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PubMed1983

Comparison of latex agglutination and counterimmunoelectrophoresis in the diagnosis of acute Streptococcus pneumoniae infections.

The ability of latex agglutination (Slidex Pneumokit) and counterimmunoelectrophoresis to detect Streptococcus pneumoniae antigen in body fluids was evaluated. The patients were classified as having proven Streptococcus pneumoniae infection, suspected Streptococcus pneumoniae infection, acute superinfection of chronic bronchitis or non-pneumococcal respiratory infection. Sixty-two non-pneumococcal meningitis patients were also included in the study. Latex agglutination and counterimmunoelectrophoresis tests were performed on serum, urine and cerebrospinal fluid specimens when indicated and repeated each week until the patient was discharged. Latex agglutination was done on samples boiled for 10 min. In vitro sensitivity of counterimmuno-electrophoresis and latex agglutination were 10 and 1 ng/ml respectively for type three antigen. In pulmonary disease (proven and suspected Streptococcus pneumoniae infection) counterimmunoelectrophoresis and latex agglutination had a clinical sensitivity of 72.9 and 87.5% respectively, a specificity of 96.3 and 92.6%, a predictive value for a positive test of 97.2 and 95.4% and for a negative test of 66.6 and 80.6%. Latex agglutination may offer an alternative to counterimmunoelectrophoresis in the rapid diagnosis of Streptococcus pneumoniae infections since it is easier to perform and gives a reliable result within 15 min.

Acute Disease↗
PubMed2000

Ulcerative keratitis caused by beta-hemolytic Streptococcus equi in 11 horses.

Purpose To describe 11 clinical cases of ulcerative keratitis in horses associated with beta-hemolytic Streptococcus equi in Florida, USA. METHODS: Retrospective clinical study (1996-99). RESULTS: Beta-hemolytic Streptococcus equi was cultured from 11 horses with deep ulcers, descemetoceles or iris prolapse (n = 8), a suture abscess found with a penetrating keratoplasty for a stromal abscess (n = 1), and ulceration that developed following keratectomy/irradiation for corneal squamous cell carcinoma (n = 2). Beta-hemolytic Streptococcus equi subspecies zooepidemicus was found in 10 eyes and subspecies equi in one. Marked signs of uveitis including miosis and hypopyon were present in 8/11 (72.7%) eyes. Keratomalacia was severe in all eyes. The mean diameter of the ulcers associated with beta-hemolytic Streptococcus was 10.2 +/- 6.1 mm. Eight of the eyes required conjunctival flap surgery (four grafts dehisced) and one eye corneal transplantation. Two eyes were treated with medication only. Isolate sensitivity to antibiotics included ampicillin (6/11), bacitracin (11/11), cephalothin (11/11), chloramphenicol (11/11), gentamicin (5/11), polymyxin B (2/11), and tobramycin (1/11). All isolates were resistant to neomycin. The average healing time was 44.7 +/- 26.7 days. The visual outcome was positive in 8/11 eyes, and the globe retained in 9/11 eyes. CONCLUSIONS: Although Gram-positive bacteria predominate in the normal conjunctival microflora of horses throughout the world, Gram-negative bacteria and fungi are more often isolated from equine ulcers. Beta-hemolytic Streptococcus spp. are associated with a very aggressive ulcerative keratitis with the capability to digest conjunctival graft tissue. Clinical signs are pronounced. Aggressive surgical and intensive medical therapy with topical antibiotics and protease inhibitors is indicated.

Journal Article↗
PubMed2003

[Autoimmune neuropsychiatric disorders associated to infection by streptococcus in the paediatric age: PANDAS].

