Group Streptococci Research Articles

Antimicrobial Susceptibility Profile of Aerococcus urinae: Recommendations for Empirical Therapy

Background We studied the susceptibility profile of Aerococcus urinae recovered from urinary clinical samples with the aim of providing guidance in the choice of empiric antimicrobial treatment for urinary tract infection (UTI). Methods We studied stored isolates collected from UTIs of adult male and female VA patients of varying race/ethnicities from January 2019 to January 2021. Susceptibility of antimicrobials in the GPALLF3 Sensititre tray was determined. Minimum Inhibitory Concentration were interpreted based on breakpoints for Aerococcus species as outlined in the CLSI M45 standard and Streptococcus species viridans group or Enterococcus species, as outlined in the CLSI M100 standard. Results A total of 64 unique A. urinae isolates were recovered from the stored isolates. All isolates were susceptible to ampicillin, penicillin, linezolid, nitrofurantoin, and vancomycin, while 92.1% were susceptible to tetracycline, 63.6% to levofloxacin, and 44.5% to ciprofloxacin. Conclusions Our findings lead us to suggest the use of ampicillin, tetracycline, and nitrofurantoin for the empirical treatment of lower UTI caused by A. urinae.

Protective Effects of Glycyrrhiza Total Flavones on Liver Injury Induced by Streptococcus agalactiae in Tilapia (Oreochromis niloticus)

Clinical studies have confirmed that Glycyrrhiza total flavones (GTFs) have good anti-hepatic injury, but whether they have a good protective effect on anti-hepatic injury activity induced by Streptococcus agalactiae in tilapia (Oreochromis niloticus) is unknown. The aims of this study were to investigate the protective effects of Glycyrrhiza total flavones on liver injury induced by S. agalactiae (SA) and its underlying mechanism in fish. A total of 150 tilapia were randomly divided into five groups, each with three replicates containing 10 fish: normal control group, S. agalactiae infection group, and three Glycyrrhiza total flavone treatment groups (addition of 0.1, 0.5, or 1.0 g of GTF to 1 kg of feed). The normal control group was only fed with basic diet, after 60 d of feeding, and intraperitoneal injection of the same volume of normal saline (0.05 mL/10 g body weight); the S. agalactiae infection group was fed with basic diet, and the S. agalactiae solution was intraperitoneally injected after 60 d of feeding (0.05 mL/10 g body weight); the three GTF treatment groups were fed with a diet containing 0.1, 0.5, or 1.0 g/kg of GTF, and the S. agalactiae solution was intraperitoneally injected after 60 d of feeding (0.05 mL/10 g body weight). After 48 h injection, blood and liver tissues were collected to measure biochemical parameters and mRNA levels to evaluate the liver protection of GTFs. Compared with the control group, the serum levels of glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), alkaline phosphatase (AKP) and glucose (GLU) in the streptococcal infection group increased significantly, while the levels of total antioxidant capacity (T-AOC), superoxide dismutase (SOD), catalase (CAT) and reduced glutathione (GSH) decreased significantly; observations of pathological sections showed obvious damage to the liver tissue structure in response to streptococcal infection. S. agalactiae can also cause fatty liver injury, affecting the function of fatty acid β-oxidation and biosynthesis in the liver of tilapia, and also causing damage to function of the immune system. The addition of GTFs to the diet could improve oxidative stress injury caused by S. agalactiae in tilapia liver tissue to different degrees, promote the β-oxidation of fatty acids in the liver, accelerate the lipid metabolism in the liver, and repair the damaged liver tissue. GTFs have a good protective effect on liver injury caused by streptococcus.

Population shifts in some faeces and rumen bacteria profiles and subsequent blood LPS and lactate concentrations in lambs in the early period of subacute ruminal acidosis.

