Celulitis por Streptococcus equi: reporte de caso y revisión de la literatura / Streptococcus equi Cellulitis: Case Report and Literature Review

El Streptococcus equi es un coco gram positivo, perteneciente al grupo C de Lancefield, causa una enfermedad de gran relevancia en caballos, la gurma o adenitis equina (1-2); en humanos, estas infecciones son poco frecuentes, siendo más frecuentes las infecciones de piel y tejidos blandos, faringitis, neumonía, síndrome tóxico similar al shock y endocarditis. Cuando la infección está asociada a bacteriemia, la mortalidad reportada es del 25%.(3) Presentamos el caso de un hombre de 44 años que ingresa al servicio de urgencias de la Clínica universidad de la Sabana con un cuadro clínico de celulitis en mano derecha por Streptococcus equi .

Streptococcus equi is a gram-positive cocci, from group C of Lance 􀃀 eld. It causes an important disease in horses, strangles or equine adenitis (1-2). In humans, these infections are rare, and skin and soft tissue infections, pharyngitis, pneumonia, toxic shock-like syndrome and endocarditis are more frequently observed. When the infection is associated with bacteremia, the reported mortality is near 25% (3). We report the case of a 44-year old man who was admitted to the emergency department of the University of Sabana Clinic with cellulitis due to Streptococcus equi in his right hand.

Optimization of flask culture medium and conditions for hyaluronic acid production by a streptococcus equisimilis mutant nc2168

A mutant designated NC2168, which was selected from wild-type Streptococcus equisimilis CVCC55116by ultraviolet ray combined with60Co-γ ray treatment and does not produce streptolysin, was employed to produce hyaluronic acid (HA). In order to increase the output of HA in a flask, the culture medium and conditions for NC2168 were optimized in this study. The influence of culture medium ingredients including carbon sources, nitrogen sources and metal ions on HA production was evaluated using factional factorial design. The mathematical model, which represented the effect of each medium component and their interaction on the yield of HA, was established by the quadratic rotary combination design and response surface method. The model estimated that, a maximal yield of HA could be obtained when the concentrations of yeast extract, peptone, glucose, and MgSO4 were set at 3 g/100 mL, 2 g/100 mL, 0.5 g/100 mL and 0.15 g/100 mL, respectively. Compared with the values obtained by other runs in the experimental design, the optimized medium resulted in a remarkable increase in the output of HA and the maximum of the predicted HA production was 174.76 mg/L. The model developed was accurate and reliable for predicting the production of HA by NC2168.Cultivation conditions were optimized by an orthogonal experimental design and the optimal conditions were as follows: temperature 33ºC, pH 7.8, agitation speed 200 rpm, medium volume 20 mL.

Expression of Toll-like Receptor 2 in Cultured Human Keratinocytes: The Effect of Bacterial Antigens, Cytokines and Calcium Concentration

BACKGROUND: Toll-like receptors (TLRs) are expressed by human epidermal keratinocytes and are involved in immune responses. OBJECTIVE: The goal of this was to investigate the expression of TLR2 in response to bacterial antigens, cytokines, and different calcium concentrations. METHODS: The expression of TLR2 was assessed after stimulation by lipoteichoic acid (LTA) and streptolysin O (SLO). In addition, TLR2 expression was evaluated after treatment with IFN-gamma and TNF-alpha, and different concentrations of calcium. The expression levels of TLR2 mRNA and protein were studied using RT-PCR and Western blot analysis. RESULTS: Cultured human epidermal keratinocytes constitutively expressed TLR2 and the expression was stimulated by LTA and SLO; in addition, IFN-gamma and TNF-alpha upregulated TLR2 expression. However, the changes in TLR2 expression associated with the calcium concentrations were insignificant. CONCLUSION: TLR2 expression increased with the concentration and duration of bacterial pathogens and this increase was amplified by several cytokines, from activated keratinocytes and other cells.

Interpretación clínica de anticuerpos anti-estreptococo en fiebre reumática / Streptococcal antibody test clinical interpretation in rheumatic fever

La Fiebre Reumática es una complicación no supurativa de la infección por Streptocococus pyogenes. Es una enfermedad prevalente con una tasa importante de morbilidad y mortalidad en países en desarrollo. El diagnóstico de Fiebre Reumática tanto en el episodio agudo como en la recurrencia se apoya en criterios clínicos sumado a la evidencia serológica de infección previa por estreptococo beta hemolítico del grupo A. Los anticuerpos anti-estreptococo disponibles comercialmente son los anticuerpos anti-estreptolisina O (ASTO) y los anticuerpos anti- DNAasa B (anti-DNAasa B). Estos deben ser analizados teniendo en cuenta la edad del paciente, el tipo de infección, las comorbilidades asociadas, los títulos de anticuerpos, el tratamiento antibiótico previo y el momento en el cual se toman las muestras para la medición de estos. En este artículo se realiza una revisión de la literatura disponible con el objetivo de determinar la utilidad e interpretación de las pruebas de anti-estreptolisina O y anti-DNAsa B.

