Group Streptococci Research Articles

Antibiotic Susceptibility Patterns in Adenotonsillar Bacterial Isolates in a Tertiary Hospital in Sub-Saharan Africa

Background: The adenoids and tonsils are parts of Waldeyer's ring and are essentially the first line of immunological defense of the upper respiratory tract. These lymphoid tissues can frequently become infected, resulting in hypertrophy and recurrent tonsillitis. Bacterial infections are the main causative agents in chronic adenotonsillitis. Frequently implicated organisms seen ln the adenoids and tonsils include Streptococcus pyogenes, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis and sometimes anaerobic bacteria. The rise of antimicrobial resistance has greatly diminished the effectiveness of widely used antibiotics. Objective: The aim of this study is to examine the microbiological characteristics and antibiotic susceptibility patterns of bacterial isolates obtained from adenotonsillar tissues of children undergoing tonsillectomy in a tertiary hospital in Nigeria. Methods: A hospital based cross-sectional study among patients undergoing adenotonsillectomy. Swab was taken from adenoid and tonsillar tissues and sent for sent for microbiology culture and sensitivity. Data entry and analysis was done using the Statistical Product and Service Solutions (SPSS) version 20. Tables and charts were used as appropriate to represent data. Numerical variables were summarized as means and standard deviation for age while categorical variables were expressed as frequencies and percentages. Results: A total of 50 patients aged 3 years to 7 years were included in the study. A median age of 4.0 years and mean age of 4.4± 1.5 years was gotten. Most (62% of the patients were under five male/female ratio of 1.3: 1. Most of the adenoid (40%) and tonsillar (32%) tissues did not yield growth. Viridan group of Streptococcus seen 20% of tonsils was the commonest organism isolated from the tonsils. Staphylococcus aureus as seen in 22% of cases was commonest bacterial isolate from the adenoid. Regarding antibiotic susceptibility, aerobic bacteria was resistant to most of the antibiotics. The sensitivity pattern of Staphylococcus aureus was as follows; erythromycin (59.5%), cefuroxime (54.1%), ciprofloxacin(51.2%) and amoxicillin/clavulanic acid (51.2%). The antibiogram of organisms showed a high rate of resistance of aerobic bacteria to antibiotics which was statistically significant. However, the predominant organisms were most sensitive to erythromycin, cefuroxime and amoxicillin/clavulanic acid.

P-821. Invasive Streptococcus pyogenes Infections: Is Anti-toxin Therapy Necessary?

Abstract Background Invasive Streptococcus pyogenes or group A Streptococcus (GAS) carries a high morbidity and mortality rate. In addition to penicillin, adjunct anti-toxin therapy (AT) with linezolid or clindamycin is the standard of care. Although the use of AT is supported by in vitro data and observational studies, there are limited conclusive data supporting its efficacy in reducing GAS mortality. Our study aimed to compare clinical outcomes of patients receiving AT versus those who did not. Methods This was a retrospective cohort study of hospitalized patients with positive blood cultures for GAS at our five-hospital system from June 2013 to August 2023. Patients were identified through Microsoft SQL Server. Patients who received AT therapy for > 48 hours were defined as the AT group; the control group did not receive AT therapy. Patients who received AT for < 48 hours were excluded. Collected variables included demographics, infection & microbiological characteristics, and clinical outcomes. Data was analyzed using SPSS. Results 265 patients were included in the study of whom 179 (68%) received AT (Table 1). About half were female, and the median age was 58 years. Comorbidities were overall similar between the two groups. Persons who inject drugs or with chronic hepatitis C were more common in the control group. Abscess/cellulitis was the most common clinical syndrome in both groups. Shock requiring vasopressors, need for dialysis and mechanical ventilation, and toxic shock syndrome were prevalent in the AT group. There was no difference in the duration of bacteremia, clindamycin resistance, and management between the two groups except for receipt of intravenous immunoglobulin (IVIG), which was more common in the AT group (Table 2). Outcomes, including length of stay, readmission for infection-related complications, and 30-day mortality, were similar between the two groups. Conclusion Utilization of AT for invasive GAS infections correlated with severity of illness, but clinical outcomes did not significantly differ between patients receiving AT and those who did not, suggesting a potential opportunity for antimicrobial stewardship. Further research is needed to determine whether AT should be reserved for patients with select infectious syndromes Disclosures Rachel M. Kenney, PharmD, BCIDP, Medtronic Inc: Spouse is an employee, stockholder

Comparison of lateral tail vein and retro-orbital venous sinus as routes of inoculation to study Group B streptococcal systemic infection.

