Streptococcal infections

Pili are essential virulence factors in many Gram-negative bacteria; however, they have not been described in most important Gram-positive pathogens. While screening the sequence of multiple genomes of Group B Streptococcus , we identified protective antigens that formed high molecular weight polymers. Immunogold electron microscopy revealed that the structures have a pilus-like form. These large structures have gone unrecognized in decades of studies of Group B Streptococcus .

Group B streptococcus (GBS) is the leading etiologic agent of bacterial meningitis and sepsis during the neonatal period, but it is an infrequent cause of meningitis in adults. We report 12 episodes of group B streptococcal meningitis in adults and review 52 cases reported in the literature. A total of 24 men and 40 women were included in the study; the mean age ({ SD) was 49.2 { 20.5 years (range, 17-89 years). All the patients had cerebrospinal fluid cultures positive for GBS. Eighty-six percent of the patients had comorbid conditions, 50% had a distant focus of infection, and blood cultures yielded GBS for 78.7%. The overall case-fatality rate was 34.4% (22 patients). Factors associated with a poor outcome were advanced mean age ({ SD) (61.5 { 17.4 years vs. 42.8 { 19.2 years; P Å .0003) and the presence of complications on admission (P Å .0001). Seven percent of survivors had neurological sequelae. Group B streptococcal meningitis in adults has become increasingly frequent in recent years; it tends to occur in patients with severe underlying conditions and is associated with a high casefatality rate. Factors associated with a poor prognosis are advanced age and the occurrence of neurological and extraneurological complications.

An outbreak of pseudobacteremia due to Streptococcus pyogenes (group A streptococci [GAS]) and methicillin-susceptible Staphylococcus aureus (MSSA) was traced to the venting procedure for aerobic bottles prior to their loading into the incubator of the BacT/Alert analyzer (Organon Teknika). Bacteria shed by a laboratory worker suffering from impetigo and cellulitis contaminated the aerobic bottles of 10 patients. All blood culture isolates, in addition to the isolates from the laboratory worker, were of the same GAS M and T types. All MSSA isolates from blood cultures and the index case's hands had the same lytic phage profile. Procedural breakdowns were identified in the laboratory. Bottles were vented outside the biological safety cabinet, gloves were not worn, and unprotected needles were used for the venting procedure. The source of the aspirated bacteria that contaminated the bottles was identified and the index case was treated promptly.

In previous studies we demonstrated that green and roasted coffee contains low molecular weight (LMW) compounds capable of inhibiting the ability of Streptococcus mutans, the major causative agent of human dental caries, to adhere to hydroxyapatite (HA) beads. This study addressed the ability of the whole high molecular weight coffee fraction (cHMW) and of its melanoidin and non-melanoidin components (GFC1-5), applied at concentrations that occur in coffee beverages, to (i) inhibit S. mutans growth; (ii) affect S. mutans sucrose-dependent adhesion to and detachment from saliva-coated HA beads (sHA); and (iii) inhibit biofilm development on microtiter plates. The results indicated that only cHMW is endowed with antimicrobial activity. The cHMW fraction and each of the five GFC components inhibited S. mutans adhesion, the strongest effect being exerted by cHMW (91%) and GFC1 (88%). S. mutans detachment from sHA was four times greater (∼20%) with cHMW and the GFC1 and GFC4 melanoidins ...

Vogt-Koyanagi-Harada disease during pregnancy rence.4 5 Because the results reported by several authors cannot be equally compared because of differences in their detailed records of courses of diseases, it is hard to select a unique factor affecting the ophthalmic findings in these patients. Recently, massive corticosteroid treatment of VKH was clinically reinvestigated.6 Yamamoto et al6 found a similarity in the prognosis of patients treated with nonsteroidal anti-inflammatory agents and those treated with massive doses of systemic corticosteroids. Therefore, it was difficult to determine ifthe remission ofthe disease during pregnancy m our patient was spontaneous or due to the pregnancy. Although a good clinical result has been obtained without the systemic administration of high doses of corticosteroids or topical corticosteroids on the basis of careful examinations of a patient with VKH in early pregnancy, further discussions will be required about its treatment during pregnancy.

