J Ophthalmic Nurs Technol, 1990 May-Jun, 9(3), 106 - 9 Periorbital cellulitis in infancy; Molarte AB et al.; To our knowledge, no previous study of periorbital cellulitis has focused on its specific characteristics found only in infants (less than 1 year of age.) We retrospectively studied 30 cases of infantile periorbital cellulitis treated at Harbor-UCLA Medical Center from 1977 to 1988 . Characteristics of the disorder in our infants older than 1 month were similar to earlier reports of older children in terms of etiology, radiological and bacteriological findings, and course . However, compared with our older infants, our seven neonates (7 to 30 days old) had a higher incidence of ruptured dacryocele (29% vs 0%) and unknown source of the infection (43% vs 4%); but a lower incidence of preceding upper respiratory infection (14% vs 78%), abnormal sinus films (0% vs 22%), and positive blood cultures (14% vs 30%) . Of the positive cultures, Hemophilus sp was the most common pathogen among the older infants (35%), while Streptococcus and Staphylococcus were the most frequent among the neonates (71%) . All infections remained preseptal and responded well to intravenous antibiotics. Pediatr Neurol, 1990 May-Jun, 6(3), 209 - 10 Cranial nerve palsies in Streptococcus pneumoniae meningitis; Chu ML et al.; Cranial nerve palsies are uncommon in nontuberculous bacterial meningitis . We report a patient with Streptococcus pneumoniae meningitis, multiple cranial nerve involvement, and cerebellar signs suggestive of basilar meningitis . Nontuberculous bacterial meningitis should be considered in the differential diagnosis of basilar meningitis. Antonie Van Leeuwenhoek, 1990 May, 57(4), 245 - 52 Involvement of human mucous saliva and salivary mucins in the aggregation of the oral bacteria Streptococcus sanguis, Streptococcus oralis, and Streptococcus rattus; Koop HM et al.; The contribution of human parotid (Par) and submandibular/sublingual (SM/SL) saliva and of the human whole salivary mucin fraction (HWSM) to saliva-induced bacterial aggregation was studied for S . sanguis C476, S . oralis I581, and S . rattus HG 59 . The mucous SM/SL saliva showed a much higher aggregation potency towards the S . sanguis and S . oralis strain than did the serous Par saliva . The SM/SL saliva-induced aggregation was observed after 30 min, at 60 min followed by the Par saliva-induced aggregation, and showed a 4-fold higher aggregation titer of 128 for S . sanguis, and an 8-fold higher titer of 516 for S . oralis . In contrast, the Par saliva showed a slightly higher aggregation activity than the SM/SL saliva towards S . rattus as judged by a twofold higher titer of 64 . Morphologically, however, the SM/SL saliva-induced aggregation of S . rattus was far more pronounced as was also found for S . sanguis . Finally, the HWSM-induced aggregation showed a 4 to 8-fold higher titer than the originating salivary source, measuring 2048 for S . oralis and 128 for S . rattus . Moreover, no difference was observed in aggregation activity between the HWSM from whole saliva of a blood group O donor and the HWSM from SM/SL saliva of a blood group A donor . All the data point to an important, though not exclusive role of the human salivary mucin fraction in the saliva-induced aggregation of these strains. Pediatr Res, 1990 May, 27(5), 514 - 8 Deficiencies in opsonic defense to pneumococci in the human newborn despite adequate levels of complement and specific IgG antibodies; Geelen SP et al.; We studied the major determinants of opsonophagocytosis against Streptococcus pneumoniae serotypes 14 and 19 in paired cord/maternal sera from 27 healthy term and 24 preterm infants in an attempt to gain more insight in the susceptibility of newborns to pneumococcal infection . For both pneumococcal serotypes studied, opsonic activity in neonatal sera varied greatly, but was moderately to profoundly deficient when compared to paired maternal sera, both in preterm (34.5 and 34.9% of the activity in maternal serum, for serotypes 14 and 19, respectively, p less than 0.001 for both) and in term serum (43.5 and 52.7% of the activity in maternal serum, for serotypes 14 and 19, respectively, p less than 0.001 for both) . The opsonic deficiency in preterm sera could be ascribed to a diminished level of the major opsonins for pneumococci, i.e . complement factor C3 deposited on the bacterial surface (69.5 and 66.2% of C3 deposition in maternal serum on serotypes 14 and 19, respectively, p less than 0.01 for both) and specific anticapsular IgG antibodies (48.5 and 14.1% of maternal levels for serotypes 14 and 19, respectively, p less than 0.001 for both) . However, the opsonic defect in serum from term infants could not be explained in a similar way, because C3 deposition and specific anticapsular IgG levels were equal to the values found in the paired maternal sera . Therefore, we conclude that the opsonic defect in newborn serum for pneumococci cannot be solely explained by a deficiency in the major opsonins for these bacteria . A dysfunction in these opsonins seems to be a more likely explanation for the observed opsonic defect in the neonate. Mutat Res, 1990 May, 235(3), 195 - 201 Excision-repair capacity in Streptococcus pneumoniae: cloning and expression of a uvr-like gene; Sicard N et al.; Although deficient in photoreactivation and some SOS-like functions, Streptococcus pneumoniae has the capacity to carry out excision repair when exposed to UV light . The repair ability and sensitivity to UV irradiation or treatment with chemical agents in the wild type and a UV-sensitive mutant strain indicate that UV-induced pyrimidine dimers might be repaired in pneumococcus by a system similar to the uvr-dependent system in Escherichia coli . A gene complementing the mutation conferring UV sensitivity of the mutant strain has been cloned . The coding region directs the synthesis of a polypeptide with a molecular weight of 78 kDa . The relationship with uvr-like protein in E . coli is discussed. Ann Thorac Surg, 1990 May, 49(5), 706 - 11; discussion 712-3 Valve repair in acute endocarditis; Dreyfus G et al.; Forty patients were operated on in the early phase of active endocarditis between 1980 and 1988 . Indications for operation were heart failure (30 patients), severe valvular regurgitation (4), uncontrolled sepsis (2), septic emboli (3), and other (1 patient) . Time between onset of endocarditis symptoms and operation ranged from 12 to 45 days (mean, 30 days) . The aortic valve was involved in 3 patients; the mitral valve, in 28; both valves, in 7; and the tricuspid valve, in 2 . There was no previous underlying valve pathology in 40% . Lesions found were cusp perforation (17 patients), annular abscess (4), vegetation (13), and chordal rupture (22) . Positive blood cultures were found in 30 patients (75%) . Bacterial findings were Streptococcus in 12 patients (30%), Staphylococcus in 15 (37.5%), gram-negative in 3 (7.5%), and unknown in 10 (25%) . Criteria to perform valve repair were adequate antibiotic therapy for at least 1 week and large excision of all macroscopically involved tissues . In all cases, Carpentier's reconstructive techniques were used . Perioperative mortality was 2.5% (1 patient) . Reoperation was necessary in 1 patient . Late mortality was 2.5% (1 patient) . Repair was assessed either by angiography or by Doppler echocardiography before hospital discharge: 32 patients showed no regurgitation, whereas 7 had mild regurgitation (3 aortic, 4 mitral) . Mean follow-up of 30 months was achieved in all survivors . There was no recurrence of endocarditis and no reoperation for valvular insufficiency . We conclude that valve repair in acute endocarditis is possible and effective in most instances. Ann Thorac Surg, 1990 May, 49(5), 701 - 5; discussion 712-3 Heart valve operations in patients with active infective endocarditis; David TE et al.; Sixty-two consecutive patients underwent heart valve operation for active infective endocarditis . There were 42 men and 20 women whose mean age was 49 years (range, 21 to 79 years) . The infection was in the aortic valve in 37 patients, the mitral valve in 18, the aortic and mitral valves in 5, and the tricuspid valve in 2 . Twenty-four patients had prosthetic valve endocarditis . Staphylococcus and Streptococcus were responsible for 86% of the infections . Annular abscess was encountered in 33 patients . Complex valve procedures involving reconstruction of the left ventricular inflow or outflow tract or both were performed in 31 patients . There were three operative deaths (4.8%) . Predictors of operative mortality were prosthetic valve endocarditis, preoperative shock, and annular abscess . Patients were followed for 1 month to 130 months (mean follow-up, 43 months) . Only 1 patient required reoperation for persistent infection . There were ten late deaths . Most survivors (96%) are currently in New York Heart Association class I or II . The 5-year actuarial survival was 79% +/- 7% . These data demonstrate excellent results in patients with native valve endocarditis, and support the premise that patients with prosthetic valve endocarditis should have early surgical intervention. J Dent Res, 1990 May, 69(5), 1154 - 9 Caries incidence in intact rats infected with Streptococcus sobrinus via transmission from desalivated cagemates; Madison KM et al.; The purpose of this study was to determine the influence of caging desalivated S . sobrinus-infected rats on the caries incidence in intact, previously uninfected cagemates . Weanlings were divided as follows: Stage I: Twenty desalivated animals paired with 20 intact animals (Group I); 20 intact animals paired with 20 intact animals (Group II) . Animals were infected with S . sobrinus and fed diet 2000 and 10% sucrose water . After five weeks, ten paired animals from each group were killed . Desalivated animals had statistically higher (p less than 0.05) caries scores than did other animals . Stage II: The remaining Stage I infected animals from Groups I and II were paired with 40 new uninfected animals 15 days of age and fed cariogenic diets . After five weeks, new intact animals paired with Stage I desalivated animals had significantly higher smooth-surface enamel caries scores (38.0; SE 7.84) than new intact animals paired with Stage I intact animals (11.15; SE 3.69) . Moreover, new intact animals caged for only five weeks with Stage I desalivated animals developed smooth-surface caries (38.0; SE 7.84) to a degree comparable with that in all Stage I intact animals in the experiment for ten weeks (36.6, SE 9.5; and 30.05, SE 4.1) . The data suggest that desalivation may select a readily transmissible strain of S . sobrinus, which demonstrates enhanced virulence. Infect Immun, 1990 May, 58(5), 1479 - 80 Evidence that a low-affinity sucrose phosphotransferase activity in Streptococcus mutans GS-5 is a high-affinity trehalose uptake system; Poy F et al.; High-affinity sucrose uptake in the oral pathogen Streptococcus mutans is mediated by the phosphoenolpyruvate-dependent phosphotransferase system . In this report, we provide evidence that a lower-affinity sucrose phosphotransferase system in S . mutans GS-5, previously described by others, is in fact a high-affinity trehalose uptake system that also recognizes sucrose as a substrate. Infect Immun, 1990 May, 58(5), 1290 - 5 Cloning and expression of the gene encoding the fructose-1,6-diphosphate-dependent L-(+)-lactate dehydrogenase of Streptococcus mutans; Hillman JD et al.; The fructose-1,6-diphosphate-dependent lactate dehydrogenase from Streptococcus mutans JH1000 was purified by a modification of published methods . The sequence of 27 amino-terminal amino acids was determined, which allowed us to construct a 17-base DNA probe that had 32-fold degeneracy . The probe was used to screen a genomic library in pBR322 . Of 18 reactive clones, 1 was found that expressed lactate dehydrogenase (LDH) activity identical to that of S . mutans with regard to dependence on fructose-1,6-diphosphate, thermal inactivation profile, and inhibition by sodium oxamate . Extracts of this clone possessed a protein band that comigrated in sodium dodecyl sulfate-polyacrylamide gel electrophoresis with purified LDH from JH1000 . Compared with controls, the clone was shown to produce elevated amounts of L-(+)-lactic acid during growth in the presence of glucose, thereby indicating that the activity was expressed in vivo . This result was substantiated by demonstrating that the activity could complement a mutation in the fermentative D-(-)-LDH of Escherichia coli . Subcloning showed that the S . mutans LDH subunit is encoded by a 1.2-kilobase gene . Our ability to clone this gene is expected to have great practical significance in the construction of an effector strain for use in the replacement therapy of dental caries. J Med Assoc Thai, 1990 May, 73(5), 253 - 7 Sensorineural hearing loss in children recovered from purulent meningitis: a study in Thai children at Ramathibodi Hospital; Charuvanij A et al.; Hearing loss is one of the serious complications of bacterial meningitis . Conventional audiometry and auditory brainstem response (ABR) methods were used to detect this complication in eighteen children who recovered from bacterial meningitis treated at Ramathibodi Hospital from January 1983 to December 1987 . Six patients (33%) were found to have persistent bilateral sensorineural hearing loss . Among them, the causes of meningitis were: Hemophilus influenzae (3 patients), Streptococcus pneumoniae (1 patient), Streptococcus agalactiae (1 patient) and Escherichia coli (1 patient) . Various clinical and demographic factors were examined in relation to the hearing loss, but no significant correlation was observed . Since meningitis