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BackgroundThe clinical courses and long-term outcomes of viridans streptococcus (VS) peritoneal dialysis (PD) peritonitis remain unclear.MethodsWe conducted a retrospective analysis of all PD patients in a single center with gram-positive cocci (GPC) peritonitis between 2005 and 2011, and divided them into 3 groups: VS, other streptococci and other GPC (apart from VS). Clinical characteristics and outcomes of the VS group were compared with the other streptococci and other GPC groups, with prognostic factors determined.ResultsA total of 140 patients with 168 episodes of GPC peritonitis (44% of all peritonitis) were identified over 7 years. Among these, 18 patients (13%) developed VS peritonitis, while 14 patients (10%) developed other streptococcal peritonitis. Patients with VS peritonitis had a high cure rate by antibiotic alone (94%), despite a high polymicrobial yield frequency (28%). We found that VS peritonitis carried a lower risk of Tenckhoff catheter removal and relapsing episodes than other GPC peritonitis (6% vs 11%), and a lower mortality than other streptococci peritonitis (0% vs 7%). However, after the index peritonitis episodes, VS, other streptococci, and other GPC group had a significantly increased peritonitis incidence compared with the period before the index peritonitis (all p < 0.01). Patients with VS peritonitis had a significantly higher incidence of refractory peritonitis compared with other streptococci or other GPC peritonitis in the long term (both p < 0.01).ConclusionsVS poses a higher risk of subsequent refractory peritonitis after the index episode as compared with other streptococcal or GPC peritonitis. It might be prudent to monitor the technique of these patients with VS peritonitis closely to avoid further peritonitis episodes.

In rats challenged with viridans streptococci poorly susceptible to antibiotic killing, single doses of antibiotics only prevent endocarditis induced by bacterial inoculum sizes that produce disease in 90% of control animals (ID90): additional doses are required to protect against inocula exceeding the ID90. We investigated whether single-dose rifampin would extend the efficacy of single-dose prophylaxis to inocula exceeding the ID90. We used two strains of viridans streptococci highly susceptible to killing by rifampin and two resistant strains. All rats were injected with 10-1,000 times the ID90 of the four strains. Single-dose rifampin successfully prevented endocarditis due to all four strains. A few prophylaxis failures were observed after challenge with the two poorly susceptible strains, but in vivo emergence of resistant variants did not account for these failures. Thus, rifampin was the first antibiotic given as a single dose that successfully prevented experimental streptococcus endocarditis after challenge with high bacterial inocula.

The role of Streptococcus species as an aetiological microorganism of vertebral osteomyelitis (VO) is considered to be of little relevance. We aimed to describe a large number of cases of streptococcal vertebral osteomyelitis (SVO), to analyze the clinical features associated with different Streptococcus species, and to compare them with a cohort of patients with VO caused by Staphylococcus aureus. An incidence study and a retrospective, multicenter, observational clinical study of cases of SVO (1991–2011) were performed. Statistical comparison of SVO by different species and between them and staphylococcal VO was carried out. Over the whole period there was an increasing incidence in the number of VOs and SVOs per year (p

Viridans streptococcus, an indigenous bacterial species of the mouth and gastrointestinal tract, is thought to be a rare cause of bacterial meningitis. The type of streptococcus involved is important because each type causes a different kind of meningitis and is associated with a different outcome. A 39-year-old previously healthy man was admitted due to the onset of acute purulent meningitis. A cerebrospinal fluid culture grew Streptococcus sanguis (S. sanguis). Although the patient was asymptomatic for dental caries, odontogenic maxillary sinusitis was found to be the cause of the meningitis. Treatment with intravenous antibiotics was successful. Following a review of the pertinent literature, we discuss the characteristics of S. sanguis meningitis.

Viridans group streptococci (36 stock strains and 167 single patient blood culture isolates) were assessed using API Rapid Strep,TM Baxter MicroScan Rapid Pos ID PanelTM, BBL Minitek Differential Identification SystemTM, IDS RapID STR SystemTM, and Vitek GPITM methods. Identification data obtained with these systems were compared with those indicated by conventional biochemical procedures. API, Baxter MicroScan, BBL, IDS, and Vitek corresponded with conventional biochemical identification in 74%, 66%, 65%, 50%, and 61% of the isolates, respectively; using recommended supplemental tests, agreement was augmented in 9%, 11%, 20%, 11%, and 21% of the isolates, respectively. Disagreement with conventional biochemical methods occurred in 14%, 17%, 14%, 32%, and 10% of the commercial techniques, respectively; no identification was possible in 2%, 5%, fewer than 1%, 6%, and 8% of specimens, respectively. BBL, API, and Baxter MicroScan systems provided the most reliable rapid identification, although supplemental testing often was required. Until a higher percentage of correct identification data can be obtained without supplemental procedures, conventional biochemical techniques will remain the methods of choice for identification of viridans streptococci.

