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PubMed1993

Disseminated meningococcal infection in HIV-seropositive patients.

OBJECTIVE: Although increasing numbers of infections due to various bacterial pathogens have been described in HIV-infected individuals, there have been few reports to date of disseminated Neisseria meningitidis infections in such individuals. We describe here the presentation and clinical course of systemic meningococcal infection in two HIV-1-seropositive men and the response to meningococcal vaccine in one. DESIGN AND METHODS: Retrospective analysis of case reports of two patients identified in a municipal hospital in Denver, Colorado, USA, and evaluation by enzyme-linked immunosorbent assay of antibody response to quadrivalent (A, C, Y, W-135) meningococcal vaccine. RESULTS: A 27-year-old HIV-seropositive man with bacteremic group Y meningococcal pneumonia and a 45-year-old man with AIDS and group B meningococcal arthritis both responded to short-term antibiotic therapy without recurrence. The second patient responded to meningococcal vaccination with seroconversion to all four serogroups. CONCLUSIONS: Disseminated meningococcal infection, although rare in HIV-infected individuals, may present with a variety of clinical manifestations and responds well to antibiotic therapy. Meningococcal vaccine appears to be immunogenic in such individuals.

AIDS-Related Opportunistic Infections↗
PubMed1991

[The characteristics of the serological diagnosis of meningococcal infection in children in the 1st years of life].

The results of clinico-immunological examination of 181 children, aged 1 month to 6 years, with generalized forms of meningococcal infection are presented. In children under observation antimeningococcal antibodies to group-specific meningococci of the main groups A, B and C were determined over the course of the disease by passive hemagglutination (PHA) test and enzyme immunoassay (EIA). The level and frequency of seroconversion were found to depend on the patient's age and the severity of the clinical course of meningococcal infection. Antibody level was found to increase simultaneously with respect to several meningococcal polysaccharides: A, B in 18.5% and A, B, C in 3.3% of cases. In the clinical interpretation of data obtained in the PHA test and EIA not only the patient's age, the form and duration of meningococcal infection, but also serotherapy should be taken into consideration, as the latter may distort the serological results.

Aging↗
PubMed1985

[Pathogenetic and pathomorphological problems of viral-bacterial associations in children dying of meningococcal infection].

The information on 63 children dying from hypertoxic forms of meningococcal infection is presented. Four groups of brain damage by respiratory viruses (RV) are distinguished on the basis of the results of morphological and virological examination: 1) with a recent RV generalization (26 cases); 2) with dissemination of an etiological agent but without clear-cut structural changes (6 cases); 3) with an isolated affection of the brain (13 cases); 4) without clear-cut brain damage. Experimental influenza-meningococcal infection was reproduced in 260 white rats. Enhancement of the animal death rate, multiplication of virus and the degree of brain damage in cases of combined action of both etiological agents is demonstrated. The ability of influenza virus, when inoculated intranasally together with meningococcus, to penetrate and to multiply in the brain provoking meningitis and choroiditis is shown virologically, histologically and electron microscopically.

Adenovirus Infections, Human↗
PubMedDate not supplied

Management of meningococcal infections.

The last 5 years has seen an increase in the number of cases of meningococcal infection. Despite the availability of highly active antibiotics, the mortality from this infection remains at 10%, rising to 40% in patients presenting in severe shock. Here we describe the spectrum and pathophysiology of meningococcal infections, and the most important aspects of treatment and management.

Bacteremia↗
PubMed1986

[Epidemiological characteristics of meningococcal infection in Cuba].

The results of the epidemiological analysis of the morbidity rate in meningococcal infection for 1976-1984 are presented. The maximum rise of morbidity rate, equal to 14.4 per 100000 of population, was observed in 1983. Primarily, the rise of morbidity rate in 1979 was induced by meningococci of two serogroups: C (44.6%) and B (36.4%). The vaccinal prophylaxis of the population, carried out in 1979 with the use of polysaccharide vaccine A + C, did not affect morbidity caused by group B meningococci. The isolation rate of these organisms reached 98.7% from patients and 81.0% from carriers. The characteristic feature of the epidemic process of meningococcal infection in Cuba was a considerable increase in the number of patients under 1 year of age and the absence of seasonal fluctuations in morbidity rate.

