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Generalized purpuric eruption.
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Neisseria meningitidis is one of the major causes of meningitis in children and adolescents, but it is rarely found during the neonatal period.
Here, we describe a neonate with meningococcal sepsis who was admitted to the hospital on postnatal day 10, and we discuss
the clinical features of neonatal infection with N. meningitidis in relation to the...
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Citations
... Окончательное значение Neisseria meningitidis как возбудителя неонатального сепсиса не выяснено до настоящего времени. В обзоре литературы, выполненном с использованием баз данных PubMed, Google Scholar и Scirus [25] за 97-летний период (с 1916 по 2012 г.), авторы нашли информацию о 33 случаях неонатальной МИ в 27 публикациях, после ревизии данных подтвержденным они сочли 31 случай. В обзоре литературы тех же баз данных за 102-летний период (1916-2018) авторы выявили только 21 случай доказанной неонатальной МИ [26]. ...
... Известно, что при развитии неонатального сепсиса следует учитывать не только носоглоточное носительство у матери и контактных лиц, но и колонизацию мочеполовой системы и кишечника матери, так как инфицирование ребенка при различных внутриутробных инфекциях возможно внутриутробно, интранатально (из-за восходящей колонизации после разрыва плодных оболочек либо при прохождении через инфицированные родовые пути), постнатально. До 40% описанных неонатальных МИ имели раннее начало (в течение первых 6-7 дней жизни) [25]. Превалирование поздних неонатальных инфекций в структуре МИ новорожденных чаще связано с воздушно-капельным инфицированием и колонизацией носоглотки и, возможно, соответствует классическим канонам патогенеза МИ. ...
... И хотя выделение менингококка из мочеполового тракта до недавнего времени было редкостью, случаи МИ у новорожденных от матерей с культурально подтвержденным цервиковагинальным носительством Neisseria meningitidis описаны [21,26,28,29]. В одном из исследований материнская вагинальная колонизация была обнаружена в 6 (18,75%) случаях неонатальной МИ [25]. Более того, описаны и клинические примеры ранней неонатальной МИ (с рождения) с доказанной плацентарной инфекцией у матери [30,[50][51][52][53]. Neisseria meningitidis в ряде случаев верифицирована не только культурально, но и с помощью масс-спектрометрии и real-time ПЦР; гистопатологическим исследованием плаценты доказано наличие васкулита сосудов пуповины и хориоамнионита, согласующихся с восходящей инфекцией и воспалительной реакцией матери и ребенка. ...
Neisseria meningitidis is one of the main etiological factors of meningitis and sepsis in children and adults, however, it is rarely diagnosed in the neonatal period. Clinical definition of neonatal meningococcal disease is complicated, the disease outcome is commonly lethal, and therefore its timely diagnosis and adequate therapy are crucial. This article describes clinical case of the newborn with meningococcal sepsis hospitalized on the 5th day after birth and provides the literature review of the data from the late 19th century until the present.
... Bacteriologically, N. meningitidis of serogroup W was isolated from the placenta [17]. The development of GMI in the neonatal period [16,23] is characterized by high mortality and the development of severe neurological complications [5,24]. The disease develops violently: a sharp deterioration of the general condition against the background of an increase in temperature with the development of shock and multiple organ failure within a few hours. ...
... The disease develops violently: a sharp deterioration of the general condition against the background of an increase in temperature with the development of shock and multiple organ failure within a few hours. Mortality is 40% among patients in whom the disease develops during the first week of life [23]. ...
Meningococcal infection in the form of sporadic cases or minor group outbreaks, mostly among children, is registered in all countries of the world. The disease has a wide range of clinical manifestations – from an asymptomatic bacterial carriage and acute nasopharyngitis to the rapid development of meningococcemia, acute meningococcal sepsis and meningitis. The article highlights and summarizes literature data related to the incidence of meningococcal infection, ways of infection, features of the clinical course of the disease in the newborn period, and modern views on the problem. A rare clinical case of the development of severe generalized forms of meningococcal infection in 3-month-old twins with a fatal outcome in one child is described. The decisive role in the development of the disease of twins is determined by the way and duration of children’s contact with their father, who has a bacteriologically confirmed (Neisseria meningitidis, biovar C) meningococcal nasopharyngitis. Early diagnosis and treatment of all forms of meningococcal infections are important to prevent the development of GMI. The key method of MI prevention is vaccination.
... Although many neonates are protected by trans-placental maternal antibodies, invasive meningococcal disease does rarely occur in infants, especially before vaccination. 26 Looking ahead, improved understanding of microbiome evolution following controlled human infection is necessary before Open access inoculation in neonates (rather than in pregnant adults) can be considered. ...
Introduction
Infant upper respiratory microbiota are derived partly from the maternal respiratory tract, and certain microbiota are associated with altered risk of infections and respiratory disease. Neisseria lactamica is a common pharyngeal commensal in young children and is associated with reduced carriage and invasive disease by Neisseria meningitidis . Nasal inoculation with N. lactamica safely and reproducibly reduces N. meningitidis colonisation in healthy adults. We propose nasal inoculation of pregnant women with N. lactamica , to establish if neonatal pharyngeal colonisation occurs after birth, and to characterise microbiome evolution in mother–infant pairs over 1 month post partum.