Streptococcus agalactiae or Group B Streptococcus (GBS) is the leading cause of invasive disease in neonates and immunocompromised adults and is implicated in severe cases of sepsis, pneumonia, and meningitis. Established murine models of hematogenous systemic infection allow for better understanding and investigation of bacterial dispersion, pathogenesis, meningeal inflammation, and interaction with the host. Here we compared two routes of infection, intravenous lateral tail vein and retro-orbital venous sinus, demonstrating that similar experimental outcomes can be observed, regardless of the route of infection for GBS, specifically. These findings help to reinforce the utility of different systemic infection models and provide insight into comparisons across different established models and how these models can be applied in microbial research.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and gut microbiota composition: what do we know?

Post-streptococcal autoimmune neuropsychiatric disorders (PANDAS) are a group of pathological condition characterized by sudden-onset obsessive-compulsive and tic disorders following beta-hemolytic Streptococcus group A (GAS) infection, hypothesized to be caused by autoimmune mechanisms targeting the basal ganglia. Scant literature is available regarding the microbiota composition in children with PANDAS, however few studies support the hypothesis that streptococcal infections may alter gut microbiota composition in these patients, leading to chronic inflammation that may impact the brain function and behavior. Notable changes include reduced microbial diversity and shifts in bacterial populations, which affect metabolic functions crucial for neuroinflammation. Elevated serum levels of sNOX2-dp and isoprostanes indicate oxidative stress, while the presence of lipopolysaccharides (LPS) may contribute to neuroinflammation. The aim of this narrative review is to explore the link between PANDAS and gut microbiota composition. The potential connection between gut microbiota and neuropsychiatric symptoms in PANDAS might suggest the importance of dietary interventions, such as promoting the Mediterranean diet and fiber intake, to reduce the inflammatory state of this patients and therefore improve their outcome.

General practitioner consultations for respiratory tract infections in children under 5 years; retrospective cohort study 2016-2023.

Little is known about how GP consultation rates for children's respiratory tract infections (RTIs) have changed since the covid-19 pandemic restrictions lifted. To describe changes in GP consultation rates for RTIs in children <5 years from 2016-2023. Population-based retrospective cohort study using electronic health records. We included all children aged <5 years registered with a general practice from April 2016 to March 2023. We compared monthly GP consultation rates for RTIs from April 2021-March 2023 with corresponding months during pre-pandemic years (April 2016-February 2020). There were 3 045 701 GP consultations for RTIs among 2 894 539 children. Pre-pandemic, monthly consultation rates ranged from lows in August to highs in November (from 2368 to 8682 per 100 000 children, respectively). Following the pandemic lockdowns in 2020, monthly rates in 2021/22 peaked in June and October, but the winter peak was less marked than pre-pandemic and mean monthly rates were 16.8% lower. In 2022/23 after all restrictions lifted, rates remained around 15% below pre-pandemic years, but the winter peak for children aged 3-4 exceeded prior winter peaks by 43.3% and coincided with a streptococcal group A outbreak. Across all ages, there was a sharp increase (around 60%) in tonsillitis, streptococcus A and bacterial ear infections. Our study shows reductions in GP consultations for RTIs for children under 5 since the lifting of covid-19 pandemic restrictions. Of concern is a sharp rise in tonsillitis, streptococcus A and bacterial ear infections that should be monitored.