often affects small children and makes conventional audiometry tests difficult, ABR was found to be a more effective method for testing this group of patients. Rev Infect Dis, 1990 May-Jun, 12 Suppl 4, S394 - 400 Neonatal susceptibility and immunity to major bacterial pathogens; Ferrieri P; Neonatal bacterial sepsis has continued in this decade to contribute significantly to neonatal mortality and morbidity and is a critical determinant of outcome in infants of very low birth weight despite the availability of antibiotics . The group B Streptococcus and Escherichia coli are the predominant pathogens for the newborn infant . Studies on the epidemiology, microbiology, and immunology of group B streptococcal disease are more extensive than those on E . coli disease . Type-specific antibodies, polymorphonuclear leukocytes, and complement are integral to immunity against group B Streptococcus, and experimental data are presented to support the importance of these components . The newborn infant is handicapped by temporary deficiencies in host defenses, and approaches for restoring immunocompetence, such as immunization of the mother or passive administration of intravenous immunoglobulins or other immune factors, are presented for consideration . Further studies are required to demonstrate the safety, feasibility, and efficacy of these approaches. Rev Infect Dis, 1990 May-Jun, 12(3), 518 - 9 Bacterial infection as a presenting manifestation of visceral leishmaniasis; Garces JM et al.; Two patients admitted to the hospital because of severe bacterial infection were diagnosed as having visceral leishmaniasis . The types of bacterial infection were perianal abscess and pneumonia; Escherichia coli and Streptococcus pneumoniae were isolated from exudates and blood cultures, respectively . A third patient admitted because of acute necrotizing infection of the pharynx and visceral leishmaniasis is also discussed . Cultures from this patient failed to yield pathogens . Anemia, leukopenia, or thrombocytopenia was present in all patients, and bone marrow aspirate revealed the presence of Leishmania in macrophages . We conclude that in areas where leishmaniasis is endemic, early bone marrow aspirate should, in most instances, be performed in patients with bacterial infection associated with anemia, leukopenia, or thrombocytopenia if hepatomegaly and/or splenomegaly is present. Rev Infect Dis, 1990 May-Jun, 12(3), 416 - 22 Streptococcus pneumoniae infections of the female genital tract and in the newborn child; Westh H et al.; Streptococcus pneumoniae is not a part of the resident vaginal flora . However, in some women S . pneumoniae can be a transient part of the vaginal flora, and pelvic infection can occur, especially if a predisposing condition exists (e.g., use of an intrauterine contraceptive device, a recent birth, or gynecologic surgery) . In the preantibiotic era, pneumococcal genital infection was more common than today, and the rate of lethality was high--26% for localized infection and 74% for peritonitis . During the last 25 years, all 24 patients reported worldwide survived their pneumococcal genital infections, including nine patients at our hospital; in contrast, five of 12 women died between 1938 and 1952 . Pneumococci can rarely be isolated as the only pathogen in cases of bartholinitis . Neonatal S . pneumoniae disease with an early onset has an intrapartum pathogenesis . Of 23 reported pediatric patients (including one whom we treated), 48% died and 13% survived with neurologic sequelae . The prognosis for these children has not improved during the last 10 years. Res Vet Sci, 1990 May, 48(3), 306 - 9 Sequestration of N-acetyl-beta-D-glucosaminidase in somatic cells during experimental bovine mastitis induced by endotoxin, Staphylococcus aureus or Streptococcus agalactiae; Kaartinen L et al.; Experimental mastitis was induced in cows by intramammary infusion of endotoxin, Staphylococcus aureus or Streptococcus agalactiae . The inflammatory response was monitored by somatic cell counting and N-acetyl-beta-D-glucosaminidase (NAGase) . NAGase activity was analysed in fresh milk samples in parallel with samples treated by a cycle of freezing and thawing combined with detergent treatment to release the cell-bound NAGase . Before the udder reacted by inflammation, the total NAGase activity consisted of free extracellular activity . Later on when the inflammation was established, much of the milk NAGase remained sequestered intracellularly . S agalactiae was linked with a high degree of cellular NAGase sequestration indicating a blockage of the lysosomal release function from the phagocytes . S aureus delayed the inflammatory response. J Reprod Med, 1990 May, 35(5), 558 - 60 Group A beta-hemolytic Streptococcus as a cause of toxic shock syndrome . A case report; Whitted RW et al.; Group A beta-hemolytic Streptococcus (pyogenes) has been associated recently with toxic-shock-like syndrome similar to staphylococcal toxic shock as described originally in 1978 . A group A beta-hemolytic streptococcal infection occurred in a recent postpartum patient and clinically resembled staphylococcal toxic shock. Surg Gynecol Obstet, 1990 May, 170(5), 403 - 6 Percutaneous placement of femoral central venous catheter in patients undergoing transplantation of bone marrow; Lazarus HM et al.; Five patients undergoing transplantation of autologous bone marrow underwent percutaneous placement of a double lumen central venous catheter into the inferior vena cava by way of the femoral vein . All had conditions that precluded access to the superior vena cava or other sites in the upper part of the torso . Patients ranged in age from 18 to 59 years . The double lumen central venous catheter was inserted using aseptic technique in the operating room, and the catheter exit site was dressed using sterile technique every 48 hours afterward . Patients received all irradiated blood product transfusions, intravenous fluids, intravenous antibiotics, parenteral alimentation and autologous bone marrow reinfusion through the catheter . The duration of severe neutropenia (less than 500 neutrophils per microliter) and severe thrombocytopenia (less than 20,000 platelets per microliter) ranged from zero to 24 days (median of 22 days) and five to 20 days (median of 15 days), respectively . Catheters remained in the groin area 23 to 45 days (median of 35 days) . Complications included one catheter-related Streptococcus species infection and one Escherichi coli bacteremia . These infections resolved with the catheter in place after appropriate institution of antibiotics . No episodes of thrombosis, kinking, migration, extravasation of drugs or local infection were noted . Central venous catheters can be safely inserted and maintained in the groin area even in severely immunocompromised patients receiving bone marrow transplants. Bull Tokyo Dent Coll, 1990 May, 31(2), 155 - 62 A rapid diagnosis of anaerobic infection in the oro-maxillary region by gas-liquid chromatography; Tanaka JI et al.; The relationship between volatile fatty acids (VFAs) in pus and infecting bacterial species was examined in order to establish a rapid identification system for anaerobic microorganisms in purulent inflammation in the oro-maxillary region . VFAs were detected by the direct injection of pus into gas-liquid chromatography (GLC) . Bacterial examination was carried out by anaerobic culture using blood agar plates . The bacterial identification was carried out mainly according to the VPI manual . Analysis of the direct VFA patterns of each sample resulted in 5 groups . The following bacterial species were the main isolates in each group: Streptococcus intermedius in Group A, Peptostreptococcus micros in Group B, Fusobacterium nucleatum in Group C, Bacteroides gingivalis in Group D, and Peptostreptococcus anaerobius in Group E . The profile of VFAs produced in the PYG culture medium of the above isolated bacteria was compared with the direct VFA patterns . Agreement ratios between direct and PYG VFA patterns were as follows: Group A, 47.1%; Groups B and C, 45.0%; Group D, 87.5%; and Group E, 62.9% . The acetic acid concentration was more than 14 x 10(-4) meq/ml in Group B, the butyric acid concentration was more than 7 x 10(-4) meq/ml in Group C, and the iso-caproic acid concentration was more than 14 x 10(-4) meq/ml in Group E . In these cases, it was found that the agreement ratios between the direct and PYG FVA pattern were high . In Group D, irrespective of the concentration of iso-valeric acid detected, the agreement ratio was very high . The antibiotic susceptibility of the isolates was studied . Efficiency rates of ABPC, PIPC, CCL, CEZ, CMZ, SBT/CPZ, JM, CLDM, MINO and GM were relatively low and resistant rates were high for the gram-negative rods. J Am Acad Dermatol, 1990 May, 22(5 Pt 1), 886 - 92 Use of mupirocin ointment in the treatment of secondarily infected dermatoses; Breneman DL; A double-blind, randomized, vehicle-controlled study was conducted to evaluate the safety and efficacy of 2% mupirocin ointment in the treatment of secondarily infected dermatoses . One hundred six patients were enrolled, 92 of whom were evaluable for efficacy . There was a significantly greater rate of eradication of Staphylococcus aureus and total pathogens in mupirocin-treated patients than in control subjects . Analysis of the clinical data relative to all pathogens showed a significant difference in skin infection evaluations performed at the interim and follow-up visits, which favored the mupirocin-treated groups . In those patients infected with S . aureus or Streptococcus pyogenes, there was a significant difference at end-point that favored mupirocin in seven clinical ratings and the skin infection evaluation at follow-up . Mild local adverse effects were noted in a small percentage of patients in each group . Mupirocin appears to be safe and effective for the treatment of secondarily infected dermatoses, especially in those infections caused by Staphylococcus aureus. J Am Acad Dermatol, 1990 May, 22(5 Pt 1), 879 - 83 Mupirocin: a new topical antibiotic; Leyden JJ; One hundred fifty-three strains of Staphylococcus aureus recovered from infected eczema frequently demonstrated resistance to multiple antibiotics . Penicillin and ampicillin resistance was extremely frequent (88%), methicillin resistance was found in nearly 14% of strains, and erythromycin and tetracycline resistance was present in 16% . S . aureus strains were uniformly sensitive to vancomycin, mupirocin, and cephalosporins . Experimental infections in human volunteers showed topical therapy with 2% mupirocin was more effective than oral erythromycin in suppression of both S . aureus and Streptococcus pyogenes. J Bacteriol, 1990 May, 172(5), 2675 - 87 Isolation and molecular genetic characterization of the Bacillus subtilis gene (infB) encoding protein synthesis initiation factor 2; Shazand K et al.; Western blot (immunoblot) analysis of Bacillus subtilis cell extracts detected two proteins that cross-reacted with monospecific polyclonal antibody raised against Escherichia coli initiation factor 2 alpha (IF2 alpha) . Subsequent Southern blot analysis of B . subtilis genomic DNA identified a 1.3-kilobase (kb) HindIII fragment which cross-hybridized with both E . coli and Bacillus stearothermophilus IF2 gene probes . This DNA was cloned from a size-selected B . subtilis plasmid library . The cloned HindIII fragment, which was shown by DNA sequence analysis to encode the N-terminal half of the B . subtilis IF2 protein and 0.2 kb of upstream flanking sequence, was utilized as a homologous probe to clone an overlapping 2.76-kb ClaI chromosomal fragment containing the entire IF2 structural gene . The HindIII fragment was also used as a probe to obtain overlapping clones from a lambda gt11 library which contained additional upstream and downstream flanking sequences . Sequence comparisons between the B . subtilis IF2 gene and the other bacterial homologs from E . coli, B . stearothermophilus, and Streptococcus faecium displayed extensive nucleic acid and protein sequence homologies . The B . subtilis infB gene encodes two proteins, IF2 alpha (78.6 kilodaltons) and IF2 beta (68.2 kilodaltons); both were expressed in B . subtilis and E . coli . These two proteins cross-reacted with antiserum to E . coli IF2 alpha and were able to complement in vivo an E . coli infB gene disruption . Four-factor recombination analysis positioned the infB gene at 145 degrees on the B . subtilis chromosome, between the polC and spcB loci . This location is distinct from those of the other major ribosomal protein and rRNA gene clusters of B . subtilis. Vet Microbiol, 1990 May, 22(4), 319 - 28 Summer mastitis in heifers: a bacteriological examination of secretions from clinical cases of summer mastitis in Denmark; Madsen M et al.; A total of 166 samples of secretions collected from Danish heifers suffering from clinically diagnosed summer mastitis were examined bacteriologically . One hundred and sixty three samples yielded positive findings whereas no growth was obtained from 3 specimens . The majority of samples revealed a mixed flora in which the predominant components were Actinomyces pyogenes, Peptostreptococcus indolicus, a microaerophilic coccus (Stuart-Schwan coccus), Fusobacterium necrophorum, Bacteriodes melaninogenicus and Streptococcus dysgalactiae . Pure cultures were recovered in only 7% of cases . P . indolicus was isolated from 875 of the cases, a microaerophilic coccus from 84%, A . pyogenes from 72%, Fusobacterium necrophorum from 52%, Str . dysgalactiae from 37%, B . melaninogenicus from 33% and various unidentified obligate anaerobic Gram-negative rods from 31% . The results confirm the complex