Abstract-Simultaneous natural changes in lipoprotein(a) [Lp(a)] and plasminogen occur in the nephrotic syndrome and offer a unique opportunity to investigate their effects on plasminogen activation under conditions fashioned in vivo. Plasminogen, Lp(a), and apolipoprotein(a) in plasma were characterized, and their competitive binding to carboxyterminal lysine residues of fibrin and cell membrane proteins was determined in nephrotic children during a flare-up of the disease (61 cases) and after 6 weeks (33 cases) and 6 months (42 cases) of remission. Low plasminogen concentrations (median 1.34 mol/L, range 0.39 to 1.96 mol/L) and high Lp(a) levels (median 0.27 g/L, range 0.07 to 2.57 g/L) were detected at flare-up. These changes were associated with an increased Lp(a) binding ratio onto fibrin (3.13Ϯ0.48) and cells (1.53Ϯ0.24) compared with binding ratios of control children (1.31Ϯ0.19 and 1.05Ϯ0.07, respectively) with normal plasminogen and low Lp(a) (median 0.071 g/L). After 6 weeks and 6 months of remission, the values for net decrease in Lp(a) binding to fibrin were 1.7Ϯ0.22 (after 6 weeks) and 1.88Ϯ0.38 (after 6 months) and were correlated with low Lp(a) concentrations (median 0.2 g/L, range 0.07 to 0.8 g/L; and median 0.12 g/L, range 0.07 to 1.34 g/L) and inversely associated with increased plasminogen levels (median 1.82 mol/L, range 1.4 to 2.1 mol/L; and median 1.58 mol/L, range 1.1 to 2.1 mol/L). These studies provide the first quantitative evidence that binding of Lp(a) to lysine residues of fibrin and cell surfaces is directly related to circulating levels of both plasminogen and Lp(a) and that these glycoproteins may interact as competitive ligands for these biological surfaces in vivo. This mechanism may be of relevance to the atherothrombotic role of Lp(a), particularly in nephrotic patients.

Both herpes simplex virus type 2 (HSV-2) seroprevalence and the proportion of HSV-1 genital ulcers are increasing in industrialized countries. The consequences of these epidemiological changes, in pregnant women in France, for both the genital shedding of HSV and vertical transmission, have been poorly evaluated. The HSV-1 and HSV-2 seroprevalence and the rate of subclinical genital shedding of herpes close to delivery were evaluated in pregnant women, with no history of genital herpes, living in the East Paris suburban area. HSV-2 antibody prevalence of 26% was significantly associated with country of origin and was higher than that reported in 2002 in French women from the general population (18%). HSV-2 and HSV-1 genital reactivations were observed in 10% of HSV-2 seropositive and in 4% of HSV-1 seropositive and HSV-2 seronegative women, respectively. The high rates of HSV-2 seropositivity and subclinical herpes genital shedding observed in this study should be considered to promote a national survey in pregnant women to propose strategies to prevent the spread of HSV within the population and to the neonate.

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We describe a case of culture-negative meningitis and endocarditis caused by Streptococcus agalactiae in a 27-day-old boy. S. agalactiae was detected in cerebrospinal fluid and serum by broad-spectrum PCR amplification. CASE REPORTA previously healthy neonate aged 27 days was admitted to the pediatric department of Robert Ballanger Hospital (Aulnay sous bois, France) because of fever onset the day before. On initial evaluation he was pale and continuously crying, and he had a temperature of 40.8°C. Neurologic examination was normal, except for an anterior bulging fontanelle. Cardiologic examination showed a 2-3/6 systolic murmur at the apex. The ears, lungs, and abdomen appeared normal. A chest radiograph was normal. Blood, cerebrospinal fluid (CSF), and urine samples were immediately taken for culture. Laboratory findings included a white blood cell (WBC) count of 21,000/ mm 3 (44% polymorphonuclear neutrophils) and a C-reactive protein (CRP) level of 157 mg/liter. Urine laboratory examination was normal. Lumbar puncture yielded cloudy CSF with 50 red blood cells/mm 3 and 7,000 WBC/mm 3 (89% polymorphonuclear neutrophils), an elevated protein level (1.75 g/liter), and a low glucose concentration (1.4 mmol/liter; serum concentration, 3.6 mmol/liter). Direct examination with Gram staining was negative. Tests for Streptococcus agalactiae and Escherichia coli K1 soluble antigens using the Pastorex Meningitis kit (Bio-Rad, Marne-La-Coquette, France) were negative in urine and CSF.Empirical intravenous antibacterial chemotherapy for neonatal meningitis was immediately started, with cefotaxime (200 mg/kg of body weight/24 h), amoxicillin (200 mg/kg/24 h), and amikacin (15 mg/kg/24 h). Blood and CSF cultures remained sterile after 5 days. A second lumbar puncture performed 48 h after admission yielded sterile bloody CSF. The temperature and CRP normalized after 2 and 5 days of treatment, respectively. Amikacin and amoxicillin were withdrawn, and cefotaxime (200 mg/kg/24 h) was continued. The boy's clinical status improved, and neurological examination remained normal. Because the systolic murmur was still present at 15 days of hospitalization, the infant was transferred to the neonatal cardiology unit of Robert-Debré Hospital for further investigations. An echocardiography showed grade 2/4 mitral regurgitation and a 3 mm vegetation on the mitral valve. The other valves were normal.Because of sterile cultures, an admission CSF sample and a day 1 serum sample, both stored at Ϫ20°C, were sent to Robert-Debré Hospital for molecular diagnosis by universal 16S rRNA PCR amplification. DNA was extracted with the QIAmp DNA Mini kit (QIAGEN, Courtaboeuf, France). The initial PCR mixture (final volume, 50 l) contained 0.4 M each universal primer, 200 M each deoxynucleoside triphosphate, and 1 U of HotStarTaq DNA polymerase (QIAGEN) in 1ϫ amplification buffer supplied by the manufacturer; the final concentration of MgCl 2 was 3 mM. The universal primers 779F (5Ј-CAAACAGGATTAGATACCC T-3Ј) and 1191R (5Ј-CGTCATCCCCACCTTCCTCC-3Ј) corr...