INTRODUCTION: The acronym PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) describes the neuropsychiatric disorders resulting from an autoimmune response to an infection by streptococcus in children. AIMS: The aim of this study was to clinically analyse 38 patients under the age of 16 with tics, Tourette syndrome (TS) or obsessive compulsive disorder (OCD) and their possible association to an infection caused by group A beta-haemolytic streptococcus (GABHS). METHOD: We reviewed the medical records at the Instituto Neurológico in Valencia (Venezuela) over a 12 year period (1988-2000). All the patients met the inclusion criteria set out by the National Institute of Mental Health in Bethesda (1997) and the DSM-IV. RESULTS: Onset of the symptoms was higher in the group of schoolchildren (n=24), followed by the group of preschool children (n=8) and adolescents (n=6). Males were predominant (n=33) (86.8%). 17 patients presented chronic tics (44.7%), 13 had transitory tics (34.2%) and there were eight cases of TS (21.1%). The most frequently related comorbid disorders were: difficulties in learning (n=30) (78.9%), ADHD (n=27) (71.1%), OCD 14 (36.8%), sleep disorders (n=14) (36.8%), behavioural disorders (n=12) (31.6%), language disorders (n=11) (28.9%), psychomotor disorders (n=10) (26.3%) and nocturnal enuresis (n=7) (18.4%). Electroencephalogram patterns were abnormal in 72.4% (n=12), and the disorganised pattern was the most frequently observed (n=12) (41.4%), followed by a slow diffuse pattern (n= 7) (24.1%) and the left centro-parieto-temporal focal paroxysmal specific pattern (n=7) (24.1%). Less frequently we found unspecific generalised paroxysmal patterns, in four cases (13.8%), and asymmetrical patterns (n=1) (3.4%). The association with an infection by streptococcus was shown in two cases, which amounted to 5.2% of the sample. CONCLUSIONS: The obtained are similar to those reported in the literature. Only 5.2% of the cases were linked to a prior streptococcus infection.

Adolescent↗
PubMed2002

[Effect of dietary fish-oil on survival of experimental animals after infection with Streptococcus pneumoniae or Klebsiella pneumoniae.].

OBJECTIVE: Dietary fish-oil has beneficial effect in infections and in autoimmune disorders. This effect is thought to be associated with alterations in the immune system. The Gram negative organism Klebsiella pneumoniae has been used as an infective agent in most studies investigating the effect of dietary fish-oil on infection. The immune response against Gram positive bacteria is somewhat different to the response to Gram negative oeganisms. Moreover, the Gram positive bacteria Streptococcus pneumoniae is a very common pathogen, particularly in children. To investigate whether dietary fish-oil has different effect in infections by Gram positive or Gram negative bacteria, we studied the survival of mice fed with fish-oil or corn-oil supplemented diets and infected in the lungs with either Klebsiella pneumoniae or Streptococcus pneumoniae. MATERIALS AND METHODS: 120 NMRI mice were divided into four groups and fed diets supplemented with fish-oil (two groups, 30 mice in each group) or corn-oil (two groups, 30 mice in each group). After six weeks, the mice were infected with Klebsiella pneumoniae (fish-oil group and corn-oil group) or with Streptococcus pneumoniae serotype 3 (fish-oil group and corn-oil group). The survival was monitored. The experiment was performed twice. RESULTS: The survival of the mice infected with Klebsiella pneumoniae was significantly better in the groups receiving the fish-oil enriched diet as compared to the groups fed the corn-oil enriched diet (p=0.0001 and 0.0013). There was no difference in the survival of mice infected with Streptococcus pneumoniae serotype 3, receiving the fish-oil or corn-oil enriched diets (p=0.74 and p=0.15). CONCLUSIONS: These results indicate that dietary fish-oil has beneficial effect on survival of mice after experimental infection with the Gram negative bacteria Klebsiella pneumoniae but not on experimental infections with the Gram positive bacteria Streptococcus pneumoniae serotype 3.

English Abstract↗
PubMed1990

[Clinical analysis of Streptococcus faecalis septicemia in children].

The clinical analysis of 59 cases of Streptococcus faecalis sepsis in infants aged 1 to 5 months has been presented. Streptococcus faecalis strains isolated from the blood were characterized by drug resistance especially against penicillin or its derivatives. The clinical picture of the Streptococcus faecalis sepsis in a majority of cases is similar to that of other Gram-positive sepsis. Meningitis, first of all purulent, was noted in twenty percent of infected children. About one third of neonates with the Streptococcus faecalis sepsis showed intrauterine infection. The mortality index in children with the Streptococcus faecalis sepsis was equal to 10.2%.

Adolescent↗
PubMed1972

Humoral antibody responses of swine infected experimentally with group E streptococcus. II. Antistreptokinase and antistreptodornase responses.