bacterial aetiology of summer mastitis. Respir Med, 1990 May, 84(3), 225 - 8 Pneumocystis carinii pneumonia in patients with AIDS in Central Africa; McLeod DT et al.; Over a period of 11 months, 37 patients infected with the Human Immunodeficiency Virus (HIV) presenting with symptoms of bronchopulmonary disease were investigated . Patients presented with cough, weight loss, fever and dyspnoea . Investigations included fibreoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy . In eight patients (22%) Pneumocystis carinii was found . Pulmonary infiltrates were found on chest radiographs of six patients, while in the remaining two patients chest radiographs showed clear lung fields . P . carinii was found in two patients with pulmonary Kaposi's sarcoma . Infection with P . carinii often occurred with other pathogens: Streptococcus pneumoniae was found in four patients, Staphylococcus aureus in two and tuberculosis in two . P . carinii pneumonia does occur in patients with HIV infection in Africa and the diagnosis is relatively simple to make provided that transbronchial biopsy and bronchoalveolar lavage are carried out through a fibreoptic bronchoscope and specimens examined after appropriate staining . However, the prevalence of P . carinii in patients with HIV infection in Africa appears to be lower than that found in patients with HIV infection in Europe and North America. J Appl Bacteriol, 1990 May, 68(5), 485 - 90 Molecular taxonomic studies on Streptococcus uberis types I and II . Description of Streptococcus parauberis sp . nov; Williams AM et al.; The nucleotide sequences of 16S ribosomal-RNA of Streptococcus uberis types I and II were determined by reverse transcriptase . Comparative analysis of the sequence data showed that the two types are phylogenetically distinct and worthy of separate species status . A new species Streptococcus parauberis is proposed for the type II strains . The type strain of Strep . parauberis is NCDO 2020. Gene, 1990 Apr 30, 89(1), 69 - 75 Cloning and expression of gene fragments encoding the choline-binding domain of pneumococcal murein hydrolases; Sanchez-Puelles JM et al.; The cloning in Escherichia coli of the 3' moieties of the lytA and cpl-1 genes is described, coding for the C-terminal regions of the lytic amidase of Streptococcus pneumoniae and the phage Cp-1 lysozyme, respectively . The truncated genes were overexpressed in E . coli and the purified polypeptides showed a great affinity for choline, although they were devoid of cell wall-degrading activity . Biochemical and circular dichroism analyses indicated that these are the domains responsible for the specific recognition of the choline-containing pneumococcal cell walls by the lytic enzymes . The data presented here suggested that these choline-binding domains can function independently of their catalytic domains. Klin Wochenschr, 1990 Apr 17, 68(8), 427 - 30 Fulminant group A streptococcal infections . Report of two cases; Christen RD et al.; We describe two female patients presenting with spontaneous peritonitis and fulminant Streptococcus pyogenes (Strep . pyogenes) septicemia and shock . Both patients recovered completely upon immediate antibiotic therapy, initially with broad range combination therapy effective against Strep . pyogenes, which was switched to penicillin G when culture results became available . This isolated strain in case 1 was M-type 28, which is the M-type most often isolated from vaginal swabs (as commensal) and from blood from patients with puerperal sepsis . Patient 1 had signs and symptoms of a toxic shock-like syndrome, including rapid onset of fever and shock, skin rash, desquamation of palms and soles, and multisystem involvement with vomiting, diarrhea, myalgia, renal failure, and severe disorientation without focal neurological deficits. J Am Vet Med Assoc, 1990 Apr 15, 196(8), 1230 - 5 Herd benefit-to-cost ratio and effects of a bovine mastitis control program that includes blitz treatment of Streptococcus agalactiae; Erskine RJ et al.; Twelve dairy herds that had participated in the Pennsylvania Dairy Herd Improvement Association (DHIA) program for at least 12 months, that had a 12-month mean DHIA somatic cell count greater than 700,000 cells/ml, and that had greater than 25% of lactating cows infected with Streptococcus agalactiae participated in a herd blitz treatment program . Initially, quarter milk samples for bacteriologic culturing were collected from all lactating cows . Subsequently, all cows identified as infected with Str agalactiae were treated, using a commercial penicillin-novobiocin intramammary infusion product . In addition, a herd mastitis management program of postmilking teat dipping and treatment of all cows at the start of the nonlactating period was instituted . Thirty days after the initial herd visit, samples from all lactating cows were again cultured, and cows infected at that time were treated . Twelve months after the initial herd visit, samples from all lactating cows were again cultured . Mean prevalence of infection with Str agalactiae decreased (P less than 0.05) from 23.0% of quarters and 41.6% of cows initially to 3.4% of quarters and 9.3% of cows at 30 days and 1.6% of quarters and 4.2% of cows at 1 year . Mean herd DHIA somatic cell count decreased (P less than 0.05) from 918,000 cells/ml initially to 439,000 cells/ml at 30 days and 268,000 cells/ml at 1 year.(ABSTRACT TRUNCATED AT 250 WORDS) Ned Tijdschr Geneeskd, 1990 Apr 14, 134(15), 770 - 2 {A child with pneumonia caused by a multiresistant pneumococcus}; Verhoef-Verhage EA et al.; Strains of Streptococcus pneumoniae resistant to penicillin have not previously been reported in The Netherlands . Now we have to report the isolation in November 1988 of a multiresistant pneumococcus (minimal inhibitory concentration 2 mg/l) from sputum of a three-year-old child from Poland . We advise isolating patients from abroad (Spain, Poland) in hospital and checking their bacteriological status to prevent introduction of penicillin resistant pneumococci into the Dutch population. Carbohydr Res, 1990 Apr 2, 198(1), 67 - 77 Structural studies of the capsular polysaccharide from Streptococcus pneumoniae type 7A; Backman-Marklund I et al.; Application of methylation analysis, specific degradations, and n.m.r . spectroscopy to the capsular polysaccharide elaborated by Streptococcus pneumoniae type 7A indicates a hexasaccharide repeating-unit with the structure (Formula; see text). Nippon Ganka Gakkai Zasshi, 1990 Apr, 94(4), 408 - 12 {The antibody titer to streptococcal and staphylococcal L-form in Behçet's disease}; Ogawa T et al.; The antibody titer to streptococcal and staphylococcal L-form was determined in the serum of Behcet's disease by enzyme-linked immunosorbent assay . These L-form bacteria were induced by the penicillin disk method . In 12 patients with Behcet's disease, the antibody titer to streptococcal L-form was significantly lower than that in the 14 normal controls by Student's t-test (p less than 0.025) . The antibody titer to staphylococcal L-form, however, showed no statistical difference between the patients and the controls . In Behcet's disease, antibody formation to streptococcus pyogenes, as well as its L-form, may be specifically disturbed. Indian J Ophthalmol, 1990 Apr-Jun, 38(2), 66 - 9 Clinicobacteriological correlates of congenital dacryocystitis; Bareja U et al.; One hundred and fourteen eyes with congenital dacryocystitis have been studied clinically and bacteriologically . Gram positive cocci constituted the major bacterial isolates (57.9%) with streptococcus pneumoniae predominating (28.9%) . The most effective antibiotic was cloxacillin with an overall efficacy of 77% . Normal conjunctival flora was sterile in majority (75%) of cases . Positive cases showed preponderance of gram positive cocci (21.6%) with staphylococcus albus (13.3%) being the major isolate . Normal nasal flora revealed diphtheroids (alone or in combination) to be the commonest bacteria (62.1%) . A statistically significant correlation was not observed between the normal conjunctival or nasal flora and flora from the affected eyes. Postgrad Med J, 1990 Apr, 66(774), 314 - 5 Osteomyelitis complicating Streptococcus milleri endocarditis; Barham NJ et al.; A patient with osteomyelitis of the spine complicating bacterial endocarditis due to Streptococcus milleri is discussed . To our knowledge, this is the first time this organism has been associated with this complication. Antibiot Khimioter, 1990 Apr, 35(4), 32 - 4 {Comparative analysis of antibiotic sensitivity of Streptococcus pneumoniae strains isolated from patients and carriers}; Ivanov NA et al.; The data on antibiotic sensitivity of 38 strains of S . pneumoniae isolated from children and 46 strains isolated from carriers are presented . The isolates from the carriers had significantly higher sensitivity to benzylpenicillin, ampicillin, methicillin, oxacillin, cefazolin, erythromycin, oleandomycin and lincomycin . Resistance to gentamicin was more frequent in the strains isolated from the carriers . Among the strains of S . pneumoniae isolated from the patients and carriers representatives of serovar K19 were more frequent . There were no statistically reliable difference in them by sensitivity to benzylpenicillin, ampicillin, cefazolin, lincomycin and rifampicin . Still, the isolates from the carriers were much more sensitive to methicillin, oxacillin, oleandomycin and erythromycin. J Trop Pediatr, 1990 Apr, 36(2), 63 - 5 Bacterial meningitis in the newborn: a Kuwaiti experience; Zaki M et al.; Forty-five neonates with bacterial meningitis admitted to a regional hospital in Kuwait over a 5-year period are reported . The attack rate was 6.7/10,000 live births . Listeria monocytogenes was the most common bacteria isolated (31 per cent), followed by Streptococcus agalactiae (15 per cent), and Escherichia coli (11 per cent) . Gram negative pathogens constituted 38 per cent of the total . Ten patients died (22 per cent) and 10 (28 per cent of the survivors) developed severe neurological sequelae. Vet Microbiol, 1990 Apr, 22(2-3), 249 - 57 Isolation and characterization of temperature-sensitive mutants of Streptococcus suis: efficacy trial of the mutant vaccine in mice; Kebede M et al.; A model of experimental Streptococcus suis infection was developed in young mice . Minimum lethal dose (MLD) values were calculated for four virulent serotypes (1/2, 1, 2, 3) of S . suis using this model . Temperature-sensitive (ts) mutants of S . suis serotypes 1/2 and 1-8 were isolated and characterized on the basis of their growth kinetics and reversion rates . Ts mutants of S . suis 1/2, 1, 2, and 3 were tested as vaccines against the virulent homologous and heterologous challenges in mice . The protection provided was evaluated by analyzing the clinical signs, death or survival . Homologous but not heterologous protection was noted in all mice vaccinated with the mutant strains . Ts mutants of S . suis 1/2 provided 100% protection against challenge by virulent strains of S . suis 1/2, 1, and 2. J Reprod Med, 1990 Apr, 35(4), 429 - 30 Streptococcus pneumoniae associated with second-trimester chorioamnionitis . A case report; Bruno R et al.; Streptococcus pneumoniae is found rarely in the normal vaginal flora but appeared to be the cause of chorioamnionitis and premature rupture of the membranes in a 16-week gestation . Both S pneumoniae and Ureaplasma urealyticum were recovered from cervical specimens, but only the Streptococcus grew from samples taken between the placental amnion and chorion. Pediatr Cardiol, 1990 Apr, 11(2), 77 - 81 Infectious endocarditis in children; Parras F et al.; With the object of analyzing current characteristics of infectious endocarditis (IE) in children, we carried out a retrospective study of 23 cases of IE in children under 15 years of age seen at the Hospital Ramon y Cajal in Madrid (Spain) between 1977 and 1985 . The incidence was high (1.3 cases per 1000 children admitted) . The male/female ratio was 2:1 . Eight patients were under 2 years of age and 15 over 2 years, the majority being adolescents . The two groups presented marked etiological and prognostic differences . Congenital heart disease was the predisposing factor in 20 of the 23 cases . Streptococcus viridans (nine cases) and Staphylococcus aureus (eight cases) were the most frequent organisms . Fourteen cases were on a native valve and nine were secondary (seven of these on prosthetic patches) . In spite of advances in therapy, IE continues to be a severe illness: the mortality rate in our series was 26% . Factors associated with a poor prognosis were: age less than 2 years, Staphylococcus aureus as the causative agent, and the presence of prosthetic material. J Clin Periodontol, 1990 Apr, 17(4), 268 - 72 Multiple periodontal abscesses after systemic antibiotic therapy; Topoll HH et al.; Multiple periodontal abscesses were reported in medically compromised patients . We examined patients with a non-contributory medical history referred for the treatment of numerous periodontal abscesses . All patients had taken oral broad spectrum antibiotics 1 to 3 weeks prior to the outburst of the abscesses (8 patients: penicillin, 2 patients: tetracycline) . The patients suffered from advanced periodontal disease, 82% of the examined sites showed probing depths greater than 3 mm, 56% attachment loss greater than 3 mm . Subgingival plaque samples were analysed from 2 different abscess sites . Bacteroides gingivalis (19/20), Fusobacterium nucleatum (13/20) and Streptococcus intermedius (13/20) were the most prevalent anaerobic microbiota . Strains resistant to the prescribed antibiotic were found in 55% (11/20) of the subgingival plaque samples . It was concluded