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[Partial properdin deficiency revealed by a septicemia caused by Neisseria meningitidis].

Properdin is one of the regulatory proteins of the alternative pathway of the complement system. Human properdin deficiency is an X-linked disorder strongly predisposing to meningococcal disease. Total deficiency (type I), partial deficiency (type II), and deficiency due to a dysfunctional molecule (type III) can be differentiated immunochemically. Four males in a family showed a selective partial deficiency of properdin. These individuals had 10% of normal properdin concentration in plasma, as measured by ELISA, while the other complement components were normal. Two of the properdin-deficient individuals in two generations had meningococcal infections. Two were clinically healthy at the time of investigation. Measurement of plasma levels of properdin has to be performed in the case of Neisseria meningitidis, especially where there is a previous history of severe bacterial infections in the same family as measurement of CH50 activity is ineffective for screening properdin deficiency.

Bacteremia↗

[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↗

Partial lipodystrophy, meningococcal meningitis and nephritis.

Partial lipodystrophy (PLD) started in a 12-year-old girl after measles. Aged 17 she had meningococcal meningitis. Nephritis, hypocomplementemia and nephritic factor were found some years later at the time of her first pregnancy. Only few patients with PLD and meningococcal infections have been described and all were hypocomplementemic. Like other patients with complement deficiency, patients with PLD should be aware of this life-threatening complication.

Adult↗

Use of bacterial vaccines for prevention of pneumococcal and meningococcal disease in the day care setting.

The pneumococcus causes severe disease, including meningitis and bacteremia, in children of day care age. It is also a frequent cause of otitis media. Unfortunately, the currently available pneumococcal polysaccharide vaccine has not been efficacious in children under 24 months old; research is currently underway on methods for increasing immunogenicity in young children. The meningococcus is a rare cause of meningitis in day care aged children, but children in day care are likely to be at increased risk of secondary disease if a case occurs in a center. The currently available polysaccharide meningococcal vaccine is poorly immunogenic in children younger than two and does not include the group B polysaccharide, which is responsible for 70% of disease in children younger than five years. Therefore, chemoprophylaxis with rifampin is recommended for decreasing the risk of secondary spread. When a group B meningococcal vaccine immunogenic in young children becomes available, vaccination will be indicated for all children in day care.

Age Factors↗

The adrenal response to exogenous adrenocorticotrophin in patients with infections due to Neisseria meningitidis.

The adrenal response to a soluble form of beta1-24-corticotropin (tetracosactrin [ACTH]: 250 microgram administered intramuscularly) was studied in 28 patients with meningitis due to Neisseria meningitidis (21 with petechiae and seven without) and in six patients with Salmonella typhi bacteremia. Six normal subjects also were tested for adrenal responsiveness at four different times of the day (8 A.M., 12 noon, 4 P.M., and 10 P.M.) and served as controls. The results showed that, whatever the time of testing, patients with meningococcal infections and typhoid fever had unstimulated (basal) levels of plasma cortisol above the 99% confidence limits for the mean unstimulated cortisol levels for the normal subjects. Furthermore, although patients with meningitis without petechiae and subjects with S. typhi bacteremia responded to ACTH stimulation in a manner similar to that of the normal subjects, most subjects with meningitis with petechiae did not have increased levels of plasma cortisol after treatment with ACTH. This lack of response could not be ascribed entirely to the higher basal levels of plasma cortisol in these patients. Patients with meningitis associated with petechiae may have a relatively decreased adrenal response to stimulation with exogenous ACTH.

Adolescent↗

[Epidemiology of meningococcal meningitis in Austria].

In Austria the report of epidemic meningitis is obligatory. Similar to other countries most of the observed strains of meningococci belong to the serogroups A, B and C. The morbidity is decreasing at present, the last peak occurred in the years 1966 to 1971. While several epidemics occurred in other parts of the world during the last years, only 1.2 cases in 100,000 persons were registered in Austria at that time, indicating an epidemiologic wave trough. During the observation period of 20 years the case fatality rate remained relatively constant at 8.6%. In comparison with other infectious diseases the percentage of deaths due to meningococcal infections has increased considerably during the last years. At present about half the deaths in children by infectious diseases are due to meningococci. Mortality and case fatality are very high in childhood and in persons over 50 years. Inversely the mean bactericidal antibody titer against group A and C meningococci is low in these age groups. Indications for meningococcal vaccination in the present situation are discussed.

