[Pharyngitis produced by Arcanobacterium haemolyticum]

Arcanobacterium haemolyticum (A.h.) was recovered from 0.43% of throat cultures of 3715 patients with sore throat, scarlatina and various skin rash. In a 57.90% patients A.h. was the only bacterial pathogen isolated, while in the remainder beta-haemolytic streptococci, Haemophilus and S. aureus were also detected. beta-haemolytic streptococci were much more frequent than A.h. in the throat cultures (26.83%). All A.h. strains were of the smooth type based on colony morphology and the ability to ferment sucrose. The strains were susceptible to penicillins, cephalosporins, erytromycin and resistant to trimethoprim-sulphamethoxazole. Pharyngeal injection in 89.47% and exanthem in 78.90% were the most common signs present to the patients.

[An outbreak of Streptococcus pyogenes infections in institutions for the mentally retarded in Greater Copenhagen 1995]

The largest reported outbreak of infections due to Streptococcus pyogenes, M-type 18, in recent years is described. Ninety persons at institutions for mentally retarded (73% residents) had infections due to the epidemic strain. Pharyngitis and scarlatina were the most common infections. Six patients died, five having a streptococcal toxic shock syndrome. During the outbreak an intensive surveillance was carried out together with improved infection control measures and prompt culturing of residents and employees before antimicrobial treatment. The primary outbreak was confined but a secondary outbreak could not be prevented. This was probably due to difficulties in implementing proper isolation precautions in this setting.

[The hydrophobicity of Streptococcus pyogenes as a possible marker of its virulence]

The hydrophobicity of 366 S. pyogenes cultures isolated from the pharynx of tonsillitis and scarlet fever patients and healthy children, as well as museum strain of type M29, was studied. The study revealed that the hydrophobicity of cultures isolated from scarlet fever patients exceeded that of cultures isolated from healthy carriers and tonsillitis patients. Among S. pyogenes cultures isolated in cases of prolonged carriership a considerable proportion of highly hydrophobic cultures was detected, which was probably indicative of an important role played by the hydrophobicity of streptococci in retaining them on the barrier epithelium. This was confirmed by the presence of correlation between the hydrophobicity of culture of S. pyogenes, type M29, and its adhesion to the fibronectin receptor and HEp-2 cells. For S. pyogenes of type M6, epidemic in the group of children under observation during the period of 1987-1988, the values characterizing its hydrophobicity were registered which significantly exceeded average hydrophobicity values. At the period of a rise in morbidity S. pyogenes cultures were characterized by significantly higher hydrophobicity. The variability of the hydrophobicity index and its relationship with the dissociation of cultures were established. The hydrophobicity index may be used as one of the virulence markers of S. pyogenes strains.

[The M-protein heterogeneity of Streptococcus pyogenes strains isolated from clinically healthy and ill children in an organized collective]

The study of the kinetic curves of the lysis of group A S. pyogenes cell-walls (cells), serovars 29 and 12 M, variants M+ and M-; with endo-N-acetyl-muramidase revealed that the kinetics of the lysis of virulent and avirulent strains was different: variant M- was lyzed faster than M+. This difference in the cell-wall lysis of both variants made it possible to use this method for the identification of M+ and M- states of the strains. 18 group A S. pyogenes cultures were studied. The cultures isolated from healthy and sick children in an organized group belonged to variants both M+ and M-. The pepsin fragments of M-proteins of group A S. pyogenes, type M 1, isolated in dynamics from a carrier and a patient, were studied. Their amino acid compositions were studied, and differences between them were established. The data thus obtained indicate that heterogeneity is characteristic of both the surface structure of streptococci and the individual components of their surface, in particular, M-protein.

