - 101 {Caries-inducing activity of soybean-oligosaccharide (SOR) in vitro and in experimental dental caries of rats}; Yoshida T et al.; The caries-inducing activity of soybean-oligosaccharide (SOR: stachyose- and raffinose-rich sugar mixture) was examined in in vitro and in vivo experiments . Streptococcus mutans MT 8148R fermented SOR and produced acids . However Streptococcus sobrinus 6715 did not ferment . SOR was not able to act as a substrate for crude glucosyltransferases (GTase) of these mutans streptococci to synthesize the water-insoluble glucan . However, SOR did not inhibit the synthesis of water-insoluble glucan from sucrose by crude GTase . SOR was proved to be of low cariogenicity in rats infected with S . sobrinus 6715. Proc Finn Dent Soc, 1991, 87(4), 477 - 87 Oxygen and the sugar metabolism in oral streptococci; Abbe K et al.; Streptococci have several ways of adapting themselves to the constantly changing environment of the human oral cavity . This paper discusses the adaptation of sugar metabolism to variations in oxygen levels . In all streptococci the Embden-Meyerhof pathway of glycolysis works under aerobic as well as anaerobic conditions, but pyruvate is converted into different metabolic end products depending on the oxygen levels . Under anaerobic conditions all streptococci form formate, acetate, and ethanol by a pyruvate formate-lyase pathway . If sugar is in excess, they also form lactate using a lactate dehydrogenase . Under aerobic conditions pyruvate formate-lyase is inactivated . This enzyme is then replaced by a pyruvate oxidase in some streptococci and by a pyruvate dehydrogenase in others . The characteristics of these enzymes help streptococci like S . sanguis, S . oralis, S . gordonii, and S . mitis to compete successfully with other bacteria in those sites of the oral cavity that are freely exposed to saliva, while mutans streptococci have to colonize anaerobic sites such as those in-between the teeth and in the occlusal fissures of the teeth. Proc Finn Dent Soc, 1991, 87(4), 449 - 61 Antibody responses to mutans streptococci in children; Tenovuo J et al.; Because mutans streptococci (Streptococcus mutans, S . sobrinus) are considered the main causative bacteria in human dental caries, immune responses to these bacteria have aroused much research interest over the last two decades . Studies in man have focused mainly on salivary and serum antibodies developing naturally in response to oral colonization by mutans streptococci, or in relation to the development of dental caries . Although both salivary (IgA) and serum-derived (IgG) antibodies have been shown in many studies to protect against the adherence of and to interfere with the metabolism of mutans streptococci, no conclusive evidence relating to their clinical significance is available . In young children, serum IgG antibodies to S . mutans seem more important than salivary IgA antibodies in relation to protection against dental caries . In studies in animals and, recently, in man, monoclonal IgG antibodies to S . mutans protein antigen I/II ("adhesin") have provided effective protection against mutans streptococci . Whether they could also prevent dental caries in man is not yet known. Proc Finn Dent Soc, 1991, 87(4), 443 - 7 Transmission of mutans streptococci; Alaluusua S; It has been shown that early establishment of mutans streptococci in the mouth of infants increases risk of caries . Extensive studies on the timing of infection, and on sources and routes of transmission of the organism have been performed . Results of many studies suggest that the source of mutans streptococci is the mother, especially her saliva . Methods used to attempt to verify this hypothesis have developed considerably in recent years . Recent research and work in progress using methods based on DNA analysis have increased and will extend knowledge about transmission . This review summarizes the results obtained by different methods of transmission of mutans streptococci . The final goal of studies is to accumulate adequate information for prevention strategies of mutans streptococcal infection. Scand J Infect Dis, 1991, 23(5), 553 - 8 Phenoxymethylpenicillin two or three times daily for tonsillitis with beta-haemolytic streptococci group A: a blinded, randomized and controlled clinical study; Fyllingen G et al.; In relation to compliance problems it was investigated whether phenoxymethylpenicillin dosed twice or 3 times daily was equally effective in tonsillitis due to beta-haemolytic streptococci group A . In a randomized, controlled and single blind multicentre study 206 patients older than 5 years with a positive culture of group A streptococci were treated with phenoxymethylpenicillin for 7 days . 101 patients received the daily dosage divided in 2 doses and 105 patients divided in 3 doses a day . The cure rate (a combination of bacteriological and clinical cure) was 82.0% in the 2-dosage regimen, and 88.2% in the 3-dosage regimen . The difference was not statistically significant . In conclusion, phenoxymethylpenicillin dosed 2 or 3 times daily seems to be equally effective in tonsillitis due to group A streptococci. Nephrologie, 1991, 12(5), 227 - 32 {A severe epidemic of Streptococcus group G infection in hemodialysis: epidemiologic survey by molecular biology and preventive measures}; Branger B et al.; An outbreak of group G streptococci infection affected 6 patients of an hemodialysis unit . Group G streptococci were isolated from patients and from numerous atmospheric specimens, different parts of two dialysis machines, and two blankets, but from only one nurse on the hospital staff . Typing of group G streptococci by an improved method of DNA fingerprinting showed that the isolates from one patient, the nurse and the two blankets differed from one another . The group G streptococci were probably transmitted to patients by dialysis machines with defective microporous filters . No further case of group G streptococci infection was reported three years later since microporous guard filters were systematically doubled. Gen Pharmacol, 1991, 22(5), 797 - 800 Ampicillin concentrations in human oral tissues following a single oral administration of lenampicillin; Akimoto Y et al.; 1 . Ampicillin concentrations in serum (n = 20), gingiva (n = 12), jawbone (n = 13), dental follicle (n = 12), radicular granuloma (n = 2) and radicular cyst (n = 2) were measured in specimens obtained during 0.5-2.5 hr after a single oral administration of lenampicillin (equivalent to 500 mg of ampicillin) . 2 . Measurable ampicillin concentrations were found in all serum and tissues . 3 . Ampicillin concentrations in serum and tissues except for some gingiva and jawbone exceeded MIC for 90% of clinically isolated strains of alpha-hemolytic Streptococci . 4 . Ampicillin concentrations in gingiva and jawbone were below the MIC for 90% in 2 out of 12 and 4 out of 13 specimens, respectively. Pediatriia, 1991, (7), 62 - 6 {Effect of various infections on the development, course and outcome of glomerulonephritis in children}; Shparvasser VV et al.; Bacteriological and virological tests were made at the disease onset and repeatedly in 100 children (66 boys and 34 girls) aged 2 to 15 years suffering from acute glomerulonephritis . The throat mucus was found to contain streptococci and staphylococci; direct immunofluorescence demonstrated antigens of influenza A1, A3, B virus, of parainfluenza virus, serotypes 1 and 3, of adenovirus and respiratory and syncytial virus; HBs-antigens, specific viral and bacterial antibodies were detected in the blood serum . At the onset of acute glomerulonephritis, 52.5% of the patients were diagnosed to have bacterial infection, 12.5% respiratory viral infection, and 27.5% mixed infection (respiratory viral and bacterial) . Besides, 25.5% of the patients showed HBs-antigenemia . HBs-antigenemia and mixed (respiratory viral and bacterial) infection were found to produce an adverse effect on the course and outcome of acute glomerulonephritis . Long-term circulation of some viral antibodies (mostly to parainfluenza-3 antigen) was revealed on repeated studies as was their untoward effect on the outcome of acute glomerulonephritis. Caries Res, 1991, 25(5), 392 - 5 Effect of intensified caries prevention on approximal caries in adolescents with high caries risk; Seppa L et al.; The aim of this study was to evaluate the effect of two preventive programs carried out in Public Dental Clinics for children with high caries risk . From all the 13-year-olds living in Kuopio (n = 871), 323 (37%) were selected as a high-risk group on the basis of the level of salivary mutans streptococci or DS score . They were randomly divided into two groups . The first group continued with the preventive care they had received before the study . The dentists treating the children in the second group were specifically informed about their high caries risk, and