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PubMed2001

Primary meningococcal arthritis in a prosthetic knee joint.

Neisseria meningitidis is known to cause a spectrum of diseases, including bacteraemia without sepsis, meningococcaemia without meningitis, meningitis with or without meningococcaemia, and chronic meningococcaemia. Less common manifestations of meningococcal infection include pharyngitis, pneumonia, pericarditis, urethritis and arthritis. To our knowledge, there have been no previous reports of N. meningitidis causing prosthetic joint infection. Herein, we report a case of primary meningococcal arthritis in a woman with a prosthetic knee joint. After surgical drainage the prosthesis was retained and the patient received appropriate and prolonged antibiotic treatment. The outcome was favourable, as with primary meningococcal arthritis affecting native joints.

Aged↗
PubMed2003

Antibody-dependent killing of meningococci by human neutrophils in serum of late complement component-deficient patients.

BACKGROUND: Thirty-one Russian patients with late complement component deficiency (LCCD) who had experienced one to five meningococcal infections were immunized with meningococcal polysaccharide vaccine (A + C + W135 + Y) and were followed for 3-8 years. We investigated the potentially protective killing effect of human neutrophils (PMNL) on serogroup A and W135 meningococci. METHODS: Meningococci were incubated in LCCD vaccine sera in the absence or presence of PMNL, and the number of live bacteria (CFU) was determined by plating onto chocolate agar. RESULTS: When meningococci were incubated in the LCCD sera alone, exponential growth of meningococci occurred despite the presence of meningococcal antibodies. After the addition of PMNL, meningococci were inhibited in their growth or even eliminated. Group A or W135 meningococci were killed effectively by PMNL in 80% of the sera which were collected 1 month to 1 year after vaccination compared to only 40% in the prevaccination LCCD sera (p < 0.05). Three years after vaccination 67% of the LCCD sera were still capable of promoting killing (and even 90% after revaccination). The rate of killing correlated with the concentration of serogroup-specific immunoglobulins. In 83% of the 72 LCCD sera with more than 5 microg/ml anti-group A immunoglobulins the killing of group A meningococci was promoted. By contrast, only 21% of 19 samples with lower specific antibody levels showed a PMNL-mediated meningococcal killing (p < 0.05). The same effect was observed for group W135 meningococci. CONCLUSION: PMNL kill meningococci during incubation in LCCD serum; this effect increases after vaccination and depends on both specific antibody and complement. Protection by vaccination may therefore be caused by an increased killing capacity of PMNL.

Adolescent↗
PubMed2006

Australia's notifiable diseases status, 2004, annual report of the National Notifiable Diseases Surveillance System.

In 2004, 60 diseases and conditions were nationally notifiable in Australia. States and Territories reported a total of 110,929 cases of communicable diseases to the National Notifiable Diseases Surveillance System (NNDSS): an increase of 4 per cent on the number of notifications in 2003. In 2004, the most frequently notified diseases were sexually transmissible infections (46,762 cases; 42% of total notifications), gastrointestinal diseases (25,247 cases; 23% of total notifications) and bloodborne diseases (19,191 cases; 17% of total notifications). There were 13,206 notifications of vaccine preventable diseases, 6,000 notifications of vectorborne diseases, 1,799 notifications of other bacterial infections (includes, legionellosis, leprosy, meningococcal infections and tuberculosis) and 877 notifications of zoonotic diseases.

Adolescent↗
PubMed1977

[Post-meningococcal rheumatism (apropos of 3 cases)].

A report is given on 3 cases of arthritis after cerebrospinal meningitis caused by B meningococci, with a relapsing course in 1 case. The observations are compared with the literature and the characteristics of articular manifestations of meningococcal infections are outlined. Three types are distinguished. Type I is characterized by banal arthralgias masked by the symptoms of meningitis. Type II encompasses septic arthritides preceding or concurring with the meningitis and like the latter sensitive to antibiotics. Type III includes postmeningococcal arthritides with sterile articular fluid refractory to antibiotics and showing a spectacular reaction to non-steroid anti-inflammatory drugs. These arthritides constitute a true infective rheumatism, post-meningococcal rheumatism, and should be related to other post-meningococcal manifestations such as pericarditis, myocarditis, cutaneous and ocular changes. All these manifestations are attributed to the production of immune complexes. Postmeningococcal arthritides, whose characteristics are described, may occur after septic meningococcal arthritis or appear as such. The distinction of postmeningococcal rheumatism where only anti-inflammatory treatment is effective might lead to the question whether certain postgonococcal arthritides refractory to antibiotics and responding to anti-inflammatory drugs are not provoked by an immuno-allergic mechanism leading to postgonococcal rheumatism -a nosological entity that has been abandoned possibly too fully and definitively.