Varicella cellulitis in children (personal experience)

Annotation. The frequency of complications with varicella is 5-30%, and their level is much higher in patients with immunodeficiencies. In 8-50% of hospitalized children with varicella virus infection develop skin and soft tissue complications such as cellulitis, lymphadenitis, abscess, hysteria, toxicoderma. They are located on vulnerable parts of the body against the background of a state of anergy in a sick child, which is caused by the varicella virus. The aim is highlight clinical and diagnostic features and methods of treatment of varicella virus cellulitis in children based on own experience and according to literature sources. The high frequency of complications is associated with untimely detection of signs of inflammation and untimely treatment in case of secondary flora joining. The main etiological factors of superinfection are β-hemolytic streptococcus group A and staphylococcus aureus. Recently, cellulitis of the subcutaneous tissue is one of the most serious complications in patients with varicella virus infection. The clinical picture of this complication includes local and general manifestations. Local symptoms are accompanied by pronounced redness in the affected area, a significant increase in tissue volume due to swelling, intense, throbbing pain that worsens with touch or movement, the presence of purulent secretions from the affected area, compaction or softening of tissues at the site of the lesion, local hyperthermia. Treatment of varicella cellulitis involves a wide range of measures, which include: antibiotic therapy, drainage of purulent foci, symptomatic treatment, local treatment, supportive therapy, physiotherapy, observation and control. Before determining the optimal antibiotic, it is important to take into account the regional characteristics of the resistance of microorganisms and information about the typical causative agents of varicella cellulitis. Broad-spectrum antibiotics such as amoxicillin with clavulanic acid, ceftriaxone, clindamycin, or vancomycin are usually used for treatment. So, the main etiological factors causing complications in the form of necrotic cellulitis on the background of varicella virus are β-hemolytic streptococcus group A and Staphylococcus aureus. Diagnosis of varicella cellulitis includes a set of examination methods to confirm the diagnosis: daily examination of the child's body surface for inflammatory foci. The optimal treatment tactic is combined therapy (surgical and conservative treatment). Vaccination is recommended for children who are in risk groups – patients with oncology who receive cytostatics, corticosteroids; children with congenital and acquired immunodeficiencies.

Pangenome – its Aspect and Prospect

Pangenome is a very new discipline showing a collection of unique and variable genomes of any species in one model. This discipline is a combination of three subjects of Biology like Computer Science and Applied Mathematics. All genes from all species or strains are called Pangenomes. Pangenome was first discovered during the preparation of protein-based vaccine of the G group of Streptococcus sp. which is the main cause of neonatal life-threatening disease by a team of scientists led by Tettelin. Conventional method of Vaccine preparation was not successful due to the existence of five different serotypes in this organism. Then Tettelin with groups of scientists tried to use the genome sequence information for preparing protein- based vaccine in G group of Streptococcus. During their studies, two gap free genomes were found in this G group of bacteria. After sequencing studies of many strains, they found several regions of diversity (genomic diversity) among different isolates of same strain. After sequencing a large number of genomes, they realized that genes belong to isolates present in the species but not present in genomes. Then the Pangenome concept came to their mind and genes were classified into Core genome, Accessory or Dispensable genome and Species-specific genomes. Bacteria genomes have a distinct number of genes but there are differences in the genomes of different strains of a single species that is mainly due to horizontal gene transfer of genes from other bacteria. The Pangenome concept and its discovery was discussed. Plant genomes are dynamic with whole genome duplication, tandem duplication, transposable element duplication, chromosomal rearrangements or structural variations like deletion, inversion, translocation and recombination between species. Several methods have already been tried for the improvement of crop plants like Marker Assisted Selection (MAS), QTL mapping, Single Nucleotide Polymorphisms (SNP), Copy number variations and Genome Wide Association Studies (GWAS) by comparing with Reference Genome Assemblies representing the genome sequence of the genome of an individual or organism. But the Reference genome is not able to locate all genetic variations of a species. To overcome this limitation the concept of Pangenomes may help in the crop improvement which has been discussed. Pangenomic studies have already been done in many crop plants like Rice, Wheat, Maize, Brassica, Soybean etc. Some of all these aspects have been discussed.

A rare case of early-onset neonatal sepsis caused by Proteus mirabilis in the first infant of tetrachorionic triamniotic triplets

Early-onset neonatal sepsis (EОNS) is one of the most severe diseases of the neonatal period and is often coupled to extremely unfavorable outcomes. In many ways, the severity of the condition and the results of newborn nursing depend on the etiology of the bacterial process. The major EОNS pathogens are traditionally considered to be Streptococcus group B and E. coli, much less common are other Gram-negative bacteria including casuistic cases caused by caused by Proteus mirabilis (P. mirabilis). The article provides a review on the P. mirabilis role in developing neonatal sepsis with pathogen-specific disease course and outcomes. In addition, we describe a clinical case of P. mirabilis-caused EОNS not only primarily characterized by the rarity of its causative agent, but also that it proceeded with a more favorable brain damage in contrast to similar cases described worldwide and because the neonatal EОNS developed in one of triplets, with two other babies being asymptomatic despite that P. mirabilis was also detected.

