The pharyngeal beta-hemolytic streptococcal carrier state among blood donors

459 blood donors aged 18-50 years were examined in 1987-1988 in Moscow. Among them, carrier state with respect to beta-hemolytic streptococci was detected in 107 donors (23.3%). The number of carriers gradually decreased with the increase of age of the examined donors. Group C streptococci occurred least of all (6.9%). Group A beta-hemolytic streptococci were isolated in 16.7% of the carriers. The isolation rate of streptococci from blood achieved its maximum in autumn and winter months and did not depend on preceding diseases, unhealthy working conditions, the rhesus factor and, with the exception of group A streptococci, the blood group. Among tonsillectomized donors carrier state with respect to beta-hemolytic streptococci occurred 2.2 times less frequently than among donors who had not undergone tonsillectomy. Carrier state with respect to beta-hemolytic streptococci was accompanied by higher levels of salivary sIgA antibodies to polysaccharide A, serum antibodies to polysaccharide A and circulating polysaccharide A. All beta-hemolytic streptococci were sensitive to erythromycin. All groups of streptococci showed the highest percentage of cultures resistant to gentamicin and tetracycline. In 100% of cases group A streptococci were sensitive to benzylpenicillin, methicillin, ampicillin, erythromycin and lincomycin.     

Periurethral aerobic microflora of pregnant and non-pregnant women.

Seventy-two pregnant and 88 non-pregnant women were examined to see whether the periurethral region had been colonised with group B streptococci (Streptococcus agalactiae), enterococci, and Gram-negative rods belonging to the Enterobacteriaeceae. A semi-quantitative method was used for periurethral sampling, and paired urethral swabs were also collected to compare the isolation rates of group B streptococci from the two sites and with the two sampling methods. A higher isolation rate was found with periurethral sampling. Most specimens showed no or scanty growth of Gram-negative rods. Pregnancy was often associated with heavy growth of enterococci. Sampling performed during menstruation and while oral contraceptives were being used produced high isolation rates of group B streptococci. These results seem to suggest that the periurethral area might protect against genital colonisation with group B streptococci as it does against urinary tract infection and that hormonal factors influence the carriage of these organisms.     

临床路径管理对糖尿病患者住院天数和住院费用的影响

目的:探讨临床路径管理对糖尿病患者住院天数和住院费用的影响,为临床治疗提供依据。方法:选择2012年1月~2014年12月本院收治的2型糖尿病住院患者245例,按照随机数字表法分为观察组和对照组,观察组实施临床路径管理,对照组按照一般治疗方法管理。比较两组患者住院天数、住院费用,血糖监测技术、胰岛素注射技术掌握情况以及患者满意度。结果:观察组患者住院天数和住院费用均少于对照组,差异有统计学意义(t=-15.700、-19.688;P0.05)。观察组患者血糖监测技术和胰岛素注射技术掌握率均为100%,显著高于对照组93.91%和86.96%,差异有统计学意义(Z=-13.450,-12.152;P0.05)。观察组患者总满意度为100%,高于对照组总满意度98.26%,差异有统计学意义(Z=-14.098;P0.05)。结论:对糖尿病患者实施临床路径管理,能够减少患者住院天数、降低住院费用、提高患者自我管理能力、提高患者满意度,值得临床推广借鉴。     

Group B streptococci in the female genital tract.

Vaginal carriage rates of group B streptococci among 250 women attending a clinic for sexually transmitted diseases, 123 attending family planning clinics, and 110 in labour wages were 36.0%, 17-1% and 6.4% respectively. The presence of group B streptococci was not associated with a vaginal discharge or the use of oral contraceptives in the non-pregnant women, or with the isolation of Neisseria gonorrhoeae or Trichomonas vaginalis from the women attending the clinic for sexually transmitted diseases. Serotyping showed a predominance of types II and III in non-pregnant women and an overall incidence of non-typable strains of 14.8%. There was no relationship between serotype and antibacterial susceptibility.     