Background: Group B streptococcus (GBS) has been implicated in adverse pregnancy outcomes. GBS recto-vaginal colonization rates significantly vary among different communities and geographic locations. Limited data is available on the prevalence and effects of GBS recto-vaginal colonization among pregnant mothers in developing countries like Ethiopia. Objective: To assess the prevalence of GBS recto-vaginal colonization among near term pregnant mothers and the antimicrobial susceptibility pattern of the isolates. Methods: A cross sectional descriptive study was conducted on pregnant mothers at gestational age of 35-37 weeks attending Ante Natal Clinics at Ghandi Memorial (GMH) and Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa. Samples from lower genital tract and rectum were collected and cultured for GBS on CHROM agar Strep B. Results: Twenty two of the 300 pregnant mothers (7.2%) studied were found to have positive GBS recto-vaginal culture. Twelve isolates (55%) were sensitive to penicillin while 20 (91%) were sensitive to ampicilline. All isolates except one were sensitive to Erythromycin. Conclusion: The study showed recto-vaginal GBS colonization among near term pregnant mothers is reasonably high in our community calling for the need to screen mothers near term and provide appropriate antimicrobial prophylaxis to prevent potential adverse maternal and neonatal outcome.

The aim of the study was to assess the level of implementation of recommendations of the Ministry of Health regarding infectious disease screening during pregnancy. The study included 477 patients who were admitted to the delivery room between December 2015 and February 2016. Data on screening test results were collected based on medical records covering the period before the admission. The Human Immunodeficiency Virus (HIV) screening was conducted in 410 (86%). 460 (96%) of patients were screened for Hepatitis B Virus (HBV) and 427 (89.5%) for Hepatitis C Virus (HCV). Syphilis screening covered 465 (97.5%) of patients. Immunoglobulin M (IgM) titer against Rubella Virus (RV) was assessed in 218 (45%) patients and immunoglobulin G (IgG) in 319 (66.9%). Screening for Toxoplasma gondii based on assessment of IgM titer was conducted in 440 (92%) patients while IgG titter was assessed in 413 (86.6%). 343 (71.9%) patients had obtained vaginal swabs for Group B Streptococci (GBS) while the...

The M1inv+ subclone of M1 group A streptococci that spread globally in the late 1980s and early 1990s was previously identified by restriction fragment length polymorphism (RFLP), M protein, and SpeA exotoxin sequence analyses. Strains representing this subclone were characterized with regard to carriage of bacteriophage and capacity to invade cultured human epithelial cells. The M1inv+ subclone was found to harbor two entirely different prophages, phage T13 and phage T14, which together supplement its genome with nearly 70 kb of DNA. Phage T14 encodes the SpeA exotoxin and is closely related to the classic converting phage T12. Plaque-forming characteristics and RFLP analyses of phages T13 and T14 were compared to each other and to phage T12. Other subclones of M1, isolated in the 1970s to the early 1980s, lacked both prophages. The M1inv+ subclone was previously reported to be efficiently internalized by human epithelial cells. This potential was confirmed and expanded by comparin...

Background and Aims. S. anginosus, constellatus and intermedius, also known as the Streptococcus milleri group (SMG) are three streptococcal species more frequently detected in cases of invasive disease, abscesses and empyema in particular. Recent research suggests they play a role in exacerbations of cystic fibrosis (CF). Owing to poor recovery on standard culture media and difficult differentiation from non-pathogenic streptococci, SMG may be underdiagnosed in routine settings. We aimed to establish the incidence of SMG in chronic obstructive pulmonary disease (COPD) patients compared to CF patients and to examine possible links of SMG to exacerbations that plays a key role in progression of COPD. Methods. Altogether, 90 respiratory tract samples of patients suffering from CF or COPD were examined during the period from July 2012 to December 2013. Semi-selective McKay agar was used for primary cultivation of SMG and MALDI TOF MS was used for species identification that was confirmed by biochemical profiling and specific PCR. Results. We confirmed the presence of SMG in CF (17.6% incidence in adult patients) and newly established its presence in COPD (10.3% incidence). In COPD, SMG was detected in 4 cases of acute exacerbations, where no other bacterial pathogen was detected. In 3/4 cases, increased CRP level indicated bacterial infection as a cause of the exacerbation and in all 3 cases, patients recovered during antibiotic treatment. Conclusions. Our data indicate SMG may act as opportunist pathogens able to cause exacerbations in COPD.

Streptococcus pyogenes is responsible for a variety of infectious diseases and immunological complications. In this study, 91 isolates of S. pyogenes recovered from oropharynx secretions were submitted to antimicrobial susceptibility testing, emm typing and pulsed-field gel electrophoresis (PFGE) analysis. All isolates were susceptible to ceftriaxone, levofloxacin, penicillin G and vancomycin. Resistance to erythromycin and clindamycin was 15.4%, which is higher than previous reports from this area, while 20.9% of the isolates were not susceptible to tetracycline. The macrolide resistance phenotypes were cMLS B (10) and iMLS B (4). The ermB gene was predominant, followed by the ermA gene. Thirty-two emm types and subtypes were found, but five (emm1, emm4, emm12, emm22, emm81) were detected in 48% of the isolates. Three new emm subtypes were identified (emm1.74, emm58.14, emm76.7). There was a strong association between emm type and PFGE clustering. A variety of PFGE profiles as well as emm types were found among tetracycline and erythromycin-resistant isolates, demonstrating that antimicrobial resistant strains do not result from the expansion of one or a few clones. This study provides epidemiological data that contribute to the development of suitable strategies for the prevention and treatment of such infections in a poorly studied area.

