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PubMed1987

[Epidemiological characteristics of meningococcal infection in a number of territories of the RSFSR (1969-1984)].

In this work the dynamics and morbidity level in respect of meningococcal infection at 11 territories of the RSFSR at the period of 1969-1984 are analyzed. The study covered altogether 16 cities and 211 districts. The role of big cities as the sources of infection spreading into rural areas and further "fixation" of this infection mainly in regions with a population of 60,000 and more had been established. The data on meningococcal morbidity and carriership among different age groups are presented. The study has shown a pronounced increase in the incidence rate of meningococcal infection among children aged up to 2 years, as well as an increase in the proportion of these children among patients with meningococcal infection in recent years.

Age Factors↗
PubMed1988

[Characteristics of the mechanism of the development of the epidemic process in meningococcal infection in organized collectives].

The specific features of the epidemiology of meningococcal infection in organized groups have been established after comprehensive (epidemiological, microbiological and immunological) studies, evaluated from the viewpoint of the law of the autoregulation of the epidemic process. The studies have revealed the phenomenon of the adaptive biological variability of meningococci with their prolonged reservation due to the transformation of typical bacterial forms of meningococci characterized by strict serogroup specificity and typical fermentative activity into serologically and biochemically undifferentiated forms, capable of prolonged persistence in human populations. The model demonstrating the development of the epidemic process in meningococcal infection in an organized group has been worked out.

Carrier State↗
PubMed1976

[Comparative effectiveness of ampicillin and benzylpenicillin in generalized forms of meningococcal infection].

Two groups of 49 patients each with generalized forms of meningococcal infection were observed. The patients of the 1st group were treated with ampicillin in a dose of 200-400 Units/kg and the patients of the 2nd group were treated with benzylpenicillin in a dose of 200000-300000 Units/kg of the body weight daily. Comparison of the ampicillin and benzylpenicillin liquor levels showed that benzylpenicillin was more persistent during the whole period between the injections. The indices of the patients' recovery in the groups observed did not differ significantly, which provided a conclusion that ampicillin was clinically effective and may be recommended as an independent etiotropic drug for treatment of generalized forms of meningococcal infection.

Adolescent↗
PubMedDate not supplied

[Meningococcal infection caused by Neisseria meningitidis serogroup C].

BACKGROUND: In recent years an increase has been observed in the prevalence of meningococcal infection by Neisseria meningitidis serogroup C and in the appearance of strains with moderate resistance to penicillin. PATIENTS AND METHODS: A microbiologic study of the cases of meningococcal infection of serogroup C treated from 1995 to 1996 in the health care area of Ferrol (La Coruña, Spain) was carried out. RESULTS AND CONCLUSIONS: Twenty-nine cases were detected in 1995 and 28 in 1996. Meningococcal infection was observed in patients ranging from 8 months to 21 years of age (mean 5.7 years). Distribution by sex was homogeneous. Two patients died. According to the clinical presentation, 11 were sepsis (38%), 4 meningitis (14%) and 14 both processes (48%). In 4 LCR samples, the analytical study was normal with posterior positive culture results. The detection of bacterial antigen by latex agglutination in CSF only detected 32% of the cases. MIC study determined that 11 strains (38%) presented moderate resistance to penicillin, 9 with a MIC of 0.12 microgram/ml, one with a MIC of 0.25 microgram/ml and another with a MIC of 0.5 microgram/ml. In all the cases the strains were sensitive to cefotaxime (MIC < or = 0.06 microgram/ml) and rifampicin (MIC < or = 0.5 microgram/ml). All the strains belonged to serogroup C serotype 2b, serosubtype P1.2,5. During the study period 4 additional cases of meningococcal disease by serogroup B were observed.

Adolescent↗
PubMed1994

Hereditary deficiency of the seventh component of complement and recurrent meningococcal infection: investigations of an Irish family using a novel haemolytic screening assay for complement activity and C7 M/N allotyping.

Terminal complement component deficiency predisposes to meningococcal infection and is inherited in an autosomal co-dominant manner. An Irish family is described, in which 2 of 3 brothers had recurrent meningococcal infection. A novel screening assay was used to investigate for terminal complement deficiency and the 2 affected brothers were found to be completely deficient in the seventh component of complement (C7). Enzyme-linked immunosorbent assay for C7 revealed lower than normal levels in the remaining brother and parents. C7 M/N protein polymorphism allotyping, used to investigate the segregation of the C7 deficiency genes, showed that the apparently complement sufficient brother was heterozygous C7 deficient and a carrier of one of the deficiency genes. Complement screening should be carried out in any individual suffering recurrent meningococcal infection or infection with an uncommon meningococcal serogroup. Identification of complement deficient patients allows the implementation of strategies to prevent recurrent infection.