Annual Report on External Quality Assessment in Immunoserology in Korea (2007) / 임상검사와정도관리

The followings are the results for external quality assessment (EQA) in immunoserology for 2007: 1. Evaluation of EQA was done in 2 trials in May and December, about 99% of laboratories participating average 7.8 items. The results were collected via internet for the first time and 96~98% of laboratories have sent their results via internet. 2. All the specimens for Immunoserology in EQA were delivered refrigerated, being received within 48 hours after sending. 3. Commercial controls, MASR Immunology Control from Medical Analysis Systems (Camarillo, CA, USA) were used to assure the quality of quantitative results of C-reactive protein (CRP), rheumatoid factor (RF) and anti- streptolysin O (ASO) tests, and the RF results of MASR Immunology Control were variable depending on the reagents used. 4. The laboratories using immunochromatography assay (ICA) were increased, however, many laboratories using ICA reported falsely negative for the positive specimens. The sensitivity of ICA test kits as well as various factors influencing the ICA results should be evaluated. 5. The HBsAg results of the ACCURUN 1R Multi-Marker Positive Control (Boston Biomedica Inc. USA) were falsely reported as negative in some laboratories using arbitrarily determined cutoff. 6. Standardization of methods including calibrators for quantitative results should be required for the harmonization of results.

Annual Report on External Quality Assessment in Immunoserology in Korea (2007) / 임상검사와정도관리

The followings are the results for external quality assessment (EQA) in immunoserology for 2007: 1. Evaluation of EQA was done in 2 trials in May and December, about 99% of laboratories participating average 7.8 items. The results were collected via internet for the first time and 96~98% of laboratories have sent their results via internet. 2. All the specimens for Immunoserology in EQA were delivered refrigerated, being received within 48 hours after sending. 3. Commercial controls, MASR Immunology Control from Medical Analysis Systems (Camarillo, CA, USA) were used to assure the quality of quantitative results of C-reactive protein (CRP), rheumatoid factor (RF) and anti- streptolysin O (ASO) tests, and the RF results of MASR Immunology Control were variable depending on the reagents used. 4. The laboratories using immunochromatography assay (ICA) were increased, however, many laboratories using ICA reported falsely negative for the positive specimens. The sensitivity of ICA test kits as well as various factors influencing the ICA results should be evaluated. 5. The HBsAg results of the ACCURUN 1R Multi-Marker Positive Control (Boston Biomedica Inc. USA) were falsely reported as negative in some laboratories using arbitrarily determined cutoff. 6. Standardization of methods including calibrators for quantitative results should be required for the harmonization of results.

Post-streptococcal reactive arthritis versus acute rheumatic fever

A migrating polyarthritis after throat infection with group A beta-hemolytic streptococci is classically attributed to acute rheumatic fever [ARF]. Sterile non-migratory arthritis may occur as a separate entity, the so called post-streptococcal reactive arthritis [PSRA]. To identify clinical and serological differences of reactive arthritis patients after infection with Lancefield group A beta-hemolytic streptococci, as compared with acute rheumatic fever. The study was conducted of 120 patients who were recruited for the study. They were equally divided into two groups according to the diagnosis of ARF or PSRA. They were consecutively seen in the Rheumatology and Rehabilitation and the Pediatric wards. Clinical and laboratory data were assessed through a questionnaire. The diagnosis of rheumatic fever was made based on the revised modified Jones criteria, while the diagnosis of post-streptococcal reactive arthritis was made based on Deighton criteria; these associated with laboratory data, electrocardiography, chest X-rays and bi-dimensional echocardiography. There was no significant difference between both groups as regard age where p>0.05, while there was a significant difference regarding the date of antecedent upper respiratory tract infection [p<0.05]. Clinical assessment showed that the duration of disease and Enthesitis, joint tenderness and joint swelling counts have a highly significant difference [p<0.01]. As regard to the response to aspirin, indomethacin and steroid there were significant differences between both groups [p<0.05]. Also, as regard the laboratory assessment ESR, CRP, ASOT, the differences between both group were highly significant for ESR, ASOT [p<0.01] and significant for CRP [p<0.05]. No significant difference was found between both groups regarding specific laboratory assessment [Anti deoxyribonuclease-B liter or anti-Hyaluronidase] [p>0.05]. Regarding the cardiological changes P-R interval on ECG was prolonged in 19 patients 31.67% and Echo study showed changes in 12 patients, 20% of cases of ARF patients only. Also there were no chest or CNS changes either in ARF or PSRA patients, so, chest X-ray changes showed no significant differencesp>0.01. Post-streptococcal reactive arthritis and acute rheumatic fever are actually having different presentations and managements