Despite the recent resurgence in reports of invasive Group A Streptococcal (GAS) infections worldwide, it remains a rare cause of pyogenic meningitis both in children and adults. We report a case of fatal GAS meningitis in a healthy adult emphasizing the need for clinicians to be aware of its fulminant course, prompting early diagnosis and treatment. There is also a need to consider postexposure chemoprophylaxis in close contacts of such cases.

We developed a rapid pulsed-field gel electrophoresis (PFGE) method that required 3 days to complete, an improvement over the standard method that required as many as 8 days. The accuracy and reproducibility of the rapid method were verified by analysis of DNA band sizes of our control group B streptococcus isolate. The rapid method was superior to the standard method, providing more precise molecular sizing and gels of higher image quality. The reproducibility of rapid PFGE substantiated its value and continued use.

Two kinds of selective agar were developed for the isolation of Streptococcus iniae, the causal agent of streptococcosis, from Japanese flounder (Paralichthys olivaceus) and from culture tanks in flounder farms. The selective agars were heart infusion agar with added thallium acetate and oxlinic acid (TAOA), and colistin sulphate and oxolinic acid (CSOA). For samples containing various bacterial flora, selective agars were supplemented with defibrinated horse blood in order to distinguish beta-haemolytic colonies of Strep. iniae. Streptococcus iniae was quantitatively isolated from the brain and kidney of diseased flounders in pure culture. Two-thirds of isolates picked up from selective blood agars inoculated with intestinal samples were identified as Strep. iniae. The bacterial colony numbers of deposits and water from culture tanks on selective blood agars were about 10-10(5) times smaller than those on control heart infusion agar; Strep. iniae was isolated from few deposit and water samples.

As part of a national surveillance program on invasive group A streptococci (GAS), isolates that caused specific manifestations of invasive GAS disease in The Netherlands were collected between 1992 and 1996. These site-specific GAS infections involved meningitis, arthritis, necrotizing fasciitis, and puerperal sepsis. An evaluation was performed to determine whether GAS virulence factors correlate with these different disease manifestations. PCRs were developed to detect 9 genes encoding exotoxins and 12 genes encoding fibronectin binding proteins. The genetic backgrounds of all isolates were determined by M genotyping and pulsed-field gel electrophoresis (PFGE) analysis. The predominant M types included M1, M2, M3, M4, M6, M9, M12, and M28. Most M types were associated with all manifestations of GAS disease. However, M2 was found exclusively in patients with puerperal sepsis, M6 predominated in patients with meningitis, and M12 predominated in patients with GAS arthritis. While ch...

Background: Necrotizing fasciitis (NF) is a severe life-threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. Its incidence owing to invasive Streptococcus pyogenes has significantly increased in children recently. Our experience with NF in children to describe diagnostic and therapeutic aspects is hence presented herein. Methods: Records of children who were treated for NF in our unit from 1999 to 2006, inclusive, were reviewed retrospectively. Information recorded for each patient included medical history, clinical characteristics, diagnostic procedures, treatment methods, and the outcome. Results: Thirteen patients with a mean age of 35 months were treated for NF during the study period. All of the 13 children had no previous immunosuppression. The predisposing factors were composed of varicella lesions, intramuscular injections, application of a cream containing menthol to the cervical region, penetrant gluteal trauma, omphalitis, dental abscess, and streptococcal toxic shock syndrome. The most common site of the initial involvement was the abdominal wall, followed by the gluteal region and thigh, head and neck, and upper and lower extremities. The initial skin presentations were induration or cellulitis and erythema and edema with progression to skin discoloration and bullae formation. Fever and tachycardia were the most common clinical features. S. pyogenes was the most common causative microorganism, followed by Staphylococcus epidermidis and Pseudomonas aeruginosa. All patients underwent extensive surgical debridement and received appropriate antibiotics and supportive therapy. Twelve patients survived, and 1 patient with delayed diagnosis of NF died of septic shock. Conclusion: Although these infections are rare in children, their lethal potential and early diagnostic signs must be recognized. All children with NF should undergo early surgical debridement to prevent delay in treatment. The mortality and morbidity associated with NF in children can be decreased with clinical awareness, early diagnosis, and adequate and urgent surgical debridement followed by intensive supportive care and early wound resurfacing.