Isolation and characterization of a mitogen characteristic of group A streptococci (Streptococcus pyogenes)

It has been supposed for many years that group A streptococci may elaborate more than the three well known erythrogenic toxins A, B or C (ETA, ETB, ETC). The analysis of the culture supernatant of streptococcal strain 27297 carrying neither genes for ETA nor ETC revealed mitogenic activity at pH 7.3 in isoelectric focusing. This mitogen of strain 27297 was purified by hydrophobic adsorption to Phenyl-Sepharose following FPLC chromatography on a Mono S column resulting in two proteins with mitogenic activity called AX and BX, respectively. Both differed in only one aminoterminal residue. The mitogenic activity of BX lacking one aminoterminal arginine was found to be about 100 times higher than that of AX. The aminoterminus of BX does not correspond to a predictable cleavage site for signal peptidase. We assume that BX was produced after translation by cleavage of the mature protein or the AX molecule with streptococcal proteinase (ETB) or an arginylaminopeptidase which is detectable on whole cells. The purified proteins BX and AX showed molecular weights of about 27 kDa in SDS electrophoresis and isoelectric points of 8.3 (AX) and 7.3 (BX) in isoelectric focusing, respectively. Both proteins were produced by practically all group A strains tested but not by groups B, C, G or H streptococci. Therefore, AX or BX seem to be proteins characteristic of group A streptococci.

Small-fragment restriction endonuclease analysis in epidemiological mapping of group A streptococci

The usefulness of small-fragment restriction endonuclease digest analysis (SF-REA) of group A streptococcal DNA with EcoRI, as a supplement to the more conventional T serotyping, was assessed for epidemiological characterisation. One hundred and thirty-five clinical isolates from 1988-1990 were examined. SF-REA provided characteristic fingerprints of all isolates, whereas eight isolates were non-typable by T serotyping. Generally, there was a striking correlation between the results obtained with the two techniques. Furthermore, SF-REA reliably classified the eight T-non-typable isolates and occasionally revealed subgroups within the T serotypes. In addition, SF-REA was useful for the clarification of discrepancies between serotyping results from two different reference laboratories. No obvious correlation was observed between the DNA fingerprints and the clinical manifestations of infection or the geographical origin of the group A streptococcal isolates. SF-REA is a valuable supplement to T typing in epidemiological studies and frequently appears to be a more efficient tool for strain differentiation.

The serotypes of Streptococcus pyogenes present in Britain during 1980-1990 and their association with disease

A total of 16,909 cultures of Streptococcus pyogenes (Lancefield group A) isolated in Britain during 1980-90 were examined for T- and M-protein antigens. One or other M antigen was detected in 92.6% of the strains. The numbers of isolates of some serotypes, such as M3 and M12, did not show great variation from year-to-year, whereas there were nationwide epidemics, extending over several years, caused by strains of serotypes M1 and M49. Isolates of serotypes M1 and M3 were associated particularly with invasive disease and fatal infections. Representatives of serotypes M80, M81 and the provisional types PT180, PT1658 and PT5757 were isolated most often from cases of pyoderma. Erythromycin resistance was detected in 30 serotypes but one half of all of the resistant isolates belonged to serotype M4.

Erythrogenic toxin type A (ETA): epidemiological analysis of gene distribution and protein formation in clinical Streptococcus pyogenes strains causing scarlet fever and the streptococcal toxic shock-like syndrome (TSLS)

Erythrogenic toxin type A (ETA) is assumed to play a causative role in both scarlet fever and the streptococcal toxic shock-like syndrome (TSLS). For a molecular epidemiological analysis of the gene of erythrogenic toxin type A (speA) we used altogether 497 clinical isolates of Streptococcus pyogenes belonging to three groups: a) isolates from patients with scarlet fever, b) isolates from cases with TSLS, c) isolates from patients with other streptococcal infections (like otitis media, tonsillitis, impetigo) (general group). We found that less than 50% of the scarlet fever-associated strains possessed the speA gene as compared to 25% of the general group. Only 5 to 30% of these strains secreted the toxin under experimental conditions in very low quantities. Among strains isolated from TSLS, 67% appeared to contain the speA gene. The amount of ETA secreted into the medium was also extremely low. Southern hybridization patterns proved to be the same with an speA-specific probe in all three groups of streptococcal isolates (HaeIII, HindIII). Increased occurrence of the speA gene among scarlet fever and TSLS-associated strains does not seem to be sufficient to support the hypothesis that ETA may have a causative role in both diseases since a considerable number of strains in these groups did not possess the speA gene.