Diagnosis of Streptococcus pneumoniae meningitis by polymerase chain reaction amplification of the gene for pneumolysin

Diagnosis of bacterial meningitis has long been based on classical methods of Gram stain, serological tests, and culture of cerebrospinal fluid (CSF). The performance of these methods, especially culture and direct smear, is thwarted by failure to detect bacteria following administration of antimicrobial agents and reluctance to performance lumbar punctures at admission. Indeed, patients with meningitis frequently receive antibiotics orally or by injection before the diagnosis is suspected or established. Thus an alternative method has become necessary to help clinicians and epidemiologists to management and control of bacterial meningitis. We evaluate the application of a polymerase chain reaction-based (PCR) assay for amplification of pneumolysin gene (ply) to diagnosis of Streptococcus pneumoniae meningitis. The PCR assay sensitivity for CSF was 96 percent (95 percent confidence interval, CI, 90-99 percent) compared to a sensitivity of 59 percent for culture (95 percent CI 49-69 percent), 66 percent for Gram stain (95 percent CI 56-74 percent), and 78 percent for latex agglutination test (95 percent CI 69-86 percent); PCR specificity was 100 percent (95 percent CI 83-100 percent). PCR results were available within 4 h of the start of the assay. This molecular approach proved to be reliable and useful to identify this bacterium compared with other classical laboratory methods for identification of bacterial meningitis pathogens.

Preparation of new protein carrier of vaccine against pneumococcal otitis media with genetic engineering technology / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To prepare pneumolysin as a new protein carrier of vaccine against otitis media with genetic engineering technology and establish the base of the study on pneumococcal conjugative vaccines.</p><p><b>METHODS</b>Genomic DNA was isolated from streptococcus pneumoniae. A pair of primers which included two restriction sites was designed based on the published pneumolysin gene sequence. The pneumolysin gene was amplified from pneumococcal DNA with PCR technology. The restriction enzyme digested fragment was linked into the cloning vector PET-28a and the recombinant plasmid DNA containing pneumolysin was then transfected into host cell E. coli JM109 (DE3).</p><p><b>RESULTS</b>DNA fragments were subcloned to construct the complete pneumolysin gene by a conventional coning and PCR. The inserted pneumolysin gene sequence was confirmed by DNA sequencing and the pneumolysin protein was successfully expressed. The relative molecular mass of the expressed product was 52 000. The expressed product amounted to 8% of the total host cell protein.</p><p><b>CONCLUSIONS</b>The pneumolysin gene was successfully cloned into host cell using genetic engineering technology. The recombinant pneumolysin was expressed and purified for preparation. This work laid a foundation of the preparation of pneumococcal conjugative vaccines.</p>

Asymptomatic Infection by Streptococcus pyogenes in Schoolchildren and Diagnostic Usefulness of Antideoxyribonuclease B

This study is designed to evaluate the immune status of schoolchildren with respect to Streptococcus pyogenes, and to ascertain the usefulness of antideoxyribonuclease B (ADNase B). Antistreptolysin O (ASO) and ADNase B concentrations were measured quantitatively in 266 serum samples from healthy elementary school children in Seoul. Simultaneously, throat cultures were taken in order to isolate S. pyogenes and other beta-hemolytic streptococci (BHS). The upper limits of the normal (ULN) concentration of ASO and ADNase B were 326 IU/mL, and 362 IU/mL, respectively. The correlation between ADNase B (y) and ASO (x) was y=0.4x+173 (r= 0.46). Mean ADNase B level (392 IU/mL) was significantly higher in children with S. pyogenes than in those with non-group A BHS (236 IU/mL) or no BHS (234 IU/ mL). Some schoolchildren were proven, via ASO and ADNase B tests, to be harboring asymptomatic S. pyogenes infections. The high ULN of ASO and ADNase B in schoolchildren should be carefully considered, in order to interpret the data collected from the patients. We could add the ADNase B test to our set of diagnostic tools, which would allow us to more accurately detect and diagnose streptococcal infections, as ADNase B was more specifically related to the results of throat cultures, and there was little correlation between ASO and ADNase B.