The API 20S (Analytab Products, Plainview, NY), the GPI card (Vitek Systems, St. Louis, MO) and the RapSTR system (Innovative Diagnostics, Atlanta, GA) were compared with conventional biochemicals for the identification of viridans streptococci. One hundred nine clinical isolates were tested that included the following species: intermedius (38) sanguis II (20), bovis (variant) (14), mitis (14), salivarius (11), sanguis I (6), constellatus (3), mutans (2), and uberis (1). With initial testing, a correct species call was made with 72% of the isolates with the GPI card, 62% with the RapSTR, and 50% with the API 20S. Identifications of viridans streptococci group or those that needed additional biochemicals for species identification occurred with 28% of isolates with the API 20S, 8% with the RapSTR, and 9% with the GPI card. Incorrect identifications occurred with 6% of the isolates tested by the GPI card, 20% with the API 20S, and 30% with the RapSTR. Most discrepancies with the RapSTR were with 66% of the intermedius isolates, whereas most, 55%, of misidentifications with the API 20S were with sanguis II isolates. No identifications were made with 2% and 13% of isolates with the API 20S and GPI, respectively.

Received for publication, August 28, 1941. Aided by grants from the John and Mary R. Markle Foundation, the Ophthalmological Foundation, and the Ettinger Fund. 1. Koske, F.: Arb. a. d. k. Gsndhtsamte. 22: 411, 1905; Stock, W.: Beitr. z. path. Anat. u. z. allg. Path. 43: 470, 1908; Guillery, H.: (1) Arch, f. Augenh. 48: 242, 1911; 78: 11, 1914; Dold, H. and Rados, A.: Deutsche med. Wchnschr. 39: 1492, 1913; Rosenow, E. C: J. Infect. Dis. 17: 403, 1915; Woods, A. C: Arch. Ophth. 45: 451, 1916; Irons, E. E. Brown, E. V. L., and Nadler, W. H.: J. Infect. Dis. 18: 315, 1916; Meisser, J. G., and Gardner, B. S.: J. Am. Dent. A. 9: 578. 1922; Haden, R. L.: Arch. Int. Med. 32: 828, 1923; Benedict, W. L., von Lackum, W. H. and Nickel, A. C: Arch. Ophth. 56: 116, 1927; Brown, A. L. and Dummer, C: Arch. Ophth. 2: 573, 1929; Berens, C, Nilson, E. L. and Chapman, G. H., Am. J. Ophth. 19:1060,1936. 2. Berens, C, Angevine, D. M., Guy, L. and Rothbard, S.: Am. J. Ophth. 21: 1315, 1938; Brown, A. L.: Arch. Ophth. 12: 730, 1934. 3. Nicholle, M. and Abt, G.: Ann. Inst. Pasteur 22: 132, 1908; Sattler, C. H.: Arch. f. Augenh. 64: 390, 1909; Kummel, R.: (1) Arch, f. Ophth. 77: 393, 1910; 79: 528, 1911; Seegal, D. and Seegal, B. C, Proc. Soc. Exper. Biol. 8c Med. 27: 390, 1930; Mott, E. and Kesten, H. D.: J. Exper. Med. 53: 815, 1931; Thompson, R., Gallardo, E. and Khorazo, D.: Am. J. Ophth. 19: 852, 1936; MacLean, A. L.: Tr. Am. Ophth. Soc. 34: 324, 1936. immunological reactions in connection with local immunity. The pathological lesions have usually been characterized by an acute inflammatory process in the form of an iridocyclitis, or less frequently as an acute choroiditis, but chronic inflammatory lesions have been rare, with the exception of tuberculous uveitis.4 Von Szily,5 however, described chronic choroiditis in rabbits produced by the intravenous injection of beef uveal pigment, and after 2 weeks an injection of similar material into the vitreous of the eye. The animals were permitted to survive for 1 week after the ocular injection. Fuchs and Meller6 and Wibaut7 also described chronic choroiditis in rabbits that were first sensitized to human, cow, or horse serum by intravenous injection and after 2 weeks were given an intraocular injection of the same antigen. An acute inflammatory reaction of the uveal tract was noted in animals killed within 3 days; but if the animals were permitted to live longer, the inflammatory reaction became chronic in many instances.

