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PubMed1976

Incidence and etiology of septic meningitis in a metropolitan county hospital.

From January 1, 1969 to December 31, 1974, 98,446 patients were admitted to Ben Taub General Hospital, one of the Harris County District Hospitals and a major teaching institution for Baylor College of Medicine. Spinal fluid specimens from 17,638 (17.9%) patients were cultured, and 787 (4.5%) cultures were positive for pathogenic microorganisms. Haemophilus influenzae, type B, was most frequently isolated (23.8%), followed by Streptococcus pneumoniae (16.0%), Staphylococcus aureus (9%), Neisseria meningitidis (7.3%), and Enterococcus (7.3%). Previous studies have indicated that more than 70% of all the septic meningeal infections are caused by H. influenzae, meningococcus and pneumococcus. At this hospital these organisms were isolated from 47% of the specimens studied, indicating a changing pattern in the etiology of purulent meningitis. Although pediatric patients constituted only 11.5% of the admissions, 58.4% of the pathogenic microorganisms were cultured from these patients.

Adult↗
PubMed2003

[Nuchal rigidity in children: meningitis or not?].

Three children, two girls aged 4 and 2.5 years and one boy aged 8 years, presented with nuchal rigidity and symptoms such as fever, headache and nausea. Upon investigation they had: torticollis on the bases of an upper respiratory tract infection, viral meningitis and bacterial meningitis (meningococcus type C) respectively. They all recovered well after treatment. Nuchal rigidity can be caused by many illnesses other than bacterial meningitis. Lumbar puncture should be performed when meningeal irritation is suspected. In children this can be identified using the Vincent test as well as the Kernig and Brudzinski tests.

Child↗
PubMed2003

Gram-negative Diplococcal Respiratory Infections.

Human respiratory tract infections caused by gram- negative diplococci continue to remain significant issues in health care. Although not addressed as frequently as the classical diplococcal pneumonia, the gram-positive Streptococcus pneumoniae (the pneumococcus), infections due to Neisseria meningitidis (the meningococcus), and Moraxella catarrhalis (formerly called both Neisseria catarrhalis and Branhamella catarrhalis) are addressed here including their microbiology, respiratory tract manifestations, antimicrobial treatment, and potential prevention with immunization.

Journal Article↗
PubMed1986

[Characteristics of the functional antigens of Neisseria meningitidis group B].

The work deals with the characterization of the functional antigens of N. meningitidis, group B. Analysis of the total extract of N. meningitidis strain B16B6 with the use of sera obtained from patients with meningococcal infection, nasopharyngitis, salmonellosis, as well as from meningococcus carriers and healthy donors, by immune blotting techniques and the affinity isolation of the functional antigens indicate that protein antigen with a molecular weight of 13-15 kd is the main common antigen inducing the formation of antibodies in patients with meningococcal infection.

Antibody Formation↗
PubMed1989

[Evaluation of soluble bacterial antigens detected by electrosyneresis in infectious diseases in children].

The diagnostic interest of the search for soluble bacterial antigens, using counter-current immunoelectrophoresis (CIE) has been evaluated in 109 children hospitalized with acute infection. In meningitis, CIE was well correlated with cerebrospinal fluid (CSF) culture and allowed a rapid diagnostic orientation in 82% of meningitis which were confirmed by classical bacteriology (CIE has to be performed using CSF and concentrated urine). False positive results were observed with type B meningococcus, especially on urine samples. In respiratory infections, the search for soluble antigens was of no interest except for focal pneumonitis; in that case, CIE was more frequently positive (35%) than blood culture (28%) and led to a 31% increase of correct diagnosis (CIE must be performed using concentrated urine). Serum and pleural fluid investigations were less sensitive. CIE was not useful in case of upper respiratory or nonfocal broncho-pulmonary infection, due to its very low efficiency.

Antigens, Bacterial↗
PubMed1985

Neisseria meningitidis.

