Streptococcal

J Immunol, 1989 Jul 15, 143(2), 565 - 70
The Fc binding site for streptococcal protein G is in the C gamma 2-C gamma 3 interface region of IgG and is related to the sites that bind staphylococcal protein A and human rheumatoid factors; Stone GC et al.; The isolated 35 kDa fragment of protein G obtained by papain digestion of group G streptococci was found to bind solid phase intact IgG, Fc (2C gamma 2 + 2C gamma 3 domains), F(ab')2 and F(acb)2 (F(ab')2 + 2C gamma 2 domains) fragments but not pFc' (2C gamma 3 domains) fragments . The level of binding to rabbit F(acb)2 and rabbit F(ab')2 fragments was similar . Protein G binding to solid phase Fc fragments was inhibited by IgG, Fc, staphylococcal protein A and its monovalent fragment D, but was enhanced by F(ab')2 fragments . Chemical modification of tyrosine but not histidine residues of IgG abrogated its ability to inhibit the binding of protein G to solid phase Fc fragments . Protein G was found to strongly inhibit the binding of a monoclonal and a polyclonal human rheumatoid factor to IgG . These findings indicate that protein G binds with separate sites to the Fc and F(ab')2 fragments of IgG, that the interaction with the Fc fragment occurs at the C gamma 2-C gamma 3 domain interface region and that tyrosine but not histidine residues in this area are likely involved . The relationship of the Fc fragment-binding site specificity of protein G to that of other microbial IgG binding proteins and human rheumatoid factors is discussed.

FEMS Microbiol Lett, 1989 Jul 15, 51(1), 179 - 82
A lysozyme isolated from rainbow trout acts on mastitis pathogens; Grinde B; The antibacterial effects of two lysozymes purified from rainbow trout kidney (type I and II) were tested on eight bacterial strains isolated from cases of clinical mastitis (staphylococci, streptococci and coliforms) . Three other lytic agents were included in the experiments as controls: hen egg-white lysozyme, lysostaphin and mutanolysin . Proliferating bacteria were incubated with the various lytic agents, either in hearts infusion broth or in milk . The type II rainbow trout lysozyme decreased the number of live bacteria (colony forming units) of all the strains tested, but was most efficient against staphylococci . The other two lysozymes had little effect.

Thromb Res, 1989 Jul 15, 55(2), 187 - 93
Group A streptococci bind human plasmin but not other structurally related proteins; DesJardin LE et al.; Certain group A streptococci are known to possess a receptor for the human enzyme plasmin . Plasmin is a member of a super gene family that includes other serine proteases and kringle containing proteins . In this study we have examined the interaction of a group A streptococcus with structurally related proteins, including plasmin, glu-plasminogen, tissue plasminogen activator, kallikrein, factor XII, prothrombin, thrombin, trypsin, and urokinase . Our studies indicate that only the key fibrinolytic enzyme, plasmin, demonstrates significant binding activity to the group A streptococcus.

N Engl J Med, 1989 Jul 6, 321(1), 1 - 7
Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A; Stevens DL et al.; There is concern that group A streptococci, which have caused less serious infections in developed countries in recent decades, may be acquiring greater virulence . We describe 20 patients from the Rocky Mountain region who had group A streptococcal infections from 1986 to 1988 that were remarkable for the severity of local tissue destruction and life-threatening systemic toxicity . Among the 20 patients (median age, 36), necrotizing fasciitis with or without myositis was the most common soft-tissue infection (55 percent) . Nineteen patients (95 percent) had shock, 16 (80 percent) had renal impairment, and 11 (55 percent) had acute respiratory distress syndrome . The mortality rate was 30 percent . All patients but 1 had positive tissue cultures for Streptococcus pyogenes; 12 had positive blood cultures . Most of the patients had no underlying disease; 2 used intravenous drugs . Strains of group A beta-hemolytic streptococci isolated from 10 patients were not of a single M or T type; however, 8 of the 10 strains produced pyrogenic exotoxin A (scarlet fever toxin A, a classic erythrogenic toxin), which has rarely been observed in recent years . From our study of this cluster of severe streptococcal infections with a toxic shock-like syndrome, we conclude that in our region, more virulent group A streptococci have reappeared that produce the pyrogenic toxin A associated with scarlet fever.

Indian J Med Res, 1989 Jul, 89, 261 - 4
Bacteriology of pyoderma including anaerobes; Kishore J et al.; Of 100 pus samples cultured from pyodermal lesions, 99 yielded positive cultures . Staphylococcus aureus alone (45%) or with beta-haemolytic streptococci (BHS, 32%) was the commonest isolate . Antimicrobial sensitivity of 71 Staph . aureus strains tested showed high degree of resistance to erythromycin (38.3%) . BHS was the second common pathogen encountered . T-agglutination patterns studied in BHS group A could type 85.7 per cent of the isolates . Non-group A BHS isolated were of group G (3) and group D (1) . Five pus specimens yielded obligate anaerobes mixed with aerobes . Bacteroides melaninogenicus/asacchrolyticus was isolated in 4 of 5 samples.

Infection, 1989 Jul-Aug, 17(4), 240 - 4
Prevention of bacteremia caused by alpha-hemolytic streptococci by roxithromycin (RU-28 965) in granulocytopenic patients receiving ciprofloxacin; Rozenberg-Arska M et al.; We previously demonstrated that ciprofloxacin prevents infections caused by gram-negative bacilli in patients with granulocytopenia . However, in patients with intensive cytotoxic treatment leading to severe mucosal damage a high incidence of bacteremias caused by alpha-hemolytic streptococci was seen . In the present study 45 consecutive patients undergoing intensive cytotoxic treatment received a short course of roxithromycin (10 days) in addition to ciprofloxacin for prevention of bacteremias caused by alpha-hemolytic streptococci . The results of this study were compared with the results obtained in previous comparable patients receiving ciprofloxacin alone . During the days with addition of roxithromycin no infections caused by alpha-hemolytic streptococci occurred, while in the control group of 80 patients 16 bacteremias (20%) were seen . Although roxithromycin was shown to antagonize bactericidal action of ciprofloxacin on gram-negative bacilli in vitro, in vivo study based on serum bactericidal titers and on results of surveillance cultures showed no antagonistic interactions.

Ala Med, 1989 Jul, 59(1), 13 - 7
Viridans streptococcal endocarditis; Harris LF; Although responsible for a declining proportion of cases of infective endocarditis, viridans streptococci remain the commonest cause and accounted for 30% of our cases seen in Huntsville, Alabama . Usually viridans streptococcal endocarditis is associated with dental manipulation or infection and underlying heart disease but both conditions were not common in our series . Similar to the experience of other investigators, our patients exhibited a subacute course with fever, dyspnea, weight loss and heart murmur . Echocardiography, reported useful in detecting vegetations in one series, was not a sensitive diagnostic tool in our patients . We confirmed the low relapse rate and mortality rate associated with earlier reports of viridans streptococcal endocarditis but observed a high rate of complications, as noted in a recent series.

Int J Cardiol, 1989 Jul, 24(1), 47 - 54
Prognostic index in prediction of mortality from infective endocarditis; Woo KS et al.; Out of 176 patients with infective endocarditis complicating rheumatic (120) and congenital heart disease (38), mortality occurred in 35 patients (19.9%) . Presence of leukocytosis, heart failure, major embolisation and isolation of certain organisms including Staphylococci, beta-haemolytic Streptococci, Pseudomonas and Klebsiella were ominous with higher mortality rates compared with those when they were absent (P less than 0.02) . Stepwise logistic multiple regression was then applied and the four most important independent variables were identified . A prognostic index for the prediction of mortality for infective endocarditis was then constructed by the summation of the regression coefficients . By applying this index, patients with infective endocarditis could be divided into subgroups with increasing proportional mortality from 5.8 to 83.3% . It provides an objective assessment of the risk patients with infective endocarditis, and a more reliable evaluation of benefit of any new treatment regimen, including cardiac surgery, during the acute stage.

J Med Microbiol, 1989 Jul, 29(3), 207 - 19
Outbreaks of human infection caused by pyogenic streptococci of Lancefield groups C and G; Efstratiou A; Within a collection of 749 strains of group C streptococci (Streptococcus equisimilis) and 2348 of group G, isolated over a period of 6 years, there were clusters from 63 probable outbreaks of infection . These occurred in burns and maternity units, hospital wards, outpatient clinics, army camps and religious communities . Overall, it was possible to identify T-protein antigens in 88% of the group C strains and in 82% of group G . Serotyping by the identification of T-protein antigens was a useful method for the subdivision of these strains.

Am J Dis Child, 1989 Jul, 143(7), 794 - 7
Non-group A streptococci in the pharynx . Pathogens or innocent bystanders?
Hayden GF, Murphy TF, Hendley JO.
OBJECTIVE: To determine whether beta-hemolytic streptococci from groups other than A are an important cause of sporadic pharyngitis in children . DESIGN: Cross-sectional, case-referent survey . SETTING: General pediatric clinic at a military base in Ohio . PARTICIPANTS: One hundred fifty children with symptomatic pharyngitis and 150 controls matched for age and time of presentation over a 20-month study period . INTERVENTIONS: None . MEASUREMENTS/MAIN RESULTS: Anaerobic culture technique was used to improve isolation of beta-hemolytic streptococci . Group A beta-hemolytic streptococci were detected significantly more often among the ill children than among the controls (39% vs 16%, respectively) . In contrast, non-group A beta-hemolytic streptococci were isolated in similar frequency from the ill and control children (17% vs 21%, respectively) . Non-group A beta-hemolytic streptococci from groups B, C, F, and G were each isolated in similar frequency among the ill and control children . The isolation rate of non-group A organisms increased with age among both patients and controls . CONCLUSIONS: Non-group A beta-hemolytic streptococci seemed not to be an important cause of sporadic pharyngitis in this pediatric population.

Zh Mikrobiol Epidemiol Immunobiol, 1989 Jul, (7), 7 - 12
{The role of fibronectin in the streptococcal adhesion process}; Lyzlova LV et al.; The work shows that fibronectin obtained from human plasma is capable of binding with streptococci of different groups with almost equal effectiveness . Fibronectin bound to bacterial cells inhibits the adhesion of group A streptococci onto vaginal cells, but it produces no effect on the adhesion of group B streptococci . The binding constant of fibronectin 125I is equal to 10(6) -M-1, which indicates that the level of the specificity of interaction is not sufficiently high.

J Dairy Sci, 1989 Jul, 72(7), 1900 - 6
Effect of freezing on bacteriologic culturing of mastitis milk samples; Schukken YH et al.; The objective was to determine the effect of freezing and length of freezing in a commercial freezer on the qualitative results of bacteriologic culturing of milk collected from glands of cows with clinical or subclinical intramammary infections . A total of 182 milk samples from cows with clinical mastitis and 55 milk samples of cows with subclinical mastitis were taken from four problem herds . Samples were split into four equal sub-samples . Three of these were frozen immediately at -20 degrees C and 1 was submitted fresh for bacteriologic analysis . At 4, 8, and 16 wk after collection, samples were thawed and submitted for bacteriologic culturing . Freezing and increased length of storage resulted in 1) a decrease in the number of samples that had cultures of Escherichia coli or Actinomyces pyogenes; and 2) an increase in the number of samples that had cultures of coagulase-negative staphylococci . Freezing had no effect on streptococci and Staphylococcus aureus.

Rev Infect Dis, 1989 Jul-Aug, 11 Suppl 5, S1231 - 6
Prevention of infections in granulocytopenic patients by fluorinated quinolones; Rozenberg-Arska M et al.; Despite the dramatic decline in the infection-associated death rate as a result of advances in antimicrobial therapy, extensive diagnostic procedures, and better supportive care, morbidity from infectious disease in granulocytopenic patients remains a problem . Several approaches are used for infection prevention . The new oral fluorinated quinolones seem promising for the prevention of infections caused by gram-negative bacilli . Results from different studies showed that these compounds are more efficacious and better tolerated than are other prophylactic regimens . Prophylactic use of quinolones leads to trends in bacteriologically documented infections toward gram-positive microorganisms associated either with the presence of central intravenous catheters (Staphylococcus epidermidis) or with chemotherapy-induced mucositis (alpha-hemolytic streptococci) . These changes suggest a need for the inclusion of an antibiotic effective against gram-positive organisms in the initial therapeutic regimen.

J Clin Microbiol, 1989 Jul, 27(7), 1657 - 8
Evaluation of the pacific biotech CARDS STREP A test for detecting group A streptococci from cases of pharyngitis; Manasse RJ; The Pacific Biotech CARD STREP A test for rapid screening of throat specimens for group A streptococci was evaluated . Relative to conventional culture, this assay had a sensitivity of 76.1% (108 of 142) and a specificity of 98.7% (392 of 397) . The relatively low sensitivity of the test makes it of questionable value as a screening procedure.

Clin Microbiol Rev, 1989 Jul, 2(3), 315 - 28
Classification and identification of the viridans streptococci; Coykendall AL; This review traces the history of the human, nonhemolytic, or viridans, streptococci and describes improvements in their taxonomy wrought by study of their biochemical profiles and analysis of their nucleic acids . The goal was to define species on the basis of genetic relationships and to describe these species by their phenotypic characteristics so that they can be easily identified . This method has resulted in the division of some species . Streptococcus mutans has been divided into four species, two of which are common in humans . Three more mutans group species are indigenous to animals . Conversely, S . constellatus, S . intermedius, and "S . milleri" have been combined under S . anginosus . S . mitis (or "S . mitior") can be well-defined and includes S . sanguis II . There is genetic heterogeneity within S . sanguis, but the species is usually easy to identify . There is also some heterogeneity in S . bovis, but most human isolates are genetically related . Discussions of the taxonomy of these species are accompanied by descriptions of the characteristics by which these streptococci can be identified . Among these species are potential pathogens which should be suspected in cases of endocarditis and purulent infections of liver, brain, and other tissues.

DICP, 1989 Jul-Aug, 23(7-8 Suppl), S21 - 6
Developmental pharmacology: relationship to drug use; Reed MD; The pharmacodynamics of drugs in children have been poorly understood, and only recently have technological advances permitted the issue to be studied . Factors that affect drug use in infants include absorption, distribution, protein binding, metabolism, renal elimination, and volume of distribution . Selection of antibiotics in this patient population should reflect commonly isolated organisms, such as staphylococci, group B streptococci, Escherichia coli, and gram-negative bacteria . An antibiotic must also have good penetration into the central nervous system . Displacement of bilirubin from its albumin-binding sites by drugs or endogenous substrates can lead to kernicterus, or bilirubin encephalopathy . The free bilirubin, rather than total concentration, appears to be only partly responsible for the development of kernicterus.

J Am Vet Med Assoc, 1989 Jul 1, 195(1), 69 - 72
Clinical, ultrasonographic, and surgical findings in foals with umbilical remnant infections; Reef VB et al.; Infection of umbilical arteries, umbilical vein, and/or urachus was diagnosed ultrasonographically in 33 foals 1 to 90 days old (mean, 17.7 +/- 17.3 days) . In these foals, the most common initial problems were umbilical abnormalities, septic arthritis, and/or neonatal septicemia . In 16 foals, abnormalities of the external umbilical stalk were noticed on admission . Abnormalities of the internal umbilical structures were identified when enlargement and echogenic material (fluid and/or gas) were imaged ultrasonographically within these structures . Multiple structures were affected in 23 foals, with the urachus the most commonly affected structure . Surgical findings confirmed ultrasonographic identification of infected umbilical structures in 23 foals . Twenty-two samples from affected umbilical remnants submitted for culture at surgery were positive for bacterial growth . Multiple organisms were isolated in 15 cultures . Escherichia coli and beta-hemolytic streptococci were the most common isolates . Two foals died of late complications associated with surgical resection, 1 foal treated surgically and 3 foals treated medically died or were euthanatized because of other complications, and the remaining 27 foals lived.

Ethiop Med J, 1989 Jul, 27(3), 115 - 9
Colonization of pregnant women and their newborn infants with group B streptococci in the Gondar College of Medical Sciences; Schmidt J et al.; In a study of Group B streptococcal carriage, 200 postpartum women and 80 newborn infants were investigated in the Gondar College of Medical Sciences from January to April 1987, using swabs from the vagina and rectum, and from the throat and external ear, respectively . We found a colonization rate of 9% (18/200) in the mothers and 5% (4/80) in the neonates . The serological typing of the 25 isolated strains showed 60% (15/25) to be Type Ib/c and 16% (4/25) to be Type Ia strains . Therefore, in newborn infants with infections, diagnostic and bacteriological procedures should include a search for Group B Streptococci.

South Med J, 1989 Jul, 82(7), 900 - 2
Spontaneous streptococcal gangrenous myositis: survival with early debridement; Doebbeling BN et al.; Spontaneous gangrenous myositis caused by Streptococcus pyogenes is usually fatal, but no longer uniformly so . There appears to be a spectrum of disease due to beta-hemolytic streptococci, from necrotizing fasciitis to pyomyositis to spontaneous gangrenous myositis . Survival is possible with early surgical debridement, reexploration at 24 to 36 hours, and intensive supportive care.

Infect Immun, 1989 Jul, 57(7), 2050 - 6
Cloning and expression of a cohemolysin, the CAMP factor of Actinobacillus pleuropneumoniae; Frey J et al.; The genetic determinant of the cohemolysin which is responsible for the CAMP phenomenon, a cohemolysis, of Actinobacillus pleuropneumoniae was cloned in Escherichia coli . Total DNA from the A . pleuropneumoniae serotype 1 type strain 4074 was used to construct a gene library in plasmid pUC18 in E . coli JM83 . A total of 10,500 clones containing recombinant plasmids have been screened for hemolysis on blood plates . Fifty-five clones which showed a weak hemolytic response after 24 to 48 h of incubation were screened for the CAMP reaction with Staphylococcus aureus . This led to the identification of one clone which showed a positive CAMP reaction . Immunoblot analysis revealed that the recombinant strain expressed a protein with a molecular mass of 27,000 daltons, similar in size to the CAMP protein of the group B streptococci . Rabbit antibodies against the CAMP+ clone neutralized the CAMP reaction mediated by the E . coli strain containing the cloned CAMP gene as well as that of A . pleuropneumoniae . Antibodies raised against the cloned CAMP cohemolysin cross-reacted with Streptococcus agalactiae protein B . We designate the 27,000-dalton molecule CAMP factor protein and name its corresponding gene cfp.

J Dent Res, 1989 Jul, 68(7), 1155 - 61
An investigation into the use of restriction endonuclease analysis for the study of transmission of mutans streptococci; Kulkarni GV et al.; Restriction endonuclease analysis (REA) was performed on the total cellular DNA from each of 396 strains of mutans streptococci (1) to determine its potential usefulness for the study of transmission of the organism and (2) to document the proportions and variety of strains harbored by members of a small group of families . The DNA was digested with restriction enzyme EcoRI and/or HindIII, electrophoresed on agarose gels, and the resulting patterns compared . The strains examined included fresh isolates from 58 subjects, including 19 strains from each member of five families . The sensitivity and reproducibility of REA patterns from the mutans streptococci seemed ideal for studies of their epidemiology and transmission . The pattern of each isolate from humans was unique, except for isolates from the same individual or from the same family . REA types from subjects from different families were always heterogeneous . A high frequency of multiple REA types (up to 5) was observed in many subjects . While evidence for intra-familial transmission was obtained, including transmission between spouses, there was also strong evidence of frequent sources of infection outside of the family . Mutations of strains to streptomycin resistance or to lactate dehydrogenase deficiency caused no detectable change in the REA patterns . The lack of plasmids in any of the 57 fresh isolates that were examined for them suggested that they may have contributed little to the heterogeneity of the patterns seen.

Proc Natl Acad Sci U S A, 1989 Jul, 86(14), 5340 - 4
Characterization of the termini and transposition products of Tn4399, a conjugal mobilizing transposon of Bacteroides fragilis; Hecht DW et al.; We have isolated a 9.6-kilobase conjugal transposon, Tn4399 from Bacteroides fragilis, that is capable of mobilizing nonconjugal plasmids in cis . Here we characterize the ends of the transposon, its target-site requirements, and the products of transposition into the B . fragilis chromosome and two sets of B . fragilis-Escherichia coli shuttle vectors . With the exception of an additional cytosine residue in the left end, there are perfect 13-base-pair (bp) inverted repeats at the ends of Tn4399 . Insertion of Tn4399 resulted in a 3-bp target-site repeat in 8 out of 12 independent transpositions and showed a high insertion-site specificity . A remarkable feature of Tn4399 insertions is the presence of an additional 5 bp located between the right inverted repeat and the target-site repeat . Four sequence variations of the 5 bp were found, with absolute conservation at positions 1, 2, and 5 . Only two of the variations were present in junction fragments of all three copies of Tn4399 contained in the chromosome of the original donor strain, B . fragilis TM4.2321 . Tn4399 appears to represent a new type of conjugal transposon . In contrast to Tn916 and Tn1545, described in streptococci, Tn4399 creates a target-site repeat and contains an additional 5 bp at the right end only, between the transposon and the target sequence . In addition, Tn4399 can mobilize plasmids in cis.

J Bacteriol, 1989 Jul, 171(7), 3603 - 8
Tn4399, a conjugal mobilizing transposon of Bacteroides fragilis; Hecht DW et al.; Conjugal transposons play an important role in the dissemination of antibiotic resistance determinants in the streptococci and have been postulated to exist in Bacteroides fragilis . To investigate the presence of conjugal transposons in B . fragilis, we employed a Tra- derivative of the transfer factor pBFTM10 contained in the chimeric plasmid pGAT400 delta BglII . We attempted to restore transferability to this plasmid from a series of transconjugants generated by crossing B . fragilis TMP230 containing the TET transfer factor with B . fragilis TM4000, a standard recipient . Transconjugant TM4.2321 transferred pGAT400 delta BglII to Escherichia coli HB101 at almost the same frequency as did the Tra+ parental plasmid, pGAT400 . Analysis of the transferred plasmids revealed the presence of 9.6 kilobases of additional DNA in every case but at different positions in independent isolates . The presence of this DNA, designated Tn4399, allowed the pGAT400 delta BglII derivatives to retransfer from the TM4000 background to B . fragilis or E . coli recipients . DNA hybridization studies demonstrated the presence of one copy of Tn4399 in TMP230 and three copies at new sites in TM4.2321 . Tn4399 is a new B . fragilis transposon with unique transfer properties that may play a role in the dissemination of drug resistance genes . It differs from previously described conjugal transposons by its ability to mobilize nonconjugal plasmids in cis.

Infect Immun, 1989 Jul, 57(7), 1906 - 15
Molecular and immunochemical characterization of recombinant Escherichia coli containing the spaA gene region of Streptococcus sobrinus; Ogundipe JO et al.; We identified and characterized a recombinant Escherichia coli containing the entire gene for surface protein antigen A (spaA) of Streptococcus sobrinus 6715 . The recombinant E . coli was isolated from a cosmid gene bank of size-fractionated S . sobrinus DNA fragments, and recombinants expressing the SpaA protein were detected immunologically . Subcloning experiments showed that the DNA sequences encoding the SpaA protein could be isolated on two contiguous EcoRI fragments, 3.7 and 3.3 kilobases (kb) in size, both contained on a 16.2-kb BglII fragment . Southern blot hybridization experiments using the EcoRI fragments to probe genomic DNAs from various serotypes of the mutans group of streptococci revealed DNA sequence homology not only to S . sobrinus 6715 (serotype g) chromosomal DNA but also to S . sobrinus serotype d DNA . Weak hybridization signals to Streptococcus mutans serotypes c, e, and f and to Streptococcus cricetus serotype a were observed with the 3.3-kb EcoRI fragment . These results suggest that the coding sequence for the spaA gene is probably conserved in S . sobrinus strains . Plasmid-encoded polypeptides made in E . coli minicells revealed that transcription of the spaA gene was initiated on the 3.7-kb EcoRI fragment and that its product size was about 210 kilodaltons . The cloned SpaA protein was purified from the periplasmic protein of E . coli, and monospecific antiserum against the cloned product was prepared in rabbits . The data obtained from various physiochemical and immunological procedures allowed us to conclude that the coding sequence for the entire spaA gene of S . sobrinus 6715 had been successfully cloned in E . coli and that faithful expression of the cloned product could be obtained.

Arch Inst Pasteur Tunis, 1989 Jul-Oct, 66(3-4), 243 - 50
{Fast identification of Streptococcus pyogenes serotype M.12 in throat swabs by an improvised coagglutination technique}; Boujaafar N et al.; A rapid procedure for identification of Streptococcus pyogenes serotype M . 12 directly in throat swabs, is reported and compared with standard culture method on blood agar plates and typing of group A Streptococci isolated, with double gel immuno-diffusion . This procedure consist of chlorhydric acid extraction of swabs and testing of the extract towards specific M . 12 protein serum using extemporaneous coagglutination technique . We have tested 1100 throat swabs, with this procedure and with standard culture procedure . Identification of group A Streptococci serotype M . 12 with reported method is obtainable within 30 to 45 minutes of receipt of the clinical specimen . This method is easy to perform, with a sensitivity and a specificity respectively: 89.7% and 98.8%.

Eur J Clin Microbiol Infect Dis, 1989 Jul, 8(7), 629 - 31
Association of penicillin-tolerant streptococci with epidemics of streptococcal pharyngitis in closed communities; Dagan R et al.; The association of penicillin-tolerant streptococci with reported epidemics of streptococcal pharyngitis in Israel was studied . The streptococcal strains had been isolated during 11 epidemics of community-acquired pharyngitis and 6 food-borne epidemics of pharyngitis occurring in the last 15 years . Strains were stocked lyophilized . Isolates were defined as tolerant if the MBC/MIC ratio for penicillin was greater than or equal to 32 . All 122 group A streptococcal strains isolated during the epidemics of community-acquired infection showed tolerance to penicillin . In contrast, none of the 52 strains from food-borne epidemics (24 group A, 18 group C and 8 group G) was tolerant.

Arch Otolaryngol Head Neck Surg, 1989 Jul, 115(7), 856 - 9
Penicillin and clindamycin therapy in recurrent tonsillitis . Effect of microbial flora; Foote PA Jr et al.; Fifty patients, scheduled for an elective tonsillectomy because of recurrent group A beta-hemolytic streptococcal tonsillitis, participated in a prospective randomized study that compared the efficacy of presurgical treatment with either phenoxymethyl penicillin or clindamycin hydrochloride in eradicating group A beta-hemolytic streptococci and beta-lactamase-producing bacteria (BLPB) from the tonsillar core . They were randomized into three groups as follows: 11 received penicillin, 22 received clindamycin, and 17 received no therapy . Group A beta-hemolytic streptococci were isolated from 8 (40%) of 17 untreated patients, 4 (36%) of 11 patients treated with penicillin, and none of 22 patients treated with clindamycin . Twenty-one BLPB were isolated from 16 (94%) of 17 untreated patients, 11 BLPB from 9 (82%) of 11 patients treated with penicillin, and 7 BLPB from 7 (32%) of 22 patients treated with clindamycin compared with penicillin or no therapy . Of the 22 patients treated with clindamycin, 10 were younger than 12 years of age . The BLPB were eradicated in nine patients (90%) . However, BLPB were eradicated only in 6 (50%) of the 12 patients who were aged 13 years and older . These data illustrate the efficacy of clindamycin therapy in eradicating group A beta-hemolytic streptococci, as well as BLPB, in recurrent inflamed tonsils, especially in persons aged 12 years old and younger.

Biochim Biophys Acta, 1989 Jun 27, 991(3), 395 - 8
Molecular surface characterization of oral streptococci by Fourier transform infrared spectroscopy; van der Mei HC et al.; In order to characterize the molecular composition of oral streptococci, infrared transmission spectroscopy on freeze-dried cells dissolved in KBr was used . All infrared spectra show similar absorption bands for the strains studied with the most important absorption bands located at 2930 cm-1 (CH), 1653 cm-1 (AmI), 1541 cm-1 (AmII) and two bands at 1236 cm-1 and 1082 cm-1, which were assigned to phosphate and sugar groups . However, calculation of absorption band ratios normalized with respect to the integrated intensity of the CH stretching region around 2930 cm-1, show significant differences between the strains . Both Streptococcus mitis strains possess high AmI/CH and AmII/CH absorption band ratios compared to the other strains . Streptococcus salivarius HBC12, a mutant strain devoid of all proteinaceous surface appendages, shows significantly lower AmI/CH and AmII/CH band ratios with respect to its parent strain S . salivarius HB . Two positive relationships could be established both between the AmII/CH absorption band ratio and the N/C elemental surface concentration ratio of the strains previously, determined from X-ray photoelectron spectroscopy (XPS) and also between AmI/CH and the fraction of carbon atoms at the surface involved in amide bonds, determined by XPS as well . From this comparison, it is concluded that transmission infrared spectroscopy can be employed as a technique to study the molecular surface composition of freeze-dried microorganisms.

Science, 1989 Jun 23, 244(4911), 1487 - 90
Protection against streptococcal pharyngeal colonization with a vaccinia: M protein recombinant; Fischetti VA et al.; Phagocytosis of group A streptococci requires type-specific antibodies directed against the variable determinants of the bacterial surface M protein molecule . As a step toward developing a broadly protective anti-streptococcal vaccine, a vaccinia virus (VV) recombinant was constructed that expresses the conserved region of the structural gene encoding the M6 molecule (VV:M6') . Mice immunized intranasally with the VV:M6' virus showed markedly reduced pharyngeal colonization by streptococci after intranasal and oral challenge with these bacteria . M protein-specific serum immunoglobulin G was significantly elevated in vaccinated animals and absent in controls . A similar approach may prove useful for the identification of protective determinants present on other bacterial and viral pathogens.

Tidsskr Nor Laegeforen, 1989 Jun 10, 109(16), 1773 - 4
{Toxic shock syndrome without any relation to the use of tampons or staphylococcal infection}; Jacobsen MB et al.; Toxic shock syndrome is a generalized disease traditionally thought to be caused by toxinproducing strains of Staphylococcus aurus . The syndrome is characterized by fever, hypotension, erythema of the skin, erythematous desquamation and multiple organ involvement . We present a case where the causative agent was most probably streptococci, thus demonstrating that the syndrome probably has a heterogeneous, toxin-related etiology.

Eur J Epidemiol, 1989 Jun, 5(2), 189 - 92
Prevalence of Streptococcus mutans and dental decay in school children from Siena (Italy); Gasparini R et al.; Epidemiological indexes of dental decay and prevalence of Streptococcus mutans in dental plaque were studied in a group of 255 schoolchildren aged 6-11 from a suburban area near Siena (Italy) . Mutans streptococci were isolated from 17.4% of subjects: a significant correlation with dental decay indexes and with the presence of active caries was observed.

Antimicrob Agents Chemother, 1989 Jun, 33(6), 970 - 2
Comparison of the in vitro activities of fenticonazole, other imidazoles, metronidazole, and tetracycline against organisms associated with bacterial vaginosis and skin infections; Jones BM et al.; The in vitro antibacterial activity of the antifungal compound fenticonazole was compared with those of clotrimazole, miconazole, tetracycline, and metronidazole against 177 strains of bacterial species associated with either bacterial vaginosis (BV) or skin infections by agar dilution MIC determinations . BV-associated Bacteroides isolates of the Bacteroides melaninogenicus-B . oralis group, Gardnerella vaginalis, Mobiluncus spp., and anaerobic, gram-positive cocci were highly susceptible to fenticonazole, clotrimazole, and miconazole; but Bacteroides spp . not associated with BV, Bacteroides ureolyticus and the Bacteroides fragilis group, were resistant . All Bacteroides strains were susceptible to metronidazole, but the susceptibility of G . vaginalis and Mobiluncus spp . varied . Among the skin bacteria, Staphylococcus aureus, coryneforms, and streptococci were highly susceptible to the imidazoles; but Staphylococcus epidermidis strains were generally resistant . This antibacterial activity may give fenticonazole a useful role in the topical treatment of vaginal discharge and in mycotic skin infections that are superinfected with bacteria.

Oral Microbiol Immunol, 1989 Jun, 4(2), 77 - 81
Possible effect of medically administered antibiotics on the mutans streptococci: implications for reduction in decay; Loesche WJ et al.; The decline in dental caries in children in North America, Scandinavia, Britain, Ireland and many Commonwealth nations is well documented . The multiple uses of fluoride can account for most, but not all, of this reduction . In this investigation, data are provided which suggest a relationship between antibiotic usage for medical purposes and a decline in both mutans streptococci (MS) and caries . Children attending Grades 1 and 2 in the Coldwater, Michigan school system and who reportedly never received antibiotics had significantly higher proportions of MS in the fissure plaques of first molars than subjects who received antibiotics . The level of decay in the primary dentition was inversely related to the reported usage of antibiotics . The frequent usage of antibiotics could reduce the incidence of dental caries by delaying the colonization of the teeth by the MS . This was evaluated by a prospective study in infants to determine what effect reported antibiotic usage would have on the colonization of newly erupting primary teeth . Only 2 of 10 infants cultured at 2 to 3 week intervals for periods up to 1 year after tooth eruption became colonized by the MS . One had never received antibiotics and the second had been on antibiotics for a single 5-day period . Seven of the 8 non-colonized infants had received antibiotic therapy for periods ranging from 10 to 181 days . Both the Coldwater study and the prospective study of infants suggested a relation between frequency of antibiotic usage for medical purposes and the MS levels on the teeth.

