Family-centered care (FCC) is a partnership approach to health care decision-making between the family and health care provider. FCC is considered the standard of pediatric health care by many clinical practices, hospitals, and health care groups. Despite widespread endorsement, FCC continues to be insufficiently implemented into clinical practice. In this paper we enumerate the core principles of FCC in pediatric health care, describe recent advances applying FCC principles to clinical practice, and propose an agenda for practitioners, hospitals, and health care groups to translate FCC into improved health outcomes, health care delivery, and health care system transformation.

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Family-Centered Care: Current Applications and Future Directions in Pediatric Health Care

Summary: Streptococci readily colonize mucosal tissues in the nasopharynx; the respiratory, gastrointestinal, and genitourinary tracts; and the skin. Each ecological niche presents a series of challenges to successful colonization with which streptococci have to contend. Some species exist in equilibrium with their host, neither stimulating nor submitting to immune defenses mounted against them. Most are either opportunistic or true pathogens responsible for diseases such as pharyngitis, tooth decay, necrotizing fasciitis, infective endocarditis, and meningitis. Part of the success of streptococci as colonizers is attributable to the spectrum of proteins expressed on their surfaces. Adhesins enable interactions with salivary, serum, and extracellular matrix components; host cells; and other microbes. This is the essential first step to colonization, the development of complex communities, and possible invasion of host tissues. The majority of streptococcal adhesins are anchored to the cell wall via a C-terminal LPxTz motif. Other proteins may be surface anchored through N-terminal lipid modifications, while the mechanism of cell wall associations for others remains unclear. Collectively, these surface-bound proteins provide Streptococcus species with a “coat of many colors,” enabling multiple intimate contacts and interplays between the bacterial cell and the host. In vitro and in vivo studies have demonstrated direct roles for many streptococcal adhesins as colonization or virulence factors, making them attractive targets for therapeutic and preventive strategies against streptococcal infections. There is, therefore, much focus on applying increasingly advanced molecular techniques to determine the precise structures and functions of these proteins, and their regulatory pathways, so that more targeted approaches can be developed.

Streptococcus Adherence and Colonization

The 2,160,267 bp genome sequence of Streptococcus agalactiae, the leading cause of bacterial sepsis, pneumonia, and meningitis in neonates in the U.S. and Europe, is predicted to encode 2,175 genes. Genome comparisons among S. agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes, and the other completely sequenced genomes identified genes specific to the streptococci and to S. agalactiae. These in silico analyses, combined with comparative genome hybridization experiments between the sequenced serotype V strain 2603 V/R and 19 S. agalactiae strains from several serotypes using whole-genome microarrays, revealed the genetic heterogeneity among S. agalactiae strains, even of the same serotype, and provided insights into the evolution of virulence mechanisms.

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Complete genome sequence and comparative genomic analysis of an emerging human pathogen, serotype V Streptococcus agalactiae

Streptococcus agalactiae is a commensal bacterium colonizing the intestinal tract of a significant proportion of the human population. However, it is also a pathogen which is the leading cause of invasive infections in neonates and causes septicaemia, meningitis and pneumonia. We sequenced the genome of the serogroup III strain NEM316, responsible for a fatal case of septicaemia. The genome is 2 211 485 base pairs long and contains 2118 protein coding genes. Fifty-five per cent of the predicted genes have an ortholog in the Streptococcus pyogenes genome, representing a conserved backbone between these two streptococci. Among the genes in S. agalactiae that lack an ortholog in S. pyogenes, 50% are clustered within 14 islands. These islands contain known and putative virulence genes, mostly encoding surface proteins as well as a number of genes related to mobile elements. Some of these islands could therefore be considered as pathogenicity islands. Compared with other pathogenic streptococci, S. agalactiae shows the unique feature that pathogenicity islands may have an important role in virulence acquisition and in genetic diversity.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2958.2002.03126.x

Genome sequence of Streptococcus agalactiae, a pathogen causing invasive neonatal disease.

SUMMARY Pore-forming toxins (PFTs) are the most common bacterial cytotoxic proteins and are required for virulence in a large number of important pathogens, including Streptococcus pneumoniae, group A and B streptococci, Staphylococcus aureus, Escherichia coli, and Mycobacterium tuberculosis. PFTs generally disrupt host cell membranes, but they can have additional effects independent of pore formation. Substantial effort has been devoted to understanding the molecular mechanisms underlying the functions of certain model PFTs. Likewise, specific host pathways mediating survival and immune responses in the face of toxin-mediated cellular damage have been delineated. However, less is known about the overall functions of PFTs during infection in vivo . This review focuses on common themes in the area of PFT biology, with an emphasis on studies addressing the roles of PFTs in in vivo and ex vivo models of colonization or infection. Common functions of PFTs include disruption of epithelial barrier function and evasion of host immune responses, which contribute to bacterial growth and spreading. The widespread nature of PFTs make this group of toxins an attractive target for the development of new virulence-targeted therapies that may have broad activity against human pathogens.