Phalloidin plays an important role in calcium ionophore A23187-induced human acrosome reaction / 中华男科学杂志

<p><b>OBJECTIVE</b>To discuss the important role of actin polymerization in calcium ionophore A23187-induced human acrosome reaction and its mechanism.</p><p><b>METHODS</b>Each spermatozoon specimen was divided into five groups, treated with A23187 3 micromol/L in Group A, Phalloidin 40 micromol/L and A23187 3 micromol/L in Group B, SLO 0.5 U/ml and A23187 3 micromol/L in Group C, SLO 0.5 U/ ml, Phalloidin 40 micromol/L and A23187 3 micromol/L in Group D, and nothing added in Grpup E. Then the percentage of the human acrosome reaction was assessed with Rhodamine-PSA (10 microg/ml).</p><p><b>RESULTS</b>The difference of the human spermatozoon acrosome reaction was significant (P < 0.01) among the 5 groups with or without SLO, Phalloidin and calcium ionophore A23187 but not between Groups A and B (P > 0.01).</p><p><b>CONCLUSION</b>Phalloidin does not work on the acrosome reaction of intact human spermatozoa, but in an SLO-permeabilized human spermatozoal model, it can obviously decrease the percentage of human spermatozoon acrosome reaction, which indicates that the polymerization of actin plays an important role in the course of human spermatozoon acrosome reaction, and mostly acts on the acrosome inside.</p>

Novas doenças estreptocócicas de interesse reumatológico. Nossa experiência com a artrite reativa pós-estreptocócica / New streptococcal diseases of interest to rheumatology. Our experience with the arthritis reactivales powder-streptococci

Os autores realizaram uma revisão da clínica das doenças estreptocócicas no tocante ao interesse reumatológico, destacando-se a artrite reativa e outros quadros cutâneos/articulares.

Streptococcal antibodies among rural school children in Bangladesh.

The upper limit of normal values of group A streptococcal antibodies should be known for a population concerned because it is influenced by many local conditions. As yet the reference value of the these antibodies has not been determined by using a quantitative method among Bangladeshi children. We determined the reference value of anti-streptolysin O and anti-deoxyribonuclease B among 361 apparently healthy rural Bangladeshi primary school children (aged 5 to 14 years, mean 9.2 years). Anti-streptolysin O was measured by an auto-analyzer and antideoxyribonuclease B was measured by microtitre method. The geometric mean titres for the entire group was 241 IU/ml and 222 IU/ml for anti-streptolysin O and anti-deoxyribonuclease B respectively. The upper limit of normal values (80th percentile) was 390 and 340 for anti-streptolysin O and anti-deoxyribonuclease B, respectively. These limits should be of value to physicians, epidemiologists and clinical laboratory personnel as well.

Producción y purificación parcial de la hemolisina principal (Neumolisina) de Streptococcus pneumoniae / Production and partial purification of the main hemolysin (pneumolysin) of Streptococcus pneumoniae

The capacity of 36 Cuban strains of Streptococcus pneumoniae to produce pneumolysin was studied, and 94.4 of them were determined to be producers of that enzyme. One of the best producers was cultured at a great scale and the pneumolysin found in the supernatan was partially purified through an ion-exchange chromatography in mono-Q column. This method made it possible to recover the enzyme whose purity level increased by 4.39 with 100 output.

Detection of antipneumolysin in invasive childhood pneumococcal infections.

Antibody levels against pneumolysin, a virulence factor in pneumococcal infections were evaluated by a neutralization test, using crude pneumolysin. A study population of 28 hospitalised children with culture proven pneumococcal meningitis and pneumonia were tested for detection of antipneumolysin antibodies in their serum. Results were compared with age and sex matched controls who were admitted with infections other than pneumococcal. Geometric mean titer (GMT) of antipneumolysin in serum of patients with pneumococcal infections showed a significant difference when compared with controls, GMT of 196.1 and 185.2 were noted in patients with meningitis and pneumonia respectively, in contrast to a titer of 40.32 among controls. A difference of more than 4-fold antibody titers between patients and controls was considered significant. Detection of antipneumolysin in serum can therefore be considered as a useful laboratory investigation in diagnosing invasive pneumococcal infections.