Swine infected experimentally with group E Streptococcus (GES) produced significant antibody titers against streptokinase (streptococcal fibrinolysin, SK) and streptodornase (streptococcal deoxyribonuclease, SD). The antibodies directed against SK (antistreptokinase, ASK) appeared two to nine weeks postexposure and persisted for the duration of the experiment (nearly six months). The ASK inhibited SK produced by GES antigenic types III, IV, and V, by GES devoid of type specific antigen, and by a group P Streptococcus. Selected strains of GES serotypes I and II and group U Streptococcus did not produce detectable SK. The antibodies directed against SD (antistreptodornase, ASD) appeared two to three weeks postexposure, reached a peak about six weeks postexposure, and persisted at high levels for nearly six months (the duration of the experiment). The ASD inhibited SD produced by all known antigenic types of GES, by GES devoid of type specific antigen, and by strains of groups P and U Streptococcus. The antibodies failed to inhibit SD produced by group C Streptococcus. The potential utilization of ASK and ASD titers as serological means of identifying swine infected with GES (carrier swine) is discussed.

Animals↗
PubMed1981

[Interest of humoral antibodies assay for diagnosis and survey of urinary tract infections by gram negative bacilli and streptococcus D in children (author's transl)].

The assay of humoral antibodies during urinary tract infections of children is performed by passive haemagglutination. In gram negative bacilli infections (176 children) the antigens are derived from the patients' bacteria. For streptococcus D infections the antigen is a phenol extract, specifically tested and used for all streptococcus D urinary tract infections (40 children). The humoral antibodies assay is of first interest to distinguish between high urinary tract infections with renal parenchym bacterial involvement and low urinary tract infections. In high urinary tract infections the antibodies are significantly elevated and almost surely indicate renal infection for a 1/2 560 titre; they raise both in gram negative bacteria and in streptococcus D infections. There is however a difference in a rather higher number of cases of streptococcus D infections where it is impossible of connect high sera titres and clinical symptoms of pyelonephritis, contrary to gram negative bacilli infections. It seems to be due to aetiological differences in urinary tract infections by streptococcus D, which are more often secondary infections, during severe urologic diseases. In such cases the symptomatology of infections is less typical than in E. Coli urinary tract infections. Another interest is the capacity of survey by this method. Three kinds of courses of antibody titres are observed: the first is a clean break of titre lower than 1/160 after three months; the second is the continuance of the same high levels over three months; the third is continuance of high significative level after a first incomplete fall. In the last two cases it is highly probable that a pyelonephritis processes is engaged. This may be useful for treatment and survey of children with urologic diseases.

Antibodies, Bacterial↗
PubMed2001

Isolation and characterization of a Streptococcus thermophilus plasmid closely related to the pMV158 family.

Twenty-two Streptococcus thermophilus strains used for milk fermentations were analyzed for their plasmid content and 13 of them (59%) were found to contain one or two plasmids. Fifteen S. thermophilus plasmids were divided into four groups using DNA homology. Ten plasmids were classified within group A and they shared homologies with all the previously sequenced S. thermophilus plasmids. Three plasmids (group B) hybridized with each other and two plasmids only hybridized with themselves (groups C and D). Single-stranded DNA was detected within strains containing plasmids of groups A, C, and D, indicating that they replicate via a rolling-circle mode. The only plasmid of group C, named pSMQ172, was further characterized. This 4230-bp plasmid replicates in Escherichia coli, Lactococcus lactis, and Streptococcus salivarius and does not confer phage resistance. Comparisons with databases showed that pSMQ172 was related to pMV158 of Streptococcus agalactiae and to pSSU1 of Streptococcus suis. These results suggest that genetic exchanges may have occurred between pathogenic and nonpathogenic streptococci.

Base Sequence↗
PubMed1998

Antimicrobial susceptibility of viridans group streptococci in Taiwan with an emphasis on the high rates of resistance to penicillin and macrolides in Streptococcus oralis.