Stimulation of human T cells by streptococcal "superantigen" erythrogenic toxins (scarlet fever toxins)

The pyrogenic (erythrogenic) exotoxins A and C (SPEA and SPEC) of Streptococcus pyogenes belong to the family of mitogenic toxins of which the staphylococcal enterotoxins are the prototypes. The erythrogenic toxin B (SPEB) is a proteinase precursor. All SPE have been reported to be superantigens. Here we have analyzed the human T cell response to these toxins. We used highly purified preparations of SPEA, SPEB, and SPEC from different S. pyogenes strains. These toxins were apparently homogenous in SDS-PAGE, IEF, and HPLC. In addition, recombinant SPEA and SPEC were produced in Escherichia coli. In cultures of PBMC, all three toxins expanded preferentially a fraction of T cells. Using mAb against V beta 2, -5, -6, -8, and -12, we investigated the phenotype of the stimulated cells. Natural SPEA, SPEB, and SPEC strongly stimulated V beta 8+ T cells, whereas recombinant SPEA and SPEC did not. Both natural and recombinant SPEA stimulated V beta 12+ cells and both natural and recombinant SPEC stimulated V beta 2+ cells. In accordance with these findings, a human V beta 8+ line responded to all three toxins derived from S. pyogenes but not to the recombinant proteins. An antiserum against natural SPEC neutralized specifically the V beta 2-stimulating activity of SPEC and the V beta 8-stimulating activity of all three toxins, but had no effect on the response to other superantigens. This shows that trace amounts of a potent novel V beta 8-stimulating activity not identical to SPEA and SPEC are responsible for the stimulation of V beta 8+ T cells by natural SPEA and SPEC reported previously. In a preliminary screening of S. pyogenes strains from patients, we found that this novel superantigen appears to be more widely distributed than SPEA and SPEC. Furthermore, we present evidence that also the superantigenic properties of SPEB are due to contaminations with this V beta 8 stimulator. The response to SPEB usually required 1000 times higher concentrations than to SPEA or SPEC. Antisera to SPEC but not to SPEB inhibited the response of PBMC and V beta 8+ Jurkat cells to SPEB. Furthermore, more stringent purification of SPEB yielded SPEB preparations devoid of mitogenic activity. These results indicate that the mitogenicity that is commonly attributed to SPEB is due to minute contaminations of the V beta 8 stimulator. These results raise two important caveats for the work with these highly potent T cell mitogens.(ABSTRACT TRUNCATED AT 400 WORDS)

Streptococcal erythrogenic toxin genes: detection by polymerase chain reaction and association with disease in strains isolated in Canada from 1940 to 1991

The presence of genes encoding pyrogenic exotoxins type A (speA), B (speB), and C (speC) and streptolysin O (slo) was determined by the polymerase chain reaction (PCR) to target specific sequences in 152 strains of group A streptococci. These included reference strains, representative M and T type strains, and strains associated with scarlet fever and pharyngitis collected between 1940 to 1991 and included strains from patients with severe invasive streptococcal infections. PCR amplicons were detected by agarose gel electrophoresis, and specificity was established by restriction fragment analysis. The frequency of occurrence for each target gene among all strains tested was 33.6% for speA, 99.3% for speB, 28.9% for speC, and 100% for slo. Strains of non-group A streptococci, recognized toxigenic bacterial pathogens, and pneumolysin-producing Streptococcus pneumoniae strains were negative for all targeted gene sequences. Detection limits in the PCR were found to be 100 pg of total nucleic acids for the speB and speC genes and 1 ng for the speA and slo genes. Isolates associated with scarlet fever, pharyngitis, and severe invasive infections showed statistically significant differences in the presence of speA, with scarlet fever strains having the highest association (81.3%), severe infections the next highest association (42.9%), and pharyngitis the lowest association (18.4%). Although no significant differences were observed in speC frequencies in isolated associated with the three disease categories, a genotype of speB slo was significantly higher in isolates associated with pharyngitis (54.1%) than in strains associated with scarlet fever (18.8%) or severe invasive disease (23.8%). Streptolysin O targets were present in all the isolates tested, and only a single strain (T-11-M-11) was devoid of targeted speB sequences, thereby demonstrating that neither speB nor slo is associated with any particular clinical presentation.

Arcanobacterium haemolyticum in children with presumed streptococcal pharyngotonsillitis or scarlet fever

Arcanobacterium haemolyticum was cultured from pharyngeal specimens obtained from 12 of 129 children with pharyngotonsillitis, some of whom had a scarlatiniform rash. This organism should be considered to be a cause of infections that are clinically similar to those caused by beta-hemolytic streptococci.