It is known that ruminal acidosis can induce harmal population shifts in some ruminal bacteria profiles. However, there is little information related to alterations in faecal and ruminal bacterial communities and relevant serum lipopolysaccharide (LPS) in sheep with subacute ruminal acidosis (SARA). This study aimed to investigate alterations in the defined faecal and ruminal bacteria profiles and serum LPS and blood lactate concentrations in lambs with empirically induced SARA. Fifteen lambs were served and undergone to induce SARA during a 7-day period. Faecal and ruminal samples were taken to measure the pH and to perform the bacteriological works at 0 (just before induction), 8, 9, and 10 days of the challenge. Blood samples were collected to determine the serum LPS and lactate levels. The rumen and faecal samples were cultured to specify colony-forming units (CFU) for Escherichia coli, Streptococcus Group D (SGD), and lactic acid bacteria (LAB). Serum LPS value had no significant increase in the affected lambs with SARA. Significant increasing trends were observed in faecal E. coli and LAB populations (p < 0.01). Rumen bacteriology revealed a rising trend for LAB and a falling trend for SGD populations (p < 0.01). Unlike cattle, LPS appears to be of minor importance in the pathogenesis of SARA in sheep. The increased ruminal and faecal LAB (4.00 × 107 CFU/ml or g) are proposed as valuable biomarkers for improving nutritional strategy and screening SARA in lambs.

Investigating the Streptococcus sinensis competence regulon through a combination of transcriptome analysis and phenotypic evaluation.

Streptococcus sinensis is a recently identified member of the Mitis group of streptococci. This species has been associated with infective endocarditis; however its mechanisms of pathogenesis and virulence are not fully understood. This study aimed to investigate the influence of the competence-stimulating peptide (CSP) and the competence regulon quorum-sensing circuitry (ComABCDE) on subsequent gene transcription and expression, as well as resultant phenotypes. In this study we confirmed the native CSP identity, ascertained when endogenous CSP was produced and completed a transcriptome-wide analysis of all genes following CSP exposure. RNA sequencing analysis revealed the upregulation of genes known to be associated with competence, biofilm formation and virulence. As such, a variety of phenotypic assays were utilized to assess the correlation between increased mRNA expression and potential phenotype response, ultimately gaining insight into the effects of CSP on both gene expression and developed phenotypes. The results indicated that the addition of exogenous CSP aided in competence development and successful transformation, yielding an average transformation efficiency comparable to that of other Mitis group streptococci. Additional studies are needed to further delineate the effects of CSP exposure on biofilm formation and virulence. Overall, this study provides novel information regarding S. sinensis and provides a substantial foundation on which this species and its role in disease pathogenesis can be further investigated.

Distribution of two-component signal transduction systems BlpRH and ComDE across streptococcal species.

Two-component signal transduction (TCS) systems are important regulatory pathways in streptococci. A typical TCS encodes a membrane-anchored sensor kinase (SK) and a cytoplasmic response regulator (RR). Approximately, 20 different types of TCSs are encoded by various streptococci. Among them, two TCSs, in particular BlpRH and ComDE, are required for bacteriocins production and competence development. The SK component of these two TCSs is highly similar and belongs to the protein kinase-10 (HPK-10) subfamily. While these two TCSs are present in streptococci, no systematic studies have been done to differentiate between these two TCSs, and the existence of these pathways in several species of the genus Streptococcus is also unknown. The lack of information about these pathways misguided researchers for decades into believing that the Streptococcus mutans BlpRH system is a ComDE system. Here, we have attempted to distinguish between the BlpRH and ComDE systems based on the location of the chromosome, genomic arrangement, and conserved residues. Using the SyntTax and NCBI databases, we investigated the presence of both TCS systems in the genome of several streptococcal species. We noticed that the NCBI database did not have proper annotations for these pathways in several species, and many of them were wrongly annotated, such as CitS or DpiB instead of BlpH. Nevertheless, our critical analyses led us to classify streptococci into two groups: class A (only the BlpRH system) and class B (both the BlpRH and ComDE systems). Most of the streptococcal groups, including bovis, pyogenic, mutans, salivarius, and suis, encode only the BlpRH system. In contrast, only in the mitis and anginosus groups were both the TCS systems present. The focus of this review is to identify and differentiate between the BlpRH and ComDE systems, and discuss these two pathways in various streptococci.