The in-vitro susceptibilities of 13 antimicrobial agents were determined for 207 isolates of viridans group streptococci recovered from patients with significant infections in Taiwan during 1995 and 1997. Variable degrees of susceptibility existed among nine species. High-level penicillin resistance (MIC > or = 4.0 mg/L) was found most frequently in Streptococcus oralis (35%), followed by Streptococcus mitis (20%) and Streptococcus salivarius (8%). However, S. salivarius showed the lowest rate of susceptibility to penicillin (50%). Macrolide resistance also occurred most frequently in S. oralis isolates (55%) but in none of Streptococcus mutans. Penicillin and macrolides tended to be less active against isolates recovered from non-invasive sites than against those isolated from invasive sites. Imipenem was the most active beta-lactam against penicillin-resistant isolates. Ofloxacin, vancomycin and teicoplanin showed good in-vitro activity against all isolates, with MIC90s of 2, 1 and 0.25 mg/L, respectively. None of these isolates displayed high-level resistance to gentamicin and most isolates were susceptible to chloramphenicol. These results indicate the species-related variability of susceptibility, especially to penicillin, macrolides and tetracycline. In addition to S. mitis, S. oralis also displayed high rates of resistance to penicillin and macrolides. The difference in susceptibilities between species of viridans streptococci indicates the importance of accurate identification and the need for continuing surveillance of antimicrobial resistance.

Anti-Bacterial Agents↗
PubMed2002

Real-time PCR for quantification of Streptococcus mutans.

A real-time polymerase chain reaction (PCR) assay was developed for the quantification of Streptococcus mutans. Primers targeting gtf genes of S. mutans were designed and tested for their specificity using 28 oral streptococcal strains, three other bacterial strains, and human DNA. The primers could amplify specifically the target DNA fragment from a mixture of oral streptococcus genomic DNA containing about 10 fg to 10 ng of S. mutans genome DNA. The real-time PCR produced a linear quantitative detection range over concentrations spanning seven exponential values, with a detection limit of a few copies of S. mutans' genomic DNA per reaction tube. The results of the real-time PCR assay corresponded well to those of conventional culture assays for S. mutans in saliva samples. A real-time PCR assay for Streptococcus sobrinus and Streptococcus downei was also established and produced results that corresponded well to those from conventional culture assays for S. sobrinus in saliva samples. These assays will be useful as a new means to assess one of the important risk factors for caries.

Bacterial Typing Techniques↗
PubMed1992

[Significance of normal oral flora, particularly group oral streptococci as defense mechanism against infection in healthy individuals (normal defense mechanism by oral Streptococcus group)].

The alpha-streptococci, consisted of normal oral flora mainly, with inhibitory activity against pathogenic microbes in healthy individuals was investigated by group A Streptococcus (indicator strain 6-22 nonmucoid T-12). Rate of alpha-streptococci with inhibitory activity against group A Streptococcus was increased as aging, and the rate in pre-school children was higher than that in school children. These results suggested that more than 90% of the tested alpha-streptococci with strong inhibitory activities (S. salivarius) against indicator strain had inhibitory activities against group A Streptococcus (mucoid T-6), H. influenzae, S. pneumoniae, group C Streptococcus, and from 40% to 70% of the tested strains had also inhibitory activities against other pathogens. As there were many strains of alpha-streptococci with inhibitory activities against pathogens, that usually detected in the upper respiratory infection, the problem on the strains in the future will explain significance of the defense mechanism against upper respiratory infection and this can be applied clinically.

Adolescent↗
PubMed2001

Identification of the psaA gene, coding for pneumococcal surface adhesin A, in viridans group streptococci other than Streptococcus pneumoniae.

The gene encoding the pneumococcal surface adhesin A (PsaA) protein has been identified in three different viridans group streptococcal species. Comparative studies of the psaA gene identified in different pneumococcal isolates by sequencing PCR products showed a high degree of conservation among these strains. PsaA is encoded by an open reading frame of 930 bp. The analysis of this fragment in Streptococcus mitis, Streptococcus oralis, and Streptococcus anginosus strains revealed a sequence identity of 95, 94, and 90%, respectively, to the corresponding open reading frame of the previously reported Streptococcus pneumoniae serotype 6B strain. Our results confirm that psaA is present and detectable in heterologous bacterial species. The possible implications of these results for the suitability and potential use of PsaA in the identification and diagnosis of pneumococcal diseases are discussed.

Adhesins, Bacterial↗
PubMed2002

Streptococcus-zebrafish model of bacterial pathogenesis.