Biofilm Production Activity and Antibiotics Susceptibility of Streptococcus mutans Isolates from Patients with Dental Caries

Dental caries, a prevalent chronic infectious ailment, commences with the adherence of cariogenic bacteria to the teeth, particularly Streptococcus mutans. These microorganisms utilize sugars to produce acid, resulting in the gradual demineralization of the dental structure. Streptococcus mutans a gram positive bacterium is found to play the most significant role in the dental caries in terms of being the earliest colonizer in the formation of caries. The current research focuses on the isolation and identification of the Streptococcus mutans pathogen in individuals affected by dental caries. The isolated strains were cultured on specific media, with one hundred samples of dental caries obtained from human teeth. Among these samples, fifty were identified as positive bacterial isolates utilizing MS-agar (Mitist Salivares agar), with ten isolates categorized under the group Streptococci and twenty isolates identified as S. mutans. Identification of bacterial isolates was carried out based on morphological and cultural characteristics, biochemical tests, and VITEK-II. Additionally, an antibiogram assay was conducted to assess the susceptibility and resistance of the pathogen to various drugs. The findings revealed that all locally isolated S. mutans strains displayed 100% resistance to Cefepime, while showing different levels of resistance and susceptibility to other antibiotics such as Doxycycline, Amoxicillin-clavulanic acid, Trimethoprim-sulfamethoxazole, Vancomycin, Tetracycline, Ampicillin, and Meropenem. In this study, ELISA was employed to differentiate between Streptococcus. mutans isolates that produced biofilms and those that did not by utilizing the optical density at 630 nm. Bacterial biofilms contribute to chronic diseases that pose challenges in treatment. Twenty distinct isolates were evaluated for their biofilm-forming capabilities, with 9 (45%) identified as strong biofilm producers, 7 (35%) classified as moderate biofilm producers, and 4 (20%) categorized as weak biofilm producers

Asymptomatic Group B Streptococcal infection, Antibiotic Sensitivity, Risk Factors and Pregnancy Outcome among Pregnant Women at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Background Streptococcus agalactiae or group B streptococcus (GBS), although a normal commensal, it is a leading cause of both maternal and neonatal sepsis. Objectives The study assessed the prevalence and sensitivity pattern of Group B Streptococcus, as well as the risk factors for infection and pregnancy outcome among pregnant women at the department of Obstetrics and Gynaecology of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Methods A prospective study among 152 pregnant women at the antenatal care clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, selected by simple random sampling technique and relevant information was obtained using semi structured interviewer questionnaire. Swab samples were collected from the vagina and rectum for culture and further evaluation. The data was managed using SPSS software version 26 and the variables were analysed using descriptive and inferential statistics, and P- value &lt; 0.05 was considered statistically significant. Result The prevalence of Group B Streptococcal infection among respondents was 4.6%. The mean age was 26.97± 5.6 with a range of 16 to 39 years. The organism was 100 % sensitive to Levofloxacin, Gentamycin and Clindamycin, but 57.1 %, 28.6 % and 14.3 % sensitive to Erythromycin, Augmentin and Penicillin respectively. The spousal educational status was statistically associated with GBS infection at a P- Value 0.04. There was 1(0.7%) each of spontaneous miscarriage and a preterm birth at 36 weeks’ gestation. Conclusion Group B Streptococcal infection is relatively common in our environment, with a contrary susceptibility pattern. It is association with spousal educational status.

Antibiotic use in a co-infection of respiratory syncytial virus and pathogenic bacteria in children in a resource-limited setting in northeast Peninsular Malaysia.