Disease- and Medication-Specific Differences of the Microbial Spectrum in Perianal Fistulizing Crohn’s Disease—Relevant Aspects for Antibiotic Therapy

Perianal fistulizing Crohn's Disease (CD) with abscess formation represents an aggressive phenotype in Inflammatory Bowel Disease (IBD) with increased morbidity. Treatment is multidisciplinary and includes antibiotics, but knowledge about the microbial spectrum is rare often resulting in inadequate antimicrobial therapy. In this single center retrospective study, all patients who were operated due to perianal abscess formation were retrospectively analyzed and the microbial spectrum evaluated. Patients were divided into a CD and non-CD group with further subgroup analysis. 138 patients were finally included in the analysis with 62 patients suffering from CD. Relevant differences were detected for the microbial spectrum with anaerobic bacteria being significantly more often isolated from non-CD patients. In a subgroup-analysis of CD patients only, medical therapy had a relevant effect on the microbial spectrum since Streptococcus groups and Enterobacterales were significantly more often isolated in patients treated with steroids compared to those being treated by antibodies. In conclusion, the microbial spectrum of patients suffering from CD varies significantly from non-CD patients and immunosuppressive medication has a relevant effect on isolated pathogens. Based on that, adaption of antibiotic treatment might be discussed in the future.

Isolation of Streptococcus Thoraltensis in A Case of Necrotizing Fasciitis

Our aim of this case report is to add significant epidemiological knowledge regarding the role of Streptococcus thoraltensis in causing human infections, emphasizing the importance of not neglecting the viridans group of streptococci in nonneutropenic patients and also patients with normal cardiac valves. Objectives of our study are to present the clinical features and laboratory findings of a patient diagnosed with Necrotizing fasciitis of perineum in whom S.thoraltesis a viridans streptococcus species was isolated in blood culture . Necrotizing fasciitis is an uncommon bacterial infection of fascial tissue which can progress to cause necrosis followed by sepsis. In microbiological aspects Necrotizing fasciitis is classified as type I and II. Type I is due to polymicrobial infection.Type II is commonly due to group A beta hemolytic Streptococci and Staphylococcus aureus .To the best of our knowledge Streptococcus thoraltensis bacteremia with necrotizing fasciitis has never been reported till now. Only a few cases of S.thoraltensis is reported in literature so far. Here we present a case of a 65-year-old male patient admitted with sepsis and shock. He had a fever, chills for two weeks, and difficulty walking for five days. On examination, there was a scrotal swelling and a swelling of 8x4 cm over the left gluteal region near the anal canal with erythema and tenderness. The computed tomographic scan of the abdomen and pelvis was suggestive of Necrotizing Fasciitis with multiple abscess formation involving perianal region,ischiorectal fossa,root of penis, and scrotum, left anterior abdominal wall with left retroperitoneal and intraperitoneal extension. Laboratory investigations revealed marked neutrophilia and elevated urea and creatinine levels.The patient expired on the same day in spite of prompt supportive treatment. The 2 blood samples drawn from different sites were culture positive for S. thoraltensis . As blood culture results play a very important role in identifying the pathogen in Necrotizing fasciitis S.thoraltensis isolation from two blood cultures throws light on the emerging pathogenic nature of viridans group of streptococci.It emphasizes the importance of treating the viridans group of streptococci and not neglecting it in non-neutropenic patients and patients with normal cardiac valves.

Self-sampling to identify pathogens and inflammatory markers in patients with acute sore throat: Feasibility study.