Streptococcus suis sequence type (ST) 7 has been spreading throughout China. To determine events associated with its emergence, we tested 114 isolates. In all 106 ST7 strains responsible for human outbreaks and sporadic infections, the tetracycline-resistance gene, tetM, was detected on the conjugative transposon Tn916. Horizontal transmission of tetM is suspected.

Six cases of disseminated intravascular coagulation in the horse are reported. They were characterised clinically by severe subcutaneous oedema of the head and neck, and clinocopathologically by abnormal partial thromboplastin and prothrombin times, a thrombocytopaenia and an increase in fibrin degradation product concentrations. Various aetiologies played a role in the pathogenesis of the condition including African horsesickness, babesiosis, lymphosarcoma and verminosis.

With the increase in cases of MRSA and VRE, difficult infections can benefit from the use of linezolid for antibiotic coverage. This single case study shows the effects of linezolid on the small-diameter nerves causing painful neuropathy. The object of this study was to provide clinical and pathological evidence of reversible painful neuropathy to small-diameter sensory nerves caused by long-term use of linezolid. Methods: A case study of a 53-year-old healthy woman with history of left knee prosthesis was described in this article. Surgical debridement and intravenous antibiotics were used during short-term episodes of infection during the course of treatment, as well as the use of linezolid. During prolonged use of linezolid, over 6 continuous months, the patient developed a painful neuropathy (VAS =82). The patient was analyzed for small-diameter nerve injury with the use of sensory examination, nerve conduction studies, quantitative sensory test, and skin biopsy. Results: This is a case study of 53-year-old female patient with an infected left knee prosthesis that was treated with continuous prescription linezolid (600 mg q12h) for more than 6 months. The patient developed a painful neuropathy during the use of linezolid that subsided after 8 months (VAS = 0). Nerve conduction studies to the upper and lower extremities were all within normal limits. Quantitative sensory testing to the dorsum of the foot showed increased warm threshold (40.0 °C) at end of continuous linezolid treatment and a reduction to 36.3 °C eight months after linezolid therapy ended. Skin biopsy to the lateral right leg, taken 2 weeks after cessation of linezolid treatment, showed epidermal nerve density to be 2.32 fibers/mm (normal > 5.88 fibers/mm). The second skin biopsy showed improvement to 9.04 fibers/mm, indicative of complete reinnervation. Conclusions: Clinical and laboratory results prove that the long-term use of linezolid can cause a painful small-diameter neuropathy to the lower extremity. This case study shows that small-diameter nerve fiber neuropathy is a reversible side effect from the extended use of linezolid.

A randomized controlled field trial was performed to evaluate the efficacy of a 3-d treatment regimen with i.m. penethamate hydriodide compared with no treatment in lactating cows with subclinical mastitis. To be included, a cow had to have 2 somatic cell counts (SCC) 300,000 cells/mL at the last 3 monthly controls, 1 or more quarters with SCC >250,000 cells/mL, and the same bacterial species isolated in 2 consecutive samples 2 to 4 d apart. A total of 151 quarters from 92 cows were monitored for 2 mo following treatment. Quarter milk samples were examined for bacteriological cure (BC) and SCC at 14, 28, and 60 d after treatment. Bacteriological cure was defined as not having the same bacterial species isolated from the quarter milk samples taken at 14 and 28 d posttreatment as in the samples taken before treatment. Systemic treatment with penethamate resulted in BC in 59.5% of quarters and 52.2% of cows, compared with 16.7 and 10.9% in the untreated cows. Somatic cell count decr...

We present a case of meningitis and endocarditis caused by Streptococcus agalactiae (group B streptococcus) in an adult patient with human immunodeficiency virus (HIV) infection. To our knowledge, only four other cases of meningitis, none of which had concomitant endocarditis, have been reported so far. A 45-year-old homosexual patient presented with fever, confusion, and signs of meningeal irritation. Streptococcus agalactiae was cultured from the blood, urine, and cerebrospinal fluid (CSF). Diagnosis of meningitis caused by streptococcus agalactiae was made. On day 35, a heart murmur was noticed, and patient developed cardiac decompensation. Echocardiography revealed vegetations on the mitral and aortic valve. After nine weeks of antibiotic treatment, the patient was discharged from the hospital in good general condition, with improved CSF and echocardiographic findings.