Evaluation of a new presumptive medium for group D streptococci.

A new medium designated as D streptococcus-enterococcus broth was formulated and evaluated for the enrichment and isolation of strains of serological group D streptococci. This medium was made by modifying Todd-Hewitt broth. Most-probable-number multiple-tube and membrane filter techniques were employed to estimate the numbers of enterococci in known cultures, wastewater, and other samples. Preliminary most-probable-number counts with this medium were as much as 3 logs higher than those counts obtained from four other media with which it was compared. The methodology for using this medium to estimate the numbers of group D streptococci in water is discussed.     

Evaluation of a new presumptive medium for group D streptococci.

A new medium designated as D streptococcus-enterococcus broth was formulated and evaluated for the enrichment and isolation of strains of serological group D streptococci. This medium was made by modifying Todd-Hewitt broth. Most-probable-number multiple-tube and membrane filter techniques were employed to estimate the numbers of enterococci in known cultures, wastewater, and other samples. Preliminary most-probable-number counts with this medium were as much as 3 logs higher than those counts obtained from four other media with which it was compared. The methodology for using this medium to estimate the numbers of group D streptococci in water is discussed.     

Broad-host-range shuttle vectors for screening of regulated promoter activity in viridans group streptococci: isolation of a pH-regulated promoter

Viridans group streptococci are major constituents of the normal human oral flora and are also identified as the predominant pathogenic bacteria in native valve infective endocarditis. Little information is available regarding the regulation of gene expression in viridans group streptococci, either in response to changes in the oral environment or during development of endocarditis. We therefore constructed a set of broad-host-range vectors for the isolation of promoters from viridans group streptococci that are activated by specific environmental stimuli in vitro or in vivo. A genomic library of Streptococcus gordonii strain CH1 was constructed in one of the new vectors, and this library was introduced into a homologous bacterium by using an optimized electroporation protocol for viridans group streptococci. Because viridans group streptococci entering the bloodstream from the oral cavity encounter an increase in pH, we selected promoters upregulated by this specific stimulus. One of the selected promoter sequences showed homology to the promoter region of the hydA gene from Clostridium acetobutylicum, the expression of which is known to be regulated by the environmental pH. The isolation of this pH-regulated promoter shows that S. gordonii can sense an increase in the environmental pH, which serves as a signal for bacterial gene activation. Furthermore, this demonstrates the usefulness of these new selection vectors in research on adaptive gene expression of viridans group streptococci and possibly also of other gram-positive bacteria.     

Role of anaerobic streptococci in human pathology. Report I. Etiological significance of anaerobic streptococci in chronic tonsillitis]

The authors describe a method of isolation of anaerobic streptococci from the blood. A high seeding efficiency of anaerobic streptococci from the depth of the tonsils (75.1%) and from their surface (59.7%) and also from the blood (36%) pointed to the leading role of these microbes in the etiopathogenesis of chronic tonsillitis. In healthy individuals anaerobic streptococci are revealed (by culture method) on the surface of the tonsils but rarely (6%). Str. micros are the most incident in chronic tonsillitis (in 85.3% of cases-from the depth of the tonsils and in 77.5%-from the surface), whereas Str. anaerobius and Str. intermedius occur in individual cases only (8.4-7.5% and 6.3-15%, respectively). Pure culture of Str. micros was found in 36% of cases. Pathogenetic scheme of development of bacteriemia in chronic tonsillitis and rheumatism is presented. The isolated cultures were found to be resistant to the widely-used antibiotics.     