IntroductionSore throat is a common reason for overuse of antibiotics. The value of inflammatory or biomarkers in throat swab or saliva samples in predicting benefit from antibiotics is unknown.MethodsWe used the ‘person-based approach’ to develop an online tool to support self-swabbing and recruited adults and children with sore throats through participating general practices and social media. Participants took bacterial and viral swabs and a saliva sponge swab and passive drool sample. Bacterial swabs were cultured for streptococcus (Group A, B, C, F and G). The viral swab and saliva samples were tested using a routine respiratory panel PCR and Covid-19 PCR testing. We used remaining viral swab and saliva sample volume for biomarker analysis using a panel of 13 biomarkers.ResultsWe recruited 11 asymptomatic participants and 45 symptomatic participants. From 45 symptomatic participants, bacterial throat swab, viral throat swab, saliva sponge and saliva drool samples were returned by 41/45 (91.1%), 43/45 (95.6%), 43/45 (95.6%) and 43/45 (95.6%) participants respectively. Three saliva sponge and 6 saliva drool samples were of insufficient quantity. Two adult participants had positive bacterial swabs. Six participants had a virus detected from at least one sample (swab or saliva). All of the biomarkers assessed were detectable from all samples where there was sufficient volume for testing. For most biomarkers we found higher concentrations in the saliva samples. Due to low numbers, we were not able to compare biomarker concentrations in those who did and did not have a bacterial pathogen detected. We found no evidence of a difference between biomarker concentrations between the symptomatic and asymptomatic participants but the distributions were wide.ConclusionsWe have demonstrated that it is feasible for patients with sore throat to self-swab and provide saliva samples for pathogen and biomarker analysis. Typical bacterial and viral pathogens were detected but at low prevalence rates. Further work is needed to determine if measuring biomarkers using oropharyngeal samples can help to differentiate between viral and bacterial pathogens in patients classified as medium or high risk using clinical scores, in order to better guide antibiotic prescribing and reduce inappropriate prescriptions.

Biomarker of neutrophil extracellular traps is associated with deep-seated infections and predicts mortality and cardiovascular morbidity in commensal streptococcal bacteremia.

Neutrophil extracellular traps (NETs) play important roles in sepsis and deep-seated infections, but whether NET formation correlates with clinical outcomes of patients with streptococcal bloodstream infections (BSIs) is unclear. We analyzed serum levels of complexes of myeloperoxidase and DNA (MPO-DNA) in patients with streptococcal-BSIs. Invitro assay of NET induction by serum from BSI patients was performed. MPO-DNA values for the Streptococci-BSI group (n=59) were significantly higher than those for healthy controls (p<0.00001) and matched control groups (n=59, p=0.004). The rate of higher MPO-DNA levels (>1.87μg/mL) were higher in abscess-prone streptococcal groups (streptococcus milleri group) (72.2% vs. 52.5%, p=0.02). For patients with BSIs due to highly infective endocarditis (IE)-prone pathogens, the values of serum MPO-DNA were also higher in patients diagnosed of IE compared to their counterparts (p=0.009). Notably, serum from patients with leukopenia could induce higher amounts of invitro NET formation, despite having low MPO-DNA levels, suggesting that NET formation could be influenced by WBC counts. Therefore, we combined WBC counts with MPO-DNA to predict all-cause 30-day mortality in patients with commensal streptococcal-BSIs. The mortality risk was lowest among patients who had neither high MPO-DNA levels nor abnormal WBC counts (p=0.058). Furthermore, this group of patients also had a favorable composite outcome consisting of major adverse cardiovascular events (MACE) and all-cause mortality (p=0.026). Together, these study data suggested that serum MPO-DNA can be a biomarker for predicting a composite outcome consisting of MACE and all-cause mortality in patients with commensal streptococcal-BSIs.

CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME: A VICIOUS CIRCLE OF CLOTTING AND BLEEDING

CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME: A VICIOUS CIRCLE OF CLOTTING AND BLEEDING

Streptococcus Intermedius Brain and Liver Abscesses After Dental Manipulation: a Case Report

Background: Brain abscesses are intracerebral infections with pus accumulation that can be fatal in most cases without appropriate treatment. The most common cause of brain abscesses are infections with streptococci and staphylococci. Streptococcus anginosus is a group of streptococci that are part of the normal flora of the oropharynx and are rarely the cause of severe bacterial infections. Case Report: Our patient is a 64-year-old man who underwent a dental procedure, and presented a few days later with a high-grade fever and decreased level of consciousness. He was found to have multiple brain abscesses and a liver abscess, and blood cultures revealed Streptococcus intermidius, which belongs to the Streptococcus anginosus group. The patient received appropriate treatment and recovered completely. Conclusion: Dental procedures, even simple tooth brushing, can cause bacteremia leading to multiple abscesses in different parts of the body, especially if a germ of the Streptococcus anginosus group has been detected in the blood culture.

A surgical protocol for sinogenic brain abscess: the Oxford experience and a review of the literature.

Rhinosinusitis-induced brain abscesses are rare but can result in devastating long-term sequalae and mortality; they require a high index of suspicion with early imaging to start early empiric parenteral antibiotic treatment covering aerobes and anaerobes. Our study was a retrospective analysis on 32 patients who were treated at Oxford University Hospitals for rhinosinusitis-induced brain abscess between February 2013 and June 2020. Mean age of presentation was 45.83 for adults and 11.14 for children. Subdural collection was the most frequent abscess but 25% of patients had multiple sites of collection; the majority were in the frontal lobe. The most commonly identified pathogens were Streptococcus milleri group and Staphylococcus aureus; 93.75% of the patients were treated with combined Ceftriaxone and Metronidazole for an average of 8 weeks. In our series most patients received also a prompt and aggressive surgical treatment with combined neurosurgical and ENT procedures in the majority; this was especially important in case of subdural empyema, Streptococcus milleri infection and direct intracranial spread of infection. More than half of the patients were treated with a single surgical procedure. Despite aggressive treatment, one third of patients experienced long-term neurological sequelae; there were no deaths.

ANTIBACTERIAL POTENTIAL OF LIME (Citrus aurantifolia) ON THE GROWTH OF Streptococcus mutans

Streptococci have a variety of solid virulence factors that allow various infections to occur. Streptococcus mutans is an obligate biofilm organism and is considered the primary etiology of dental caries. Lime (Citrus aurantifolia) is widely consumed because of its natural safety factors and is a vital ingredient in most herbal ingredients with antibacterial properties. Prevention in dentistry needs to be improved, one of which is through the potential of herbal plants to reduce world health problems, especially in Indonesia. Objective To determine the possibility of lime antibacterial compounds inhibiting the growth of Streptococcus mutans. Streptococcal groups, especially S. mutans, are aciduric and acidogenic organisms and can create environmental conditions that lethal to other bacteria. Streptococcus mutans produces several extracellular sucrose metabolite enzymes that contribute to the organism's ability to cause dental caries. Streptococcal virulence factors are usually due to adesin attachment to cell surface proteins, glucosyltransferase (GTF) production, acid production, and acid tolerance. Oranges are one of the largest plant species distributed throughout the world. Plants of the citrus genus are mainly valued for their edible fruit and traditional medicinal value and have an important role in health. Lime is a herbal plant that has the potential as an antibacterial against streptococci because it contains beneficial active compounds such as saponins, flavonoids, citric acid, amino acids, essential oils, resins, glycosides, vitamin B1, vitamin C, citric acid, fats, iron, calcium, sulfur, phosphorus, and is expected to be a choice of chemical drugs that have many side effects. Conclusion Lime is a herbal plant that contains antibacterial compounds that show various biological activities, are proteolytic and lipolytic, and contain active antibacterial compounds that are expected to reduce the incidence of dental and oral diseases.