Periorbital cellulitis is often difficult to distinguish from orbital cellulitis, which is a rare but potentially fatal disease. There are only a few small studies in the literature and we aim to look at an ideal way of managing periorbital cellulitis in a paediatric population using our department's experience. Retrospective analysis of case notes and computer records of children attending our hospital with periorbital cellulitis over 26 month period. Thirty-four patients met the criteria. Sixteen patients had reduced visual acuity, proptosis or ophthalmoplegia. Twenty-three had white cell count checked, 14 were raised and 7 of these had an operation. Eleven had blood cultures checked and all were negative. Seven had other cultures taken, Streptococcus milleri was the predominant organism isolated. Sixteen were CT scanned, 14 showed significant sinus disease. All patients were treated with intravenous antibiotics and ten required operative intervention. Two patients developed l...

Rheumatic fever (RF) is an autoimmune disease which affects more than 20 million children in developing countries. It is triggered byStreptococcus pyogenesthroat infection in untreated susceptible individuals. Carditis, the most serious manifestation of the disease, leads to severe and permanent valvular lesions, causing chronic rheumatic heart disease (RHD). We have been studying the mechanisms leading to pathological autoimmunity in RF/RHD for the last 15 years. Our studies allowed us a better understanding of the cellular and molecular pathogenesis of RHD, paving the way for the development of a safe vaccine for a post-infection autoimmune disease. We have focused on the search for protective T and B cell epitopes by testing 620 human blood samples against overlapping peptides spanning 99 residues of the C-terminal portion of the M protein, differing by one amino acid residue. We identified T and B cell epitopes with 22 and 25 amino acid residues, respectively. Although these epi...

The inhibitory activity of seven bacteriocins produced by Staphylococcus aureus (aureocins A70, A53, and 215FN) and Staphylococcus epidermidis (Pep5, epidermin, epilancin K7 and epicidin 280) was tested against strains of both S. aureus (165 strains) and Streptococcus agalactiae (74 strains) isolated from udders of cows suffering from bovine mastitis. Most strains of the two species were inhibited by epidermin (>85%), aureocin A53 (>67%) and by a combination of aureocins A70 and A53 (>91%), co-expressed in the genetic background of strain A70, the native producer of aureocin A70. Synergy between aureocins A70 and A53 was also demonstrated, which broadened the spectrum of strains inhibited. The remaining staphylococcins inhibited either none of, or a lower percentage (<48%) of, the mastitis-causing pathogens tested. Our results therefore show that the use of epidermin and/or a combination of aureocins A53 and A70 may represent a new non-antibiotic alternative for successfully inhibiting both mastitic staphylococci and streptococci.

The susceptibility of 110 group A and 179 group B streptococci to 25 antimicrobics was tested by broth microdilution and agar disk diffusion tests. Representative strains were used in killing kinetics, penicillin-gentamicin synergy, and minimal bactericidal concentration tests. Group A streptococci were more susceptible than group B streptococci to 17 of the 25 antimicrobics tested. Group A and B streptococci were killed at the same rate if the amount of penicillin used was equivalent to their respective penicillin minimal inhibitory concentrations. Synergism was demonstrated for both group A and B streptococci when penicillin was used at concentrations equal to each respective minimal inhibitory concentration and subinhibitory concentration of gentamicin. This synergy could be demonstrated best using minimal bactericidal concentrations obtained by culturing 3- and 6-h cultures from the microdilution checkerboard tests rather than from 24-h subcultures. A greater synergistic effect ...

The misdiagnosis of intramammary infections (IMI) with Streptococcus agalactiae (S. agalactiae) could lead farmers to treat or cull animals unnecessarily. The objective of this field study was to estimate the sensitivity (Se) and specificity (Sp) of real-time PCR at different cutoffs for cycle threshold (Ct) values against bacterial culture (BC) for diagnosis of S. agalactiae IMI using latent class analysis to avoid the assumption of a perfect reference test. A total of 614 dairy cows were randomly selected from 6 herds with bulk tank PCR Ct value ≤39 for S. agalactiae and S. aureus. At milk recording, 2456 quarter milk samples were taken aseptically for BC and the routinely taken cow level milk samples were analyzed by PCR. Results showed that 53 cows (8.6%) were positive for S. agalactiae IMI by BC. Sensitivity of PCR at cutoffs ; ≤39, ≤37, ≤34, and ≤32, was 96.2%, 91.9%, 87.2% and 73.9%, while Se of BC was 25.7%, 29.9%, 59.9% and 72.1%. Specificity of PCR at cutoffs ; ≤39, ≤37, ≤34, and ≤32, was 96.8%, 96.9%, 96.7%, and 97.22%, while Sp of BC was 99.7%, 99.5%, 99.2%, and 98.9%. The estimated prevalence of S. agalactiae IMI by PCR was higher than the apparent prevalence at the tested cutoffs , indicating under estimation of S. agalactiae IMI in the examined dairy cows. In conclusion, Se of PCR is always higher than Se of BC at all tested cutoffs. The lower cutoff , the more comparable becomes Se of PCR and Se of BC. The changes in Se in both PCR and BC at different Ct-value cutoffs may indicate a change in the definition of the latent infection. The similar Se of both tests at cutoff ≤32 may indicate high concentrations of S. agalactiae viable cells, representing a cow truly/heavily infected with S. agalactiae and thus easier to detect with BC. At cutoff ≤39 the latent definition of infection may reflect a more general condition of cows being positive for S. agalactiae. Our findings indicate that PCR Ct-value cutoffs should be chosen according to the underlying latent infection definition of interest. Latent class analysis proposes a useful alternative to classic test evaluation of diagnostic tests used for detection of S. agalactiae IMI in milk.