Oral Microbiol Immunol, 1989 Jun, 4(2), 71 - 6
Relationship between mutans streptococci in saliva and their colonization of the tooth surfaces; Lindquist B et al.; The relationship between the salivary concentration of mutans streptococci and their prevalence on different tooth surfaces was studied in 114 subjects . Plaque samples were obtained from all tooth surfaces in the dentition and the infection magnitude of mutans streptococci was determined . The salivary concentrations of mutans streptococci correlated significantly with the number of colonized tooth surfaces and with the infection level of mutans streptococci for individual teeth or groups of tooth surfaces . The highest correlation values were found for buccal and approximal surfaces and for molars followed by premolars and anterior teeth . The 10 tooth surfaces best reflecting the salivary levels of mutans streptococci were 5 buccal and 5 approximal sites, 6 of them localized on maxillary posterior teeth . A significant positive relationship was noted between the prevalence of mutans streptococci in saliva and on the dorsum of the tongue.

J Dairy Sci, 1989 Jun, 72(6), 1547 - 56
Field survey of clinical mastitis in low somatic cell count herds; Hogan JS et al.; Nine commercial dairy herds, each with low herd milk somatic cell counts, were monitored for 1 yr to determine prevalence of intramammary infections and rates of clinical mastitis . Staphylococcus species was the bacterial group most frequently isolated from quarters at calving and at drying off . Environmental streptococci and coliform intramammary infections totaled less than 6% of quarters at both calving and at drying off . Staphylococcus aureus were isolated from less than 1% of quarters and Streptococcus agalactiae from 0% of quarters at both calving and drying off . A total of 646 clinical cases of mastitis were diagnosed in 548 quarters of 406 cows . Mean rate of clinical mastitis among herds was .457 clinical cases/305 cow-days . Rates of clinical mastitis ranged among herds from .273 to .748 clinical cases/305 cow-days . Coliforms and bacteriologically negative and environmental streptococci accounted for 82.3% of clinical cases . Rates of clinical mastitis and severity of clinical signs differed among herds, seasons of the year, parity groups, and stages of lactation . Rates of clinical mastitis were highest during summer, in first lactation cows, and during the first 7 d of lactation.

Zentralbl Hyg Umweltmed, 1989 Jun, 188(3-4), 343 - 64
{Medical waste . 1 . Microbiologic studies of wastes of various specialties at a large and small hospital in comparison to housekeeping waste}; Jager E et al.; Hospital wastes, similar to household refuse, from normal and high risk areas of a big and a smaller hospital were tested quantitatively and qualitatively for nosocomial infective agents . The results were compared with those of household refuse . 20-25 samples from care and operating wards were examined each for 3 months . The whole content of a waste bag was suspended without a preceding sorting . After this treatment the eluat was microbiologically examined . The results of the test proved that the germ concentration of the hospital waste was less or similar than that of household refuse . The median for gram negative rods in household refuse was e.g . 4 log10-steps higher than in wastes from operating wards . The statistical analysis confirmed these highly significant differences between the wastes from the high risk operating areas of the big and smaller hospital and the household refuse for all investigated bacteria groups . There are nearly no differences between the wastes from normal wards and from household refuse regarding germ concentration for different groups, e.g . gram negative rods or D-streptococci, and no higher germ concentration in any case . In conclusion hospital wastes must be disposed with special hygienic measures inside the hospital, outside the hospital they can be disposed together with household refuse.

J Perinatol, 1989 Jun, 9(2), 131 - 6
Polymicrobial sepsis among intensive care nursery infants; Faix RG et al.; To determine the incidence, characteristics, and course of polymicrobial sepsis among infants in intensive care nurseries, we reviewed all such episodes in our neonatal unit from September 1971 through June 1986 . We identified 15 episodes (3.9% of all cases of culture-proven sepsis during the survey period) in which blood or cerebrospinal fluid (CSF) culture yielded multiple organisms felt to represent true pathogens . Mortality associated with late-onset polymicrobial sepsis (7 of 10; 70%) was significantly higher (P less than .001) than in late-onset monomicrobial sepsis (86 of 370; 23%) . Six patients were 37 weeks' gestation or greater at birth, and five were younger than 4 days of age when the polymicrobial culture was obtained . Group D streptococci were recovered in eight cases (53%) . Gastrointestinal foci appeared to be common among infants with late-onset polymicrobial infection (5 of 10), while prolonged rupture of membranes was frequently associated with early-onset infection (4 of 5) . Though recovery of multiple organisms from blood or CSF may not always be significant, one should not immediately assume contamination . A report of more than one organism growing from a normally sterile body fluid in an intensive care nursery infant should be considered significant, and therapy should be adjusted to provide appropriate antimicrobial agents for all reported organisms if the infant has not substantially improved in the interval since the culture was actually obtained.

Epidemiol Infect, 1989 Jun, 102(3), 379 - 90
Group C streptococci in human infection: a study of 308 isolates with clinical correlations; Barnham M et al.; A collection of 308 clinical isolates of beta-haemolytic Lancefield group C streptococci was assembled from laboratories in England, Nigeria and New Zealand . Of these, 276 isolates were Streptococcus equisimilis, 23 S . milleri and nine S . zooepidemicus . Isolates of S . equisimilis in the African collection, though few, gave higher rates of lactose and raffinose fermentation, aesculin hydrolysis and positive alpha-galactosidase reactions than those from elsewhere . Erythromycin resistance was found in 1.9% of the English isolates of S . equisimilis . Strains from superficial infections accounted for 88% of the collection and were most commonly isolated from the upper respiratory tract, skin or wounds . Amongst the 36 patients yielding isolates from deep sites S . equisimilis was found in septicaemia, cellulitis, abscess, peritonitis, septic arthritis, pneumonia, mycotic aneurysm and acute epiglottitis, S . milleri was found in abdominal abscesses, peritonitis, pleural empyema and osteomyelitis and S . zooepidemicus was found in septicaemia, pneumonia, meningitis and septic arthritis . Within the collection an unselected general catchment of 214 isolates of group C streptococci from the laboratories in Yorkshire showed the following species: from 199 superficial infections 94% S . equisimilis, 5% S . milleri and 1% S . zooepidemicus and 15 patients with deeper, more aggressive infections 67, 27 and 6.7% of these species respectively.

J Bacteriol, 1989 Jun, 171(6), 2981 - 5
Transport of glutamine by Streptococcus bovis and conversion of glutamine to pyroglutamic acid and ammonia; Chen GJ et al.; Streptococcus bovis JB1 cells energized with glucose transported glutamine at a rate of 7 nmol/mg of protein per min at a pH of 5.0 to 7.5; sodium had little effect on the transport rate . Because valinomycin-treated cells loaded with K and diluted into Na (pH 6.5) to create an artificial delta psi took up little glutamine, it appeared that transport was driven by phosphate-bond energy rather than proton motive force . The kinetics of glutamine transport by glucose-energized cells were biphasic, and it appeared that facilitated diffusion was also involved, particularly at high glutamine concentrations . Glucose-depleted cultures took up glutamine and produced ammonia, but the rate of transport per unit of glutamine (V/S) by nonenergized cells was at least 1,000-fold less than the V/S by glucose-energized cells . Glutamine was converted to pyroglutamate and ammonia by a pathway that did not involve a glutaminase reaction or glutamate production . No ammonia production from pyroglutamate was detected . S . bovis was unable to take up glutamate, but intracellular glutamate concentrations were as high as 7 mM . Glutamate was produced from ammonia via a glutamate dehydrogenase reaction . Cells contained high concentrations of 2-oxoglutarate and NADPH that inhibited glutamate deamination and favored glutamate formation . Since the carbon skeleton of glutamine was lost as pyroglutamate, glutamate formation occurred at the expense of glucose . Arginine deamination is often used as a taxonomic tool in classifying streptococci, and it had generally been assumed that other amino acids could not be fermented . To our knowledge, this is the first report of glutamine conversion to pyroglutamate and ammonia in streptococci.

Zh Mikrobiol Epidemiol Immunobiol, 1989 Jun, (6), 34 - 8
{Phase changes in the population of group A streptococci and their influence on the course of the epidemic process of tonsillitis}; Khodyrev AP et al.; This work presents the data on the complex evaluation of the population of group A streptococci, studied at each of four phases (reservation, epidemic transformation, epidemic spread, reservational transformation) of the course of the epidemic process of streptococcal infection of the respiratory tracts (tonsillitis) in an organized group of adults . The characterization of the phases of the infective agent in accordance with the level of the carrier state, the size of streptococcal foci and the virulence of streptococci is given . Thus, the study shows that the heterogeneity of group A streptococci with respect to their virulence reaches its maximum level at the phases of reservation and epidemic spread and its minimum level at the phases of epidemic and reservational transformation . The size of streptococcal foci in carriers and the virulence of streptococci isolated from them are the inter-related unidirectional signs of the population of the infective agent and, at the same time, the main factors responsible for the phase character of the epidemic process and the morbidity level in tonsillitis.

Vaccine, 1989 Jun, 7(3), 217 - 24
Structural similarity of the type-specific group B streptococcal polysaccharides and the carbohydrate units of tissue glycoproteins: evaluation of possible cross-reactivity; Hayrinen J et al.; Type-specific capsular polysaccharides of group B streptococci show striking structural similarity with the terminal sugar sequences of tissue glycoconjugates . The polysaccharides have been put forward as vaccines against neonatal meningitis . A potential source of hazard in immunization of pregnant mothers may be the presence of the cross-reactive components in adult or fetal tissues . A radioactive ligand binding assay was used to test human immune sera to type Ia, II and III group B streptococcal polysaccharides for binding to tissue-derived glycopeptides showing structural similarities with the streptococcal polysaccharides . Of the 13 glycopeptides of human and rat tissues studied, representing a wide selection of structures known to occur in glycoproteins, only two showed some reactivity with the antisera . The reactivity with human small intestinal glycopeptides could be explained by the presence of natural blood group A antibodies, and was not related to the streptococcal group B antibodies . The basis of the reactivity of a high-molecular-weight glycopeptide from rat kidney with some of the sera was unknown, but was unrelated to the vaccination and clearly could not be inhibited with the streptococcal polysaccharides . Thus, no immunological cross-reactions of the tissue glycopeptides studied could be demonstrated with the group B streptococcal antisera.

J Clin Microbiol, 1989 Jun, 27(6), 1352 - 6
Restriction endonuclease analysis of human and bovine group B streptococci for epidemiologic study; Denning DW et al.; Group B streptococci, a frequent cause of neonatal sepsis and meningitis, postpartum endometritis, and bovine mastitis, may be acquired by several modes of transmission . Detailed epidemiologic study is hampered by the lack of a sufficiently discriminatory typing system, especially for type III and nontypable strains . We examined 54 epidemiologically well-characterized strains by restriction endonuclease analysis (REA) and compared the results with those obtained by serotyping . REA patterns were inspected without knowledge of the epidemiological or serotyping data . Among 21 type Ia, Ia/c, and Ib/c isolates, we found 10 REA patterns; among 5 type II and IIc isolates, we found 5 REA patterns; among 13 type III isolates, we found 6 REA patterns; and among 15 nontypable human and animal isolates, we found 7 different REA patterns . Double digestion of type III isolates with EcoRI and BglII helped us to distinguish the isolates . In total, 28 REA patterns were found in six serotype groups and one nontypable group . Some geographically and epidemiologically separate isolates had identical REA patterns, suggesting dissemination of a limited number of clones . We conclude that REA is a promising tool for detailed epidemiological study of group B streptococci.

Eur J Obstet Gynecol Reprod Biol, 1989 Jun, 31(3), 221 - 6
Chlorhexidine for prevention of neonatal colonization with group B streptococci . V . Chlorhexidine concentrations in blood following vaginal washing during delivery; Nilsson G et al.; Chlorhexidine 2 g/l was applied to the vagina of 96 women during delivery, whereas 28 served as controls . Both groups were given a shower using a chlorhexidine soap, and outer washing of the outer anogenital tract was also performed in all patients using chlorhexidine 2 g/l . Using a gas chromatographic method with a detection limit of 10 ng chlorhexidine per ml blood, 10-83 ng/ml was demonstrated in 34 (35%) of the study group patients, whereas the remaining study group patients and controls showed no detectable chlorhexidine . Performing the washing a second time after 6 hours in 14 patients and a third time in 3 patients after a further 6 hours did not result in increased serum levels . It was concluded that small amounts of chlorhexidine are absorbed through the vaginal mucosa and that chlorhexidine is not accumulated in the blood on repeated usage with 6 hour intervals during delivery.

Infect Dis Clin North Am, 1989 Jun, 3(2), 221 - 45
Infections of prosthetic heart valves and cardiac pacemakers; Heimberger TS et al.; Prosthetic valve endocarditis may be considered present when two fo the following criteria are met: (1) two or more blood cultures are positive with the same organism in the absence of extracardiac infections, (2) evidence of bacterial endocarditis by histology or cultures is obtained from surgical or autopsy specimens, and/or (3) a clinical picture compatible with endocarditis (fever, new or changing regurgitant murmur, splenomegaly, hematuria, or evidence of peripheral emboli) is present . The overall incidence of PVE ranges from 0.98 to 4.4 per cent . Early and late PVE (that is endocarditis developing less than 60 and 60 or more days following valve implantation, respectively) accounts for 18 to 36 per cent and 64 to 82 per cent of infections, respectively . The overall mortality is 53 per cent and is higher in patients with early versus late PVE . Coagulase-negative staphylococci are responsible for a higher percentage of early (43 per cent) than late (28 per cent) infections . Streptococci are more common in late (27 per cent) than in early (3 per cent) PVE, while diphtheroids are most common in early PVE . The diagnosis of PVE may be difficult to establish, especially in patients with postoperative bacteremias who have other potential sources of extracardiac infections . Antimicrobial therapy is generally based on the susceptibility of the offending pathogen . With respect to the use of synergistic combinations, results are controversial, and most available data are derived from patients with native-valve endocarditis . Surgery remains an important aspect of treatment, and the mortality among patients who undergo early surgical intervention, particularly if their illness is complicated, is less than in those who are treated only with antibiotics . Indications for surgery include: (1) moderate-severe refractory congestive heart failure, (2) persistent bacteremia or fungemia, (3) multiple emboli, (4) myocardial abscesses, (5) relapsing PVE, and possibly (6) patients with clinical evidence of PVE and negative blood cultures and persistent fever despite 1 week or more of appropriate antibiotics . Pacemaker infections occur in less than 6 per cent of patients who undergo pacemaker insertion . These infections generally result from wound contamination at the time of surgery, and 75 per cent of infections are due to staphylococci . Staphylococcus aureus causes most infections occurring within 2 weeks after surgery, while S . epidermidis causes most later infections . The need to remove infected pacemakers is controversial.

Eur J Pediatr, 1989 Jun, 148(7), 679 - 81
Concentrations of ceftazidime, tobramycin and ampicillin in the cerebrospinal fluid of newborn infants; Tessin I et al.; Thirty-five neonates with suspected septicaemia were randomized to treatment with tobramycin or ceftazidime, both in combination with ampicillin . Concentrations of antibiotics in the CSF were measured 1 h after the third, fourth or fifth injection . In 13 of 17 neonates tobramycin CSF concentrations were below 0.5 mg/l . Ceftazidime CSF concentrations ranged from 2.5 to 17 mg/l, which should be sufficient for treatment of infections with group B streptococci and most aerobic gram-negative bacilli but not all strains of Staphylococcus aureus . Ampicillin CSF concentrations ranged from 1 to 80 mg/l, which should be sufficient for treatment of meningitis caused by enterococci and Listeria monocytogenes, the most important neonatal pathogens not covered by ceftazidime.

Epidemiol Infect, 1989 Jun, 102(3), 391 - 400
Beta-haemolytic streptococci from the female genital tract: clinical correlates and outcome of treatment; Lewis RF; Clinical features, treatment and outcome were assessed retrospectively by means of a questionnaire in 174 patients in general practice whose vaginal swabs yielded beta-haemolytic streptococci . These were compared with 96 patients whose swabs yielded no recognized microbial pathogens . Patients with group B streptococci did not differ in any of these parameters from the control group, but those with group A streptococci were more likely to have vaginal soreness, a purulent discharge, and to respond to anti-streptococcal antibiotics . Implications for laboratory reporting are discussed.

Proc Natl Acad Sci U S A, 1989 Jun, 86(12), 4741 - 5
Fc-receptor and M-protein genes of group A streptococci are products of gene duplication; Heath DG et al.; The partial nucleotide sequence for an Fc-receptor gene from an M-type 76 group A streptococcus was determined . DNA sequence analysis revealed considerable sequence similarity between the Fc-receptor and M-protein genes in their proposed promoter regions, signal sequences, and 3' termini . Additional analysis indicated that the deduced Fc-receptor protein contains a proline-rich region and membrane anchor region highly similar to that of M protein . In view of these results, we postulated that Fc-receptor and M-protein genes of group A streptococci are the products of gene duplication from a common ancestral gene . It is proposed that DNA sequence similarity between these two genes may allow for extragenic homologous recombination as a means of generating antigenic diversity in these two surface proteins.

Arch Dermatol, 1989 Jun, 125(6), 779 - 82
Streptococcal cause of erysipelas and cellulitis in adults . A microbiologic study using a direct immunofluorescence technique; Bernard P et al.; We prospectively studied 42 adult patients with acute dermis and soft-tissue infections (27 with erysipelas and 15 with acute cellulitis) involving the lower limb in all except one case . Streptococcus organisms (groups A, C, D, and G) were researched in skin biopsy specimens by a direct immunofluorescent (DIF) technique using commercially available antibodies . Our results showed that DIF gives a sensitivity of 0.70 for the in situ detection of streptococci in cases of erysipelas and cellulitis . With the obvious contribution of this DIF technique, streptococcal pathogens could be detected in situ and grouped in 19 of 27 cases of erysipelas (group A, 13; group B, 1; group C, 1; and group G, 4) and in ten of 15 cases of cellulitis (group A, 9; group B, 1) . Combined data, including conventional cultures, DIF studies, and serologic findings, established that Streptococcus organisms, especially Streptococcus pyogenes (A), were, in nearly all cases, responsible for both erysipelas (26/27 cases) and acute cellulitis (11/15 cases) involving the lower limb in adults.

Gifu Shika Gakkai Zasshi, 1989 Jun, 16(1), 16 - 39
{Characterization of fatty acid composition in the cytoplasmic membrane of Streptococcus mutans}; Kato M; The present study was performed to investigate the role of the fatty acid composition of cytoplasmic membranes in bacterial differentiation and the appearance of cariogenic properties of Streptococcus mutans . Bacterial fatty acid composition was effective for differentiation of Streptococcus mutans from the other oral streptococci . The composition obtained from the reference strains and the clinical isolates involved five groups and was useful as a rapid screening index for Streptococcus mutans . Compositional changes in membrane lipids played important roles in synthesis and secretion of extracellular glucosyltransferase for Streptococcus mutans . A characteristic property of Streptococcus mutans, resistance to 40% sucrose in the medium, is ascribable to compositional changes in membrane lipids, especially the glycolipids, of Streptococcus mutans.

G Ital Dermatol Venereol, 1989 Jun, 124(6), 303 - 5
{Persistent lymphedema of the penis and scrotum after recurrent episodes of cellulitis and urethritis caused by Chlamydia trachomatis}; Carlino A et al.; A 20 year old man affected by a persistent peno-scrotal lymphedema is reported . This condition followed recurrent attacks of cellulitis and a chronic urethritis . From the urethral discharge we isolated Chlamydia trachomatis and, only during the attacks of cellulitis, Group G Streptococcus . This pathogen cannot be isolated from microflora of the normal urethra and rarely cause cellulitis . In our opinion Chlamydial infection favoured the urethral colonization of Group G Streptococci and their passage in the loose connective tissue of the penis and scrotum . Lymphedema, clinically inapparent before the first attack, become progressively more severe and recurrent attacks took place at intervals without obvious re-exposure to an exogenous source of streptococci . The operative treatment of persistent lymphedema is lymphangiectomy and lymphangioplasty.

Tokushima J Exp Med, 1989 Jun, 36(1-2), 11 - 6
Biliary stones and bacteriae in bile study in 211 consecutive cases; Matin MA et al.; A retrospective study have been performed to investigate the correlation between stone formation and bacteriae in the bile of 211 consecutive biliary stone patients (133 females and 78 males, age ranged 1.3 to 87.0 years old, 196 cholecystolithiasis, 54 choledocholithiasis and 9 hepatolithiasis) . They had undergone surgery since January 1980 to December 1987 . Bile was collected to perform bacterial culture from the gallbladder and common bile duct during operation and all stones had been classified according to morphology after surgery and confirmed with component analysis if necessary . Totally 5115 stones had been collected and 20.4% had been classified as pure cholesterol stone, 16.8% as combination stone, 17.2% as mixed stone, 23.6% as calcium bilirubinate stone, 17.6% as black stone, 0.8% as calcium fatty acid stone and 3.6% as unknown . In bile culture, 84 from the gallbladder and 31 from the common bile duct were positive . Streptococci were the most frequent and followed by Klebsiella, Escherichia coli and so on . A higher incidence of positive culture was shown in calcium bilirubinate and lower incidence was shown in cholesterol stones . These results suggest that bacteriae in the bile may play a role in the formation of pigment biliary stones.

Nippon Sanka Fujinka Gakkai Zasshi, 1989 Jun, 41(6), 676 - 82
{Antibodies to group B streptococci in maternal and cord sera}; Kubota T et al.; Group B Streptococcus (GBS) antibody concentrations were studied in 214 pregnant women, of which 91 were carriers and 123 were noncarriers . The method using EIA was designed to measure antibodies to Type Ia, Ib, Ic, II, III and Group B . By means of AGG (Agglutination), antibodies to Type Ib, II, and Group B could also be measured . 1) The Group B antibody concentration in pregnant carriers of GBS (mean: 13.9 microliters with EIA, 4.77 microliters with AGG) was significantly greater than that in noncarriers (mean: 10.6 microliters with EIA, 3.64 microliters with AGG) . 2) In most of the cases studied, the cord serum concentration was similar to the maternal concentration when EIA was used . On the other hand the antibody concentrations in cord serum were lower than those in the maternal serum when AGG was used . 3) In a premature baby (1,768g) and in a baby with Downs' syndrome the cord serum concentration was lower than the maternal concentration, while in a large baby (4,074g) the cord serum concentration was higher than the maternal concentration . 4) Using EIA, the type-specific antibody which coincided with the type of strain isolated from each vaginal carrier showed a higher concentration than any other type-specific antibody.

Zh Mikrobiol Epidemiol Immunobiol, 1989 Jun, (6), 86 - 90
{Autoantibodies to different layers of epidermis during immunization of BALB/c mice with a culture of Group A Streptococcus treated with pepsin}; Bazanova EA et al.; As revealed in the indirect immunofluorescence test, antibodies to the cross-reacting group A streptococcal polysaccharide determinant (A-PS), common to the antigen of the basal cell layer of the epidermis, regularly occur at the end of the first cycle and disappear after further immunization of BALB/c mice with the pepsin-treated culture of group A streptococci . This model may be used for the study of antibodies to A-PS, cross-reacting with the cells of the basal layer of the epidermis, in the development of the autoimmune process linked++ with group A streptococcal infection.

Pathol Biol (Paris), 1989 Jun, 37(5 Pt 2), 568 - 72
{Selection of constitutive mutants of gram-positive cocci inducible resistant to macrolides, lincosamides and streptogramins (MLS): comparison of the selective effects of the MLS}; Leclercq R et al.; Mutation frequencies to constitutive resistance were determined for 7 strains inducible resistant to the MLS antibiotics (5 Staphylococcus aureus, 1 group G Streptococcus and 1 Streptococcus sanguis) . In the 5 staphylococcal strains, mutants were generally selected at a frequency of 10(-9) to 10(-10) (ranging from 4.10(-8) to 9.10(-11) on plates containing 50 mg/l of the following non-inducer MLS: spiramycin, josamycin, midecamycin, miocamycin, lincomycin, clindamycin, and pristinamycin factor I (PI) . No mutant was selected by 50 mg/l of pristinamycin factor II (PII) or by pristinamycin complex (P) . Absence of selection of constitutive mutant by P was due to the low MICs of the antibiotic against the constitutively resistant strains and to the effect of PII: the emergence of the mutants constitutively resistant to PI was prevented by a 6-hour contact of the culture with PII (50 mg/l) . MICs and MBCs of the pristinamycin against 9 constitutive mutants were respectively 2 to 4-fold and 2 to 8-fold greater than that against the wild-strains . In the streptococci, no constituvely resistant mutant was selected . Therefore, the risk of selection of resistant mutants by a non inducer MLS in the course of the treatment of infections due to inducible resistant staphylococcus appeared to be low, especially in the case of pristinamycin.

Pediatr Dermatol, 1989 Jun, 6(2), 134 - 8
Impetigo contagiosa III . Comparative efficacy of oral erythromycin and topical mupirocin; Barton LL et al.; Ninety-seven patients with impetigo were prospectively enrolled in a study to determine the comparative efficacy of systemic and topical antibiotic therapy . After obtaining a bacterial culture from a representative lesion, the children were randomized to receive seven days of either oral erythromycin or topical mupirocin administered three times daily . Staphylococcus aureus alone was isolated from 51% and in association with group A beta-hemolytic streptococci (GABS) from 29%; GABS alone was isolated from 4% of patients . Of 48 children who received erythromycin, 43 (90%) were clinically improved or cured, and 11 of 17 were bacteriologically cured . Of 49 children who received mupirocin, 47 (96%) were clinically improved or cured, and 10 of 14 were bacteriologically cured . At three-week follow-up, clinical cure rates and number of secondary household cases of impetigo were equivalent in both treatment groups . Mupirocin appears to be a well-tolerated, albeit expensive, alternative to erythromycin for the treatment of impetigo.

Epidemiol Infect, 1989 Jun, 102(3), 401 - 12
Inhibitory substances produced by Streptococcus salivarius and colonization of the upper respiratory tract with group A streptococci; Huskins WC et al.; It has been proposed that inhibitory substances produced by viridans streptococci colonizing the upper respiratory tract aid in eradication of established group A streptococcal colonization of that site . We studied the prevalence of inhibitory-substance producing strains of Streptococcus salivarius in throat cultures from three groups of children: 16 children with persistently positive throat cultures for group A streptococci despite receiving recommended therapeutic courses of antibiotics (group I), 26 children from whom group A streptococci were eradicated from the upper respiratory tract by antibiotic therapy (group II), and 18 children who never harboured group A streptococci in their upper respiratory tract during the study period (group III) . An in vitro deferred antagonism method was employed to detect inhibitory substances; 5233 strains of S . salivarius were examined . Strains of S . salivarius producing inhibitory substances were isolated from 76-88% of the children in each group on at least one occasion . However, only a small percentage of subjects in each group harboured strains producing these substances in every throat culture . The mean total percentage of S . salivarius strains producing inhibitory substances was 21.8% in children in group I, 22.4% in children in group II, and 16.4% in children in group III; these percentages were not statistically different (P greater than 0.1) . In this study, we could not confirm a significant role for inhibitory substances produced by S . salivarius in the eradication of group A streptococci from the upper respiratory tract of colonized individuals.

Pathol Biol (Paris), 1989 May, 37(5), 459 - 64
{Frequency and severity of systemic infections caused by Streptococcus mitis and sanguis II in neutropenic children}; Leblanc T et al.; We have retrospectively evaluated 24 sepsis episodes caused by viridans streptococci in 23 neutropenic children during a 21 months period at the Pediatric Hematology Unit of St . Louis Hospital . The underlying malignancies included acute lymphoblastic leukemia, acute non lymphoblastic leukemia, aplastic anemia and solid tumor . In 17 children neutropenia, defined as a neutrophil count of less than 500 per cubic millimeter, was caused by cytotoxic chemotherapy . For 6 other children neutropenia was consequential to pretransplant treatment regimen for autologous bone marrow transplantation including cytotoxic chemotherapy and total body irradiation . All patients had a silicone rubber atrial catheter . In 9 patients sepsis was associated only with fever for less than 48 hours . In 5 other children fever was prolonged more than 72 hours in spite of specific antimicrobial therapy . No other organism was isolated . In 10 patients, however, the infectious syndrome was severe and the features included cardiac failure (7 patients), pneumonia (7 patients) resembling adult respiratory distress syndrome, encephalopathy (3 patients) without meningitis and proteinuria, 7 of these patients needed a management in a pediatric intensive care unit and 2 died in spite of adapted antibiotics . Streptococci were isolated in blood cultures in 23 children.

Gaoxiong Yi Xue Ke Xue Za Zhi, 1989 May, 5(5), 249 - 63
{Bacteriological study of chronic paranasal sinusitis}; Juan KH; Analysis was done on the bacteria flora and the antibiotic sensitivity of 533 maxillary sinuses in 430 patients with chronic sinusitis treated at the Kaohsiung Medical College Hospital during the past 10 years . Among antral flora, Streptococcus sp . were the most common (212 strains, 38.4%), followed by Staphylococcus epidermidis (140 strains, 25.4%) and Staphylococcus aureus (33 strains, 5.9%) . These three G(+) bacteria made up 70% (69.87%) of the total . The percentage of gram-negative and anaerobic bacteria was 20.8% and 8.7%, respectively . Of the total bacteria cultures, 17.8% showed no-growth . These results were similar to those reported in a similar study 10 years before . For the Streptococci and Staphylococci (70% of the total number), the most susceptible antibiotics in vitro were cephalosporin, followed in order by clindamycin, erythromycin, chloramphenicol, and cotrimoxazole . The effectiveness of ampicillin, gentamicin, minocycline appears to have been decreasing in the past 10 years . Tetracycline and penicillin effectiveness was worse . The susceptibility spectrum of the G(-) bacteria did not appear greatly changed from 10 years ago, for example, colistin and newly-synthesized aminoglycoside were rather sensitive . In addition a review was conducted of related papers of the past 70 years with a discussion of some controversial problems.

Stomatologiia (Mosk), 1989 May-Jun, 68(3), 23 - 5
{Indices of microorganism sensitivity to antiseptics in apical periodontitis}; Budevskaia TV et al.; High incidence of detection of staphylococci aur . and epiderm.; streptococci hemolyt . and virid., and gram-negative microorganisms in dental root channels in periodontic patients was established . Among antiseptic drugs, most toward major periodontal++ initiators were pervomur, iodopyrone, chlorhexidine, ethonium.

Zentralbl Bakteriol, 1989 May, 271(1), 54 - 60
Streptolytic activities of a lytic enzyme from Staphylococcus hyicus; Frede C et al.; The LE IIIb fraction of the bacteriolytic enzyme from Staphylococcus hyicus could be isolated by ionic exchange chromatography and subsequent gel filtration . Isoelectric focusing of the highly purified enzyme preparation revealed an isoelectric point at pH 10.3 . The lytic activity of LE IIIb on streptococci of various serogroups could be effectively analyzed with the help of an aggregometer and expressed as increase of transmittance at 546 nm . The streptococci differed in their LE IIIb lysis pattern, which was more pronounced with those of serological groups C and D and Streptococcus uberis . The lytic effect of the LE IIIb fraction was optimal at low molarity (0.01 mol/l) of the lysis buffer and reduced in the presence of HgCl2 and EDTA.

Vet Med (Praha), 1989 May, 34(5), 257 - 66
{Isolation and characteristics of nutritional variants of streptococci of animal origin}; Skardova O; Four strains of nutritionally variant streptococci (NVS) were isolated from the milk of mastitic cows and one strain from the lungs of a laboratory Norway rat which died from suppurative pneumonia . In primary cultivation NVS grew aerobically and anaerobically within 48-hour incubation at a temperature of 37 degrees C as minute nonhemolytic satellite colonies around a previously overlaid S . aureus strain or around other gram-positive and gram-negative bacteria . In the first subcultures NVS were growing in nutrient media enriched with 10% bovine serum and 5% staphylococcal filtrate, or 0.02% to 0.002% pyridoxal hydrochloride . All isolates did not grow in presence of 10%, 40% bile, and 6.5% of sodium chloride, neither did they grow at a temperature of 45 degrees C, they did not hydrolyze sodium hippurate, esculin, arginine, they did not produce levane and dextran from saccharose, they produced acid from mannitol, sorbitol, inulin, lactose, raffinose, trehalose, glucose, saccharose and maltose . Two strains produced acid from xylose and four strains from salicin . The strains isolated from mastitis did not have different biochemical properties from those isolated from a laboratory Norway rat with pneumonia . All strains of NVS were sensitive to chloramphenicol, ampicillin, gentamycin, lincomycin and cephalothin, four strains were sensitive to erythromycin and tyrosine, two to penicillin and one to streptomycin, oxytetracycline, chlortetracycline and novobiocin . All strains were resistant to neomycin, tetracycline, oxacillin and sulphonamides . The antigen prepared from the isolated strains by the method of Fuller did not react with any streptococcal group serum A-Z.

