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PubMed1997

Decreased plasma levels of factor II + VII + X correlate with increased levels of soluble cytokine receptors in patients with malaria and meningococcal infections.

The levels of coagulation factors II + VII + X and of blood platelets (thrombocytes) as well as of cytokines and soluble cytokine receptors were studied in the patients with malaria or meningococcal infections. The coagulation factors were decreased particularly in the meningococcal patients, while thrombocytes were lowest in the Plasmodium falciparum malaria patients. There was no correlation between factors II + VII + X and thrombocytes, but plasma levels of coagulation factors II + VII + X were found to correlate inversely with levels of soluble interleukin-2 receptor (sIL-2R) and soluble tumour necrosis factor-I (sTNF-RI) in patients with malaria and meningococcal infections. Elevated sIL-2R and sTNF-RI levels and decreased coagulation factors reverted to normal within 3-5 days after initiation of therapy in P. falciparum patients followed consecutively. Estimation of coagulation factors may be used to monitor the course of these common and potentially life-threatening infections.

Acute Disease↗

PubMed1983

[Cardiac complications in meningococcal infections].

The clinical courses of three children with meningococcal meningitis and cardiac complications are described. In two patients a mixed peri/myocardial form of cardiac involvement is probable. One child showed a pericarditis with relapses as found in the postpericardiotomy syndrome. The pathogenesis of the cardiac involvement in meningococcal infections is discussed based on the literature. The three cases observed are tentatively classified accordingly.

Adolescent↗

PubMed1989

[Relationship of eicosanoids to cellular and humoral immunity factors in meningococcal infection].

The dynamics of the content of thromboxane B2, 6-keto-prostaglandin F1 alpha, T- and B-lymphocytes and titers of antibodies to group polysaccharides of meningococci, groups A, B and C, have been studied in 44 patients with generalized forms of meningococcal infection. As shown in this study, in patients with the clinical course of moderate severity a decrease in the number of T-lymphocytes in the first days of infection correlates with a decrease in the concentration of thromboxane B2. In some cases the concentration of thromboxane B2 and 6-keto-prostaglandin F1 alpha has been found to correlate with the titers of antibodies to group polysaccharide of group A meningococci. The severe course of meningococcal infection is characterized by the absence of correlation between eicosanoids and the immunity factors under study.

Adolescent↗

PubMed1978

Meningococcal infection and proteolytic control.

Cascade enzyme inhibitors (C1-esterase inhibitor, C3b inactivator, antithrombin III) and other major proteolytic enzyme inhibitors (alpha 1 trypsin inhibitor, alpha 1 chymotrypsin inhibitor, inter-alpha-trypsin inhibitor, alpha 2 macroglobulin) as well as C3 and alpha 1 acid glycoprotein, have been examined in the sera of Nigerian patients suffering from meningococcal infection of varied severity. Patients with meningococcaemia had lower serum concentrations of important inhibitors than did patients with localised meningitic infection. Within the coccaemic group, those who died had the lowest values, notably of antithrombin III and alpha 2 macroglobulin (and also of C3). The clinical end-result of meningococcal infection may be related to the degree of disequilibrium of the linked system of proteolytic control induced by the meningococcal endotoxin.

Antithrombin III↗

PubMed1996

Risk factors for Neisseria meningitidis carriage in a school during a community outbreak of meningococcal infection.

As part of the management of an outbreak of meningococcal infection, 119 school contacts of an index case were swabbed for nasopharyngeal carriage. In a cohort study, risk factors for Neisseria meningitidis carriage were ascertained by means of a questionnaire, completed by 114 (96%) of those swabbed. Twenty five (21%) cultures were identified as "neisseria positive'; of which there were 18 (15%) Neisseria meningitidis isolates, 2 (2%) Neisseria lactamica isolates and 5 (4%) showed contaminants only. Two (2%) carriers were identified as harbouring the implicated outbreak strain. Single variable analysis identified six statistically significant risk factors for meningococcal carriage; increasing age, female sex, manual social class, personal smoking, regular attendance at a discotheque and rhinorrhoea. Multivariate analysis, using logistic regression modelling, found that of these six variables only age, sex and social class remained statistically significant when the other factors were controlled for. Nevertheless the role of smoking, social events and respiratory/viral infections in nasopharyngeal carriage, and other plausible mechanisms whereby age, sex and social class might exert their effect, could usefully be investigated further.

Adolescent↗

PubMed1989

[Diagnosis of cardiac lesions in the generalized form of meningococcal infection].