Streptococcus suis is an important swine and human pathogen. Inflammation, a hallmark of S. suis infection, is thought to be responsible for most clinical signs of meningitis, septicaemia and sudden death. In this work, using a porcine whole blood model, S. suis serotype 2 was shown to trigger the release of several proinflammatory cytokines as evaluated by reverse transcriptase-PCR and enzymelinked immunosorbent assay. Although individual variations were observed among different S. suis strains, no correlations were observed between the strain origin/phenotype and cytokine levels. Live bacteria induced higher tumour necrosis factor alpha, interleukin-1 beta (IL-1b) and IL-6 levels than did heatkilled bacteria. In contrast, heat-killed bacteria stimulated higher levels of IL-8 and monocyte chemotactic protein one (MCP-1). The bacterial cell wall was observed to be the major cytokine-inducting components, whereas capsule expression was important for MCP-1 activation. The presence of specific antibodies suppressed bacterial growth resulting in significantly reduced levels of cytokine production. Thus, antibody-mediated bacterial phagocytosis combined with suppressed inflammation may be beneficial for infection control strategies. We provide first evidence of S. suis-induction of pro-inflammatory swine cytokines and demonstrate the strength and relevance of the whole blood culture systems in the investigation of S. suis modulation of cytokine production.

m Carcinomatous meningitis results f r o m infiltration of the meninges b y malignant cells a n d mimics the clinical picture of meningitis of infectious origin. In this paper, the case report of a pat ient with carcinoma of the breast , w h o was found to have simultaneous carcinomatous a n d bacterial meningitis, is presented and discussed. This case illustrates that the cerebrospinal fluid white blood count and differential can be used in the differential diagnosis o f these t w o conditions.

We evaluated the Strep B optical immunoassay (OIA; ThermoBiostar, Inc.) for detecting light and heavy group B streptococcus colonization in 1,306 pregnant women. The women were examined at 20 to 32 weeks gestation and were from six countries. Compared to culture, the sensitivity and specificity of OIA were 13.3 and 98.4%, respectively, for light colonization and 41.5 and 97.7%, respectively, for heavy colonization.

The aim of this study was to investigate the presence of transient bacteremia after the removal of a modified bonded rapid maxillary expansion appliance. Methods: The sample consisted of 25 subjects (15 girls, 10 boys; mean age, 14.4 years; range, 12.2-16.6 years). All subjects underwent rapid maxillary expansion at the start of the orthodontic treatment with the same type of appliance. Two 10-mL blood samples were taken, the first as a baseline and the second 3 minutes after removal of the appliance. All blood samples were incubated in an automated blood culture system, and bacteria were identified by using conventional biochemical methods and API kits (bioMérieux, Marcy l'Etoile, France). Results: Overt soft-tissue bleeding was observed in 11 of the 25 patients during appliance removal, and 8 of 25 patients showed bacteremia after appliance removal. The data were analyzed with the Fisher exact test. No statistically significant relationship was found between overt bleeding and bacteremia incidence (P ϭ 0.054). Conclusions: Because transient bacteremia is caused by trauma from the removal of the modified bonded rapid maxillary expansion appliance, orthodontists should consider the possibility of bacterial endocarditis in at-risk patients when using splint-type tooth-and-tissue-borne rapid maxillary expansion appliances. (Am J

Most cases of Streptococcus suis infection in humans are caused by serotype 2 strains, and only a few cases caused by other serotypes have been reported. Among 177 human isolates of S. suis in Thailand, 12 (6.8 %) were identified as being of serotype 14, and an occurrence of sporadic S. suis serotype 14 infection was noted during 2006–2008, particularly in northern Thailand. Clinical presentations of the 12 patients (median age 62.9 years) included meningitis (58.3 %), septic arthritis (25 %) and sepsis (16.7 %). These clinical features were similar to those previously reported for S. suis infections, except that there were no fatal cases. All of the 12 serotype 14 strains belonged to the multilocus sequence types (ST) 105 (n=11) and the novel ST127 (n=1). Molecular typing by PFGE revealed four different pulsotypes, including an identical pattern for nine ST105 strains and three closely related patterns for two ST105 strains and one ST127 strain. Our PFGE data suggested clonal disse...

