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PubMed1995

Rapid detection of meningococci from petechiae in acute meningococcal infection.

In order to evaluate the diagnostic usefulness of Gram-staining films from petechial lesions in suspected meningococcal infection, data from 52 patients with confirmed infection were reviewed. Gram-negative diplococci were found in specimens from skin films in 80% (24/30) patients with petechiae. This is significantly better than results reported for Gram-staining of needle aspirates from petechiae (46%; 12/26). Positive skin films were obtained from 89% (17/19) blood culture negative cases and 85% (17/20) CSF negative cases. In 14 cases meningococcal infection was identified only by skin films. Skin film results were not significantly affected by previous antibiotic. Gram-staining of films from petechial lesions in suspected meningococcal infection is a very rapid and effective investigation. Blood culture, CSF examination and culture, and skin films each identified meningococcal infection not identified by the other two investigations.

Acute Disease↗

PubMed1992

Incidence, serogroups and case-fatality rate of invasive meningococcal infections in a Swedish region 1975-1989.

In a retrospective study of invasive meningococcal infections in Greater Gothenburg, Sweden, 213 cases of culture-verified meningitis or septicaemia were identified during the 15-year period 1975-1989. The annual incidence was 2.0/100,000. Cases were seen in all age-groups with the highest rates in the 0-4 and 15-19 year-old groups, 9.5 and 6.2/100,000 respectively. 20% of the patients were less than 2 years. 91% of the patients had no known risk factors. In only 10 cases (5%) was contact with another case of meningococcal infection known. The main clinical manifestations were meningitis (57%), septicaemia with no sign of focal infection (25%) and septic shock (17%). The case-fatality rate for all the patients was 6.6% and did not change during the 15-year period. One-third of the patients who presented with septic shock died. The serogroup was known for strains from 192 patients. 51% of the strains belonged to serogroup B, 10% to group A and 23% to group C. In conclusion, the incidence of meningococcal infection was low but the relatively high case-fatality rate warrants a search for effective prophylaxis. About 30% of the cases were potentially preventable by the currently available tetravalent (A, C, Y and W135) polysaccharide vaccine, which is immunogenic in children greater than 2 years. Widespread use of antibiotic prophylaxis to close contacts of known cases would not lower the incidence markedly.

Adolescent↗

PubMed2004

[The meningococcal infection on Navy: modern clinical-and-epidemiological aspects].

The article presents the own data about modern clinical-and-epidemiological peculiarities of a meningococcal infection on Navy for 20 consecutive years (1982-2002) based on the analysis of the annual reports of fleet medical services and the inspection of 275 centers of a meningococcal infection in military troops. The centers with the single generalized form of a meningococcal infection prevailed. The centers with the number of people from 10 to 40 men amounted to 82%. The frequency of the meningococcal defeat of the people in the centers varied from 25% to 37% with the main role of meningococcae A. In the structure of a meningococcal infection the generalized forms amounted to 16%, located forms--25%, carriers--59%. In all regions the major form of the display of epidemic process in military collectives was seasonal sick rate. The article proved the electoral approach to the character and volume of curative-and-preventive measures.

Humans↗

PubMed1986

Complement abnormalities during an epidemic of group B meningococcal infection in children.

During an epidemic of group B meningococcal infection mean values obtained in 96 consecutively affected children showed a reduction in classical pathway function (CH50), normal alternate pathway function (AP50), C4 and factor B levels, and raised C3 levels. CH50, C3 and Factor B were however significantly lower in those children who had a rapid onset of illness, were in shock, had signs of septicaemia, had extensive skin purpura, or who died. The presence of detectable meningococcal antigen by Counter Immuno Electrophoresis (CIE) and laboratory evidence of Disseminated Intravascular Coagulation (DIC) also correlated with lower complement levels. The significant reduction in CH50 and Factor B in the more severely affected patients suggests that activation of both classical and alternate pathways occurs in group B meningococcal infection.

Child↗

PubMed1993

Systemic meningococcal infections in patients with acquired complement deficiency.