Scarlet fever and types of erythrogenic toxins produced by the infecting streptococcal strains

Group A streptococcal strains were isolated from the throats of 46 children suffering from scarlet fever. For detection of erythrogenic toxins (ETs), the culture supernatants were concentrated 100 times by ethanol precipitation and solubilisation in acetate buffer. ELISA was used to identify ETA and double immunodiffusion to identify ETB and ETC. The presence of the ETA gene was detected by a specific DNA probe. ETA (alone or in combination with ETB and/or ETC) was found in 51.9% of the strains, ETB (alone or in combination with ETA and/or ETC) in 76.9% and ETC (in combination with ETA and ETB) in 28.9%. Only 5.8% of strains did not produce any detectable ET. In SDS-PAGE, supernatants of ETB-producing strains showed a pronounced band in either the region of the proteinase zymogen or the active proteinase. There was no correlation between the type of erythrogenic toxin and the serological M or T type of the producing strain. The mitogenic potency of culture supernatants did not differ significantly irrespective of the toxin type(s) present. Culture supernatants of strains without a detectable amount of the known ETs were highly mitogenic, indicating the production of other streptococcal mitogens. A correlation with clinical symptoms was determined with regard to exanthema and fever. Strains producing two or three toxins caused a more intense exanthema. Patient temperature was higher (greater than or equal to 38 degrees C) when the infecting strain produced ETB. The toxin-producing patterns of the strains of this study were compared with those isolated during the last epidemic outbreak of scarlet fever in East Germany.

Staphylococcal enterotoxins in scarlet fever complicating chickenpox

Two cases of scarlet fever are described, both following super-infection of chickenpox. Enterotoxin B and C producing staphylococci were the only pathogens identified. The role of staphylococcal and streptococcal toxins in the pathogenesis of scarlet fever and toxic shock syndrome is discussed.

[A dying clinical diagnosis of scarlet fever--the last sixteen years survey]

11,119 patients with scarlet fever admitted in the last sixteen years, from 1973 to 1988, to Sapporo City General Hospital, were studied statistically on symptoms and laboratory findings. The results were summarized as follows: 1. Annual number of patients have reduced suddenly since 1981, and become zero in 1989. The patients increased in number during the winter season. Eighty two percent of the cases were between 3 and 8 years of age, and the average age was 5.8 year-old. 2. Cases of above-38 degrees C temperature were seen in about 81.4%, and from 2 to 5 days-duration of temperature were seen in 86.6% of the patients in the year 1976. Cases of above-moderate rash were observed in 68.2%, sever redness of throat in 29.9%, strawberry tongue in 86.3% and angular stomatitis in 37.7% of the patients. In recent statistical analysis (1982-1988), we found, however, a tendency that patients having stronger symptoms were being introduced to our hospital. 3. The higher rates of cases showing elevated ASD titer were seen in the elder patients and in the winter. C-reactive protein (CRP) titers were mostly in the range of (-) to (greater than or equal to 6+), having 2.4 + on an average. 4. Patients who developed into overt nephritis were not seen. Cases of microscopic hematuria (greater than or equal to 3 red cells/f in urine sediments), however, were observed in 1.1% (125/11,119). Sever complications were hardly seen. 5. Reappearance of beta-hemolytic streptococci (on a week after discharge) were found in 3.1% (241/7,877). 6. Reinfection or relapse cases of scarlet fever were found in 6.7% (642/9,585).(ABSTRACT TRUNCATED AT 250 WORDS)

[A 23-year longitudinal study on the antibiotic sensitivities of group A streptococci from the scarlet fever patients--1956-1978]