Activity of the enzymes indicating heart affection in the acute period and in disease dynamics was increased in 97 patients with generalized forms of meningococcal infection. Signs of cytolysis, according to the data of enzymatic blood examination, were revealed to the utmost degree in patients with typical complications of meningococcal infection--brain edema, which persisted for 10 days of the disease. Herpetic infection joins twice as often in patients with brain edema and is accompanied by a pronounced cytolytic component in the myocardium and liver. Infectious cardiopathy as compared to other complications is characterized by a longer period of hyperenzymemia and the increment of the enzyme activity is greater in the acute period.

Adenylyl Cyclases↗

PubMedDate not supplied

Meningococcal infections in the German Democratic Republic 1971-1984.

Since May 1979 all meningococcal strains isolated in the GDR have been investigated microbiologically. Despite a generally low incidence, a marked increase in meningococcal infections has been observed. From a total of 650 strains sent to our institute up to 1984, 515 could be serogrouped. 54 strains belonged to serogroup A, 292 to B, 125 to C, two to X, eight to Y, one to Z, 30 to W-135 and three to 29E. There were no substantial changes in the distribution of the groups. In our study we tried to find out whether there are any correlations between the epidemiological and microbiological data. A record was made of the age distribution, clinical picture and regional distribution of the meningococcal strains isolated. Rifampicin chemoprophylaxis of contacts was introduced in 1981.

Age Factors↗

PubMed1980

Recurrent meningococcal infections associated with a functional deficiency of the C8 component of human complement.

A patient is described who had a functional deficiency of the C8 complement component. His serum contained abnormal C8 which lacked some of the antigenic determinants of normal C8. The defect was associated with recurrent meningococcal infections due at different times to at least two strains. The patient's serum contained antibodies to meningococci and could induce phagocytosis and intracellular killing of the cocci by polymorphs. However, the serum was bactericidal only after the addition of C8-containing serum. As the patient did not give a history of susceptibility to other pyogenic organisms and has normal polymorph function, the circumstances of meningococcal infection must be unusual in that the plasma bactericidal activity critically determines the outcome: it may be that if large numbers of meningococci are not killed in the plasma, the polymorphs are overwhelmed.

Adolescent↗

PubMed1979

[Acute meningococcal infection (author's transl)].

Authors report 49 patients bacteriologicallyly diagnosed of acute meningococcal infection collected during a 12 months period out of a series of 76 cases diagnosed on clinical grounds. "N. meningitidis" was found in 18 blood and 43 CSF cultures. 31 cases were of the B-group, one was A-group and 17 were not typed. All of them were sulphamide resistant. Hyperthermia with vomiting, cephalea, arthralgia and seizures were the initial symptoms. All patients showed pettechiae, purpura and/or ecchymoses. Endotoxic shock was diagnosed in 26,5% of the cases. In them systolic blood pressures were under p-5. Overall mortality was 14%, and that of endotoxic patients 53%. Therapeutic routines and chemoprophylaxis are reviewed.

Acute Disease↗

PubMed1983

[Efficacy of penicillin therapy of meningococcal infection in children undergoing different regimes of pathogenetic therapy].

The course of meningococcal infection and nonspecific and specific immunity in children subjected to different regimens of pathogenetic therapy were studied. It was shown that the clinico-immunological indices were more favourable in children treated with lasix as a diuretic agent. Recovery with defects was observed in 6.8 per cent of the children of this group, while in patients subjected to routine treatment the respective value amounted to 14.6 per cent. The use of lasix in combination with penicillin increased the efficacy of penicillin therapy and shortened the recovery period by 8.4 +/- 0.2 days as compared to that of routine treatment. No unfavourable effect of elevated penicillin concentrations on the lysozyme activity, blood bactericidal characteristics and composition of immunoglobulins A, M and G in the children was recorded.

Adolescent↗

PubMed1998

Plasma patterns of tumor necrosis factor-alpha (TNF) and TNF soluble receptors during acute meningococcal infections and the effect of plasma exchange.

In 39 patients with acute meningococcal infections, the plasma concentrations of tumor necrosis factor-alpha (TNF) and its soluble receptors (sRs) TNFsR-p55 and TNFsR-p75 were measured from admission till recovery. At admission, patients with shock had significantly higher TNF, TNFsR-p55, and TNFsR-p75 values than patients without shock. In addition, during the first 24 hours, patients with shock had higher TNFsR-p75 to TNFsR-p55 ratios, indicating that in shock the increase of TNFsR-p75 exceeds that of TNFsR-p55. TNF measured more than 12 hours after admission failed to differentiate between shock and nonshock because TNF concentrations normalized within 12-24 hours. However, because concentrations of TNFsRs remained elevated for 5-6 days, at that time plasma TNFsRs still differentiated between shock and nonshock. Plasma exchange or whole blood exchange (PEBE), performed in 20 patients with shock, accelerated the decrease of plasma TNFsRs. However, because of a rebound after each PEBE session, the overall half-lives of both TNFsRs were not affected by PEBE.