Ann Pediatr (Paris), 1989 May, 36(5), 303 - 7
{Materno-fetal infections caused by unusual germs . Apropos of 9 cases}; Rapin F et al.; A retrospective study carried out from January 1981 through August 1988 identified nine cases of materno-fetal infections (Staphylococcus aureus, 1 case; Klebsiella pneumoniae, 3 cases; enterococcus, 3 cases; Hemophilus influenzae, 1 case; and Pneumococcus, 1 case) in six girls and three boys; four premature infants developed respiratory distress requiring mechanical ventilation . In four cases, maternal history found risk factors for infection . All patients developed circulatory failure and one had purulent meningitis . Diagnosis was confirmed upon recovery of the microorganism from a central sample in six cases; in three cases, only the peripheral cultures were positive but diagnosis was supported by the positive maternal history and by clinical findings . Bacterial species were not associated with specific clinical or biological features, but infections due to Hemophilus influenzae, Klebsiella pneumoniae and pneumococcus were particularly severe (two deaths and two infants with neurologic sequelae) . In some studies, unusual microorganisms account for 46% of septicemias and 36% of purulent meningitis . Group D streptococci are the most common bacteria in this category and may account for 10% to 15% of early neonatal septicemias . Organism-specific features are analyzed on the basis of data from the literature . Concerning therapy, this epidemiologic aspect of materno-fetal infections complicates the choice of the initial antimicrobial agents; because third-generation cephalosporins are not effective on listeria and group D streptococci, we advocate more widespread use of the ureidopenicillins instead of ampicillin.

Br Vet J, 1989 May-Jun, 145(3), 263 - 75
Pathology and bacteriology of adult male Antarctic fur seals, Arctocephalus gazella, dying at Bird Island, South Georgia; Baker JR et al.; A high mortality rate occurs in Antarctic fur seal males on the breeding breaches of Bird Island, South Georgia . The main causes of death were infections of fighting wounds and pneumonias . The bacteria involved appear to be opportunistic pathogens, predominantly various strains of streptococci.

J Med Microbiol, 1989 May, 29(1), 19 - 27
Identification of viridans streptococci by pyrolysis-gas chromatography; French GL et al.; An isothermal method of pyrolysis-gas chromatography (Py-GC) was used for the identification of viridans streptococci . Pyrograms from 104 reference strains were subjected to a discriminant analysis to produce classification coefficients for the identification of 74 test organisms . Five groups representing recognised species were discriminated but Streptococcus milleri strains could not be distinguished from S . sanguis . If S . milleri and S . sanguis are regarded as a single pyrogroup, only three strains out of 74 were incorrectly identified by Py-GC . A multidimensional scaling analysis of the Py-GC data produced a similar species grouping, but this statistical method was less satisfactory for pyrogram data than discriminant analysis . While Py-GC was moderately successful for the identification of viridans streptococci, this study indicated that the technique has limited use in diagnostic medical microbiology because it is time-consuming and lacks flexibility.

Am J Clin Pathol, 1989 May, 91(5), 620 - 4
Molecular analysis of viridans and nutritionally deficient (variant) streptococci causing sequential episodes of endocarditis in a patient; Stein DS et al.; Clinical blood isolates from sequential episodes of endocarditis occurring over a six-month period of time in an addict were investigated . The pathogens were Streptococcus sanguis II, Streptococcus mitis, and a nutritionally deficient (variant) streptococcus . The authors determined the DNA relatedness of these isolates by antibiograms, plasmid profiles, chromosomal endonuclease restriction digestions, and dot blot DNA-DNA hybridization analyses . The S . sanguis II and nutritionally deficient streptococcal strain had similar antibiograms being resistant to penicillin; neither produced beta-lactamase . No plasmids were found . The restriction endonuclease chromosomal digestion patterns of these isolates were unique and epidemiologically unrelated to each other . Dot blot DNA-DNA hybridizations, using the nutritionally deficient streptococcal DNA as the probe, showed homology to the preceding clinical isolates, S . sanguis II and S . mitis, at 15.4% and 45.1% hybridization levels, respectively . The nutritionally deficient streptococcus was only 4.2% homologous to a S . mitis ATCC strain and another nutritionally deficient streptococci isolate . Therefore, this patient had endocarditis with three distinct streptococcal strains.

Obstet Gynecol, 1989 May, 73(5 Pt 1), 721 - 6
Use of ampicillin and corticosteroids in premature rupture of membranes: a randomized study; Morales WJ et al.; A randomized study was conducted to investigate the effects of antenatal corticosteroids and ampicillin in the management of preterm pregnancies under 34 weeks complicated by premature rupture of membranes . Patients with documented lecithin/sphingomyelin (L/S) ratios of less than 2.0 and a singleton gestation were eligible to participate in the study . One hundred sixty-five patients qualified and were randomized, using sealed envelopes, to four study groups . All patients were followed expectantly . Group I (41 patients) received neither ampicillin nor corticosteroids . Group II (43 patients) received 24 mg of antenatal betamethasone . Group III (37 patients) received 2 g of intravenous ampicillin every 6 hours, with discontinuation of antibiotic therapy if cultures were negative for pathogenic bacteria . Group IV (44 patients) received both corticosteroids and ampicillin as described for groups II and III, respectively . Compared with patients not receiving corticosteroids, those administered antenatal corticosteroids experienced a reduction in the incidences of respiratory distress syndrome (53 versus 26%), bronchopulmonary dysplasia (23 versus 9%), severe grades of intracranial hemorrhage (15 versus 3%), and patent ductus arteriosus (18 versus 6%), with no difference in the incidence of maternal or neonatal infection . Compared with patients not receiving antenatal antibiotics, the group of patients treated with ampicillin on admission had a lower incidence of clinical chorioamnionitis (4 versus 26%) and neonatal sepsis (5 versus 10%) . This reduction in infectious morbidity by antenatal ampicillin was restricted to those patients (28.4% of the study population) colonized with group B streptococci.(ABSTRACT TRUNCATED AT 250 WORDS)

J Infect, 1989 May, 18(3), 231 - 48
Invasive streptococcal infections in the era before the acquired immune deficiency syndrome: a 10 years' compilation of patients with streptococcal bacteraemia in North Yorkshire; Barnham M; Significant streptococcal (non-pneumococcal, non-enterococcal) bacteraemia was detected in 100 patients in two Health Districts of North Yorkshire in the decade 1978-1988 . Patients with these infections accounted for 11% of the total 902 patients in the districts in whom bacteraemia was diagnosed during the period . Infection was most often seen with beta-haemolytic streptococci (52 patients) comprising Lancefield group A (Streptococcus pyogenes) (20 patients), group B (13), group C (5), group G (9), haemolytic Streptococcus milleri and non-groupable streptococci (5) . The wide variety of serious infections included cellulitis, abscess, septicaemia, pneumonia, septic arthritis, necrotising fasciitis, acute endocarditis and mycotic aneurysm . Of these 52 patients, 21 (40%) died . alpha-Haemolytic streptococcal bacteraemia was diagnosed in 38 patients of whom 24 (63%) suffered from endocarditis and three (8%) died . Three of ten patients with non-haemolytic or anaerobic streptococcal bacteraemia died also . Six of the 100 patients with streptococcal bacteraemia had concomitant acute virus infections . Of the total 56 patients with infective endocarditis diagnosed in the districts during the period, streptococci were responsible in 30 (54%) of them . The predisposing factors, clinical features and outcome of the infections are described and discussed.

J Clin Microbiol, 1989 May, 27(5), 1008 - 10
Evaluation of the Minitek Gram-Positive Set for identification of streptococci isolated from bovine mammary glands; Watts JL; A total of 127 isolates were used to evaluate the Minitek Gram-Positive Set for identification of streptococci cultured from bovine mammary glands . The overall accuracy of the Minitek Gram-Positive Set was 34.6% . Of 12 Streptococcus agalactiae strains, 4 (33.3%) were correctly identified . Of 43 Streptococcus dysgalactiae strains, 32 (74.4%) were identified correctly . Of 44 Streptococcus uberis strains, 42 (95.5%) were identified as Enterococcus spp . Poor performance was attributed to the limited number of veterinary strains in the data base . Incorporation of large numbers of veterinary isolates into the data base is needed for further development of this system.

Am J Clin Pathol, 1989 May, 91(5), 589 - 93
A double-blinded comparative evaluation of three media for chromophore testing with viridans and nutritionally variant (deficient) streptococci; Stein DS et al.; A double-blinded prospective comparison of chromophore testing among 109 clinical isolates of alpha-hemolytic gram-positive cocci and 48 strains of nutritionally variant (deficient) streptococci (NVS) for its sensitivity, specificity, and predictive value under stimulated clinical laboratory conditions was performed after growth in three different media--Todd-Hewitt broth supplemented with 10 micrograms/mL of pyridoxal (THBP), THBP with 0.8% (w/v) yeast-extract (THBP + YE), and a semisynthetic chemically defined medium with Todd-Hewitt dialyzate (CDMT) . The chromophore detection rates of Streptococcus mitis were 60.7, 67.9, and 78.6% after growth in THBP, THBP + YE, and CDMT, respectively . After growth in THBP there was significantly lower chromophore detection than either THBP + YE or CDMT for NVS (P less than 0.001), with a trend toward significantly less detection for S . mitis (0.15 greater than P) . For Streptococcus sanguis II the detection rates were 45.7, 57.1, and 54.3%, respectively, for each medium . There was no significant difference between the detection rates after growth in THBP + YE or CDMT . One NVS was persistently chromophore negative, the first so described . There was a similar number of presumably false positive chromophore S . sanguis I strains (3 of 12) detected after growth in THBP + YE or CDMT . The sensitivity of chromophore detection for NVS (pooling results in THBP + YE and CDMT) was 95.8% and specificity was 59.6% . For a nonvariant streptococcus, the sensitivity was 61.9% and specificity was 93.5% for an isolate to be either S . mitis or S . sanguis II.

J Dent Res, 1989 May, 68(5), 750 - 60
Bacterial adhesion to oral tissues: a model for infectious diseases; Gibbons RJ; The majority of bacteria which colonize humans display sharp host and tissue tropisms; consequently, relatively little is known about how they initiate colonization on mucosal surfaces . The mouth has a variety of features which have enabled it to serve as a useful model for the discovery of basic principles of host-parasite interactions occurring in mucosal environments . Early studies demonstrated that indigenous bacteria attach to surfaces of the mouth in a highly selective manner; attachment was often observed to correlate with colonization . These studies led to the recognition that bacterial attachment is an essential step for colonization in environments which contain surfaces exposed to a fluid flow . Bacterial adhesion has subsequently grown into a major area of infectious disease research . Many bacteria have been found to possess proteinaceous components, called "adhesins", on their surfaces which bind in a stereochemically specific manner to complementary molecules, or "receptors", on the tissue surface . Adhesins are often lectins which bind to saccharide receptors, but some adhesins are thought to bind to proteinaceous receptors . Studies of components of human saliva, which adsorb to hydroxyapatite (HA) surfaces similar to those of teeth, and promote the attachment of prominent plaque bacteria, have revealed that the acidic proline-rich proteins (PRPs) promote the attachment of several important bacteria . These include strains of Actinomyces viscosus, Bacteroides gingivalis, some strains of Streptococcus mutans, and others . The salivary PRP's are a unique family of molecules . However, segments of PRPs are structurally related to collagen . This may be significant, since B . gingivalis and certain cariogenic streptococci bind to collagenous substrata, and such interactions may facilitate their invasion into gingival tissues, or into dentin or cementum, respectively . Another unexpected observation was that although A . viscosus and other bacteria bind avidly to PRPs adsorbed onto apatitic surfaces, they do not interact with PRPs in solution . PRP molecules evidently undergo a conformational change when they adsorb to HA, and adhesins of A . viscosus recognize cryptic segments which are only exposed in adsorbed molecules . This provides the bacteria with a mechanism for efficiently attaching to teeth while suspended in saliva . It also offers a molecular explanation for their sharp tropisms for human teeth . It has proven convenient to refer to such hidden receptors for bacterial adhesins as "cryptitopes" (from cryptic, meaning hidden, and topo, meaning place).(ABSTRACT TRUNCATED AT 400 WORDS)

Infect Immun, 1989 May, 57(5), 1573 - 81
Identification of non-immunoglobulin A-Fc-binding forms and low-molecular-weight secreted forms of the group B streptococcal beta antigen; Brady LJ et al.; The beta antigen expressed on the surfaces of certain strains of group B streptococci has been reported to bind to the Fc region of human immunoglobulin A (IgA) . In this study, we screened 100 isolates of group B streptococci for expression of both beta antigen and IgA-Fc-binding activity . We identified two isolates which expressed the beta antigen but could not bind human IgA Fc fragments and also observed variability in IgA-Fc-binding activity among other beta-antigen-expressing strains . Novel low-molecular-weight forms of beta antigen were secreted by four beta-antigen surface-negative isolates and included IgA-Fc-binding (Mrs, 55,000 and 53,000) and non-IgA-Fc-binding (Mr, 38,000) molecules . These results suggest that the IgA-Fc-binding site represents a unique domain of the beta antigen . The 55,000- and 53,000-Mr forms of secreted beta antigen were functionally and antigenically representative of the size-heterogeneous (Mr, up to 145,000) beta-antigen molecules expressed by surface-positive strains . The cell surface-localized IgA-Fc-binding molecules could bind only human serum IgA efficiently; however, once solubilized, these molecules could bind both human serum and secretory IgAs.

Nippon Jibiinkoka Gakkai Kaiho, 1989 May, 92(5), 703 - 8
{Bacteriological investigation of the pre- and postoperative transition of the pharyngeal flora in the patients received tonsillectomy}; Fujimori I et al.; Several investigations have been reported on the interactive relation between the normal flora and the pathogenic micro-organisms in the human upper respiratory tracts (Thompson, Sanders, etc) . It has also been known that some alpha-streptococci have inhibitory effect on the growth of group A beta-hemolytic streptococci . A study upon the role of alpha-streptococci in the throat (tonsil and pharynx) was performed using 73 culture specimens (throat swabs) obtained from 42 patients . Forty-four specimens were taken from the patients who received tonsillectomy, pre- and postoperatively, and 29 were from the patients who did not receive the operation . In the group of patients who received tonsillectomy, alpha-streptococci with inhibitory effect on the growth of group A beta-streptococci were detected less frequently preoperatively, when compared with the patients without tonsillectomy . On the other hand, postoperatively, marked increase of alpha-streptococci of these types was found in the normal flora of the throat . However, further detailed study on this subject is necessary because of the exceptional results in our observations.

Indian Pediatr, 1989 May, 26(5), 460 - 5
Analysis of blood-culture isolates from neonates of a rural hospital; Chaturvedi P et al.; All blood culture reports obtained from newborns admitted in a neonatal care unit during 1983-87 were reviewed to determine the current bacteriological profile of neonatal septicemia . A total of 1160 neonates of high risk category or having clinical features suggestive of septicemia were subjected to blood culture study during this period . The culture positivity rate was 73% . Of these, 24.9% cultures were polymicrobial . Among the 1059, growths obtained, 60.1% were Gram negative, with Klebsiella, E . coli and Pseudomonas as the commonest pathogens . In Gram positive group, coagulase negative Staphylococci were most frequent, constituting 24% of the total isolates . An increasing incidence of coagulase positive Staphylococci and Pseudomonas infections was observed in recent years . Another significant finding was a comparatively high prevalence of Group D beta hemolytic isolates among streptococcal growths, with S . fecalis as the single commonest streptococci isolate.

J Hosp Infect, 1989 May, 13(4), 337 - 47
An outbreak of puerperal fever caused by group C streptococci; Teare EL et al.; Between 19 February and 18 April 1987, 33 confirmed cases of puerperal fever caused by Streptococcus equisimilis serotype T204 occurred at three hospitals in and around Chelmsford . Most of the cases (70%) occurred on one ward, in which toilet seats and a shower are believed to have aided transmission, although insufficient data were obtained to exclude a role for person-to-person spread . Possession of M-protein antigen was demonstrated in the outbreak strain.

J Infect, 1989 May, 18(3), 221 - 9
Topical antibiotics in the treatment of superficial skin infections in general practice--a comparison of mupirocin with sodium fusidate; White DG et al.; A total of 413 eligible patients took part in an observer-blind randomised multicentre clinical trial in order to compare the clinical and bacteriological efficacy of mupirocin (Bactroban) ointment with sodium fusidate (Fucidin) ointment for treating superficial skin infections seen in general practice . Mupirocin was applied twice daily and sodium fusidate thrice daily for a period of 7 days . Both treatments were similarly effective with 97% patients treated with mupirocin and 93% patients treated with sodium fusidate responding . Mupirocin was significantly more effective in the treatment of acute primary skin infections and in the treatment of a subgroup of patients with impetigo (P less than 0.01) . Of the organisms detected before treatment began, 93% were not found after treatment with mupirocin compared with 89% after treatment with sodium fusidate . Staphylococcus aureus and/or beta-haemolytic streptococci appeared to be eliminated in significantly more patients treated with mupirocin (96%) compared with those treated with sodium fusidate (88%), (P = 0.03) . Both treatments were well tolerated.

J Clin Microbiol, 1989 May, 27(5), 1050 - 4
Molecular species of R-protein antigens produced by clinical isolates of group B streptococci; Flores AE et al.; Clinical isolates of group B streptococci from body fluids and mucosal surfaces were examined for production of a trypsin-resistant antigen known as R protein . R protein was extracted with 1% trypsin from cells grown in a semidefined medium . The extracts were tested by immunodiffusion in agarose with a panel of antisera for detection and precise identification of the four species of R protein described by Wilkinson . R antigen was present in 49 of 131 (37%) of the strains tested . Analysis by serotype revealed that 0 of 2 type Ia, 0 of 11 Ib, 1 of 16 (6%) Ia/c, 12 of 15 (80%) II, 0 of 20 II/c, 35 of 49 (71%) III, 0 of 6 IV, and 1 of 12 (8%) nontypeable strains produced R antigen . Production of the R protein and the trypsin-resistant or alpha component of the c protein appeared to be mutually exclusive . R antigen was more prevalent in isolates from blood (50%) than in those from mucosal sites (27%) for type II strains; no difference was seen for type III strains from these sites . Concordant results were obtained with five paired body fluid-mucosal surface isolates from individual patients and with isolates from 17 mother-baby pairs . The most frequent species of R antigen was R4 (45 of 49), followed by R1 (4 of 49) . These two species of R protein were biochemically (trypsin resistant and pepsin sensitive) and immunologically identical to the R-protein antigens produced by prototype strains of groups A, B, and C streptococci.

J Periodontol, 1989 May, 60(5), 255 - 8
Oral hygiene and the prevalence of oral group D streptococci in medically-physically compromised and periodontal disease patients; McCrary BR et al.; The relationship between oral hygiene and oral Group D streptococcal carrier status was examined in two groups of dental clinic patients . Eighteen medically-physically compromised and 20 periodontitis patients were selected for study . Oral hygiene status was assessed and the prevalence of oral Group D streptococci was determined by sampling the oral cavity with a vigorous 15 second rinse with 5 ml peptone-saline solution . Three ml of each sample was cultured at 40 degrees C in 30 ml of SF broth for 72 hours . Esculin fermenting colonies isolated from the SF broth were characterized biochemically according to standardized procedures and patients were classified as either carriers or non-carriers . Group D streptococci were detected in 27.8% of the medically-physically compromised group and 4.5% of the periodontal disease patients . The mean DI-S score of the medically-physically compromised group was significantly lower than in the periodontal group . Within the medically-physically compromised group, the DI-S means of carriers and non-carriers were not significantly different . The data indicated no important relationship between oral hygiene and the prevalence of oral Group D streptococci in the groups studied.

Arch Mal Coeur Vaiss, 1989 May, 82(5), 779 - 84
{54 cases of infectious endocarditis seen in 32 years in a population of 2038 congenital heart diseases}; Corone P et al.; A longitudinal study of a 32-year period (1954-1987) involving 2038 patients with congenital heart defects followed by the same physician yielded 54 cases of infective endocarditis (IE) . Complex cyanogenic cardiopathies were particularly exposed to the risk of infection (8.2 IE for 1000 patient-years), then came ventricular septal defects (2.4), tetralogy of Fallot (2.3), aortic stenosis (2.0) and atrioventricular canal (1.7) . The risk was smaller in patients with Eisenmerger complex (1.2), persistent arterial canal (1.4) and coarctation (0.7) . Patients under 10 years of age (16.7%) were less affected than young adults in the 20-29 years age-group (33.4%) . The organisms most frequently isolated were streptococci (42%); staphylococci ranked second (23%) . Less common organisms were found in 14% of the cases, and blood cultures were negative in 21% . Systemic prophylaxis with penicillin V, introduced 16 years ago, seems to have almost halved the incidence of infective endocarditis due to penicillin-sensitive organisms.

Ann Intern Med, 1989 Apr 15, 110(8), 612 - 6
Pharyngitis in adults: the presence and coexistence of viruses and bacterial organisms; Huovinen P et al.; STUDY OBJECTIVE: To determine the presence and coexistence of viruses and bacterial organisms causing pharyngitis in adults . DESIGN: Open study using diagnostic methods, including rapid antigen-detection techniques, to test for the presence of viruses of the respiratory tract, as well as Mycoplasma pneumoniae . Chlamydia trachomatis, the Chlamydia species strain TWAR, and beta-hemolytic streptococci . SETTING: Open health care . PATIENTS: One hundred six consecutive adult patients, 15 to 65 years old, whose chief complaint was sore throat . MAIN RESULTS: Of the 106 patients, beta-hemolytic streptococci were found in only 24 patients (5 patients with group A streptococci, 13 with group C, 5 with group G, and 1 with group F); M . pneumoniae was found in 10 patients, the Chlamydia species strain TWAR in 9 patients, and viruses in 27 patients . Two microbes were simultaneously isolated in 3 patients, and no microbial findings were detected in 33 patients . CONCLUSION: Because 19 patients were infected with the Chlamydia species strain TWAR and M . pneumoniae, and 24 patients were infected with beta-hemolytic streptococci, the diagnostic procedures and therapies for adult patients with pharyngitis need to be reconsidered . The results of our study also confirm earlier suggestions that the Chlamydia species strain TWAR alone is a causative agent for pharyngitis in adults.

Infect Immun, 1989 Apr, 57(4), 1177 - 85
Protracted anemia associated with chronic, relapsing systemic inflammation induced by arthropathic peptidoglycan-polysaccharide polymers in rats; Sartor RB et al.; Mild hypoproliferative anemia with abnormal iron metabolism frequently accompanies chronic inflammation and infection in humans . To determine whether anemia is associated with chronic relapsing arthritis induced by bacterial cell wall polymers, serial determinations of the hematocrit were measured in rats injected intraperitoneally with sonicated peptidoglycan-polysaccharide fragments from group A streptococci . Acute anemia peaked 5 to 10 days after injection, and chronic, spontaneously relapsing anemia persisted for 309 days . 51Cr labeling demonstrated decreased erythrocyte survival, i.e., a half-life of 8.4 days in cell wall-injected rats versus 11.8 days in controls . Erythrocytes were mildly microcytic, and leukocyte counts were elevated during early spontaneous reactivation of arthritis, 15 days after injection of peptidoglycan-polysaccharide . Bone marrow myeloid/erythroid precursor ratios were elevated in arthritic rats (P less than 0.0001) . Purified peptidoglycan produced an acute anemia lasting 10 days, while injection of group A streptococcal polysaccharide and mutanolysin-digested cell wall did not affect the hematocrit . The minimal effective dose of peptidoglycan-polysaccharide was 5 micrograms of rhamnose per g (body weight) . Serum iron and transferrin levels were decreased in cell wall-injected rats (P less than 0.005) and were closely correlated with hematocrit values and joint inflammatory scores . Stainable iron was increased in the liver, spleen, and mesenteric lymph nodes and unchanged in the bone marrow of cell wall-injected rats . Anemia accompanying chronic, relapsing systemic inflammation induced by peptidoglycan-polysaccharide polymers appears to be an excellent animal model of the anemia of chronic disease.

FEMS Microbiol Lett, 1989 Apr, 49(2-3), 239 - 42
Determination of viridans streptococci surface lipoteichoic acid by enzyme linked immune sorbent assay; Hogg SD et al.; An enzyme linked immune sorbent assay (ELISA) was developed to measure bacterial surface lipoteichoic acid (LTA) . Numerous strains of oral streptococci belonging to the 'viridans' group were examined on three separate occasions . The results show that, under these cultural conditions, oral streptococci do not normally express LTA on the cell surface . Occasionally strains produced amounts of LTA detectable using the ELISA but this was not a reproducible phenomenon.

Can J Microbiol, 1989 Apr, 35(4), 515 - 7
Invasion of HeLa cells by beta-hemolytic group G streptococci; Nath SK; The invasion of HeLa cells by beta-hemolytic Lancefield group G streptococci was studied by measuring the number of bacterial cells that survive exposure to gentamicin . Approximately 50% of bacteria introduced to the HeLa cell monolayer survived gentamicin treatment, suggesting that they were intracellular . Electron microscopy of these preparations showed intracellular bacteria in the cytoplasm, not surrounded by host cell membranes . Trypsinized bacteria incubated with HeLa cells were all killed by gentamicin . It appears that the beta-hemolytic group G streptococci have mechanisms for entry into human epithelial cells which may have importance in the virulence of the organisms.

Antimicrob Agents Chemother, 1989 Apr, 33(4), 580 - 2
Antimicrobial susceptibilities of Streptococcus species that cause septicemia in neutropenic patients; Venditti M et al.; Sixty-three consecutive streptococcal blood isolates from neutropenic patients, represented mainly by viridans group streptococci, were evaluated in vitro for antibiotic susceptibility . Of these isolates, 79.3% were highly susceptible to penicillin (MIC, less than or equal to 0.12 microgram/ml) . Overall, imipenem was the most active agent, followed by teicoplanin and vancomycin . All other agents showed decreased activity against streptococcal isolates that were not highly susceptible to penicillin.

J Antimicrob Chemother, 1989 Apr, 23 Suppl D, 55 - 60
Treatment of skin and soft tissue infections: a comparative study of cefmetazole and cefoxitin; Frank E et al.; In this comparative study, both cefmetazole and cefoxitin were found to be safe and effective in the treatment of skin and soft tissue infections . Greater activity of cefmetazole against some strains of Staphylococcus aureus, Streptococcus pneumoniae, beta-haemolytic streptococci and aerobic Gram-negative bacilli was confirmed . A 90% or better cure rate was achieved with both drugs . At late follow up, three patients treated initially with cefmetazole had recurrent signs and symptoms . However, these three patients had vascular insufficiency which predisposed them to infection . Since cefmetazole has a longer half-life than cefoxitin, it may prove to be more convenient, or more cost effective, or both, in these and other infections.

Mol Gen Genet, 1989 Apr, 216(2-3), 372 - 9
Cell surface proteins of a group A streptococcus type M4: the IgA receptor and a receptor related to M proteins are coded for by closely linked genes; Lindahl G; Two genes coding for cell surface proteins were cloned from a group A streptococcus type M4: the gene for an IgA binding protein and the gene for a fibrinogen binding protein . Both proteins were purified and partially characterized after expression in Escherichia coli . There was no immunological cross-reaction between the two proteins . The IgA binding protein, called protein Arp4, is similar to an IgA receptor previously purified from another strain of group A streptococci, but the proteins are not identical . Characterization of many independent clones showed that the two proteins described here are coded for by closely linked genes . Bacterial mutants have been found which have simultaneously lost the ability to express both genes, and a simple method to isolate such mutants is described . The existence of these variants indicates that expression of the two cell surface proteins may be coordinately regulated . Binding of fibrinogen is a characteristic property of streptococcal M proteins, and the available evidence suggests that the fibrinogen binding protein is indeed an M protein.

J Rheumatol, 1989 Apr, 16(4), 506 - 11
Skin hypersensitivity to streptococcal antigens and the induction of systemic symptoms by the antigens in Behçet's disease--a multicenter study . The Behcet's Disease Research Committee of Japan; {The effect of blood serum components on the growth et al.; Savel'ev EP, Bitko SA, Dynga LO, Shmakova ZF, Smirnova MN.

The components of cattle blood serum, added to the medium for the cultivation of group A streptococci, considerably decrease the period of adaptation and increase the balanced growth rate of streptococci, which is manifested by changes in the surface structures of the cell wall: the absence or modification of protein M . Streptococci grown under these conditions lose their capacity for phagocytosis, and from the cell walls obtained from these streptococci no surface protein M can be isolated by pepsin treatment . Nevertheless, the ratio of the main cell-wall components (proteins, polysaccharide and peptidoglycan), the amino acid composition, as well as the resistance of the cell walls to the action of trypsin and endo-N-acetylmuramidase are the same in M+ and Mx variants, that makes it possible to infer that the modification of protein M or the inhibition of its synthesis occurs during the growth of streptococci in the presence of blood serum components.

Hautarzt, 1989 Apr, 40(4), 215 - 21
{Treatment of chronic recurrent erysipelas with streptococcal vaccine}; Haustein UF et al.; One hundred patients suffering from relapsing erysipelas were treated with streptococcal vaccine consisting of a phenol- und heat-inactivated mixture of 12 different types of streptococci . Simultaneously the entry point was cured and general disposition and local terrain factors were treated . In the majority of cases further relapses were avoided or their frequency reduced . The results of the treatment with streptococcal vaccine were compared with those of long-term benzathine-penicillin therapy in 47 patients . The vaccine has proved to be equivalent to the penicillin therapy and can be recommended as a real alternative to it for prevention of further infections and late sequelae, especially those of chronic lymphedema . The beneficial therapeutic effect of the vaccine is probably attributable to a non-specific immune stimulation . A partial cellular immune defect involving the protective M-antigen together with simultaneous partial abnormalities of immune reactivity is discussed as a cause of relapsing erysipelas.

Eur J Obstet Gynecol Reprod Biol, 1989 Apr, 31(1), 47 - 51
Prevention of group B streptococci transmission during delivery by vaginal application of chlorhexidine gel; Kollee LA et al.; In a prospective study in 227 parturients, carriership of group B streptococci was established to be 25% . In carriers, transmission of streptococci to the newborn occurred in 50% . 10 ml of a chlorhexidine gel containing hydroxypropylmethylcellulose was introduced into the vagina during labor in 17 parturients, who were known to be carriers of group B streptococci from the first trimester of pregnancy . In none of the newborns from these mothers colonization by group B streptococci did occur . Vaginal application of chlorhexidine may prevent transmission of group B streptococci, and serve as an alternative to intrapartum prophylaxis using antibiotics . A large multicenter randomized controlled study should be performed to confirm this hypothesis.

J Med Microbiol, 1989 Apr, 28(4), 275 - 86
A physiological classification of viridans streptococci by use of the API-20STREP system; French GL et al.; Physiological reactions of viridans streptococci were examined by the API-20STREP system and a selection of conventional tests . Cluster analysis of these results produced a classification similar to a taxonomic scheme based on that of Colman and Williams . The organisms could be divided into the six recognised species--Streptococcus mutans, S . bovis, S . mitior, S . sanguis, S . salivarius and S . milleri . Analysis confirmed that S . mitior and S . sanguis can be distinguished in the API-20STREP test by hydrolysis of arginine but not by dextran production . Although S . mutans, S . mitior and S . sanguis can be divided into two further subgroups, the taxonomic significance of this is unclear . With this means of classification, most organisms could be identified easily by a small number of tests . API-20STREP is convenient for performing physiological tests on viridans streptococci, but the information provided by the manufacturers in regard to identification and nomenclature is in need of revision.

Obstet Gynecol, 1989 Apr, 73(4), 678 - 81
Reliability of a rapid latex fixation test for detecting group B streptococci in the genital tract of parturients at term; Brady K et al.; The purpose of this prospective investigation was to determine the reliability of a rapid latex particle agglutination test in detecting group B streptococci in the lower genital tract of laboring women . Five hundred asymptomatic patients with intact membranes who were in labor at term underwent sterile speculum examination . Secretions from the endocervix and vagina were collected with sterile swabs . One swab was inoculated directly onto a blood agar plate for culture . The other was initially placed into a Culturette transport system and then transferred into a test tube containing an enzyme extraction reagent . After a 60-minute incubation at 37C, the latex fixation test was performed on the residual liquid in the tube . The frequency of positive cultures in our population was 5.0% . The sensitivity and specificity of the rapid slide test were 88 and 99.6%, respectively . The positive and negative predictive values were 91.7 and 99.4%, respectively . The group B streptococci latex fixation test appears to be a rapid and reliable means of detecting group B streptococci in the lower genital tract of term patients with intact membranes . Use of this method should permit a more selective approach to the intrapartum chemoprophylaxis of women colonized with group B streptococci.

J Osaka Dent Univ, 1989 Apr, 23(1), 39 - 43
Zeta potential of oral bacteria (Streptococci); Kambara M et al.; This study was carried out to examine whether oral bacteria can be treated electrochemically in the same manner as colloid particles . The zeta potentials for 13 Streptococcus strains incubated in trypticase soy broth (TSBY) and heart infusion broth (HIB) were determined in 1/30 M phosphate buffer solution of pH 7.0 by standard microelectrophoresis . The zeta potentials for the Streptococci showed a wide range of values from -28.7 mV to -2.1 mV in TSBY and from -28.5 mV +2.0 mV in HIB . The zeta potential was useful in determining the potential structure of the bacterial cell as living colloid, especially Streptococcus.