N. meningitidis continues to be a worldwide cause of human disease, usually in otherwise healthy individuals. The natural habitat and reservoir for meningococci are the mucosal surfaces of the human nasopharynx and to a lesser extent, the urogenital tract and anal canal. In most instances meningococcal colonization of mucosal surfaces is asymptomatic but may produce local infection. In those individuals who lack serum bactericidal activity against the meningococcus, colonization of mucosal surfaces and bloodstream invasion by N. meningitidis can lead to devastating meningitis and septicemia. Recent studies on the ultrastructure of the meningococcus and on the mechanisms of pathogenesis have given us new insight into meningococcal infections and suggest ways for improved immunoprophylaxis. Currently, penicillin is the drug of choice for the treatment of meningococcal meningitis and septicemia. However, the report of meningococci with antibiotic resistant plasmids is alarming and in the future may alter traditional treatment regimens.

Cephalosporins↗
PubMed1999

[Meningococcal infections: aspects of microbiology, epidemiology and prevention].

Neisseria meningitidis (meningococcus) is responsible for an average of 40% of all cases of bacterial meningitis in Germany. Cerebrospinal fluids, blood cultures, throat swabs and scratches, aspirations and biopsies of the skin rash are appropriate materials for the diagnosis of meningococcal disease. The materials should reach the laboratory without delay. Since 1993, the incidence of meningococcal disease in Germany is less than 1 case per 100,000 inhabitants. The case fatality rate is about 10%. Most cases of meningococcal disease occur in the first quarter of the year. Almost half of all invasive N. meningitidis isolates are from children under five years of age. In the period 1990-1998, in Germany an average of 74% of cases were caused by serogroup B and 21% by serogroup C. In serogroup B disease, isolates of serotype 15, in group C disease strains of serotype 2a are predominating. Chemoprophylaxis should be given to all household members and all contacts living in institutions with household-like character, contacts in institutions for children under six years of age and all persons who had contact with the oropharyngeal secretions of the patient. At present, only capsular polysaccharide vaccines against serogroups A, C, Y and W135 are available for immunoprophylaxis in Germany.

Adolescent↗
PubMed2004

Infection with an avirulent phoP mutant of Neisseria meningitidis confers broad cross-reactive immunity.

Successful vaccines against serogroup A and C meningococcal strains have been developed, but current serogroup B vaccines provide protection against only a limited range of strains. The ideal meningococcal vaccine would provide cross-reactive immunity against the variety of strains that may be encountered in any community, but it is unclear whether the meningococcus possesses immune targets that have the necessary level of cross-reactivity. We have generated a phoP mutant of the meningococcus by allele exchange. PhoP is a component of a two-component regulatory system which in other bacteria is an important regulator of virulence gene expression. Inactivation of the PhoP-PhoQ system in Salmonella leads to avirulence, and phoP mutants have been shown to confer protection against virulent challenge. These mutants have been examined as potential live attenuated vaccines. We here show that a phoP mutant of the meningococcus is avirulent in a mouse model of infection. Moreover, infection of mice with the phoP mutant stimulated a bactericidal immune response that not only killed the infecting strain but also showed cross-reactive bactericidal activity against a range of strains with different serogroup, serotype, and serosubtyping antigens. Sera from the mutant-infected mice contained immunoglobulin G that bound to the surface of a range of meningococcal strains and mediated opsonophagocytosis of meningococci by human phagocytic cells. The meningococcal phoP mutant is thus a candidate live, attenuated vaccine strain and may also be used to identify cross-reactive protective antigens in the meningococcus.

Animals↗
PubMed1992

[Cutaneous vasculitis during bacteremia caused by Meningococcus serogroup B].

We report a patient with an upper respiratory tract infection who presented outbreaks of erythematosus-purpuric macules and papules (the pathological substrate of which was a leukocytoclastic vasculitis with numerous intravascular thrombi) coinciding with two autolimited febrile episodes. In serial hemocultures B meningococcus was identified oral antibiotic treatment was given achieving a good clinical evolution. Although both episodes could be considered as a meningococcemia without sepsis, they could also correspond to the initial phase of a chronic meningococcemia. The possible etiopathogenesis of the cutaneous lesions is discussed and the therapeutic and prognostic repercussion of an early identification of these forms of meningococcal disease, which are poorly expressed clinically, are highlighted.

