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PubMed1977

Which Neisseria?

A case of disseminated gonococcal infection in which the gonococcus was isolated from the blood and genitalia and the meningococcus from the throat is described. A second patient, in whom the meningococcus was isolated from the throat and the gonococcus from the genitals but in whom no organisms were recovered from the blood, had lesions resembling those of a disseminated infection. The results of 150 throat cultures from patients who were examined at a clinic because they had a history of oral sexual intercourse are presented. The meningococcus was isolated nearly six times more often in patients with genital gonorrhoea than in those in whom genital cultures were negative, while the gonococcus was found 2 1/2 times more often in those who carried the meningococcus in the throat than in those who did not. If these findings can be confirmed it could indicate an individual susceptibility to the acquisition of Neisserian organisms that would merit further investigation.

Adult↗
PubMed1988

Antibody deficiency syndromes and novel immunodeficiencies.

Antibody deficiency syndromes can be quantitative or qualitative. The major categories of antibody deficiency syndrome are: (1) X-linked agammaglobulinemia, involving the maturation arrest in the development of the B cells; (2) transient agammaglobulinemia, which affects both sexes is often associated with defective T helper function for immunoglobulin production; (3) acquired agammaglobulinemia, a heterogeneous disorder caused by a primary B cell defect, absence of B cells, presence of B cells but with an activation defect, failure of helper factor production by T cells or increase in suppressor cells; (4) IgG2 and IgG3 subclass deficiencies, causing significant and recurrent infections and, with IgG2, a significant impairment of the ability to respond to carbohydrate antigens such as Haemophilus influenzae, pneumococcus and meningococcus; (5) qualitative antibody deficiency syndrome in the response to carbohydrate antigens, presenting as recurrent infection and involving the inability of the patient to respond to immunization with polysaccharide antigens such as Haemophilus influenzae type b; (6) antibody deficiency states associated with T cell dysfunction. Impairment of T cell function, which is required for B cell activation, presents often as antibody deficiency syndrome. In these cases, total gamma-globulin level is normal, but the quality of the antibody is very poor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Mechanisms of the intractability of bacterial infections in immunodeficiency status in childhood].

Most of the primary immunodeficiency diseases develop in childhood. The patients with antibody deficiency are susceptible to pyogenic bacteria since antibody is essential to opsonize bacteria. T cell deficiency causes defect of cytokine production needed to activate macrophages to kill intracellular bacteria such as mycobacteria and leeds to intractable infection of such bacteria. Complement mediated bacteriolysis is important to protect neisseria such as meningococcus and deficiency of C5-C9 provides susceptibility to the bacteria. Defect of superoxide synthesis or adhesion of neutrophils is related to severe infection of pyogenic bacteria. On the way of development of immune system, children especially in early infancy display susceptibility to bacterial infections.

Age Factors↗
PubMed2006

The majority of genes in the pathogenic Neisseria species are present in non-pathogenic Neisseria lactamica, including those designated as 'virulence genes'.

BACKGROUND: Neisseria meningitidis causes the life-threatening diseases meningococcal meningitis and meningococcal septicemia. Neisseria gonorrhoeae is closely related to the meningococcus, but is the cause of the very different infection, gonorrhea. A number of genes have been implicated in the virulence of these related yet distinct pathogens, but the genes that define and differentiate the species and their behaviours have not been established. Further, a related species, Neisseria lactamica is not associated with either type of infection in normally healthy people, and lives as a harmless commensal. We have determined which of the genes so far identified in the genome sequences of the pathogens are also present in this non-pathogenic related species. RESULTS: Thirteen unrelated strains of N. lactamica were investigated using comparative genome hybridization to the pan-Neisseria microarray-v2, which contains 2845 unique gene probes. The presence of 127 'virulence genes' was specifically addressed; of these 85 are present in N. lactamica. Of the remaining 42 'virulence genes' only 11 are present in all four of the sequenced pathogenic Neisseria. CONCLUSION: Assessment of the complete dataset revealed that the vast majority of genes present in the pathogens are also present in N. lactamica. Of the 1,473 probes to genes shared by all four pathogenic genome sequences, 1,373 hybridize to N. lactamica. These shared genes cannot include genes that are necessary and sufficient for the virulence of the pathogens, since N. lactamica does not share this behaviour. This provides an essential context for the interpretation of gene complement studies of the pathogens.