that in patients with advanced periodontal disease, systemic antibiotic therapy without subgingival debridement may change the composition of the subgingival microbiota, thus favouring the outburst of multiple periodontal abscesses. J Antimicrob Chemother, 1990 Apr, 25 Suppl C, 107 - 13 Bacteraemia--a New York perception; Neu HC et al.; Positive blood cultures (in total 7541) obtained from patients of varied social background in a New York medical centre between 1984 and 1989 are reviewed . Streptococcus pneumoniae predominated in community-acquired infections, and coagulase-negative staphylococci and Staphylococcus aureus in nosocomial infections, the latter often arising from intravenous lines . The reported trend towards Gram-positive isolates is confirmed in this series. Aust N Z J Med, 1990 Apr, 20(2), 177 - 8 Streptococcus zooepidemicus cellulitis and bacteraemia in a renal transplant recipient; McKeage MJ et al.; A case of renal transplant recipient with Streptococcus zooepidemicus (Lancefield group C) cellulitis and bacteraemia is described . Human infections with this organism are very rare and this is the first case report of cellulitis caused by S . zooepidemicus . While animals are the reservoir for most human infections, a source was not defined in this patient. J Med Microbiol, 1990 Apr, 31(4), 259 - 70 Surface-associated properties of Streptococcus milleri group strains and their potential relation to pathogenesis; Willcox MD et al.; Thirty strains from the Streptococcus milleri (anginosus) group (SMG) obtained from various sources were tested for a range of characters that could be associated with pathogenicity and the results were compared with those for type strains of S . sanguis, S . mutans and S . pyogenes . The SMG strains were heterogeneous in all tests . Most (18) belonged to one of the Lancefield groups with group F predominating . Adherence of strains isolated from abscesses to buccal epithelial cells was greater than that of other strains (p = 0.033) . Compared with strains of S . sanguis, SMG strains were generally not aggregated by human saliva . They differed from the type strain of S . pyogenes in their relative ability to bind fibrinogen and fibronectin; they were less effective in binding fibrinogen (0.33-4.28% cf . 22% for S . pyogenes) and generally more effective in binding fibronectin (0.49-12.37% cf . 0.95%) . Strains isolated from infections were statistically better at binding fibronectin than other strains (p less than 0.001) . The ability of strains to adhere to saliva-coated hydroxyapatite (SHA) varied 10-fold, from 0.16-16.35% . The amount of fibronectin bound by SMG strains correlated with their ability to adhere to SHA (p less than 0.001) . The hydrophobicity of the strains, as measured in the hexadecane partition assay, ranged from 0.0% to 99.0% . Some strains carried both positive and negative cell-surface charges and some strains with a highly hydrophobic cell surface also possessed a relatively high cell-surface charge . A minority of strains possessed a net positive cell-surface charge . Neither hydrophobicity nor cell-surface charge was related to the capacity of strains to adhere to SHA . Strains of SMG co-aggregated weakly with strains of Veillonella parvula, V . dispar, Actinomyces viscosus and A . naeslundii. J Infect Dis, 1990 Apr, 161(4), 736 - 40 Does naturally acquired IgG antibody to cell wall polysaccharide protect human subjects against pneumococcal infection? Musher DM, Watson DA, Baughn RE. Antibody to the non-serotype-specific cell wall polysaccharide (CWPS) of Streptococcus pneumoniae has been said to confer a degree of non-serotype-specific protection against pneumococcal infection . The hypothesis underlying the present study was that if this antibody is protective, relatively higher levels are likely to be detected in patients who are colonized by pneumococci but do not have infection, those who have febrile bronchitis but do not have pneumonia, and those who have pneumococcal pneumonia but are not bacteremic . Mean IgG reactive with CWPS by ELISA in 15 healthy young adults was 43.9 micrograms/ml and in 126 randomly selected hospital patients of all ages was 41.9 micrograms/ml . In subjects with chronic bronchitis with or without known pneumococcal carriage, mean anti-CWPS IgG was 87.7 micrograms/ml . In three groups of patients (3 with acute purulent tracheobronchitis, 13 with nonbacteremic pneumococcal pneumonia, and 14 with S . pneumoniae bacteremia) at the time of admission, mean antibody levels were essentially identical, 104.9-110.1 micrograms/ml . The data suggest that naturally present anti-CWPS IgG does not protect against the evolution of acute pneumococcal infection from colonization to acute purulent bronchitis, from bronchitis to pneumonia, or from pneumonia to bacteremia. J Infect Dis, 1990 Apr, 161(4), 728 - 35 Pneumococcal polysaccharide vaccine in young adults and older bronchitics: determination of IgG responses by ELISA and the effect of adsorption of serum with non-type-specific cell wall polysaccharide; Musher DM et al.; Available pneumococcal vaccines provide only limited protection for certain at-risk populations . Fifteen healthy young adults and 11 older chronic bronchitics received 23-valent pneumococcal vaccine . ELISA showed that IgG reactive with capsular polysaccharides from Streptococcus pneumoniae serotypes 3, 4, 8, 14, and 19F increased after vaccination . Bronchitics exhibited lesser responses for four of these serotypes, although differences between the groups were significant only for serotype 3 . Adsorption of postvaccination sera with pneumococcal cell wall polysaccharide significantly reduced mean antibody levels in both groups and lowered the proportion of sera that demonstrated type-specific antibody responses . Reactive IgG was largely restricted to the IgG2 subclass . Pneumococcal vaccine may provide suboptimal protection of older adults because antibody responses to some capsular polysaccharides are lower in elderly bronchitics than in healthy young adults . A substantial proportion of measured antibody reflects IgG reactive with cell wall polysaccharides rather than with type-specific, capsular constituents, suggesting that antibody responses in subjects of all ages deserve reappraisal. Infect Immun, 1990 Apr, 58(4), 1043 - 7 Isolation, characterization, and inhibition kinetics of enolase from Streptococcus rattus FA-1; Huther FJ et al.; One aspect in a broad spectrum of possible mechanisms of cariostatic reactions of fluoride is its interaction with the metabolism of oral bacteria . Information on the mechanisms and kinetics of fluoride inhibition of essential enzymes of the glycolytic pathway of the relevant bacteria is lacking . In this work, the isolation and purification of enolase from Streptococcus rattus and its characterization are described . The enzyme has been isolated in a monomeric (22 kilodaltons) and dimeric (49 kilodaltons) form . The Km for 2-phosphoglycerate is 4.35 mM . Fluoride inhibition kinetics have competitive character, while phosphate in concentrations above 2 mM and in the presence of 0.5 mM fluoride alters the inhibition kinetics from competitive to noncompetitive . Without fluoride, 2 mM phosphate has a slight stimulatory effect on the enzyme . Monofluorophosphate has a noncompetitive inhibiting effect on the enzyme . This finding suggests that the effect of phosphate may be due to an additional binding of fluoride to the enolase, resulting in a conformational change of the enzyme. Arq Bras Cardiol, 1990 Apr, 54(4), 265 - 9 {Endocarditis caused by Streptococcus bovis and colorectal neoplasms}; Grinberg M et al.; PURPOSE--To evaluate the association of Streptococcus bovis endocarditis with large bowel neoplasms . PATIENTS AND METHOD--Twenty episodes (19 patients) of Streptococcus bovis endocarditis (5.05%) selected from 396 episodes of endocarditis followed up from 1978 to 1990 . The mean age was 57.68 years, 16 (84.21%) were males . Previous heart disease was not known in nine (45%) . Previous manipulation that might induce bacteremia was identified in three patients . Symptoms related to neoplasia of the digestive system were not informed . The mean time of follow up (17 cases) was 33.76 months, standard deviation 27.37 months . Sixteen patients were submitted to colonic evaluation (barium enema in 11, colonoscopy in 5 patients, and both were performed in 5 patients) . RESULTS--Bowel neoplasias were diagnosed in 12 (75%) of 16 patients submitted to colonic evaluation, one colonic adenocarcinoma in one (8.33%), patient, histologic benign polyps in eight (66.6%) . Two patients are waiting for colonoscopic resection . In one patient the polyp was lost after colonoscopic resection . CONCLUSION--The high incidence of large bowel neoplasia in patients with Streptococcus bovis endocarditis indicates that evaluation of the large bowel must be performed on in patients with S . bovis endocarditis in order to diagnose neoplasias, even in the absence of symptoms of bowel disease. Zh Mikrobiol Epidemiol Immunobiol, 1990 Apr, (4), 3 - 7 {The physicochemical and biochemical characteristics of the cell walls in M+ and M- variants of Streptococcus group A type 29}; Bitko SA et al.; The amino acid composition of cell walls and surface proteins, isolated from virulent (M+) and avirulent (M-) streptococcal strains (group A, type 29) has been determined by the method of E . H . Beachey et al . The kinetics of the lysis and proteolysis of streptococcal cell walls with muramidase and protease obtained from Actinomyces levoris and streptolysin has been studied . The constants describing the progress rates of these processes has been determined; their values in case of both lysis and proteolysis are higher in virulent strains than in avirulent ones. Vet Med (Praha), 1990 Apr, 35(4), 193 - 9 {Determination of antibodies to Streptococcus agalactiae in the milk of dairy cows using the ELISA test}; Madr P et al.; A sensitive 4-layers ELISA test for determination of antibodies against the pathogens of Streptococcus agalactiae in cows' milk was used for diagnosis of mastitis, with the aim to broaden these methods . Antigen was linked on the solid phase in the form of the whole bacteria, and milk was tested, diluted in the ratio of 1:10 . Antigen bound-specific antibodies were labelled with pig antibodies against bovine immunoglobulins and in the next layer with rabbit antibody conjugated with peroxidases against pig immunoglobulins . After test visualisation and reading on the photometre, the results were given in the positivity per cent as a 100-multiple of the proportion of absorbance of the unknown sample and the positive control after subtraction of the negative control . Milk was examined in 36 dairy cows from three various breeding herds by that method . The samples were parallelly examined bacteriologically and cytologically . In the milk of dairy cows with positive S . agalactiae finding, the main level of antibodies expressed a positivity per cent, was 15.0%, while in bacteriologically negative animals it was only 6.2% . The dairy cows were divided into 8 groups, characterizing various stages of mastitis, according to the results of the individual treatments. Biochem J, 1990 Apr 1, 267(1), 171 - 7 Expression and purification of a truncated recombinant streptococcal protein G; Goward CR et al.; The gene for Protein G from Streptococcus strain G148 was cloned and expressed in Escherichia coli . The regions on the gene corresponding to the albumin-binding domains and the Fab-binding region were then deleted by site-directed mutagenesis . The translation of regions corresponding to the cell-wall- and membrane-binding domains was prevented by introduction of stop codons upstream of these domains . This recombinant DNA sequence codes for a protein (G') that contains repetitive regions and that binds only the Fc portion of IgG, analogously to Protein A . Translation of the sequence produces a protein with an Mr of about 20,000 . The nucleotide sequence differs from those published previously {Guss, Eliasson, Olsson, Uhlen, Frej, Jornvall, Flock & Lindberg (1986) EMBO J . 5, 1567-1575; Olsson, Eliasson, Guss, Nilsson, Hellman, Lindberg & Uhlen (1987) Eur . J . Biochem . 