Austria↗

Fc gamma receptor IIa (CD32) polymorphism in fulminant meningococcal septic shock in children.

Antibodies are essential in host defense against Neisseria meningitidis. Therefore, interactions among IgG and Fc receptors (Fc gamma R) on phagocytes may be crucial. Genetic polymorphic forms of Fc gamma RIIa (CD32) express different functional activities. In a retrospective study, Fc gamma R polymorphisms were determined in 25 children who survived fulminant meningococcal septic shock: 11 had Fc gamma RIIa-R/R131, the poor IgG2-binding allotype, which is a significantly more frequent rate than found in a healthy white population (44% vs. 23%; P = .028; odds ratio = 2.67; 95% confidence interval, 1.09-6.53). The relevance of this finding was further supported by the fact that neutrophils with the Fc gamma RIIa-R/R131 allotype phagocytized N. meningitidis opsonized with polyclonal IgG2 antibodies less effectively than did IIa-H/H131 neutrophils. Our findings suggest an important role for anti-N. meningitidis IgG2 and the Fc gamma RIIa polymorphism in host defense against systemic meningococcal infections.

Adolescent↗

Analysis of the human Ig isotype response to individual transferrin binding proteins A and B from Neisseria meningitidis.

Subcapsular antigens, including transferrin binding proteins, are being considered as potential vaccines against serogroup B meningococci. This study examined the human isotype antibody responses in cases of meningococcal disease to meningococcal TbpA (transferrin binding protein A) and TbpB (transferrin binding protein B) from two strains (SD and B16B6) expressing high and low molecular mass TbpB respectively. TbpA isolated from both strains were recognised more frequently and higher durable ELISA absorbance values were detected than those detected against TbpB from either strain. These antibody responses to Tbps were independent of the infecting meningococcal strain type. The antibody response to the four proteins was highly variable between individuals and differed significantly against all four antigens. The variability of immune responses to each Tbp from the two strains suggests that a successful vaccine would need to include TbpA and TbpB from a number of strains.

Antibodies, Bacterial↗

Evaluation of a diagnostic polymerase chain reaction assay for Neisseria meningitidis in North America and field experience during an outbreak.

CONTEXT: Meningococcal infection has a high public profile because of its dramatic presentation, high fatality rate, and propensity to occur in outbreaks and clusters of cases. Use of a diagnostic polymerase chain reaction (PCR) assay could enhance laboratory confirmation of cases and guide the public health response in North America. OBJECTIVE: To assess the performance of a PCR assay for the diagnosis of meningococcal disease after its implementation in a North American setting and to evaluate sensitivity and specificity of the assay for the detection of prevalent bacterial isolates. DESIGN: Laboratory evaluation of the sensitivity and specificity of a PCR assay for Neisseria meningitidis and observational study of a series of cases comparing molecular diagnosis against the criterion standard of conventional laboratory diagnostic tests. SETTING: A Canadian province with a population of 4 million people. PATIENTS: Children and adults presenting with suspected meningococcal disease in British Columbia. MAIN OUTCOME MEASURES: The sensitivity and specificity of the PCR assay when compared against standard laboratory methods. RESULTS: The PCR assay correctly identified all of 38 Canadian isolates of Neisseria meningitidis and correctly assigned the serogroup to each isolate. None of 57 other gram-positive or gram-negative bacteria or yeasts were detected by the PCR assay. In a clinical evaluation, for diagnosis of meningococcal disease, the PCR assay had a sensitivity and specificity of 91% and 76%, respectively, against conventional methods of diagnosis. Use of the PCR assay increased the laboratory confirmation of clinically suspected cases by 36%. During an outbreak, the PCR assay allowed serogroup determination in 3 of 7 cases, aiding in the public health decision to launch an immunization campaign. CONCLUSIONS: The PCR assay is more sensitive than conventional methods for the diagnosis of meningococcal disease, and enhanced surveillance may help direct the public health response to the changing epidemiology of disease in North America.

Adolescent↗

Articular complications of meningococcal meningitis. An immune complex disorder.

A case of noninfectious arthritis was associated with meningococcal meningitis. Elevated levels of immune complexes were demonstrated in both serum and synovial fluid by the C1q binding assay and Raji cell assay. We believe this complication of meningococcal infection is another disorder in which immune complexes may play a pathogenic role.