Genes, Bacterial↗
PubMed1977

Meningococcus.

Explore the source record for details and available documents.

Carrier State↗
PubMed1986

Does splenectomy predispose to meningococcal sepsis? An experimental study and clinical review.

Splenectomy is a recognized factor predisposing to the late complication of serious sepsis. The meningococcus has been listed as an important organism in postsplenectomy infection. A survey of the literature, however, revealed a total of only 13 documented case reports over a 31-year period, including ten pediatric cases. No documented cases of meningococcal sepsis in children following splenectomy for trauma were found. In an experimental mouse meningococcal infection model, the intraperitoneal LD50 was similar between normal and splenectomized mice (4 X 10(8) v 4 X 10(7) cfu, respectively; P = not significant). Bacteremic patterns were similar in both groups. Uniform survival was seen in normal and splenectomized mice after various intravenous challenge doses of meningococci up to 10(6) cfu. This was associated with efficient bacterial clearance in both groups. It appears unlikely that the defect resulting from splenectomy alone is an important predisposing factor in meningococcal sepsis.

Adolescent↗
PubMed1976

Septicemia and meningitis in children splenectomized for hodgkin's disease.

Retrospective evaluation of the occurrence of septicemia and meningitis in 200 children who had staging laparotomy iwth splenectomy for Hodgkin's disease revealed 20 episodes occurring in 18 children. Symptoms were usually fulminant; only 10 of these patients survived their episode. Infections occurred eight days to three years after splenectomy. Adolescents, as well as younger children, were affected; half were older than 10 years of age. Leukopenia was not a major factor in onset or survival since the average white-cell count was 12,000 in both survivors and children who died. Pneumonococcus accounted for 50 per cent, and streptococcus for 15 per cent of infections; there was one episode each of Haemophilus influenzae and meningococcus; in 25 per cent, no organism was isolated. Predominance of penicillin-sensitive organisms and high mortality suggest that penicillin prophylaxis and the protection offered by bacterial vaccines should be evaluated in children with Hodgkin's disease whose staging laparotomy includes splenectomy.

Adolescent↗
PubMed1994

[Treatment of bacterial meningitis in newborn infants and children].

Third generation cephalosporin as cefotaxime or ceftriaxone is the best first line treatment. Duration of treatment is 7 to 10 days in uncomplicated disease. Dexamethasone used very early--before or at the same time of the antibiotic injection--seems to decrease sensorial sequelae. Amikacin by IV route, decreases short term complications. For bacterial meningitis due to intermediate penicillin pneumococci, an increase in daily dose of beta-lactamin is recommended; for resistant pneumococci, vancomycin by continuous infusion and with large doses is used. Chemoprophylaxis by rifampicine is effective for both Meningococcus and Haemophilus. Haemophilus influenzae b vaccination will decrease systemic infection due to this pathogen. In newborns, morbidity is higher, due in part to brain abscesses. Therapeutic choice is not the same for materno-foetal and postnatal infection. Antibiotherapy duration is, at least, 15 days and 21 days for gram-negative bacteria.

Age Factors↗
PubMed1977

[Humoral immunity aspects of meningococcal infection. I. A method of performing and the characteristics of the immune bacteriolysis reaction].

Immune bacteriolysis test with meningococcus, group A, was used for the purpose of serum antibody study. Meningococcus cultures with a bright orange fluorescence of the colonies in oblique illumination (the I type) proved to possess the greatest lysability. Guinea pig serum sorbed with meningococcus suspension was found to be the best source of the complement. Sera obtained after 1 to 3 days of rabbit immunization, containing mostly IgM antibodies, had the greatest bactericidal capacity. Only those fractions which contained IgM possessed bactericidal activity in the hyperimmune rabbit sera with a high IgG antibody concentration. No lytic activity was displayed against meningococcus by unfractionated hyperimmune sera.