To investigate co-infection of bacterial isolates associated with respiratory syncytial virus (RSV) in children aged less than two years who were admitted to hospital with confirmed lower respiratory tract infection (LRTI) in Kelantan, Malaysia. The demographic data, clinical history, case management, haematological as well as infectious parameters (white blood cell differential and count, plus C-reactive protein, CRP) of the patients were systematically recorded. Less than one-third of cases were RSV-positive (21.03% and 26.23% were diagnosed as acute bronchiolitis or pneumonia, respectively). Blood cultures from approximately 10% of patients demonstrated growth of Haemophilus influenzae, Staphylococcus aureus, coagulase-negative Staphylococcus, Pseudomonas stutzeri, haemolytic Streptococcus group A, and Bacillus subtilis. Further analysis indicated that children with positive bacterial growth had an insignificant predictive value of CRP (2.32-7.16 mg/dl). The total white cell counts were 2.97-7.33 x 109sup>/L despite increased lymphocyte values in the bacteria-positive blood culture. Platelet counts were also within normal limits except for a single case of H. influenzae infection (685.50 x 109sup>/L). Interestingly, 95.01% of patients were treated with antibiotics; 66.23% of RSV infection cases were administered with a combination of antibiotics and 33.77% with only a single antibiotic. The data indicate that the use of antibiotics, either singly or in combination, is not always effective in treating LRTI in infants. Alternative therapeutic regimens should be considered, especially in Asian countries that may have limited resources.

Predisposing Factors and Etiology of Deep Neck Space Infections – A Hospital-based Cross-sectional Study

Abstract Background: Deep neck space infections (DNSI) are serious infections of the potential spaces of the neck. In developing countries, dental infections have been found to be the most common cause of these infections. The signs and symptoms depend on the neck space involved. Timely surgical drainage remains the main mode of treatment. This study aims to determine the predisposing factors and etiology responsible for these infections. Materials and Methods: This cross-sectional study of 1 year was conducted in a tertiary care teaching hospital setting and included 52 cases of clinically diagnosed DNSI. The clinico-demographic profile, microbiological profile, predisposing factors, and etiology of DNSI were recorded in all patients and analyzed. Results: The mean age was 43.46 ± 18.07 years. The male-to-female ratio was 1.7:1. The most common presenting complaint was cervicofacial/oropharyngeal swelling (100%). The most frequently involved neck space was submandibular space (56%). Poor oral hygiene (78.8%), anemia (65.3%), and diabetes mellitus (55.7%) were the common predisposing factors, respectively. Streptococcus group of organisms were found in majority of the cases (19%) and cephalosporin was the most sensitive drug (100%). Dental infection was observed as the most common etiological cause (67.3%). Conclusion: Primary health-care physician should be aware of the signs and symptoms of DNSI so that early detection and timely referral can be done to prevent life threatening complications. Regular health and dental checkups should be encouraged for decreasing the incidence of these infections.

INVESTIGATION INTO THE IMPACT OF CARVCROL EXTRACTS ON BACTERIA ISOLATES FROM OSTEOMYLITIS AFTER SURGERY

Carvacrol is one of the most ancient medicinal herbs. Carvacrol contains different alkaloids, flavonoids and saponins. In present studies the antimicrobial activity of Carvacrol alcoholic extract against Gram-negative bacterial and Gram-positive bacterial were determined by the microtiter plate method. Gram-negative bacterial and Gram-positive bacterial strains isolated from osteomyelitis patients after surgery in Mosul city , A total of 60 samples were collected from various sources in Mosul hospitals, during the period from January 10, 2024 , to May 1, 2024. The Aim of this study is determining the effectiveness and effect of alcoholic extract of carvacrol on bacterial isolates taken from a Osteomyelitis after surgery. Bacterial culture results on blood agar, MacConkey agar and nutreint agar revealed 54 positive samples for bacterial growth. Among these, Staphylococcus aureus 22 isolates (32.8%), Pseudomonas aeruginosa 12 isolates (17.9%), Enterobacter cloacae 5 isolates (7.5%) Klebsiella pneumoniae 4 isolates (5.9%), Escherichia coli 4 isolates (5.9%), Proteus mirabilis 3 isolates (4.5%), Streptococcus viridans 3 isolates (4.5%), Corynebacterium spp 2 isolates (3%). As for the following bacterial isolates, each of them constituted one isolate out of a total of 67 isolates, at a rate of 1.5% for each: Providencia spp. , Acinetobacter spp., Staphylococcus saprophyticus , Klebsiella oxytoca , Enterococcus spp. , Enterococcus faecium , Citrobacter freundii , Streptococcus groups C , Bacillus cereus , Enterobacter spp. , Acinetobacter baumannii , Morganella morganii, using vitek-2. High-performance liquid chromatography (HPLC) analysis of Oregano plant revealed the presence of active compounds such as Carvacrol, thymol. Plant extracts from carvacrol demonstrated a substantial inhibitory effect. Results: study indicated that plant extracts exhibited higher inhibition than antibiotics. The minimum inhibitory concentration (MIC) while the results of the lowest inhibitory concentration of carvacrol for the bacterial species under study showed that it had an effect at a concentration of 615 µg/ml against Escherichia coli, 307.5 µg/ml for the species Corynebacterium stratium, Morganella morganii and Pseudomonas aeruginosa, and the least effect was 76.875 µg/ml on Staphylococcus aureus, it gave less results than the antibiotic used Carvacrol (Absorbance was measured at Wavelength 600) .