Due to its small size, rapid generation time, powerful genetic systems, and genomic resources, the zebrafish has emerged as an important model of vertebrate development and human disease. Its well-developed adaptive and innate cellular immune systems make the zebrafish an ideal model for the study of infectious diseases. With a natural and important pathogen of fish, Streptococcus iniae, we have established a streptococcus- zebrafish model of bacterial pathogenesis. Following injection into the dorsal muscle, zebrafish developed a lethal infection, with a 50% lethal dose of 10(3) CFU, and died within 2 to 3 days. The pathogenesis of infection resembled that of S. iniae in farmed fish populations and that of several important human streptococcal diseases and was characterized by an initial focal necrotic lesion that rapidly progressed to invasion of the pathogen into all major organ systems, including the brain. Zebrafish were also susceptible to infection by the human pathogen Streptococcus pyogenes. However, disease was characterized by a marked absence of inflammation, large numbers of extracellular streptococci in the dorsal muscle, and extensive myonecrosis that occurred far in advance of any systemic invasion. The genetic systems available for streptococci, including a novel method of mutagenesis which targets genes whose products are exported, were used to identify several mutants attenuated for virulence in zebrafish. This combination of a genetically amenable pathogen with a well-defined vertebrate host makes the streptococcus-zebrafish model of bacterial pathogenesis a powerful model for analysis of infectious disease.

Animals↗
PubMed2025

RRNPP quorum-sensing repertoires in the salivarius group genomes: overrepresentation and synchronous activation of SHP/Rgg systems in Streptococcus thermophilus.

UNLABELLED: In Bacillota, quorum sensing can be mediated by RRNPP regulators that are activated by autoinducing peptides (AIPs). In this study, we derived a hidden Markov model profile from a 3D-informed alignment to establish RRNPP repertoires for 527 genomes of streptococci in the salivarius group and identified probable AIPs. The salivarius group encompasses Streptococcus salivarius and Streptococcus vestibularis, which are part of the normal human oral microflora, and Streptococcus thermophilus, one of the most widely used bacteria in the dairy industry. We observed a large amount of plasticity in these repertoires, as well as profound differences among species. Notably, S. salivarius displayed an accumulation of ComR regulators, while S. thermophilus displayed an accumulation of Rgg regulators. The latter family included SHP-associated Rgg regulators, systems in which SHPs serve as AIPs; most of these regulators control the production of post-translationally modified peptides (RaS-RiPPs). Their level of richness contrasts with the genome reduction that accompanied S. thermophilus' adaptation to milk. We then used liquid chromatography-high resolution tandem mass spectrometry to analyze the activity of the eight most common SHP/Rgg systems by characterizing the SHPs and RaS-RiPPs found in the supernatants. We detected four SHPs and one RaS-RiPP that have never been seen before in S. thermophilus, and we showed that seven of the eight SHP/Rgg systems were functional. Finally, by simultaneously monitoring the amounts of both the SHPs and RaS-RiPPs, we demonstrated that the fates of these two peptide types differed during growth. SHP presence in the supernatant was transient, a pattern likely related to the peptides' signaling role. IMPORTANCE: Streptococcus thermophilus possesses an unusually high number of Rgg regulators, which are activated by SHP pheromones that control the production of RaS-RiPPs, peptides with cyclization motifs and growth inhibition properties. We conducted an in silico analysis of regulator repertoires across a wide range of strains; a subsequent experimental study revealed that the majority of the SHP/Rgg systems were functional. Employing an optimized liquid chromatography-high resolution tandem mass spectrometry protocol, we were able to better detect and follow SHP and RaS-RiPP accumulation. While RaS-RiPPs accumulated during growth, SHPs were only transiently present in the extracellular environment. This observation suggests that we could manipulate quorum sensing by adding SHPs to the growth medium and highlights the need to study the functions of the RaS-RiPPs.

Streptococcus thermophilus↗
PubMed1975

Glucose-6-phosphate-dependent pyruvate kinase in Streptococcus mutans.

Pyruvate kinase of Streptococcus mutans JC 2 had an absolute and specific requirement for glucose-6-phosphate. Inorganic phosphate was a strong inhibitor. The enzyme required K+ or NH4+ and Mg2+ or Mn2+. S. mutans FIL and E 49, Streptococcus bovis ATCC 9809, and Streptococcus salivarius ATCC 13419 had also glucose-6-phosphate-dependent pyruvate kinases, whereas Streptococcus sanguis NCTC 10904 had an enzyme activated by fructose-1,6-diphosphate.

Ammonia↗
PubMed1995

Distribution of proteins similar to IIIManH and IIIManL of the Streptococcus salivarius phosphoenolpyruvate:mannose-glucose phosphotransferase system among oral and nonoral bacteria.