Among the group A streptococci isolated during the period 1956 to 1978 from the pharynx and the nostril of the scarlet fever patients quarantined in the Tokyo Metropolitan Toshima Hospital within 1 week of hospitalization, 1,586 strains of types 4, 6 and 12, the most prevalent serotypes, were estimated for their sensitivities to various antibiotics. Among the sensitivities, those to tetracycline (TC), chloramphenicol (CP) and erythromycin (EM), these being in close relation to prevalent serotypes, are to be reported. The first appearance of TC-resistant strain was seen in one strain (type 6) isolated in 1959, and, in 1964, the resistant strain increased in proportion in accordance with the prevalence of type 4. The resistant strain decreased a little in 1968 and in 1969, increased again from 1970, exceeded over 90% from 1973, and reached 100% in 1978. The first appearance of CP-resistant strain was seen in one strain (type 4) isolated in 1969, and then the resistant strain increased year by year along with the prevalence of type 12. The first appearance of EM-resistant strain was seen in 30 strains (type 12) isolated in 1972, and then, similarly to the case of CP-resistance, the resistant strain increased year by year together with the prevalence of type 12. Meanwhile, among the 1,586 strains isolated at the time of hospitalization and estimated of their minimum inhibitory concentrations (MIC), 932 strains (58.8%), 452 strains (28.5%), and 574 strains (36.2%) showed resistance to TC, CP, and EM, respectively. Variations of drug-resistance by serotypes were as follows: TC-resistant strains increased in accordance with the prevalence of type 4 in 1964; CP- and EM-resistant strains increased in accordance with the prevalence of type 12 in 1972; and type 6 strains were low in the rate of resistant strain to any of the three drugs. So far, prevalence of a serotype of group A streptococci has been considered to be caused by the accumulation of the subjects non-immune to the serotype. In the present study, a phenomenon was observed that prevalence of a serotype was effected by the state of resistance-acquisition to commonly used drugs. It would be clear that the resistance-acquisition plays, in addition to the immune state, a great role in evoking prevalence of a serotype.

[A study on atypical scarlet fever]

An analysis of 135 cases of scarlet fever in Harbin Municipal infection hospital in 1987 was carried out. The patients of 0-15 years old were 75.65%, the males were higher than the females. All the patients had atypical clinical manifestation. 45.18% of them were no fever. 30.37% no angina and 40% no strawberry-like tongue. The 60 strains of beta-hemolytic Streptococcus were isolated from 129 cases (positive rate 46.51%). 49 strains of them were identified as Biotype identification was carried out in 28 strains of them. They are all Group A. 14, 6 and 6 strains as biotype 1, 4 and 8/25 respectively. The results of antibiotics resistant test showed that strains which were susceptible to ampicillin and cephalosporin were 81.58% and the strains of resistant penicillin were 21.05%. Some causes of atypical clinical manifestations were discussed.

[An explosive outbreak of respiratory streptococcal infection with a droplet transmission mechanism]

The data obtained in the study of an explosive outbreak of acute respiratory diseases, tonsillitis and scarlet fever in one of schools in Moscow have made it possible to exclude the alimentary mechanism of its development and to demonstrate the role of the droplet mechanism of transmission in the appearance of its outbreak. The epidemiological analysis of the outbreak has permitted the formulation of the hypothesis on the conditions of the formation and spread of the epidemic variant of the infective agent; this hypothesis corresponds to the available data in literature on the qualitative changes of the infective agent in the course of the epidemic process. The study has shown that the prophylaxis of the explosive outbreaks of respiratory streptococcal infections must be ensured by the system of epidemiological surveillance with timely intervention into the epidemiological process at its early stages.

[The general characteristics of the epidemic process and of the circulating streptococcal strains during an upsurge in scarlatina morbidity in Leningrad]

The dynamics of scarlet fever morbidity in Leningrad for many years was studied and the absence of any effect produced by the existing system of preventive measures against this disease for the last 30 years was shown. On the basis of epidemiological and bacteriological data the authors came to the conclusion on the unity of the epidemic process of scarlet fever in the whole city and the relatively autonomous character of the process in individual districts. The necessity of the realization of epidemiological surveillance on streptococcal infection, with special emphasis on the multilevel social structure of the city and the wide use of the bacteriological diagnosis of streptococcal diseases, is substantiated.