Induction, production and purification of streptolysin S. [SLS]

Strain C203S of Streptococcus pyogenes group A was examined for the production of Streptolysin S [SLS]. The strain under investigation produced the highest yield of Streptolysin S. The combined material [crude SLS] was further purified by hydroxylapatile column chromatography. The purified product had a specific activity 3.5 x 10[5] haemolytic units [mg protein]-1

Distribution and Upper Limit of Normal Antistreptolysin O Concentrations of School / 감염

BACKGROUND: Antistreptolysin O (ASO) is very useful as an indicator of recent streptococcal infections and their sequelae, such as rheumatic fever and acute glomerulonephritis. To interpret single ASO level of patients, the upper limit of normal (ULN) ASO from the same age group in the area should be known. As Streptococcus pyogenes infections are quite common in elementary school, we measured ASO and analyzed them by the results of throat culture to determine upper limit of normal ASO of school children in Chinju area. METHODS: ASO concentrations were measured quantitatively by nephelometry on 436 sera of healthy elementary school children in Chinju area. Throat cultures were taken at the same time to evaluate the relationship between ASO concentrations and throat culture results, including serogroup, colony forming units (CFU), and M types. RESULTS: The mean ASO concentration was 285IU/ml and the upper limit of normal ASO was 433IU/ml. The ASO levels were even (253-285IU/ml) through whole school grades except the 5th grade (350IU/ml). Not only the carriers of group A streptococci, but also those of group C or group G streptococci had higher ASO levels. The children from whom more than 10 CFU of S. pyogenes were isolated showed higher ASO levels than those who had less than 10 CFU. The ASO levels were higher in M type 6 or 22 compared to M type 12 or 28. CONCLUSIONS: The upper limit of normal ASO of children in Chinju was 433IU/ml, that is between Seoul(326IU/ml) and Chungnam (499IU/ml). The children who had more than 10 CFU tended to have higher ASO levels, which indicate asymptomatic infections, are associated with burden of bacteria. Group C or group G streptococci may induce serum response like group A streptococci. Certain M types may be implicated as strong producer of streptolysin O.

Detection of antibody isotypes to streptolysin O by dot ELISA

The presence of antibody isotypes (IgG, IgA and IgM) to streptolysin O was determined by dot ELISA in 222 serum samples from patients with different levels of anti-streptolysin O (SLO) antibodies as measured by the neutralizing assay (NA), from patients with diseases not related to nonsuppurative complications of Streptococcus pyogenes infection, and from clinically healthy individuals. Immunoglobulin G antibodies were found in 72 per cent of sera from patients with SLO antibodies higher than 333 Todd units (TU), and IgA antibodies were also detected in 53 per cent, but no IgM antibodies were demonstrable. High copositivity (0.94), conegativity (0.97), and positive (0.96) and negative (0.96) predictive values were observed when IgG and IgA findings were combined. The dot ELISA gave highly reproducible results. The present data suggest that the assay may be of practical value for routine detection of SLO antibodies when employed with an anti-human immunoglobulin light chain peroxidase conjugate.

Effect of streptolysin S on responsiveness of polymorphonuclear leucocytes

Most strains of Streptococcus pyogenes [group A, beta-haemolytic] contain a potent leukotoxic factor. When bacteria containing relatively large quantities of this factor are ingested by or come into contact with Poly Polymorphonuclear Leucocytes [PMNs], the neutrophils are destroyed. Death of PMNs is associated with intracytoplasmic rupture of PMN granules; this release of granule contents is thought to be the leukocidal killing mechanism. Purified, Streptolysins S [SLS], at concentrations of b etween 8000 HU/ml, when added directly to zymosan - induced rabbit PMNs, caused iinhibition of the PMNs chemiluminescence response

Síndrome de shock tóxico estreptocócico asociado a faringitis no invasiva / Streptococcal toxic shock syndrome asociated to noinvasive pharyngitis

Se presenta el caso de un síndrome de shock tóxico asociado a faringitis estreptocócica no invasiva en un paciente de 16 años previamente sano. El diagnóstico por aumento del título de anticuerpos frente a la estreptolisina (ASTO) de 6,25 veces el valor basal a los 15 días de haber comenzado el cuadro clínico. El síndrome de shock tóxico fue precedido por síntomas de odinofagia 7 días antes de su aparición. A nuestro entender éste es el tercer caso comunicado de shock tóxico asociado a infección no invasiva por Streptococcus Beta Hemolítico Grupo A. La creciente frecuencia de infecciones severas por este microorganismo que se comunica en Norteamérica parece tener una evolución paralela en nuestro medio y tal vez sea un fenómeno epidemiológico universal