instructions concerning intensified prevention were given . For comparison, half of the 13-year-olds with low caries risk were included in the study (group 3, n = 248) . No special instructions concerning these children were given . After 2 years, approximal caries increment in the two risk groups was three times that of the low-risk group (2.6, 2.3 and 0.7 in groups 1-3, respectively) . There was no significant difference between the two risk groups in spite of the fact that significantly more preventive procedures were provided for group 2 than for group 1 . The results indicate that assessment of the subjects as high and low-risk groups was successful, but caries prevention targeted for the risk groups failed to lower the rate of caries to the same level as that of the children with an anticipated low risk . For children at high risk, the intensified prevention program monitored by dental authorities was no more successful than prevention planned by individual dentists. Arch Oral Biol, 1991, 36(10), 703 - 8 Crevicular IgG antibodies and Streptococcus mutans on erupting human first permanent molars; Camling E et al.; The specific IgG antibody activity against indigenous Streptococcus mutans in gingival crevicular fluid (GCF) was determined in 25, 6-7-yr-old children . Samples of plaque and GCF were collected from all erupting first permanent molars . Plaque samples were also collected from the adjacent second primary molars . The presence of clinical caries was scored as defs . In the same individual a highly significant correlation (p less than 0.005) was found between the level of specific antibody activity in GCF when comparing first permanent molars with each other . No correlation was found between the specific antibody activity in GCF and the number of indigenous Strep . mutans colonizing the buccal surfaces of the first permanent molars . Caries-free children had significantly less specific antibody activity in GCF than children with caries experience (p less than 0.05) . In the same child a highly significant correlation (p less than 0.0001) was found between the level of colonization by mutans streptococci on the permanent molars and the adjacent second primary molars. Microbios, 1991, 65(264-265), 155 - 67 Dextranase activity of streptococcal isolates from human dental plaques; Johnson IH; Streptococci were isolated from sixty human dental plaques . Of those isolates which exhibited dextranolytic activity on culture media containing dextran, three were selected for further investigation . Two of these isolates were identified as Streptococcus mitior and the other was a strain of Streptococcus mutans . The organisms were cultivated in a dialysed medium and enzyme activities isolated from culture supernatants by precipitation with ammonium sulphate, dialysis and lyophilization . Decolourized annuli surrounding wells in agar plates containing Blue Dextran 2000 provided evidence of dextranase activity present in culture supernatants, precipitated and redissolved proteins, dialysis retentates and lyophilized materials . The pH optima for the crude enzyme preparations were determined using the modified assay of Koh and Khouw (1970) . Dextranases from the Streptococcus mitior isolates had optima at pH 6, and the optimal activity for the enzyme from the Streptococcus mutans isolate occurred at pH 5.5 . Additional studies of the purified enzymes are necessary to increase understanding of the possible effects of these enzymes in human dental plaques. Infect Immun, 1991 Jan, 59(1), 204 - 10 A monoclonal antibody identifies a protective C-protein alpha-antigen epitope in group B streptococci; Madoff LC et al.; Group B streptococci (GBS) are the leading causes of neonatal sepsis and meningitis in the United States, with a high rate of fatality and serious morbidity despite appropriate therapy . The C-protein antigens of GBS appear to be important in immunity to experimental infection, yet these antigens remain incompletely characterized with respect to their number, structure, and function . None of these proteins has yet been purified to homogeneity . We have developed a novel method for extraction of surface proteins from the A909 (Ia/c) strain of GBS by using mutanolysin . Antibodies raised in rabbits against these partially purified proteins conferred passive protection to lethal GBS infection in mice challenged with a GBS strain expressing C proteins with a heterologous capsule type . In addition, mouse monoclonal antibodies were produced and identified by reactivity with the mutanolysin-extracted proteins . One of these monoclonal antibodies (4G8) identifies an epitope on the alpha-antigen of the GBS C proteins (identified by protease susceptibility and mouse protection) . On sodium dodecyl sulfate-polyacrylamide gels, this epitope appears as a series of regularly spaced bands ranging in apparent molecular mass from 160,000 to 30,000 Da . The monoclonal antibody 4G8 induces opsonic killing of GBS and protects mice from lethal challenge with GBS . Thus, the 4G8 monoclonal antibody identifies a fully protective epitope on the C-protein alpha-antigen of GBS. J Enzyme Inhib, 1991, 5(2), 99 - 110 Some properties of an endodextranase inhibitor from continuous cultures of Streptococcus sobrinus; Pearce BJ et al.; Cell-free filtrates of Streptococcus sobrinus, cultured at low growth rate in the chemostat, contain a dextranase inhibitor that can completely inhibit the activity of S . sobrinus endodextranase . The range of conditions under which inhibition occurs, and the situations in which enzyme activity can reappear, have been examined in continuous cultures of strain 6715-13WT and the dextranase-deficient mutant 6715-13-201 . A purified preparation of the inhibitor was specific for S . sobrinus dextranase, having no action on dextranases from other oral streptococci . The percentage inhibition of S . sobrinus dextranase varied with the enzyme concentration, and the complete inhibition of low amounts of enzyme indicated a very tight bond between the inhibitor and the enzyme. Bull Soc Pathol Exot, 1991, 84(5 Pt 5), 532 - 9 {Genital carriage of Streptococcus group B in the pregnant woman in Abidjan (Ivory Coast)}; Faye-Kette Achi H et al.; To determine the prevalence of group B streptococci to the pregnant woman in Abidjan, we have proceeded an inquiry to a carrier regrouping 150 women examined during a systematic prenatal consultation . The pregnant women did not present any clinical symptoms which can evoke a genital infection . The sampling to the research of group B streptococci have been made to the level of vulva, vagina and cervix . The global frequency of isolation to the pregnant woman is of 19.33% with a frequency of 9.33% to the level of the cervix and the vagina and of 11.33% to the level of the vulva. Drugs Exp Clin Res, 1991, 17(3), 187 - 90 Piperacillin/tazobactam in the treatment of serious acute soft tissue infection; Gould IM et al.; Twenty-five consecutive patients admitted to hospital with severe soft tissue infection were entered into an open trial designed to evaluate safety and efficacy of the drug combination tazobactam/piperacillin . The dosage regimen was 4 g piperacillin/500 mg tazobactam Q8H . There were twenty cases of uncomplicated cellulitis and five cases with associated abscess formation . These five cases required adjunctive surgical drainage . Mean duration of therapy was 7.6 days . No other antibiotics were administered unless treatment with the study drug failed . There were eight treatment failures, six related to the trial drug . Four patients developed an allergic response to the trial drug, necessitating a change of therapy . Three patients failed to respond; all three had acute cellulitis in association with peripheral vascular disease . Significant bacterial isolates were grown in thirteen patients; Group A streptococci in three, S . aureus in five, other pathogenic streptococci in four and coliforms or Ps . aeruginosa in five . The majority of isolates except the streptococci were resistant to piperacillin but all isolates except one strain of Ps . aeruginosa were susceptible to the combination . The combination is suitable for the treatment of serious soft tissue infection, but increased doses may be appropriate in infection at poorly perfused sites. Free Radic Res Commun, 1991, 12-13 Pt 1, 179 - 85 The SOD like activity of copper:carnosine, copper:anserine and copper:homocarnosine complexes; Kohen R et al.; Carnosine, anserine and homocarnosine are natural compounds which are present in high concentrations (2-20 mM) in skeletal muscles and brain of many vertebrates . We have demonstrated in a previous work that these compounds can act as antioxidants, a result of their ability to scavenge peroxyl radicals, singlet oxygen and hydroxyl radicals . Carnosine and its analogues have been shown to be efficient chelating agents for copper and other transition metals . Since human skeletal muscle contains one-third of the total copper in the body (20-47 mmol/kg) and the concentration of carnosine in this tissue is relatively high, the complex of carnosine:copper may be of biological importance . We have studied the ability of the copper:carnosine (and other carnosine derivatives) complexes to act as superoxide dismutase . The results indicate that the complex of copper:carnosine can dismute superoxide radicals released by neutrophils treated with PMA in an analogous mechanism to other amino acids and copper complexes . Copper:anserine failed to dismute superoxide radicals and copper:homocarnosine complex was efficient when the cells were treated with PMA or with histone-opsonized streptococci and cytochalasine B . The possible role of these compounds to act as physiological antioxidants that possess superoxide dismutase activity is discussed. J Immunol, 1990 Dec 15, 145(12), 4284 - 9 Effect of glycolipids of Leishmania parasites on human monocyte activity . Inhibition by lipophosphoglycan; Frankenburg S et al.; Lipophosphoglycan (LPG) and glycosyl phosphatidylinositol Ag (GPI), are glycolipids present on the membrane of Leishmania parasites . Both glycolipids have been chemically characterized . LPG is a polysaccharide of repeating phosphorylated units linked to a phosphocarbohydrate core that is anchored to the membrane by lysoalkyl phosphatidylinositol (PI) . The GPI are smaller glycolipids with a structure resembling the phosphocarbohydrate core of the LPG . They are anchored to the membrane by alkyl acyl PI . Their relative abundance, uniqueness of structure, and cellular location suggest a role in interactions of the parasites with host cells . In the present study we examined the effect of LPG and GPI on the activation of human peripheral blood monocytes . Three parameters were studied: the production of IL-1, chemotactic locomotion, and oxidative burst . We found that whereas neither GPI nor LPG directly affected monocyte activity, preincubation of the monocytes with LPG strongly inhibited further activation: The production of IL-1, after stimulation with LPS, was decreased in a dose-dependent manner . Previous incubation with LPG also inhibited chemotactic locomotion of monocytes and neutrophils in response to diacylglycerol, zymosan-activated serum, FMLP and LTB4 . Luminol-dependent chemiluminiscence caused by stimulation of the monocytes with streptococci and histone was also inhibited . After fragmentation of the LPG into phosphoglycan and 1-O-alkylglycerol by phosphatidylinositol-phospholipase C, only the phosphoglycan retained inhibitory activity . No difference in inhibitory activity was found between LPG prepared from Leishmania major or Leishmania donovani promastigotes . These results show that the phosphoglycan of LPG inhibits the immunologic response of normal human monocytes and neutrophils, and suggest that LPG may influence the nature of the inflammatory response surrounding infected cells. J Immunol, 1990 Dec 15, 145(12), 4089 - 93 Identification of an epitope of type 1 streptococcal M protein that is shared with a 43-kDa protein of human myocardium and renal glomeruli; Kraus W et al.; The localization of opsonic and tissue-cross-reactive epitopes within the amino terminus of type 1 streptococcal M protein was investigated by using murine mAb raised against synthetic peptides of type 1 M protein . Two mAb (IIIA2 and IIIB8) reacted with epitopes located within amino acid residues 1-12 of type 1 M protein . These antibodies opsonized type 1 streptococci and did not cross-react with human kidney and heart tissue . Another mAb (IC7) reacted with mesangial cells of renal glomeruli and human myocardium . The cross-reactive epitope of mAb IC7 was localized to position 13-19, indicating that it is not the same epitope as the previously described vimentin-cross-reactive epitope at position 23-26 of type 1 M protein . In Western blots of mesangial cell and myocardial proteins, mAb IC7 cross-reacted with a 43-kDa protein . Neither vimentin nor actin inhibited the binding of mAb IC7 to the cross-reactive protein, as determined by Western blot or immunofluorescence inhibition tests . These results provide evidence that type 1 M protein contains at least one autoimmune epitope shared with both human glomeruli and myocardium. J Antimicrob Chemother, 1990 Dec, 26 Suppl F, 109 - 23 Prevention of infection by ciprofloxacin in neutropenia; Warren RE et al.; Ciprofloxacin with erythromycin, each at a dose of 250 mg 12-hourly, is effective prophylaxis against Gram-negative bacteraemia in neutropenic patients . The erythromycin component may contribute little to prophylaxis and does select for erythromycin-resistant viridans streptococci which then cause bacteraemia . Ciprofloxacin prophylaxis does not prevent coagulase-negative staphylococcal bacteraemia and resistant strains are selected . Initial use of vancomycin with a ureidopenicillin in pyrexial patients is currently justified by the exclusively Gram-positive nature of breakthrough bacteraemia . In patients failing to respond to this regimen, treatment modification to include full-dose amphotericin is frequently effective . Surveillance and containment isolation of patients carrying resistant Gram-negative species is prudent to prevent the spread of such resistant bacteria in oncology/haematology units. J Antimicrob Chemother, 1990 Dec, 26 Suppl F, 101 - 7 High dose intravenous ciprofloxacin in febrile neutropenic patients; Johnson PR et al.; We have evaluated the use of high-dose intravenous ciprofloxacin as monotherapy in the empirical therapy of febrile episodes in neutropenic patients during the course of a randomized trial comparing ciprofloxacin with a standard combination regimen . Sixty-four episodes of fever were studied in a high risk population of 42 patients mostly undergoing intensive chemotherapy for leukaemia . Ciprofloxacin achieved clinical responses as follows: completely successful in 39%, partially successful in 20%, and unsuccessful in 41% . Infections were microbiologically documented in 37 (58%), with Gram-positive bacteria (of which 37% were coagulase negative staphylococci and 34% were streptococci) accounting for 81% of all organisms cultured . Responses in documented infections were as follows; completely successful in 32%, partially successful in 27%, and unsuccessful in 41% . One infection-related death occurred 30 h after starting ciprofloxacin, and a further three patients died before the resolution of neutropenia . The early death was caused by fulminant infection with a ciprofloxacin-resistant Pseudomonas aeruginosa . No other ciprofloxacin resistance was seen amongst eight Gram-negative isolates . There was no evidence of emerging ciprofloxacin resistance during the course of the study . Ciprofloxacin was associated with a low incidence of adverse events with skin rash (five cases) and nausea (one case) being reported as possibly or probably related to ciprofloxacin . We conclude that high-dose intravenous ciprofloxacin may be safely employed as monotherapy in the empirical treatment of febrile episodes in neutropenic patients . It has the additional advantages of twice daily administration, the availability of intravenous and oral presentations, and absence of cross-allergy in beta-lactam antibiotic hypersensitive patients. J Clin Microbiol, 1990 Dec, 28(12), 2834 - 6 Properties of group B streptococci with protein surface antigens X and R; Wibawan IW et al.; A total of 128 bovine and 134 human group B streptococci were serotyped by conventional methods . Among the bovine cultures, 60 (47%) had type antigen X, and among the human cultures, 53 (39%) had type antigen R . The occurrence of type antigens X and R was significantly related to the growth pattern of the bacteria in fluid media . Type X- and R-positive cultures and most of the nontypeable cultures predominantly formed long chains and grew as granular sediment with clear supernatant . In addition, group B streptococci with surface antigen X or R showed compact colony formation in soft agar and reacted positively in the salt aggregation test . These properties, possibly caused by the surface charges of the X- and R-positive cultures, might be related to bacterial pathogenicity. Br J Oral Maxillofac Surg, 1990 Dec, 28(6), 359 - 66 A microbiological and clinical review of the acute dentoalveolar abscess; Lewis MA et al.; Early microbiological studies of acute suppurative dental infection implicated streptococci or staphylococci as the causative microorganisms but recent studies suggest that the microbial flora of acute dentoalveolar abscess is usually polymicrobial, predominantly involving CO2-dependent streptococci, strictly anaerobic Gram-positive cocci and strictly anaerobic Gram-negative bacilli . These differences are probably due to poor sampling techniques and inadequate culture methods used in the early investigations . It is now accepted that specimens should be obtained by aspiration to avoid contamination and processed promptly using strict anaerobic culture . Traditionally the bacterial strains isolated have been regarded as members of the normal oral commensal microflora but it is becoming increasingly apparent from experimental infections that they have pathogenic properties . Although the vast majority of isolates have been found to be sensitive to a variety of antimicrobial agents there would not appear to be a uniformly effective drug . At the present time a penicillin, such as amoxycillin, would probably be the first choice antimicrobial agent with the addition of metronidazole if clinical improvement does not occur. J Trop Med Hyg, 1990 Dec, 93(6), 417 - 8 Persistent occurrence of beta-haemolytic streptococci in a population of Lagos school children; Lawal SF et al.; A total of 354 (8%) out of 4395 primary school pupils located in seven Lagos primary schools were positive for beta-haemolytic streptococci (BHS) . Eighty-three (23%), 99 (28%) and 113 (32%) of the respiratory tract isolates and 25 (53%), 14 (30%) and seven (15%) of the skin-lesion isolates were identified as belonging to Lancefield groups A, C and G respectively . Prevalence rate of BHS in a rural school was different from that in urban schools. Tubercle, 1990 Dec, 71(4), 259 - 66 Improved immunotherapy for pulmonary tuberculosis with Mycobacterium vaccae; Bahr GM et al.; We previously demonstrated that a single intradermal injection of 10(9) irradiation-killed M . vaccae, given 1 month after starting chemotherapy, caused significant changes in responses to mycobacterial antigens . Amongst 38 patients with pulmonary tuberculosis, 29% had lymphocytes responding to common myocobacterial antigens after the injection, compared with only 11% of 49 similar patients after an injection of saline (p less than 0.03) . To increase the proportion of responders to these antigens, six modifications of the potentially immunotherapeutic injection, randomized with injections of saline, have been assessed by biochemical, clinical, haematological, immunological and radiological criteria . Subsequent lymphocyte proliferation to mycobacterial antigens enabled the modifications to be ranked in order of efficacy . Tuberculin plus murabutide plus 10(9) irradiated M . vaccae (36% of 25), an autoclaved preparation of 10(9) M . vaccae (45% of 22), and 2 x 10(9) irradiated M . vaccae (75% of 12) were the most effective . Antibody responses in several IgG subclasses to mycobacteria, but not streptococci, were also significantly increased by the most effective modifications over the 8 weeks following injection . Detailed radiological study showed that use of the autoclaved bacilli was followed by a delay in clearing of consolidation, but by better closing of cavities than was found in the control group, suggesting enhanced, or altered, immunological activity around the lesions. Br J Dermatol, 1990 Dec, 123(6), 793 - 6 Perianal streptococcal cellulitis with penile involvement; Duhra P et al.; Perianal streptococcal cellulitis is described occurring in a 5-year-old boy . The condition also involved the penis and presented as a possible case of sexual abuse . The correct diagnosis was established by culturing beta-haemolytic streptococci group A from the penile and perianal skin. J Exp Med, 1990 Dec 1, 172(6), 1757 - 64 Differentiation between two biologically distinct classes of group A streptococci by limited substitutions of amino acids within the shared region of M protein-like molecules; Bessen DE et al.; Group A streptococci can be categorized into two classes (I and II) based on immunodeterminants contained within a surface-exposed, conserved region (C repeat domain) of the major virulence factor, M protein . Previous studies have shown that several biological properties correlate strongly with streptococcal class, and thus, there is a strong impetus to precisely define the antigenic epitopes unique to class I and II M proteins . Using synthetic peptides, the binding sites of two class I-specific mAbs were mapped to distinct epitopes within the C repeat region of type 6 M protein (class I) . A class II M protein-like gene (type 2) was cloned and sequenced, and the predicted amino acid sequence was compared for homology to class I and II molecules, whose sequences were previously reported . For a given C repeat block 35 amino acid residues in length, 20 residue positions were conserved among all sequences analyzed . Of the 15 variable amino acid positions, only four were class specific, and three of the four positions were localized in the area to which the class I-specific mAbs bound . The predicted secondary structures of class I and II C repeat blocks reveals that they are alpha-helical, except for a single area of disruption . In the class I molecules, the area of disruption corresponds to the class I-specific mAb binding sites . Importantly, the predicted conformational characteristics of this disruption differs for class I and II molecules . The data suggest that only limited changes in amino acid residues differentiate between class I and II molecules in the C repeat region . Therefore, selective (biological) pressures may have contributed to the evolution of these two classes of molecules. Am J Dis Child, 1990 Dec, 144(12), 1313 - 5 Impetigo . Current etiology and comparison of penicillin, erythromycin, and cephalexin therapies; Demidovich CW et al.; We attempted to determine the causative bacterial pathogens of impetigo in children in our area, to compare the effectiveness of three frequently used oral antimicrobial treatment regimens, and to correlate the antimicrobial sensitivity of the bacterial isolates with clinical responses to treatment . Seventy-three children with impetigo were randomly assigned to receive penicillin V potassium or cephalexin monohydrate, both administered in dosages of 40 to 50 mg/kg per day, or erythromycin estolate administered in a dosage of 30 to 40 mg/kg per day . All drugs were given in three divided doses for 10 days . Treatment failure was defined as persistence of lesions 8 to 10 days after initiation of drug therapy as determined by examiners blinded to the treatment therapies . Forty-five (62%) cultures showed Staphylococcus aureus only, 14 (19%) showed S aureus and group A beta-hemolytic streptococci, six (8%) showed group A beta-hemolytic streptococci only, and eight (11%) showed no growth or other organisms . Treatment failure occurred in six (24%) of 25 patients treated with penicillin V, one (4%) of 25 patients treated with erythromycin estolate, and no patients treated with cephalexin . We conclude that S aureus is the most common cause of impetigo in children in our study population, that cephalexin is the most effective treatment, that erythromycin estolate is nearly equally effective and may be preferred on a cost-effectiveness basis, and that penicillin V is inadequate for treatment of this infection. Br J Haematol, 1990 Dec, 76 Suppl 2, 45 - 8 Using teicoplanin for empiric therapy of febrile neutropenic patients with haematological malignancies; Menichetti F et al.; The cumulative experience with teicoplanin in treating febrile neutropenic patients included in three different comparative clinical trials conducted at a single institution during a 3-year period, is presented . 152 febrile episodes in 129 neutropenic patients were treated with i.v . teicoplanin (6 mg/kg/d) combined with amikacin (15 mg/kg/d) plus ceftazidime (90 mg/kg/d) . The study population comprised 75 patients with acute leukaemia and 77 marrow recipients: 53% (81/152) had a central venous catheter in place and 68% (103/152) had severe neutropenia (less than 100/mm3) at the beginning of the febrile episode . The overall response rate of the evaluable febrile episodes was excellent: 88% (107/122) improved . Bacteraemias due to Gram-positive cocci accounted for 75% of the total (42/56) and pathogens in the blood isolates were mostly staphylococci (coagulase-negative 14, coagulase-positive 13) and streptococci (13) . The response rate of Gram-positive bacteraemias was good: 88% (37/42) improved and 75% (9/12) of Gram-positive bacteraemias having teicoplanin as the only antibiotic with in vitro activity against the infective strains were cured . Death due to infection accounted for 7% of total febrile episodes (11/152) . Side effects were documented in 14% of the episodes . In a setting of high prevalence of Gram-positive infections caused by strains with a high rate of resistance to aminoglycoside and beta-lactam antibiotics, there may be an advantage in including teicoplanin in the initial empiric antibiotic regimen for febrile neutropenic cancer patients. Br J Haematol, 1990 Dec, 76 Suppl 2, 1 - 5 Options and limitations of teicoplanin in febrile granulocytopenic patients; De Pauw BE et al.; During the years 1985-89 three studies on the efficacy and