168, 319-324} . The protein can be substantially purified on a large scale by chromatography on IgG-Sepharose 4B . Homogeneous Protein G' can be prepared by anion-exchange f.p.l.c . on Mono Q HR . This Protein G' has a pI of 4.19 and SDS/PAGE gives an apparent anomalous Mr of 35,000. Oral Surg Oral Med Oral Pathol, 1990 Apr, 69(4), 502 - 5 The microbiology of periapical granulomas; Iwu C et al.; Of the 16 periapical granulomas studied, 14 (88%) yielded a positive growth when homogenized and cultured . The concentration of colony-forming units per milliliter of the suspension ranged from 10(1.3) to 10(4.0) (mean 10(2.2)) . A total of 47 isolates comprising 26 (55%) facultative anaerobes and 21 (45%) strict anaerobes were obtained . The organisms most commonly cultured were Veillonella species (15%), Streptococcus milleri (11%), Streptococcus sanguis (11%), Actinomyces naeslundii (11%), Propionibacterium acnes (11%), and Bacteroides species (10%) . Most of the organisms (96%) were sensitive to either amoxicillin, clindamycin, or tetracycline, whereas only 45% were sensitive to metronidazole. J Infect Dis, 1990 Apr, 161(4), 741 - 6 Demonstration and characterization of buoyant-density subpopulations of group B Streptococcus type III; Hakansson S et al.; Group B Streptococcus (GBS) type III (18 strains) was investigated for the presence of buoyant-density subpopulations; 10 strains originated from invasive isolates causing early-onset septicemia, and 8 were colonizing isolates from pregnant women . By repeated processing in hypotonic density gradients of Percoll, high- (HD) and low-density (LD) subpopulations were recovered from all strains . Synthesis of type-specific polysaccharide (TPS) was increased in the invasive isolates and their respective LD variants compared with the colonizing strains and their LD subpopulations . Production of capsular TPS correlated directly with synthesis of soluble TPS; there was an inverse exponential relationship between soluble TPS production and buoyant density . LD variants were more resistant to phagocytic killing by human polymorphonuclear leukocytes (PMNL) than were the original strains and HD variants . In a luminol-enhanced chemoluminescence assay, LD variants elicited a weak, slow response . In contrast, the HD subpopulations evoked a prompt, strong respiratory burst in the PMNL. Clin Prev Dent, 1990 Apr-May, 12(1), 18 - 21 Bicarbonate-based powder and paste dentifrice effects on caries; Tanzer JM et al.; The effects of sodium bicarbonate-based powder and paste dentifrices on dental caries and Streptococcus sobrinus recoveries in rats were studied . Three S . sobrinus 6715-13WT infected groups of specific pathogen-free weanling rats, consuming a diet which contains 56% sucrose, were topically treated with either demineralized water, dentifrice paste, or dentifrice powder . Both the paste and powder contained 0.22% (w/w) NaF . All topical treatments were given for one min daily per rat, five days a week . Animals' teeth were swabbed for recovery of 6715-13WT and total recoverable flora . Recoveries of 6715-13WT were 75% lower from both powder-treated and paste-treated dentifrice than from water-treated rats' teeth (p less than 0.001) . Total caries scores were 45% lower for the powder-treated and 43% lower for the paste-treated rats than the water-treated ones (p less than 0.01) . The major portion of the caries inhibition was evident on smooth tooth surfaces, 68% for powder-treated and 65% for paste-treated by comparison with water-treated animals (p less than 0.01), although a lesser caries reduction was also evident in tooth fissures (sulci) . Thus, both powder and paste formulations of a sodium bicarbonate-based dentifrice containing 0.22% NaF equally and potently inhibited caries in rats, challenged bacteriologically and dietarily to develop severe caries. Biophys J, 1990 Apr, 57(4), 779 - 96 Energy transduction in the bacterial flagellar motor . Effects of load and pH; Khan S et al.; The effect of load and pH on the relation between proton potential and flagellar rotation has been studied in cells of a smooth-swimming Streptococcus strain . The driving potential, speeds of free-swimming bacteria, and rotation rates of bacteria tethered to glass by a single flagellum were measured . The relation between rotation rate of tethered bacteria and potential was remarkably linear up to nearly -200 mV . The relation between swimming speed and potential exhibited both saturation and threshold, as previously observed in other species . The form of these relations depended on pH . The equivalence of the electrical and chemical potential components of the proton potential in enabling swimming depended on the voltage . Our observations may be most simply accommodated by a kinetic scheme that links transmembrane proton transits to a tightly coupled work cycle . The properties of this scheme were elucidated by computer simulations of the experimental plots . These simulations indicated that the protonable groups that participate in the rate limiting reactions have a fractional electrical distance between three-fourths to all of the way toward the cytoplasm with a corresponding mean proton binding affinity of 10(-7.3)-10(-7.0) M, respectively. Scand J Dent Res, 1990 Apr, 98(2), 112 - 9 Expulsion mechanism of xylitol 5-phosphate in Streptococcus mutans; Pihlanto-Leppala A et al.; The expulsion mechanism of xylitol 5-phosphate in Streptococcus mutans ATCC 25175 was studied using resting cells incubated in the presence of 14C-xylitol . The expulsion appeared to be a two-step process: xylitol 5-phosphate was first hydrolyzed to xylitol and inorganic phosphate, and the xylitol was subsequently expelled from the cells . The dephosphorylation step appeared to be energy-requiring and it was most likely associated with a phosphatase which was active on xylitol 5-phosphate . Two to three successive cultivations of the cells in the presence of 6% xylitol increased this enzyme activity 4.3-fold . These results are in accordance with the presence of an energy-dependent xylitol 5-phosphate cycle in S . mutans, which is regulated by exogenous xylitol. Antimicrob Agents Chemother, 1990 Apr, 34(4), 510 - 4 Effects of dosage, peak and trough concentrations in serum, protein binding, and bactericidal rate on efficacy of teicoplanin in a rabbit model of endocarditis; Chambers HF et al.; The effect of dosage and the relative importance of peak and trough concentrations in serum for efficacy of teicoplanin were examined in a rabbit model of aortic valve endocarditis . Concentrations of teicoplanin in serum exceeded the MIC by several hundredfold, yet teicoplanin was less rapidly bactericidal than penicillin both in vitro and for endocarditis caused by a strain of Streptococcus sanguis . Because teicoplanin was 90% protein bound in rabbit serum, low free-drug concentrations probably resulted in less activity in vivo than in vitro . Because teicoplanin has a relatively low bactericidal rate and a high degree of protein binding, a sustained concentration in serum several times greater than the MIC may be important for efficacy in vivo . An intravenous regimen with relatively high peak concentrations in serum was less effective than an intramuscular regimen for endocarditis caused by a strain of Staphylococcus aureus, indicating that high peaks are unlikely to be an important determinant of efficacy . The therapeutically more relevant concentration in serum may be the trough. J Chemother, 1990 Apr, 2(2), 108 - 12 Oral ciprofloxacin for treatment of acute bacterial pharyngotonsillitis; Esposito S et al.; The clinical efficacy and tolerability of ciprofloxacin orally administered at the dosage of 250 mg twice a day was evaluated in 25 patients affected by acute bacterial pharyngotonsillitis . All patients were non-responders to previous conventional antibiotic therapies due to in vitro resistance of the responsible bacteria, or possibly the low antibiotic concentration at the infection site . None of the patients had infections caused by group A beta-haemolyticus streptococcus . Treatment with ciprofloxacin lasted for 5-10 days (mean 6.7) . A favorable clinical response was observed in 92% of patients (15 resolutions and 7 improvements) at the end of the therapy and two weeks later (follow-up) . One patient was not evaluable because of the unfortunate onset of glossitis that caused the interruption of the treatment . No other side-effects were recorded in the other 24 patients . The bacteriological response was excellent: 83% bacteriological eradication, 13% persistence and super-infection in only one patient (4%) . Ciprofloxacin administered orally at low dosages is highly effective in the treatment of bacterial pharyngotonsillitis and is also well tolerated. Pediatr Res, 1990 Apr, 27(4 Pt 1), 349 - 52 Group B streptococcus promotes oxygen radical-dependent thromboxane accumulation in young piglets; Shook LA et al.; Both thromboxane A2 and oxygen-derived free radicals appear to play central roles in group B streptococcus (GBS)-induced pulmonary hypertension in piglets . This study tested the hypothesis that GBS promotes oxygen radical-dependent thromboxane accumulation and pulmonary hypertension in infant piglets . Piglets 4-12 d old were anesthetized and prepared for assessment of pulmonary arterial pressure and arterial blood gases . In control animals, GBS (10(8) organisms/kg/min for 15 min) increased mean pulmonary artery pressure by 30 +/- 1.5 torr and reduced arterial PO2 by 100 +/- 20 torr . Thromboxane A2, radioimmunoassayed in venous blood as thromboxane B2, increased by 2452 +/- 800 pg/mL . A second group of piglets was treated with dimethylthiourea (DMTU: 750 mg/kg), a putative oxygen radical scavenger . In these animals, GBS increased pulmonary arterial pressure by only 7 +/- 1 torr and reduced arterial PO2 by a modest 10 +/- 8 torr . Importantly, thromboxane B2 content in venous blood failed to increase above control levels in DMTU-treated animals . The protective effects of DMTU in GBS-treated piglets could not be ascribed to inhibition of cyclooxygenase or thromboxane synthase because the oxygen radical scavenger failed to attenuate increases in pulmonary arterial pressure and venous thromboxane B2 content or reductions in arterial PO2 caused by i.v . infusions of arachidonic acid . DMTU also did not ameliorate pulmonary hypertension evoked by the thromboxane mimetic U44069, thereby suggesting that the scavenger did not act as an end-organ antagonist of thromboxane receptors . These observations suggest that GBS promotes accumulation of thromboxane A2 and attendant pulmonary hypertension through an oxygen radical-dependent mechanism. Invest Ophthalmol Vis Sci, 1990 Apr, 31(4), 696 - 701 Differential binding of P . aeruginosa and S . aureus to corneal epithelium in culture; Panjwani N et al.; Adherence of bacteria to corneal epithelium is a prerequisite for corneal infection . We used two methods to study the binding of Pseudomonas aeruginosa and Staphylococcus aureus to rabbit corneal epithelial cells in culture . In the first method, rabbit corneal epithelial cells grown on glass slides were incubated with P . aeruginosa or S . aureus (10(7) CFU/ml) at room temperature for 90 min, and the bacterial binding to the epithelial cells was examined by light microscopy . Both P . aeruginosa and S . aureus bound to epithelial cells . P . aeruginosa was bound to the cell periphery whereas S . aureus was bound randomly to the cell surface . In the second method, suspension cultures of corneal epithelial cells were used . In contrast to the findings in cultures on slides, binding pattern with cells in suspension was similar for both species and resembled that for S . aureus in cultures on slides . A much greater number of P . aeruginosa (186 +/- 11 bacteria/epithelial cell) than S . aureus (30 +/- 1.5 bacteria/epithelial cell) bound to epithelial cells grown on glass slides . In contrast, a similar number of P . aeruginosa (25 +/- 5.1) and S . aureus (20 +/- 4.7) bound to epithelial cells grown in suspension cultures . Using either method, Escherichia coli and Streptococcus pyogenes did not bind significantly (less than 5/cell) to corneal epithelial cells . The above methods should prove useful for characterization of bacterial binding to corneal epithelial cells in culture. Cornea, 1990 Apr, 9(2), 102 - 7 Recurrent postoperative endophthalmitis; Stern GA et al.; We treated five patients for postoperative endophthalmitis who demonstrated an initially good response to intravitreal management of their infection and then suffered a later recurrence . Four of the five patients received a single intravitreal injection of antibiotics as the only intravitreal therapy, and the fifth patient received a single antibiotic injection in addition to a partial vitrectomy . All recurrent infections occurred between 10 and 21 days after the original intravitreal injection of antibiotics . At the time of the recurrence, all five patients remained culture positive with the same organism that was initially isolated . The bacterial species isolated were S . epidermidis, group D streptococcus, P . acnes, P . mirabilis, and P . aeruginosa . All patients were ultimately sterilized with repeated intravitreal injections of antibiotics, vitrectomy, and/or intraocular lens removal . Factors that were related to recurrent infection were marginal susceptibility of the organism to the originally injected antibiotics, infection with a slowly replicating organism, and infection with a gram-negative bacillus . A single intravitreal injection of antibiotics may only partially treat bacterial endophthalmitis . Patients should be observed for at least 3 weeks following treatment of endophthalmitis for recurrence of their infection, and aggressive management, including vitrectomy and repeated intravitreal injections of antibiotics, should be used to treat recurrent infections. Oral Microbiol Immunol, 1990 Apr, 5(2), 98 - 107 Humoral immunity in root caries in an elderly population . 1; Butler JE et al.; IgA, IgG and IgM antibody activity (ELISA Units/ml) to Streptococcus mutans, Actinomyces viscous and Escherichia coli CF8 in serum, parotid saliva and whole saliva was measured using the amplified ELISA (a-ELISA) while the concentration (microgram/ml) of each isotype of immunoglobulin as well as albumin and lactoferrin, was determined using sandwich ELISAs . Selection of suitable reagents from those commercially available was based on specificity tests using purified human immunoglobulin; most polyclonal reagents required further absorption to attain class specificity . Cross-absorption studies indicated the absence of patient antibodies that were cross-reactive among the bacteria studied, except for IgM in some cases . Expression of response in ELISA Units (E.U.) per microgram of immunoglobulin, i.e . specific activity, revealed that IgG specific activity was significantly higher in parotid saliva than in either whole saliva or serum for all bacteria studied; serum and whole saliva did not differ except for the higher specific activity in whole saliva to E . coli . The value of one E.U . was determined using the Comparative Antibody-immunoglobulin Capture Assay (CACA) . Using this novel method, we estimated that about 0.05 percent of serum IgA was specific for Streptococcus mutans, 0.008 for Actinomyces viscosus and 0.004 for Escherichia coli CF8 . The percentage of specific IgM antibodies was higher than for IgA and IgG . The concentration of IgA anti-Streptococcus mutans, Actinomyces viscosus and Escherichia coli levels are approximately 92 ng/ml, 25 ng/ml and 16 ng/ml in whole saliva and 46 ng/ml, 9.4 ng/ml and 6.3 ng/ml in parotid saliva.