New structural insights into the PI-2 pilus from Streptococcus oralis, an early dental plaque colonizer.

Streptococcus oralis is a member of the mitis group of oral streptococci and an early colonizer in dental plaque biofilm, a major cause of periodontal disease, dental caries, and other oral infections. S. oralis promotes biofilm growth by coaggregating in a mutualistic partnership with other early colonizers such as Actinomyces oris. For this cell-to-cell interaction, A. oris is known to use its sortase-dependent pilus (type 2), but whether S. oralis uses its PI-2 (pilus islet 2) pilus is still to be determined. The PI-2 pilus is predicted to have a heterodimeric structure consisting of two different protein subunits with their own location and function: the tip PitA pilin for adhesion and the backbone PitB pilin for length. Thus far, structural information remains incomplete about the role of PI-2 pili in the mutualistic mechanism between S. oralis and A. oris. We now report on the crystal structure analysis of PitA and PitB using X-ray crystallography, small-angle X-ray scattering, and molecular docking studies. Accordingly, we propose a structural model for the PI-2 pilus, wherein repeating PitB subunits are arranged head-to-tail to form the long backbone structure with PitA on the outer tip. By performing both in vitro and in vivo experiments, we examined the role played by PitA in mediating the mutualistic interaction between S. oralis and A. oris, which appears to involve the coaggregation factor CafA. We also reveal that the galactose monosaccharide is a conceivable ligand for PitA and thereby might be used to inhibit coaggregation and control oral biofilm development. DATABASE: Structural coordinates for the PitA fragment, PitA fragment TbXO4 derivative, full-length PitA, and PitB from S. oralis have been deposited at the Protein Data Bank as 7VCR, 7W7I, 7VCN, 7W6B, and 7W7I, respectively. Streptococcus pneumoniae PitB coordinates have been deposited as 7F7Y.

Antibiotic resistance and modern strategy of antibacterial therapy

Antibiotic resistance is a serious health problem. The use of new dosage forms of antibiotics should comply with the strategy of rational use of antimicrobials, which includes a set of measures for hospitals and outpatient network aimed at preserving the effectiveness of existing antibiotics. The principles of the strategy for the use of antimicrobial/antibacterial drugs: the exclusion of unjustified prescribing of antibiotics, the priority of prescribing drugs based on the identification of the bacterial agent and its sensitivity to the antibiotic in comparison with empirical prescribing, taking into account data on regional antibiotic resistance, the application of the principle of minimum sufficiency in relation to the choice of the drug – its dose, the choice of route of administration, safety and duration of treatment. The article uses the example of healthcare systems in different countries to assess the effectiveness of the strategy of rational use of antimicrobials. The problem of unjustified use of antibiotics in the treatment of COVID-19 is discussed. New innovative forms of antibiotics are dispersible tablets. Amoxicillin EXPRESS and Amoxicillin + Clavulanic Acid EXPRESS are antibiotics with improved pharmacokinetic properties in the form of dispersible tablets that have proven their safety and effectiveness against many gram-positive and gram-negative microorganisms. The analysis of the effectiveness of therapy of diseases caused by beta-hemolytic streptococcus group A, with the use of two forms: Amoxicillin and Amoxicillin + Clavulanic acid. A clinical case of the use of Amoxicillin + Clavulanic acid EXPRESS in the form of dispersible tablets is presented, which confirms the effectiveness of this drug in the treatment of acute streptococcal tonsillitis.