safety of teicoplanin in the treatment of febrile granulocytopenic patients suffering from haematological malignancies were assessed . In the first prospective study, teicoplanin at a dose of 400 mg/d was added to the initial empiric therapy of 65 febrile granulocytopenic episodes . When teicoplanin was given because of proven or presumed Gram-positive infection, 67% of cases were treated successfully . Patients with skin and soft-tissue infections achieved a 78% response rate . The second study on 120 patients was designed as a prospective randomized trial to compare the efficacy and toxicity of ceftazidime with and without teicoplanin . Response was achieved in 25/51 (49%) cases from the ceftazidime and in 33/52 cases (63%) from the combination groups . Seven of 18 (39%) cases with initial bacteraemia in the monotherapy group compared with 10/20 (50%) cases in the combination group responded to the empiric regimen . A retrospective analysis was carried out on the efficacy of teicoplanin in 125 cases of proven Gram-positive Hickman line-associated bacteraemia . Teicoplanin proved to be effective in eradicating 80% of the Staphylococcus epidermidis, 72% of the Staph . aureus, 90% of the 'viridans' streptococci and 67% of the enterococci . Removal of the catheter was required in 13% of cases in order to control the infection, and only one patient died of a catheter-related septicaemia caused by Staph . aureus . The total success rate leaving the catheter in situ was 78%, and 92% if cases with catheter removal were included . Serum levels of teicoplanin were predictable giving a peak and trough concentration on the fourth day of 30.4 +/- 5.0 mg/l and 9.8 +/- 1.7 mg/l . Hearing loss of 20 dB at 8000 Hz was noted in one case and transient liver or kidney disturbances attributable to the drug were observed in 4% of cases. J Dent Res, 1990 Dec, 69(12), 1847 - 51 Influence of hydrophobicity on oligopeptide utilization by oral streptococci; Cowman RA et al.; The growth responses of Streptococcus mutans VA-29R, Streptococcus sanguis ATCC 10556, and Streptococcus mitior NIH to hydrophilic and hydrophobic peptides obtained following isopropanol fractionation of Trypticase were compared . Although the two fractions contained peptides of similar molecular size, differences were observed with respect to amino acid compositions . S . mutans VA-29R showed a pronounced difference in growth response to hydrophilic vs . hydrophobic peptides . While growth of this micro-organism on hydrophilic peptides was indistinguishable from that on unfractionated Trypticase, only very slow growth occurred on the hydrophobic peptides . S . sanguis ATCC 10556 and S . mitior NIH also displayed some selectivity, as evidenced by their faster relative growth rates on hydrophilic, as compared with hydrophobic, peptides . The results of this study support the conclusion that the properties of the substrate, as defined by its amino acid composition, may be more important than molecular size as a factor influencing recognition and subsequent utilization of oligopeptides as sources of amino acids for growth by these three oral streptococci. Oral Microbiol Immunol, 1990 Dec, 5(6), 320 - 3 In vitro survival of Bacteroides intermedius in five transport media, alone or in the presence of Streptococcus sanguis; Deveaux E et al.; The survival rate of Bacteroides intermedius was first tested in monoculture, and Streptococcus sanguis was then added in 5 different transport media; 2 nonnutritious media, the viability-preserving medium of the University of Goteborg No . IV (VMG IV), reduced transport fluid (RTF), and 3 nutritious media, thioglycolate medium (TG), peptone yeast extract medium (PY) and PY medium with 1% glucose (PYG) . All manipulations were carried out in an anaerobic chamber . After a given transport time (6 or 24 h) aliquots were spread on plates containing solid PY medium by means of an automated spiral system device, thus permitting counts after incubation . The slight variations in the counts of B . intermedius in monoculture, not exceeding 0.5 log10 in the 5 media tested, indicated its good survival capability, i.e . at least 24 h . By contrast, when S . sanguis was added, it was only possible to use nutritious media such as PY or TG for 6 h . In the glocose-containing media (PYG, TG), the multiplication of rapidly glucose-fermenting microorganisms such as streptococci influenced the B . intermedius survival rate . Therefore, the transport time for oral microbiological samples needs to be reduced as much as possible . The use of excessively rich media (particularly media containing a high level of glucose) should be avoided. J Pediatr, 1990 Dec, 117(6), 859 - 63 Lack of influence of beta-lactamase-producing flora on recovery of group A streptococci after treatment of acute pharyngitis; Tanz RR et al.; Because production of beta-lactamase by normal pharyngeal flora could account for penicillin treatment failure, we studied the effect of anaerobic and aerobic beta-lactamase-producing bacteria on bacteriologic outcome in acute group A beta-hemolytic streptococcal (GABHS) pharyngitis . We compared 10-day courses of orally administered phenoxymethyl penicillin and amoxicillin-clavulanic acid, using a randomized, single-blind treatment protocol . Eligible patients were 2 to 16 years of age and had culture-proven acute GABHS pharyngitis; 89 patients (43 penicillin, 46 amoxicillin-clavulanic acid) were compliant with therapy . beta-Lactamase-producing organisms were isolated before therapy from the throats of 67% of patients treated with penicillin and 63% treated with amoxicillin-clavulanic acid . Throat cultures after completion of therapy were positive for GABHS in 7 (7.9%) of 89 patients . The initial GABHS T type persisted (treatment failure) in only 4 (4.5%) of 89 patients, including 3 (6.5%) of 46 who received amoxicillin-clavulanic acid and in 1 (2.3%) of 43 who received penicillin (not statistically significant) . Bacteriologic treatment failure was unrelated to recovery of beta-lactamase-producing bacteria at the time of enrollment or after treatment . We conclude that beta-lactamase production by normal pharyngeal flora does not fully explain the failure of penicillin therapy for acute streptococcal pharyngitis . Using an antibiotic effective against beta-lactamase-producing bacteria will not eliminate the problem of bacteriologic treatment failure. Oral Microbiol Immunol, 1990 Dec, 5(6), 352 - 9 Control of sugar utilization in oral streptococci . Properties of phenotypically distinct 2-deoxyglucose-resistant mutants of Streptococcus salivarius; Gauthier L et al.; The physiological and biochemical characterization of Streptococcus salivarius mutants isolated by positive selection for resistance to 0.5 mM 2-deoxyglucose in the presence of lactose are reported . We found 2 classes of mutants following a series of experiments that included: growth rate determinations, uptake studies, measurement of phosphotransferase system (PTS) activities and detection of the IIIman proteins by Western blotting and analysis of {32P}PEP-phosphorylated proteins . Class 1 mutants did not possess the low-molecular-weight form of IIIman . They did not grow on mannose and were unable to transport 2-deoxyglucose . On the other hand, class 2 mutants possessed the 2 forms of IIIman, grew readily on mannose and transported 2-deoxyglucose, albeit at a lower rate than the parental strain . Both classes of mutants exhibited abnormal growth in media containing mixtures of sugars . Moreover, derepression of genes coding for catabolic enzymes was observed in all the mutant strains . Our data suggested that the role of the mannose PTS in the control of sugar utilization in S . salivarius is complex and may involve the participation of several components. Oral Microbiol Immunol, 1990 Dec, 5(6), 309 - 14 Dental caries in congenitally athymic rats; Stack WE et al.; The importance of the immune response in dental infection was evaluated in heterozygous (rnu/+) normal and homozygous (rnu/rnu) congenitally athymic "nude" Rowett rats . Animals of both types were infected, or immunized and infected, with mutans streptococci (Streptococcus sobrinus strain 6715) . The mean numbers of S . sobrinus cells recovered from the nude rats were higher than those from comparable (immune/nonimmune) normal rats in 10 of 12 possible comparisons . Also, S . sobrinus constituted a greater percentage of the total streptococci in the nude rats compared with normal animals (6 of 6 possible comparisons) . Antibody to S . sobrinus whole cells or to S . sobrinus glucosyltransferase from nude rats in serum or in saliva was significantly lower (or absent) than that of comparable normal rats . This was seen after infection, but was most pronounced after immunization (and infection) . Dental caries was also significantly elevated in the congenitally athymic animals . Immunologic deficiency of congenitally