(ABSTRACT TRUNCATED AT 250 WORDS) Oral Microbiol Immunol, 1990 Apr, 5(2), 72 - 6 Some aspects of protease production by a strain of Streptococcus sanguis; Rogers AH et al.; Our previous studies indicated that Arginine (Arg) plays a key nutritional role in Streptococcus sanguis P4A7 and that this organism can grow on whole casein as the sole nitrogen source . Its protease activities were therefore studied after glucose-limited continuous culture in a chemically-defined medium with either free amino acids or casein as the nitrogen source . Both culture supernatant and cell-associated endopeptidase (EP) and exopeptidase (amino-AP and carboxy-CP) activities were determined . Growth rate (mu) had little effect on EP, 75% of which was consistently in culture supernatants; AP and CP both decreased as mu was increased and both were predominantly cell-associated . At high growth pH, EP was substantially increased while AP and CP activities were optimal at pH 7 . The most striking nutritional effect occurred under nitrogen limitation (glucose excess) when EP and AP were greatly increased and CP greatly decreased . It was concluded that S . sanguis is well equipped to scavenge its environment for Arg under a wide range of growth conditions. Biochim Biophys Acta, 1990 Mar 26, 1033(3), 273 - 6 Characterization of cross-reactive polysaccharide antigen with serotype a and d strains from Streptococcus sobrinus 6715; Takada K et al.; The polysaccharide antigen (designated SI) from Streptococcus sobrinus 6715 (serotype g) which cross-reacts with serotype a and d strains was purified by a specific anti-cross-reactive g-a antibody-Sepharose 4B affinity column . By a double immunodiffusion analysis, the SI antigen was found to lack the serotype-specific g site, but contained the cross-reactive sites g-a, g-d and g-(a-d) on a single molecule . Polysaccharide SI was composed of galactose, glucose and rhamnose in a molar ratio of 4.79:1.52:1 . The results of the test on the inhibition of the precipitin reaction and methylation analysis suggested that the cross-reactive site g-a of the SI antigen appeared to have two regions, one containing galactose residues and the other, beta-linked glucose residues. Carbohydr Res, 1990 Mar 25, 197, 93 - 100 Synthesis of di- and tri-saccharides related to the polysaccharide from Streptococcus pneumoniae type 23 and a study of their inhibition in the precipitin reaction; Ray AK et al.; Syntheses of methyl 2-O-beta-L-rhamnopyranosyl-beta-D-galactopyranoside (9), methyl 2-O-alpha-L-rhamnopyranosyl-beta-D-galactopyranoside (13), and methyl 4-O-beta-D-glucopyranosyl-2-O-alpha-L-rhamnopyranosyl-beta-D- galactopyranoside (16) in good yields are described . Both 13 and 16 significantly inhibit antigen-antibody precipitation in the S . pneumoniae Type 23 immune system . The results indicate that the rhamnosyl group in the side chain of the repeating unit of the antigen is alpha and not beta as reported previously, and that the trisaccharide related to 16 is the immunodominant group. J Immunol, 1990 Mar 15, 144(6), 2327 - 33 CD18-dependent and -independent mechanisms of neutrophil emigration in the pulmonary and systemic microcirculation of rabbits; Doerschuk CM et al.; Neutrophil (PMN) migration in the systemic and pulmonary circulation of rabbits was compared by using different inflammatory stimuli to determine the role of the leukocyte adhesion complex, CD11/CD18, in each of these vascular beds . The adhesion complex was blocked by administering the anti-CD18 mAb 60.3 . The data show that mAb 60.3 blocks PMN emigration into inflammatory foci in the abdominal wall produced by implanting sponges containing either hydrochloric acid, Streptococcus pneumoniae, Escherichia coli endotoxin, or PMA . mAb 60.3 also inhibited PMN emigration in response to peritoneal instillation of S . pneumoniae . The effect of mAb 60.3 on PMN emigration in the lungs varied depending upon the stimulus . PMN failed to migrate into the PMA-induced pneumonia; however, mAb 60.3 pretreatment only partially inhibited endotoxin-induced pneumonia and did not inhibit S . pneumoniae or hydrochloric acid-induced pneumonias . PMN lavaged from the alveolar spaces in the Streptococcal pneumonia had similar quantities of mAb 60.3 bound to their surfaces as the circulating PMN . We conclude that the CD11/CD18 complex mediates PMN adherence in the systemic circulation . However, PMN adherence in the pulmonary circulation may occur by either CD18-dependent or -independent mechanisms that are specific to the inciting stimulus. Infect Immun, 1990 Mar, 58(3), 687 - 94 Synthesis and immunological properties of conjugates composed of group B streptococcus type III capsular polysaccharide covalently bound to tetanus toxoid; Lagergard T et al.; A synthetic scheme for covalently binding group B streptococcus type III to tetanus toxoid (TT), using adipic acid dihydrazide as a spacer, is described . Type III alone or as a conjugate with TT was injected subcutaneously into laboratory mice, and the type-specific and TT antibody responses elicited by these immunogens were assayed . Type III-TT elicited significantly higher levels of type-specific antibodies after each immunization than did the type III alone . These levels were related to the dosage of the conjugate, enhanced by Freund adjuvant, and exhibited booster responses . Type III alone elicited only immunoglobulin M (IgM) antibodies in Swiss albino mice and mostly IgM and low levels of IgG antibodies of the IgG3 subclass in BALB/c mice . Type III-TT conjugates, in contrast, elicited mostly IgG antibodies in both strains of mice . IgA type III antibodies were not detected . The first two immunizations with the conjugates elicited type III antibodies in the IgG1 and in the IgG3 subclasses . Low levels of IgG2a type III antibodies were detected after a third injection of type III-TT . Conjugate-induced antibodies facilitated opsonization of group B streptococcus type III organisms and did not react with the structurally related pneumococcus type 14 . TT alone or as a component of type III-TT induced mostly antibodies of the IgG class: IgG1 levels were the highest of the four subclasses . No IgA TT antibodies were detected . The conjugation procedure, therefore, enhanced the immunogenicity of and conferred T-cell dependent properties to the type III while preserving the immunogenicity of the TT component . The T-cell dependent properties of the conjugates were responsible for stimulating IgG type III antibodies which could be boosted . Evaluation of type III-TT conjugates in antibody-negative women of child-bearing age is planned. Int Endod J, 1990 Mar, 23(2), 92 - 6 Stimulation of the growth of Streptococcus sanguis (NCTC 7864) by zinc in vitro; Meryon SD et al.; Zinc, which is present in many materials used in dentistry, including restorative and endodontic materials and mouthwashes, is reputedly bactericidal . However, the addition of this element at concentrations in the range 10-50 ppm to cultures of Streptococcus sanguis (NCTC 7864) stimulated the growth of the micro-organism relative to that of controls . A second antibacterial element, namely fluoride, reduced growth . Similar results were obtained whether the organism was grown aerobically or anaerobically . In view of the susceptibility of some organisms to zinc, the results of this study may help to explain conflicting reports in the literature; the results will vary depending on which organism is predominant. Kinderarztl Prax, 1990 Mar, 58(3), 143 - 9 {Enterococci as pathogens of severe infections in newborn infants and young infants}; Halle E et al.; We report about severe perinatal infections caused by enterococci during a 5 year-period . Between January 1983 and December 1987 8 infants were treated in the Department of Neonatology of the Charite-Hospital, 5 of them died . In 4 of the infants this infection was of the early onset type and in 4 infants the infection had a late onset . The clinical course of the four infants with early onset type was very similar to that of infants with group-B-streptococcus disease . The increase of severe infections caused by enterococci in 1987 (7 cases) is unclear . One cause of the increase could be, that the chemotherapy of septicemia and meningitis in the Department of Neonatology of the Charite is the combination cefotiam and gentamicin or cefotaxime and gentamicin . Enterococci are resistant to all cephalosporins and a selection of these pathogens after this therapy is possible . In vitro and clinical experience has demonstrated, that a ampicillin-gentamicin combination constitutes effective therapy for enterococcal infection. Minerva Cardioangiol, 1990 Mar, 38(3), 85 - 8 {Bacterial endocarditis in pregnancy . Description of 2 cases and review of the literature}; Zamprogno R et al.; Bacterial endocarditis in pregnancy is uncommon . We described two cases: the first case of endocarditis, caused by staphylococcus epidermidis (at the 35th week of pregnancy) was complicated by severe aortic valvular insufficiency; the second case, endocarditis caused by streptococcus alpha hemolytic (at the 32nd week of pregnancy) was complicated by severe mitral valvular insufficiency associated with multiple systemic emboli . Therapy consisted, in the first case of partum-induction followed by antibiotic therapy; in the second case it consisted of specific antibiotic therapy followed by gestation . There was no maternal or fetal mortality in the two cases. P N G Med J, 1990 Mar, 33(1), 55 - 7 Massive empyema in a five-week-old baby: a case study; Spicer PE; A 5-week-old male child was admitted to Tabubil Hospital with a rapidly progressive, fulminating right-sided empyema which necessitated thoracotomy and drainage . The causative organism was a haemolytic Streptococcus. Antimicrob Agents Chemother, 1990 Mar, 34(3), 467 - 9 Comparative in vitro activities of several new fluoroquinolones and beta-lactam antimicrobial agents against community isolates of Streptococcus pneumoniae; Mazzulli T et al.; The in vitro susceptibilities of 551 community isolates of Streptococcus pneumoniae from the Canadian province of Ontario to several new fluoroquinolones and beta-lactam antimicrobial agents were determined by a broth microdilution technique . Eight (1.5%) of these isolates were moderately susceptible (MICs, greater than or equal to 0.12 and less than or equal to 1.0 microgram/ml) to penicillin; none was resistant . Temafloxacin, ciprofloxacin, and ofloxacin (MICs for 90% of strains tested, between 1 and 2 micrograms/ml) were the most active fluoroquinolones tested, and BMY-28100 (MIC for 90% of strains tested, 0.25 microgram/ml) was the most active of the new beta-lactams tested. FEMS Microbiol Lett, 1990 Mar 1, 56(1-2), 223 - 7 Complete nucleotide sequence of the sr gene from Streptococcus mutans OMZ 175; Ogier JA et al.; The nucleotide sequence encoding the SR protein of Streptococcus mutans OMZ 175 (serotype f) has been determined . The sr gene consists of 4667 bp and codes for a 171177 Da protein . Comparison of the inferred amino acid sequence with the one of PAc antigen from S . mutans MT 8148 (serotype c) indicates a 88% conservation of amino acid residues which reflects the close relatedness of both proteins . Major differences in amino acid composition are located at the C-terminal part of the sequence where only 298 amino acids of the terminal 420 are conserved. Zentralbl Bakteriol, 1990 Mar, 272(3), 276 - 82 Isolation and characterization of hyaluronidases from Streptococcus dysgalactiae, S . zooepidemicus and S . equi; Sting R et al.; 10 out of 10 cultures each of Streptococcus dysgalactiae and S . zooepidemicus and 6 out of 10 cultures of S . equi tested for hyaluronidase produced this enzyme . Hyaluronidase could be precipitated from the cell-free culture supernatant with ammonium sulphate and purified by chromatography on DEAE-cellulose, isoelectric focussing and preparative polyacrylamide gel electrophoresis . The isoelectric points of the hyaluronidases from S . dysgalactiae and S . equi were near pH 5, of that from S . zooepidemicus near pH 6 . The hyaluronidases from S . dysgalactiae, S . zooepidemicus and S . equi had molecular weights of about 55,000 D . Maximal enzyme activities developed between 40 degrees C and 45 degrees C and pH 5.6 and 5.8 . The Michaelis constants ranged from 7.5 x 10(-2) to 8.8 x 10(-2) mg/ml . Hyaluronidase activities were stimulated by Ca++, Mg++, Mn++, Co++, K+, and Li+ and inhibited by Zn++ and Cd++. Ann Clin Lab Sci, 1990 Mar-Apr, 20(2), 140 - 6 Low levels of unsaturated transferrin as a predictor of survival in pneumococcal pneumonia; Lambert CC et al.; A study was conducted to evaluate factors which might influence the prognosis of persons with pneumonia owing to Streptococcus pneumoniae . Serum iron, total iron binding capacity and unbound iron binding capacity (UIBC), were evaluated in 35 such patients . Of the 10 patients with UIBC levels less than 130 micrograms per dl on admission to the hospital, six died, three had complications, and only one recovered uneventfully . Of the 25 surviving patients, 21 (84 percent) had UIBC greater than 130 micrograms per dl on admission . Positive blood cultures were also correlated with survival . However, the strongest prognostic indicator was the combination of UIBC and blood culture