Prevalence, Predictors, Echocardiographic Features, and Clinical Outcomes of Infective Endocarditis in Patients with Streptococcus agalactiae Septicemia

Background: Streptococcus agalactiae or Group B Streptococcus (GBS) infective endocarditis (IE) is less common but associated with serious morbidity and mortality. Evidence regarding the prevalence of GBS IE in patients with GBS septicemia is scant. There is also no recommendation for the use of echocardiography in patients with GBS septicemia in the current guidelines. Objective: The primary objective was to determine the prevalence of GBS IE in patients with GBS septicemia. The secondary objective was to assess the predictors, echocardiographic features, and clinical outcomes, including in-hospital mortality, and valvular surgery in patients with GBS IE. Materials and Methods: Consecutive patients older than 18 admitted to Siriraj Hospital due to GBS septicemia between 2005 and 2019 were enrolled. The patients’ characteristics, echocardiographic index reports, and clinical outcomes were reviewed. Univariable and multivariable analyses were performed to determine the predictors of GBS IE. Clinical outcomes of patients with and without GBS IE were compared. A p-value of less than 0.05 was considered statistically significant. Results: Two hundred seven patients were included in the present study. The prevalence of GBS IE was 10.6% (95% CI 6.8 to 15.6). Age, new murmur, and stroke/systemic embolism (SE) were independent predictors for IE in the patients with GBS septicemia. GBS IE caused a sizable proportion of intracardiac complications (36.4%) and moderate-severe valvular regurgitation (68.2%). There was a significant higher rate of in-hospital mortality and valvular surgery in the IE group than in the non-IE group at 63.3% versus 14.1% (p&lt;0.001). Conclusion: There was a sizable proportion of GBS IE in patients admitted due to GBS septicemia. Younger age, new murmur, and stroke/SE were independent predictors of IE in patients with GBS septicemia. Echocardiography should be performed in patients with these predictors to find the evidence and intracardiac complications of GBS IE. Keywords: Echocardiography; Group B Streptococcus; Infective endocarditis; Septicemia; Valvular heart disease

Echocardiographic features of infective endocarditis in South Africa: A prospective cohort study

Background. Historically, infective endocarditis (IE) in South Africa (SA) was associated with the viridans group of streptococci affecting patients with underlying rheumatic heart disease (RHD). A changing IE bacteriological profile raises the question of whether the profile of underlying valvular abnormality has changed. Objectives. To investigate the prevalence of underlying structural valve abnormalities and their aetiologies associated with IE in SA, and describe the typical imaging findings. Methods. The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and April 2021. Patients underwent detailed transthoracic and transoesophageal echocardiography to assess their underlying cardiac and valvular structure. Results. Among 71 patients included, a predisposing endocardial abnormality was detected in 49.3%, with RHD the most common single identifiable aetiology (16.9%). The in-hospital mortality rate was similar in patients with and without a predisposing endocardial abnormality (20% v. 16.7%; p=0.72), as was the rate of embolic events (20% v. 27.2%; p=0.58). Significantly more patients with a predisposing endocardial abnormality had an indication for surgery (94.3% v. 69.4%; p&lt;0.01). The viridans group of streptococci was more prevalent in patients with a predisposing endocardial abnormality (25.7% v. 2.7%; p&lt;0.01). Left-sided linear vegetation size &gt;10 mm was associated with an increased risk of in-hospital mortality (24% v. 5%; p=0.05). Conclusion. We observed a marked decrease in the prevalence of RHD in this cohort of patients with IE. The viridans group of streptococci was an uncommon cause of IE in patients with no predisposing endocardial abnormality detected. The presence of a predisposing endocardial abnormality was not associated with an increased risk of in-hospital mortality or embolic events. Linear vegetation length &gt;10 mm was associated with an increased risk of in-hospital mortality in patients with left-sided IE.

