JOHN A. WASHINGTON II, M.D.
To the editor: Carey, Brause, and Roberts (Ann Intern Med 87:150-154, 1977, and Reference 1) have emphasized the importance of nutritionally variant streptococci as a cause of endocarditis. In addition to the pyridoxine (vitamin B6)-deficient strains reported by them and earlier by George (2), streptococci have been identified with requirements for D-alanine and thiol groups (2-5). To complicate matters further, we have isolated from the blood of a patient with endocarditis a pyridoxine-sensitive viridans streptococcus (6).
Fifteen of 23 streptococci included in these reports (Frenkel and Hirsch  stated the sources of their strains but not the numbers) were from
WASHINGTON JA. Nutritionally Variant Streptococci. Ann Intern Med. ;87:793–794. doi: 10.7326/0003-4819-87-6-793
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Published: Ann Intern Med. 1977;87(6):793-794.
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