athymic rats can lead to a greater infection level with mutans streptococci and increased dental caries. J Commun Dis, 1990 Dec, 22(4), 269 - 73 Serogroups of beta-haemolytic streptococci isolated from clinical specimens in parts of eastern Nigeria; Nwankwu EO et al.; From 470 patients, mainly of respiratory infection, attending University of Nigeria Teaching Hospital, Enugu, Nigeria 212 (45 per cent) strains of beta-haemolytic streptococci were isolated and 25 per cent of the isolates belonged to Group B Streptococcus . Percentage isolation of other groups was A(21.2), G(20.3), C(16.1), D(10.8) and F(5.2) . Maximum (11.2 per cent) isolates were from age group of 5-17 years . All serogroups were sensitive to penicillin G and ampicillin despite the prevalent misuse of drugs in the state and the country at large. Zentralbl Bakteriol, 1990 Dec, 274(3), 359 - 65 Biological properties of staphylococcal lipoteichoic acid and related macromolecules; Ohshima Y et al.; Lipoteichoic acids (LTAs) and related macromolecules (e.g . cell surface substance, CSS; cell surface antigen, CSA; cell surface complex, CSC) are a group of phosphate-containing polymers associated with the cell walls of Gram-positive bacteria (32) . They may be considered as surface-reactive antigens (immunogens, biological response modyfiers) as well as membrane components which mediate the attachment of certain bacteria (S . saprophyticus, S . aureus, group A streptococci) to host cell tissues. Zentralbl Bakteriol, 1990 Dec, 274(3), 325 - 32 Hypothesis on the pathogenesis of post-streptococcal glomerulonephritis based on recent clinical and experimental research; Holm SE; The current theories on the pathogenesis of post streptococcal glomerulonephritis are reviewed . Clinical findings during the last decades have indicated the involvement of an immune mechanism . However, the lack of adequate animal models has hampered a thorough understanding of the development of the disease from the initiating infection to the final glomerulonephritic sequelae . Several facts point to the presence of a special nephritogenic streptococcal factor which is directly or indirectly involved in the pathogenesis . There seems to be a plasminogen activator (PA) with unique properties . Data on animals experiments using streptococci producing this factor as well as on injections of the pure substance are presented and correlated to the finding in post streptococcal glomerulonephritis in man. Mol Microbiol, 1990 Dec, 4(12), 2071 - 9 Isolated DNA repeat region from fcrA76, the Fc-binding protein gene from an M-type 76 strain of group A streptococci, encodes a protein with Fc-binding activity; Heath DG et al.; The DNA repeat region of fcrA76, the gene encoding a group A streptococcal Fc-binding protein, was subcloned in-frame into an Escherichia coli plasmid expression vector . The expressed protein product displayed the same Fc-binding properties as the full-length Fc-binding protein expressed from fcrA76 . The affinity-purified, full-length Fc-binding protein was found to compete with staphylococcal protein A or streptococcal protein G for binding to beads coated with human IgG . These results are consistent with earlier studies suggesting that the binding sites on human IgG for protein A, protein G and the type II Fc-binding protein from group A streptococci are located at the interface of the CH2 and CH3 domains of the Fc region. Appl Environ Microbiol, 1990 Dec, 56(12), 3890 - 4 Intrageneric coaggregation among strains of human oral bacteria: potential role in primary colonization of the tooth surface; Kolenbrander PE et al.; Of the 122 human oral bacterial strains tested from 11 genera, only streptococci and a few actinomyces exhibited coaggregation among the strains within their respective genera . Eight of the ten streptococci showed multiple intrageneric coaggregations, all of which were inhibited by galactosides . The widespread intrageneric coaggregation among the streptococci and the less extensive coaggregation among the actinomyces offers an explanation for their accretion on cleaned tooth surfaces and their dominance as primary colonizers. Eur J Clin Microbiol Infect Dis, 1990 Dec, 9(12), 901 - 3 Two cases of severe infection with beta-haemolytic group A streptococci associated with a toxic-shock-like syndrome; Chomarat M et al.; Two cases of severe infection due to Streptococcus pyogenes associated with a toxic-shock-like syndrome (TSLS) and also with serious soft-tissue infection are described . Serotyping and detection of A, B and C exotoxins were carried out on strains isolated from blood cultures and skin samples . The strain of serotype M1 T1, which produced 10 ng/ml of exotoxin A and also synthesised exotoxins B and C, caused severe TSLS associated with major skin lesions . The second strain of serotype M12 T12, which produced only 1 ng/ml of exotoxin A and synthesised exotoxin B, was associated with clinical manifestations of adult respiratory distress syndrome . The relationship between the magnitude of exotoxin production and the severity of clinical manifestations cannot be established from these two cases. Zh Mikrobiol Epidemiol Immunobiol, 1990 Dec, (12), 22 - 6 {A new method for the rapid diagnosis of acute streptococcal infection}; Grevnina GS et al.; The work deals with the development of the rapid method of the identification of acute streptococcal infection on the basis of the coagglutination test . The rapid method of the extraction of group-specific polysaccharide antigen from the cell walls of group A streptococci is proposed . The data on the use of native sera and their fractions in the development of coagglutination diagnostica have been described and analyzed . The advantages of the new method of the diagnosis of acute streptococcal infection in comparison with the traditional microbiological method are shown. JAMA, 1990 Nov 28, 264(20), 2644 - 7 Association of group C beta-hemolytic streptococci with endemic pharyngitis among college students; Turner JC et al.; Throat cultures were performed throughout 2 school years to determine whether non-group A beta-hemolytic streptococci (NGA BHS) could be isolated more frequently in 232 college students who had symptomatic pharyngitis than from 198 age-matched controls with noninfectious problems . Duplicate throat swabs were inoculated onto plates that contained sheep blood agar, one plate being incubated in a 5% CO2 atmosphere and the other in an anaerobic environment . The BHS were grouped using latex agglutination . Among the NGA BHS, only those from group C were isolated significantly more often among the patients compared with the controls (26% vs 11%) . Quantitative colony counts of isolates of group C BHS were generally higher among patients than controls . Patients with group C BHS had fever, exudative tonsillitis, and anterior cervical adenopathy significantly more frequently than did patients who had throat cultures that were negative for group C BHS . Group C BHS were epidemiologically associated with endemic pharyngitis in this college student population. Schweiz Rundsch Med Prax, 1990 Nov 6, 79(45), 1383 - 6 {In-vitro activity of cefuroxime-axetil against pathogens of bacterial infections of the respiratory tract}; Kayser FH et al.; Cefuroxime-Axetil is an ester of cefuroxime, which can be used as an oral antimicrobial agent . The prodrug is hydrolysed by esterases of the gut mucosa, setting free the active cefuroxime . This second generation cephalosporin is well known since more than a decade as a cephalosporin possessing high stability against gram positive and gram negative beta-lactamases . Due to its pharmacokinetic properties and its wide spectrum of activity, cefuroxime-axetil was recommended to be used as an oral agent in bacterial infections of the respiratory tract . This paper describes the in vitro activity of cefuroxime against respiratory tract pathogens and compares it with that of ampicillin and amoxicillin, amoxicillin/clavulanic acid, cefaclor, chloramphenicol, tetracycline, erythromycin and trimethoprim/sulphamethoxazole . Cefuroxime had good activity against beta-lactamase-producing and beta-lactamase-negative H . influenzae and M . catarrhalis . As expected, the aminopenicillins showed reduced activity against beta-lactamase-producing strains of these organisms . Amoxicillin/clavulanic acid and, to a lesser degree, cefaclor also showed good activity against these bacteria . Cefuroxime was highly active against penicillin-susceptible pneumococci, but showed impaired activity against penicillin-resistant strains . Therefore, this drug should not be used in infections caused by penicillin-resistant pneumococci . Resistance to penicillin in pneumococci isolated in Switzerland is not a problem at the present time . For many years, such strains were isolated only sporadically . Cefuroxime showed also a high in vitro activity against streptococci of serogroups