Molecular epidemiologic analysis of the type A streptococcal exotoxin (erythrogenic toxin) gene (speA) in clinical Streptococcus pyogenes strains

A molecular epidemiology analysis was performed with over 440 clinical isolates of Streptococcus pyogenes obtained from 11 different countries in order to determine the frequency of occurrence of the type A streptococcal exotoxin (erythrogenic toxin) gene (speA) among group A strains. The colony hybridization technique employing a specific internal fragment of the speA gene was used for initial screening, and all positive results were further confirmed by the Southern hybridization technique. Among over 300 general strains obtained from patients with a variety of diseases, except scarlet fever (such as tonsillitis, impetigo, cellulitis, pyoderma, abscess, rheumatic fever, and glomerulonephritis), 15% were found to contain the speA gene. Among a group of 146 strains obtained from individuals described as having scarlet fever, 45% were shown to contain the speA gene. Further analysis of the data indicated that strains with certain M- or T-type surface antigens showed a higher (such as M and T types 1 and 3/13) or lower (such as M2, M12, T4, T5, and T28) tendency to contain the speA gene. No correlation was found between speA content of a strain and the ability to cause a specific disease, although strains possessing the speA gene were more likely to be associated with scarlet fever and rheumatic fever than with other types of disease.

[Laboratory and clinical studies of cefpodoxime proxetil in pediatric field]

We have carried out laboratory and clinical studies on cefpodoxime proxetil (CS-807, CPDX-PR). The results are summarized as follows. CPDX-PR was given via oral administration to each 2 children at a single dose of 3 mg/kg and to each of 3 children in a 100 mg tablet. After the oral administration, mean peak serum levels of CPDX obtained for the 2 dose levels were 1.86 +/- 0.35 micrograms/ml and 2.16 +/- 0.63 micrograms/ml at 2 hours, respectively, and mean half-lives were 1.31 +/- 0.02 hours and 1.47 +/- 0.18 hours, respectively. The mean urinary excretion rate of CPDX was 32.8 +/- 1.0% in the first 12 hours after the oral administration of 3 mg/kg. When a dose of 100 mg tablet was given to each of the 3 children, urinary excretion rates in the first 12 hours were 43.5%, 48.6% and 24.8%, respectively. Treatment with CPDX-PR was done in 38 cases of pediatric bacterial infections; 19 cases of tonsillitis, 3 cases of pharyngitis, 1 case of bronchitis, 3 cases of pneumonia, 3 cases of scarlet fever, 2 cases of impetigo, 4 cases of UTI and 1 case each of phlegmone, subcutaneous abscess and balanitis. Results obtained were excellent in 23 cases, good in 15 cases. No significant side effect due to the drug was observed in any cases.

[Pharmacokinetic and clinical studies on cefpodoxime proxetil dry syrup in the field of pediatrics]

Cefpodoxime proxetil (CPDX-PR, CS-807) is a new oral cephem derivative drug in which carboxylic acid was esterified to the 4-position of CPDX (oxime type cephem antibiotic). CPDX-PR is hydrolyzed mainly with esterase in intestinal wall and CPDX exists as an active form in body fluid. While there are numerous study reports using CPDX-PR in tablet forms in Japan, the dry syrup formula for pediatric use was newly developed. The dry syrup of CPDX-PR was orally administered 20 minutes after meal to the 6 boys of ages from 8 years and 1 month to 10 years and 10 months, with doses of 3 and 6 mg/kg, respectively, for 3 cases each. Serum concentrations and urinary concentrations and recovery rate of the drug were investigated. In addition to the above, the clinical and bacteriological studies were performed in a total of 105 cases consisting of children with ages ranging from 2 months to 11 years and 8 months, upon administering an average dose of 3.4 mg/kg, 3 to 4 times per day (96 cases of 3 times and 9 cases of 4 times). The 105 cases included 13 cases of pharyngitis, 21 cases of tonsillitis, 4 cases of acute bronchitis, 6 cases of pneumonia, 1 case of pleurisy, 13 cases of scarlet fever, 41 cases of urinary tract infection, 3 cases of posthitis and 3 cases of bacillary dysentery. Drug sensitivity test was performed for the following strains: (i) Strains retained by our department; 52 strains of Streptococcus pyogenes, 18 strains of Streptococcus agalactiae, and 11 strains of Bordetella pertussis, and (ii) strains isolated from cases to which CPDX-PR was administered; 2 strains of Staphylococcus aureus, 8 strains of S. pyogenes, 2 strains of Haemophilus influenzae, 10 strains of Escherichia coli, and 1 strain of Proteus mirabilis. Drug sensitivities of the strains retained by our department were tested with the inoculum sizes of 10(8) and 10(6) cfu/ml for R-3746 (Na-salt of CPDX), cefaclor (CCL), cephalexin (CEX), amoxicillin (AMPC), and methicillin (DMPPC), and those against strains separated from the cases to which CPDX-PR was administered were tested with the same inoculum sizes for R-3746, CCL, CEX, cefadroxil, ampicillin (ABPC), DMPPC and cloxacillin (MCIPC). Adverse reactions and abnormal clinical laboratory test results were also examined.(ABSTRACT TRUNCATED AT 400 WORDS)