Newer Insights in Etiology and Pathogenesis of Neonatal Sepsis

Neonatal sepsis is a pathophysiological response to the presence of microorganisms or their toxins in the blood during the first 28 days of life. Despite advances in neonatal intensive therapy and care, sepsis is still an important cause of morbidity and mortality in neonates, especially preterm and low birth weight neonates. Early neonatal sepsis manifests itself in the first 72 hours of life. The main risk factor for early neonatal sepsis is chorioamnionitis, and the most important causative are Streptococcus group B and Escherichia coli. Late neonatal sepsis manifests itself after 72 hours of life, and most often occurs in preterm neonates. Among the causative agents of late neonatal sepsis, coagulase-negative Staphylococcus dominates. The neonates are highly dependent of the innate immune system to defend against infection. In the pathophysiological response of the organism to infection, microcirculation, neutrophils and monocytes are first activated, and then the complement and the coagulation system. Also, mitochondrial dysfunction contributes to tissue damage in neonatal sepsis. The delayed response of adaptive immunity in the neonatal period is compensated by transplacental transfer of IgG antibodies originated from the mother, but also the IgA antibodies that the neonates receive from mother's milk. Compared to adults, the immune response have quantitative and qualitative differences, which contributes to their increased susceptibility to infection.

Long-term dietary intervention of the hydrolyzed feather meal on microbiota composition of adult female dogs

This research delves into the impact of substitution of 7% of poultry meal (PM) with hydrolyzed feather meal (HFM) on the animal performance and fecal microbiota of dogs. The study was conducted on six adult female English setter dogs, split into control (CTR), and treated (TRT) dietary treatment groups, with similarity for age, initial body weight, and body condition score. During 45-days, body weight, body condition score, muscle condition score, fecal consistency score and microbiota were monitored at the beginning of the trial and after 3, 7, 15 and 45days. No significant differences (P>0.05) were observed for these parameters over the whole period of the trial, neither in relation to diet, nor to time, nor to the interaction diet x time. Significant differences were observed for alpha between diets and the TRT group displayed higher evenness compared to the CTR group. Beta diversity analysis revealed distinctions in microbiota composition between the CTR and TRT groups, with the former demonstrating higher biodiversity. Discriminant analysis highlighted 9 significant taxa and 6 of them were significantly different at the Kruskal Wallis test between diets. The results showed an increase in relative abundance (RA) for the CTR group of Streptococcus, Colinsella stercoris, Ruminococcus gnavus, and Bacteroides coprophilus. Conversely, higher RA was observed in the TRT group for Peptostreptococcaceae and Bacteroides uniformis. These findings indicated that the inclusion of hydrolyzed feather meal in the diet of dogs is well accepted and do not have adverse effects in the parameters analyzed.