Adult↗

[The etiological structure of acute bacterial meningitis in different regions].

In 1985-1989 the etiological structure of acute bacterial meningitides (ABM) in children was studied in 4 largest industrial cities in different regions of the European part of the former USSR, as well as in 2 industrial cities of western Siberia. Due to the common methodological approach used in all investigations, comparable data were obtained in all cities. These investigations revealed that meningococci caused 53.0-86.7% of all cases of ABM in children, which corresponded to moderately increased morbidity rate in meningococcal infection (3.9-11.0 cases per 100,000 of the population, mostly 5.0-7.0 cases) in these cities with its progressive decrease during 3-4 years of observation. The gradual change of meningococci from group A, prevailing in the '70s and early '80s, to group B and in some cases the appearance of group C meningococci, accompanied by a decrease in morbidity rate, were noted. In St. Petersburg the indices of ABM morbidity in children aged up to 5 years for 1987 and 1988, caused by Haemophilus influenzae (0.74 and 4.13) and pneumococci (3.23 and 4.86), could be calculated. A great number of ABM cases of unclear etiology (15.9-33.3%) suggests that the number of ABM cases caused by these two infective agents was underestimated.

Acute Disease↗

[Clinical laboratory basis for using kanamycin sulfate for treating meningococcal meningitis].

Satisfactory penetration of lincomycin sulfate through the hematoencephalic barrier was shown in experimental meningococcic meningitis of rabbits and in treatment of patients with meningococcic meningitis. Constant high levels of the antibiotic in the cerebrospinal fluid, meninx vasculosa, penetration into the brain tissues may be achieved after intramuscular injection of the drug in a dose of 500 mg every 8 hours. The study showed therapeutic efficacy of kanamycin in the treatment of the patients with meningococcic meningitis. It may be recommended for the clinical use as a reserve antibiotic. As an independent etiotropic agent kanamycin may be used in sensitivity to benzylpenicillin or its inefficiency in treatment of the meningococcic infection. Kanamycin may be used in combination with benzylpenicillin in severe forms of meningitis, meningoencephalitis or purulent meningitis of an unknown etiology.

Animals↗

Species, population and age diversity in cell resistance to adhesion of Neisseria meningitidis serogroups A, B and C.

The variation of cell adherence of meningococci serogroups A, B and C and influenza viruses was investigated in 11 animal species and in humans of different age groups (1st, 2nd, 3rd and 4th weeks; 2nd-3rd months; 4th-12th months, 2nd-3rd years; and 18th-60th years of life) as well as in women during pregnancy (17th-36th weeks) and childbirth. Red blood cells of all animals tested as well as of human newborns were absolutely resistant to attachment of meningococci. In neonatal and the later periods the human cells become far differently sensitive individually to meningococcal adhesion. In contrast, the viral adhesion was characterized by different individual cell sensitivity in all age groups tested. Pregnancy and childbirth did not influence the women's cell sensitivity to adhesion of Neisseria meningitidis. Different receptors are involved in interactions of human cells with influenza viruses and meningococci. The function of meningococcal receptors on human cells develops during postnatal ontogenesis. The variations express both specific (genetic) and ontogenetic (individual) differences in natural resistance to meningococcal infection.

Adolescent↗

A mouse model utilising human transferrin to study protection against Neisseria meningitidis serogroup B induced by outer membrane vesicle vaccination.

We have previously developed a mouse model based on transient bacteraemia in normal B10.M mice to evaluate the protective efficacy of outer membrane vesicle vaccines against serogroup B meningococci. To obtain a course of infection similar to that observed in man, we have in this work modified the mouse model by administration of human holo-transferrin upon bacterial challenge. Co-challenge with holo-transferrin induced increasing bacteraemia and subsequent death in normal non-immune mice, but not in vaccinated animals. The model system is dependent on challenge with meningococci expressing the transferrin receptor which is obtained by culturing the bacteria under iron restriction. The modified model system for protection against meningococcal infection presented here makes it possible to measure outer membrane vesicle vaccine induced protection by using bacteraemia as well as survival as parameters.

Animals↗

Meningitis in a community with a high prevalence of tuberculosis and HIV infection.