Acute Disease↗

PubMed1993

[Evaluation of the exhaustiveness and representativeness of a surveillance system using the capture-recapture method. Application to the surveillance of meningococcal infections in France in 1989 and 1990].

If surveillance data is to be correctly interpreted, the degree of exhaustiveness and representativeness of the surveillance system must be known. The capture-recapture method, which can be used for this evaluation - provided that at least two data sources are available - was applied to the surveillance of meningococcal infections in France. To identify those cases common to both surveillance systems, cases of the disease occurring in 1989 and 1990 and appearing on detailed Mandatory Notification (MN) records (702 cases) or reported to the National Reference Centre (NRC) (727 cases) were compared. The total number of cases of meningococcal infection was estimated at 1,367, using the capture-recapture method. Exhaustiveness rates, which did not differ for the various bacterial strains, were 51% for MN and 53% for NRC, although large regional differences were found for both systems. More cases were notified to MN in the age group 5-24 (60%), than in other age groups (49%). Quarterly exhaustiveness rates were unrelated to incidence of the disease. A district by district analysis of the correlation between exhaustiveness rates for each system suggests that the two data sources were probably independent. Scrupulous identification of common cases and study of the independence of the two systems are indispensable prerequisites for using this method, which provides a good alternative to exhaustive studies.

Adolescent↗

PubMed2000

Meningococcal infection among pilgrims visiting Madinah Al-Munawarah despite prior A-C vaccination.

OBJECTIVE: To study the profile of meningococcal infection among pilgrims despite prior A-C vaccination. SETTING: King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia. SUBJECTS AND METHODS: Fifteen patients admitted to the hospital during the study period of April 1992 to June 1993 were evaluated prospectively regarding their clinical and laboratory features, culture and antibiotic sensitivity and meningococcal serotypes. RESULTS: Twelve cases presented as meningitis while 3 cases had meningococcaemia. Most (53.3%) were from Pakistan while rest were from 6 other countries. Clinical and laboratory features at presentation were similar as reported in the literature. In 13 cases where serotyping could be done, most belonged to group A (54%) and C (23%). Antimicrobial sensitivity showed the isolates to be sensitive to most of the antibiotics commonly used to treat this infection. Mortality was 33% with the poorest outcome in patients with W135 infection. CONCLUSION: This study underscores the need of further studies in Makkah and Madinah, Saudi Arabia to find out the serotypes and immunological factors responsible for meningococcal infection in A-C vaccinated pilgrims so as to explore the possibility of use of polyvalent meningococcal vaccine.

Adult↗

PubMed1987

Congenital properdin deficiency and meningococcal infection.

We report a family in which three males in two generations had meningococcal infections; one of them died. Hemolytic activity of the alternative complement pathway in the two survivors and in one healthy boy belonging to the family was reduced, as measured in a kinetic system. These three individuals had 10-11% of normal properdin concentration in plasma, as measured by a catching ELISA method, while the other complement components were normal. Hemolytic complement activity was normalized when purified properdin was added. The data are compatible with an X-linked mode of inheritance of properdin deficiency.

Complement Activation↗

PubMed1981

[Clinical-therapeutical correlations in meningococcal infection: prophylactic heparin therapy (author's transl)].

A number of 241 patients with meningococcal infection, treated between 1972 and 1978, is analysed. Some new therapeutic patterns are established based on the application of the prognosis score of Stiehm. With these patterns consisting in the use of volume expansors with anti-aggregating properties and low dosage prophylactic heparin administration, authors have considerably improved their results reported in 1972, succeeding in diminishing the global mortality to 3.73%, a figure inferior to that of all known series to date.

Adolescent↗

PubMed1979

Meningococcal infections during infancy: confidential inquiries into 10 deaths.

The first 10 deaths from meningococcal infections in children aged under 2 years that were reported to a DHSS multicentre study were reviewed. Confidential inquiries were made of the parents, family doctors, health visitors, and hospital staff concerned with each case, and management was discussed with a paediatrician and pathologist. Diagnosis and treatment were often delayed because doctors did not realise the importance of the purpuric rash. One child died at home, and by the time they were admitted to hospital all the remaining nine were shocked and needed resuscitation. Prodromal symptoms, mainly changes in behaviour, preceded the rash in all cases. These prodromal symptoms should arouse the suspicion of septicaemia and prompt a search for petechiae so that early effective treatment may be started.