Adolescent↗
PubMed1998

Changing patterns of antibiotic sensitivity and resistance during an outbreak of meningococcal infection in Jos, Nigeria.

Isolates of Neisseria meningitidis from blood and cerebrospinal fluid (CSF) of 87 children admitted to the emergency paediatric unit (EPU) at the Jos University Teaching Hospital (JUTH) during an outbreak of meningococcal infection (between February and April 1996) were tested against the commonly used antibiotics in an attempt to determine the sensitivity and resistance pattern. There were 11 (15.1 per cent) positive for N. meningitidis out of 73 blood cultures and 61 (70 per cent) positive out of 87 CSF cultures. Seventy-seven and thirty-eight per cent respectively of the CSF isolates were resistant to benzylpenicillin and ampicillin. Sensitivity to chloramphenicol and erythromycin was 97 and 95 per cent, respectively. Out of the 11 positive blood cultures, 82 and 27 per cent were resistant to benzylpenicillin and ampicillin, respectively, while all the isolates (100 per cent) were sensitive to chloramphenicol and erythromycin. It is concluded that in view of the high level of resistance of the meningococci to benzylpenicillin in our environment, this drug should no longer be the drug of choice for the empirical and initial treatment of meningococcal infection. We recommend that chloramphenicol be the drug of choice for the empirical and initial treatment of meningococcal infection in our environment.

Anti-Bacterial Agents↗
PubMedDate not supplied

Frequency of myocarditis in cases of fatal meningococcal infection in children: observations on 31 cases studied at autopsy.

The frequency of myocarditis associated with meningococcal disease in children was reported only in two autopsied series (United States and South Africa). Here we report the frequency of associated myocarditis in 31 children who died of meningococcal infection at Hospital Infantile N.S. da Glória in Vitória, Espirito Santo State, Brazil. The diagnosis was confirmed by isolation of Neisseria meningitidis. At least three sections of fragments of both atria and ventricles were studied using the Dallas Criteria for the morphologic diagnosis of myocarditis. The mean age was 47.6 +/- 39.8 months and the mean survival time after the onset of symptoms was 46.1 +/- 26.5 h (12-112 h). Myocarditis was present in 13 (41.9%) patients, being of minimal severity in 11 cases and of moderate severity in 2 cases. There were no cases with severe diffuse myocarditis. The frequency of myocarditis was not influenced by sex, presence of meningitis, survival time after the onset of symptoms or use of vasoactive drugs. The frequency of myocarditis reported here was intermediate between the values reported in the only two case series published in the literature (57% in the United States and 27% in South Africa). Although our data confirm the high frequency of myocarditis in meningococcal disease, further investigations are necessary to elucidate the contribution of myocarditis to myocardial dysfunction observed in cases of meningococcal infection in children.

Autopsy↗
PubMed2000

Outbreak of group C meningococcal infection affecting two preschool nurseries.

Five cases of meningococcal infection caused by Neisseria meningitidis group C type 2a, subtype P1.5, P1.2 occurred within six days. Two of the affected children attended the same preschool nursery. The mother of two other children at the nursery was affected, as were the mother and sibling of another child (not a case) at the nursery. The 'sibling' case attended a different nursery. As the situation evolved, the control aspects of the outbreak changed. Antibiotic prophylaxis and vaccination were given to all staff and children attending both nurseries, and to parents, siblings, and household contacts of all children attending the first nursery.

Adult↗
PubMed1981

[Level of rosette-forming cells in patients with meningococcal infections].