Eur J Clin Microbiol Infect Dis, 1989 Apr, 8(4), 308 - 10
Reliable five-minute test strip method for identification of Streptococcus pyogenes; Dealler SF et al.; A novel and rapid method (Strep Strip, Lab M) for identification of Streptococcus pyogenes was evaluated . The method combines the established test for pyroglutamyl aminopeptidase (PYR) with a rapid chromogenic test for beta-glucosidase on a paper strip . The test was evaluated with 274 clinical isolates and 237 culture collection isolates of beta-haemolytic streptococci . Streptococcus pyogenes was identified with 100% specificity . Six isolates identified as Lancefield group A and which might therefore be assumed to be Streptococcus pyogenes were shown by the test strip method not to be this species . The beta-glucosidase test on the test strip allowed differentiation between enterococci and Streptococcus pyogenes (both PYR positive) in all cases . The test strip method represents an economical and accurate method for identification of Streptococcus pyogenes in clinical material.

Zentralbl Bakteriol Mikrobiol Hyg {B}, 1989 Apr, 187(4-6), 382 - 9
{The disinfection of the oral mucosa}; Gundermann KO; For evaluation of antiseptics intended for use on mucous membranes various effects, as bactericidal and fungicidal but also bacteriostatic and fungistatic effects as well as other mechanisms, have to be considered . The application of antiseptics on the oral mucous membrane is indicated to prevent wound infections, bacteremia following surgical intervention, infection caused by injuries as for example prosthetic ulcers as well as it is indicated for prophylaxis and therapy of infections like colds and for prevention of exogenic dissemination of bacteria . The substances used essentially are PVP-iodine-solutions, cation-active compounds, organic mercury- and silver-compounds and hydrogen peroxide-solutions . It has to be taken into account, however, that the toxicological properties of these substances vary . To this day there exists no generally accepted test model for the evaluation of these mucous membrane antiseptics . Therefore a test-solution on the basis of chlorhexidine digluconate was examined with the help of a rinse- and a swab-method, respectively . The total bacterial counts and the number of alpha-haemolytic streptococci was determined . The rinse-method resulted in reduction factors of log 1.0 after 5 to 120 min and the swab-method--applied at the buccal mucous membranes--in reduction factors of about log 1.5 after 5 min and log 1.0 to 1.2 after 120 min . At the gingival margin of the front teeth reduction factors rose from log 1.55 after 5 min to log 1.85 after 120 min . Possibly this rise was due to an after-effect of the tested antiseptic in this region . For examination of antiseptics a combination of both test methods is recommended.

Eur J Clin Microbiol Infect Dis, 1989 Apr, 8(4), 306 - 8
Fatal Streptococcus suis septicemia in an abattoir worker; Bungener W et al.; A 51-year-old abattoir worker became ill with high fever and was admitted to hospital late in the evening, where he died 4 h later . Smears of peripheral blood taken 7 h after death showed numerous cocci . Cultures of the blood grew beta-hemolytic streptococci exhibiting the biochemical properties of Streptococcus suis II . A complete autopsy with extensive microscopical studies showed numerous bacteria in small vessels of several organs, but no bacterial colonisation of tissues, meningitis, or other relevant lesions were found . The group R antigen of the bacteria could be demonstrated by immunofluorescence in paraffin sections of the kidney and the adrenal gland . Two similar cases of fulminant fatal Streptococcus suis II septicemia have been reported from Denmark . This appears to be the first case observed in the Federal Republic of Germany.

Eur J Clin Microbiol Infect Dis, 1989 Apr, 8(4), 289 - 93
Evaluation of a rapid latex agglutination test for detection of group B streptococci in vaginal specimens; Lotz-Nolan L et al.; A rapid latex agglutination test (Bactigen Group B Streptococcus Cervical Screen) for detection of group B streptococci in cervical-vaginal specimens was evaluated using two different slide systems, the traditional serologic slide and capillary action track (Trak) slide . Culture was used as reference method . A total of 344 cervical-vaginal specimens were tested . The group B streptococci carrier rate was found by culture to be 10.8%, 56.8% of these specimens being heavily colonized . The sensitivity and specificity of the latex agglutination test in heavily colonized specimens was 95.2% and 99.3% for the serologic and track slides respectively . The overall sensitivity, including lightly colonized specimens, was 62.2% . The positive predictive value was 92% for both slide systems, and the negative predictive value 95.4% and 95.6% for the serologic and track slides respectively . The latex agglutination test, used with either slide, provides a rapid and effective method for identification of specimens heavily colonized with group B streptococci . The track slide may provide a convenient alternative to serologic slides since it does not require rotation.

Eur J Clin Microbiol Infect Dis, 1989 Apr, 8(4), 282 - 8
Cefadroxil versus penicillin in the treatment of streptococcal tonsillopharyngitis; Milatovic D et al.; In a randomized multicentre study the efficacy of phenoxymethyl-penicillin and cefadroxil was tested in the treatment of acute tonsillopharyngitis caused by group A streptococci . These organisms were detected in 269 of the 300 children studied . Of the 239 patients in whom results could be evaluated, 121 received penicillin and 118 cefadroxil . After ten days of therapy the microbiological failure rate was 19% in the penicillin group and 6.8% in the cefadroxil group (p less than 0.01) . Ten of 23 cases of microbiological failure in the penicillin group and two of eight in the cefadroxil group also had clinical symptoms of infection . All streptococcal isolates were sensitive to penicillin, cefadroxil and clindamycin with the exception of one strain with intermediate sensitivity to cefadroxil . Seven strains had intermediate sensitivity to erythromycin and one was resistant . No penicillin tolerance was observed . Patients in whom penicillin therapy failed more frequently had beta-lactamase producing staphylococci in the pharyngeal flora in comparison to successfully treated patients . The clinical and bacteriological results showed that cefadroxil was clearly superior to penicillin.

Obstet Gynecol, 1989 Apr, 73(4), 583 - 7
Prevention of neonatal group B streptococcal disease: intrapartum detection and chemoprophylaxis of heavily colonized parturients; Tuppurainen N et al.; Parturients with heavy vaginal colonization of group B streptococci were selected randomly to receive either penicillin or no antibiotic . A simple and fast latex agglutination test, applied in 8977 consecutive parturients, detected 412 women with heavy colonization with group B streptococcus, 199 of whom were eligible for the study . The offspring of penicillin-treated women had a lower incidence of early-onset group B streptococcal disease (1.1%; 95% confidence interval 0-3.4%) than the controls (9.0%; 95% confidence interval 3.6--14.4%) (P less than .01) . Among the offspring of streptolatex-negative parturients, the incidence of streptococcal disease was very low (0.07%) . Thus, antibiotic prophylaxis of latex agglutination test-positive parturients would reduce the total incidence of group B streptococcal disease in the newborn by 25-80%.

J Infect Dis, 1989 Apr, 159(4), 701 - 7
Mechanisms of bacterial opsonization by immune globulin intravenous: correlation of complement consumption with opsonic activity and protective efficacy; Yang KD et al.; To study the mechanism of bacterial opsonization by immune globulin intravenous (IGIV) complement consumption and polymorphonuclear leukocyte (PMNL) membrane receptor (FcRlo, CR1, and CR3)-mediated phagocytosis of Staphylococcus epidermidis, Klebsiella pneumoniae, and groups A and B streptococci were examined . IGIV alone did not consume complement and showed no opsonic activity by itself for these organisms . When these bacteria were preopsonized in IGIV, significant amounts of complement were consumed (44%-94%) and the uptake and killing of bacteria occurred . The in vitro opsonic activity of IGIV for these organisms was significantly correlated with the amount of complement consumed by the IGIV-opsonized bacteria (r = .85, P less than .05) . The in vivo protective efficacy of IGIV also appeared to be directly associated with its ability to activate and consume complement (r = 1.0, P less than .001) . Antibodies to FcRlo (Leu 11) markedly inhibited phagocytosis of bacteria opsonized in IGIV but not that of bacteria opsonized in specific IgM . Both CR1 and CR3 receptors on PMNLs were involved in uptake, but the contribution of each is different with different organisms.

Infect Immun, 1989 Apr, 57(4), 1089 - 94
Isolation and characterization of type IV group B Streptococcus capsular polysaccharide; Wessels MR et al.; An antigenically distinct serotype, type IV, has recently been added to the recognized serotypes of group B streptococci (GBS) . We isolated and purified the capsular polysaccharide antigen from a prototype type IV GBS strain . The type IV capsular polysaccharide formed a precipitin line with rabbit antiserum to type IV GBS organisms but not with antiserum to organisms of GBS serotype Ia, Ib, II, or III . Enzyme-linked immunosorbent assay inhibition experiments showed no cross-reaction between type IV antiserum and other GBS serotypes . Capsular polysaccharide released from the bacterial cells with mutanolysin and that isolated from the culture supernatant had similar elution profiles on Sepharose CL-6B, with a Kav of 0.30 and an estimated Mr of 200,000 . The purified type IV polysaccharide was found to contain galactose, glucose, N-acetylglucosamine, and N-acetylneuraminic acid (sialic acid) as exclusive sugars . The polysaccharide contained 23% (by weight) sialic acid and galactose, glucose, and N-acetylglucosamine in a relative ratio of (1):1.10:0.55 . These results are compatible with a repeating structure of six monosaccharide residues containing galactose, glucose, N-acetylglucosamine, and sialic acid in a molar ratio of 2:2:1:1 . Unlike type Ia, II, and III GBS polysaccharides, desialylation of the type IV polysaccharide produced an antigen which formed a line of identity with the native type IV antigen in double diffusion in agar against homologous antiserum . This result suggests that sialic acid is not as critical to the immunodeterminant structure of the type IV antigen as it is for other GBS capsular types.

Wien Klin Wochenschr, 1989 Mar 31, 101(7), 230 - 3
{Rational dosing intervals in streptococcal infections of the pharynx}; Rauchegger H et al.; Optimum therapy of streptococcal pharyngitis is still a matter of great debate . Kill kinetics of streptococci group A were investigated under the influence of fluctuating concentrations of penicillin V, ampicillin, cefalexin and erythromycin . Antibiotic concentrations in our in vitro model were adjusted to concentrations found in vivo in tonsillar tissue, penicillin V showed superior antimicrobial activity to ampicillin, cefalexin and erythromycin . Only the eight hourly administration of concentrations determined after the in vivo administration of either 100,000 IU/kg BW penicillin or 100 mg/kg BW of ampicillin or cefalexin effectively eradicated streptococci in the kinetic model . beta-lactamase forming bacteroides did not interfere with the elimination of streptococci by non beta-lactamase stable antibiotics . These data suggest that penicillin V constitutes the optimum choice of antibiotic . Efficient eradication can be achieved by the administration of a total daily dosage of 100,000 IU/kg BW at 8 hourly intervals.

Practitioner, 1989 Mar 22, 233(1465), 404 - 6
Infection as a consequence of ear piercing; George J et al.; Infection associated with earrings is a particular problem in girls aged five to 11 years and in patients with dermatitis . Potentially fatal septicaemia due to beta-haemolytic streptococci may occur . There is a need for greater public awareness of the problem and of the potential benefit of silver jewelry.

J Dent Res, 1989 Mar, 68(3), 468 - 71
A new method for the estimation of mutans streptococci in human saliva; Jensen B et al.; A new method for quantitating the numbers of mutans streptococci in saliva--the "Strip mutans" test--was developed . It includes the following steps: A prepared plastic spatula is contaminated with saliva, transferred to a selective broth, incubated for two days, and dried . A predetermined area is counted or evaluated for CFUs of mutans streptococci . The medium contains sucrose to promote adhesion of mutans streptococci to the strip . Bacitracin, added just before use, is the basis for the selectivity . Results with the new medium were compared with those from the "spatula technique" and with those from conventional saliva sampling with dilution . The studies involved 302 and 60 schoolchildren, respectively . There was a highly significant correlation between the results from the new method and those from conventional methods . The strip mutans test is easy to used and has long shelf-life, and the spatulas with adherent colonies can be saved for future comparisons.

J Dent Res, 1989 Mar, 68(3), 463 - 7
The effects of pellicle formation on streptococcal adhesion to human enamel and artificial substrata with various surface free-energies; Pratt-Terpstra IH et al.; The influence of a pellicle on streptococcal adhesion was studied . A "ripened" two-hour salivary pellicle and an "early" five-minute salivary pellicle were formed on human enamel and artificial solid substrata with varying surface free-energies . Three strains of oral streptococci, also with widely different surface free-energies, were used for adhesion studies . Pellicle formation and streptococcal adhesion took place at a constant shear rate of 21 s-1 . Adhesion of S . mitis BMS to bare and pellicle-covered enamel was low and not significantly affected by the presence of a pellicle (0.7 x 10(6) and 0.6 x 10(6) cells.cm-2, resp.), whereas the numbers of S . sanguis 12 and S . mutans NS adhering to bare enamel (4.2 x 10(6) cells.cm-2 and 13.8 x 10(6) cells, cm-2, resp) were significantly reduced by the presence of a pellicle . This reduction was almost complete after only five minutes of salivary protein adsorption (1.9 x 10(-6) and 1.1 x 10(6) cells.cm-2 for S . sanguis and S . mutans, resp.) but further reduced for S . sanguis adhering to a ripened pellicle (0.7 x 10(6) cells.cm-2) . The numbers of streptococci adhering at equilibrium to bare enamel could be fitted to a thermodynamically based model, which was previously described for bacterial adhesion to homogenous artificial substrata . Streptococcal adhesion to artificial substrata exposed to saliva was low, and the differences among uncoated materials were markedly reduced even after only five minutes' exposure to saliva.

Taiwan Yi Xue Hui Za Zhi, 1989 Mar, 88(3), 213 - 7
Retrospective analysis of 97 patients with infective endocarditis seen over the past 8 years; Cheng JJ et al.; The medical records of 97 consecutive patients (101 episodes) of infective endocarditis seen from January 1979 through January 1987 were reviewed . Only 30% of the patients were over 50 years of age and the majority (69%) of infecting organisms were streptococci (mainly of the viridans group), which were similar to those reported from the West in the early antibiotic era . Pseudomonas organisms and enterococci accounted for 6% and 5%, respectively . Fungal infections were noted in 2 patients . There was a high incidence (38%) of predisposing rheumatic valvular disease; approximately half of these patients had prosthetic valve infections . Mitral valve prolapse was also an important predisposing disease (11%) . One-third (34%) of the patients had febrile illness for longer than 8 weeks before the diagnosis was established . The hospital morality rate was 22%; cerebral embolism and ruptured mycotic aneurysm, congestive heart failure, and sudden death were the major causes of death . Echocardiography disclosed vegetations on the cardiac valves and preexisting lesions in 75% of the episodes . Early recognition and proper treatment should be the focus of efforts to reduce mortality from infective endocarditis.

Zh Mikrobiol Epidemiol Immunobiol, 1989 Mar, (3), 11 - 6
{Dynamics of proteins in a culture broth growing beta-hemolytic streptococci group C}; Nikandrov VN et al.; The dynamic study of the protein spectrum of culture fluid during the growth of beta-hemolytic streptococcal strain H46A has been carried out by the methods of electrophoresis and isoelectrofocusing in polyacrylamide gel . Changes in the protein spectrum have phasic character and, on the whole, reflect the state of the microbial population, the presence of fractions corresponding to streptokinase and streptolysins being detected at all phases of growth . The electrophoretic mobility of streptokinase perceptibly changes at the end of the logarithmic phase; as shown by electrofocusing, at all stages of the population growth the heterogeneity of streptokinase is observed.

J Antimicrob Chemother, 1989 Mar, 23 Suppl C, 65 - 74
Comparative inhibitory and bactericidal activities of FCE 22101 against gram-positive cocci and anaerobes in vitro; Maskell JP et al.; The inhibitory activity of penem FCE 22101 was compared with those of imipenem and other relevant antibiotics against over 500 clinical isolates of Gram-positive cocci and anaerobes . The relative bactericidal activities of FCE 22101 and imipenem were compared by a killing curve method . FCE 22101 showed good inhibitory activity against most aerobic Gram-positive cocci although generally less than imipenem . A substantial number of Staphylococcus aureus isolates (43%) were highly susceptible to imipenem (MIC less than 0.0015 mg/l); the mode MIC for FCE 22101 was 0.06 mg/l . Methicillin-resistant Staph . aureus (MRSA) were often slightly more susceptible to FCE 22101 than to imipenem . Streptococci were more susceptible to imipenem than to FCE 22101; mode MICs for group A streptococci were 0.003 and 0.03 mg/l and for enterococci 1 and 4 mg/l, respectively . The anaerobic organisms tested were equally susceptible to both FCE 22101 and imipenem . Imipenem and FCE 22101 showed similar bactericidal activity at a concentration equivalent to 4 x MIC . Fully susceptible staphylococci were killed rapidly by both compounds, whereas less susceptible isolates, especially MRSA, were killed slowly . Streptococci, other than Str . pneumoniae, were also killed relatively slowly . Bacteroides fragilis group organisms were rapidly killed by both FCE 22101 and imipenem.

J Antimicrob Chemother, 1989 Mar, 23(3), 417 - 25
Roxithromycin as a possible agent for prophylaxis of endocarditis: a study in normal volunteers; Smith GE et al.; A single dose of roxithromycin, 300 mg, was taken by six healthy male volunteers on three occasions at consecutive weekly intervals . It was well tolerated . On the first two occasions, roxithromycin was assayed in serum samples taken at intervals up to 8 h after the administration . The mean peak concentration at 1 h was 3.0 mg/l (range 0.3-7.3) . The serum samples from the volunteers showed variable bactericidal activity against a strain of Streptococcus sanguis isolated from a case of bacterial endocarditis . Roxithromycin was not detected in saliva or gingival fluid . Smooth surface plaque samples taken at intervals were investigated for the emergence of streptococci resistant to roxithromycin at 2 and 8 mg/l . Initially two volunteers had small number of roxithromycin-resistant streptococci . At the end of the study all six volunteers had resistant streptococci detectable in their plaque samples and these accounted for 100% of the streptococci in two volunteers . The most resistant isolates (in several cases with MIC greater than 64 mg/l) were Str . sanguis or Str . mitior; individual volunteers tended to yield the same strain on consecutive samplings.

An Esp Pediatr, 1989 Mar, 30(3), 198 - 200
{Streptococcal perianal disease and balanoposthitis}; Guerrero Vazquez J et al.; Two cases are reported in which Lancefield group beta-haemolytic streptococci were isolated from culture- from the perineal skin . The physical examination showed perianal irritation and excoriation in both cases and seropurulent anal and balano-preputial discharge in the first only . To the best of our knowledge, this is the first case in which the streptococcal perianal disease is associated to a balanoposthitis and at the same time increments the clinical spectrum of the illness.

Vet Med (Praha), 1989 Mar, 34(3), 149 - 56
{Bacteriological findings in samples of milk from cows studied for the causative agent of mastitis}; Mazura F; Milk samples (483,413 on the whole), collected from 237,026 cows, were investigated in the State Veterinary Institute at Pardubice in the period from 1983 to 1987 . In the individual years, the proportion of cows whose milk contained the mastitis-inducing bacteria ranged from 18.0 to 24.8%, the average being 21.0% . Streptococcus agalactiae was identified most frequently as the causative agent of mastitis in the examined cows (6.4%); then followed Streptococcus dysgalactiae (3.7%), Staphylococcus aureus (3.4%), and Streptococcus uberis (1.9%) . The presence of the beta-haemolytic streptococci with group antigens C, G and L was demonstrated in the milk of 720 cows (i . e . 0.3%) and the remaining species of streptococci were identified in 1.0% of the cows . Coliform microorganisms were detected in 0.6% and Actinomyces pyogenes in 0.1% of the cows . The remaining bacterial species were isolated from the milk of 3.6% of the cows . Coaglucase-negative staphylococci dominated in this group . Over the five years of study, the occurrence of Streptococcus agalactiae in the examined stocks declined from 10.8 to 3.5% but the occurrence of other streptococci and staphylococci increased.

Acta Otorrinolaringol Esp, 1989 Mar-Apr, 40(2), 75 - 6
{Comparative study between an easy coagglutination test and traditional cultures for the detection of group A beta-hemolytic streptococci in the oropharynx}; Gomez Rueda JC et al.; The authors make a comparative study of the conventional culture media and a commercially available coagglutination test for detection of streptococcus beta-haemolyticus . They draw attention to the simplicity and quickness of the coagglutination test and to their high value of prediction.

Indian J Med Res, 1989 Mar, 89, 76 - 9
Spot CAMP test for the prompt presumptive identification of group B streptococci; Prakash K et al.; Spot and conventional CAMP tests done on 200 strains (120 human and 80 bovine) of group B streptococci showed 96 per cent of human and 90 per cent of bovine strains positive by both tests, indicating 100 per cent agreement . None of the 20 non-group B streptococci strains was positive for CAMP test for group B streptococci . The advantage of spot CAMP test is that it can be performed on a single isolated colony, easy to perform, inexpensive and can presumptively identify group-B streptococci within 30 min on primary sheep blood agar plate.

Agents Actions, 1989 Mar, 26(3-4), 301 - 9
Eicosanoid regulation of acute intestinal vascular permeability induced by intravenous peptidoglycan-polysaccharide polymers; Woolverton CJ et al.; A model of rapidly developing, self-limited acute vascular permeability changes localized to the gut-associated lymphoid tissue (GALT) of the rat was used to study the role of prostaglandins (PGs), thromboxanes (Txs), and leukotrienes (LTs) in the in vivo regulation of early intestinal inflammatory events . Sprague-Dawley rats were pretreated with metabolites, enzyme inhibitors, or receptor antagonists of the arachidonic acid pathway before intravenous injection of sonicated peptidoglycan-polysaccharide polymers derived from group A streptococci (PG-APS, 5 micrograms rhamnose/g body weight) . Rats were killed five minutes after PG-APS injection and were evaluated grossly for petechiae of the intestinal parenchyma and lymphoid aggregates . Indomethacin or dexamethasone increased intestinal injury by PG-APS by inducing mid-small bowel and cecal parenchymal hemorrhage . Indomethacin significantly diminished colonic lymphoid aggregate hemorrhage . PGE1, PGE2, and prostacyclin dramatically inhibited GALT hemorrhage; prostacyclin was the most potent with an effective dose of 0.1 microgram/kg . Dazmegrel, a specific Tx synthetase antagonist, significantly inhibited PG-APS-induced vascular permeability . Dazmegrel continued to diminish colonic lymphoid aggregated hemorrhage during concurrent treatment with indomethacin, which removed potential endogenous prostaglandin protection . Diethylcarbamazine, a lipoxygenase inhibitor, and FPL-55712, a LT receptor antagonist, inhibited the PG-APS-induced lesions, with FPL-55712 being more potent . LT blockade had a predominant effect on the intestinal parenchymal hemorrhage . We postulate that the normal homeostatic suppression of inflammation induced by phlogistic bacterial cell wall polymers is PG mediated, and that pathological responses are Tx and LT dependent.

Z Gesamte Inn Med, 1989 Mar 1, 44(5), 144 - 8
{Type 2 Streptococcus suis (R-Streptococci) as pathogens of occupational diseases . Report of a case and a review of the literature}; Kohler W et al.; Report on the second human case of a Streptococcus suis type 2 (group R streptococci) infection in the GDR . The patient, a 33-year-old butcher, fell ill with an acute meningitis and an initial myocarditis . Group R streptococci were isolated from cerebrospinal fluid and blood . The patient was treated with penicillin G, ampicillin and gentamicin, followed by trimethoprim-sulfamerazine . Both, meningitis and myocarditis disappeared and the patient recovered completely . The disease was recognized as an occupational disease . Review of the literature . Since 1968 108 cases of human S.suis type 2 infections were described, mostly as meningitis . In most of the cases a close contact to pigs could be confirmed.

Am J Obstet Gynecol, 1989 Mar, 160(3), 566 - 8
Rapid detection of vaginal colonization with group B streptococci by means of latex agglutination; Stiller RJ et al.; Latex agglutination testing for colonization of the vagina with group B streptococci was carried out in 1100 patients . Samples underwent latex testing after 8 to 12 hours of preincubation in selective growth medium . This technique allowed a sensitivity of 91.8% and specificity of 97.6% . This study demonstrates the usefulness of latex agglutination testing in the detection of vaginal colonization with group B streptococci.

Pediatrics, 1989 Mar, 83(3), 380 - 4
Group A streptococcus-associated upper respiratory tract infections in a day-care center; Smith TD et al.; Little information is available about the epidemiology of group A streptococcal upper respiratory tract infections in child day-care centers . During an initial 3-month period, symptomatic upper respiratory tract infections associated with throat cultures or rapid antigen detection tests positive for group A streptococci developed in 55 of 214 (26%) children and adult staff in one day-care center . When the entire day-care center population (except for those receiving antibiotics at the time) was then surveyed, 52 of 146 (36%) children and two of 24 (8%) adult staff had throat cultures positive for group A streptococci . Of the 54 group A streptococcal isolates found during the survey, the three most frequently encountered serotypes were M2,T2/28 (35%), M3,T3/13 (30%), and M-NT, T25 (20%) . Rapid antigen detection was performed at the same time as the throat culture in the first 98 individuals examined during the culture survey but was positive in only 11 (35%) of 31 individuals with positive throat cultures . Sensitivity of the rapid antigen test was related to degree of positivity of the throat culture but not to age . The overall group A streptococcal positivity rate was 49% for 187 children and 33% for 27 adult staff; 18 of 66 (27%) children younger than 31/2 years of age were found to have group A streptococci in their upper respiratory tracts . This is the first report of high prevalence rates of group A streptococci associated with upper respiratory tract infections in a day-care center . The group A Streptococcus may represent a significant upper respiratory tract pathogen in the day-care setting.

Br J Clin Pract, 1989 Mar, 43(3), 94 - 6
Spiramycin versus penicillin V in the empiric treatment of bacterial tonsillitis; Manolopoulos L et al.; The efficacy and safety of spiramycin were compared with those of penicillin V in the treatment of 55 patients with acute bacterial tonsillitis . The most frequently isolated pathogens were streptococci and about one-third were group A/beta haemolytic streptococci . There was one clinical failure in the patients treated with penicillin, and none with spiramycin . No side effects were reported in either of the treatment groups . Thus in this study, spiramycin proved to be equivalent to penicillin in the treatment of acute bacterial tonsillitis in adults.

Am J Dis Child, 1989 Mar, 143(3), 343 - 7
Prostaglandin E1 selectively reduces group B beta-hemolytic streptococci-induced pulmonary hypertension in newborn piglets; Hammerman C et al.; Group B beta-hemolytic streptococci (GBS)-induced pulmonary hypertension was generated in ten newborn piglets . Intravenous infusions of either prostaglandin E1 (PGE1) (n = 5) or placebo (n = 5) were begun after 60 minutes of stable pulmonary hypertension . The effects of these interventions on cardiopulmonary hemodynamics were studied . Pulmonary artery pressure (PAP) increased similarly in both groups during the first 60 minutes of GBS infusion . By two hours after intervention, PAP was significantly lower in the animals given PGE1 (20 +/- 4 vs 32 +/- 5 mm Hg for PGE1 vs placebo) . The ratio of pulmonary to systemic vascular resistance followed a pattern analogous to PAP, increasing with the GBS infusion, indicating selective pulmonary vasoconstriction . The pulmonary vascular resistance/systemic vascular resistance ratio decreased after intervention in the group given PGE1 only (0.25 +/- 0.08 vs 0.50 +/- 0.12 for PGE1 vs placebo), indicating selective pulmonary vasodilation . Transient systemic hypotension was noted at one hour after initiation of PGE1 infusion . Prostaglandin E1 infusion selectively improved GBS-induced pulmonary hypertension and hypoxemia in newborn piglets with only transient systemic hypotension.

Mol Microbiol, 1989 Mar, 3(3), 319 - 27
Protein G genes: structure and distribution of IgG-binding and albumin-binding domains; Sjobring U et al.; Protein G (also designated Fc receptor type III) is the IgG-binding protein of group C and G streptococci . Protein G has also been shown to bind human serum albumin but at a site that is structurally separated from the IgG-binding region . From the known gene sequence of protein G, two synthetic oligonucleotides were constructed for use as probes in DNA-hybridization experiments to study the structure and distribution of the albumin- and IgG-binding regions in bacterial strains belonging to different species . Thus, one of the probes corresponded to repeats within the IgG-binding region (I) and the other corresponded to repeats in the albumin-binding encoding region (II) . Probe I showed strong hybridization to DNA isolated from 31 human group C and G strains, whereas hybridization to probe II was variable . With the three restriction endonucleases used, three restriction patterns were found in Southern blot experiments . No fundamental difference could be detected in hybridization experiments, either between strains of group C and G streptococci, or between isolates of different clinical origin . No hybridization to DNA from other bacterial species was found.

J Biol Chem, 1989 Feb 15, 264(5), 2957 - 62
Serine and tyrosine protein kinase activities in Streptococcus pyogenes . Phosphorylation of native and synthetic peptides of streptococcal M proteins; Chiang TM et al.; Two forms of protein kinase activity were isolated from crude extracts of Streptococcus pyogenes and partially purified by ion exchange chromatography and affinity chromatography . The phosphorylation activities were shown to be insensitive to cAMP, required the presence of divalent cations, and eluted from a Sephadex G-200 column with approximate molecular masses of 60 and 45 kDa, respectively . Both enzymes were capable of phosphorylating eukaryotic proteins and synthetic polypeptides in addition to endogenous and heterologous prokaryotic proteins at serine and tyrosine residues . Firm evidence for tyrosine kinase activity was obtained by the use of a tyrosine kinase-specific substrate, a 4:1 glutamate:tyrosine copolymer . Both protein kinases phosphorylated HPr, a phosphocarrier protein of the phosphotransferase system isolated from S . pyogenes and Bacillus stearothermophilus, but failed to phosphorylate HPr isolated from Escherichia coli . Both also phosphorylated a native polypeptide fragment (pep M24) as well as synthetic peptide copies of M protein, the major virulence determinant of group A streptococci . These results indicate that prokaryotic protein kinases are capable of phosphorylating eukaryotic proteins and suggest that the protein kinases of streptococci may play an important role not only in the phosphotransferase system but also in the virulence properties of these organisms.

Biochem Biophys Res Commun, 1989 Feb 15, 158(3), 803 - 10
Serine and tyrosine phosphorylation of 28- and 35-kDa proteins of human T lymphocytes stimulated by streptococcal M protein; Kotb M et al.; Purified polypeptide fragments of certain surface M proteins of group A streptococci stimulate blastogenesis and the differentiation of cytotoxic T lymphocytes of normal human lymphocytes . The biochemical basis of lymphocyte stimulation by a type M5 protein polypeptide fragment (pep M5) was investigated . Optimal blastogenic doses of pep M5 or phytohemagglutinin stimulated the phosphorylation of several cellular proteins . However, pep M5 but not phytohemagglutinin induced the phosphorylation of 28- and 35-kDa proteins . The 28-kDa protein was shown to be phosphorylated only at serine residues, whereas the 35-kDa protein was phosphorylated only at tyrosine residues . Stimulation of peripheral blood lymphocytes with pep M5 caused a two-fold increase in the CD8+ and CD4+ 4B4+ subpopulations of T lymphocytes . The phosphorylation of the 28-kDa protein appeared to be confined to the CD4+ T cell subpopulation.

N Z Med J, 1989 Feb 8, 102(861), 33 - 6
Infective endocarditis in a racially mixed community: a 10 year review of 78 cases; Peat EB et al.; Over a 10 year period, 78 cases of infective endocarditis were seen at a general hospital serving a multiracial community . There was a bimodal distribution by age and by race . Rheumatic heart disease was a predisposing factor in 45% of cases and was particularly common in young Polynesians . Only eight patients had undergone procedures which might have caused bacteraemia . Most cases were due to streptococci (67%) or staphylococci (27%) . Eighteen of 78 patients (23%) died in hospital, usually as a result of overwhelming sepsis or neurological complications . The 60 discharged have been followed for an average of almost three years . There have been 11 deaths but only two related to the previous endocarditis . Three of 41 patients infected with viridans streptococci died . There were no relapses and only one microbiological failure due to these organisms . All 14 patients with viridans streptococcal endocarditis treated with combined therapy for two weeks were cured . Ten of 16 cases of Staph aureus endocarditis were fatal . All but one involved the left side of the heart . The series included no intravenous drug abusers . Sixteen cases of endocarditis involved prosthetic valves and in this group the mortality, frequency of complications and need for surgery were significantly more frequent than in those with native valve infection.

J Trop Med Hyg, 1989 Feb, 92(1), 35 - 8
Importance of group G streptococci in human pyogenic infections; Brahmadathan KN et al.; Streptococci that belong to groups other than A are involved in a variety of human infections . In the present study, we report the pyogenic infections associated with group G streptococci (GGS), observed at the Christian Medical College Hospital, Vellore, Tamil Nadu, India . Of 2314 beta-haemolytic streptococci isolated from 31,857 pus specimens processed during the period 1975-1986, GGS accounted for 338 (14.6%) . Twelve of these were grown in pure culture . The clinical conditions associated with them included pyogenic arthritis, osteomyelitis, paravertebral sinus and an abdominal burst . Clinical analysis of 99 of 125 patients with GGS, grown in mixture with another organism or skin contaminants, showed that 59% of them were from surgical wound infections, diabetic lesions or wound infections in leprosy patients . Surgical management and antibiotic treatment resulted in full recovery of these clinical conditions.

