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Meningitis due to group C streptococci in an adult.

Group C streptococci are generally considered to be a rare cause of infection in man. Infections due to these microorganisms, however, are common in several animal species. To our knowledge, the literature contains only two previous cases of meningitis in man which were due to group C streptococci. In one of these cases meningitis developed as a complication of endocarditis due to group C streptococci. Our recent clinical experience with a patient with severe acute meningitis caused by group C streptococci is reported and the pertinent literature is reviewed. The illness manifested itself as a severe form of acute meningitis, with slow but statisfactory response to therapy with penicillin.

Humans

[Immunoelectronmicroscopic localization of cell wall antigens in streptococci. II. Localization of the group-specific polysaccharide of group C streptococci with ferritin- and peroxidase-labelled Helix pomatia-agglutinin (author's transl)].

The carbohydrate of the cell wall of group C streptococci is one of the best known group-specific streptococcal antigens with respect to its chemical structure. In the present paper, the ultrastructural location of the carbohydrate was investigated by means of immunoelectronmicroscopic techniques. Besides group-specific antibodies, the specific binding of an agglutinin (protectin Anti-AHP) of the edible snail (Helix pomatia) to structures with terminal N-acetylgalactosamine was used to demonstrate the antigen. The agglutinin was extracted from the albumen gland of the snail and purified by column chromatography. By means of glutardialdehyde it was coupled with ferritin or horesradish peroxidase. The investigations were done on strains of Streptococcus equisimilis and Streptococcus equi. Str. pyogenes (group A streptococci) was used as a control. On whole cells of group C streptococci the carbohydrate was demonstrated on the surface of the triple-layered cell wall. Near the cross-wall the carbohydrate seems to be more concentrated. In the presence of N-acety-D-galactosamine the labelling of the cell wall was inhibited. N-acetyl-D-glucosamine did not have such an effect. On isolated cell walls, both the outer and the inner surface were tagged. This suggests that the group-specific carbohydrate covers the peptidoglycan (mucopeptide) on both sides. The cytoplasmic membrane shows no reaction.

Agglutinins

Infections due to group C streptococci in man.

Although a common cause of infection in animals, group C streptococci are rarely noted to be pathogenic in man. A total of 150,000 blood cultures obtained at the Mayo Clinic from 1968 to 1977 revealed group C streptococci in only eight patients. Acute bacterial endocarditis, meningitis, pheumonia, cellulitis and bacteremia due to group C streptococci are described in a host who had undergone immunosuppression (immunosuppressed host), and the relatively few cases previously reported are reviewed. Although severe, these infections may respond favorably to penicillin therapy. Endocarditis caused by group D streptococci is acute and destructive, and associated with early cardiac decompensation. The manifestations of cellulitis and pneumonia are similar to those when group A streptococci are causative organisms. Meningitis due to group C streptococci is acute and severe, and responds slowly to antimicrobial therapy. Colonization also occurs.

Adolescent

Streptococcus zooepidemicus (group C streptococci) as a cause of human infection.

Cervical lymphadenitis with high fever and respiratory distress in a 3-year-old boy is reported. Group C streptococci were isolated from the boy's throat and these were identified as Streptococcus zooepidemicus. The patient recovered after treatment with penicillin. Strep. zooepidemicus is extremely rare as a causative organism of human infections. Even symptomless carriers are very rare. Group C streptococci isolated from humans normally belong to the species Strep. equisimilis.

Bacteriological Techniques

Simple procedure for production by group C streptococci of phage-associated lysin active against group A streptococci.

Phage-associated lysin of high potency was prepared by growing the host group C streptococcal strain 26RP66 in a semisynthetic medium. The lysin was stabilized by adding dithiothreitol and neutralized ethylenediaminetetraacetic acid (EDTA) to facilitate further concentration and partial purification. The lysin remained active when stored at -65 C for 1 year. Lysin was active against all strains of group A streptococci tested and was more active against living cells than heat-killed cells. The procedure outlined is practicable for most bacteriological research laboratories and does not require column purification or other complex biochemical procedures. It should be useful to any laboratory which requires small amounts of lysin to produce L-forms and protoplasts or to release streptococcal antigens.

Ammonium Sulfate

Experimental induction of cervical lymphadenitis in guinea-pigs with group C streptococci.

Streptococcal lymphadenitis with macroscopic abscesses was induced in guinea-pigs when an isolate of Lancefield's group C streptococci of guinea-pig origin was sprayed orally. The disease was also produced in guinea-pigs when another isolate was injected sublingually but not when it was sprayed orally. Treatment with prednisolone did not increase the susceptibility to the latter isolant when sprayed orally. Abscesses could not be induced in the cervical lymph nodes of guinea-pigs exposed by injecting group E streptococci sublingually, although the organism was isolated from the cervical lymph nodes 2 days after inoculation. Neither could abscesses be induced by injecting these streptococci sublingually in guinea-pigs treated with prednisolone.

Abscess

Fibrinogen binding structures in beta-hemolytic streptococci group A, C, and G. Comparisons with receptors for IgG and aggregated beta 2-microglobulin.

Binding of radiolabelled fibrinogen was measured to 197 strains of 16 different bacterial species. All streptococcal strains belonging to groups A, C, and G isolated from human sources were strongly positive. S. aureus strains showed low binding values. Occasional group B streptococci were positive. Reactive strains were also noted among group C streptococci of animal origin, Streptococcus zooepidemicus and Str. equii, and bovine beta-hemolytic group G streptococci. Bovine alpha-hemolytic group G strains as well as the remaining seven species of human origin were all negative. Inhibition experiments and correlation studies indicated that the streptococcal receptor for fibrinogen was different from immunoglobulin Fc binding reactivity. Comparisons with the newly discovered beta 2-microglobulin binding factor showed that trypsin concentrations which destroyed this receptor left the fibrinogen receptor intact. Although the two receptors correlate in strain population studies and show competition for binding the difference in trypsin sensitivity indicates that they represent two different structural entities. Both receptors might serve as basic markers for M-protein like surface components of Gram positive cocci.