Animals↗
PubMed2003

Mucosal vaccination against encapsulated respiratory bacteria--new potentials for conjugate vaccines?

Polysaccharide (PS)-encapsulated bacteria such as Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (pneumococcus), Neisseria meningitides (meningococcus) and group B streptococcus (GBS), cause a major proportion of disease in early childhood. Native PS vaccines are immunogenic and provide protection against disease in healthy adults but do not induce immunological memory. PSs are T-cell-independent antigens and do not elicit antibodies in infants and young children, but by conjugating PS to proteins they become T-cell dependent and immunogenic at an early age. Despite excellent efficacy of PS-protein conjugate vaccines against invasive disease, protection against mucosal infections such as pneumococcal otitis media has been less efficacious. Circulating PS-specific antibodies may protect against infections at mucosal sites, but mucosal immunoglobulin A antibodies may also contribute significantly to protection against mucosal infections. Mucosal immunization of experimental animals with conjugate vaccines against Hib, pneumococcus, meningococcus and GBS induces systemic and mucosal immune responses, which provide protection against carriage, otitis media and invasive disease in a variety of challenge models, providing new means for protection against encapsulated bacteria. In addition, mucosal immunization of neonatal mice with a pneumococcal conjugate and the nontoxic adjuvant LT-K63 has been superior to parenteral immunization in eliciting protective antibodies and PS-specific memory, and thus circumventing the limitations of antibody responses to PS that are responsible for enhanced susceptibility of neonates and infants to infections caused by encapsulated bacteria. Through T-cell dependent enhanced immunogenicity of PS-protein conjugate vaccines, mucosal immunization could be an attractive approach for early life immunization against encapsulated bacteria.

Adult↗
PubMed1993

Infantile spasms: infectious disorders.

Infections were considered to be etiological factors in 29 patients (10%) with infantile spasms; congenital CMV (n = 5), congenital or acquired CMV (n = 1), acquired CMV (n = 5), congenital rubella (n = 2), herpes simplex virus (n = 5), enterovirus (n = 1), adenovirus (n = 1), viral encephalitis of unknown agent (n = 3), meningococcus (n = 4), pneumococcus (n = 1) and pertussis (n = 1). The children with congenital infections had long-lasting tremor and convulsions from birth. Early EEG pattern was characteristic for children with herpes encephalitis but not for other patients. Infantile spasms appeared only some weeks after viral encephalitis. One patient with enterovirus and another with probable adenovirus infection had necrotic changes in their brain CT resembling those of herpes encephalitis. The response to ACTH was poor (38%) compared to the whole series (60%). The long-term outcome was also poor compared to the whole series; mental retardation in 90%, convulsions in 62%, abnormal EEG in 89%. Four children died during the follow-up of 7 years. Autopsy showed disseminated CMV infection in one patient and chronic CMV infection in another. The outcome of children with infectious etiology appears to be particularly poor. Thus, the prevention and specific diagnosis and treatment are important. Steroid therapy should be avoided in children with a history of herpes virus encephalitis (CMV, herpes simplex) in the past.

Adolescent↗
PubMed2004

Diversity in pathogenicity can cause outbreaks of meningococcal disease.