J Clin Microbiol, 1989 Feb, 27(2), 309 - 12
Rapid detection of group C streptococci from animals by latex agglutination; Inzana TJ et al.; A group C latex agglutination reagent, included as the negative control in the PathoDx Strep A latex agglutination test (Diagnostic Products Corp., Los Angeles, Calif), was compared with culture for rapid detection of group C streptococci (Streptococcus equi, S . equisimilis, S . zooepidemicus, and S . dysgalactiae) from swabs of veterinary specimens . The overall sensitivity of the latex test was 78%, and specificity was 97.6% . Only 25% of S . dysgalactiae isolates were detected, thereby accounting for the relatively low sensitivity . Ninety-three percent of the group C streptococci other than S . dysgalactiae were isolated from horses . When the latex test was evaluated for detection of group C streptococci other than S . dysgalactiae from horses, the sensitivity and specificity were 95.3 and 100%, respectively . We found the group C latex agglutination test to be a rapid and accurate method for the detection of the major pathogenic group C streptococci from swabs of equine specimens.

Infect Immun, 1989 Feb, 57(2), 331 - 7
Isolation of a corncob (coaggregation) receptor polypeptide from Fusobacterium nucleatum; Kaufman J et al.; Corncobs, which are distinct morphological units formed by the ordered coaggregation of a filamentous microorganism and streptococci, can be made in vitro by using oral strains of Fusobacterium nucleatum and Streptococcus sanguis . Previous studies have shown that strains of F . nucleatum contain one of at least two different types of corncob receptor . The objective of this study was to isolate the receptor from F . nucleatum ATCC 10953 as the first step in the elucidation of the molecular basis of corncob formation . The cell envelope fraction from this bacterium was treated with trypsin, delipidated with chloroform-methanol, and subjected to ion-exchange chromatography . A single polypeptide (apparent Mr, 39,500), which was eluted from the column with 0.5 M sodium chloride and extracted with dodecyltrimethylammonium bromide to remove contaminating lipopolysaccharide, inhibited corncob formation between strain ATCC 10953 and S . sanguis CC5A . Similarly derived cell fractions from either F . nucleatum FDC 364 or Fusobacterium necrophorum failed to effect coaggregation in the inhibition assay . Amino acid analysis of the polypeptide showed a moderately hydrophobic character (polarity index, 41) and 11% basic residues . Antiserum made against the purified polypeptide agglutinated F . nucleatum ATCC 10953, neutralized the ability of this bacterium to form corncobs, and agglutinated whole cells of S . sanguis CC5A that were precoated with the receptor polypeptide . The identification and isolation of this receptor should greatly enhance our ability to define some of the complex intergeneric coaggregation mechanisms that are thought to occur in the human oral cavity.

Mol Microbiol, 1989 Feb, 3(2), 239 - 47
Receptor for IgA in group A streptococci: cloning of the gene and characterization of the protein expressed in Escherichia coli; Lindahl G et al.; The gene for an IgA-binding protein from a group A streptococcal strain was cloned and expressed in Escherichia coli . The IgA-binding protein, called protein Arp, was purified on IgA-Sepharose, allowing complete purification in a single step . Analysis of protein Arp by Western immunoblotting demonstrated a major IgA-binding band, with an apparent molecular weight of 42 kD . The purified protein was shown to bind serum IgA and secretory IgA, as well as monoclonal IgA of both subclasses . There was no binding to IgM, IgD or IgE, but a weak binding to IgG . Inhibition experiments with whole bacteria indicated that IgA and IgG bind at separate sites . Experiments with immunoglobulin fragments showed that protein Arp binds to the Fc region of both IgA and IgG . The equilibrium constant of the reaction between protein Arp and polyclonal human IgA was determined to be 5.6 x 10(8) M-1 . Amino acid sequencing of protein Arp demonstrated a direct repeat of 7 amino acids in the NH2-terminal region, a feature previously found in several streptococcal M proteins . This suggests that protein Arp, like M proteins, may be a streptococcal virulence factor.

Mol Microbiol, 1989 Feb, 3(2), 197 - 205
The streptokinase gene of group A streptococci: cloning, expression in Escherichia coli, and sequence analysis; Huang TT et al.; The gene specifying the group A streptokinase (ska) gene was cloned from an M type 49 strain of Streptococcus pyogenes and shown to express in Escherichia coli . The nucleotide sequence of the DNA fragment carrying ska was determined and compared to that of the group C streptokinase gene (skc) . There is 90% sequence identity between the two genes, with highly conserved transcription and translation control regions . The deduced amino acid sequence of the group A streptokinase (SKA) contains the same number of amino acids as that of group C streptokinase, with 85% sequence identity between the two proteins . Among 440 amino acid residues specified by the coding sequence, there are 62 non-identical residues with 45 conserved and 17 non-conserved residues . The non-identical residues are located in two major regions, spanning residues 174 to 244 and 270 to 290, with 40 and 10 amino acid changes, respectively . The sequence differences provide an explanation at the molecular level for the previous findings of immunological and chemical heterogeneity among streptokinase produced by pathogenic streptococci.

J Chemother, 1989 Feb, 1(1), 35 - 8
Clinical and microbiological evaluation of miocamycin activity against group A beta-hemolytic streptococci in pediatric patients . Three years' incidence of erythromycin-resistant group A streptococci; Borzani M et al.; The authors have evaluated the incidence of Group A streptococci, and the prevalence of erythromycin-resistant strains in the years 1985/86/87 at the I.C.P . of Milan . The minimum inhibitory concentrations (MICs) for erythromycin, penicillin and miocamycin of 40 erythromycin-resistant strains were also studied (MIC50-MIC90 = 4.5-8, 0.015-0.015, 0.041-0.186 micrograms/ml respectively) . A clinical trial with miocamycin vs . erythromycin in the elimination of Group A streptococci (67 patients) showed good and comparable efficacy for both the antibiotics.

FEMS Microbiol Lett, 1989 Feb, 48(3), 329 - 33
Conjugative co-transfer of penicillin tolerance and high-level resistance to kanamycin in group A streptococci; Lakshmi TM et al.; To understand further the association between high-level resistance to kanamycin and penicillin tolerance in group A streptococci, high-level resistance to kanamycin was transferred from a penicillin-tolerant group A streptococcal strain possessing a high-level resistance to kanamycin to a penicillin non-tolerant, kanamycin-susceptible group A streptococcal strain and transconjugants were examined for penicillin tolerance . Transfer of high-level resistance to kanamycin occurred at a frequency of 10(-6) . Transconjugants carrying high-level resistance to kanamycin exhibited characteristics of penicillin tolerance . These findings suggest that the genetic basis for penicillin tolerance is related to that for high-level resistance to kanamycin in group A streptococci . Further studies are needed to characterize the transferable genetic element(s).

Clin Invest Med, 1989 Feb, 12(1), 44 - 9
The role of fluoroquinolones in the management of skin, soft tissue, and bone infections; Fong IW; The fluoroquinolones are a group of potent antimicrobials with marked in vitro activity against gram negative bacteria and, to a lesser extent, staphylococci . Their major advantages include the availability of oral preparations, relative safety, and excellent tissue penetration . Controlled clinical studies have shown that the oral quinolones are as effective as cephalexin in mild skin and soft tissue infections, and that ciprofloxacin is as effective as cefotaxime in more severe infections . Uncontrolled studies chiefly with ciprofloxacin in patients with acute and chronic osteomyelitis with staphylococci and gram negative bacteria have resulted in cure rates of 60-85% . The quinolones offer definite advances in the management of gram negative osteomyelitis and could be substituted for the aminoglycosides or third generation cephalosporins in nosocomial soft tissue infections . However, the quinolones offer no advantage over standard therapy for mild skin and soft tissue infections, particularly those caused by streptococci or methicillin-sensitive staphylococci . Development of resistant mutants may become a problem with indiscriminate use of these agents.

Epidemiol Infect, 1989 Feb, 102(1), 85 - 91
A community outbreak of group A beta haemolytic streptococci with transferable resistance to erythromycin; Scott RJ et al.; Erythromycin resistance amongst group A streptococci (GAS) in Great Britain is a relatively rare occurrence and outbreaks have been sporadically reported . Over an 8-month period in 1986 ten associated cases occurred in the town of Bridgewater in Somerset . Isolates were group A, type M4 and resistant to erythromycin (MIC 8 mg/l) but sensitive to lincomycin and clindamycin . Erythromycin resistance was transferable from all isolates to a group A recipient strain . No plasmid DNA could be detected in the original isolates or transconjugants.

J Am Acad Dermatol, 1989 Feb, 20(2 Pt 1), 302 - 10
Alexander Ogston, micrococci, and Joseph Lister; Lyell A; This paper recalls the notable achievement, in 1880, of Alexander Ogston, a surgeon who, seeking the cause of suppuration, showed that acute abscesses result from micrococci . There were two kinds . One, arranged in chains, had been called streptococci already; the other, in clumps, he named staphylococci . He injected micrococci into animals . If blood poisoning occurred in them, it followed localized tissue infection . This information, applied to surgical events, suggested that the "hospital diseases" were a sequel to wound suppuration and explained why antiseptic surgery controlled both conditions . Ogston's observations are now common knowledge, but Lister rejected them . It is suggested he did so because he relied on intuition rather than experiment . The scene is set for Lister and Ogston's discoveries by a review of the historical background . Patients subjected to surgery faced a terrible ordeal and a very real chance of death from the mysterious hospital diseases . Surgeons viewed the mortality with bland detachment, blaming fate . But Simpson and Semmelweis were deeply concerned . However, puerperal fever was regarded as entirely distinct from the hospital diseases, and neither condition connected in any way with suppuration in wounds . Simpson, Semmelweis, Lister, and Ogston all found their ideas scorned by members of the profession, which may have feared being held responsible for deaths . Ogston's achievement lives on, but he has been forgotten . We should remember him.

Chest, 1989 Feb, 95(2), 359 - 63
Streptococcal tonsillitis and acute nonrheumatic myopericarditis; Karjalainen J; Two young men with streptococcal tonsillitis had acute myopericarditis mimicking myocardial infarction . Subsequently, 264 consecutive army conscripts hospitalized with a fever and sore throat underwent throat cultures . Group A streptococci were found in 84 patients . When these patients were systematically screened by serial electrocardiography for myocarditis, one case of probable asymptomatic myocarditis was diagnosed . None had signs of acute rheumatic fever . All three patients received penicillin therapy when the signs of myocarditis appeared . Their recovery was good.

Infect Immun, 1989 Feb, 57(2), 502 - 6
Heterogeneity of the streptokinase gene in group A streptococci; Huang TT et al.; A molecular epidemiological study was conducted to determine the distribution of the streptokinase gene in group A streptococcal strains of different M types and in other streptococcal species . Plasmid pNC1, containing only the internal coding sequence of the streptokinase gene from group C streptococcal strain H46A, was used as a DNA probe in colony and Southern hybridization experiments . Only the pathogenic group A, C, and G streptococci contained a streptokinase gene; 12 other Lancefield group strains did not . A total of 134 group A strains, including 61 M types and 6 T types, were tested . Although only 62% (83 of 134) of the strains tested showed positive streptokinase activity by the casein-plasminogen overlay assay, all strains contained the streptokinase gene as evidenced by strong hybridization with the pNC1 probe . Southern blot DNA hybridizations were carried out with 101 strains of group A streptococci . The restriction enzymes HindIII and HaeIII were used to digest the genomic DNA . Six hybridization patterns were observed after HindIII digestion . Double hybridization bands appeared in all of the patterns, which indicated the existence of a highly conserved HindIII site . More complex hybridization results were obtained after HaeIII digestion . Twelve hybridization patterns were observed; three were characterized by a single hybridization band, and nine were characterized by double bands . Variations in hybridization patterns were observed in strains of both the same and different serotypes . The overall results at the gene level indicate that there is considerable heterogeneity among the streptokinases of group A streptococci, consistent with previous findings of immunological and chemical differences among streptokinases of group A streptococci.

J Clin Microbiol, 1989 Feb, 27(2), 274 - 8
Genetic diversity within Streptococcus mutans evident from chromosomal DNA restriction fragment polymorphisms; Caufield PW et al.; Attempts to study the acquisition, transmission, and other aspects of the natural history of Streptococcus mutans infections in humans have been hampered by limitations and inconsistencies in methods by which phenotypic characteristics of individual isolates are examined . Because most mutans streptococci associated with human dental caries fall within the biotype I (serotypes c and f) grouping, designated S . mutans, these typing methods are of little value in distinguishing individual isolates . Here we show that strains of S . mutans obtained from over 30 individuals demonstrate unique "fingerprints" of chromosomal DNA digested with restriction endonuclease HaeIII . To demonstrate that this polymorphism in restriction fragments can be used to study the acquisition and transmission of this organism, we examined isolates of S . mutans from three mother-infant pairs obtained at the time the infant first became colonized by this organism . Results indicate that strains of S . mutans found in infants exhibit restriction fragment profiles identical to those of their mothers, strongly supporting the notion that mothers transmit this organism to their infants . Also, we show that strains of S . mutans with the same restriction fragment profile were stably maintained over a 3-year interval in the one mother-infant pair studied . Moreover, we found that mothers and their infants harbored only a few individual strains, suggesting that transmission of this organism is probably confined within discrete family cohorts . Collectively, these findings demonstrate the potential utility of genomic fingerprinting in studying the natural history of S . mutans infections in humans.

J Immunol, 1989 Feb 1, 142(3), 966 - 70
Cellular and biochemical responses of human T lymphocytes stimulated with streptococcal M proteins; Kotb M et al.; Purified group A streptococcal M proteins, pep M5 and pep M6, bearing heart cross-reactive epitopes were compared with pep M24, which lacks such epitopes, in their ability to induce functional differentiation of human T lymphocytes . Lymphocytes activated by pep M5 and pep M6 demonstrated cytotoxic activity against cultured heart cells, whereas pep M24-activated cells differentiated into suppressor T cells, which specifically blocked cytotoxic T lymphocytes against cultured human myocardial cells and not NK cell activity against K562 cells . Pep M5 and not pep M24 induced an increase in the number of CD4, 4B4, helper/inducer T cells . In addition, these M proteins appear to induce different biochemical changes in T lymphocytes . Both pep M5 and pep M24 induced the phosphorylation of a 35-kDa cytoplasmic protein; however, only pep M5 induced the phosphorylation of a 28-kDa membrane protein, primarily in CD4 T cells . These data indicate that the virulent M protein Ag of group A streptococci may exert their effect on the human immune system via different mechanisms . Determining these mechanisms and the biochemical pathways involved in T cell differentiation triggered by these Ag may be important in understanding the pathogenesis of post-streptococcal diseases.

FEMS Microbiol Lett, 1989 Feb, 48(3), 349 - 52
A new simple method of curing plasmids in lactic streptococci (Streptococcus cremoris; Streptococcus lactis, plasmids); Sinha RP; A simple method for curing plasmid DNA from lactic streptococci is described . When strains of lactic streptococci are grown overnight at 32 degrees C in an unbuffered medium (M17-) and held at the same temperature for an extended period (96 h), the acid environment induces loss of plasmid DNA of different sizes . If the process of growth in M17- broth followed by extended incubation at 32 degrees C is repeated, most of the plasmids are lost, as revealed by gel electrophoretic profiles of DNA . The method is simple and efficient in curing plasmids of lactic streptococci without use of any mutagenic chemical.

Infect Immun, 1989 Feb, 57(2), 507 - 12
Effects of interleukin-1, lipopolysaccharide, and streptococci on procoagulant activity of cultured human cardiac valve endothelial and stromal cells; Drake TA et al.; Fibrin is the primary constituent of the vegetation in infective endocarditis, and tissue factor expression is a major mechanism of coagulation activation on infected valves . To determine which cells may participate in coagulation activation in this setting, expression of procoagulant activity (PCA; shown to be tissue factor) was studied in cultured endothelial and stromal cells derived from human cardiac valves . Endothelial cells had negligible PCA (99 +/- 50 mU/10(5) cells, mean +/- 1 standard deviation) unless stimulated by lipopolysaccharide or interleukin-1, which increased PCA to 5,592 +/- 1,482 and 5,901 +/- 1,497 mU/10(5) cells, respectively, in 6 h . Incubation of cells with viable enterococci or viridans streptococci or with an enterococcal cell wall preparation did not induce PCA . Cultured valve stromal cells constitutively expressed high levels of PCA (14,276 +/- 8,738 mU/10(5) cells) which was not changed with exposure to interleukin-1 . PCAs of stromal or stimulated endothelial cells from valves of both right and left sides of the heart were comparable . The results suggest that endothelial cells may contribute to fibrin deposition during infection if stimulated, but PCA is not directly induced by bacteria . Stromal cells could contribute PCA if exposed to blood in the course of valve injury.

Infect Immun, 1989 Feb, 57(2), 384 - 9
Hemagglutination activities of group B, C, D, and G streptococci: demonstration of novel sugar-specific cell-binding activities in Streptococcus suis; Kurl DN et al.; A total of 378 streptococcal isolates of Lancefield groups B, C, D and G were tested for their ability to hemagglutinate untreated, sialidase-treated, and endo-beta-galactosidase-treated human erythrocytes . Of the 43 strains showing positive hemagglutination, 9 were inhibitable with neutral monosaccharides . Four strains were inhibited with galactose and N-acetylgalactosamine, whereas five were inhibited with galactose only . A third, sialic acid-specific adhesion activity was suggested for two additional strains on the basis of their agglutination of native and endo-beta-galactosidase-treated but not sialidase-treated erythrocytes . All the sugar-specific agglutination activities detected were confined to Streptococcus suis strains of group D streptococci, whereas streptococci of other groups did not exhibit these types of hemagglutination activities . The adhesins were sensitive to proteases and heat treatment, which indicates that they were proteins . The hemagglutinating isolates of S . suis originated from pig brain and lung, human brain, and the tonsils of healthy pigs . No clear correlation with a particular serotype was observed . These results demonstrate the occurrence of unique sugar-specific adherence activities in S . suis, an important pig pathogen with occasional human pathogenicity.

Nature, 1989 Jan 26, 337(6205), 385 - 6
Bacterial growth blocked by a synthetic peptide based on the structure of a human proteinase inhibitor; Bjorck L et al.; Cysteine proteinases are important not only in the intracellular catabolism of peptides and proteins and in the processing of prohormones and proenzymes, but also in the penetration of normal human tissue by malignant cells and possibly microorganisms, including viruses . Cystatin C is a human cysteine proteinase inhibitor present in extracellular fluids . We have synthesized peptide derivatives mimicking the proposed proteinase-binding centre of cystatin C and find that they irreversibly inhibit cysteine proteinases . Several bacteria produce proteinases, so we tested a tripeptide derivative (Z-LVG-CHN2) for in vitro anti-bacterial activity against a large number of bacterial strains belonging to thirteen different species . It was found to inhibit specifically the growth of all strains of group A streptococci . The susceptibility of these human pathogens to the peptide was compared with that to well-established anti-streptococcal antibiotics such as tetracycline and bacitracin . Moreover, the peptide was active in vivo against group A streptococci: mice injected with lethal doses of these bacteria were cured by a single injection of Z-LVG-CHN2 . The cysteine proteinase produced by group A streptococci was isolated and found to be inhibited by Z-LVG-CHN2; moreover, excess proteinase relieved the growth inhibition caused by the peptide derivative, suggesting that the antibacterial activity of Z-LVG-CHN2 is due to inhibition of this cysteine proteinase . This strategy of blocking proteinases with peptide derivatives that mimic naturally occurring inhibitors could be useful in the construction of new agents against other microorganisms, including viruses.

J Clin Pathol, 1989 Jan, 42(1), 77 - 80
Tolerance to penicillin in streptococci of viridans group; Powley L et al.; Tolerance to penicillin was investigated in 40 isolates of optochin-resistant, alpha-haemolytic streptococci . Thirteen strains exhibited tolerance to penicillin (MBC:MIC ratio greater than or equal to 32) when stationary phase inocula were used, but only seven strains retained the tolerance phenotype in experiments with logarithmic phase inocula . There was a striking association between tolerance and Eagle's optimum dosage effect, particularly among strains that displayed tolerance in both the stationary and the logarithmic growth phases . Sequential viable counts on representative strains showed that reliance on the arbitrary criterion of bactericidal activity of 99.9% reduction of the original inoculum after 24 hours' exposure may occasionally lead to difficulties in the recognition of penicillin tolerance . In general, however, the 99.9% killing criterion provided a useful discriminator between strains that were rapidly killed by penicillin and those (tolerant strains) in which the bactericidal activity was much reduced.

Head Neck, 1989 Jan-Feb, 11(1), 27 - 9
Role of aerobic gram-negative rods, anaerobes, and fungi in wound infection after head and neck surgery: implications for antibiotic prophylaxis; Johnson JT et al.; The prevention of wound infection after major contaminated head and neck surgery is a critical issue for the head and neck surgeon . The proper interpretation of cultures taken from wounds is uncertain . Multiple organisms are invariably isolated from this nonsterile site including indigenous aerobic and anaerobic flora, aerobic gram-negative rods, and fungi . We present evidence from controlled antibiotic trials that demonstrate the pathogenicity of oropharyngeal anaerobic flora . The presence of aerobic gram-negative rods and fungi generally represent colonization and antibiotic coverage need not routinely be directed at these organisms . On the other hand, the antibacterial spectrum of an agent used for head and neck would prophylaxis should include coverage for pathogenic oral flora, namely the gram-positive aerobic cocci (especially streptococci) and anaerobic bacteria.

Caries Res, 1989, 23(1), 14 - 7
Acidogenesis by oral streptococci at different pH values; de Soet JJ et al.; Streptococcus mutans is known to be one of the most cariogenic oral microorganisms . Recently, organisms classified as S . mutans have been shown to be genotypically heterogeneous and to form at least six separate species . In this study, differences in acid production between the mutans streptococci and Streptococcus sanguis were investigated at pH values from 5.0 to 7.0 . While all of the species investigated were able to produce acids, Streptococcus sobrinus was found to be significantly more acidogenic than the others . S . sobrinus was capable of sustained acid production at pH levels below 6.0, while acid production by other species ceased or was strongly inhibited . These results indicate that S . sobrinus deserves more attention as a potentially cariogenic microorganism.

Rev Infect Dis, 1989 Jan-Feb, 11(1), 86 - 8
Neonatal meningitis due to Streptococcus mitis; Bignardi GE et al.; A baby girl became ill 2 days after a normal delivery . Streptococcus mitis was isolated from the cerebrospinal fluid, and she recovered uneventfully on treatment with penicillin and, for the first 2 days, netilmicin . The organism was penicillin-tolerant in vitro . Non-groupable alpha-hemolytic streptococci are an uncommon cause of meningitis; three cases have been ascribed to S . mitis.

Indian J Med Res, 1989 Jan, 89, 16 - 23
Speciation of viridans streptococci & their significance in human infections; Joag SV et al.; Sixty strains of viridans streptococci recovered, from various infections, encountered in a large referral Hospital in Tamil Nadu (south India) from December 1983 to May 1985 were characterised by conventional tests . Of these, 57 (95%) belonged to four species viz., Sanguis II, Mitis, Intermedius and Constellatus . Of the 40 strains that were assessed for their clinical significance, 23 (57.5%) were found to be either significant or of suggestive significance . The study suggested viridans streptococci are not particularly virulent pathogens . But local/systemic factors were found to predispose the subjects to this infection.

Schweiz Monatsschr Zahnmed, 1989, 99(1), 13 - 8
{Microbiologic in vitro comparison of plaque-inhibiting mouthwashes}; Altenhofen E et al.; The colonization on rat molars of S . sobrinus OMZ 176, S . mutans OMZ 376, or a combination S . sanguis OMZ 9 and S . sobrinus OMZ 176 after a short exposition to various fluoride solutions and disinfectants was tested in vitro . The test solutions included Act, Candida, Veadent, sodium fluoride, amine fluoride, stannous fluoride, zinc fluoride hexetidine, stannous fluoride/amine fluoride solutions, chlorhexidine and water . The sterilized rat molars were immersed in the above test solutions for 60 seconds, then incubated with streptococci in broth for 8 hours, again dipped into the same test solutions for 60 seconds and reincubated for an additional 30 hours . The streptococcal suspension contained 14C labelled sucrose solutions . The deposits on the molars were dissolved in 6N potassium hydroxide during 16 hours . Finally, the beta rays emitted by the dissolved radiolabelled suspension were counted using a scintillation counter . The sodium fluoride containing solutions exerted no or a very limited effect on the bacterial deposits . In contrast to the other test solutions, sanguinaria extract (Veadent mouth rinse) mildly inhibited the S . sobrinus and S . mutans deposits, but plaque formation by the combination of streptococci was not hampered . Zinc fluoride/hexetidine, amine fluoride and stannous fluoride/amine fluoride solutions had a distinct and significant inhibitory effect on S . sobrinus and S . mutans deposits, but only a weak effect when mixed cultures were used for plaque formation . Chlorhexidine significantly inhibited the deposits of the three bacterial strains used in these experiments.

J Clin Microbiol, 1989 Jan, 27(1), 207 - 9
Enzymatic extraction and spectral analysis of the chromophore from cell walls of nutritionally deficient streptococci; Stein DS et al.; We demonstrated by spectral analysis a method to enzymatically cleave the chromophore precursor from nutritionally deficient streptococcal cell walls by treatment with lysozyme . The peak absorbances without and with lysozyme pretreatment were 511.4 +/- 2.02 nm and 513.1 +/- 0.69 nm, respectively . Extraction yields varied among strains and were found to be growth phase dependent . A secondary peak of absorbance (mean of 477 nm) was found in only five of eight strains . The chromophore at a neutral pH undergoes a reaction with phenol consistent with that of a furan, indicating its carbohydrate composition.

J Dent Res, 1989 Jan, 68(1), 16 - 9
Difference in amounts between titratable acid and total carboxylic acids produced by oral streptococci during sugar metabolism; Iwami Y et al.; The acid produced by the resting cells of Streptococcus mutants NCTC 10449 and HS 6 and S . sanguis ATCC 10556 during sugar metabolism was estimated with a pH-stat and a carboxylic acid analyzer . Lactic, formic, acetic, pyruvic, and carbonic acids were detected in the reaction mixtures, but propionic, citric, succinic, iso-butyric, butyric, iso-valeric, and valeric acids were not detected . The amount of titratable acid estimated by alkaline titration with the pH-stat was larger than the amount of total carboxylic acids estimated with the carboxylic acid analyzer . The difference in quantity between the titratable and the total carboxylic acids increased significantly with an increase in the period of incubation with sugar . Moreover, the value of the alkaline titration of standard lactic, formic, acetic, and pyruvic acids was equal to the amount analyzed with the carboxylic acid analyzer . The results indicated that these two streptococci produced not only these carboxylic acids but also other acid(s), possibly non-carboxylic acid(s), during their sugar metabolism.

Pediatrics, 1989 Jan, 83(1), 79 - 85
Ureaplasmal pneumonia and sepsis associated with persistent pulmonary hypertension of the newborn; Waites KB et al.; Ureaplasma urealyticum was isolated from the lower respiratory tract of three infants with persistent pulmonary hypertension of the newborn . In one, cultures positive for U urealyticum were obtained on multiple occasions from trachea, blood, and pleural fluid prior to the infant's death on postnatal day 6 . Autopsy findings confirmed the presence of severe pneumonia and the organism was again recovered from multiple sites . A second infant had no apparent predisposing factors for development of persistent pulmonary hypertension of the newborn but U urealyticum and Staphylococcus epidermidis were recovered from the trachea antemortem and from lung tissue obtained during autopsy on the 12th postnatal day . The third infant had persistent pulmonary hypertension of the newborn and a pulmonary infiltrate within hours after birth with tracheal cultures positive for both U urealyticum and Mycoplasma hominis . Erythromycin was given for ten days, and the infant gradually improved . Prolonged ventilation with supplemental oxygen was necessary, and chronic lung disease developed . This is the first report of neonatal ureaplasmal pneumonia with sepsis and persistent pulmonary hypertension of the newborn as well as the first time a microorganism other than streptococci has been specifically implicated in the pathogenesis of persistent pulmonary hypertension of the newborn . Respiratory infections with U urealyticum or other bacteria should be considered as possible causative or contributory factors in infants with persistent pulmonary hypertension of the newborn.

Tierarztl Prax, 1989, 17(3), 263 - 6
{Lincomycin therapy of streptococcal and staphylococcal mastitis in cattle}; Staudacher G et al.; Lincomycin has a good influence on mastitis caused by gram positive bacteria especially streptococci and staphylococci . Applied parenterally lincomycin is very toxic . Therefore it is not a regular therapeutic drug . The tubes for intramammary application are completely non-toxic . Lincomycin is very useful for treating dairy herds with galt mastitis.

Ann Chir Gynaecol, 1989, 78(2), 153 - 4
Surgical scarlet fever; Gote H et al.; A case of surgical scarlet fever is described in a 57-year-old woman . Identification of beta-haemolytic streptococci and treatment with penicillin is essential to prevent spread of surgical scarlatina.

Chemotherapy, 1989, 35(5), 355 - 9
Susceptibilities to ceftriaxone of streptococcal strains associated with infective endocarditis; Etienne J et al.; We determined the bactericidal activity of ceftriaxone on 20 streptococci isolated from patients with infective endocarditis and that of penicillin G on 5 strains . The MICs of ceftriaxone were less than or equal to 2 micrograms/ml and the MBCs were low for 5 nontolerant strains (less than or equal to 2 micrograms/ml) and high for 15 tolerant strains (greater than or equal to 16 micrograms/ml) . The maximal reduction of the viable bacterial counts after 24 h of exposure to antibiotic was achieved for a concentration of ceftriaxone of 4, 32 and 256 micrograms/ml, respectively for 5, 10 and 19 strains . The activity of penicillin G was similar.

Med Microbiol Immunol (Berl), 1989, 178(2), 69 - 79
Growth and adsorption of Streptococcus mutans 6715-13 to hydroxyapatite in the presence of lactoferrin; Visca P et al.; The growth of Streptococcus mutans 6715-13 in a rich medium (Todd Hewitt broth) was drastically reduced by addition of apo-lactoferrin (apo-Lf); this effect was bacteriostatic and reversible by saturation of Lf with iron . The influence of Lf, salivary proteins (SP) and bovine serum albumin (BSA) on the attachment of Streptococcus mutans to hydroxyapatite (HA) was successively investigated . Sorption of Lf, SP, and BSA to HA was dependent on the protein concentration and reached the end-point at about 80 mg of proteins per gram of HA . Similarly, the number of streptococci adsorbed to HA was correlated to the amount of cells available up to at least 10(7) cells per mg of HA . The adsorption of Lf, SP and BSA on HA reduced the number of attaching S . mutans cells . In particular, SP reduced the adsorption of S . mutans by 30%, whereas pre-coating of HA with apo- or iron-saturated Lf resulted in a three orders of magnitude reduction of S . mutans adsorption to HA, as demonstrated by means of different experimental procedures . The powerful adherence-inhibiting effect of apo-Lf together with its noticeable antibacterial activity towards S . mutans points to a biological significance of these phenomena also in vivo.

World J Surg, 1989 Jan-Feb, 13(1), 132 - 6; discussion 136
The surgical treatment of infective endocarditis; Mullany CJ et al.; We have reviewed 108 cases of bacterial endocarditis treated surgically since 1968 . The mean age of the patients was 47.7 +/- 15.6 years (+/- SD) (range, 14-79 yr) . Seventy-seven percent were male . The most common causative organisms were staphylococci (46%), streptococci viridans group (5%), and other streptococci (20%) . Forty-five percent, 25%, and 13% of patients had native aortic valve, native mitral valve, or native double valve (AV/MV) involvement, respectively . Eighteen patients had prosthetic valve endocarditis . No patient underwent surgery for tricuspid valve endocarditis . Seventy-three patients were considered to have active endocarditis (AE) (positive blood or tissue cultures and/or annular abscess) . The 35 remaining patients had healed endocarditis (HE) . Preoperative complications in patients with either AE or HE were stroke (11%, 11%), renal failure (33%, 3%; p less than 0.001), pulmonary edema (83%, 34%; p less than 0.001), anemia (36%, 8%; p less than 0.01), and inotrope dependence (22%, 6%; p less than 0.05) . Hospital mortality for native valve AE was 19.5% (11/56), and for healed endocarditis, 5.7% (2/35) . Independent predictors of hospital mortality were inotrope dependence (p less than 0.001), annular abscess (p less than 0.01), pulmonary edema (p less than 0.01), and staphylococcal infection (p less than 0.05) . The 5-year actuarial survival for operative survivors was 68.4 +/- 7.5% (AE) and 78.3 +/- 9.2% (HE) . We conclude that the operative mortality for patients with continuing sepsis is high and that surgery should be undertaken early in staphylococcal endocarditis . If surgery is successful, then the long-term prognosis is good.

FEMS Microbiol Lett, 1989 Jan 1, 48(1), 97 - 103
Immunological detection of penicillin-binding protein 2' in clinical isolates of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis; O'Hara DM et al.; The additional penicillin-binding protein (PBP 2') that is important in determining intrinsic resistance in methicillin-resistant strains of Staphylococcus aureus (MRSA) has been detected immunologically in strains from a variety of world-wide locations . This additional protein has also been definitively identified both immunologically and as a PBP in methicillin-resistant strains of S . epidermidis (MRSE) . The assay described is rapid, specific and sensitive and has been used to detect PBP 2' in S . haemolyticus but not in beta-lactam resistant Streptococci.