The susceptibility of Streptococcus suis strains (n=384) isolated from diseased pigs in seven European countries to 10 antimicrobial agents was determined. For that purpose a microbroth dilution method was used according to CLSI recommendations. The following antimicrobial agents were tested: ceftiofur, cefquinome, enrofloxacin, florfenicol, gentamicin, penicillin, spectinomycin, tetracycline, tilmicosin and trimethoprim/sulphamethoxazole. Using breakpoints established by CLSI for veterinary pathogens, all strains were susceptible to ceftiofur, florfenicol, enrofloxacin and penicillin. MIC-90 values of these antibiotics were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.03, 0.5, 2 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.13 microg/mL, respectively. A low degree of resistance was observed for gentamicin (1.3%), spectinomycin (3.6%) and trimethoprim/sulphamethoxazole (6.0%). MIC-90 values of these antibiotics were 8, 16 and 2 microg/mL, respectively. A high level of resistance was observed for tetracycline (75.1%). A MIC-90 value of 64 microg/mL was found for this antibiotic. Serotype-associated differences in MIC-90 values were observed for tetracycline, tilmicosin and trimethoprim/suphamethoxazole.

It has been recognized that the cholinergic and adenosinergic systems have an essential role in immune and inflammatory responses during bacterial fish pathogens, such as the enzymes acetylcholinesterase (AChE) and adenosine deaminase (ADA), which are responsible for catalysis of the anti-inflammatory molecules acetylcholine (ACh) and adenosine (Ado) respectively. Thus, the aim of this study was to investigate the involvement of the cholinergic and adenosinergic systems on the immune response and inflammatory process in gills of experimentally infected Rhamdia quelen with Streptococcus agalactiae. Acetylcholinesterase activity decreased, while ACh levels increased in gills of infected animals compared to uninfected animals. On the other hand, a significant increase in ADA activity with a concomitant decrease in Ado levels was observed in infected animals compared to uninfected animals. Based on this evidence, we concluded that infection by S. agalactiae in silver catfish alters the ...

Innate immune sensors such as Toll-like receptors (TLRs) differentially utilize adaptor proteins and additional molecular mediators to ensure robust and precise immune responses to pathogen challenge. Through a gain-of-function genetic screen, we identified the gamma catalytic subunit of protein phosphatase 1 (PP1-c) as a positive regulator of MyD88dependent proinflammatory innate immune activation. PP1-c physically interacts with the E3 ubiquitin ligase TRAF6, and enhances the activity of TRAF6 towards itself and substrates such as IKKc, whereas enzymatically inactive PP1-c represses these events. Importantly, these activities were found to be critical for cellular innate responses to pathogen challenge and microbial clearance in both mouse macrophages and human monocyte lines. These data indicate that PP1-c phosphatase activity regulates overall TRAF6 E3 ubiquitin ligase function and promotes NF-kB-mediated innate signaling responses.

All 83 bacterial strains isolated from seven farms in three areas of the island of Java in Indonesia investigated in the present study could be identified as Streptococcus agalactiae. Identification was performed by cultural, biochemical and serological properties and by polymerase chain reaction amplification of species-specific parts of the gene encoding the 16S rRNA, the 16S-23S rDNA intergenic spacer region and the CAMP factor (cfb) gene. All isolates were unpigmented. almost all of the isolates had the serotype pattern II/X. Despite these similarities a macrorestriction analysis of the chromosomal DNA of the bacteria revealed no significant homologies of the DNA-fingerprints of the S. agalactiae from the various areas. This last finding might possibly indicate that a single ancestral unpigmented serotype II/X S. agalactiae clone was responsible for the mastitis situation on Java and had evolved separately in the various farms and regions.

Rheumatic fever (RF) is an autoimmune disease which affects more than 20 million children in developing countries. It is triggered byStreptococcus pyogenesthroat infection in untreated susceptible individuals. Carditis, the most serious manifestation of the disease, leads to severe and permanent valvular lesions, causing chronic rheumatic heart disease (RHD). We have been studying the mechanisms leading to pathological autoimmunity in RF/RHD for the last 15 years. Our studies allowed us a better understanding of the cellular and molecular pathogenesis of RHD, paving the way for the development of a safe vaccine for a post-infection autoimmune disease. We have focused on the search for protective T and B cell epitopes by testing 620 human blood samples against overlapping peptides spanning 99 residues of the C-terminal portion of the M protein, differing by one amino acid residue. We identified T and B cell epitopes with 22 and 25 amino acid residues, respectively. Although these epi...