results . Only 14 percent of patients with abnormalities in both parameters survived, whereas 80 percent to 88 percent of those with negative blood culture and/or normal UIBC survived . This suggests that insufficient unsaturated transferrin may facilitate bacteremia and contribute to lethality of pneumococcal pneumonia. J Reprod Med, 1990 Mar, 35(3), 297 - 8 Neonatal Streptococcus pneumoniae septicemia and meningitis . A case report; Di Nello CH et al.; Neonatal septicemia/meningitis from Streptococcus pneumoniae occurred in a 36-hour-old infant . The mother had no overt evidence of infection . This case illustrates the pathogenic potential of this common bacterium in the neonate. Scand J Immunol, 1990 Mar, 31(3), 361 - 6 Low T- and B-cell reactivity is an apparently paradoxical request for murine immunoprotection against Streptococcus mutans . Murine protection can be achieved by immunization against a B-cell mitogen produced by these bacteria; Soares R et al.; C57BL/6 mice thymectomized as adults or depleted of CD4+ cells were much less susceptible than intact conventional mice to the B-cell mitogenic and specific immunosuppressive effects of a protein designated as F5'EP-Sm secreted by Streptococcus mutans . These mice were also considerably more resistant to infection by these bacteria than intact individuals . The immunosuppressor effect of F5'EP-Sm was also abrogated, however, in conventional intact mice when immunized intraperitoneally against heat-inactivated F5'EP-Sm . On the other hand, resistance to bacterial infection could be achieved by immunization of conventional intact C57BL/6 mice against heat-inactivated F5'EP-Sm by intraperitoneal or intradermal routes even when the animals were infected 3 months after immunization and even when the immunization procedure did not include Freund's adjuvant, which was the case with the intradermal route . Interestingly, the protection against the bacterial infection was accompanied by only a minor increase in specific serum antibodies against F5'EP-Sm . These results are discussed in the context of adequate strategies for immunoprotection against Streptococcus mutans and other micro-organisms which are secretors of substances that share both B-cell mitogenic and immunosuppressive properties and which are thus able to suppress the immune response by overstimulation of the immune system of the host. J Vet Pharmacol Ther, 1990 Mar, 13(1), 43 - 8 Effects of experimentally induced Streptococcus suis infection on the pharmacokinetics of penicillin G in pigs; Zeng ZL et al.; The pharmacokinetics of potassium penicillin G were studied in both healthy (n = 8) and experimentally Streptococcus-suis-infected (n = 6) pigs following intramuscular administration (15,000 iu/kg) . Streptococcus-suis infection was induced artificially in young cross-bred pigs by subcutaneous inoculation with 9 x 10(8) to 10(9) colony-forming units of S . suis . The rectal temperature of infected pigs was significantly increased (P less than 0.01) before penicillin G injection and this was maintained for 8 h after the drug was given . Other clinical symptoms were also present . The serum concentration-time data for penicillin were found to fit a one-compartment open model with first-order absorption in the two groups of pigs . Significant changes were not observed between healthy and diseased pigs in following parameters: A, Ka, Ke and Tmax . However, in diseased pigs, significant increases (P less than 0.01) were found in Vd and ClB, and significant decreases (P less than 0.01) in Cmax and AUC occurred . The increased body clearance (ClB) and greater apparent volume of distribution (Vd) of penicillin G could partly explain why the serum values of the drug were much lower in diseased pigs than in healthy pigs. J Perinatol, 1990 Mar, 10(1), 60 - 4 The role of the lumbar puncture in the admission sepsis evaluation of the premature infant; Hendricks-Munoz KD et al.; Premature infants with respiratory distress commonly receive evaluation for sepsis, including a lumbar puncture, within a short time after admission to a neonatal intensive care unit . We questioned the use of the lumbar puncture during the early sepsis evaluation, and since 1979, have omitted this procedure as part of the initial evaluation for sepsis (within 6 hours of birth) of premature infants . We monitored this policy to detect any change in the incidence of meningitis, and now report results accumulated over a 7-year period . From 1979 to 1986, 1390 inborn premature infants of 34 weeks' gestation or less were evaluated for early sepsis within 6 hours of birth . Thirty-two infants (2.3%) were diagnosed with sepsis . Fifteen of these infants died in the first 24 hours of life . Meningitis was not demonstrated by autopsy evaluation . The surviving 17 infants diagnosed with sepsis did not have meningitis . One hundred twenty-three infants whose initial blood cultures were negative developed infection later in their hospital course . Eleven of these 123 infants had infections with perinatally acquired organisms; two had group B streptococcus (GBS) meningitis . Their cases were not compatible with missed meningitis . The remaining 112 infants developed nosocomial infections of which 38.3% developed meningitis without associated bacteremia . These results suggest that the omission of the lumbar puncture in the early sepsis evaluation of the premature infant did not result in any missed meningitis and spared many infants the procedure shortly after birth . The lumbar puncture, however, continues to be vital in the assessment of late infections of the neonate. Immunology, 1990 Mar, 69(3), 443 - 8 A thymus-independent (type 1) phosphorylcholine antigen isolated from Trichinella spiralis protects mice against pneumococcal infection; Lim PL et al.; A phosphorylcholine (PC)-containing glycoprotein of 68,000 molecular weight (MW) was isolated from Trichinella spiralis . The potential of this antigen (Tsp) as a species-specific vaccine against Streptococcus pneumoniae was studied in both immunologically deficient (CBA/N) and normal (CFW) mice . Unlike the PC determinant found in S . pneumoniae, Tsp is a type 1 thymus-independent (TI-1) antigen, as it was able to stimulate PC-specific antibody production in CBA/N animals, though less well than in CFW mice . Immunological memory to this antigen was observed in both strains of mice, and the predominant class of antibodies formed was IgM . In further studies, Tsp-immunized CFW mice were protected against a fatal challenge of S . pneumoniae type 3 . Protection in these animals is probably mediated by the PC-specific antibodies present, which comprised 87.9% of antibodies reactive to S . pneumoniae, or 58.7% of total antibodies formed. Infect Immun, 1990 Mar, 58(3), 838 - 40 Size of the Streptococcus mutans GS-5 chromosome as determined by pulsed-field gel electrophoresis; Tudor JJ et al.; Rare cutting restriction endonucleases were used to cut the Streptococcus mutans chromosome into large fragments . Restriction enzymes utilizing recognition sites containing 6-, 7-, or 8-base-pair sequences with only G and C nucleotides produced few fragments, most of which were greater than 100 kilobase pairs in size . Addition of the fragments from digests of SmaI, NotI, ApaI, RsrII, and EagI yielded a molecular size for the S . mutans GS-5 genome of 2,819 +/- 60 kilobase pairs. Infect Immun, 1990 Mar, 58(3), 667 - 73 Sequence analysis of the gene for the glucan-binding protein of Streptococcus mutans Ingbritt; Banas JA et al.; The nucleotide sequence of the gbp gene, which encodes the glucan-binding protein (GBP) of Streptococcus mutans, was determined . The reading frame for gbp was 1,689 bases . A ribosome-binding site and putative promoter preceded the start codon, and potential stem-loop structures were identified downstream from the termination codon . The deduced amino acid sequence of the GBP revealed the presence of a signal peptide of 35 amino acids . The molecular weight of the processed protein was calculated to be 59,039 . Two series of repeats spanned three-quarters of the carboxy-terminal end of the protein . The repeats were 32 to 34 and 17 to 20 amino acids in length and shared partial identity within each series . The repeats were found to be homologous to sequences hypothesized to be involved in glucan binding in the GTF-I of S . downei and to sequences within the protein products encoded by gtfB and gtfC of S . mutans . The repeated sequences may represent peptide segments that are important to glucan binding and may be distributed among GBPs from other bacterial inhabitants of plaque or the oral cavity. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi, 1990 Mar-Apr, 31(2), 69 - 75 Septic arthritis in early infancy; Wang CH et al.; Septic arthritis in infants who are less than two months of age is a rare condition . During a recent seven-year period, eighteen cases of infantile septic arthritis were diagnosed at Mackay Memorial Hospital . The ratio of males to females was 1.6:1 . The most common symptoms were crying during diaper change, and an immobile and swollen joint . Nonspecific symptoms such as fever, poor appetite and lethargy were uncommon . The hip was the most commonly affected joint with the knee taking second place . Ten cases (55%) demonstrated concomitant osteomyelitis . A bacterial etiology was established in 16 cases (88%) . The predominant pathogens were S . aureus (5 cases) followed by group B streptococcus (4 cases) . Total parenteral nutrition was the predisposing factor of infection in 4 of the 5 S . aureus arthritis cases . The duration of treatment ranged from 21 to 44 days . Two patients developed sequelae: namely discrepancies in leg length, and a limping gait . Early diagnosis and prompt antibiotic treatment are crucial elements in the prevention of disabling and catastrophic sequelae in young infants who have septic arthritis . In addition, open drainage is highly recommended in hip and shoulder arthritis. Rev Eur Odontoestomatol, 1990 Mar-Apr, 2(2), 127 - 30 {Bacteriocins of Streptococcus mutans: mutacins}; Baca Garcia P et al.; A bioliographic survey about the production of a certain bactericidal substance (mutacins) by Streptococcus mutans has been done . The importance of bacteriocins of this micro-organism is due to its utility as a possible anti-caries agent performing as an influential factor in the colonization of the oral cavity, and also for serving for the typing of bacteria as an epidemiological "finger printing", determining the way of transmission of this micro-organism . Besides of stressing its clinical and epidemiological utility, we develop a review of other microbiological aspects. Oralprophylaxe, 1990 Mar, 12(1), 36 - 40 {Demonstration of Streptococcus sobrinus in human oral cavity}; Gehring F et al.; From 133 saliva samples of humans we isolated 32 strains (24%) of Streptococcus sobrinus on an BYCSB selective medium . The very hard colonies of S . sobrinus on this medium were characterized by a distinct chalky white halo of water insoluble glucan ("glucan-halo") produced in large amounts from the sucrose by extracellular glucosyltransferase which has diffused out into the isolation medium . All of the isolated S . sobrinus strains fermented ordinarily mannitol and sorbitol, but not raffinose and melibiose . The occurrence of this special subspecies within the S . mutans-group may play a more important role in the etiology of dental caries of caries-active persons in the future. Oralprophylaxe, 1990 Mar, 12(1), 22 - 5, 27 {In-vitro plaque accumulation on different filling materials}; Einwag J et al.; The influence of the surface roughness of dental filling materials as well as of specific properties of materials on plaque accumulation was to be tested in a comparative study for various materials (Degulor S, Amalcap SAS, Visio Dispers, Ketak-Fil, CuproDur, Harvard Cement) was to be tested in a comparative investigation . For this purpose, the different materials were placed in a Streptococcus mutans NCTC 10449 culture medium containing sucrose, and incubated for three days at 37 degree C . Following this, the specific accumulation of polysaccharides formed outside of cells (plaque) was subjected to gravimetric analysis . Filling materials that take a high polish (Degulor S, Amalcap SAS, Visio Dispers) accumulated only 25 to 50% as much plaque as did cements . Within the group of cements there were also differences (up to 40%) in spite of similar surface roughness . These differences are presumably due to properties specific to the materials . In preliminary examinations of the products named, antibacterial effects were registered in three cases (Degulor S, Harvard Cement and Cupro-Dur--inhibiting areola between 1 and 7.5 mm). Microb Pathog, 1990 Mar, 8(3), 189 - 96 Relationship between intracellular survival in macrophages and pathogenicity of Streptococcus suis type 2 isolates; Williams AE; Naturally-occurring Streptococcus suis type 2 meningitis affects pigs and man; experimental models of the disease have also been established in pigs and mice . A sustained, high-level bacteraemia is an important phase preceding the development of S . suis type 2 meningitis . The main cellular clearance mechanism for circulating bacteria is the resident hepatic and splenic macrophages . The interaction between various isolates of S . suis type 2 and murine macrophages was investigated to determine whether there were differences in the outcome of the interaction that would reflect observed differences in pathogenicity . Phagocytosed non-pathogenic isolates were killed whereas intracellular pathogenic organisms survived and replicated within phagosomes in the absence of anti-S . suis type 2 antibody and complement . The addition