Neisseria meningitidis, the meningococcus, is a major cause of bacterial meningitis and septicemia worldwide. Infection in most cases leads to asymptomatic carriage and only rarely to disease. Meningococcal disease often occurs in outbreaks, which are both sporadic and highly unpredictable. The occurrence of disease outbreaks in a host population in which the etiological agent is widely carried is not well understood. A potential explanation lies in the fact that meningococci are diverse with respect to disease-causing potential. We formulated a stochastic mathematical model to investigate whether diversity of the bacterial population is related to outbreaks of meningococcal disease. In the model, strains that occasionally cause the disease appear repeatedly in a population dominated by a nonpathogenic strain. When the pathogenicity, i.e., the disease-causing potential, of the pathogenic lineage was low, the model shows distinct outbreaks, the size distribution of the outbreaks follows a power law, and the ratio of the variance to the mean number of cases is high. Analysis of notification data of meningococcal disease showed that the ratio of the variance to the mean was significantly higher for meningococcal diseases than for other bacterial invasive diseases. This result lends support to the hypothesis that outbreaks of meningococcal disease are caused by diversity in the pathogenicity of meningococcal strains.

Disease Outbreaks↗
PubMed2004

[Pneumococcal conjugate vaccine in children].

Streptococcus pneumoniae is one of the major causes of severe invasive infections in young children. As purified polysaccharide are not immunogenic in infants, vaccines containing the bacterial polysaccharide conjugated to a carrier protein have been developed according to the model that has proved to be effective for Haemophilus influenzae b and group C meningococcus. A conjugate vaccine containing the 7 serotypes responsible for about 90% of the invasive infections occuring in children in the United States has been shown to have a 97% protective efficacy against infections caused by vaccine serotypes. Pneumococcal conjugate vaccines are also protective, although to a lesser extent, against otitis media caused by vaccine serotypes, but the global impact of these vaccines on the total number of otitis media remains limited. The large scale use of this vaccine has demonstrated its epidemiological impact on the burden of invasive pneumococcal disease in the age group targeted by vaccination as well as among the adult contacts of the vaccines. On the basis of these informations, the conjugate pneumococcal vaccine has been included in the recommended vaccination schedule in Belgium. However, repeated vaccine shortages as well as the high cost of the product make the implementation of this recommendation uncertain.

Child, Preschool↗
PubMedDate not supplied

Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited.

Absence of the spleen or splenic function predisposes individuals to risk of overwhelming infection. These infections are most often due to encapsulated organisms, especially pneumococcus, Haemophilus influenzae type b, and meningococcus, but any bacterial agent may cause the rapid onset of septicemia, meningitis, pneumonia, and shock characteristic of the asplenic-hyposplenic condition. The risk is greatest in infants and young children, but asplenic-hyposplenic adults also have an increased risk of infection. Prophylactic antibiotics and immunization with polyvalent pneumococcal, H. influenzae type b, and meningococcal vaccines have reduced the incidence of infections in asplenic-hyposplenic individuals, but even these measures have not eliminated the risk. Surgeons have adopted techniques to save as much splenic tissue as possible and some splenic functions, such as pitting red cells, have been preserved, but conservative surgery has not provided total protection against overwhelming infection. Therapies designed to interrupt the cascade of overwhelming sepsis have not yet been successful. In those cases in which the spleen is surgically removed, the underlying disease or condition leading to splenectomy influences the risk of sepsis. Splenectomy incidental to other operations, such as gastrectomy, results in the lowest risk for overwhelming infection, but this is still some 35-fold greater than the risk for overwhelming infections in the general population. In increasing order of risk, the other main indications for surgical removal of the spleen are idiopathic thrombocytopenia purpura, trauma, transplantation procedures, hereditary spherocytosis, staging Hodgkin's disease, portal hypertension with hypersplenism, and thalassemia. Pathologists should comment on the risk of overwhelming sepsis when spleens are processed as surgical specimens, and should carefully weigh all splenic tissue, including accessory spleens and splenic implants (splenosis), in autopsy cases with and without overwhelming sepsis.

Adult↗
PubMed1986

[Subacute septicemia caused by Meningococcus of serogroup Y and acquired deficiency of complement C3 fraction].

The high frequency of meningococcal infections in patients with congenital deficiency of a component of the complement terminal pathway emphasizes the critical role of this system in host resistance against Neisseriaceae. We report the observation of a subacute septicaemia due to N. meningitidis serogroup Y. This girl had an acquired deficit of the C3 fraction of complement due to a high titre of C3 nephritic factor (C3NeF). There was no evidence of partial lipodystrophy or biological symptoms of glomerular disease. The meningococcal infection revealed this biological abnormality.