A, B, C and G, which are encountered as respiratory tract pathogens . Against beta-lactamase-positive and -negative staphylococci, cefuroxime showed good activity . The drug was inactive, however, against methicillin-resistant strains. Br J Clin Pract, 1990 Nov, 44(11), 523 - 4 Community outbreak of invasive group A streptococcal infection; Taylor AK; In a two-month period, three cases of septicaemia and one of suppurative tenosynovitis caused by a single strain of Lancefield group A streptococcus, serotype T/M/R 3/3/3, occurred in the district of Nairn (population: 10,239) . A primary portal of entry for the organism could not be identified in any of the cases . Laboratory isolates from all four patients were highly susceptible to beta-lactam antibiotics, but prompt treatment failed to prevent the deaths of two previously healthy adults . Group A streptococci of M-type 3 have not previously been associated with outbreaks of invasive infection. Int J Cardiol, 1990 Nov, 29(2), 249 - 52 Isolated rheumatic carditis, a disease in search of diagnostic criteria; Bauwens F et al.; We report a case of acute dilated cardiomyopathy with histologic proof of inflammatory myocarditis . Although immunosuppressive therapy seemed to induce the resolution of the inflammatory infiltrate, it had no effect on the clinical course . The diagnosis of isolated rheumatic carditis was considered because of the finding of a very high antistreptolysin O titre and lack of evidence for either viral disease, infection with group C and G streptococci or other causes of spuriously high titres of anti-streptolysin O . In view of our conclusion longterm chemoprophylaxis was instituted. Dtsch Zahnarztl Z, 1990 Nov, 45(11), 733 - 6 {Electrophoretic analysis of potential receptors for oral streptococci in human saliva}; Bergmann JE et al.; Initial adhesion of oral streptococci occurs at specific binding sites present in the dental pellicle . These receptors are salivary proteins and glycoproteins which by necessity possess affinity to dental enamel as well as to the adhering microorganism . By gel electrophoresis and immunoblotting, five such proteins were shown which bound to hydroxyapatite and oral streptococci . Information on the molecular events of initial adhesion to dental surfaces by oral microorganisms may possibly open new avenues in caries prevention. Acta Paediatr Scand, 1990 Nov, 79(11), 1023 - 30 Incidence and etiology of neonatal septicaemia and meningitis in western Sweden 1975-1986; Tessin I et al.; In a retrospective study of neonatal septicaemia and meningitis in a defined region of western Sweden 1975-1986, 231 cases were identified . The incidence was 2.8/1000 live births . The case-fatality rate was 15% . thirty-three patients had meningitis . Only 55 patients (24%) had no known risk factors . Preterm delivery was a most important risk factor for both morbidity and mortality . The most common causative organisms were group B streptococci, Staphylococcus aureus and aerobic Gram-negative rods, together isolated from 82% of the patients . The cases were approximately equally divided between very early, early and late onset infections . Group B streptococci were over-represented in very early onset infections in all birthweight groups and aerobic Gram-negative rods were the most common isolates from low birthweight infants with late onset infections . However, group B streptococci, Staphylococcus aureus and Gram-negative rods were found in all birthweight and gestational age groups . Thus, initial antimicrobial therapy must be equally broad in all neonates with suspected septicaemia. Zentralbl Veterinarmed B, 1990 Nov, 37(9), 680 - 3 Demonstration of alpha and beta components of group B streptococcal protein antigen c in serum-soft agar; Wibawan IW et al.; Among 85 group B streptococcal cultures with protein type antigen c 56 cultures demonstrated a diffuse type of colony morphology in plain soft agar . The addition of monospecific antibodies against the protein antigen c components c alpha and c beta converted specifically the colony morphology from diffuse to compact . According to this results the serum-soft agar technique could also be used to further characterize individual cultures of group B streptococci with protein antigen c. J Clin Microbiol, 1990 Nov, 28(11), 2576 - 7 Ability to bind salivary alpha-amylase discriminates certain viridans group streptococcal species; Kilian M et al.; A collection of 144 viridans group streptococcal strains recently characterized as part of a taxonomic study was examined for the ability to bind salivary alpha-amylase . This property was found in most strains of Streptococcus gordonii and Streptococcus mitis and in occasional strains of Streptococcus anginosus and Streptococcus salivarius . In contrast, all strains of Streptococcus sanguis, Streptococcus oralis, Streptococcus vestibularis, and Streptococcus mutans lacked alpha-amylase-binding capacity . A rapid and easy assay described in this paper may be an important supplementary test for identification of oral streptococci. J Clin Microbiol, 1990 Nov, 28(11), 2467 - 72 Enumeration of mutans streptococci in clinical samples by using monoclonal antibodies; de Soet JJ et al.; Mutans streptococci have been strongly associated with dental caries . Two members of this group of bacteria, Streptococcus mutans and Streptococcus sobrinus, are often found in human dental plaque . Identification of mutans streptococci on the basis of sugar fermentation is troublesome and easily leads to erroneous conclusions . Furthermore, the recovery on selective media differs for different species . This causes incorrect enumeration of S . mutans and S . sobrinus in clinical samples . The aim of this study was to develop a method for simultaneous identification and enumeration of S . mutans and S . sobrinus in dental plaque and saliva samples . With this immunoblot technique (IBT), significantly more plaque samples containing S . sobrinus were detected than on the selective medium Trypticase-yeast-cysteine-sucrose-bacitracin agar (TYCSB) (P less than 0.01) . The numbers of plaque samples harboring S . mutans were equal on TYCSB and by IBT . However, the numbers of CFU of S.mutans as well as of S . sobrinus detected with the IBT were significantly higher than those obtained on TYCSB (P less than 0.001) . The recovery of primary isolations of S . sobrinus on TYCSB seems to have been inhibited in 26 of the 45 S . sobrinus-containing plaque samples . False-positive or false-negative reactions with the IBT were not found. APMIS, 1990 Nov, 98(11), 1045 - 52 Arginine catabolism by strains of oral streptococci; Floderus E et al.; Arginine catabolism via the arginine deiminase pathway was found in Streptococcus sanguis 903 . Citrulline and ornithine were released from resting cells incubated with arginine, arginine-containing peptides, or saliva . Maximum arginine catabolism by resting cells of S . sanguis 903 was found in the pH range 7-8 and at 45-48 degrees C . Arginine deiminase activity was found in the cytoplasm and in the cell-wall extract of this strain, while ornithine carbamoyltransferase activity was found in the cytoplasm and in extracts of cell walls and cytoplasmic membranes . Streptococcus mutans GS-5 and Streptococcus sobrinus strains OMZ 176 and 6715 could release arginine from salivary peptides but were incapable of significant arginine catabolism. APMIS, 1990 Nov, 98(11), 1027 - 32 Early response in neonatal septicemia . The effect of Escherichia coli, Streptococcus agalactiae and tumor necrosis factor on the generation of lactoferrin; Gutteberg TJ et al.; Using an in vitro model, we report the early effect of Escherichia coli (E . coli), Streptococcus agalactiea (group B streptococci, GBS) and recombinant tumor necrosis factor alpha (TNF) on the release of lactoferrin (LF) and the generation of interleukin-1 (IL-1) due to E . coli, using heparinized whole blood from healthy full-term newborns . We wanted to find a dose response relationship between lactoferrin generation on the one hand and the amount of E . coli, GBS and TNF on the other hand . In a final concentration of 10(7) per ml both bacteria increased the release of LF significantly . The response to E . coli was immediate and mg/l +/- 0.29 mg/l, E . coli 1.83 mg/l +/- 0.76 mg/l, p less than 0.001) . GBS was a less potent stimulant than E . coli and the response was only apparent after 20 minutes (mean +/- S.D.: 1.06 mg/l +/- 0.49 mg/l, p less than 0.01) . TNF in a concentration of 10000 pg/ml as well as 1000 pg/ml increased the release of LF significantly (after 20 minutes mean +/- S.D.: 1.09 mg/l +/- 0.42 mg/l and 0.97 mg/l +/- 0.36 mg/l, respectively), whereas a concentration of 100 pg/ml had no effect . Whole blood incubated with different preparations of LF for 20 minutes did not increase the generation of LF significantly . No significant changes in IL-1 levels were observed . Lactoferrin