Presumptive Identification of Group A, B, and D Streptococci

A battery of five tests was used for presumptive identification of the pathogenic streptococci. The non-serological methods included determination of hemolysis for all strains, bacitracin susceptibility for group A streptococci, hippurate hydrolysis by group B streptococci, and bile-esculin reaction for group D streptococci. Enterococcal group D streptococci were differentiated from non-enterococcal group D streptococci by 6.5% NaCl tolerance. Two other categories of streptococci resulted: beta-hemolytic streptococci non-groups A, B, or D; and alpha- or nonhemolytic streptococci, not enterococci, not further identified (viridans streptococci). The tests were used as a battery and not as single entities. In this manner more than 99% of the group A, 99% of the group B, 81% of the beta-hemolytic streptococci non-group A, B, or D, 99% of the group D enterococci, 97% of the group D non-enterococci, and 94% of the viridans streptococci were correctly identified.     

Selective Broth Medium for Isolation of Group B Streptococci

A selective medium containing Todd-Hewitt broth, sheep blood, nalidixic acid, and gentamicin sulfate was found to enhance significantly the isolation of group B streptococci from vaginal cultures. Preparation of the medium, which is stable for up to 4 weeks at 4 C, is simple and inexpensive. Use of such a medium should facilitate identification of vaginal colonization with group B streptococci.     

Broad-Host-Range Shuttle Vectors for Screening of Regulated Promoter Activity in Viridans Group Streptococci: Isolation of a pH-Regulated Promoter

Viridans group streptococci are major constituents of the normal human oral flora and are also identified as the predominant pathogenic bacteria in native valve infective endocarditis. Little information is available regarding the regulation of gene expression in viridans group streptococci, either in response to changes in the oral environment or during development of endocarditis. We therefore constructed a set of broad-host-range vectors for the isolation of promoters from viridans group streptococci that are activated by specific environmental stimuli in vitro or in vivo. A genomic library of Streptococcus gordonii strain CH1 was constructed in one of the new vectors, and this library was introduced into a homologous bacterium by using an optimized electroporation protocol for viridans group streptococci. Because viridans group streptococci entering the bloodstream from the oral cavity encounter an increase in pH, we selected promoters upregulated by this specific stimulus. One of the selected promoter sequences showed homology to the promoter region of the hydA gene from Clostridium acetobutylicum, the expression of which is known to be regulated by the environmental pH. The isolation of this pH-regulated promoter shows that S. gordonii can sense an increase in the environmental pH, which serves as a signal for bacterial gene activation. Furthermore, this demonstrates the usefulness of these new selection vectors in research on adaptive gene expression of viridans group streptococci and possibly also of other gram-positive bacteria.     

Occurrence and drug-resistance of beta-hemolytic streptococci

The aim of this study was the analysis of drug-resistance and frequency appearance of beta-hemolytic streptococci strains which were isolated in 2003-2005 in the University Hospital at the L. Rydygier Collegium Medicum in Bydgoszcz University of Nicolaus Copernicus in Toruń. Among investigeted beta-hemolytic streptococci the most frequency isolated species was S. agalactiae. All isolates examined in our study were susceptible to penicillin, the higest rate of resistance was found for tetracycline. The rates of resistence to macrolide-lincosamide-streptogramin B (phenotyp MLS(B)) were as follows: S. agalactiae (18.7%), S. pyogenes (10.1%), group G streptococci (10.6%) and group C streptococci (8.0%). In our study we presented also a special case patient from which in investigeted period S. agalactiae was isolated twenty eight times. For ten chromosomal DNA isolated from this patient three different PFGE profiles were obtained.     

The OF characteristics of streptococci group A and immunity to streptococcal infection based on the results of OF and anti-OF tests

The influence of the OF activity of group A streptococci on their specific pathogenic properties has been shown, which is manifested by increased virulence of these streptococci for children of younger age groups and by a two times higher isolation rate of OF+ strains in tonsillitis than in scarlet fever. The possibility of the indirect evaluation of the content of anti-M-antibodies by the results of the anti-OF test has been revealed, which permits using this test instead of the bactericidal test, more complicated, in the study of immunity to infection induced by group A OF+ streptococci. Among the main methods of laboratory support of epidemiological surveillance on streptococcal infection, the introduction of the highly discriminating OF typing and the anti-OF test into practical use is recommended.     