Adolescent↗
PubMed1988

[The role and place of serologic research in the system of epidemiologic surveillance of meningococcal infection].

The results of serological surveys, carried out with a view to the detection of capsular meningococcal polysaccharides in the passive hemagglutination (PHA) test and covering 1,289 patients with systemic meningococcal infection, 221 patients with bacteriologically confirmed meningococcal nasopharyngitis, 2,820 persons in organized groups of children and adults with different epidemiological situation (including 650 carriers) and 4,050 residents of 8 cities with different morbidity levels, were analyzed. The patients, the carriers and the members of organized groups underwent multiple surveys. As shown in this study, the confirmation of the meningococcal etiology of the systemic forms of meningococcal infection (meningitis, meningococcemia) in all cases with the exception of children under 1 year of age, as well as the determination of the groups of meningococci, could be achieved in the PHA test twice as frequently, i.e. in 60-70% of cases, as with the use of the bacteriological method. The same regularities were observed in nasopharyngitis. The conclusion was made on the possibility of using the PHA test for more exact determination of the group of meningococci, prevailing at the initial stage of diseases, this determination playing an essential role in the epidemiological surveillance. The data obtained as the result of serological surveys in organized groups may lead to conclusions on the circulation of meningococci and their group composition, thus showing the necessity of profound epidemiological study with ensuring epidemic-control measures. The selective serological study of some hundreds of donor sera is not expedient in big cities, as it provides no data on the circulation of meningococci there.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Bacterial↗
PubMed1996

[Definitions of sepsis in severe juvenile meningococcal infection. A review of 80 cases].

OBJECTIVE: To describe the definitions for sepsis proposed by ACCP/SCCM Consensus Conference and to evaluate its capacity to classify children with severe meningococcal infection in homogeneous risk groups. METHODS: Eighty children with acute meningococcal infection and severe sepsis or septic shock, admitted to the pediatric ICU during a ten years period were reviewed. Mean age: 38 months (1,3 mo-14 yrs). RESULTS: N. meningitidis was isolated in 84%. Sixty-four percent of the patients were bacteremic and 39% showed a positive culture in CSF. Overall mortality was 19%. Fifty-two patients (65%) were in severe sepsis on admission, fifteen of them (29%) developed shock, mortality for this group was 4%. Twenty-eight patients (35%) were in septic shock on admission, mortality was 44%. Overall mortality of the shock group was 35%, mortality of shock on admission was higher than mortality of shock postadmission (44% vs 13%, p = 0.0001). Major complications were: DIC (28%), ARDS (26%), purpura fulminans (21%). There were not major complications or deaths in patients who did not develop shock. Bacteremia was not significant associated with shock or death. Meningitis was more frequent in severe sepsis group but 62% of deaths got it. Univariant analysis showed significant differences between both groups relative to tissular perfusion variables, coagulation and meningeal involvement. Multivariate analysis allowed us to establish a predictive model of survival feasible on admission to the ICU. For its determination three parameters are used: blood pressure, platelets and base excess. CONCLUSION: Definitions proposed for severe sepsis and septic shock are a valuable tool to classify children with acute meningococcal infection in homogeneous risk groups.

Acute Disease↗
PubMed1978

Evaluation of the prophylactic effect of gamma globulin in meningococcal infection.

Results of two controlled epidemiological tests evaluating the prophylactic effect of gamma globulin of Monogolian and Soviet production against meningococcal infection are presented. Observations were carried out on children aged 3 months to 4 years, not attending children's establishments. The results of the observation revealed the following prophylactic effect of gamma globulin of Mongolian production in the first two months after administration: index of efficiency--5.0, coefficient of efficiency--80%, P greater than 0.01. The efficiency of the prophylactic effect of Soviet gamma globulin was limited to one month: the index of efficiency amounted to 5.3, the coefficient of efficiency to 82.2%, P greater than 0.01. The course of meningococcal infection in the children who had received gamma globulin was less severe than in the children of the control group. Lethal outcome was recorded only in the group of children who had not received gamma globulin. The duration of the prophylactic effect of gamma globulin was found to depend on the height of the titres of specific antibodies in the preparation. The preparations are recommended as prophylactic means for children aged from 3 months to 4 years in doses of 1.5 ml (one dose) in the foci of meningococcal infection.

Child, Preschool↗
PubMed1984

[Cross-reacting intraspecies antigens of Neisseria meningitidis. II. The dynamics of antimeningococcal antibodies to cross-reacting antigens in different forms of meningococcal infection].