Recent data indicate that the human pathogen group B Streptococcus (GBS) produces pilus-like structures encoded in genomic islands with similar organization to pathogenicity islands. On the basis of the amino acid sequence of their protein components, 3 different types of pili have been identified in GBS, at least 1 of which is present in all isolates. We recently demonstrated that recombinant pilus proteins protect mice from lethal challenge with GBS and are thus potential vaccine candidates. Here, we show that GBS pilin island 1, transferred into the nonpathogenic microorganism Lactococcus lactis, leads to pilus assembly. We also show that systemically or mucosally delivered Lactococcus expressing pilin island 1 protects mice from challenge with GBS isolates carrying pilus 1. Furthermore, lactococci engineered to express hybrid pili containing GBS pilus 1 and pilus 2 components confer protection against strains expressing either of the 2 pilus types. These data pave the way to the design of pilus-based, multivalent live vaccines against streptococcal pathogens.

During the period 1993-2001, a total of 1,499 pneumococci isolates were recovered through the Argentinean surveillance of Streptococcus pneumoniae causing invasive disease in children under 6 years of age, 3.5% of which were erythromycin resistant. Among the 50 erythromycin-resistant strains available, 58% (n=29) harbored mefA/E genes (15 mefA, 30%; and 14 mefE, 28%), 34% (n=17) ermB, and 6% (n=3) both mefA/E plus ermB genes, while one isolate was negative for all the acquired genes studied. The England14-9 (42%), Poland6B-20 (20%) and Spain9V-3 (16%) clones were responsible for the emergence of pneumococcal macrolide resistance in pediatric population from Argentina.

Group B streptococcus (GBS) is a leading neonatal sepsis pathogen globally. Investment in GBS disease prevention, such as maternal vaccination, requires evidence of disease burden, particularly in high infant mortality regions like sub-Saharan Africa. We aimed to provide such evidence by conducting a systematic literature review and meta-analysis to estimate maternal colonization proportion, GBS disease incidence, and GBS serotype distribution. MEDLINE, MEDLINE in process, and Cochrane Library were searched for studies published 1990 - 2014, pertaining to sub-Saharan Africa. Eligible studies were used to estimate the proportion of pregnant women colonized with GBS, early-onset GBS (EOGBS) disease incidence, late-onset GBS (LOGBS) disease incidence, and respective serotype distributions. Random effects meta-analysis was conducted to estimate weighted means and confidence intervals. We identified 17 studies of colonization, nine of disease incidence, and six of serotype distribution m...

Objectives: This study investigated the vaginal colonization rate of Streptococcus agalactiae (group B streptococci, GBS) in an antenatal population in a maternity hospital. Subjects and Methods: Anal, vaginal and combined anal and vaginal specimens were obtained from 110 pregnant women (mean age 30.7 B 5.5 years) at 35-37 weeks of gestation, using a commercially prepared culturette, and transported in 0.5 ml of Stuart's transport medium. The specimens were then cultured in standard selective Todd-Hewitt broth medium, supplemented with gentamicin and nalidixic acid. After 36 h of incubation, the broth culture was subcultured onto sheep blood agar and incubated in 5% carbon dioxide for 18-24 h. Representative colonies morphologically resembling GBS were tested with latex agglutination kit. Each culture-positive woman was given ampicillin or piperacillin prophylactically and followed up through labour and postpartum. Detailed records of biodata, antecedent antenatal events and pregnancy outcome were reviewed. Results: The combined vaginal and anal specimens were positive for GBS in 18 (16.4%) women. Gestational age at delivery was 39.01 B 1.79 weeks. The deliveries were uneventful and no neonate developed sepsis. Diabetes mellitus and pregnancy-induced hypertension/hypertension were detected antenatally in 16.6 and 11.5%, respectively. GBS carriage was not associated with adverse outcome of pregnancy. Conclusion: The colonization rate of GBS in pregnant women in Kuwait is high, and on the basis of the documented benefits of antenatal screening in Western countries, we recommend routine screening especially for our at-risk patients.

Background: The incidence of invasive group A streptococcus (iGAS) infections varies in time and geographically for unknown reasons. We performed a nationwide survey to assess the population-based incidence rates and outcomes of children with iGAS infections. Methods: We collected data on patients from hospital discharge registries and the electronic databases of microbiological laboratories in Finland for the period 1996-2010. We then recorded the emm types or serotypes of the strains. The study physician visited all university clinics and collected the clinical data using the same data entry sheet. Results: We identified 151 children with iGAS infection. Varicella preceded iGAS infection in 20% of cases and fasciitis infection in 83% of cases. The annual incidence rate of iGAS infection was 0.93 per 100,000