The incidence of inflammation among patients suffering from cervix cancer with positive beta haemolytic streptococci cultures from genital tract

AimThe main goal of this investigation was to evaluate the influence of positive beta haemolytic streptococci culture from the genital tract on patients receiving radiation therapy who suffer from cervical cancer. The other aim was to observe radiation therapy complications.BackgroundGroup B streptococci (GBS), group C streptococci (GCS) and group G streptococci (GGS) have been described as frequent invasive pathogens in elderly patients, often in association with underlying medical conditions including immunodeficiency and cancer.Materials and methodsIn the years 2006–2015, vaginal swabs from 452 patients were examined. A total of 118 women with positive beta haemolytic streptococci (BHS) groups A, B, C, F, G cultures were analysed, of whom 111 were diagnosed with cervix cancer of IB to IVA degree according to the FIGO 1988 clinical classification.ResultsOf the 452 patients suffering from cervix cancer 26.1% were positive for A, B, C, F or G group BHS isolated from the genital tract. All of the 114 examined strains were sensitive to beta-lactam antibiotics. The antimicrobials for which resistance was noted were erythromycin, clindamycin, ciprofloxacin and tetracycline.ConclusionsPositive cultures of BHS from the genital tract were demonstrated to occur in patients with cervix cancer. Complications were found during radiotherapy in 30 (27%) of these patients, including 20 (18%) patients suffering from clinical symptoms of inflammation. When beta-lactam antibiotics are not recommended because of allergy, sensitivity tests to other drugs are necessary.     

Detection of Group A Streptococci in Throat Swabs by Direct Fluorometry

A direct fluorometric test for the rapid detection of group A streptococci from throat swabs was compared with the microscopic fluorescent-antibody test. Formalinized throat swab cultures (490) were examined by the two methods, and the results agreed on 84% of the specimens. In another comparison, 15-hr broth cultures of 103 freshly taken throat swabs were tested by both methods. Of the specimens tested, 101 (98%) were either positive or negative by both methods. In all cases, the latter results correlated with the demonstration of presence or absence of group A streptococci in the specimens by cultural isolation and precipitin grouping tests. It may be feasible to use the direct fluorometric test in a diagnostic laboratory as described or possibly to adapt it for automatic processing of throat swab cultures.     

Specific features of normal vaginal microflora in girls of preschool age

The study of the vaginal microbial cenosis in 20 healthy girls aged 3-7 years did not confirm the notion on the dominating role of cocci (including epidermal staphylococci). The associations of 2-5 different microorganisms represented by more than 20 species in an amount of 4-6 Ig PFC/g of discharge were established. In the overwhelming majority of the examinees (84.2%) the microbial associations of the vagina were found to contain bifidobacteria. Gram positive cocci (staphylococci and streptococci) took the 2nd and 3rd places in the isolation rates and were detected in vaginal associations in 78.9% of the girls. Staphylococci were represented by 5 coagulase-negative staphylococcal species with S. simulans and S. epidermidis prevailing. Hemolytic streptococci variants alpha and beta were isolated in the proportion of 2:1. The latter belonged to serogroups C and F. No S. aureus, Lactobacillus sp., streptococci of groups A and B, yeast-like fungi were detected. Genital mycoplasms (M. hominis) could rarely be found in the vaginal discharge of the girls aged 3-7 years (5.3%). No resident and transitory components could be isolated from the normal vaginal microflora and no quantitative domination of any bacterial species (genus) was shown. The concentrations of all organisms in this association were moderate or low.     