had bacteriostatic but no bactericidal effect on GBS and Streptococcus mutans. J Clin Invest, 1990 Nov, 86(5), 1428 - 33 Immunogenicity in animals of a polysaccharide-protein conjugate vaccine against type III group B Streptococcus; Wessels MR et al.; The native capsular polysaccharide of type III group B Streptococcus elicits a specific antibody response in only 60% of nonimmune human subjects . To enhance the immunogenicity of this polysaccharide, we coupled the type III polysaccharide to tetanus toxoid . Prior to coupling, aldehyde groups were introduced on the polysaccharide by controlled periodate oxidation, resulting in the conversion of 25% of the sialic acid residues of the polysaccharide to residues of the 8-carbon analogue of sialic acid, 5-acetamido-3,5-dideoxy-D-galactosyloctulosonic acid . Tetanus toxoid was conjugated to the polysaccharide by reductive amination, via the free aldehyde groups present on the partially oxidized sialic acid residues . Rabbits vaccinated with the conjugate vaccine produced IgG antibodies that reacted with the native type III group B streptococcal polysaccharide (3/3 rabbits), while rabbits immunized with the unconjugated type III polysaccharide failed to respond (0/3 rabbits) . Sera from animals receiving conjugate vaccine opsonized type III group B streptococci for phagocytic killing by human peripheral blood leukocytes, and protected mice against lethal challenge with live type III group B streptococci . The results suggest that this method of conjugation to a carrier protein may be a useful strategy to improve the immunogenicity of the type III group B Streptococcus polysaccharide in human subjects. Infect Immun, 1990 Nov, 58(11), 3802 - 6 Binding of viridans group streptococci to human platelets: a quantitative analysis; Sullam PM et al.; The binding of viridans group streptococci with human platelets was analyzed by two-color flow cytometry . Binding was detected within 15 s of mixing bacteria and platelets . At ratios of bacteria to platelets of 1:1, 10:1, 100:1, and 1,000:1, the percentages of bound streptococci (mean +/- standard deviation) were 93.2% +/- 5.4%, 80.0% +/- 8.6%, 39.8% +/- 11.1%, and 12.5% +/- 2.0%, respectively . Binding of labeled bacteria was reversed by adding a 500-fold excess of unlabeled streptococci . These results demonstrate that streptococcus-platelet binding is rapid, reversible, and saturable, which suggests a specific receptor-ligand interaction. Infect Immun, 1990 Nov, 58(11), 3545 - 52 Immunological cross-reactivity between Streptococcus mutans and human heart tissue examined by cross-immunization experiments; Wu HY et al.; Hyperimmunization of rabbits with Streptococcus mutans or other related cariogenic streptococci sometimes induces serum antibodies that react with human heart muscle . To determine whether antigen I/II (AgI/II), a major surface protein antigen present in most human isolates of these organisms, was responsible for inducing cross-reactive antibodies, we tested it for antigenic similarity to heart components, exploiting the ability of immune systems to mount anamnestic responses to antigens previously encountered . Mice immunized with a strain of Streptococcus pyogenes type M6, known to be heart cross-reactive, or with intact S . mutans cells developed antibodies that could be detected on a human heart sarcolemmal preparation . However, mice immunized with AgI/II and boosted with sarcolemma were unable to develop significant antisarcolemmal antibodies attributable to prior sensitization by AgI/II . Similarly, AgI/II was unable to recall antisarcolemmal responses in mice previously immunized with sarcolemma . Nevertheless, strong immunoglobulin G antibody responses to AgI/II were detected at the single-cell level in spleens and as circulating antibodies in all mice immunized with AgI/II or AgI/II-bearing S . mutans . We conclude that the ability of S . mutans to induce heart-reactive antibodies is not due to antigenic similarity between AgI/II and components of human heart but may be caused by other cross-reactive antigens in the bacterial cells or by nonspecific stimulation of the immune system. Circulation, 1990 Nov, 82(5 Suppl), IV105 - 9 Splenic septic emboli in endocarditis; Ting W et al.; The significance of septic emboli to the spleen is inferred by the frequency of septic emboli in general seen in patients with left-sided infective endocarditis who are referred for valve replacement . To determine the proper management of splenic infarcts and abscess due to septic emboli, we retrospectively reviewed the records of 108 patients with left-sided endocarditis who underwent valvular surgery at the University of Illinois Hospital from 1980 through 1988 . Intravenous drug abuse was the etiology in 68% (n = 73) . The incidence of splenic infarcts and abscess was 19% (n = 20), but an incidental finding of splenic infarcts was found in 38% (n = 11) of 29 asymptomatic patients who had computed tomograms . Streptococci and staphylococci were the causative organisms in 85% (n = 17) . Localized findings were absent in 90% of splenic infarcts and abscesses . Abdominal computed tomograms were diagnostic of the sequelae of splenic septic emboli in 100% . No patient had intra-abdominal bleeding complications associated with cardiopulmonary bypass . Splenectomy was performed in 50% (n = 10) of patients 3-24 days (mean, 11.2 days) after valve replacement . Indications for splenectomy included persistent sepsis in 60% (n = 6), large (greater than 2 cm) and peripheral lesions in 30% (n = 3), and splenic rupture in 10% (n = 1) . Perioperative mortality of patients who underwent splenectomy was 30% (n = 3) . The following conclusions can be drawn: 1) Splenic septic embolus is common in endocarditis . 2) Abdominal computed tomography should be performed for all patients.(ABSTRACT TRUNCATED AT 250 WORDS) Obstet Gynecol, 1990 Nov, 76(5 Pt 1), 882 - 5 A rapid method for detection of group B streptococcal colonization: testing at the bedside; Wang E et al.; Vertical transmission of group B streptococci, the most frequent cause of early neonatal sepsis, can be interrupted by intrapartum antibiotics . However, rapid methods for detecting colonized women must be developed to limit the administration of antibiotics to those who are at risk of delivering an infected infant . The accuracy of a colorimetric test using starch serum medium on vaginal and rectal specimens from women with preterm labor or prolonged rupture of membranes was evaluated . The test was interpreted by labor and delivery room nurses without special microbiologic training . Starch serum medium results were compared with those obtained from routine cultures . Thirteen of 29 positive vaginal cultures (45%) and eight of 18 positive rectal swabs (44%) were identified by nurses using the rapid method . This was significantly different (P less than .001) from sensitivities of 93 and 95%, respectively, for the same vaginal and rectal specimens interpreted by a bacteriology technologist . The specificity for the test from both sites was 95% for the nurses . The sensitivity was 53 and 36% for vaginal and rectal swabs, respectively, for a subgroup of mothers whose infants were assessed as clinically septic . The low sensitivity of starch serum medium as interpreted by nurses in the labor suite is inadequate to allow the test to replace cultures in identifying women colonized with group B streptococci . Efforts to increase the sensitivity should be directed toward improving nursing staff interpretation rather than improving the medium itself. Obstet Gynecol, 1990 Nov, 76(5 Pt 1), 825 - 7 Increased cell adherence of group B streptococci from preterm infants with neonatal sepsis; Helmig R et al.; Most women with group B streptococcus cervical colonization have uncomplicated pregnancies, but about 1% experience preterm premature rupture of membranes (PROM) followed by neonatal group B streptococcal sepsis . In such cases, streptococcal adherence to and penetration of the membranes may be an important step in the pathogenesis . In the present study, chorionic epithelial cells were incubated with group B streptococci isolated from either children developing sepsis after preterm PROM (complicated pregnancies) or from uncomplicated pregnancies . Incubation periods varied . The numbers of adherent bacteria per chorionic epithelial cell were counted by microscopic examination . After 70 minutes' incubation, the number of adherent group B streptococci in complicated pregnancies was 38, compared with 14 in uncomplicated pregnancies (P less than .001) . This difference in vitro might reflect the virulence of group B streptococci. Clin Pediatr (Phila), 1990 Nov, 29(11), 646 - 8 Optimal dosing interval for penicillin treatment of streptococcal pharyngitis; Krober MS et al.; One-hundred-forty-two children with symptomatic pharyngitis had throat cultures positive for group A beta-hemolytic <