Vestn Akad Med Nauk SSSR, 1989, (11), 59 - 62
{Identification of the gene of type A erythrogenic toxin in strains of group A Streptococcus}; Save'leva IA et al.; The article specifies the mechanisms of toxigenicity in clinical streptococci strains . The production of type A erythrogenic toxin is found to be related to the toxigenicity gene expression localized in moderate bacteriophage genome . The possibility of using DNA probes to assess the degree of toxigenicity is discussed together with the relationship between the toxigenicity and the gene dose.

Vestn Akad Med Nauk SSSR, 1989, (11), 4 - 12
{Comparative aspects of adhesion of group A and B streptococci to human epithelium}; Grabovskaia KB et al.; The international and original research data on the adhesion of group A and B streptococci are over-viewed . Based on the conducted studies, a conclusion has been drawn on the polyfactor pattern of pathogenic streptococci adhesions . The polyfactor pattern of adhesion is manifested in (a) different ranges of tissue sensitivity to streptococci adhesion, (b) a correlation between the adhesiveness and particular phenotypes (M(+)-M-; OF(+)-OF- in group A streptococci, TSA(+)-TSA- in group B streptococci), (c) different sensitivity of adhesives to proteolytic enzymes, and (d) interaction with fibronectin . M-protein was found to be involved in specific pyogenic streptococcal adhesion to the pharyngeal epithelium, which opens up new vistas for the search of approaches to the prevention of mucosal colonization . The participation of lipoteichoic acid (LTA) in group A and B streptococci adhesion in different tissues was shown The involvement of proteins in group B streptococcal adhesion was suggested by indirect evidence, which needs to be confirmed by direct isolation of an adhesive . It is suggested, that different quantitative combinations as well as structural organization of protein complexes and LTA in the streptococcus cell wall may determine the strain and species specificity of pathogenic group A and B streptococci interaction with host tissues.

Vestn Akad Med Nauk SSSR, 1989, (11), 37 - 41
{Streptococcal immunoglobulin Fc receptors as inductors of anti-immunoglobulins}; Koroleva IV et al.; The activity of IgG Fc-receptor was studied in 71 strains of serological group A streptococci isolated from streptococcal infection patients and carriers . The group of practically healthy subjects and those with diseases of non-streptococcal origin were found to have almost identical streptococcal strain distribution for IgG FcR+ and IgG FcR- (42.4 and 57.6 per cent, respectively) . In the strains isolated from streptococcal infection patients, IgG FcR+ strains made up 63.1 per cent . In rabbit immunization, the capacity of IgG FcR-positive strains that were isolated from patients to induce anti-immunoglobulin synthesis was revealed . The induced synthesis of anti-immunoglobulins was noted also in rabbit immunization with purified streptococcal IgG Fc-receptors of M15 streptococcus and rabbit IgG eluated with streptococcal Fc receptors . Possible mechanisms of anti-immunoglobulin synthesis in experimental immunization are discussed.

Vestn Akad Med Nauk SSSR, 1989, (11), 22 - 8
{Clinical and laboratory diagnosis of streptococcal infection}; Beliakov VD et al.; The problems related to the clinical and laboratory diagnosis of streptococcal infection at all levels of health service are analysed . The principles of microbiological streptococcal identification with the aid of express-systems and standard culture techniques are outlined . Particular emphasis is placed upon immunoassay of streptococci using a broad spectrum of extracellular products and antigens of the cell wall of group A streptococcus, and upon methodological approaches to solving certain clinical and diagnostic problems.

Rheumatol Int, 1989, 9(3-5), 229 - 32
Lymphocyte stimulation by cell wall constituents; Emmrich F; T cells recognize peptides in association with self-MHC structures on antigen-presenting cells and become activated upon ligand binding to the T cell receptor . It is not known whether T cells are also able to recognize carbohydrate antigens . As a model system, we have investigated the human T cell immune response to the group-specific carbohydrate of A streptococci . This antigen stimulated specific antibody production in B cells very effectively, but was unable to stimulate proliferation in T cell lines or clones that reacted specifically to streptococcal A particles . Therefore, streptococcus A-specific T cells seem to recognize other structures of the particulate antigen than the carbohydrate, as was confirmed by the persistence of stimulation after periodate treatment.

Biomater Artif Cells Artif Organs, 1989, 17(4), 385 - 91
Zeta potential and the adhesion of oral streptococci to polymethylmethacrylate; Uyen HM et al.; Adhesion of Candida albicans to the acrylic fitting surface of dentures can lead to the development of denture induced stomatitis and is suggested to be preceeded by the adhesion of indegeneous oral bacteria . Bacterial adhesion can be considered as a result of attractive van der Waals and repulsive electrostatic forces . In this paper we investigate the role of electrostatic interactions in the adhesion of oral streptococci to polymethylmethacrylate (PMMA), the most commonly employed denture-base material . Zeta potentials of the bacterial strains as well as of PMMA fillings were reduced by increasing the ionic strength in the buffer suspension, causing an elevated number of adhering S . mitis, S . sanguis and S . mutans . As streptococcal adhesion is suggested to be a prerequisite for the subsequent adhesion of Candida albicans, the use of more negatively charged denture-base materials can be recommended in order to prevent streptococcal adhesion and therewith adhesion of candidae, and the occurrence of denture-induced stomatitis.

Acta Obstet Gynecol Scand, 1989, 68(2), 153 - 5
The clinical significance of the genital microbiologic flora at vacuum aspiration following miscarriage; Knudsen A et al.; 85 women undergoing vacuum aspiration following miscarriage were studied . At the time of vacuum aspiration, immunofluorescent stainings for detection of C . trachomatis proved positive in 5.9% of the patients . Group B streptococci were isolated in 7.5%, coliforms in 3.5%, and Gardnerella vaginalis in 51% of the patients . The overall frequency of postabortal pelvic inflammatory disease (PID) was 3.5%, whereas 40% of chlamydia-positive women contracted postabortal PID (p less than 0.05) . No significant relation between other microorganisms and postabortal PID was observed . The duration of postabortal bleeding was unrelated to the genital microbiologic flora . Based on anamnestic information about previous pregnancies and duration of preoperative bleeding it was possible to define subgroups at risk of harboring C . trachomatis and coliforms . The clinical significance of this is unknown.

Swed Dent J, 1989, 13(5), 193 - 200
New trends in antibiotic prophylaxis of infective endocarditis in patients undergoing surgery in the oral cavity; Hall G et al.; Viridans-streptococci, which normally reside in the oral cavity, are still the most common pathogens in infective endocarditis . During surgical procedures in the oral cavity, pharynx and respiratory tract, microorganisms may disseminate into the blood and cause infective endocarditis in predisposed patients . It is, therefore generally considered that these patients should be protected during surgery by an effective and simple antibiotic regimen . During recent years new recommendations for prevention of endocarditis have been presented in several countries . Single high dose amoxycillin or 2-dose phenoxymethylpenicillin are used in normal risk patients while 2-dose erythromycin or single high dose clindamycin may be used in patients allergic to penicillins . Parental agents are usually recommended in high risk patients with prosthetic heart valves, however, some countries prefer to administer peroral prophylaxis . Topical prophylaxis in the oral cavity is not included in any national recommendation, but may decrease the magnitude, as well as the frequency, of postsurgical bacteremia . Commonly used antiseptics such as chlorhexidine are not selective enough and causes overgrowth of some viridans-streptococci . More selectively acting agents, such as topical vancomycin, appear to be more suitable.

Respiration, 1989, 55 Suppl 1, 33 - 40
Bacterial adherence of group A streptococci to mucosal surfaces; Beachey EH et al.; It is now recognized that bacteria bind to and colonize mucosal surfaces in a highly selective manner . After the organisms penetrate the nonspecific mechanical and cleansing forces, ligands (or adhesins) on the surface of the bacteria interact in a lock-and-key (or induced fit) fashion with complementary receptors on mucosal surfaces of the host . The adhesins are usually composed of proteins in the form of fimbriae or fibrillae and the receptors of glycolipids or glycoproteins . In group-A streptococci the adhesin, lipoteichoic acid (LTA), is anchored to a protein(s) on the surface of the bacterial cells and interacts through its lipid moiety with fibronectin molecules deposited on and bound to the epithelial cells . In an attempt to locate the region of fibronectin recognized by LTA and group-A streptococci, fibronectin was cleaved with thermolysin and the fragment mixture absorbed with Staphylococcus aureus or Streptococcus pyogenes . Staphylococci adsorbed several high molecular weight fragments as well as a 28- and a 23-kdalton fragment, whereas S . pyogenes cells absorbed only the 28-kdalton fragment completely . The adsorbtion of the fragments by S . pyogenes was blocked by LTA . Antibodies raised against a synthetic peptide copying the NH2 terminus of fibronectin reacted in a Western blot with the 28-kdalton fragment, indicating that S . pyogenes and its LTA react with the NH2-terminal region of fibronectin at a site distinct from that of S . aureus . Our findings are consistent with the idea that LTA mediates the attachment of group-A streptococci to fatty acid-binding sites of fibronectin deposited on mucosal epithelial cells.

Adv Pediatr, 1989, 36, 39 - 65
Reappearance of rheumatic fever; Markowitz M et al.; Even though incompletely understood, much of the information about the epidemiology and pathogenesis of rheumatic fever has become available only in the last few decades, a time when there have been significant fluctuations in rheumatic fever and rheumatic heart disease in the United States . The precise roles of the bacteria, the human host, and the environment and their interrelationships require more study . Determining their roles and defining the pathogenesis can have important practical application . If one could identify a susceptible population, if one could identify the serotypes and/or strains of group A streptococci that are more dangerous (rheumatogenic) and if one could identify the reason for an abnormal immune response, vaccines might be made with specific protective components of the group A streptococci and administered only to known susceptible individuals . Providing optimal public health programs to control a disease that still is a major problem in a large segment of the world's population is the goal . It is quite clear from the resurgence of acute rheumatic fever in the United States in the mid-1980s that antibiotics alone are not the answer to rheumatic fever control . If antibiotics are not completely effective in a country such as the United States, they cannot be expected to be effective in many of the developing countries of the world where primary health care delivery is even more difficult . Intensified efforts to understand the pathogenetic mechanisms responsible for the development of rheumatic fever should be undertaken . In the meantime, the preventive methods that are available should be vigorously applied.

Vestn Akad Med Nauk SSSR, 1989, (6), 49 - 51
{Methodologic aspects of the isolation of beta-hemolytic streptococci}; Shevchuk MS et al.; A quick test, Phadirect Strep A (Pharmacia, Sweden), for the detection of faucial streptococcus A (SA) within a few minutes was compared to bacteriologic investigation in 67 patients with rheumatic diseases and tonsillitis . The test is fairly sensitive and convenient for screening purposes, although nonspecific reactions are possible . Studies, carried out in a maternity hospital, have demonstrated the value of tests for the isolation and identification of streptococcus B (SB) . Optimum nutrient media for SB isolation and identification techniques described . A coagglutination test for SB serotyping has been developed on the basis of a Soviet staphylococcal reagent, manufactured as a dry preparation, and put to clinical trial.

Vestn Akad Med Nauk SSSR, 1989, (6), 34 - 6
{Serologic indices of the persistence of L forms of group A streptococci in patients with rheumatism}; Goncharova SA et al.; A study of 1343 rheumatic patients has shown that during acute disease high titres of antibodies to streptococcus L forms were detected in 76%, and were declining rapidly with clinical improvement . In protracted rheumatism, high antibody titres were maintained constantly in 70%; those were mostly IgM, incapable of blocking L-form growth . The antigen of streptococcus L form was only detected in 18-25% of the patients, obviously because it was bound to circulating immune complexes in 64% . It is suggested that streptococcal L forms are capable of prolonged persistence in the body, affecting the course of disease in rheumatic patients; possible persistence of L forms as part of immune complexes is of particular importance.

Vestn Akad Med Nauk SSSR, 1989, (6), 30 - 4
{Detection and determination of the biological activity of IgG Fc receptors in strains of streptococci isolated from carriers and patients}; Burova LA et al.; Mechanism of anti-IgG induction during the immunization of animals by IgG Fc+ streptococcal strains has been studied . Streptococcal proteolytic activity did not influence microbial IgG Fc-receptor ability to induce synthesis of anti-IgG . The induction of anti-IgG by purified Fc-receptors and rabbit IgG, eluted from streptococcal IgG Fc-receptors has been examined . Biological activity of streptococcal IgG Fc+ strains, isolated from carriers and patients with acute streptococcal diseases has been evaluated according to their ability to induce synthesis of anti-IgG; data on the distribution of IgG Fc+ and IgG Fc- streptococcal strains among carriers and patients with streptococcal diseases are presented . IgG Fc+ strains were mostly isolated from patients with streptococcal diseases . Mechanisms of the transformation of rabbit IgG into autoantigen are discussed.

Microbios, 1989, 58(236-237), 135 - 46
Iron and glucose affecting growth and haemolysin production in human strains of group B streptococci; Griffiths BB; Seven strains of group B streptococci aetiologically related to humans were investigated in order to observe the role of glucose and medium iron on their growth and haemolysin production, and the necessity of a 'carrier' molecule to ensure the stability of the haemolysin . Both growth and haemolysin production were significantly influenced by glucose and medium iron concentrations . Iron concentrations between 5 and 7 micrograms/ml and 0.5% to 1% glucose were critical . Maximum haemolysin production (detected by lysis of sheep erythrocytes) was obtained during the late exponential phase of the growth cycle, but declined, producing sigmoidal-like curves as the organism entered the stationary phase . RNA-core, serum and bovine serum albumin, stabilizers of streptolysin S had no stabilizing effect for the haemolysin of group B streptococci . However, bovine serum albumin-starch mixture (0.5% bovine serum albumin and 0.5% starch in phosphate buffered saline or brain-heart infusion) was an effective stabilizer.

Scand J Infect Dis, 1989, 21(3), 285 - 96
Central nervous system complications in patients with bacteremia; Syrjanen J; The occurrence of central nervous system (CNS) complications was studied retrospectively in 150 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, beta-hemolytic streptococci or Escherichia coli . The incidence and clinical manifestations of different CNS complications were noted during 1 month after the bacteremia . Special attention was paid to vascular complications (infarction or hemorrhage), infections (meningitis or brain abscess) and mental changes when they were the only signs of CNS origin (lowered level of consciousness, confusion or delirium) . The risk of cerebral infarction was elevated in the patients with bacteremia during the first month after the positive blood culture as compared with the overall risk of stroke in the general population . 10/150 patients (7%) developed cerebral infarction during that month . Two of these cases were associated with bacterial meningitis and 1 with endocarditis . Mental changes as a main symptom of CNS origin occurred in 27% of patients with bacteremia . Increasing patient age predisposed to this complication . Mental changes were not associated with any bacterial species studied . Altogether 40% of the patients developed CNS complications, which were a significant risk factor for death during the first month after the bacteremia.

J Basic Microbiol, 1989, 29(3), 177 - 84
{A fermenter dialysis cultivation technic for encapsulated pathogenic bacteria . II . Group B streptococci}; Starke R et al.; For mass cultivation of group B streptococci (B-III and B-variant streptococci), a fermenter dialysis culture technique is described and compared to conventional shaking culture and fermenter batch culture techniques . The influence of two kinds of cultivation media on the bacterial yield is demonstrated . The growth rate of the bacteria and the yield of the microbes is higher in modified POPE medium than that observed with Nahrbouillon I . The type-specific polysaccharide of B-III-streptococci prepared by phenol-water extraction followed by gel-chromatography can be used as a screening antigen for the production of monoclonal antibodies against B-III-streptococci.

Immunol Invest, 1989 Jan-May, 18(1-4), 161 - 70
IgA1 proteases of oral streptococci: ecological aspects; Kilian M et al.; The ecology and identity of IgA1 protease-producing streptococci in the human oral cavity were studied in an attempt to obtain insight into the significance of IgA1 proteases for host-parasite relationships . Contrary to previous observations, a detailed taxonomic analysis of oral streptococci revealed that all strains of S . sanguis and S . oralis ("S.mitior") produced IgA1 protease . In addition, IgA1 protease activity was observed in some isolates of S.mitis . Of the streptococci that initiate plaque formation on dental enamel 88% (median value) had IgA1 protease activity . Low proportions of the streptococci that colonize the tongue and oropharyngeal mucosae produced IgA1 protease, in contrast to 60% of streptococci isolated from buccal mucosa . The IgA1 proteases from S . sanguis I-III, S . sanguis IV, S . oralis, and S.mitis were distinct as revealed by studies using enzyme-neutralizing antibodies.

Scand J Infect Dis, 1989, 21(2), 161 - 7
Effect of latex agglutination test on prescribing for group A streptococcal throat disease in primary care; Makela M; Diagnosis and treatment of 849 sore throat patients in primary care was studied with regard to the utilization and accuracy of a latex test for group A beta-hemolytic streptococci . 78% were tested, but 11% of the rapid test results were uncertain, and 15% conflicted with traditional culture results . The negative predictive value of the test was 98%, and the positive predictive value only 59% . 52% of all patients received antibacterials, the rapid test result influencing the treatment decisions clearly but not solely . The nurses utilized the rapid test more often than the physicians . The study stresses the difficulties inherent in introducing new tests in primary care and illustrates the realities of overutilization of the test and overmedication despite test results.

Microbiol Immunol, 1989, 33(2), 123 - 7
Solubilization of IgG-binding proteins from group A and G streptococci; Goward CR et al.; The release of IgG-binding proteins from the cell surface of streptococcal strains AR-1 and G148 with various proteolytic enzymes, acid, alkali or SDS was investigated . The IgG-binding proteins were purified by affinity chromatography using IgG-Sepharose Fast Flow . After SDS-polyacrylamide gel electrophoresis and immuno-electroblotting the major proteins identified varied in relative molecular mass from 15,000 to 65,000 depending on the solubilizing agent used . The results showed that solubilization with trypsin gave the highest yield of IgG-binding proteins, that strain G148 yielded about twice the amount of protein as strain AR-1, and that elastase released an IgG-binding protein of high relative molecular mass of 65,000.

Clin Pharmacokinet, 1989, 16 Suppl 1, 38 - 45
Tissue penetration and clinical efficacy of enoxacin in respiratory tract infections; Wood MJ; Enoxacin, in common with other new oral 4-quinolones, has a broad spectrum of antimicrobial activity which includes most pulmonary pathogens (with the exception of Streptococcus pneumoniae, against which its activity is poor); this spectrum has provided the impetus for investigation of its potential in the treatment of respiratory infections . Initial pharmacokinetic studies have demonstrated that the drug has a large volume of distribution and achieves concentrations in the secretions of the respiratory tract that are at least as high as those attained in the serum . These concentrations are sufficient to suggest that enoxacin would be effective treatment for most respiratory infections . Furthermore, the concentration of enoxacin that is achieved within the bronchopulmonary tissues is considerably higher than peak serum concentrations and suggests not only that there is an active transport mechanism, but also that the drug could be expected to eradicate organisms in the lungs such as streptococci that are considered moderately sensitive to the drug in vitro . There are relatively few clinical studies of, and thus limited data on, the efficacy of enoxacin in the treatment of respiratory tract infections . A review of the evidence suggests that enoxacin is as successful as other therapies used in the treatment of acute exacerbations of chronic bronchitis . There have sometimes been failures of eradication of, and occasional superinfections with, pneumococci . Enoxacin is also likely to interact with the metabolism of theophylline and so lead to elevated theophylline plasma concentrations . Hence when these 2 agents are given concurrently, careful monitoring of theophylline concentrations and/or dosage adjustments are recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1989 Jan, 270(3), 379 - 84
Rapid detection of group B streptococci in vaginal swabs of parturients by latex particle agglutination; Hoppe JE et al.; Duplicate high vaginal swabs were obtained from 200 parturient women at Abeokuta (Nigeria) . By culture on a selective agar twenty-two women (11%) were found to harbour group B streptococci . The second swab was subjected to a 45 min enzymatic extraction procedure and then tested in a latex agglutination test for group B streptococcal antigen (Wellcogen Strep B; Wellcome Diagnostics, Dartford, UK) . The latex test permitted the detection of three out of 22 colonized women (overall sensitivity 13.6%) . The sensitivity for detection of heavy colonization was 50% (three out of six women) . It is concluded that the sensitivity of the method employed for rapid detection of group B streptococcal antigen in vaginal swabs is still unsatisfactory.

Rev Infect Dis, 1989 Jan-Feb, 11(1), 34 - 45
Group C beta-hemolytic streptococcal infections in children: nine pediatric cases and review; Arditi M et al.; Streptococci of Lancefield group C colonize healthy individuals but infrequently cause invasive disease . Eight pediatric cases of infection due to group C streptococci were identified in a retrospective survey of a recent 6-year period at a children's hospital . An additional case of group C meningitis diagnosed in 1975 was included . These nine cases and 22 pediatric cases from the literature are presented to illustrate important points with respect to clinical presentations and complications and to show that these organisms can cause serious, sometimes fatal infection: pneumonitis, sinusitis, septicemia, endocarditis, osteomyelitis, and meningitis . Group C streptococci are described in terms of their biochemical properties, the infections they cause in animals, and their tendency to produce disease in humans . With increasingly frequent serologic grouping of non-group A beta-hemolytic streptococci, recognition of the role of specific non-group A streptococci is likely to increase . The antimicrobial agent of choice for infections due to group C streptococci is penicillin G . The minimum inhibitory and minimum bactericidal concentrations for the organism should be determined since penicillin tolerance may occur and may be responsible for the slow response to penicillin therapy in some cases.

J Infect, 1989 Jan, 18(1), 29 - 34
Severe group B streptococcal eye infections in adults; Ormerod LD et al.; Group B beta-haemolytic streptococci have not been described as causing invasive eye infection in adults . Our observation of 10 such infections in nine patients indicates that persons with damaged ocular surfaces are especially vulnerable.

Acta Microbiol Hung, 1989, 36(2-3), 289 - 95
Differentiation of Listeria and Streptococcus strains; Herendi A et al.; Colonial morphology of non-beta haemolytic Listeria strains is frequently similar to that of non-haemolytic streptococci . Biochemical characteristics, motility, haemolysis on ox blood agar, growth on Clauberg, selective streptococcus (Si) and Mitis-Salivarius agar medium, CAMP test, serological behaviour of 16 Listeria strains were studied and the results were compared with the properties of Streptococcus strains . Microscopic morphology, motility and catalase activity are useful for distinguishing these strains . To avoid a false diagnosis, latex-agglutination should be supplemented with the above tests.

Arch Inst Pasteur Tunis, 1989 Jan-Apr, 66(1-2), 53 - 9
{A rapid method of grouping beta-hemolytic streptococci using extemporaneous coagglutination}; Boujaafar N et al.; Extemporaneous coagglutination procedure for the serological grouping of beta-hemolytic streptococci is reported . Streptococcal group antigens were extracted with nitrous acid . 250 strains of groups A, B, C, F and G streptococci were tested with this method . An agreement of 100% was found between this method and the Lancefield capillary precipitation procedure . Extemporaneous coagglutination method was found to be rapid, reliable, easy and economical and could be adopted in any routine diagnostic laboratory.

Arch Oral Biol, 1989, 34(11), 889 - 94
A comparison between the elemental surface compositions and electrokinetic properties of oral streptococci with and without adsorbed salivary constituents; van der Mei et al.; In order to characterize the functional cell surface, isoelectric points and elemental surface concentration, the ratios of nitrogen, oxygen and phosphorus to carbon of saliva-coated strains were determined by pH-dependent zeta potential measurements and X-ray photoelectron spectroscopy and compared with those of uncoated strains . The measurements of potential were carried out on completely hydrated cells, whereas the spectroscopy was on freeze-dried micro-organisms . The small increase in the nitrogen:carbon surface concentration ratio of saliva-coated streptococci in comparison to uncoated strains varied from 0.001 (Streptococcus mitis BA) to 0.029 (Streptococcus sanguis CH3) and was concurrent with an increase of the isoelectric point, ranging from 0.0 to 0.9 . Increases in the oxygen:carbon ratio ranged from 0.006 (Strep . mitis BA) to 0.041 (Streptococcus mutans NS), whereas the phosphorus:carbon surface concentration ratio was unchanged after saliva treatment . Despite the fact that isoelectric and compositional measurements were made in different states of surface hydration, a decrease in the nitrogen:carbon ratio accompanied by an increase in oxygen:carbon ratio, was related to a decrease of the isoelectric point of the saliva-coated strains, and so analogous with previous observations for uncoated strains . Although there were changes in the physico-chemical properties of the strains upon saliva coating, all more or less kept their own surface identity despite adsorption of salivary constituents, possibly indicating some capacity to protect their own physico-chemical identity.

Arch Oral Biol, 1989, 34(10), 825 - 8
Comparative cariogenicity and dental plaque-forming ability in gnotobiotic rats of four species of mutans streptococci; Willcox MD et al.; The four species, each represented by two strains, all produced high levels of fissure caries in the upper and lower jaws of gnotobiotic Fisher rats . Streptococcus rattus strains and Streptococcus mutans NCTC 10832 gave low levels of approximal caries, whereas Streptococcus cricetus, Streptococcus sobrinus and Strep . mutans NCTC 10449 gave high levels . The only strains to produce buccal surface lesions were Strep . sobrinus and Strep . cricetus . All strains were able to form dense plaque in the central fissure of the second molar . Strep . cricetus, Strep . rattus and Strep . sobrinus strains were capable of producing smooth-surface plaque . This difference in plaque-forming ability did not correlate precisely with differences in cariogenicity, and such differences occurred between strains of the same species.

Arch Oral Biol, 1989, 34(5), 335 - 40
The influence of saliva on infection of the human mouth by mutans streptococci; Emilson CG et al.; The relationship between oral implantation of Streptococcus mutans IB1600 (serotype c) and Streptococcus sobrinus OMZ65 (serotype g), the aggregating activity of saliva, and its influence on the adherence of these bacterial strains in vitro was examined in seven human subjects . All the saliva samples aggregated strain IB1600 but not strain OMZ65 cells . Whole saliva from subjects with low levels of infection by Strep . mutans aggregated strain IB1600 to a greater degree than did whole saliva from those who were readily infected . Whole saliva from subjects most resistant to infection supported the adsorption of the highest number of either strain IB1600 or OMZ65 to hydroxyapatite surfaces . Thus the ability of whole saliva to aggregate Strep . mutans may influence the ability of these microorganisms to infect the mouth.

Int J Biochem, 1989, 21(9), 1047 - 51
DNA homology of surface protein antigen A gene in mutans streptococci; Abiko Y et al.; 1 . A recombinant plasmid, pYA724, containing an 8.45 kb DNA fragment encoding surface protein antigen A (spaA) from Streptococcus sobrinus 6715 was used to examine the DNA homology of the spaA gene with chromosomal DNA of various mutans streptococci strains . 2 . Restriction endonuclease BamHI-digested pYA724 DNA was radio-labeled by nick-translation, and a DNA-DNA hybridization experiment was carried out . pYA724 DNA hybridized with chromosomal DNA of serotypes a, c, d, e, f and g strains, but not with b by dot DNA-hybridization and Southern blot DNA hybridization . 3 . Chromosomal DNAs were isolated from several serotype c Streptococcus mutans strains, digested with BamHI, and analyzed by Southern blot DNA hybridization . pYA724 DNA hybridized with different sizes and numbers of BamHI-digested DNA fragments of the chromosomal DNAs . 4 . These data indicated that all mutans streptococci strains except serotype b have DNA homologous with the spaA gene, although within the same serotype strain the spaA gene has a diversity of arrangement within the chromosome.

Scand J Infect Dis, 1989, 21(5), 543 - 9
The value of C-reactive protein as a marker of bacterial infection in patients with septicaemia/endocarditis and influenza; Lindback S et al.; In order to evaluate the capacity of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC) and polymorphonuclear neutrophils (PMNs) to differentiate between bacterial and viral infection we studied 176 patients with septicaemia/endocarditis (SE), 59 patients with uncomplicated influenza (UI) and 22 patients with complicated influenza (CI) retrospectively . All 4 parameters were significantly more elevated in SE and CI than in UI . Among patients with SE 10 176 had a CRP value less than 50 mg/l and in patients with UI 5/56 had a CRP value greater than 100 mg/l . Patients with SE caused by pneumococci had the highest CRP levels and patients with alfa-haemolytic streptococci the lowest . The sensitivity and specificity favours the use of CRP as an indicator of bacterial superinfection in influenza.

Scand J Infect Dis, 1989, 21(5), 537 - 42
The etiology of bacterial cellulitis as determined by fine-needle aspiration; Sigurdsson AF et al.; Bacterial cellulitis is a common problem, etiologic diagnosis often unrewarding and opinions differ on empiric therapy . The purpose of this study was to determine the major microbiologic causes of bacterial cellulitis in a walk-in Emergency Room setting . 94 cases in 89 patients with clinical signs of cellulitis were studied . The infection was closed in 74 cases and associated with an open skin lesion in 22 . The infection site was aspirated with a suction air-buffer technique employing a Cameco handle for easier handling and stabilization of the aspiration needle . After exclusion of contaminated samples, positive cultures were obtained from 30 cases (31.9%) . Cultures were positive in 30.6% of open lesions and in 36.4% of closed ones . Staphylococcus aureus was the most common organism, present in 11 cases, S . epidermidis in 8 and group A beta-hemolytic streptococci in 5 . All S . aureus strains were methicillin-sensitive and only 1 was sensitive to penicillin . The most common site of infection was the lower extremity (59%) . According to these data the optimal initial therapy for bacterial cellulitis in adults should be with drugs active against both staphylococci and streptococci.

J Postgrad Med, 1989 Jan, 35(1), 49 - 50
Fatal outcome of group-G streptococcal meningitis (a case report); Mohan PK et al.; An adult woman developed meningitis caused by Group-G streptococci . The organism was successfully isolated both from blood and cerebrospinal fluid of the patient . The woman succumbed to infection despite an appropriate antibiotic therapy.

Vestn Akad Med Nauk SSSR, 1989, (11), 49 - 54
{Conjugation in group A streptococci}; Ravdonikas LE; The paper presents data on the nature of the conjugation-like process (CLP) of genetic marker transfer on the membrane filters in group A streptococci . Studied are the CLP development depending on the duration of the donor-recipient contact and the influences of various physiological conditions on the degree of CLP manifestation and frequency . The effect of sub-inhibiting erythromycin concentrations on the frequency of the erythromycin marker transfer is first found . The original experimental evidence and literature data suggest a role played by transposing elements in CLP determination on the membrane filters in group A streptococci.

Allergy, 1989, 44 Suppl 9, 79 - 83
Infections as contributing factors to atopic dermatitis; Rystedt I et al.; Certain cutaneous viral infections, such as Herpes simplex, vaccinia and varicella infections are known to occasionally run an usually severe course in AD . Patients with AD display increased frequencies of recurrent cold sores and Herpes zoster and they also have increased antibody titers to Epstein-Barr virus . Heavy colonization of the skin with staphylococci and streptococci is common . The findings of increased severity and/or frequencies of these infections in AD may be explained by dysfunctional cell-mediated immunity and by cutaneous changes associated with AD . There is suggestive, but not any firm evidence, that infections play a causal role in the precipitation and exacerbation of AD . Infections are thus, in most cases, probably consequences rather than causes of the disease.

Rev Laryngol Otol Rhinol (Bord), 1989, 110(2), 173 - 7
{Mycoses in otorhinolaryngology . Apropos of 167 cases}; Ette A et al.; The authors observed 167 cases of E.N.T . mycoses over a 14-year period (1974-1988) in the E.N.T . Departments of the Abidjan University Hospitals in the Ivory Coast, and in two private health institutions in the city . The majority of cases involve candidiasis (91 cases, or 54.5%), followed by aspergillosis (72 cases, 43.1%) and rhinoentomophtorosis (4 cases, 2.4%) . Men are more affected than women (125 as against 42) . Men suffering from rhinoentomophtorosis are, for the most part, farmers . Among the contributory factors, we found respectively the abuse of antibiotics, either alone or in association with corticoids for general or local use (ear drops), bathing in lagoons, and diabetes . Bacterial infection is often associated with these mycoses--mainly streptococci and staphylococci aurei . Clinical signs are dominated by pruritus, dull pains, a feeling of fullness in the ear, or of burning in the pharynx . An association of systemic Miconazole and Amphotericin B (local use) has given the best results for candidiasis and aspergillosis . For rhinoentomophtorosis, treatment was long, and even disappointing, until the use of Ketoconazole which may without doubt be considered as the medicament of choice.

Microbios, 1989, 58(236-237), 183 - 7
The occurrence of nicotinamide adenine dinucleotide glycohydrolase and the serum opacity reaction in groups B, C, F and G streptococci; Reitmeyer JC et al.; The frequency of the serum opacity reaction (SOR) and nicotinamide adenine dinucleotide glycohydrolase (NADase) production in non-A groups of beta-haemolytic streptococci isolated from humans and animals was surveyed . The SOR was positive with five of eighteen group B isolates (28%), four of fifteen group C (27%), two of five group F (40%), and thirty-seven of sixty-eight group G (54%) isolates . NADase activity, in addition to SOR, was found in three of eighteen group B isolates (17%), three of fifteen group C (20%), forty of sixty-eight group G (59%), and none of the group F isolates . The SOR was produced by forty-eight (45%) and NADase was produced by fifty-one (48%) of the one hundred and six isolates of non-group A beta-haemolytic streptococci . Twenty-five percent of the isolates were both NADase and SOR positive.