Suspensions of living pneumococci in approximately isotonic standard solutions and in approximately isotonic bouillon with pH varying from about 4.0 to 8.0 after incubation show dissolution of organisms in those solutions having a pH higher than about 5.0. Dissolution is most marked at a critical range of about pH 5.0 to 7.0. Some dissolution also takes place toward the more alkaline end of the scale. No dissolution occurs at the most acid end of the scale. Dissolution in the standard solutions occurs at incubator, room, and ice box temperature. It is less marked at ice box temperature. Dissolution takes place in standard pH solutions with pneumococci allowed to grow and die out in glucose bouillon but unlike dissolution with living organisms is progressive from the acid toward the alkaline end of the scale. Pneumococci killed by heat for I hour undergo less dissolution than living organisms, the general character of the curve being similar to that with living organisms. Pneumococci killed by heat at 100°C. for 5 minutes do not undergo dissolution. The addition of fresh human serum to the suspensions of pneumococci at varying pH prevents dissolution. Dissolution of pneumococci takes place more rapidly at pH 6.1 in standard solutions in which large numbers of pneumococci have been previously dissolved than in fresh standard solutions at the same pH. The dissolution of pneumococci under the conditions of the experiments may be ascribed to an enzyme derived from the bacteria themselves. Other organisms such as Streptococcus viridans and hœmolyticus and Staphylococcus aureus do not undergo dissolution under conditions similar to those to which the pneumococcus was exposed.

To detect streptococcal bacteraemia in patients undergoing dental extraction blood cultures containing glucose broth with 0.05% sodium polyanethol sulphonate (Liquoid) were compared with identical cultures without Liquoid.

Most of the bacterial strains isolated from the acute oral diseases are streptococci and staphylococci, and a greater part of these bacteria accounts for hemolytic streptococci. Generally speaking, hemolytic streptococci responsible for the incidence of sup-purative diseases in man are chiefly streptococci pyogenes and they are immunologically representated by Group A of the Lancefield's classification. However, those hemolytic streptococci which are found in the oral suppurative diseases differ greatly in terms of their biological properties from the streptococci pyogenes. As a matter of fact, if we except the fact of hemolysis these hemolytic streptococci are very much similar to those in the viridans group. When examined in terms of their antigen, they do not come under any of Lancefield's A, B, C, D, E and F groups and thus they are rich in the strain specificities. In the previously published researches conducted by the author and his collaborators [1-5], many cases were pointed out which gave rise to a suspicion that these hemolytic streptococci might be variationally derived from viridans streptococci that were invariably found in the infected canal or foci of the root inflammation. This thinking has important bearings on the incidence mechanism of the acute oral suppurative diseases and, as a consequence of a series of experiments, the author has been able to devise a method by means of which streptococci viridans can be variationally changed into hemolytic streptococci as follows.

THE CLINICAL, bacteriologic, immunologic, and pathologic criteria necessary for establishing the diagnosis of bacterial endocarditis are difficult to fulfill. Fortunately, since the advent of antibiotics the mortality due to bacterial endocarditis has diminished markedly, so that the majority of patients now recover, whereas previously recovery was a rare event. At the autopsy table it was possible to demonstrate the characteristic valvular vegetations and to culture the causative bacteria from the vegetations. At the present time more and more reliance must be placed on the clinical, bacteriologic, and immunologic findings in an effort to establish the correct diagnosis and the etiologic bacteria, because most patients properly treated do not reach the pathologist. Correct bacteriologic diagnosis is a necessity, because the choice of antibiotic to be employed in treatment depends on the particular bacteria responsible for the infection. There are very few reported cases of bacterial endocarditis due to Brucella. Smith and

The interaction of man's indigenous microflora and exogenously acquired pathogens has been the subject of sporadic investigation and continuous speculation for more than 5 decades. However, only recently has it been demonstrated conclusively that antagonistic interactions may enhance man's capacity to resist infection. The exploitation of this phenomenon, labeled bacterial interference, in control of staphylococcal disease among newborn infants [1] has stimulated renewed interest in the potentially beneficial activities of man's normal microbial flora. The