Brain abscess caused by Streptococcus anginosus group: Three case reports

BACKGROUND This case series investigated the clinical manifestations, diagnoses, and treatment of cerebral abscesses caused by Streptococcus anginosus . We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature. CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever, confusion, and vomiting as primary symptoms. Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection. Case 2 experienced dizziness for two days as the primary symptom. Postoperative pus culture suggested an intermediate streptococcal brain abscess. Case 3: Enhanced head magnetic resonance imaging (MRI) and diffusion-weighted imaging revealed occupancy of the left temporal lobe, initially suspected to be a metastatic tumor. However, a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection. The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection. All three patients demonstrated sensitivity to penicillin, ceftriaxone, vancomycin, linezolid, chloramphenicol, and levofloxacin. Successful treatment was achieved through stereotaxic puncture, drainage, and ceftriaxone administration with a six -week course of antibiotics. CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses. Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important. This case series was in accordance with the CARE guidelines.

Antimicrobial Effect of Dental Adhesive on Cariogenic Multi-Species Biofilm

Dental caries, or tooth decay, is one of the most widespread chronic and multifactorial diseases affecting people worldwide. It is described as the localized destruction of tooth structure by acids produced from bacteria fermentation of edible carbohydrates. The disease process begins within the bacterial biofilm on the surfaces of the teeth. Streptococcus sanguinis, Sreptococcusgordonii, and Streptococcus mutans are the main organisms in the biofilm associated with health or disease conditions in the oral cavity. Streptococcus mutans is believed to be the primary cause of enamel demineralization and the development of dental caries. S. gordonii and S. sanguinis belong to a group of streptococci considered health-related commensal oral bacteria, crucial for forming a biofilm on oral hard tissues. Several types of materials with multipurpose characteristics have been incorporated into dental adhesives. Recently, the calcium salt of an acidic monomer (calcium salt of 4-methacryloxyethyl trimellitic acid, or CMET) has been included in dental adhesive and demonstrated to suppress cariogenic biofilm formation of S. mutans. However, using a single-species model may not mimic the intricate antagonistic and synergistic relations that occur in oral biofilms. Therefore, the effect on cariogenic multi-species biofilm was assessed in this study. Dental adhesive consisting of CMET and 10-methacryloyloxydecyl dihydrogen calcium phosphate (MDCP) (Bio-Coat CA) was spread over the flat-bottom surface of the 96-well plate and LED light-cured. Then it was coated with sterile saliva at 37 °C for 45 min to form an acquired pellicle for microbial attachment. The multi-species bacterial suspension containing Streptococcus mutans ATCC 25715, Streptococcus sanguinis ATCC 10556, and Streptococcus gordonii ATCC 10558 was prepared and added to the saliva-coated well. Then, the plate was incubated at 37°C in a 5% CO2 atmosphere for 24 h, 48 h, and 72 h to support the biofilm formation. The number of vital bacteria in the biofilm was determined with the WST-8 Microbial Cell Counting Kit (Dojindo Molecular Technologies, USA). All tests were done in triplicate and repeated three times. For statistical analysis, Kruskal-Wallis and Dunn’s tests were employed. The results showed that at 24 h, 48 h, and 72 h, dental adhesive with CMET could inhibit the biofilm formation of multi-species bacteria significantly compared with controls. The percentages of biofilm inhibition were 29.1%, 34.7%, and 33.2% at 24 h, 48 h, and 72 h, respectively. Dental adhesive containing CMET displayed favorable multi-species biofilm-inhibiting effects up to 72 h of biofilm growth. It is a promising adhesive for use to prevent secondary caries at the sites of restorations.