Adult↗
PubMed1990

[Persistence and transmission of Neisseria meningitidis in a family with a case of fatal infection].

We described two cases of meningococcal infection in a family. Both were detected in a period of seven months. We studied the epidemiological markers of strains isolated from cases and close contacts of the second case. The isolate of first case is identical to the rest of strains studied and we suggest the possibility of persistence and transmission of infection of the index case to the close contacts and the second case. In this paper it is discussed the application of control measures to eradicate the meningococcus from the nasopharynx of patients after the illness, principally in workers with close contacts with populations at risk and in epidemic periods.

Carrier State↗
PubMed2001

Neurodevelopmental outcome in meningococcal disease: a case-control study.

AIMS: To determine long term neurodevelopmental outcome following the spectrum of meningococcal infection. METHODS: Between 1988 and 1990, 152 cases of meningococcal disease were recruited; 139 survived. Between 1998 and 1999, 115 survivors (83%) were evaluated, together with 115 sex and age matched controls. Standard measures of neurological function, coordination, cognition, behaviour, and hearing were used to assess neurodevelopmental status. RESULTS: One case has spastic quadriplegia. Gross neurological examination was normal in all other cases and all controls. Five cases and no controls have significant hearing loss. Cases performed at a lower level than controls on measures of coordination, cognition, and behaviour. Four cases and no controls had major impairments. The adjusted odds ratios for moderate and minor impairments were 3.6 (95% CI 1.3 to 10.3) and 1.6 (95% CI 0.8 to 3.4) respectively. CONCLUSION: The majority of survivors from this cohort do not have gross neurological deficits. However, when objective measures of motor function, cognitive ability, and behaviour were applied significant detriments were found in meningococcal survivors.

Adolescent↗
PubMedDate not supplied

Invasive meningococcal disease in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

BACKGROUND: Neisseria meningitidis (N. meningitidis) remains the leading worldwide cause of acute bacterial meningitis and fatal sepsis in healthy individuals. MATERIALS AND METHODS: A total of 12 cases of N. meningitidis from patients with invasive meningococcal infections in University of Malaya Medical Centre, Kuala Lumpur during the years 1987-2004 were reviewed together with details of age, sex, disease, risk factors treatment and outcome of these patients. RESULTS: Their ages ranged from 10 months to 64 years (median age 29.75 years). The male to female ratio was 1.42:1. Fever, neck stiffness, headache, vomiting and confusion were predominant symptoms. Upper respiratory tract viral infection and Hajj pilgrimage were directly associated with invasive meningococcal disease. Penicillin or ceftriaxone or both in some cases were administered as empirical therapy. All isolates were sensitive to penicillin, ceftriaxone, chloramphenicol and rifampicin. The case fatality ratio was 1:4. One Hajj pilgrim died despite having received polyvalent meningococcal vaccine. Amongst the survivors, two patients had neurological deficit, hearing loss and arthritis. CONCLUSION: Early antimicrobial therapy has been shown to reduce these adverse outcomes. Clinicians need to be alerted to the presence of the disease in the community and the disease should be made notifiable within 24 hours of detection both for early treatment of cases and to facilitate contact tracing, institution of prophylactic treatment and prevention of secondary cases.

Adolescent↗
PubMed1987

[Meningococcal serogroup B infection].

The results obtained in the examination of patients with meningococcal infection during the period of 1980-1985 are analyzed. The increasing role of serogroup B meningococci in the etiology of the generalized forms of infection, especially in children aged under 3 years and in adults over 50 years, is shown. As noted in this investigation, the disease induced by group B meningococci runs a more severe course. Morbidity caused by this serogroup of meningococci does not result in epidemics in our country. The distribution of patients among different age groups and specific features of the clinical course of the disease in connection with the serogroup of the causative agent make it possible to regard the risk groups as groups with decreased reactivity, which raises doubts concerning the possibility of forming effective postvaccinal immunity against group B meningococci in such persons.