OBJECTIVES: To evaluate the spectrum of aetiologies, and distinguishing clinical and laboratory features, of meningeal infection in a community with a high prevalence of tuberculosis (TB) and HIV infection. SETTING: A hospital serving mineworkers, originating from rural areas of Southern Africa. DESIGN: Prospective cohort of 60 consecutive lumbar punctures (LPs), performed for suspected meningitis. MEASUREMENTS: Clinical history and examination; concurrent cerebrospinal fluid (CSF) and blood samples; mortality status six months after entry to study. RESULTS: 38 of 57 patients (66.7%) were HIV-1 positive, 59.5% of whom had a CD4 count <200 cells/mm3. Nine patients had tuberculous meningitis (TBM) and two had tuberculomas; four developed disease while on TB therapy. There was one case of multidrug, and two of isoniazid-resistant TBM. There were nine episodes of cryptococcal meningitis (seven patients), nine of aseptic meningitis, two of neurosyphilis and 20 normal LPs, including four with AIDS dementia complex (ADC). Ten patients with meningococcal infection, part of a larger outbreak, were significantly younger (p=0.004). All patients with tuberculous, cryptococcal (most immune-suppressed p<0.001) and aseptic meningitis were HIV-1 positive. Within six months, 19 patients had died. Death was associated with HIV positivity (p=0.004), low CD4 count (p<0.001) and a diagnosis of cryptococcal meningitis, CNS TB or ADC. CONCLUSION: HIV has a major impact on the burden of disease and mortality, with a predominance of opportunistic chronic meningitides, despite a meningococcal outbreak, in this community. Of concern is the development of TBM despite therapy, and the emergence of drug-resistant strains.

AIDS Dementia Complex↗

Clinical manifestations in humans of combined C7 and C4 deficiency associated with low levels of C2, C8, and C9.

64 members of a large kindred with inherited deficiency of the seventh component of complement, C7, were studied for plasma levels of antigenetic and functional components of complement as well as for clinical manifestations of infections and autoimmune diseases. Thirty-six individuals showed a low level of C2, C7, C8, and/or C9, including null alleles for C4A and C4B. Two subjects had a complete C7 deficiency. One of them concomitantly presented a low C2 level and a C4BQ0 allele. HLA allotyping strongly suggested C2 depression associated with a C4BQ0 allele. The 2 individuals with total absence of C7 suffered from fulminant disseminated meningococcal infections. The partial depression of one or more complement components associated with apparent good health. These results may indicate that simultaneous partial depressions of up to four complement components do not lead to clinical manifestation of infectious and autoimmune disease.

Adult↗

Meningococcal disease in The Netherlands, 1958-1990: a steady increase in the incidence since 1982 partially caused by new serotypes and subtypes of Neisseria meningitidis.

In order to explain a threefold increase in the incidence of meningococcal disease in the Netherlands during the 1980s, we serotyped and subtyped Neisseria meningitidis isolates recovered between 1958 and 1990 from > 3,000 patients with systemic disease. No single strain could be held responsible for the increase. Apart from the newly introduced strain B:4:P1.4, which became the most prevalent phenotype in 1990 (21% of all isolates), the majority of the cases in 1990 were caused by many different strains that were already present in the Netherlands before 1980. For the period 1980-1990, a shift in the age distribution of patients with meningococcal disease from younger to older age categories was found, particularly with regard to cases due to meningococci of serogroup B; this shift is explained by the changing distribution of serotypes and subtypes within serogroup B. A polyvalent group B, class 1 outer-membrane-protein vaccine of a stable composition could theoretically have prevented approximately 80% of all group B meningococcal infections in the Netherlands during the past 30 years.

Adolescent↗

[The validity of the system of obligatory disease declaration for the epidemiologic surveillance of meningococcal meningitis].

In Spain meningococcic meningitis is a disease of obligatory declaration which is declared under the name of "Meningococcic infection". In this section other process are also included with the declaration being made under suspicion, with no knowledge of the degree of fulfillment and the significance of the official data. To know this the clinical history of meningitis patients of all the hospitals in Aragon from January 1985 to December 1988 were reviewed comparing the results with those from the system of obligatory disease declaration. The degree of fulfillment for meningococcic meningitis was 90% with the annual rates of incidence of meningococcic meningitis being 1.11 to 2.13 fold higher, according to hospitalary data, higher than the rates of the obligatory disease declaration system.

Communicable Disease Control↗