Prospective study on streptococcal pharyngitis among a town population

A one-year-round study on pharyngitis incidence among the general population of a town (24,300 inhabitants) was carried out. All patients, with pharyngitis who visited health centres were examined clinically and mcirobiologically. The overall pharyngitis incidence rate and the streptococcal pharyngitis incidence rate were, respectively, 8.3 and 3.9 cases per 100 population. Age-related incidence was highest in the group of 5-10 years, seasonal incidence was highest in autumn. Clinical diagnoses made preliminary to bacteriological examination were correct in only a half of the streptococcal pharyngitis cases. The accuracy of clinical diagnosis of streptococcal pharyngitis could, at best, be raised to 80% if fever of less than or equal to 38.0 degrees C and presence of exudate on tonsils should be considered significant criteria. A great majority of the streptococcal pharyngitis cases were caused by group A streptococci; the prevailing M types were 12, 1 and 3. Emphasis is laid on the necessity of performing microbiological examination of all pharyngitis cases in order to ensure etiological diagnosis and causal therapy. 15)     

Streptococcal L forms and phage. A clinical-epidemiologic study

This study showed that streptococcal L forms could not be isolated from children who were either carriers of group A streptococci or had disease due to this pathogen. It was possible to induce L colony formation in 15 strains of group A. Streptococcal bacteriophages were demonstrated in 20% of group A streptococci isolated from school children who were carriers, but did not have clinical evidence of streptococcal disease, and from 44.9% of children whose physicians considered they had acute streptococcal upper respiratory infections. Lysogeny (bacteriophage) was demonstrated more frequently during 1969-70 when carrier rates were high and from children who had manifest streptococcal disease, suggesting a possible positive relationship between lysogeny, high carrier rates, and infection in the children studied. Lysogeny and erythrogenic toxin production by group A streptococci occurred simultaneously in approximately half of the strains of group A streptococci tested, suggesting that lysogeny is not a sine qua non for erythrogenic toxin production.     

Selectivity of Mitis Salivarius agar and a new selective medium for oral streptococci in dogs

An evaluation on the applicability of Mitis Salivarius agar (MS) medium, commonly used for the detection of oral streptococci in human and animals, to dog specimens and the development of a new selective medium for isolating streptococci from the canine oral cavity are described. Oral samples from dogs were cultured on MS medium under anaerobic conditions. The predominant facultative anaerobic bacteria on MS plates were gram-negative rods. Selectivity of streptococci on MS medium was 21.2%. A new selective medium, designated MS-CAN-AE, was developed for the isolation of streptococci from the canine oral cavity. The average growth recovery of laboratory and clinically isolated strains of streptococci on MS-CAN-AE medium was 84.1% of that on MS medium. Gram-positive rods and gram-negative rods and cocci rarely grew on the MS-CAN-AE. The selectivity of MS-CAN-AE was 95.0% for clinical samples. MS-CAN-AE medium will be helpful for investigations of streptococci in the canine oral cavity.     

连续肾脏替代疗法治疗重症急性胰腺炎时机的探讨

目的:探讨连续肾脏替代疗法(CRRT)治疗重症急性胰腺炎的最佳时机。方法:选取我院收治的30例重症急性胰腺炎(SAP)患者为研究对象,按发病后行CRRT的时间分将患者随机为A、B两组,A组发病后72小时内治疗,B组发病后72小时后治疗,分析和比较两组治疗后的临床转归及生命体征变化、APACHEⅡ评分变化急性生理与慢性健康状况、住院费用、平均住院时间。结果:经CRRT治疗后,A组死亡率(14.3%)低于B组(43.7%),差异有统计学意义(P0.05);A、B两组治疗后体温、心率、呼吸、平均动脉压平稳,A组优于B组,差异有统计学意义(P0.05);A组的平均住院时间(15.7±8.9)d、住院费用(107000±65000)万元均明显优于B组,差异有统计学意义(P0.05);两组患者治疗后APACHEⅡ评分均明显优于治疗前,治疗后A组APACHEⅡ评分明显优于B组,差异显著有统计学意义(P0.05)。结论:早期行CRRT能明显改善重症急性胰腺炎患者的疗效和预后,最佳治疗时机可能为发病后72小时内。