Adolescent↗
PubMed1991

Laboratory-acquired meningococcemia--California and Massachusetts.

Although Neisseria meningitidis is commonly isolated in clinical laboratories, laboratory-acquired infection is rare (1). This report describes two fatal cases of meningococcal infection in laboratory workers; both of these cases probably were laboratory acquired.

California↗
PubMed1979

Meningococcal colonization and infection in children and their household contacts.

A bacteriologic survey was performed to estimate the prevalence and duration of meningococcal carriage in children in Montreal, Canada. Infants and children with proven meningococcal infection, or with asymptomatic meningococcal nasopharyngeal (NP) carriage, and their household contacts, were also studied to define communicability. N. meningitidis was present in 30 (2.4%) of the NP cultures from 1238 asymptomatic infants and children in this civilian population during a non-epidemic period. Meningococcal carriage was not found in 278 subjects 1--60 days of age; there was no difference in carriage rates between the sexes and between hospitalized and non-hospitalized children in all age groups. Meningococci were initially isolated from 11 of 106 household contacts of 29 ill index cases and from 15 of 104 contacts of 29 asymptomatic carriers; 35% of all contacts (index cases and carriers) were colonized by the eighth week of surveillance. Duration of NP carriage was longer (mean 15.2 weeks) in disease-free families than in families of ill patients (mean 5.5 weeks). Serogroups B and C were most commonly isolated from both ill and asymptomatic subjects. Resistance to sulfadiazine (MIC greater than or equal to mg/100 ml) was present in 6.5% and 39.4% of group B and group C strains, respectively. Although chemoprophylaxis was not used, there were no secondary cases among the 29 families of index cases.

Adolescent↗
PubMed1997

Non-culture diagnosis and serogroup determination of meningococcal B and C infection by a sialyltransferase (siaD) PCR ELISA.

Rapid, non-culture, serogroup determination of meningococcal infection is important in contact management where vaccination may be possible. The impending availability of polysaccharide-protein conjugate vaccines for serogroup C disease requires maximal case ascertainment, with serogroup determination, at a time when the number of culture confirmed meningococcal infections is decreasing. A polymerase chain reaction assay (PCR), based on a restriction fragment length polymorphism (RFLP) in the meningococcal serogroup B and C sialytransferase (siaD) gene, was developed to combine the non-culture diagnosis of meningococcal infection from CSF, whole blood and serum with serogroup (B and C) identification. The PCR assay was adapted to an ELISA format incorporating hybridization with serogroup-specific B and C oligonucleotide probes. Specificity for CSFs was 100% and sensitivities were respectively 81, 63 and 30% for CSFs, whole blood and sera. The serogroup-specific PCR ELISA is a significant addition to currently available tests for non-culture diagnosis of meningococcal infection and outbreak investigation.

Base Sequence↗
PubMed1990

Group A meningococcal disease in England associated with the Haj.

An outbreak of group A meningococcal infection amongst the Muslim population in England followed the outbreak of meningococcal disease associated with the 1987 Haj to Mecca. There were 18 primary cases amongst pilgrims returning from Mecca and 15 subsequent cases among Muslims over the following 19 months. The meningococcal strains were shown to be of the same clone as strains from the Mecca outbreak by possession of an outer membrane protein PI.9. Strains of this group A clone (A III-I) had only rarely been encountered in England before this outbreak.

Adult↗
PubMed1972

Murine resistance to inhaled Neisseria meningitidis after infection with an encephalomyocarditis virus.