Child↗
PubMed2001

[Pediatric deaths due to community-acquired bacterial infection. Survey of French pediatric intensive care units].

A retrospective survey has been conducted in the Pediatric Intensive Care Units (PICUs) affiliated to the Groupe Francophone d'Urgence et de Réanimation Pédiatrique over two years (1999 and 2000). The purpose was to determine the number of children aged from 10 days to 18 years who died from community acquired bacterial infections and to compare the data to those obtained from official surveys (statistics of death from the Institut National de la Santé et de la Recherche Médicale) and from the Institut National de Veille Sanitaire as well as from punctual studies. Thirty two (60%) PICUs have participated and 100 cases of children without known risk factors, dead from community acquired documented bacterial infection have been considered for analysis (36 in 1999, 54 in 2000). Infants aged between 10 days and 2 months represent 1/3 of the fatalities. Neisseria meningitidis is the first pathogen responsible for death (34% including 10 not documented cases of purpura fulminans). B group is predominant (14/24) compared to the C group (6 cases). A lethal infection due to W135 group occurred in 2 infants in 2000. Streptococcus pneumoniae is the second pathogen responsible for death (28%). None of the cases were due to antibiotic resistant pneumococcus. Bordetella pertussis is surprisingly the third pathogen responsible for death (13%), all of them being younger than 2 months. Pertussis is the first cause of death in infants aged 10 days-2 months. An important increase was observed between 1999 (3 cases) and 2000 (10 cases). Meningitis is the first disease responsible for death (42%): 26 are related to pneumococcus, 5 to meningococcus and 6 to group B streptococcus. Purpura fulminans is the second cause (30%), due mainly to group B meningococcus (11 cases). Group C meningococcus accounts for 6 cases only. One case is related to pneumococcus. Lung infections are a rare cause of death (5 cases) and particularly staphylococcal pleuro pneumonia seems to be no longer a significative cause of fatality. Toxic shock syndrome is an emergent disease responsible for 5 death (2 staphylococcal, 3 streptococcal). These data fit with those provided by the Institut National de Veille Sanitaire with respect to meningococcal infections and the Renacoq network with respect to pertussis, as well as the data provided by a previous GPIP survey on pneumococcal meningitis. However, the data provided by INSERM seem not to be relevant. In spite of the bias due to a retrospective study and the lack of exhaustivity, this survey provides data which could help decision making with respect to new vaccines against pneumococcus.

Bacterial Infections↗
PubMed1991

Safety and immunogenicity of multiple conventional immunizations administered during early HIV infection.

Twenty-one asymptomatic adults who had recently received multiple polysaccharide, live viral, and protein-derived vaccines were identified as being infected with human immunodeficiency virus (HIV). The mean subject age was 24 years (range 18-33); 20 of 21 (95%) were male. The mean T4 count was 523/mm3 with a mean T4/T8 ratio of 0.6. Serologic responses to immunization with meningococcus group C, adenovirus types 4 and 7, tetanus, and diphtheria were evaluated for the HIV seropositive subjects and were compared with the responses of similarly vaccinated age-, sex-, and race-matched HIV-seronegative controls. Significantly fewer (p less than 0.03) HIV subjects responded to meningococcus C (bactericidal antibody) and adenovirus 4 (neutralizing antibody) vaccines than did normals; the HIV-infected subjects who did respond produced functional antibody comparable to that of normals. Booster responses of HIV subjects to tetanus and diphtheria were comparable to those of normals. HIV-infected vaccine nonresponders did not differ from HIV-infected responders in total white blood cell, T4, T4/T8, total serum IgG, or delayed-type hypersensitivity skin test reactivity. All HIV subjects had negative cultures for live vaccine viruses (rubella, measles, adenovirus, and poliovirus). Postimmunization, no clinically apparent adverse reactions to vaccination were detected.

Adult↗