Beta-Globulins

[Acute bacterial endocarditis caused by streptococci of Lancefield group C (author's transl)].

An Angell-Shiley heterograft valve was implanted in a 32-year-old woman with severe aortic regurgitation and stenosis. Post-operatively acute bacterial endocarditis occurred, due to group C streptococci. Because of severe acute aortic insufficiency with partial dehiscence of the heterograft valve and increasing left heart failure re-operation was necessary. After successful replacement of the valve an aortocoronary bypass was connected to the left circumflex artery because of displacement of the left coronary ostium. In addition, an aortoplasty was performed for spontaneous aortic rupture. Because of severe left heart failure with myocardial infarction in the course of the operation circulatory support with a paracorporeal artificial heart was necessary for 60 hours postoperatively. Despite transitory improvement the patient died from septic shock 30 days after the re-operation.

Adult

An idiotypic marker for the VL region of an homogeneous antibody.

Studies on the inheritance of idiotypes in rabbits have not yielded consistently positive results. This inconsistency may be due to the fact that an idiotype is a complex phenotype, dependent in most cases on the coordinate expression of unlinked H and L chain genes. In an attempt to reduce this complexity, H and L chain specific idiotypes have been sought. In one fortuitous instance, an homologous antiidiotypic serum raised against homogeneous antistreptococcal antibody 4539 was shown to bind free 4539 L chain. An anti-idiotypic antibody fraction specific for the L chain was isolated from this antiserum by affinity chromatography on a column to which 4539 L chains had been covalently bound. The specificity of this preparation was demonstrated by radioimmunoassay, and sera from both related and unrelated rabbits were screened for the presence of the L chain idiotype. Positive tests were obtained for sera from 56% of related rabbits immunized with group C streptococci, while preimmune sera and group C and group A antisera from unrelated rabbits had no detectable levels of the 4539 L chain idiotype. The 4539 L chain also expressed a recently described, genetically determined CL marker (b4var). This combination of markers will allow CL-VL linkage studies. More recently a procedure specifically designed to elicit chain-specific idiotypic antisera has been successfully tested, yielding an antiserum specific for the H chain of another antistreptococcal antibody, 4135.

Animals

Comparative studies on binding of vitronectin and fibronectin to groups A and C streptococci.

Binding of 125I-labelled fibronectin and vitronectin to streptococci of group A (S. pyogenes), group B (S. agalactiae) and group C (S. dysgalactiae and S. zooepidemicus) isolated from various human infections and bovine mastitis, and S. uberis bovine isolates, was studied. Binding of vitronectin and fibronectin was common among both human groups A and C, and bovine group C streptococci. S. agalactiae strains of human and bovine origin as well as S. uberis bovine isolates bound low levels of both proteins. The binding of radiolabelled fibronectin and vitronectin to selected groups A and C streptococcal strains was specific, time-dependent and occurred with both live and heat-killed (80 degrees C for 15 min) cells. Binding declined rapidly after treatment of cells with trypsin or proteinase K, while pepsin digestion at pH 5.5 affected vitronectin but not fibronectin binding.

Culture Media

Effect of near ambient exposures to sulfur dioxide and ferrous sulfate particles on murine pulmonary defense mechanisms.

An infectivity model was used to test the safety margins for presently established air quality standards for sulfur dioxide and sulfate particles. Mice and rats were exposed to atmospheres of sulfur dioxide and mono-disperse ferrous sulfate particles from 3 to 6 times the standard for 17 hr prior to, or 4 hr after infection with aerosols of Staphylococcus aureus or Group C Streptococci. Exposure to these concentrations of pollutants did not impair the rodents' ability to ingest and inactivate the minimally virulent Straphylococcus or enhance the virulence of the Group C Streptococci. Insofar as these results can be extrapolated to man, the present air quality standards for sulfur dioxide and sulfate particles are protective in regard to respiratory bacterial infection.

Aerosols

Septicemia due to Streptococcus equisimilis in a child with acute lymphoblastic leukemia.

A 4-year-old boy with acute lymphoblastic leukemia in relapse with documented septicemia due to group C Streptococci (Streptococcus equisimilis) is described. The patient responded well to therapy with appropriate cytotoxic and antimicrobial agents. There is a general lack of recognition of the pathogenicity of group C Streptococci in man. The potential opportunistic nature of these organisms in immunocompromised hosts and the need for early recognition and appropriate treatment of such infection is emphasized.

Antineoplastic Agents

Pigs with von Willebrand disease may be resistant to experimental infective endocarditis.

Indirect evidence suggests that the blood platelet is important in the pathogenesis of experimental infective endocarditis. Mechanical injury to the endocardial surface causes deposition of fibrin and platelets; injected microorganisms quickly localize to this lesion. Endocarditis pathogens also bind to and activate platelets. We used our previously described animal model for inducing infective endocarditis in normal pigs and applied it to animals with severe von Willebrand disease. The model uses catheter-induced trauma to the aortic valve and endocardium, followed by intravenous injection of group C streptococci. Control animals all showed typical clinical and laboratory evidence of endocarditis. In contrast, in pigs with von Willebrand disease (n = 4) endocarditis failed to develop. Studies in vitro of platelet-bacteria interactions showed that platelets derived from both normal and diseased pigs were equal in their ability to bind to and be activated by group C streptococci. These data suggest that normal platelet function is important in the pathogenesis of experimental infective endocarditis.

Animals