Scand J Infect Dis, 1989, 21(2), 169 - 74
Acute tonsillitis in young men: etiological agents and their differentiation; Ylikoski J et al.; Group A beta-hemolytic streptococci were found in 38% of 257 young men in military service with acute tonsillitis . Of the 108 patients tested also for viral antibodies, 42% showed a 4-fold rise in antibody titers . Adenovirus was the most frequent (31%) nonstreptococcal agent, followed by Epstein-Barr virus (6%), and influenza virus (5%) . Non-group A streptococci were isolated in about the same proportion (18%) as in healthy control subjects . Other data also suggested that these bacteria were carried and not true infecting organisms . Group A streptococci and adenovirus occurred in mixed infection in 9% of the 108 cases . In group A streptococcal tonsillitis compared to others, white blood cell counts were higher (13.3 vs . 8.3 x 10(9)/l, p less than 0.01), C-reactive protein was higher (70 vs . 48 mg/l, p less than 0.01), tonsillitis was more often non-exudative (p less than 0.05), and the duration of fever was shorter (2.2 vs . 3.5 days, p less than 0.01), while there was no difference in the height of the fever or erythrocyte sedimentation rate.

Cesk Epidemiol Mikrobiol Imunol, 1989 Jan, 38(1), 10 - 7
{A tonsillitis epidemic caused by adenoviruses}; Kahlich R et al.; An epidemic of lacunar angina which affected, in relatively close common life, mostly only one of nine military units living in the same area . The failure of penicillin and negative finding of streptococci resulted in a retrospective establishment of the agent, which with all probability was adenovirus type 4 . It has become obvious that the typical picture of lacunar or even pseudomembranous angina is not a reliable sign indicating streptococcal etiological even in a mass infection . The authors draw attention to the importance of continuous bacteriological surveillance even if only several cases of pharnygotonsillitis occur in a community . Uncertainties of the use of penicillin are then unnecessary in the therapy and even prophylaxis of the whole group, even if the first view may suggest its use . Some epidemiological features of the mass adenovirus angina are discussed.

Arkh Patol, 1989, 51(5), 26 - 32
{Dynamics of early morphologic shifts in the bronchopulmonary system in intranasal infection of mice with streptococcus group B}; Bartazarian ND et al.; When mice are intranasally infected with avirulent and virulent B streptococci, one may single out 2 phases of microbe interaction with bronchopulmonary tissue: 1) streptococcal adhesion, epithelial detachment and causative agent phagocytosis occur within the first 2 hours; 2) hematogenic phagocytes are involved in the process 5 or more hours later . Unlike avirulent streptococci, virulent ones frequently lead to the formation of destructive foci and are less actively phagocytized . On infection with avirulent strain, the microbes seed from the lung during 24 hours . The phagocytotic index and mean alveolar macrophage destruction values are in excess of the similar values seen in polymorphonuclear leukocytes, becoming lower on day 6 of postinfection.

Scand J Infect Dis Suppl, 1989, 58, 1 - 55
Pharmacodynamics of beta-lactam antibiotics . Studies on the paradoxical and postantibiotic effects in vitro and in an animal model; Odenholt-Tornqvist I; The pharmacodynamics of antibiotics, i.e . the rate of killing and the time before regrowth of surviving bacteria, may be important factors for determination of the dosage interval . In the present study the effect of protein binding, antibiotic concentrations, bacterial growth phase and bacterial inoculum on the rate of bacterial killing was investigated . The postantibiotic effect (PAE) was also studied in vitro and in vivo . The killing rate of S . aureus did not differ when the bacteria were exposed to the same free concentrations of dicloxacillin in medium with and without albumin . Protein binding per se did thus not diminish the bactericidal activity . A paradoxically reduced bactericidal effect was noted when S . aureus was exposed to high concentrations of dicloxacillin, cloxacillin and benzylpenicillin . For determination of PAE of imipenem on Ps . aeruginosa, counts of viable bacteria were compared with assay of bacterial intracellular ATP . Both methods demonstrated a PAE for the strains tested at an inoculum of 10(6) cfu/ml . At an inoculum of 10(8) cfu/ml no PAE was found, which coincided with a lack of bactericidal effect . Both the PAE and the bactericidal effect were restored with aeration of the cultures, indicating insufficient penetration of imipenem to the target sites at low oxygen tension . An in vivo model in rabbits with implanted tissue cages was developed for evaluation of the PAE . Group A beta-hemolytic streptococci showed a PAE of approximately 2 h in vivo, which correlated well with the PAE found in vitro . Despite that streptococci in postantibiotic phase (PA-phase) were non-multiplying, such bacteria were killed as efficiently as previously untreated controls when exposed to 10xMIC of penicillin both in vitro and in vivo . However, streptococci in PA-phase were much more sensitive to the repeated challenge to subinhibitory concentrations of penicillin than previously untreated controls . In vivo, no difference in sensitivity to sub-MIC penicillin concentrations between streptococci in PA-phase and untreated controls was seen, probably due to the presence of host factors in the tissue cage fluid . It seems that for streptococci, subinhibitory antibiotic concentrations are more important for the sucess with intermittent dosing than the PAE, especially when a normal host defence is present.

Shoni Shikagaku Zasshi, 1989, 27(4), 1018 - 24
{Non-cariogenicity of maltitol in vitro and animal experiments}; Izumitani A et al.; The caries inducing activity of maltitol was examined in in vitro and animal experiments . Fifteen strains of oral streptococci were not able to ferment maltitol . Also, maltitol inhibited the glucan synthesis from sucrose by GTases from mutans streptococci . However, the inhibition of growing-cell adherence was not so marked with the addition of maltitol to sucrose culture . In the animal experiments, maltitol did not induced dental caries in rats infected with mutans streptococci . Furthermore, maltitol significantly inhibited the sucrose-induced dental caries in rats infected with S . sobrinus 6715 . However, there was no significant difference in rats infected with S . mutans MT8148R . These results indicated that maltitol is useful as a non-cariogenic sucrose substitute.

Shoni Shikagaku Zasshi, 1989, 27(4), 1010 - 7
{Caries-inducing activity of isomaltooligosugar (IMOS) in in vitro and rat experiments}; Minami T et al.; The caries-inducing activity of Isomaltooligosugar (IMOS: a isomaltose rich sugar mixture) was examined in in vitro and in vivo experiments . Strains of Streptococcus mutans MT8148R and Streptococcus sobrinus 6715 fermented IMOS and produced acids . IMOS inhibited the glucan synthesis from sucrose by glucosyltransferases from both of S . mutans and S . sobrinus . Furthermore, IMOS inhibited sucrose-dependent adherence of those mutans streptococci . IMOS was found to induce significant but minimal caries SPF Sprague-Dawley rats infected with either MT8148R and 6715 . However, IMOS did not inhibit the caries which was induced by sucrose.

Shoni Shikagaku Zasshi, 1989, 27(2), 317 - 23
{Changes of antibody and splenic plaque forming cell responses to mutans streptococci in the rats infected with S . sobrinus 6715}; Kitamura K et al.; The study was undertaken to examine the changes in humoral IgM, IgG and IgA antibodies and splenic plaque forming cell responses against Streptococcus sobrinus 6715 in rats infected with the same mutans streptococci . The serum samples were collected every week for 24 weeks after infection (20 day old, Sprague Dawley rats) . Humoral anti-S . sobrinus 6715 IgG and IgA antibodies were determined by an enzyme-linked immunosorbent assay . In the separate experiment, rat splenic IgM, IgG and IgA anti-trinitrophenyl (TNP) conjugated S . sobrinus plaque-forming cell (PFC) responses were also determined from 1 to 12 weeks after the infection . The results obtained were as follows: 1 . From 1 to 4 weeks after infection, a slight increase in serum IgG anti-S . sobrinus antibody response was observed in the group of rats infected with S . sobrinus 6715 when compared with the non-infected rat group . However, beyond the 5th week, there was no difference in serum antibody responses between these two groups . 2 . Infected rats showed a 2-9 times higher serum anti-S . sobrinus IgA antibody response than those of uninfected rats for 6 weeks after the infection . After this period just as with the IgG response, no difference in the IgA titers was found between these two groups . 3 . Splenic IgM, IgG and IgA anti-TNP-S . sobrinus PFC responses showed a remarkable decrease shortly after the infection . These results suggest that the infected rats would gradually acquire oral tolerance to S . sobrinus antigen after the infection.

Lab Delo, 1989, (12), 69 - 70
{The ability to grow on Levine's or Endo's media as a test for the identification of enterococci}; Fel'dman IuM et al.; The suggested test for the identification of enterococci is based on their ability, unlike other streptococci, to grow in Levine's or Endo's media . A total of 128 enterococcal and 251 other streptococcal cultures were examined . The studies have demonstrated reliability of the suggested test, which permits, as a rule, cutting down the time for identification by 1 day and simplifying the investigation.

Vestn Akad Med Nauk SSSR, 1989, (11), 54 - 9
{OF- and anti-OF test systems in microbiological and epidemiologic practice}; Beliakova IV et al.; The possibilities of group A streptococcus typing are opened up, the microorganism being the causative agent of a highly prevalent infectious disease . The first Soviet-made kit of immune anti-OF sera for typing OF-positive group A streptococci have been prepared . A possibility of preparing a human donor kit of anti-OF sera is discussed.

Vestn Akad Med Nauk SSSR, 1989, (6), 51 - 6
{Group-specific antigens of streptococci in the make-up of circulating immune complexes in rheumatism and rheumatoid arthritis}; Zborovskii AB et al.; The level of "A" and "B" streptococcal antigens in the circulating immune complexes, structure and the level of antibodies to the group specific streptococcal polysaccharides in the patients with minimal activity and latent course rheumatism and in the patients with rheumatoid arthritis of different duration is studied . It is shown that the concentration of the "A" group streptococcal antigens in the circulating immune complexes is higher in rheumatic patients, than in healthy subjects and tonsillitis patients . The high "B" group streptococcal antigen content is found in the patients with rheumatoid arthritis . A high titer of antibodies to streptococcal polysaccharides of "B" group, especially in the synovial fluid was revealed . A possibility of streptococcal antigens and their antibodies' participation in the development of pathologic process is discussed . A value of obtained indexes in the diagnosis of small activity rheumatism and early stages of rheumatoid arthritis is shown.

Vestn Akad Med Nauk SSSR, 1989, (6), 46 - 9
{Use of immunoenzyme analysis for determining the persistence and biodegradation of antigens in the cell wall of group A streptococci in patients with rheumatism}; Shikhman AR et al.; A sandwich ELISA system was used for the study of the identification of antigenic group A polysaccharide determinants by antibodies in a suspension of streptococcus cells with varying degrees of lysis . Antibodies were able to identify less than 0.01% of antigenic A polysaccharides determinants in intact streptococcal cells . It is concluded that A polysaccharide is a marker of the destroyed group A streptococcus cells . The circulation of group A polysaccharide was examined in the sera of patients with rheumatism and acute streptococcal tonsillitis . Group A polysaccharide was detectable more frequently in rheumatic patients, as compared to those with tonsillitis, and circulated for long periods of time in the vascular network . Avidity and titres of antibodies to group A polysaccharide were determined in rheumatic patients with different degrees of antigenemia . In cases of marked antigenemia, correlation was disrupted between the titre and avidity of antibodies to group A polysaccharides.

Z Hautkr, 1988 Dec 15, 63(12), 1016 - 22
{The effectiveness of ciprofloxacin in bacterial skin infections}; Meisel C et al.; Ciprofloxacin in a low dosage of 250 mg twice a day was applied in the treatment of bacterial infections of the skin . All cultured staphylococci, streptococci, and pseudomonas proved to be highly sensitive to ciprofloxacin . The cases of pyoderma showed quick healing, but there were relapses of Lyme borrelia within 6 weeks . As the titers of IgM and IgG steadily increased during the following months, additional therapy was necessary . The tolerance of ciprofloxacin was generally very good.

Can J Ophthalmol, 1988 Dec, 23(7), 311 - 4
Infectious crystalline keratopathy; Zabel RW et al.; Crystalline deposits developed in the anterior third of the stroma in a 60-year-old woman . The deposits resolved only after aggressive treatment with intravenously given penicillin and topical erythromycin and vancomycin hydrochloride . Review of reported cases indicated that infectious crystalline keratopathy is caused by chronic colonization of the stroma by bacteria, usually streptococci of the viridans group . Local tissue trauma, concomitant use of topical corticosteroids, an intact overlying epithelium and use of a bandage-type soft contact lens are factors in the development of the infection . Patients with crystalline formations in this setting should undergo early lamellar biopsy for histologic examination, culture and sensitivity testing, followed by aggressive therapy with appropriate antibiotics.

J Antimicrob Chemother, 1988 Dec, 22(6), 881 - 4
In-vitro assessment of lomefloxacin (SC-47111)--a new quinolone derivative; Finch R et al.; The activity of lomefloxacin (SC-47111) was studied in vitro against 500 clinical isolates . Comparison was made with enoxacin and ciprofloxacin . Lomefloxacin was comparable in activity to enoxacin, but less active than ciprofloxacin . Most Gram-negative bacilli were susceptible, including several multi-resistant strains . Pseudomonas aeruginosa showed variable susceptibility . Streptococci, including Streptococcus pneumoniae, were generally the least susceptible organisms.

Br J Exp Pathol, 1988 Dec, 69(6), 813 - 31
Streptococcal necrotizing fasciitis: development of an animal model to study its pathogenesis; Seal DV et al.; Necrotizing fasciitis is a serious and increasingly common human disease which can be caused by an infection with beta-haemolytic streptococci (BHS) of Lancefield groups A, C or G, spreading rapidly in the loose connective tissue over the muscle fascia . To facilitate study of its pathogenesis, we have developed an animal model for the production of a spreading infection with BHS in the loose connective tissue over the muscle layer in the skin of New Zealand White rabbits . Intradermal injection of group A BHS alone into the flank was unsatisfactory in that a spreading lesion occurred on only 12% of occasions . When the group A BHS were co-injected with cultures of Staphylococcus aureus, the results depended on the strain of S . aureus used: an abscess-producing strain isolated from pigs gave rise to a spreading lesion on 50% of occasions . When BHS were injected with the alpha-lysin of S . aureus at a titre which produced inflammation without necrosis, spreading lesions occurred on 75% of occasions . However, both inoculated and uninoculated broth acted synergistically with the alpha-lysin in potentiating the spread of the streptococci . This demonstration of synergy between BHS and alpha-lysin of S . aureus may reflect the clinical situation in the human, as both organisms have been found to occur together at sites where spreading streptococcal infections have originated.

J Dent Res, 1988 Dec, 67(12), 1483 - 7
Effect of zeta potential and surface energy on bacterial adhesion to uncoated and saliva-coated human enamel and dentin; Weerkamp AH et al.; Physicochemical surface characteristics of early plaque-forming bacteria and of human tooth surfaces were measured to establish their role in bacterial adhesion to intact dental tissue slabs . In addition, the influence of an experimental salivary pellicle was evaluated . Strains of S . mutans, S . sanguis, S . salivarius, A . viscosus, and A . odontolyticus showed relatively high surface free energies (range, 99-128 mJ.m-2) and carried a negative surface charge, at both physiological (mu = 0.057) and low (mu = 0.020) ionic strengths of the medium . Very large differences in hydrophobicity were detected when the hexadecane adsorption test was used for measurement . Powdered enamel and dentin were also negatively charged at low ionic strength but were slightly positively charged in the physiological buffer . The surface free energy of enamel and dentin increased upon saliva coating, whereas the surface charge was always negative . The adhesion experiments showed: (1) large differences in the binding of various bacteria to the same surface; (2) an up to 20-fold difference in the binding of the same bacterium to different surfaces, although the binding of some strains was relatively independent of the type of surface or presence of a salivary pellicle; (3) a significant decrease in adhesion when the ionic strength of the medium was lowered, due to increased electrostatic repulsion (however, the adhesion of some bacteria was independent of the ionic strength of the medium); (4) different time-dependent adherence kinetics, depending on both the bacteria and nature of the solid surface; and (5) a propensity for plaque streptococci to bind to uncoated dentin.

Crit Care Med, 1988 Dec, 16(12), 1225 - 8
Respiratory alkalosis attenuates thromboxane-induced pulmonary hypertension; Schreiber MD et al.; Mechanically induced respiratory alkalosis decreases pulmonary arterial pressure in infants with persistent pulmonary hypertension of the newborn and in newborn lambs with hypoxia-induced pulmonary hypertension . Since thromboxane A2 may mediate the pulmonary hypertension in infants with Group B beta-hemolytic streptococci and Escherichia coli pneumonia, we studied the effect of respiratory alkalosis on thromboxane-induced pulmonary hypertension . A specific thromboxane A2-mimetic, U46619, was infused into six normoxic, sedated, mechanically ventilated lambs . U46619 produced pulmonary hypertension which was significantly attenuated during respiratory alkalosis . These results support the use of respiratory alkalosis to treat infants and children with pulmonary hypertension regardless of the presumed etiology.

Infect Immun, 1988 Dec, 56(12), 3216 - 20
Plasmid-containing strains of Streptococcus mutans cluster within family and racial cohorts: implications for natural transmission; Caufield PW et al.; The transmission of mutans streptococci is thought to occur along familial lines based on investigations which have shown common strains within family units by using phenotypic typing methods, such as bacteriocin production and immunity profiles and serotyping . Difficulties in implementing these typing methods, coupled with conflicting interpretations of results between laboratories, led us to study the conservation of Streptococcus mutans strains within a mother-child cohort by using a genotypic marker, plasmid DNA . Plasmids (all 5.6 kilobases in size) were observed at an overall frequency of 3.3%, with a significantly different frequency in whites (1.5%) compared with blacks (6.6%) . Plasmid-containing strains were significantly clustered in mother-child pairs compared with nonrelated individuals (58 versus 3.3%; P less than 0.001) . Moreover, the different plasmid groups (I and II) were highly conserved within racial boundaries (P = 0.007) . In those instances in which we were able to characterize distinct strains by either biotype or plasmid profile, we found that mothers harbored a more heterogeneous population of mutans streptococci than did their children . This suggested, among other possibilities, that children acquire additional strains as they approach adulthood . Alternatively, we may have been unable to detect more heterogeneity of strains in children because of quantitative differences of strains in saliva . We present collective data which show that strains of S . mutans are highly conserved within not only mothers and their children but also racial groups, suggesting vertical transmission of this organism within human populations . Moreover, we show that levels of S . mutans found in the saliva of the mother correlated with levels found in her child, demonstrating a quantitative relationship within mother-child pairs.

Infect Immun, 1988 Dec, 56(12), 3201 - 8
Specific and nonspecific inhibition of adhesion of oral actinomyces and streptococci to erythrocytes and polystyrene by caseinoglycopeptide derivatives; Neeser JR et al.; Various caseinoglycopeptide derivatives prepared from mammalian milk were evaluated as inhibitors of hemagglutinations mediated by Actinomyces viscosus Ny1, Streptococcus sanguis OMZ9, and, for comparative purposes, plant lectins from Arachis hypogaea and Bauhinia purpurea . It was found that recognition of the beta-D-galactose-(1----3)-2-acetamido-2-deoxy-D-galactose carbohydrate chain by Actinomyces viscosus Ny1 organisms and Arachis hypogaea and B . purpurea agglutinins had similar structural requirements; in all cases, the desialylated bovine caseinoglycomacropeptide, on which several units of the above mentioned disaccharide are clustered, behaved as the most potent hemagglutination inhibitor . By contrast, none of the preparations tested inhibited erythrocyte agglutination by S . sanguis OMZ9 . Thus, the desialylated bovine caseinoglycomacropeptide acts as a potent and specific inhibitor of oral Actinomyces adhesion to cell membranes (a soft surface) and could be used as a probe for the study of recognition mechanisms mediated by Actinomyces galactose-binding lectins . During the present study, both native and desialylated variants of the same bovine glycomacropeptide also totally prevented the adhesion of Actinomyces viscosus Ny1, S . sanguis OMZ9, and S . mutans OMZ176 to polystyrene surfaces . Comparative evaluations of various structurally different compounds gave the following results . Neither mono- nor disaccharides related to caseinoglycopeptide carbohydrates prevented adhesion; highly positively or negatively charged polypeptides and polysaccharides were either not or only moderately active . Besides these glycomacropeptides, an inhibitory activity was also exhibited by other mucin-type glycoproteins carrying short O-linked carbohydrate chains (including bovine submaxillary mucin), polyethylene glycol, and bovine serum albumin . Consequently, caseinoglycopeptide prevention of oral bacterial adhesion to polystyrene tubes (a hard surface) takes place with no species specificity and can be compared to nonspecific inhibition exhibited by various polymers with very different structural characteristics.

Magnes Res, 1988 Dec, 1(3-4), 223 - 30
The role of magnesium in the aetiology and prevention of caries: some new findings and implications; Luoma H; While some epidemiological studies seem to indicate that a high intake of magnesium should be associated with a low prevalence of dental caries, the results of experimental studies are mainly equivocal . Magnesium is probably not bound to the apatite lattice of dental enamel or dentine, or it is bound to a small degree only . It is mainly located in the hydration layer of the apatite crystallites . In the dental caries process it is preferentially dissolved together with the carbonate of the mineral phase . It is not known to what extent feasible dietary changes can modify tooth magnesium content during pre-eruptive tooth development . Animal experiments indicate that the elevation of dietary magnesium alone after tooth eruption has no definite capacity to modify the occurrence of dental caries . When fed in combination with small fluoride supplements in the diet magnesium and fluoride may support each other in preventing various calcium salt imbalances such as dental caries, arteriosclerosis and nephrocalcinosis . Although some recent in vitro findings indicate that extra magnesium in the fluid environment of cariogenic streptococci may protect them against the inhibitory action of fluoride, such magnesium changes do not seem possible in the human mouth under present or envisaged dietary conditions.

Microbiologia, 1988 Dec, 4(3), 177 - 9
Evaluation of four methods for the detection of streptococcal group A antigen directly from throat swabs; Betriu C et al.; We have compared the sensitivity, specificity and reproducibility of four rapid tests for the detection of group A beta-hemolytic streptococci antigen directly from a throat swab . The four methods were very specific, all of them offered reproductibility and surpassed conventional culture in speed and simplicity.

Int J Dermatol, 1988 Dec, 27(10), 716 - 9
Treatment of impetigo and ecthyma . A comparison of sulconazole with miconazole; Nolting S et al.; In a randomized, double-blind, parallel comparative study of 80 patients, impetigo and ecthyma were treated effectively by sulconazole nitrate 1% cream and miconazole nitrate 2% cream applied to lesions twice daily for 14 days . When treatment began, bacterial cultures from all pyodermal lesions yielded Group A beta-hemolytic streptococci or pathogenic staphylococci . Among the 32 sulconazole-treated impetigo patients, bacterial cultures from 26 (69%) were negative by treatment day 4, and those from all 32 (100%) were negative by treatment day 7; among the 34 miconazole-treated impetigo patients, cultures from 17 (50%) were negative by treatment day 4, cultures from 32 (94.1%) were negative by treatment day 7, and cultures from 29 (97%) were negative by treatment day 14 . Each treatment promptly relieved the pyodermal signs (crusts, vesicles, pustules, bullae, and exudate) . Both agents were considered to be safe and effective medications for treating impetigo and ecthyma.

Genitourin Med, 1988 Dec, 64(6), 387 - 90
Patterns of carriage of group B streptococci in genitourinary medicine clinic patients; Monteiro EF et al.; Anogenital carriage of group B streptococci was found in 46% (57/125) of men and 38% (68/179) of women attending a genitourinary medicine clinic . Colonisation with group B streptococci was more common in patients who had a history of more than one sexual partner in the preceding three months, but was not related to any previous sexually transmitted infection . Group B streptococci were isolated from either one or both partners of 28 couples, in 12 of which both partners yielded isolates that were indistinguishable by serotyping and phage typing . Colonisation with matching isolates of group B streptococci was more common in couples who had relatively stable relationships.

Int Dent J, 1988 Dec, 38(4), 211 - 7
Risk factors in dental caries; Hunter PB; The three main factors in dental caries--diet, microflora and a susceptible tooth--were identified almost 100 years ago . Since that time a large number of further local and general risk factors have been identified . Diet has long been suspected of contributing towards the caries process but positive proof of its role has been difficult to establish . However, the total consumption of sugar, as well as the frequency of its intake, undoubtedly contributes to the onset of dental caries . Diet is a dominant variable in determining dental caries prevalence and it can mask other factors . Differences of opinion exist as to whether specific micro-organisms are the cause of dental caries . There is, however, substantial evidence to support the key role of mutans streptococci in the process . Among local risk factors are the form and arrangement of teeth, salivary flow and oral hygiene . General risk factors include age, sex, race, geographic location and social class . In fact, the whole social-cultural environment of the community in which the individual lives may have an influence on the development of dental caries.

APMIS, 1988 Dec, 96(12), 1097 - 108
A streptococcal plasminogen activator in the focus of infection and in the kidneys during the initial phase of experimental streptococcal glomerulonephritis; Holm SE et al.; Strains of group A streptococci known to secrete the nephritis strain-associated protein (NSAP), a plasminogen activator, were studied for their ability to produce APSGN in rabbits . A tissue cage model was used to monitor the secretion of NSAP at the focus of infection and histopathological examination of kidney tissue was used to determine glomerular pathology . Animals infected with NSAP positive strains exhibited NSAP deposits in the glomerular tissue by day 7 in the absence of antibody to this molecule with progressive pathology indicative of APSGN three weeks later . Animals infected with the NSAP negative streptococcal strain exhibited no abnormal pathology . The ability of NSAP to bind to kidney tissue suggested that it has unique nephrotropic properties; and its ability to activate plasminogen to plasmin, possibly in situ, suggests that much of the pathological events associated with APSGN may be initiated by plasmin activity.

J Trop Med Hyg, 1988 Dec, 91(6), 306 - 14
Epidemiology of streptococcal pyoderma in an orphanage community of a tropical country; Brahmadathan KN et al.; A group of 89 children residing in an orphanage, situated about 12 km from Vellore town, Tamil Nadu, India, were surveyed for streptococcal pyoderma, every month, from October 1976 through to December 1978 . The prevalence rate of pyoderma as defined by the isolation of group A streptococci (GAS) was 10.1% with monthly variations from 2.1% to 17.1% . Three meteorological data, namely, temperature, humidity and rainfall did not show any significant relationship with seasonal patterns of pyoderma . However, a hot and humid climate, prevalent for most of the year in Vellore, may be linked to the endemicity of this condition . Studies performed on a limited number of GAS strains showed a variety of M types in the lesions . During this survey, poststreptococcal glomerulonephritis (PSGN) was not detected . In one child, a moderate albuminuria was observed; this resolved subsequently . We attest that an active surveillance of detection and treatment of pyoderma in a highly susceptible population plays an important role in the prevention of PSGN.

J Infect Dis, 1988 Dec, 158(6), 1317 - 23
DNA fingerprints of Streptococcus pyogenes are M type specific; Cleary PP et al.; DNA from group A streptococci of various M and T types was cleaved with endonucleases to produce a DNA fingerprint . Comparison of DNA fingerprints proved to be a very useful tool for studying the epidemiology of isolates from various outbreaks of streptococcal disease . Patterns of DNA fragments from HindIII digests of samples of total DNA were conserved among strains of the same M serotype yet were easily distinguished from those of different M serotypes . Different M types were associated with specific restriction enzyme profiles . DNA fingerprints of strains of the same M type were stable enough to establish a clonal relationship between strains obtained from an isolated outbreak of disease or strains endogenous to people geographically isolated by continent . Strains of the same serotype from different continents had very similar, but distinguishable, restriction profiles . Those strains unable to be typed with standard typing sera were also amenable to comparison because they yielded unique fingerprints.

Am Rev Respir Dis, 1988 Dec, 138(6 Pt 2), S45 - 8
Bacterial adherence . Adhesin receptor-mediated attachment of pathogenic bacteria to mucosal surfaces; Beachey EH et al.; Pathogenic bacteria adhere to and colonize mucosal surfaces of the susceptible host in a highly selective manner . After the organisms penetrate the nonspecific mechanical and cleansing forces, ligands (or adhesins) on the surface of the bacteria interact in a lock-and-key fashion with complementary receptors on mucosal surfaces of the host . The adhesins are usually composed of proteins in the form of fimbriae or fibrillae and the receptors of glycolipids or glycoproteins . At the epithelial cell surfaces, two classic examples of bacterial adherence are the lipoteichoic acid-mediated attachments of group A streptococcal and the type 1 fimbriae-mediated attachment of Escherichia coli . In group A streptococci, the adhesin, lipoteichoic acid (LTA), is anchored to a protein(s) on the surface of the bacterial cells and interacts through its lipid moiety with fibronectin molecules deposited on and bound to the epithelial cells . In type 1 fimbriated E . coli, a minor 29-kDa protein located at the tip of the fimbriae interacts with D-mannose residues of glycoprotein receptors on host cells . Similar adhesin-receptor interactions have now been described for a number of pathogenic microbial agents, and undoubtedly play a central role in the early steps of the infectious process.

J Appl Bacteriol, 1988 Dec, 65(6), 483 - 9
Inhibition of adhesion of viridans streptococci to fibronectin-coated hydroxyapatite beads by lipoteichoic acid; Hogg SD et al.; Fibronectin-coated hydroxyapatite (FnHA) beads were used in a model adhesion assay to isolate the lipoteichoic acid (LTA) mediated adhesion of oral streptococci . Representative strains of the commonly isolated viridans streptococci were incubated with FnHA beads in the presence and absence of exogenous LTA . The LTA inhibited the adhesion of all strains to a greater or lesser extent, but only a very few strains were inhibited by more than 90% . Strains of Streptococcus sanguis Type II and Streptococcus mitis which synthesize an amphiphile other than LTA were also inhibited . The findings provided circumstantial evidence for the involvement of LTA in the adhesion of this group of oral bacteria.

Inflammation, 1988 Dec, 12(6), 525 - 48
Lipoteichoic acid-antilipoteichoic acid complexes induce superoxide generation by human neutrophils; Ginsburg I et al.; Human neutrophils (PMNs) which have been incubated with lipoteichoic acid (LTA) from group A streptococci generated large amounts of superoxide (O2- chemiluminescence and hydrogen peroxide when challenged with anti-LTA antibodies . Cytochalasin B further enhanced O2- generation . The onset of O2- generation by the LTA-anti-LTA complexes was much faster than that induced by BSA-anti-BSA complexes . LTA-treated PMNs generated much less O2- when challenged with BSA complexes, suggesting that LTA might have blocked, nonspecifically, some of the Fc receptors on PMNs . PMNs treated with LTA-anti-LTA complexes further interacted with bystander nonsensitized PMNs resulting in enhanced O2- generation, suggesting that small numbers of LTA-sensitized PMNs might recruit additional PMNs to participate in the generation of toxic oxygen species . Protelolytic enzyme treatment of PMNs further enhanced the generation of O2- by PMNs treated with LTA-anti-LTA . Superoxide generation could also be induced when PMNs and anti-LTA antibodies interacted with target cells (fibroblasts, epithelial cells) pretreated with LTA . This effect was also further enhanced by pretreatment of the target cells with proteases . PMNs incubated with LTA released lysosomal enzymes following treatment with anti-LTA antibodies . The amounts of phosphatase, beta-glucoronidase, N-acetylglucosaminidase, mannosidase, and lysozyme release by LTA-anti-LTA complexes were much smaller than those released by antibody or histone-opsonized streptococci, suggesting that opsonized particles are more efficient lysosomal enzyme releasers . However, since the amounts of O2- generated by the LTA complexes equaled those generated by the opsonized particles, it is assumed that the signals for triggering a respiratory burst and lysosomal enzyme secretion might be different . Generation of O2- by LTA complexes was strongly inhibited by lipoxygenase inhibitors but not by cyclooxigenase inhibitors . Also phenylbutazone, trifluorperazine, and DASA markedly inhibited O2- generation induced by LTA complexes . These data suggest that bacterial products in the presence of antibody might have important biological effects on phagocytic cells and that these effects may be inimical to the host.

Zh Mikrobiol Epidemiol Immunobiol, 1988 Dec, (12), 29 - 34
{Biological properties of Streptococcus group B: the interrelations of the virulence in mice, the adhesion to human epithelial cells and the production of type-specific antigen}; Bulgakova TN et al.; The results presented in this work confirm the possibility of selecting the subpopulations of group B streptococci by the passage of these microorganisms through mice . This process was accompanied by the accumulation of cells with a high level of type-specific antigen (TSA) . The passage of group B streptococci in the presence of type-specific antibodies led to the selection of avirulent microorganisms with low TSA production and high adhesiveness . These data may be considered to be the indirect evidence of the screening effect of TSA contained in the capsule of group B streptococci with respect to the ligand structures of these microbes . This suggestion is confirmed by the behavior of the variants of group B streptococci, obtained in the course of this investigation, on virus-infected tissue when TSA+ strains lost their ability to recognize viral polypeptides serving as receptors for TSA- variants of the streptococci.