Behavior↗

PubMed1997

The pattern of interleukin-1beta (IL-1beta) and its modulating agents IL-1 receptor antagonist and IL-1 soluble receptor type II in acute meningococcal infections.

Interleukin-1beta (IL-1beta) is considered an important mediator in the pathogenesis of septic shock or bacterial meningitis. Its activity is specifically modulated by IL-1 receptor antagonist (IL-1Ra) and IL-1 soluble receptor type II (IL-1sRII). We now describe the time-course of IL-1beta and these modulating agents in 59 patients with acute meningococcal infections, the prototype human disease of acute endotoxin exposure. Plasma IL-1beta was increased only in severe shock and normalized within 12 to 24 hours, indicating that patients were admitted in an early stage of cytokine activation. Increased IL-1beta values in cerebrospinal fluid (CSF) were confined to patients with meningitis. Plasma IL-1Ra was elevated in both shock and nonshock patients, extremely high values being measured in severe shock. High concentrations of IL-1Ra in CSF were found in meningitis. Plasma IL-1Ra peaked shortly after IL-1beta and decreased steeply in 1 to 2 days, followed by sustained moderately elevated levels in shock patients. Interestingly, IL-1sRII showed a completely different pattern. At admission, both nonshock and shock patients manifested a similar moderate increase of plasma IL-1sRII. However, during recovery plasma IL-1sRII further increased reaching maximal concentrations 3 to 5 days after admission, 1 to 2 days after normalization of IL-1Ra. In shock patients this increase was more prominent than in nonshock patients. It is hypothesized that this increase in plasma IL-1sRII can be explained by a synergistic effect of dexamethasone and endotoxin. A second interesting observation was that, unlike the pattern in plasma, IL-1sRII levels in CSF paralleled those of IL-1beta and IL-1Ra. This suggests different modulation of IL-1beta activity in the subarachnoid space and the plasma compartment. We conclude that: (1) During the early stage of meningococcal infections IL-1Ra modulates IL-1 activity, whereas during recovery IL-1sRII may be more important. (2) Modulation in CSF and in the plasma compartment are differentially regulated.

Acute Disease↗

PubMedDate not supplied

Clinical spectrum of meningococcal infection in infants younger than six months of age.

BACKGROUND: Neisseria meningitidis is one of the most significant bacterial infections in children and adolescents. As transplacental antibodies in the circulation gradually decline, the prevalence of meningococcal disease among young infants is high, and often presents an invasive clinical manifestation. The purpose of the study was to investigate the clinical spectrum of meningococcal infection in young infants. METHODS: We retrospectively reviewed of the medical charts and analyzed the clinical characteristics and outcomes of 10 infants younger than 6 months old with meningococcal disease at the Chang Gung Children's Hospital from 1994 through 2004. RESULTS: A total of 10 male infants with a mean onset age of 2.9 +/- 1.79 months old were enrolled. All patients presented initial symptoms of fever and decreased activity. Seizure attack was noted in six cases, and only three patients had purpuric or petechial rash. Laboratory findings reflected pyogenic infection including elevated C-reactive protein (159.1 +/- 108.8 mg/L), pleocytosis (791.11 +/- 660.83/microL), high protein levels (190.43 +/- 157.91 g/dl) and hypoglycorrhachia (28 +/- 20.89 mg/dl) in the cerebrospinal fluid. Seven cases presented meningitis; among those, N. meningitidis was isolated from blood in two cases. Three of the remaining patients had meningococcemia. Penicillin was the most common drug of choice; cephalosporin was the alternative. Prolonged antimicrobial therapy (range, 14 to 42 days) was prescribed in six patients complicated with subdural empyema. No deaths were documented. During long-term follow up, two patients developed mental retardation, and one of those two also had epilepsy. Both of them had lower birth body weight, altered initial conscious level, leukocytopenia and subdural empyema with encephalomalacia on brain images. One had insufficient therapy and another one was infected by a penicillin resistant strain. CONCLUSIONS: Clinicians should be aware of meningococcal infection in young infants because the initial presentations may be difficult to distinguish from viral syndrome, and may rapidly progress to clinical deterioration. Patients with subdural empyema required prolonged courses of antimicrobial therapy. Brain images confirmed the presence of encephalomalacia which increased the risk of permanent neurologic deficit.

Follow-Up Studies↗