Common Colonization Genes Profiling and BOX-PCR Based Genotyping of Streptococcus agalactiae from Pregnant Women in Tehran, Iran

Background: Streptococcus agalactiae or group B Streptococcus (GBS) is a prominent cause of severe neonatal infections. Group B Streptococcus is a part of the intestinal and vaginal normal flora. Maternal colonization is recognized as the main path of GBS transmission. Group B Streptococcus is a pathobiont that changes from a non-symptomatic mucosal carriage state to a significant bacterial pathogen, causing major infections. Objectives: This study aimed to investigate the concomitant presence of major colonization genes, including ftsA, ftsB, lmb, and sfbA, and to determine the genetic relatedness of clinical GBS isolates. Methods: The GBS isolates were obtained from urinary and placental samples of pregnant women with a urinary tract infection, who were admitted to a hospital in Tehran, Iran. The presence of some major colonization factors was investigated via multiplex PCR assay. Genotyping of the isolates was performed using the BOX-PCR fingerprint technique with a BOX-A1R primer. Next, the data were analyzed using the UPGMA method and the coefficient of Jaccard in NTSYS software. Results: A total of 60 GBS isolates were examined in this study. The concomitant presence of target colonization genes was observed in all isolates. The BOX-PCR discriminated GBS isolates into six different genetic clusters at a 60% cutoff point. The majority of isolates (80%) from both clinical samples were clustered into genotypes 2, 6, and 4, while the rest (20%) were distributed equally into three different genotypes. Conclusions: Determining the colonization associated genes and genetic polymorphism in a different geographical area provides the epidemiological basis for the prevention of GBS infections in pregnant women and infants.

Streptococcal Pharyngitis and Rheumatic Fever

Streptococcus pyogenes (Group A Streptococcus) causes a variety of diseases, from benign self-limiting infections of the skin or throat to lethal infections of soft tissue accompanied by multi-organ failure. GAS is one of significant species among Gram-positive pathogens which is responsible for several suppurative infections and non-suppurative sequelae. They also cause pharyngitis, streptococcal toxic shock syndrome (STSS), necrotizing fasciitis and other diseases. Currently, global burden of RF / RHD is undervalued. In 2010, RF and RHD were estimated as 15.6 million cases and deaths around 200,000 annually. Laboratory diagnosis includes cultural techniques, serology, PYR test, Bacitracin susceptibility test and antibiotic resistance testing helps in differentiating the Streptococcus pyogenes from other groups of Streptococci. Most of the Acute Rheumatic Fever cases gets missed or does not present in the initial stage rather it has been developed into advanced Rheumatic Heart Disease condition. Modified Jones criteria in 2015 will be helpful especially to the low risk population as it is challenging because of limited access to primary health care, diagnosis of streptococcal disease. In addition to this revised criteria, diagnosis still relies on clinical diagnostic algorithm. Vaccines based on M protein and T antigens are continuing to evolve with different results. Ongoing vaccine development is still challenging for the GAS research community, it will make a positive and lasting impact on the peoples globally.

Incidence of Vaginal Colonization of Group B Streptococci among Pregnant Women Attending a Tertiary Care Hospital – Chennai, India

Streptococcus agalactiae or Group B Streptococcus (GBS) is an important pathogen, which can cause serious illness and sometimes death especially in newborns, pregnant women and in people with compromised immune system. The major risk factor for neonatal disease is vaginal colonization of GBS during pregnancy and delivery. 1) To study the incidence of vaginal colonization of Group B Streptococcus (GBS) among pregnant women. 2) To compare the efficacy of sheep blood agar vs selective medium like HiCHROME Strep B Selective agar (HIMEDIA) in the isolation of GBS. Vaginal swabs were collected from 150 antenatal women at 35-37 weeks of gestation or at any gestational age if additional risk factors were present. The swabs were cultured on non-selective medium like Blood agar and a chromogenic medium (HiCHROME Strep B Agar, HiMedia). GBS was identified by standard microbiological techniques. Bluish, purple-colored colonies were confirmed as GBS by CAMP test and latex agglutination test. Only 3 out of 150 women (2%) of the screened antenatal women were colonized with GBS. Incidence was quite low, compared to the literature from the West. All the 3 babies born to the three women colonized with GBS were healthy with no indication of invasive GBS disease. The chromogenic medium supported the growth of Group B Streptococcus and Enterococcus spp. only and was a useful selective medium for isolation of GBS.