J Immunol, 1988 Nov 15, 141(10), 3551 - 6
Group B streptococci inhibit the chemotactic activity of the fifth component of complement; Hill HR et al.; Infection with group B streptococci (GBS) is associated with a poor acute inflammatory response in which neutrophils fail to localize at the site of invasion . In the present studies, we have examined the effects of group B streptococci on C-derived chemotactic activity in human serum . Fresh human serum was activated to form C5a and C5adesarg by incubation with zymosan . The activated serum was then incubated with group B organisms, centrifuged, and the supernatants tested for chemotactic activity for human polymorphonuclear leukocytes . Group B organisms caused a dose-dependent decrease in C-dependent chemotactic activity . The degree of inhibition was profound with 1 X 10(9) bacteria/ml (10% of control) . Experiments indicated that significant chemotactic factor inactivation occurred within 2 min of exposure to GBS organisms, while maximal inhibition occurred after 30 min incubation . A number of different strains of GBS of types I, II, and III possessed inhibitory activity . In contrast, group D streptococci, Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae failed to inhibit the C-derived chemotactic activity in human serum . Group A streptococci that were M protein positive also inactivated C-dependent chemotactic activity in serum, as previously reported . The inhibitory activity of the GBS strains could be abolished by heat or trypsin treatment but not by neuraminidase, pronase, or pepsin . C5a levels in zymosan-activated serum as measured by RIA were not decreased after incubation with an inhibitory strain suggesting that absorption was not involved . SDS-PAGE analysis revealed that group B streptococci degrade the C5a molecule, increasing its electrophoretic mobility by removing a fragment with a m.w . of approximately 650 Da . Thus, one of the reasons for the poor inflammatory response at the site of GBS infection may reside in the ability of these pathogens to inactivate C-derived inflammatory mediators . The GBS C5a-ase activity probably serves as an additional virulence factor for these organisms contributing to the poor inflammatory response characteristic of group B streptococcal infection.

J Immunol, 1988 Nov 15, 141(10), 3592 - 9
Mapping the immunodeterminants of the complete streptococcal M6 protein molecule . Identification of an immunodominant region; Fischetti VA et al.; The immune response to the complete streptococcal M6 protein was examined by kinetic ELISA to determine the reactivity of rabbit and human sera to M6 peptides representing 82% of the native molecule . The results revealed that rabbits immunized with purified native M6 protein or whole streptococci responded by reacting early and predominantly to one of the three sequence repeat regions of the molecule, the B-repeat, antibodies which have been shown to be non-opsonic . Antibodies to peptides representing the hypervariable N-terminal and adjacent A-repeat regions appear when opsonic antibodies are detected in the serum . Antibodies to peptides located within the conserved C-terminal half of the molecule (proximal to the cell) were restricted even after several immunizations . An examination of human sera from individuals with no recent streptococcal infection (greater than 3 yr), revealed that those sera opsonic for M6 streptococci contained antibodies reactive predominantly to the N-terminal and A-repeat regions, supporting the view that opsonic antibodies are long lived . Nonopsonic human sera to M6 streptococci exhibited a low reactivity to all peptides . However, by Western blot analysis, all human sera tested contained antibodies to the conserved region of the molecule, whereas only sera opsonic for M6 streptococci reacted with the variable region . Evidence is presented supporting the view that antibodies to the conserved regions of the M molecule may be conformation dependent.

Schweiz Med Wochenschr, 1988 Nov 12, 118(45), 1633 - 40
{Diagnosis and therapy of pleural empyema}; Mordasini C et al.; 21 patients with thoracic empyema were treated at this clinic over a period of 3 years . 15 patients had metapneumonic empyema, 2 empyema associated with sepsis, and 4 postsurgical empyema . In 12 patients the underlying illness was chronic disease while 9 patients were thus far in good health . The most frequent causative pathogens were staphylococci and streptococci, together with anaerobic bacteria . One patient died of the underlying disease . Three cases of metapneumonic empyema healed completely with antibiotics only . Closed chest tube drainage with small chest tube was performed 13 times and was successful 11 times with a mean drainage duration of 13 days . Six patients underwent surgery (early decortication in 4 instances, late decortication in 2) . The surgical indication was in 4 instances multilocular of the empyema which inhibited chest tube drainage, imminent loss of function in 1 case and unsuccessful drainage in a case of bronchopleural fistula in 1 instance . Apart from high-dose antibiotic therapy, earliest possible drainage is of crucial importance in the treatment of thoracic empyema . Surgery should be considered only in uncomplicated empyema if drainage is impossible for technical reasons.

J Immunol Methods, 1988 Nov 10, 114(1-2), 175 - 80
A novel approach to monoclonal antibody separation using high performance liquid affinity chromatography (HPLAC) with SelectiSpher-10 protein G; Ohlson S et al.; Protein G, a bacterial cell wall protein extracted from strains of Streptococci, has been employed as a ligand in high performance liquid affinity chromatography (HPLAC) for separation of monoclonal antibodies . Examples are given of rapid high-resolution separations of rat and mouse monoclonal antibodies belonging to various subclasses . In comparison with protein A chromatography, we were able to show superior binding characteristics for SelectiSpher-10 protein G columns under conditions of 'low' ionic strength (about 0.1 M) and neutral pH (pH approximately 7) . The monoclonal antibodies were isolated in high purity (greater than 90%) and with good recovery of specific activity (80-100%) . We believe that the HPLAC technology based on SelectiSpher-10 protein G is of potential value in the analysis and purification of monoclonal antibodies from various species and subclasses.

N Engl J Med, 1988 Nov 3, 319(18), 1180 - 5
Immunization of pregnant women with a polysaccharide vaccine of group B streptococcus; Baker CJ et al.; Immunization of pregnant women with a polysaccharide vaccine of group B streptococcus is a promising strategy for the prevention of perinatal infections caused by group B streptococci . To explore the feasibility of this strategy, we vaccinated 40 pregnant women at a mean gestation of 31 weeks with a single 50-microgram dose of the Type III capsular polysaccharide of group B streptococcus . The only adverse effect detected was a mild local reaction in nine women (22 percent) . Of the 35 women with low or unprotective antibody levels before immunization (less than 2 micrograms per milliliter), 20 (57 percent) responded to the vaccine . The geometric mean antibody level rose from 1.3 to 7.1 micrograms per milliliter four weeks after vaccination (P less than 0.02), and these levels persisted at delivery and three months post partum . Sixty-two percent of the vaccine-induced immunoglobulin in the mothers was IgG, which readily crosses the placenta . Infant antibody levels in cord serum correlated directly with maternal antibody levels at delivery (r = 0.913, P less than 0.001) . Of the 25 infants born to women who responded to the vaccine, 80 percent continued to have protective levels of antibody at one month of age and 64 percent had protective levels at three months . Serum samples from infants with greater than or equal to 2 micrograms of antibody to Type III group B streptococcus per milliliter uniformly promoted efficient opsonization, phagocytosis, and bacterial killing in vitro of Type III strains . This effect could be mediated exclusively by the alternative complement pathway . Although this vaccine with an overall response rate of 63 percent is not optimally immunogenic, we conclude that maternal immunization is feasible and can provide passive immunity against systemic infection with Type III group B streptococcus in the majority of newborns . Larger trials with better vaccines will be required to evaluate the safety and clinical effectiveness of this strategyPIP: Of the 11,000 cases of neonatal infection with group B streptococcus that occur each year in the US, 2/3 are caused by Type III strains . Although only 63% of adults produce an immune response to the Type III capsular polysaccharide of group B streptococcus, the high infant morbidity from this strain makes the development even of a less than optimal maternal vaccine worthwhile if the antibodies can cross the placental barrier and confer immunity to the infant . 40 pregnant women, aged 21-39, in the 26th to the 36th week of pregnancy, were immunized subdermally with 50 mc of Type III capsular polysaccharide of group B streptococcus . 63% of the women responded to the vaccine, and 62% of the antibodies produced in response to the vaccine were IgG, which readily crosses the placental barrier . Serum samples from the 25 infants born to the responders contained more than 21.8 mc per milliliter of antibody to Type III group B streptococcus at birth . 64% of these infants' serum still showed protective antibody levels at 3 months of age . These antibody levels were sufficiently high to activate the alternative complement pathway required for the opsonization and phagocytosis of Type III strains . Thus, even though this vaccine is only 63% immunogenic, it can prevent a substantial number of group B streptococcus infections in infants .

Q J Med, 1988 Nov, 69(259), 907 - 19
Community-acquired bacteraemia; a prospective survey of 239 cases; Rayner BL et al.; Over a one-year period 239 patients with community-acquired bacteraemia were studied prospectively to evaluate their clinical profile, course and outcome . Gram-negative organisms accounted for 108 (45 per cent) episodes of bacteraemia, Gram-positive 121 (51 per cent) and polymicrobial 10 (4 per cent) . The organisms isolated most commonly were E . coli (28.9 per cent), Klebsiella spp . (7.5 per cent), S . pneumoniae (21.3 per cent), S . aureus (12.1 per cent) and haemolytic streptococci (4.6 per cent) . The overall mortality was 29.2 per cent and most deaths were caused by bacteraemia or related complications . This condition therefore still has a high mortality despite modern antimicrobial drugs and intensive care . The most important factor in reducing mortality is early recognition and administration of appropriate antimicrobial drugs.

J Clin Microbiol, 1988 Nov, 26(11), 2429 - 31
Evaluation of rapid, commercial latex techniques for serogrouping beta-hemolytic streptococci; Daly JA et al.; The clinical need to rapidly and correctly differentiate beta-hemolytic streptococci into Lancefield groups has prompted the development of commercially available rapid agglutination techniques . A modified Streptex (Wellcome Diagnostics, Research Triangle Park, N.C.) technique and the PathoDx latex Strep Grouping Kit (Diagnostic Products Corporation, Los Angeles, Calif.) technique were applied to 220 strains of beta-hemolytic streptococci that were serologically grouped by standard techniques . Agreements between standard and modified Streptex and PathoDx techniques were 99.1 and 100%, respectively . Modified Streptex produced a false-negative for one group G isolate and a weak-positive reaction for a group G reagent with a nongroupable isolate . Sixty-five strains representative of bacteria that may be found in the posterior pharynx in concentrations high enough to cause potential reactions with antigen detection reagents were tested with Streptex and PathoDx reagents . No cross-reactions were observed with any reagent tested when challenged with these 65 strains . When combined with colonial morphology and hemolytic reaction, both modified Streptex and PathoDx were rapid, specific tests for identifying streptococci, with PathoDx being slightly faster.

J Burn Care Rehabil, 1988 Nov-Dec, 9(6), 610 - 2
The epidemiology of methicillin-resistant Staphylococcus aureus in a burn center; Heggers JP et al.; The emergence of methicillin-resistant Staphylococcus aureus (MRSA) in a critical care facility creates a multifaceted epidemiological problem in uncovering the source of infection . This study was undertaken to determine the true etiology of MRSA burn wound infections . Patients with a 30% or greater TBSA burn had both burned and unburned skin surface cultured upon admission, using RODAC plates . All other body fluids were cultured when sepsis was suspected . Admission cultures of 14 patients who developed MRSA wound infections were examined for methicillin-resistant organisms . Both admission isolates and infection isolates were compared by antibiogram analysis . Of the 14 patients admitted who developed MRSA infections, 57.1% of these had methicillin-resistant staphylococci present on admission . However, the remaining 42.9% of the patients had methicillin-sensitive, B-lactamase positive staphylococci present on admission . Isolates of group D streptococci resistant to methicillin were isolated in 35.7% of the patients . This data suggests that burn wound infections caused by MRSA very likely arise from the endogenous flora present at the time of injury through conferring the resistant plasmid by conjugational transfer.

Infect Immun, 1988 Nov, 56(11), 2912 - 7
Glucan-binding factor in saliva; Cowan MM et al.; High-molecular-weight polymers of alpha-1,6-linked D-glucans are insoluble in alcohol solutions . Whole, but not parotid, saliva prevented the precipitation of D-glucans by 80% (vol/vol) ethanol, showing that the whole saliva contained a factor which complexed with the glucan to render it alcohol soluble . The glucan-binding factor was retained on a column of Sephacryl S-200 which had been preequilibrated with 80% ethanol . The factor was then eluted with water . Passive hemagglutination assays revealed that the glucan-binding factor could sensitize erythrocytes to agglutination with anti-poly(glycerolphosphate), suggesting that the active glucan-binding component with lipoteichoic acid . The glucan-solubilizing factor was resistant to heat (100 degrees C), proteases, sialidase, lysozyme, lactoperoxidase, trichloroacetic acid, and Triton X-100 . When sucrose was added to saliva, a suspension of Streptococcus cricetus AHT, or a suspension of Streptococcus sanguis 10556, relatively large amounts of glucan-binding factor were released in a soluble form . In addition, penicillin G caused the release of the glucan-solubilizing component from a suspension of S . cricetus AHT . It is suggested that whole saliva contains a component, tentatively identified as lipoteichoic acid, which can complex with glucans in a relatively hydrophobic solvent . This type of complex formation may be important in the adhesion of oral streptococci to saliva-coated surfaces.

J Oral Pathol, 1988 Nov, 17(9-10), 471 - 4
Suppression of Streptococcus sobrinus 6715 (g) in plaques by Streptococcus mutans 32K (c); Ikeda T et al.; The dental plaque of 96 healthy donors was screened for the production of such antibacterial substances as mutalipocin and bacteriocin and 192 strains of mutans streptococci isolated: 28 produced mutalipocin and 22 produced bacteriocin . Mutalipocin produced by these 28 S . mutans strains possessed similar biochemical and biological characteristics of well-characterized mutalipocin-producing strain S . mutans 32K (serotype c) . When equal amounts of S . mutans 32K and S . sobrinus 6715 (g) were cultured together, cells of S . sobrinus 6715 were completely killed in 18 h . In addition, S . mutans 32K inhibited in vitro plaque formation by S . sobrinus 6715, and S . mutans 32K also eliminated in vitro plaque preformed by S . sobrinus 6715 . In rat experiments, S . mutans 32K could pre-emptively colonize in plaque preformed by S . sobrinus 6715 . On the other hand, S . sobrinus 6715 could not colonize in plaque preformed by S . mutans 32K . The results indicate that S . mutans serotype c which produces antibacterial substances is able to invade dental plaque and replace the other mutans streptococci . This investigation offers one of the possible explanation why S . mutans serotype c is a predominant species among mutans streptococci in human plaque.

Infect Immun, 1988 Nov, 56(11), 3001 - 3
A pneumococcal surface protein (PspB) that exhibits the same protease sensitivity as streptococcal R antigen; McDaniel LS et al.; A monoclonal antibody against Streptococcus pneumoniae, designated T4A49, detected a 64,000-molecular-weight protein that was immunologically unrelated to the previously described surface protein PspA . This new protein, designated PspB, was pepsin sensitive and trypsin resistant, as is the R antigen of type 28 group A streptococci.

Microb Pathog, 1988 Nov, 5(5), 345 - 55
Properties of high and low density subpopulations of group B streptococci: enhanced virulence of the low density variant; Hakansson S et al.; From the group B streptococcus (GBS) reference strain 090 la Colindale two subpopulations, which differed markedly regarding their capacities for biosynthesis of type-specific polysaccharide, were obtained by separation on a hypotonic Percoll density gradient . In the original strain and the high and low density variants, there was a negative correlation between buoyant density and bio-synthesis of type-specific polysaccharide as determined by ultrastructure and quantitative assays . The invasiveness of these variants was investigated by infecting rabbits via subcutaneously implanted tissue cages . In the animals infected with highly encapsulated bacteria, heavy bacteremia was detected 8 h post-infection, whereas in the animals which received high density bacteria with small amount of capsule, heavy bacteremia was not detected until after five days . All isolates recovered from the blood or organs of these rabbits were of the capsule rich phenotype, indicating a phenotypic shift in the subpopulation of high density bacteria . An apparently similar phenotypic shift was noted in an isolate from a baby with early onset septicemia . There was a dominance of low density bacteria in the isolate obtained from the baby as compared with the colonizing population of bacteria isolated from the cervix of the mother . From these type III isolates, subpopulations with different density maxima were obtained . A reversed shifting towards dominance of less encapsulated, high density bacteria was observed during in vitro passage of these subpopulations.

Scand J Prim Health Care, 1988 Nov, 6(4), 245 - 9
A year of rapid slide-culture in health centres: novelty wears off; Makela M; Usage of rapid slide-culture for streptococci was observed in health centres one year after its introduction and first evaluation . The proportion of culture sore-throat patients returned to the original 55% level after an initial period of enthusiasm . The proportion of antibiotic prescriptions remained unchanged at 40%, and rationality of treatment did not increase . Doctors' decisions were based mostly on clinical assessment, while patients' opinions were unpopular decision aids . Evaluation of new tests should extend beyond specificity and sensitivity to their effect on diagnostic and treatment decisions in actual working environments . An observation done shortly after a method has been introduced may be biased by the enthusiasm for novelty, which could be called the "honey-moon effect".

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1988 Nov, 270(1-2), 28 - 34
Cell electrophoresis of group B streptococci: separation of types Ia, Ib/c, II, III and IV before and after neuraminidase treatment; Uhlenbruck G et al.; Group B streptococcal strains of types Ia, Ib/c, II, III and IV could be characterized by distinct electrophoretic mobilities before and after neuraminidase treatment . By this method of cell electrophoresis in the type I a strain, two subpopulations could be detected; whereas in all strains the electrophoretic mobility is markedly reduced after enzymatic removal of neuraminic acid, type II remained unaffected . The method of "bacteriopheresis" offers a new approach to classification of bacteria with respect to the primary and secondary surface structures.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1988 Nov, 269(4), 479 - 91
Localization and characterization of fibronectin-binding to group A streptococci . An electron microscopic study using protein-gold-complexes; Wagner B et al.; The location and nature of the binding sites for fibronectin (Fn) and its N-terminal 29 K fragment (FnF) on group A streptococci were studied by electron microscopy using these proteins labelled with colloidal gold . The investigated strains exhibited a different labelling intensity as well as a different labelling pattern varying from a strong regular distribution to a weak focal binding . Binding of Fn and FnF was inhibited by itself as well as by lipoteichoic acid (LTA), anti-LTA and concanavalin A . Simultaneous labelling of the bacteria with marker complexes of FnF, human serum albumin and fibrinogen revealed separate receptor sites for each protein . Our results confirmed LTA to be mainly responsible for the binding of Fn on group A streptococci.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1988 Nov, 269(4), 454 - 9
Further characterization of haptoglobin binding to streptococci of serological group A; Lammler C et al.; Certain group A streptococci with surface antigen T 4 possess surface receptors for human haptoglobin (Hp) . Binding of 125I Hp 2-1 to two representative group A streptococcal cultures could be inhibited by unlabelled Hp 2-1, Hp 2-2 and Hp 1-1 but not by the alpha 1, alpha 2 or beta chains of Hp . Hp complexes formed with equine hemoglobin and asialo-Hp also reduced 125I-Hp 2-1 binding to group A streptococci . Hp binding proteins could be solubilized from streptococcal surface by hot acid treatment of the bacteria and purified by subsequent affinity chromatography on human Hp 2-1 sepharose . The isolated Hp binding proteins specifically inhibited 125I-Hp 2-1 binding to group A streptococci and retained their 125I-Hp 2-1 binding activity in a dot binding assay on nitrocellulose membranes . SDS-PAGE and protein blots of Hp binding proteins developed with 125I-labeled Hp 2-1 revealed numerous high molecular weight proteins with 125I-Hp 2-1 binding activity.

J Bone Joint Surg Br, 1988 Nov, 70(5), 812 - 4
Skeletal infection by group B beta-haemolytic streptococci in neonates . A case report and review of the literature; Baxter MP et al.; In the neonate, Group B beta-haemolytic streptococcal osteomyelitis presents with few inflammatory signs, a mild clinical course, extensive bony destruction, and usually single bone involvement . Onset is late (10 to 60 days after birth) and obstetric trauma appears to predispose to infection . Serotype studies suggest transmission from mother to child at the time of delivery.

J Infect Dis, 1988 Nov, 158(5), 965 - 72
Two novel antigens associated with group B streptococci identified by a rapid two-stage radioimmunoassay; Brady LJ et al.; A two-stage radioimmunoassay (RIA) has been developed that identifies type-specific antigens on the surfaces of group B streptococci . In addition to detecting the type-specific carbohydrate antigens Ia, Ib, II, and III, the RIA identified four unique antigens reactive with the Centers for Disease Control's c-protein typing antiserum . Analysis of hot-acid extracts by immunoelectrophoresis confirmed that two of these reactivities corresponded to the reported alpha and beta antigens of the c-protein marker . In addition, the identification of two heretofore unidentified antigens, gamma and delta, by the two-stage RIA is detailed in this report . The assay uses intact bacteria and does not require hot-acid extraction, a procedure thus enabling detection of acid-labile antigens in their native unmodified form . The semiquantitative RIA requires less typing reagent than does precipitin testing and is more objective, reproducible, and rapid . The assay described here could be applied to the detection of any cell surface antigen for which a monospecific antiserum is available.

Infect Immun, 1988 Nov, 56(11), 2907 - 11
Role of immunoglobulin G in platelet aggregation by viridans group streptococci; Sullam PM et al.; The aggregation of human platelets by the viridans group streptococci requires both direct platelet-bacterium binding and plasma components . Some of these extracellular constituents (e.g., fibrinogen) are cofactors for ADP, which mediates the terminal events in platelet activation by these organisms . In addition, other plasma components which are specific for viridans group streptococci are necessary . To better define these latter cofactors, we examined the role of immunoglobulin G (IgG) in platelet aggregation by two strains of viridans group streptococci . The addition of either strain to washed human platelets suspended in normal plasma resulted in a 5- to 12-min lag phase, followed by brisk and irreversible platelet aggregation . In contrast, neither strain aggregated platelets suspended in IgG-depleted plasma (IgG concentration, less than or equal to 6.7 micrograms/ml) . The addition of IgG (1.0 mg/ml) to the platelet suspension restored normal aggregation . Absorption of the IgG with intact bacteria abolished its ability to support aggregation . Preincubation of washed platelets with a murine monoclonal antibody to the 40,000-Mr platelet Fc receptor blocked aggregation by both strains, but had no effect on aggregation by ADP (5 microM) or collagen (200 micrograms/ml) . Neither strain aggregated gel-filtered platelets supplemented with fibrinogen (100 micrograms/ml), whereas ADP induced a maximal platelet response . When IgG (1.0 mg/ml) was added to the suspension of gel-filtered platelets, both strains produced normal aggregation . These results indicate that specific IgG is required for platelet aggregation by viridans group streptococci and that platelet activation is mediated through the 40,000-Mr Fc receptor on the platelet surface.

Proc Natl Acad Sci U S A, 1988 Nov, 85(21), 8271 - 5
Spontaneous M6 protein size mutants of group A streptococci display variation in antigenic and opsonogenic epitopes; Jones KF et al.; Deletions of highly, but not entirely, homologous intragenic sequence repeats result in amino acid sequence and conformational changes in the M proteins of spontaneous M protein-size variants of group A streptococci . To determine if antigenic changes occurred as a result of these deletion mutations, monoclonal and polyclonal antibodies with defined epitopes were used in competition assays . Competing antigens were either purified pepsin-derived fragments (representing the amino-terminal half of the molecule) of parent and mutant M proteins or were intact bacterial cells . These assays showed that antigenic variation occurred at the site(s) of these deletions but not at adjacent or distant epitopes . Once cleaved from the bacterium by pepsin, the M molecules also underwent conformational changes, which were reflected in their ability to compete . A monoclonal antibody opsonic for M6 streptococci lost its ability to completely opsonize one of the size mutants in this study . Therefore, spontaneous intragenic events between repeats within emm-6, the structural gene for the M6 protein, do result in structural variations within the mutant M molecules . This variation alters the ability of certain antibodies, originally produced in response to sequences in the parental M molecule, to bind to the mutant M molecules or opsonize the mutant organisms . Group A streptococci have evolved a mechanism for generating antigenic diversity that differs from currently known mechanisms in other bacterial species.

Infect Immun, 1988 Nov, 56(11), 2851 - 5
Mediation of adherence of streptococci to human endothelial cells by complement S protein (vitronectin); Valentin-Weigand P et al.; The role of S protein in the adherence of group A and G streptococci to human umbilical vein endothelial cells cultivated in 96-well microdilution plates was studied by utilizing fluorescein-labeled streptococci . The assay proved suitable for quantitative determination of bacterial adherence to cultured endothelial cells for all tested strains of streptococci . Only bacterial strains with significant S protein binding but weak fibronectin binding were included in these studies . Fibronectin-mediated adherence to endothelial cells of these streptococci was less than 25% of total and could be blocked by antifibronectin immunoglobulin G . Further treatment of endothelial cell monolayers with anti-S protein immunoglobulin G at concentrations up to 1 mg per well led to an almost complete inhibition of adherence for all tested streptococcal cultures, indicating significant contribution of S protein in the streptococcus-endothelial cell interaction . Blocking of S-protein-binding sites on streptococci by preincubation with exogeneous S protein at a concentration of 10 micrograms per 4 x 10(7) streptococci led to about 75% reduction of S-protein-mediated adherence to endothelial cells . Trypsin pretreatment of group G streptococci and pronase pretreatment of group A and G streptococci, modifications known to destroy the bacterial binding sites of S protein, also inhibited the capacity of the streptococci for S-protein-mediated adherence to endothelial cells by 75 to 80% . These results indicate that S protein plays a mediatory role in adherence of streptococci to endothelial cells and that S-protein-specific binding sites on streptococci are involved in this interaction.

J Immunol, 1988 Oct 15, 141(8), 2767 - 70
Protective immunity evoked by locally administered group A streptococcal vaccines in mice; Bronze MS et al.; The present studies were undertaken to determine the pathogenicity of group A streptococci introduced intranasally (i.n.) into mice in an attempt to mimic mucosal infections in humans and to determine the efficacy of streptococcal vaccines administered via the mucosal route . The LD50 of type 24 streptococci (M24 strep) administered i.n . was 3 x 10(4) CFU . Throat cultures were performed in M24 strep-inoculated mice . Of 11 mice that died, 9 had positive throat cultures 3 or 4 days after i.n . challenge, and of 9 mice that survived, only 1 had a positive throat culture, indicating an association between mucosal infection and death . Postmortem examination performed on 35 mice that died after i.n . challenge showed that all had evidence of disseminated infections, and group A streptococci were recovered from the cervical lymph nodes, blood, spleen, liver, and brain . To determine vaccine efficacy, heat-killed M24 strep or pep M24 were administered i.n . to groups of mice . Whole, heat-killed streptococci and pep M24 administered locally protected mice against death from i.n . challenge infections with homologous M24 strep . The whole cell vaccine also protected against i.n . challenge infections with heterologous type 6 streptococci . Our data suggest that streptococcal vaccines administered locally evoke protective immunity against streptococcal infections.

J Immunol, 1988 Oct 15, 141(8), 2760 - 6
Human monoclonal antibodies reactive with antigens of the group A Streptococcus and human heart; Cunningham MW et al.; Human mAb were produced from tonsillar or PBL of normal individuals or patients infected with group A streptococci . Lymphocytes were purified on Ficoll-Hypaque gradients and stimulated in vitro with purified group A streptococcal membranes or M protein extracts . The mAb were selected for study based on their reaction with group A streptococci, pep M5 protein, and/or M6 Escherichia coli protein . Further analysis by Western immunoblot or competitive inhibition ELISA revealed that there were two types of antibodies: one type that reacted with myosin and DNA and the other type that reacted with myosin, keratin, and/or actin . The specificities of these human mAb are similar to specificities observed in our previous studies of murine mAb reactive with group A streptococci and heart Ag . For comparison, anti-myosin antibodies were affinity purified from the sera of infected or acute rheumatic fever patients and were shown to react with myosin and DNA as well as with group A streptococci and M protein . To affinity purify these antibodies from normal sera, five times the amount of sera was required to obtain detectable quantities . These data suggest that the human mAb reactive with group A streptococci and myosin reflect the antibodies seen in sera from infected patients or acute rheumatics and that the B lymphocyte clones capable of producing these cross-reactive antibodies are also present in normal individuals.

J Immunol Methods, 1988 Oct 4, 113(1), 137 - 42
Assessment of phagocytosis of plastic adherent group B streptococci by ELISA quenching; Rainard P; An ELISA was devised to quantitate the number of group B streptococci (GBS) adherent to flat-bottomed 96-well microtiter plates . Ingestion of GBS by bovine polymorphonuclears (PMN) led to a decrease in ELISA values . This ELISA quenching proved to be proportional to phagocytosis . The method is suitable for kinetic studies of phagocytosis using glutaraldehyde to block the uptake of bacteria . The ELISA quenching test is applicable to a large number of samples and permits the use of the semi-automated equipment developed for ELISA.

Int J Dermatol, 1988 Oct, 27(8), 585 - 8
Necrotizing fasciitis . A report of five patients; Tharakaram S et al.; Five patients with necrotizing fasciitis are reported . Streptococci were isolated in all but one patient, in whom Staphylococcus albus was responsible . Other organisms were also isolated in culture . Surgical debridement and skin grafting were needed in all our patients, in addition to systemic antibiotics and topical treatment, comprising Eusol paraffin soaks . One patient developed this condition after a skin biopsy; another had chronic venous leg ulcer . There was no predisposing cause in the remaining three patients.

Community Dent Oral Epidemiol, 1988 Oct, 16(5), 253 - 7
Effect of a preventive program on dental caries and mutans streptococci in Polish schoolchildren; Carlsson P et al.; The effect of a preventive program was studied in Polish schoolchildren . The study was carried out in a group of 133 children, aged 10-12 yr, divided into a test and a control group . Children in the test group were initially treated with temporary restorations and were then given oral health education and preventive treatment by a specially trained chairside assistant . The preventive treatment included prophylaxis and topical fluoride treatment and was carried out at least 10 times a year . The mean 3-yr DFS increment was 1.7 in the test and 10.9 in the control group . The salivary counts of mutans streptococci were similar in test and control group at baseline and after 1 and 2 yr . At the examination after 3 yr, a difference was established between the two groups.

Int J Cardiol, 1988 Oct, 21(1), 3 - 10
The fall and rise of rheumatic fever in the United States: a commentary; Kaplan EL et al.; After a documented decline in the incidence of acute rheumatic fever in the United States during the past three decades, an apparent resurgence has occurred in the mid-1980s . Although standards of living have continued to improve with concomitant decrease in crowding and easier accessibility to medical care, the precise reasons for the decline remain unexplained . Furthermore, the decline has occurred even though there is no epidemiologic evidence to suggest any reduction in the incidence of group A streptococcal pharyngitis . Just as the decline remains unexplained, so also does the "resurgence" . Of considerable interest are the facts that the preceding pharyngitis has been mild in the majority of cases, the incidence of documented carditis has been high (over 90% in one series), and the rheumatic fever has been concentrated in middle class families with ready access to medical care . Even more intriguing has been the appearance of very mucoid strains of group A streptococci at the same time . While this simultaneous appearance suggests "rheumatogenicity", this has not been substantiated; no "rheumatogenic factor" has yet been isolated from these strains . This outbreak, although small in comparison with the number of cases occurring in many of the developing countries of the world, has important implications for those countries . Unless and until the pathogenesis of rheumatic fever is fully understood, methods of control will not be optimal.

Zh Mikrobiol Epidemiol Immunobiol, 1988 Oct, (10), 15 - 8
{A comparison of 2 methods for determining the hydrophobicity of Streptococcus groups A and B}; Ravdonikas LE et al.; A simple method for the evaluation of the hydrophobic properties of streptococci, pathogenic for humans, by their adherence to polystyrene and a modified method for measuring their hydrophobic properties by their sorption on hexadecane have been developed . The results obtained in the evaluation of the hydrophobic properties of streptococci by these two methods have been compared and the complete correlation of these results in classifying the cultures as hydrophobic and hydrophilic has been shown . For the first time the differences in the hydrophobic properties of different strains of group B streptococci have been established.

J Prosthet Dent, 1988 Oct, 60(4), 467 - 70
Comparison of the antimicrobial capability of an abrasive paste and chemical-soak denture cleaners; Dills SS et al.; The objective of this research was to compare the ability of the two most popular methods for denture cleaning to remove plaque microorganisms from dentures . Dentu-Creme abrasive denture paste and Efferdent alkaline peroxide denture-cleanser soak were selected for study . Two trials were completed in which these materials were used alone and in combination along with a no-treatment control to determine the level of recoverable plaque bacteria from removable dentures . Plaque was allowed to accumulate for 48 or 72 hours in individuals with healthy oral mucosa during which time they refrained from all denture hygiene procedures . The results of two studies following similar double-blind cross-over designs were consistent in that soaking with the denture cleanser caused a significantly greater reduction of microorganisms than did brushing with the denture paste . Further, combining brushing with the soak did not reduce the level of recoverable microorganisms significantly more than soaking alone . Overall, brushing alone did not consistently remove more microorganisms than were observed in the no-treatment group . The denture-cleanser soak displayed broad antimicrobial activity against gram-negative anaerobic rods (Fusobacterium sp.), gram-positive facultative cocci (streptococci), and gram-negative anaerobic cocci (Veillonella sp.), as well as total recoverable microorganisms, which were all equally reduced by the denture-cleanser treatment . These results support the need for use of a denture cleanser in addition to brushing with a denture paste for proper denture hygienePublication Types:

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