The presence of antibodies to meningococci has been determined in the sera of 203 patients with meningococcal infection and 234 healthy persons by means of the indirect hemagglutination tests with the use of polyvalent erythrocyte diagnosticum. The tests have shown that antibodies to cross-reacting antigens can be detected both in patients with generalized forms of meningococcal infection and in healthy persons; the level and occurrence of these antibodies depend on the age of the subjects under examination and the form taken by the course of meningococcal infection. The study has revealed that the background level of antibodies to meningococci in healthy persons is mainly formed due to meningococcal carriership. Antibodies to cross-reacting meningococcal antigens have been shown to be capable of being transferred transplacentally.

Adult↗
PubMed1975

[Pericardial lesion in meningococcal infection].

The study was carried out in 52 patients with a severe course of meningococcal infection. In two of them having meningococcemia and in three with meningococcal meningitis and meningococcemia the disease was complicated by concomitant symptoms of allergic pericarditis. Complex therapy with steroid hormones, antibiotics, oxygen, cardiac glycosides and vitamins was effective in meningococcal infections complicated by myo- and pericarditis but failed to prevent their development.

Adolescent↗
PubMed2005

Risk factors for death from meningococcal infection in Recife, Brazil.

To determine the case fatality rate and risk factors for death in children with invasive meningococcal infection, 163 children admitted with meningococcal disease to the Instituto Materno Infantil de Pernambuco, a tertiary paediatric teaching hospital in Recife, Brazil, were included in this retrospective cohort study. Cases were categorised as meningitis, septicaemia and septicaemia with meningitis. Forty-six (28.2 per cent) children had meningitis alone, 88 (54 per cent) septicaemia and meningitis and 29 (17.8 per cent) only septicaemia. Four of the patients with meningitis died (8.7 per cent), compared to 31 out of the 88 (35.2 per cent) with septicaemia and meningitis and 18 of the 29 (62.1 per cent) with septicaemia alone (p < 0.001). Symptoms <24 h (AOR 3.8, 95 per cent CI 1.1-13.1), platelet count <100 000 mm(3) (AOR 13.8, 95 per cent CI 3.1-60.9) and acidosis (AOR 6.0, 95 per cent CI 1.7-21) were the significant risk factors for death. Invasive meningococcal infection has a high case-fatality rate in this tertiary centre in Recife, especially in the septic forms. The identification of risk factors for death could contribute to the early recognition of patients with higher risk on admission in a middle-income country population.

Adolescent↗
PubMed1977

Serum immunoglobulin levels in various forms of meningococcal infection and in meningococcus carriers.

The levels of serum IgG, IgA and IgM were examined in 191 adults including 103 patients with various forms of meningococcal infection, 32 meningitis convalescents and 56 carriers, in order to elucidate the causes of different susceptibility to the meningococcal infection. The IgD level was determined in 54 meningitis patients as well as in convalescents and carriers. The amount of immunoglobulins was determined by radial immunodiffusion. The level of IgG at the beginning of the disease in patients with the generalized forms of meningococcal infection (meningitis, meningitis combined with meningococcaemia, meningococcaemia) was found to be considerably lower than in healthy subjects. The levels of all immunoglobulins, particularly of IgA and IgM, increased in the course of the disease. The levels of IgG, IgA and IgM in meningitis convalescents a year after recovery were found to be the same as in the controls. The levels of IgG, IgA and IgM in patients with meningococcal nasopharyngitis were significantly lower than in healthy subjects. The carriers showed a decreasd level of IgA and a considerably increased level of IgG while the levels of IgM and IgD did not differ from the control.

Carrier State↗
PubMed1975

[Vascular and immunological processes in the pathogenesis of meningococcal infection].

A pathomorphological investigation of 115 lethal cases of various forms of meningococcal infection was carried out. Meningococcemia, its instantaneous forms in particular, are characterized by acute decompensation of the lymphoid system and generalized microangiopathy with the thrombohaemorrhagic syndrome. Haemorrhagic necrosis of the adrenals and damage of the hypophysis represented manifestations of the acute decompensation of the hormonal regulation. Inflammatory changes in meningococcemia were observed not in all the cases (they were absent in 1/4 of the deceased). In meningitis (meningoencephalitis) without sepsis no generalized angiopathy was noted, immunomorphological changes were of a proliferative character. Previous sensibilization of the macroorganism was an important prerequisite for the development of meningococcal infection.

Acute Disease↗
PubMed1996

Interleukin-6 and its soluble receptor during acute meningococcal infections: effect of plasma or whole blood exchange.