In patients with the generalized form of meningococcal infection a disease in the level of T-lymphocytes was revealed at early stages of the disease. This decrease correlated with the gravity of the process. On week 2 of the disease an increase in the level of B-lymphocytes was observed, which probably occurred due to the appearance of the clone of antibody-producing precursor cells. The content of specific rosette-forming cells, carrying receptors to the cell-wall antigens of group A and C meningococci, increased in the blood of patients on week 1 of the disease, which did not correlate with the increase of the titer of specific antibodies on weeks 2-3.

Adolescent↗
PubMed2001

Recombinant Neisseria meningitidis transferrin binding protein A protects against experimental meningococcal infection.

To better characterize the vaccine potential of Neisseria meningitidis transferrin binding proteins (Tbps), we have overexpressed TbpA and TbpB from Neisseria meningitidis isolate K454 in Escherichia coli. The ability to bind human transferrin was retained by both recombinant proteins, enabling purification by affinity chromotography. The recombinant Tbps were evaluated individually and in combination in a mouse intraperitoneal-infection model to determine their ability to protect against meningococcal infection and to induce cross-reactive and bactericidal antibodies. For the first time, TbpA was found to afford protection against meningococcal challenge when administered as the sole immunogen. In contrast to the protection conferred by TbpB, this protection extended to a serogroup C isolate and strain B16B6, a serogroup B isolate with a lower-molecular-weight TbpB than that from strain K454. However, serum from a TbpB-immunized rabbit was found to be significantly more bactericidal than that from a TbpA-immunized animal. Our evidence demonstrates that TbpA used as a vaccine antigen may provide protection against a wider range of meningococcal strains than does TbpB alone. This protection appears not to be due to complement-mediated lysis and indicates that serum bactericidal activity may not always be the most appropriate predictor of efficacy for protein-based meningococcal vaccines.

Animals↗
PubMed1996

[The enzyme activity and pyruvate, lactate and 2,3-DPG levels in the erythrocytes of patients with severe forms of meningococcal infection and suppurative meningitis].

Red cell metabolism (RCM) was examined in 63 patients with severe and complicated meningococcal infection and purulent meningitis of another etiology. There were complex pathobiochemical shifts with changes in glycolysis (in activity of lactate dehydrogenase, piruvatkinase, in the amount of piruvate, lactate and 2,3-DPG), antioxidant status (in the activity of glucose-6-phosphate-dehydrogenase, glutathione reductase), Mg+2, Na+, K(+)-dependent ATPase. Primary depression of red cell metabolism changed for compensatory activation for hypoxia adaptation in clinical improvement. RCM disturbance coincided with emergence of early complications and reached maximum in lethal outcome. Pathogenetic and clinical implications of RCM in meningococcal infection and purulent meningitis are described.

2,3-Diphosphoglycerate↗
PubMed1984

[Immunoenzyme method in the diagnosis of meningococcal infections].

The materials on the development and use of the test system, based on the enzyme-linked immunosorbent assay (ELISA) and intended for the detection of specific group A and C meningococcal polysaccharides and type b Haemophilus influenzae polysaccharide in the spinal fluid of patients, are presented. In this work commercial preparations manufactured in the USSR were used, and all parameters of the assay were developed on the basis of these preparations. The study was made on the samples of spinal fluid from 410 patients; of these, 203 had meningococcal infection, 57 had purulent bacterial meningitides and 150 had other diseases (acute respiratory diseases, influenza, etc.). As demonstrated by the results of this study, ELISA proved to be a highly specific and sensitive technique. In the investigation of the spinal fluid samples from the patients with meningococcal infection the use of ELISA with bacteriological techniques increased the number of positive results to 67%; with countercurrent electrophoresis, to 78%; and with bacterioscopy, to 83.8%. ELISA is recommended for practical use as an auxiliary laboratory technique and as a rapid method for the diagnosis of meningococcal infection.

Animals↗
PubMedDate not supplied

[An analysis of the epidemic cycle of meningococcal infection in Russia (1969-1993)].