of anti-S . suis type 2 antibody and complement to macrophages containing ingested pathogenic organisms resulted in inactivation of the intracellular bacteria . Thus whilst the pathogenicity of S . suis type 2 isolates may be related to an ability to survive within macrophages, immunity to S . suis type 2 meningitis may result from anti-S . suis type 2 antibody preventing pathogenic organisms surviving within macrophages. Zh Mikrobiol Epidemiol Immunobiol, 1990 Mar, (3), 26 - 31 {Microbiologic and histomorphologic characteristics of experimental Mycoplasma-pneumococcus infection}; Baizhomartov MS et al.; The specific features of the development of Mycoplasma pneumoniae and Streptococcus pneumoniae infections in mice have been studied in cases of mixed and monoinfections . As shown in this study, mixed infection is characterized by the mutual inhibition of the proliferation of both pneumococci and mycoplasmae in the lungs, the liver and the spleen of the animals, while the associative interaction of these infective agents in isolated mouse lung tissue is characterized by the inhibition of pneumococcal proliferation only . In mixed infection the early activation of cells of the immunocompetent system is observed, which is accompanied by the development of mainly cell-mediated immune processes manifested as delayed hypersensitivity with the late formation of fibrillogenesis . During the development of mixed mycoplasmal-pneumococcal infection the histopathology of mycoplasmal infection prevails, which is probably due to the early formation of delayed hypersensitivity to M . pneumoniae in the animals. Bol Med Hosp Infant Mex, 1990 Mar, 47(3), 146 - 52 {Streptococcus group B in the etiology of neonatal infection}; Solorzano-Santos F et al.; Group B Streptococcus (GBS) causes maternal infections during perinatal period and serious neonatal infections . Their frequency in our country is still unknown . This study analyzed the clinical and epidemiological characteristics of 13 neonates inborn at the Instituto Nacional de Perinatologia with early or late onset group B streptococcal infection . The incidence of early onset diseases (EOGBS) was 0.7 cases/1,000 live births among 20,054 inborn, and 1 case/20,000 live births of late onset diseases . EOGBS was more common in preterm newborn (median 33.2 w), low birth weight (median 2.025 g) with several maternal risk factors . Lethality rate was 38.5% (5/13) . GBS is a recent important pathogen in our institute that must be investigated in another institution of our country . Group B Streptococcus; neonatal septicemia; neonatal pneumonia. Semin Respir Infect, 1990 Mar, 5(1), 10 - 29 Bacterial pneumonia in solid organ transplantation; Mermel LA et al.; Approximately 4% of recipients of solid organ transplants in the United States develop bacterial pneumonia in the posttransplant period, often in the first 3 months following transplantation . The incidence of bacterial pneumonia is highest in recipients of heartlung (22%) and liver transplants (17%), intermediate in recipients of heart transplants (5%), and lowest in renal transplant patients (1 to 2%) . The crude mortality of bacterial pneumonia in solid organ transplantation has exceeded 40% in most series . Beyond those risk factors identified for nosocomial pneumonia, the occurrence of primary cytomegalovirus (CMV) infection, graft rejection, maintenance antirejection therapy with prednisone, azathioprine, and antilymphocyte globulin, antirejection therapy with high-dose corticosteroids or OKT3 and splenectomy have been associated with a significantly increased risk of bacterial pneumonia in these patients . In the first 3 months posttransplant, gram-negative bacilli, Staphylococcus aureus and Legionella predominate and mortality is very high, in excess of 60% . Thereafter, bacterial pneumonias are caused primarily by Streptococcus pneumoniae and Hemophilus influenzae, with considerably lower mortality . Bacterial pneumonia must be suspected in any transplant patient presenting with fever and cough, especially associated with dyspnea or infiltrates on chest radiograph . If large numbers of bacteria and polymorphonuclear leukocytes are not visualized in respiratory secretions the work-up should proceed directly to fiberoptic bronchoscopy with bronchoalveolar lavage and/or protected brush specimen to establish the microbiologic diagnosis as accurately as possible . For presumptive gram-negative bacillary pneumonia, the initial regimen must be effective against Pseudomonas aeruginosa . Prevention of bacterial pneumonia in transplant patients must begin with immunization against S pneumoniae and Influenza A, and include precautions taken to prevent nosocomial pneumonia . It further may include measures to prevent CMV infection and the use of trimethoprim/sulfamethoxazole prophylaxis during the first year posttransplantation . Ultimately, novel technologies such as selective antimicrobial decontamination and/or protective isolation during the early postoperative period may prove effective. Fam Med, 1990 Mar-Apr, 22(2), 122 - 4 Evaluation in rural practice of a rapid group B streptococcus screening test; Yawn BP et al.; Group B streptococcus (GBS) is the leading cause of infant mortality from infection . A rapid screening immunoassay for GBS was evaluated in a rural obstetrical population and was found to have an unacceptably low specificity (90%) and sensitivity (50%) . With a culture proven GBS colonization rate of 6.8%, the positive predictive value of the rapid screening test was only 27%, and the negative predictive value was 96% . Current recommendations for routine vaginal cultures, on all women based on urban research data with high maternal colonization rates (15%-23%) and high prematurity rates (15%-40%) are reviewed in relation to this community's low colonization and prematurity rates. Clin Exp Immunol, 1990 Mar, 79(3), 353 - 60 Neutrophil-potentiating factors released from stimulated lymphocytes; special reference to the increase in neutrophil-potentiating factors from streptococcus-stimulated lymphocytes of patients with Behçet's disease; Niwa Y et al.; The potentiating effect of the soluble factors released from normal or diseased lymphocytes on neutrophil functions were investigated in the presence or absence of mitogens and wall preparations of Streptococcus pyogenes . When normal T lymphocyte populations were stimulated with T cell mitogens or with streptococcal preparations, the supernatants from these cultures potentiated neutrophil chemotaxis, phagocytosis and O2- generation . Upon gel-filtration of these stimulated lymphocyte supernatants, the neutrophil-potentiating activity was inactivated by trypsin or by a 30-min incubation at 130 degrees C, but was not affected by acid treatment at pH 2 or heat treatment at 56 degrees C for 60 min . Its activity was almost not affected by antisera against human interleukin-1, interleukin-2, interferon-gamma or tumour necrosis factor . With the stimulation of T cell mitogens, the supernatants released from the lymphocytes of not only the patients with Behcet's disease but also healthy and diseased controls enhanced neutrophil functions . However, supernatants from streptococcal preparation-stimulated lymphocytes from patients with Behcet's disease had a higher potentiating effect on neutrophil functions . Our study suggests that the enhanced neutrophil functions in patients with Behcet's disease may be related to an abnormally high level of circulating activated T cells in these patients. Appl Environ Microbiol, 1990 Mar, 56(3), 829 - 31 Formation of a clear zone on tannin-treated brain heart infusion agar by a Streptococcus sp . isolated from feces of koalas; Osawa R; Gram-positive cocci, isolated from the feces of koalas and identified as Streptococcus bovis biotype I, formed a distinct clear zone on tannin-treated brain heart infusion agar, suggesting that this isolate has the unique characteristic of degrading the tannin-protein complex. Orthopedics, 1990 Mar, 13(3), 341 - 3 The effects of contrast dye on bacterial growth: an in vitro model; Lee WA et al.; We devised an in vitro model to examine the effects of Conray 60 contrast dye on microorganisms commonly found in septic arthritis . Using 42 culture plates in aerobic and anaerobic environments, we found no adverse effect on bacterial growth using 30, 7.5, 3.75, and 1.875% concentrations of Conray 60 contrast dye on cultures of Staphylococcus aureus, Hemophilus influenza, and Streptococcus pneumonia. Chem Pharm Bull (Tokyo), 1990 Mar, 38(3), 717 - 20 Effect of tea polyphenols on glucan synthesis by glucosyltransferase from Streptococcus mutans; Hattori M et al.; In the course of our studies on the development of anti-plaque agents for prevention of dental caries, we investigated effects of some of tea preparations and their individual components on the glucan synthesis catalyzed by glucosyltransferase (GTF) from Streptococcus mutans . Extracts of green tea and black tea, and polyphenol mixtures showed appreciable inhibition in the synthesis of insoluble glucan . Among the components isolated from tea infusions, theaflavin and its mono- and digallates had potent inhibitory activities at concentrations of 1-10 mM against GTF . (+)-Catechin, (-)-epicatechin and their enantiomers had moderate inhibitory activities at these concentrations, while galloyl esters of (-)-epicatechin, (-)-epigallocatechin and (-)-gallocatechin had increased inhibitory activities. J Int Med Res, 1990 Mar-Apr, 18(2), 164 - 70 Efficacy and safety of clarithromycin versus josamycin in the treatment of hospitalized patients with bacterial pneumonia; Straneo G et al.; The efficacy and safety of 500 mg clarithromycin and 1000 mg josamycin both given twice daily for a maximum of 14 days were compared in the treatment of 72 hospitalized patients with bacterial pneumonia . The predominant pathogens isolated were Streptococcus pneumoniae and Staphylococcus aureus . Clinical success was reported for 91.5% of patients treated with clarithromycin and for 87.0% of those treated with josamycin . Eradication of the causative pathogen was noted in 85.7% of patients receiving clarithromycin and in 90% of those receiving josamycin . Adverse events considered probably to relate to therapy were experienced by 2% of patients treated with clarithromycin and by 12.5% of those treated with josamycin; one patient treated with josamycin was withdrawn because of severe nausea and moderate vomiting . Treatment with clarithromycin at half the dosage of josamycin was found to have comparable efficacy and to be associated with a lower incidence of adverse events. Zhonghua Ya Yi Xue Hui Za Zhi, 1990 Mar, 9(1), 26 - 32 {Isolation and biotyping of Streptococcus mutans among preschool children in Kaohsiung city}; Chen HS et al.; Strains of streptococcus mutans were isolated from the saliva of preschool children in Kaohsiung City . The unstimulated whole saliva samples were inoculated onto modified Gold's agar plates and incubated for 24-48 hours anaerobically at 37 degrees C . Strains of S . mutans were classified according to Shklair and Keene's biochemical methods and biotyped according to the methods of Farghaly et al . S . mutans could be detected in 102 (89.5%) of 114 preschool children . The most common biotype of S . mutans in single isolation was biotype I (72.9%) . The percentages of the other biotypes are as follows: biotype II (5.2%), biotype III (7.3%), biotype IV (7.3%) and biotype V (7.3%) . Our study revealed that the deft index was significantly higher in children who were biotype I carriers than in those who were nonbiotype I carriers . This observation suggests that biotype I may be related to the higher incidence of dental caries in our preschool children. J Perinatol, 1990 Mar, 10(1), 27 - 31 Complement C3 deposition onto bacteria by neonatal serum is not enhanced after the infusion of intravenous immunoglobulin; Lassiter HA et al.; To determine the effect of intravenous immunoglobulin (IVIG) on the capacity of serum from septic neonates to deposit complement C3 and IgG onto the bacteria isolated from their blood, 500 mg/kg of IVIG was administered to 18 neonates suspected of being septic . Blood was obtained just before the infusion, and again 15 minutes after its completion . Group B streptococcus type II, group B streptococcus type III, Staphylococcus aureus, and Staphylococcus epidermidis were isolated from the pre-infusion blood of four neonates . Bacteria were incubated with the appropriate serum, washed, and the amount of C3 and IgG subsequently bound to the organisms was quantified by radioimmunobinding assay . Sera from the four septic neonates and sera from four neonates of similar gestational age but whose blood cultures were negative were compared with pooled sera from healthy adults . Before the administration of IVIG, C3 deposition onto the bacteria by sera from five of the seven neonates tested was significantly less than that observed for adult sera . Following the infusion, no increase in C3 deposition was observed for any of the seven sera assayed, and in two cases C3 deposition fell significantly . In contrast, in seven of eight cases, IVIG enhanced the IgG deposition to levels greater than or equal to those observed for adult sera . Therefore, following the infusion of IVIG into neonates with proven or suspected sepsis, the deposition of C3 onto invasive bacteria by their serum was not enhanced even though IgG deposition was increased. Paediatr Indones, 1990 Mar-Apr, 30(3-4), 120 - 4 Sydenham's chorea; Danial R et al.; P, an Indonesian boy, 5 years old, 15 kg of body weight and 110 cm of body length, was admitted to the PTP IX Hospital on March 30, 1987 with cerebral palsy . The patient had fever since 10 d