Adolescent↗
PubMed2006

Pneumococcal septicaemia with Purpura fulminans in an 11-month-old child.

Purpura fulminans (PF) is a syndrome characterised by acute onset of rapidly progressive haemorrhagic necrosis of the skin due to dermal vascular thrombosis, mainly occurring during meningococcal sepsis. It occurs rarely in the course of infection with Streptococcus pneumoniae and most cases report Meningococcus as the causing agent. This is a case report of successful conservative limb-preserving management of PF and sepsis caused by Streptococcus pneumoniae in an 11-month-old girl.

Bacteremia↗
PubMed1972

Immunoelectroosmophoresis in the diagnosis of meningococcal infections.

Specimens of cerebrospinal fluid and serum from 22 cases of meningococcal infection were examined by immunoelectroosmophoresis and the results compared with those obtained by microscopy and culture. The results were the same except that three of 10 cases of group B infection were not diagnosed by immunoelectroosmophoresis and two of 10 cases of group C infection were not diagnosed by culture. The sensitivity of the method depends on the potency of the antiserum used and antisera from commercial sources were satisfactory except for those prepared against group B meningococci. The method may be more sensitive than microscopy and culture under certain conditions, in particular, where the patient has already begun antibiotic treatment, where the specimens have become contaminated and, where the infecting organism is either a group A or group C meningococcus.

Anti-Bacterial Agents↗
PubMed1955

Meningitis; a review of one year's cases from an active children's hospital service.

Fifty-six cases of bacterial meningitides, other than tuberculous, observed in a period of one year on an active children's hospital medical service were reviewed. All age groups were involved but most commonly infected were patients in the first year of life. There was no inordinate incidence of infection with any one kind of organism in any specific age bracket, except possibly for infection with enteric organisms which in the present series occurred preponderantly in infants less than six months old. Meningococcus and H. influenza type B were the most common organisms; they were the infecting agents in 71 per cent of cases. Of the immediate complications noted, subdural effusions were the most common (23 per cent of this series). In all except two cases, effusion was resolved by multiple aspirations. In two cases craniotomy was done with good results. Ten electroencephalograms were made and all were abnormal. In most of the patients, multiple antibiotic and chemotherapeutic drugs were used, parenterally during the first few days of hospitalization and then orally as tolerated. Intraspinal therapy was not given. Four of the 56 patients died.

Anti-Bacterial Agents↗
PubMed2001

Automation of fluorescence-based PCR for confirmation of meningococcal disease.

A fluorescence-based PCR method was developed, fully automated, and used to confirm infection with Neisseria meningitidis by detection of the meningococcus-specific ctrA gene. The method provided a highly sensitive, high-throughput assay that was reproducible and less labor-intensive than manual methods.

Bacterial Proteins↗
PubMed2003

[Respiratory virosis and invasive bacterial superinfections. The case for influenza and meningococcal diseases].

The pathophysiology of bacterial superinfections of influenza, including meningococcal diseases, remains obscure. Mice, normally resistant to the meningococcus, become susceptible after previous influenza A virus infection. This immunosuppressive effect is transitory and is associated with the peak of the inflammatory anti-virus reaction. These results underline the importance of preventing bacterial superinfections of influenza by the surveillance of any relapse of fever after improvement of the influenza syndrome. At the community level, influenza vaccine, beside its specific effects, might also prevent many cases of invasive superinfections, including meningococcal diseases.

Humans↗
PubMed1993

[Morphology of recent meningococcal infections in children].

An analysis of 108 cases of children's death which occurred in 1981-1991 from hypertoxic meningococcal infection (MI) in St. Petersburg is presented. Serogroup B meningococcus as a causative agent was found in 44% of the cases. The role in the thanatogenesis of inflammatory and immune reactions, viral-bacterial associations was shown on the basis of detailed study of 47 cases. Hemorrhagic adrenal necrosis was diagnosed in 94.7% of the cases. Two clinicomorphological variants of the disease are distinguished: 1) variant with a moderate hemorrhagic eruption without pronounced kidney lesion, 2) variant with an abundant confluent rash and pronounced kidney lesions and choroid plexus immune lesions.

Adrenal Glands↗