OBJECTIVES: To determine the pattern of the soluble interleukin (IL)-6 receptor during acute meningococcal infections and recovery phase, and to measure the effect of plasma or whole blood exchange on the plasma concentrations of these mediators. DESIGN: Prospective, descriptive patient study. SETTING: University hospital intensive care unit. PATIENTS: Patients with bacteriologically proven meningococcal infections were entered in the study. Three group were formed: a) patients with meningitis without shock (group A); b) patients with meningitis and shock (group B); and c) patients with shock only (group C). INTERVENTIONS: Part (n = 9) of the patients with shock underwent plasma or whole blood exchange. MEASUREMENTS AND MAIN RESULTS: Serum concentrations of interleukin-6 and soluble IL-6 receptors were determined sequentially during the acute and recovery phases. Peak concentrations of IL-6 were highest in group C, followed by group B and group A. Soluble IL-6 receptor concentrations showed an opposite pattern and were all below normal. Soluble IL-6 receptor concentrations were negatively correlated with the IL-6 concentrations. During recovery, IL-6 rapidly decreased and soluble IL-6 receptors increased to supranormal concentrations, after which concentrations returned to normal. Plasma or whole blood exchange did not significantly influence IL-6 concentrations but did increase the soluble IL-6 receptor concentration directly after an exchange session followed by a rapid decrease. CONCLUSIONS: Soluble IL-6 receptor concentrations are low in acute meningococcal infections. Plasma or whole blood exchange temporarily increases these concentrations. It needs to be determined whether the effect of this therapy is beneficial to the patient.

Acute Disease↗
PubMed2002

Meningococcal infections in children from Arkansas.

BACKGROUND: Infections with Neisseria meningitidis are an important cause of morbidity and mortality in children of all ages. With wide-spread use of the heptavalent pneumococcal conjugate vaccine, this organism might become the prominent pathogen for invasive disease in children. METHODS: Retrospective reviews of medical and microbiologic records from Arkansas Children's Hospital were done to identify patients with invasive N. meningitidis infections from January, 1988, through December, 2000. Basic demographic and clinical data were gathered and reviewed. Data on invasive meningococcal infections were obtained from the Arkansas Department of Health. RESULTS: Three hundred ninety-four cases of invasive meningococcal infection were reported to the Arkansas Department of Health during the study period. Two hundred ninety-six cases were in patients <21 years of age. The estimated annual incidence of meningococcal disease for the State of Arkansas was calculated to be 1.2-cases/100000 population during the study period. The annual incidence of meningococcal disease in patients <21 years of age was estimated at 2.9 and 21.7 cases/100000 population for children < 1 year of age. One hundred fifty patients (51%) <21 years of age with 151 episodes of invasive meningococcal infections were treated at our institution. Eighty percent of the patients were Caucasian, 55% were male, 31% live in a rural area and the median age at presentation was 30 months (range, 2 weeks to 21 years). The most common signs and symptoms at admission included fever (95%), petechial/purpuric rash (62%), nuchal rigidity (41%) and hypotension (41%). Thirty-eight patients (26%) required both inotropic support and mechanical ventilation during hospitalization, 15 patients died and 18 patients had long term sequelae. Eighty-three of the isolates were serogrouped and included the following: A (2); B (38); C (33); and Y (10). Eighty-four of the index cases were treated with parenteral cephalosporin therapy alone and did not receive additional chemoprophylaxis. CONCLUSIONS: Many infections in the general pediatric population are a result of N. meningitidis. Although most patients do well and recover without sequelae, there are a significant number who experience major morbidity and mortality as a result of this infection.

Adolescent↗
PubMed1989

Meningococcal infections in children: a review of 100 cases.

One hundred children with meningococcal infection diagnosed from January 1, 1985, to February 29, 1988, were reviewed. Clinical manifestations ranged from fever alone to fulminant septic shock with purpura fulminans. Twenty-nine percent of the children presented without skin lesions. Of the 55 patients with meningitis, 6 lacked cerebrospinal fluid abnormalities on initial lumbar puncture but cerebrospinal fluid cultures were positive. An overall case fatality rate of 10% was noted with the following poor prognostic indicators identified: hypothermia; seizures or shock on presentation; a total peripheral white blood cell count less than 5000/mm3; a platelet count less than 100,000/mm3; and the development of purpura fulminans. Meningococcal infections remain an important cause of morbidity and mortality in children. Infections caused by Neisseria meningitidis (including meningitis) should be considered even in the absence of skin lesions or cerebrospinal fluid abnormalities.

Adolescent↗
PubMed2006

[Invasive meningococcal infections: two cases that demonstrate the broad spectrum in clinical manifestation and outcome].

Invasive meningococcal infections show a broad clinical picture including sepsis and meningitis. Here we report on a case of sepsis and a case of meningitis, two clinical manifestations of meningococcal infections with striking differences in the clinical presentation and outcome. Meningococcal sepsis is characterized by a systemic release of endotoxins, that triggers an intense cytokine response of the host that can lead to shock and multi organ failure and death within hours. Meningococcal meningitis occurs when bacteria breach into the subarachnoidal and ventricular space during bacteremia and mortality is much lower that in sepsis. Thus meningitis may be seen as a consequence of lower pathogenicity and/or more efficient host control of the meningococci compared to sepsis.

Adolescent↗