In Streptococcus salivarius, the phosphoenolpyruvate (PEP):mannose-glucose phosphotransferase system, which concomitantly transports and phosphorylates mannose, glucose, fructose, and 2-deoxyglucose, is composed of the general energy-coupling proteins EI and HPr, the specific membrane-bound IIIMan, and two forms of a protein called IIIMan, with molecular weights of 38,900 (IIIManH) and 35,200 (IIIManL), that are found in the cytoplasm as well as associated with the membrane. Several lines of evidence suggest that IIIManH and/or IIIManL are involved in the control of sugar metabolism. To determine whether other bacteria possess these proteins, we tested for their presence in 28 oral streptococcus strains, 3 nonoral streptococcus strains, 2 lactococcus strains, 2 enterococcus strains, 2 bacillus strains, 1 lactobacillus strain, Staphylococcus aureus, and Escherichia coli. Three approaches were used to determine whether the IIIMan proteins were present in these bacteria: (i) Western blot (immunoblot) analysis of cytoplasmic and membrane proteins, using anti-IIIManH and anti-IIIManH rabbit polyclonal antibodies; (ii) analysis of PEP-dependent phosphoproteins by polyacrylamide gel electrophoresis; and (iii) inhibition by anti-IIIMan antibodies of the PEP-dependent phosphorylation of 2-deoxyglucose (a mannose analog) by crude cellular extracts. Only the species S. salivarius and Streptococcus vestibularis possessed the two forms of IIIMan. Fifteen other streptococcal species possessed one protein with a molecular weight between 35,200 and 38,900 that cross-reacted with both antibodies. In the case of 9 species, a protein possessing the same electrophoretic mobility was phosphorylated at the expense of PEP. No such phosphoprotein, however, could be detected in the other six species. A III(Man)-like protein with a molecular weight of 35,500 was also detected in Lactobacillus casei by Western blot experiments as well as by PEP-dependent phosphoprotein analysis, and a protein with a molecular weight of 38,900 that cross-reacted with anti-III(Man) antibodies was detected in Lactococcus lactis. In several cases, the involvement of these putative III(Man) proteins in the PEP-dependent phosphorylation of 2-deoxyglucose was substantiated by the inhibition of phosphorylation activity of anti-III(Man) antibodies. No proteins cross-reacting with anti-III(Man) antibodies were detected in enterococci, bacilli, and E. coli. In S. aureus, a membrane protein with a molecular weight of 50,000 reacted strongly with the antibodies. This protein, however, was not phosphorylated at the expense of PEP.

Bacillus↗
PubMed1989

Surface structures, co-aggregation and adherence phenomena of Streptococcus oralis and related species.

Seven strains of Streptococcus oralis were found to possess surface structures. Four strains possessed long fimbriae which ranged in length from 266-366 nm, while the remaining three strains possessed shorter peritrichously distributed fibrils which ranged in length from 80-197 nm. The fibrillar strains were morphologically similar to strains of Streptococcus sanguis I and II and Streptococcus mitis. No strain of S. oralis produced tufts of fibrils like certain strains of S. sanguis I. Strains of Streptococcus milleri produced peritrichously distributed fimbriae which were morphologically dissimilar to the fimbriae produced by S. oralis strains. S. oralis strains were moderately to highly hydrophobic, but hydrophobicity could not be related to adhesion parameters or type or length or density of surface structures. Furthermore, there appeared to be no correlation between type of surface structures and adhesion parameters. Two of the three fibrillar strains of S. oralis and the peritrichously fibrillar strains of S. sanguis, together with one strain of S. milleri, were able to co-aggregate with actinomycetes.

Actinomyces↗
PubMed1981

[Prophylaxis and treatment of streptococcus infections (author's transl)].

Authors review and bring up to date problems related to prophylaxis and treatment of streptococcus infections in children. In those caused by the Group A streptococcus, the problem is rather one of medical education and practical application of techniques, and medicines. Active vaccination is still a remote possibility. In the case of streptococcus B and its perinatological incidence, there is still no standard therapeutic prophylaxis covering both the mother and child. With reference to streptococcus D plans proposed are somewhat discordant since it is difficult to carry out studies with sufficiently large groups but there are also proposals which can be carried out perfectly well and are reasonably safe. As far as the infectious, and to a great extent contagious, processes are concerned, measures of individual and collective hygiene are particularly important.

Anti-Bacterial Agents↗