Congenital deficiency of the late components of the complement may predispose the individual to systemic meningococcal infection. Assuming that patients with acquired complement deficiencies may also have an increased risk of contracting meningococcal infections, a retrospective and prospective study to assess this association was conducted. Over 20 years (1970-1989), 30 patients with meningococcemia or meningococcal meningitis, proven by blood or CSF culture, were treated at the Beilinson Medical Center. Only one patient died of the infection. Risk factors were found in three patients (10%). One had a congenital deficiency of C7, and two had acquired complement deficiency due to systemic lupus erythematosus (SLE) and membranoproliferative glomerulonephritis (MPGN). These latter two patients had low serum concentration of C3 and C4 and reduced complement hemolytic activity before onset of the infection. Since the incidence of culture-proven systemic meningococcal infection in the Jewish population in central Israel is 1/100,000, and the prevalence of SLE and MPGN is, at most, 250/100,000, the finding of two patients with meningococcal infection and these rare disorders is over 100 times the expected incidence. We conclude that patients with acquired complement deficiency are at significant risk of meningococcal infection.

Adolescent↗

PubMed2001

PCR and the investigation of meningococcal infection.

We examined the use of polymerase chain reaction (PCR) in investigating suspected cases of meningococcal infection in Birmingham. Data held by Birmingham Health Authority were interrogated to determine cases of suspected or confirmed meningococcal infection for a 3-year period from April 1996. The microbiology departments of five local hospitals completed a standard proforma about the microbiological investigation of cases and included details of patient age, clinical presentation and method of confirmation of the clinical diagnosis. Of 273 cases, 123 had PCR performed on either cerebrospinal fluid and/or blood. Groups more likely to have a PCR done were those presenting with septicaemia alone, and those in the 5-14 year age group. In 33 cases. PCR was the only positive microbiological result. Over the study period there was increasing but variable use of PCR in the investigation of meningococcal infection and PCR increased the yield of confirmed cases.

Adolescent↗

PubMedDate not supplied

Chemoprophylaxis for bacterial infections: principles of and application to meningococcal infections.

Chemoprophylaxis with antibiotics is both feasible and desirable for prevention of a potentially serious disease when specific groups at risk can be defined and when a safe, effective, and affordable prophylactic agent is available. Although the Advisory Committee on Immunization Practices recommends rifampin for prophylaxis of meningococcal disease, there are failures of treatment and adverse reactions associated with the administration of this drug, and it cannot be used during pregnancy. In 1987, during an outbreak of group A meningococcal disease in Saudi Arabia, the efficacy of a single intramuscular dose of ceftriaxone was compared with the standard regimen of rifampin for eradication of pharyngeal carriage of Neisseria meningitidis among persons at risk. Follow-up cultures indicated successful eradication for 97% of those who received ceftriaxone and 75% of those who received rifampin. Thus, although ceftriaxone exceeds rifampin in fulfilling the criteria for an effective prophylactic agent, recommendations regarding its use still must be made with caution because of limited clinical experience.

Carrier State↗

PubMed1993

Predictors of outcome in acute meningococcal infection in children.

OBJECTIVES: To develop a rapid and sensitive method for identification of patients at risk for organ system failure and death due to acute meningococcal infection, and to evaluate the reliability of the Pediatric Risk of Mortality score in predicting mortality rates from acute meningococcal infection. DESIGN: A prospective study which followed a retrospective analysis. SETTING: The Emergency Department and pediatric intensive care unit (ICU) of a university-affiliated children's hospital. PATIENTS: The hospital records of 86 pediatric patients with acute meningococcal infection during a 5-yr period (group 1) were reviewed. Twenty-two ICU patients (group 2) were then prospectively evaluated, and the occurrence rate of organ system failure was compared with that rate predicted by the model developed from the analysis of group 1. INTERVENTIONS: The occurrence of prognostic factors was compared with the development of organ system failure and death by Fisher's exact test and logistic regression analysis for patients in group 1. The mortality rates for groups 1 and 2 were compared with those rates that were predicted by the use of the Pediatric Risk of Mortality score. MAIN RESULTS: Eighteen of 86 patients in group 1 developed organ system failure, and seven (8.1%) patients died. Logistic regression analysis found that the combination of circulatory insufficiency, peripheral WBC counts of < 10,000 cells/mm3, and coagulopathy best predicted organ system failure. Ten of 22 patients in group 2 developed organ system failure, and two died. All patients with organ system failure exhibited > or = 1 of three identified prognostic factors. The probability of organ system failure occurring was > .5 for nine of ten patients with organ system failure. A total of nine patients in groups 1 and 2 developed multiple organ system failure, and all nine patients died. Based on Pediatric Risk of Mortality scoring, the mortality risk for nonsurvivors ranged from 27% to 94%, compared with 1% to 48% for survivors. The overall mortality rate was consistent with that rate predicted by the Pediatric Risk of Mortality scoring system. CONCLUSIONS: Patients with acute meningococcal infection who exhibit signs of circulatory insufficiency, a peripheral WBC count of < 10,000 cells/mm3, or a coagulopathy have a high probability of developing organ system failure. Death is highly probable when multiple organ system failure develops, and the overall mortality rate is accurately predicted by the Pediatric Risk of Mortality score.