In this work the specific features of the epidemiological rise of morbidity in meningococcal infection in Russia for the period of 25 years are analyzed. Some factors influencing the intensity of the disease, such as etiology, specific features arising from the age of patients, social and territorial factors, are analyzed. Two waves of epidemic have been established in a single epidemic cycle. The first wave of epidemic was caused by meningococci of group A and characterized by the prevalence of city-dwellers among the patients; the second wave was caused by meningococci of groups A and B with the prevalence of the latter, especially during the period of the slump of the wave. The "Asiatic" and "European" types of morbidity were distinguished (in Moscow and St. Petersburg). The analysis of the epidemic cycle of meningococcal infection indicates the expediency of the development of new specific wide-profile preparation for prophylaxis.

Adolescent↗
PubMed2000

[Development and testing of polymerase chain reaction method for detection of meningococcal infection pathogen].

A system of primers has been developed for the diagnosis of meningococcal infection has been developed on the basis of the polymerase chain reaction (PCR). Specificity and sensitivity of detection of N. meningitidis has been evaluated in analysis of the model clinical specimens. The proposed test system was tried in detection of N. meningitidis in nasopharyngeal discharge specimens from patients with acute nasopharyngitis and normal subjects from the focus of meningococcal infection.

Humans↗
PubMed1989

Secondary cases of meningococcal infection among close family and household contacts in England and Wales, 1984-7.

To determine the incidence of secondary meningococcal infection in close family and household contacts of index patients and to review the efficacy of chemoprophylaxis the records of 3256 cases occurring from 1984 through 1987 were examined. Seventeen secondary cases (0.5%) of infection were identified among these groups. The median interval between index and secondary cases was seven weeks. Fourteen secondary cases occurred more than one week after the disease was diagnosed in the index case. Three secondary cases had not received chemoprophylaxis and in another case the infecting strain had acquired resistance to rifampicin. Prophylaxis for the close contacts of 10 out of 11 of the remaining index patients failed to fulfil all the criteria of an optimal regimen. Even after optimal chemoprophylaxis the medical practitioner and the family should be aware of the increased and prolonged risk of secondary meningococcal infection among close contacts of patients with the disease.

Adult↗
PubMed1985

The epidemiology of meningococcal infections in England and Wales, 1912-1983.

The epidemiology of meningococcal infections that arose in England and Wales during the period 1912-1983 has been reviewed. The outcome of meningococcal disease was dramatically improved when treatment with sulphonamides was introduced. With the emergence of sulphonamide-resistant strains, penicillin has become the drug of choice. Despite modern treatment, however, the mortality ratio during the last 30 years has remained about the same. Prompt diagnosis as well as immediate and effective treatment are cardinal needs. Even so, when infection is overwhelming there is little chance of saving the patient. Immunisation is probably the only effective answer but as yet there is not an effective vaccine to prevent group B infections which predominate in this country.

Age Factors↗
PubMed1996

[Epidemiology of meningococcal infections in military communities within the catchment area of the Military Medicine Institute in Plzen 1994-1995].

The authors submit information on the epidemiological position as regards the prevalence of invasive meningococcal diseases in military communities on roughly half the territory of the Czech Republic in 1994-1995. For illustration of the clinical picture the authors present brief case-histories focused on the development of the different diseases before admission to hospital. The authors submit results of examination of carriership of Neisseria meningitidis in military communities focused on the serological group C. Analysis of the epidemiological position and surveillance of meningococcal infections conducted by the National Reference Laboratory for meningococcal infections in the National Institute of Public Health and facilities of the military hygiene and epidemiological service in 1993-1995 were the basis for joint sessions which culminated by the decision to start vaccination of Czech Army conscripts, starting in July 1995. This procedure was approved by the Chief Hygiene Officer of the Czech Republic and it was recommended to continue monitoring of carriership in vaccinated groups of conscripts.

Adolescent↗