Role of Pore-Forming Toxins in Bacterial Infectious Diseases

Group B streptococci (GBS) express a beta-haemolysin/cytolysin that contributes to disease pathogenesis. We report an independent discovery and extension of a genetic locus encoding the GBS beta-haemolysin/cytolysin activity. A plasmid library of GBS chromosomal DNA was cloned into Escherichia coli, and a transformant was identified as beta-haemolytic on blood agar. The purified plasmid contained a 4046 bp insert of GBS DNA encoding two complete open reading frames (ORFs). A partial upstream ORF (cylB) and the first complete ORF (cylE) represent the 3' end of a newly reported genetic locus (cyl) required for GBS haemolysin/cytolysin activity. ORF cylE is predicted to encode a 78.3 kDa protein without GenBank homologies. The GBS DNA fragment also includes a previously unreported ORF, cylF, with homology to bacterial aminomethyltransferases, and the 5' end of cylH, with homology to 3-ketoacyl-ACP synthases. Southern analysis demonstrated that the cyl locus was conserved among GBS of all common serotypes. Targeted plasmid integrational mutagenesis was used to disrupt cylB, cylE, cylF and cylH in three wild-type GBS strains representing serotypes Ia, III and V. Targeted integrations in cylB, cylF and cylH retaining wild-type haemolytic activity were identified in all strains. In contrast, targeted integrations in cylE were invariably non-haemolytic and non-cytolytic, a finding confirmed by in frame allelic exchange of the cylE gene. The haemolytic/cytolytic activity of the cylE allelic exchange mutants could be restored by reintroduction of cylE on a plasmid vector. Inducible expression of cylE, cylF and cylEF demonstrated that it is CylE that confers haemolytic activity in E. coli. We conclude that cylE probably represents the structural gene for the GBS haemolysin/cytolysin, a novel bacterial toxin.

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Genetic basis for the beta-haemolytic/cytolytic activity of group B Streptococcus.

PurposeIn pediatric teaching hospitals, medical decisions are traditionally made by the attending and resident physicians during rounds that do not include parents. This structure limits the ability of the medical team to provide “family-centered care” and the attending physician to model communicat

Parental responses to involvement in rounds on a pediatric inpatient unit at a teaching hospital: a qualitative study.

Group B streptococci (GBS) are typed by capsular polysaccharide type. IS 1381, an insertion sequence previously described in Streptococcus pneumoniae, was cloned from GBS strain A909. The presence of multiple copies of IS1381 in A909 suggested that IS1381 analysis might be an effective subtyping tool. IS1381 was found by Southern blot analysis to be present in 18 (72%) of 25 of unrelated GBS isolates tested. IS1381 analysis allowed discrimination between strains that contain IS1381 with a discriminatory power >99%. Eight of 8 sets of epidemiologically related isolates containing IS1381 give identical or nearly identical patterns of IS1381 insertion. For 2 maternallinfant sets, a single additional insertion was seen in 1 strain, suggesting that an additional insertion occurred between maternal colonization and infection of the infant. Insertion patterns of IS1381 are an effective tool for subtyping GBS.

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Analysis of restriction fragment length polymorphisms of the insertion sequence IS1381 in group B Streptococci.

Streptococcus agalactiae or group B streptococci (GBS) are gram-positive diplococci and are the leading bacterial cause of pneumoniae, sepsis, and meningitis in neonates. Neonatal GBS infections may occur prior to or during birth. GBS have been cultured from the chorioamnionic membrane of pregnant women and have therefore been associated with chorioamnionitis and premature labor. A potential route for GBS to establish infection of a neonate would be to penetrate the placental membrane of colonized pregnant women. In our laboratory, we have constructed in vitro systems to emulate certain events during the colonization and invasion of host epithelial cell tissues by GBS. By utilizing techniques to grow primary cultures of both chorion cells and amnion cells isolated from human C-section placentas, we have established a relevant model to investigate certain aspects of GBS adherence and invasion into the placental membrane. To identify relevant molecules required for GBS to colonize the multiple tissues it encounters during an infection, we have applied a variety of biochemical approaches with host cell membrane preparations as well as purified extracellular matrix proteins. These techniques are enabling us to further characterize the pathogenic mechanisms utilized by GBS.

Glen S. Tamura

Papers

Genetic basis for the beta-haemolytic/cytolytic activity of group B Streptococcus.

Parental responses to involvement in rounds on a pediatric inpatient unit at a teaching hospital: a qualitative study.

Analysis of restriction fragment length polymorphisms of the insertion sequence IS1381 in group B Streptococci.

In vitro systems for investigating group B streptococcal : host cell and extracellular matrix interactions

In vitro systems for investigating group B streptococcal