Oral origin of the placenta microbiome in pregnant women with preeclampsia

Preeclampsia (PE) is a leading cause of morbidity and mortality in pregnancy with elusive etiology. Patients with PE are thought to be associated with a higher rate of periodontal diseases (PDs) and changes of oral bacteria with targeted PCR techniques. However, few studies have investigated the associations between oral microbiome dysbiosis and secondarily disseminated microbes in the placenta simultaneously in patients with PE. The association between detected microbiome in placenta and systemic inflammation in PE is also unclear. We enrolled 54 pregnant patients with and without PE and PD, and profiled the subgingival and placenta microbiome by the V4 region of 16S rRNA gene sequencing. Systemic inflammatory markers tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), lipopolysaccharide binding protein (LBP), and interleukins 6 and 8 (IL-6 and IL-8) in blood were measured by ELISA. We found that PD significantly increased the risk of PE after adjusting for age and smoking status (OR = 2.26, 95% CI = 1.14–4.48, p = 0.024). A combined group of oral-associated bacteria Veillonella, Fusobacterium, Haemophilus, Granulicatella, Streptococcus, Gemella, and Neisseria in placenta had a significantly higher prevalence in women with PE compared to women without PE (53.8% vs. 19.0%, p = 0.018), with the highest prevalence in patients with both PE and PD (58.8%). The relative abundance of Haemophilus, Veillonella, and Fusobacterium in subgingival samples was significantly higher in patients with PE than those without PE. The relative abundance of Haemophilus in subgingival samples was associated with increased risk of PE (OR = 2.11, 95% CI = 1.11–4.52, p = 0.032). Proinflammatory cytokine analysis showed that PE patients with PD had higher blood IL-8 levels than PE patients without PD (p = 0.026). CRP, LBP, and TNF-α showed no statistical difference in patients with and without PE or PD. Blood IL-6 levels were significantly higher in patients with detectable placenta microbiome compared to those without placenta microbiome (p = 0.028). Together, our data suggest a potential oral origin of the placental microbiota present in patients with PE, and the microbiota detected in placenta is associated with increased IL-6 level in the blood.

Vancomycin-Resistant Streptococcus thoraltensis: A Case Report of Bacterial Endocarditis and Review of Literature on Infections Caused by This Pathogen.

Streptococcus thoraltensis is a rare species, part of the viridans streptococcus group, found initially in rabbits and pigs, which can be vancomycin-resistant. We present the case of a 65-year-old patient, a smoker and chronic alcohol consumer with chronic obstructive pulmonary disease (COPD) and multiple dental foci who had been diagnosed with bacterial endocarditis caused by Streptococcus thoraltensis. The particular elements of the case consisted of an atypical clinical presentation with diarrheal stools, abdominal pain, concomitant damage to the aortic and tricuspid valves, the presence of large vegetations (>2 cm), and a vancomycin-resistant strain of Streptococcus thoraltensis. The evolution of the patient was unfavorable due to septic embolisms, respiratory failure requiring orotracheal intubation, and septic and cardiogenic shock. Infections with Streptococcus thoraltensis are challenging to treat because of the severity of the clinical form it causes and the pattern of antibiotic resistance in this germ. Based on our brief review, Streptococcus thoraltensis is an extremely rare human pathogen previously described as the etiologic agent of infectious endocarditis in only one case.

Progress in research of rash and fever syndrome surveillance and early warning

Objective: To introduce the progress in research of rash and fever syndrome (RFS) surveillance and early warning both at home and abroad, and provide reference for surveillance and prevention of RFS in China. Methods: The keywords "fever" "rash" and "surveillance" and others were used for a literature retrieval by using China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed and Web of Science. The languages of literatures were limited in Chinese and English. The key information of the literatures were collected and analyzed with Excel. Results: A total of 36 study papers (21 in Chinese and 15 in English) were included. The studies mainly focused on the pathogen surveillance of RFS (n=19). The pathogens included measles virus, varicella-zoster virus, rubella virus, enterovirus, human B19 virus, dengue virus, streptococcus group A, Salmonella typhi and Salmonella paratyphoid,human herpesvirus, mumps virus and adenovirus. Eight studies were about the surveillance in major events, such as sport game, World Expo and religious gathering, or sudden natural disasters, such as earthquake and tropical storm, during 2010-2015. Eight studies focused on case or epidemic surveillance, most of which were studies from other counties. The surveillance sites were medical institutions. RFS was diagnosed according to the International Classification of Diseases, 9th (ICD-9) and symptoms descripted in chief-complaint. Only one study in Mongolia conducted RFS epidemic prediction. The analysis methods of 36 papers included simple descriptive analysis, time-based early warning models (such as regression analysis, fixed threshold method, Hugh Hart control chart method and cumulative sum control chart method) and time series analysis method. Conclusions: In the future, RFS surveillance system should cover both known pathogens and emerging pathogens. Automatic surveillance using information capture and intelligent modelling can be applied to improve the sensitivity and specificity of RFS surveillance and early warning.