A reduction in pulmonary anti-bacterial activity due to a preceding viral illness has been suggested as the mechanism responsible for some meningococcal infections of the lung. We investigated this proposed pathogenesis by infecting mice with airborne encephalomyocarditis virus (EMC) and then challenging them 1, 4, and 7 days later with aerosols of Neisseria meningitidis. Meningococcal clearance was assessed by comparing the numbers of bacteria present immediately after inhaling the aerosols with the numbers present 3 hr later. To insure that EMC virus adequately depressed murine defense mechanisms, we also determined staphylococcal killing rates at 4 hr by using radiophosphorus-labeled staphylococcal aerosols. Viral infection depressed murine pulmonary antimeningococcal activity at 1 and 4 days (P < 0.01) but not at 7 days. Intrapulmonary staphylococcal killing was impaired on day 4 (P < 0.01) but not on days 1 or 7. Pulmonary viral titers decreased rapidly from 10(7) to 10(3) plaque-forming units/ml of lung during the experimental period. According to these data viral disease transiently depresses resistance to meningococcal infection. This impairment in host resistance is present while the viral titer is decreasing and follows a relatively similar pattern to the transient decrease noted for staphylococci.

Aerosols↗
PubMed2006

Pneumonia and empyema caused by penicillin-resistant Neisseria meningitidis: a case report and literature review.

Pneumonia is an uncommon manifestation of Neisseria meningitidis infection, and empyema is rarely reported. Uniform penicillin susceptibility has been assumed for meningococcal infections for many years, but decreased penicillin susceptibility has been recognized recently with increasing frequency. Breakpoints to define different categories of susceptibility were published recently by the Clinical and Laboratory Standards Institute. We report the case of a teenage girl with sepsis and extensive bilateral pneumonia with empyema caused by an N meningitidis isolate that was resistant to penicillin. Her protracted clinical course suggested that penicillin resistance contributed to her delayed recovery. Our experience with this patient suggests that susceptibility testing should be performed in every case of N meningitidis isolation, and treatment with a third-generation cephalosporin should be provided until the susceptibility results are known. Clinical suspicion of N meningitidis as a possible cause of respiratory symptoms accompanied by hypotension, even in the absence of a rash, may aid in diagnosis and therefore in the treatment and provision of prophylaxis to contacts of patients with meningococcal disease.

Adolescent↗
PubMed1997

Community immunization programme in response to an outbreak of invasive Neisseria meningitidis serogroup C infection in the Trent region of England 1995-1996.

Between 8 December 1995 and 16 January 1996 seven laboratory confirmed cases of septicaemia owing to infection with Neisseria meningitidis serogroup C strains and one highly probable case of meningococcal septicaemia occurred in three electoral wards in south Rotherham and the Retford area of north Nottinghamshire. All cases occurred among children aged 1-17 years. One patient died. The public health response to this outbreak was the largest community prophylactic antibiotic and immunization programme against meningococcal infection, to date, in the United Kingdom. The target group for each Health Authority was 8900 for Rotherham Health Authorities and 8000 for North Nottinghamshire Health. Local logistical factors led to differences in the implementation of the programme by each Health Authority. At the completion of each programme, 8320 doses of vaccine had been administered (92.5 per cent coverage) during the Rotherham Health Authorities programme and 7660 (95.7 per cent coverage) during the North Nottinghamshire Health programme. The additional financial cost of the exercise amounted to approximately Pounds 125000 for each Health Authority. This paper describes the evolution of the outbreak, the decision-making process resulting in the immunization programme in each Health Authority, the implementation of each programme, problems identified and lessons learned.

Adolescent↗
PubMed1989

Antibody production to a meningococcal outer membrane protein cloned into liv Salmonella typhimurium aroA vaccine strain.

We cloned a 28 kDa outer membrane protein (OMP) of Neisseria meningitidis group B into a live Salmonella typhimurium aroA vaccine strain SL3261. The cloned 28 kDa protein was produced in large amounts in the S. typhimurium transformant SH8182 and located in the outer membrane. A mouse-passaged derivative of SH8182 was used as a live vaccine to immunize mice; with antibiotic pressure the strain survived in the mice as well as the parent strain SL3261 and maintained the plasmid carrying the gene encoding the 28 kDa OMP. The mice produced a high titer of antibodies to the 28 kDa OMP, showing that it had been effectively presented to the immune system. The hyperimmune mouse serum bound in an enzyme immunoassay to whole cells of E. coli and group B meningococci expressing the 28 kDa OMP, but its bactericidal activity towards the meningococci was marginal. In a passive protection study, the antiserum did not protect infant rats from meningococcal infection. The results indicate that the antibodies elicited did not bind to intact meningococcal cells, possibly because of inaccessibility of the 28 kDa OMP.

Animals↗