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Restrictions No restrictions. Members that are marked public are visible to any method of any class. The members in class A that are marked private are accessible only to methods of class A. The members in class A that are marked protected are accessible to methods of class A and also to methods of classes derived from class A. The protected access modifier is used with derived classes, as explained in 11. The members in class A that are marked internal are accessible to methods of any class in A s assembly. An assembly is a collection of files that appear to the programmer as a single executable or DLL. The members in class A that are marked protected internal are accessible to methods of class A, to methods of classes derived from class A, and also to any class in A s assembly. This is effectively protected or internal; there is no concept of protected and internal.

Group A -hemolytic streptococci are not normal skin flora Streptococcal skin infections result from colonization of nor-

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Necrotizing fasciitis is a rapidly spreading infection involving the fascia of deep muscle The clinical findings at presentation may be those of severe cellulitis, but the presence of systemic toxicity and severe pain, which may be followed by anesthesia of the involved area due to destruction of nerves as infection advances through the fascial planes, is a clue to the diagnosis Surgical exploration is mandatory when the diagnosis is suspected Early and extensive debridement is essential for survival Any streptococcal infection and necrotizing fasciitis in particular can be associated with streptococcal toxic shock syndrome, typified by invasion of skin or soft tissues, acute respiratory distress syndrome, and renal failure The very young, the elderly, and those with underlying medical conditions are at particularly high risk for invasive disease Bacteremia occurs in most cases Skin rash and desquamation may not be present Mortality rates can be up to 80% The syndrome is due to elaboration of pyrogenic erythrotoxin (which also causes scarlet fever), a superantigen that stimulates massive release of inflammatory cytokines believed to mediate the shock A -lactam remains the drug of choice for treatment of serious streptococcal infections, but clindamycin, which is a potent inhibitor of toxin production, should also be administered at a dose of 600 mg every 8 hours intravenously for invasive disease, especially in the presence of shock Intravenous immune globulin has also been recommended for streptococcal toxic shock syndrome for presumed, although unproven, therapeutic benefit from specific antibody to streptococcal exotoxins in immune globulin preparations Two dosage regimens have been used: 450 mg/kg once daily for 5 days or a single dose of 2 g/kg with a repeat dose at 48 hours if the patient remains unstable Outbreaks of invasive disease have been associated with colonization by invasive clones that can be transmitted to close contacts who, though asymptomatic, may be a reservoir for disease Tracing contacts of patients with invasive disease is controversial.

Public methods are part of the class s public interface: they define how this class behaves. Private methods are helper methods used by the public methods to accomplish the work of the class. Because the internal workings of the class are private, helper methods need not (and should not) be exposed to other classes. The Box class and its method DisplayBox( ) are both declared public so that any other class can make use of them. If DisplayBox( ) had been private, you wouldn t be able to invoke DisplayBox( ) from any method of any class other than methods of Box itself. In Example 7-1, DisplayBox( ) was invoked from a method of Tester (not Box), and this was legal because both the class (Box) and the method (DisplayBox) were marked public.

Stevens DL et al; Infectious Diseases Society of America Practice guidelines for the diagnosis and management of skin and soft-tissue infections Clin Infect Dis 2005 Nov 15;41(10): 1373 406 [PMID: 16231249] Vinh DC et al Rapidly progressive soft tissue infections Lancet Infect Dis 2005 Aug;5(8):501 13 [PMID: 16048719]

recommend the addition of low-dose gentamicin, 1 mg/kg every 8 hours Viridans streptococci, which are nonhemolytic or hemolytic (ie, producing a green zone of hemolysis on blood agar), are part of the normal oral flora Although these strains may produce focal pyogenic infection, they are most notable as the leading cause of native valve endocarditis (see below) Group D streptococci include Streptococcus bovis and the enterococci S bovis is a cause of endocarditis in association with bowel neoplasia or cirrhosis and is treated like viridans streptococci

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