Acute Disease↗

PubMed1995

Sequence variation in class 1 outer membrane protein in Neisseria meningitidis isolated from patients with meningococcal infection and close household contacts.

The meningococcal porA gene encodes the class 1 outer membrane protein which contains the VR1 and VR2 regions responsible for sero-subtype specificity. However, sequence variations may occur within these regions which are not recognised by the currently available subtype antibodies. Since this "silent" microheterogeneity represents a potential hidden source of information, in the current study we have used porA gene sequence analysis to study strains isolated from cases of meningococcal infection and close household contacts. With each of the three subtypes studied, the index cases could be differentiated from each other by sequence variations within at least one of the VR1, VR2 and SV1 regions. In addition, although isolates from close household contacts showed a high degree of homology significant differences could be detected within some family groups. These data demonstrate that it is possible to use sequence information to differentiate between potential sources of infection which appear identical using conventional serological methods.

Amino Acid Sequence↗

PubMed1983

Unusual manifestations of meningococcal infection. A review.

Unusual manifestations of meningococcal infection as pneumonia, pericarditis, endocarditis, arthritis, urogenital infections and acute abdominal disease are seen combined with meningitis or septicemia, but can also appear alone without systemic disease. Incidence, diagnosis, clinical symptoms and therapy are briefly discussed with documentation from literature.

Arthritis↗

PubMed1979

An epidemic of meningococcal infection at Zaria, Northern Nigeria. 3. Meningococcal carriage.

Meningococcal carriage was studied in household contacts of patients with group A meningococcal disease and in controls. The carriage rate of group A meningococci among 1,098 household contacts was low (3.8%) and only slightly higher than the carriage rate found among 416 controls (2.6%). However, higher carrier rates were found among those in close contact with a patient. Carriage was found most frequently among children and young adults and was commoner in adult females than in adult males. Sulphonamides had no effect on carriage and all 60 strains tested in vitro were resistant to sodium sulphadiazine at a concentration of 10 micrograms/ml.

Adolescent↗

PubMed1989

[Study of cardiac function in generalized meningococcal infection based on various biochemical indicators].

The complicated course of meningococcal infection is distinguished by a long-term increase in the level of aspartate transferase and creatine phosphokinase. There were three types of changes in the activity of creatine phosphokinase, while changes in the activity of aspartate transferase were not so diverse. Patients had isolated as well as combined increase in the activity of both these enzymes. Lipid peroxidation was also augmented which corresponded to changes in the level of aspartate transferase. The high level of enzymes in the blood in meningococcal infection is the result of cytolysis as well as myocardial hyperfunction in the acute period of the disease.

Adult↗

PubMedDate not supplied

Diagnosis and stage-related treatment of disseminated intravascular coagulation in meningococcal infections.

Disseminated intravascular coagulation (DIC) is a frequent complication of meningococcal sepsis in children. Despite the availability of potent antibiotics, mortality in meningococcal disease remains high (about 10%), rising to 40% in patients presenting in severe shock and consecutive DIC. As the clinical course and the severity of manifestations of systemic meningococcal infections varies there is a need for early diagnosis of the infection and of the stage of coagulopathy in order to reduce the high mortality rate. Few and rapidly available parameters are needed to classify the wide spectrum of clinical and laboratory findings in patients with DIC. The parameters include partial thromboplastin time, prothrombin time, plasma levels of fibrinogen, antithrombin III (AT III), fibrin monomers and D-dimer concentration, fibrin degradation products and the thrombocyte count. Monitoring the course of hemostasis findings in 28 pediatric patients (age between 3 months and 8 years, mean 3.1 years) with systemic meningococcal infections we observed a change of coagulation parameters already in the first stages of the infection: A prolongation of partial thromboplastin time mean 69.1 sec (range 22-150 sec, normal 30-45 sec), a decrease of prothrombin time to 45.7% (range 13-71%, normal 70-100%) and of AT III to an average level of 70% (normal 85-125%) was found 1 to 4 (-6) hours after admission. The following deterioration of prothrombin time and partial thromboplastin time turned out to be statistically significant (p < 0.05, signed rank test). The monitoring of hemostasis parameters mentioned above made it to possible define the stage of coagulopathy and thus to start a stage related therapy. Treatment consisted of shock control by liquid substitution, compensation of metabolic acidosis, correction of clotting disorders (AT III and heparin in case of pre-DIC; AT III and fresh frozen plasma in case of advanced DIC), antibiotic treatment (beta-lactam antibiotics e.g. cefotaxime or ceftriaxone), and--when necessary--catecholamine infusions. An early assessment of the coagulation disorders in meningococcal disease can be based on few coagulation parameters. Thus an appropriate treatment can be arranged in order to prevent a fatal outcome of meningococcal sepsis and to protect against the development of a Water-house-Friderichsen-syndrome.