[Evaluation of cefpodoxime proxetil in the pediatric field]

Pharmacokinetic and clinical evaluation of cefpodoxime proxetil (CPDX-PR, CS-807) were performed in the field of pediatrics. The obtained results are summarized as follows. 1. Peak serum concentrations of CPDX upon single oral doses of 3.0 mg/kg and 4.4 mg/kg of CPDX-PR were 1.26-1.46 micrograms/ml and 1.45 micrograms/ml, respectively, achieved at 4 hours and 1 hour after administration. Urinary excretion rates for CPDX in the first 8 hours ranged between 28.1 and 30.2%. 2. Clinical efficacy rates for pediatric infections obtained at single dose levels ranging 3 to 6 mg/kg were 97.5%, and that at a single dose of 1 mg/kg were 90.9%. 3. Bacteriological effectiveness was determined in 45 strains identified in recent cases. Eradication rates for these bacteria at dose levels of 3 to 6 mg/kg and 1 mg/kg were 91.3% and 95.5%, respectively. 4. No side effect nor abnormal laboratory test data were found in any of the cases examined. From these results, CPDX-PR appeared to be a useful antibiotic agent in the field of pediatrics.

Changes in the pattern of infection caused by Streptococcus pyogenes

The distribution of T- and M-protein antigens was determined in 12,469 cultures of Streptococcus pyogenes sent to a reference laboratory. Of these 7232 (58%) were isolates from hospital patients, 249 (2%) from hospital staff and 4988 (40%) from the community. The survey extended from January 1980 to June 1987. During this time the numbers of isolates of M-types 6, 49 and 81 rose then fell, being replaced by types 1, 3 and 28. The proportion of isolates of M-types 4 and 12 remained constant. Few strains were received from cases of nephritis or rheumatic fever but there has been an increase in the number of strains from serious infections and deaths. Forty-four of the 55 (80%) strains received since 1985 from fatal infections have belonged to M-type 1. All other strains, bar two, received from fatal infections in those years belonged to M-type 3. Representatives of M-type 1 were also associated with erysipelas. Types 3 and 4 predominated among the isolates from scarlet fever, types 1, 4, 12 and 49 from nephritis, types 49 and 81 from skin infections in meat workers and type 28 in cases of puerperal sepsis. The M-typability rate was 97% but new M antigens await definition among strains causing pyoderma.

Streptococcal outbreaks and erythrogenic toxin type A

Reference strains of Streptococcus pyogenes and strains from recent epidemics and sporadic cases of scarlet fever were examined for their ability to produce erythrogenic toxin type A (ET A) by ELISA and double immunodiffusion (Ouchterlony) using an anti-ET A antibody purified by affinity chromatography. Of the reference strains (most of them isolated before 1945) 16/51 produced more or less ET A (Table 1). ET A synthesis is strain-specific, but not type-specific. Well-known toxin producers like the strains NY-5; 594 or "Smith" produce up to 16.000 micrograms/l under optimal culture conditions. Type 3 strains isolated from scarlet fever patients during the outbreak 1972/73 seem to belong to one clone as evidenced by the uniform SDS-PAGE pattern: They were found to produce 5-200 micrograms/l (mean 68 micrograms/l) ET A only. Type 3 strains from sporadic cases, isolated 10 years later, produced 0-138 micrograms/l (mean 30 micrograms/l). Strains of the type 1 clone, causing the epidemic in 1982/83 produced only 0.75-10 micrograms/l (mean 8 micrograms/l) ET A (Table 3). Only a few strains of S. pyogenes isolated 1984 or later synthesized ET A but they were found more often to produce ET B (proteinase precursor) in batch cultures. S. pyogenes strains seem to have lost their ability to produce large amounts of ET A during the last decades. Because this toxin must be considered as a pathogenicity factor the decrease in toxin production may be one reason for the present mild form of scarlet fever.