Anti-Bacterial Agents↗

PubMed1987

Invasive haemophilus influenzae and meningococcal infections in Finland. A climatic, epidemiologic and clinical approach.

A nationwide epidemiological survey on invasive (blood and/or CSF culture positive) Haemophilus influenzae (HI) and meningococcal infections was performed in Finland in 1976-1980. The mean annual incidence of HI infection was 3.4/100,000 inhabitants (813 cases) vs. 2.0/100,000 (469 cases) of meningococcal infection. HI infections showed no geographical predilection, but meningococcal disease, mainly of group B, was more common in northern than in southern Finland (p less than 0.005). Meningitis accounted for 61% of the HI and 91% of the meningococcal infections. The overall fatality rates were 3.1% and 7.9%, respectively. Children accounted for 94% of the HI and 59% of the meningococcal cases. The overall annual incidence of bacterial meningitis in children (less than 15 years) was 19/100,000; in children less than 5 years it was 52/100,000. HI was the most common (62%) causative agent, followed by meningococci (18%) and pneumococci (5%). The fatality rate was 4%. Major neurological sequelae were found in 5%, minor ones in 16%. It was calculated that 42% of the cases of meningitis could have been prevented by vaccines now available on the market. Vaccines now under field investigation may increase the preventability to about 65%.

Adolescent↗

PubMed1986

[Previous antibiotic treatment in meningococcal infections].

Seventy four cases of meningococcal infection were studied. They attended the "Valle del Nalón" Hospital in Asturias, from february 1979 until january 1985. Seven children died (9.4%). We divided them into two groups: A, without any previous antibiotic treatment when they arrived at the hospital (58 cases), and B, with previous antibiotic treatment (16 cases). All the children who died belonged to group A. Only 56.2% from group B had petechias, contrasting greatly with the 93.1% in group A. The most predominant meningococcus was from the serum group B. In the 22 cases of meningitis brainstem auditory evoked response was carried out to detect any hearing impairment. This was found in 21.7% of the cases.

Child↗

PubMed1989

[Antibodies to meningococcal lipopolysaccharide in different forms of meningococcal infection].

The results of the determination of antibodies to lipopolysaccharide (LPS) in 270 patients with different forms of meningococcal infection and in 816 healthy persons by means of the passive hemagglutination test are presented. The role of antibodies to LPS in the formation of humoral immunity to meningococci in sick children and adults is shown. Different forms of meningococcal infection have been found to have their specific features of the accumulation of antibodies to LPS. As revealed, the time of the sanation of liquor and the level of antibodies to LPS are unrelated, which indicates that antibodies to LPS may play some role in the pathogenesis of meningococcal infection.

Adult↗

PubMed2000

Postnatal mortality from meningococcal infections during the period 1950-1991 in the US.

Research has been conducted on the relationship between postnatal mortality from meningococcal infections and age, using data from the US during the period 1950-1991. The logarithm of mortality caused by meningococcal infections fell linearly with the logarithm of age, during the interval of 1-30 years for men and women in the US. The slope of this straight line is equal to -1. The mortality from meningococcal infections is inversely proportional to the age in the US. The risk of death at age 2 is one half of the risk at age 1, at age 3 it is one third of the risk of death at age 1, etc. up to the age of 30 in the US. The same decline was observed for the risk of death from congenital anomalies and pneumonia.

Adolescent↗

PubMed1983

Increased tissue thromboplastin activity in monocytes of patients with meningococcal infection: related to an unfavourable prognosis.

In 16 patients, 13 with meningococcal infection and 3 suspected to have this infection, 8 patients were found to possess significant higher level of tissue thromboplastin activity of their monocytes isolated from the blood at the admission to the hospital than normal. Five of those 8 patients had an extremely high concentration, greater than 60-300 fold increase, and all these patients died. The exposed tissue thromboplastin activity on the surface of the endotoxin stimulated monocytes is probably the direct inducer of disseminated intravascular coagulation (DIC) in meningococcal infection.

Adolescent↗