Methods and analysis
20 healthy pregnant women will receive nasal inoculation with N. lactamica (wild type strain Y92-1009) at 36–38 weeks gestation. Upper respiratory samples, as well as optional breastmilk, umbilical cord blood and infant venous blood samples, will be collected from mother–infant pairs over 1 month post partum. We will assess safety, N. lactamica colonisation (by targeted PCR) and longitudinal microevolution (by whole genome sequencing), and microbiome evolution (by 16S rRNA gene sequencing).
Ethics and dissemination
This study has been approved by the London Central Research Ethics Committee (21/PR/0373). Findings will be published in peer-reviewed open-access journals as soon as possible.
Trial registration number
NCT04784845 .
... One study compared a 10-day-old neonate with meningococcal sepsis to literature reports spanning a 97-year period, which included 31 cases of IMD. 20 In 13 cases, IMD developed in the first week of life, with typically insignificant clinical signs and symptoms; symptoms became distinctive approximately 1 week after onset and included irritability (53%), fever (47%), hypotension (31%), and petechiae (31%). Diagnosis was made by blood or CSF cultures, with the most common serogroups being serogroup B (28%) and serogroup C (19%). ...
This review considers the pathogenesis, diagnosis, and epidemiology of invasive meningococcal disease in infants, to examine and critique meningococcal disease prevention in this population through vaccination. High rates of meningococcal disease and poor outcomes, particularly for very young infants, highlight the importance of meningococcal vaccination in early infancy. Although effective and safe meningococcal vaccines are available for use from 6 weeks of age, they are not recommended globally. Emerging real-world data from the increased incorporation of these vaccines within immunization programs inform recommendations regarding effectiveness, appropriate vaccination schedule, possible long-term safety effects, and persistence of antibody responses. Importantly, to protect infants from IMD, national vaccination recommendations should be consistent with available data regarding vaccine safety, effectiveness, and disease risk.
... Neisseria meningitidis as a causative organism in EOS is extremely rare. 4,5 This article describes a case of early onset neonatal sepsis caused by Neisseria meningitidis. ...
... IMD in neonates has been caused by all major serogroups of Neisseria meningitidis such as A, B, C, Y and W135. [4][5][6][7][8] However, literature reviews highlight the preponderance of Neisseria meningitidis serogroup B as the major causative agent in neonatal IMD. 4,[6][7][8][9] Koplick, in 1916, published the first case of neonatal meningococcal meningitis (NMM). ...
... [4][5][6][7][8] However, literature reviews highlight the preponderance of Neisseria meningitidis serogroup B as the major causative agent in neonatal IMD. 4,[6][7][8][9] Koplick, in 1916, published the first case of neonatal meningococcal meningitis (NMM). 9 The exact incidence of Neisseria meningitidis as a causative agent for neonatal sepsis is not well known. ...
A 36-week-2-day-old male infant was admitted to the neonatal unit with respiratory distress, hypoglycaemia and suspected early onset neonatal sepsis for respiratory support, monitoring and intravenous antibiotics. His initial C-reactive protein was 12 mg/L, this increased to 66 mg/L at 24 hours. Blood cultures at 48 hours confirmed Neisseria meningitidis serogroup B. As the isolate was sensitive to benzylpenicillin the same antibiotic was continued for a total of 7 days. His mother remained asymptomatic but was monitored closely. Ciprofloxacin chemoprophylaxis was given to close family contacts. Neisseria meningitidis causing early onset neonatal sepsis is extremely rare and neonates may have minimal symptoms at presentation. A table reviewing all documented cases of early onset neonatal sepsis caused by Neisseria meningitidis over a 102-year time period is included. There is need for early identification and initiation of empirical antibiotic therapy pending confirmation and sensitivities.
... Bacterial meningitis and sepsis (referred to as invasive meningococcal disease) are rare illnesses, but Neisseria meningitidis is a frequent cause of the invasive disease in children and adults with high rate of mortality especially in the newborn infants. 1) No reliable estimates have been available for the global meningococcal disease burden because of inadequate surveillance in several parts of the world; however, previous studies have found that meningococcal meningitis comprises approximately 0.54% of neonatal meningitis cases. 2,3) Among serologically distinct meningococcal serogroups, the majority of invasive disease in young children less than 1 year of age is caused by serogroup B as demonstrated in our case. 4) This case report is to review meningococcal infections in neonates and to emphasize the necessity of prevention and chemoprophylaxis of exposed family members and health care staff. ...
... 5) Nasopharyngeal carriage rate of meningococcus is reported to be approximately 10% in the general population and is carried asymptomatically by young adults, but invasive disease can occur in infants. 2,9,12) Probably because of immunologic immaturity, infants have the highest incidence rate of meningococcal disease and second incidence peak is observed in adolescence and young adults possibly due to increase opportunity for exposure from social activities. 4) World Health Organization and The United States Centers for Disease Control and Prevention defined high risk groups who need vaccination as: infants, preteens, teens, young adults, and those living especially in community settings, as well as individuals with certain immune deficient conditions. ...
... Les IMF à méningocoque sont rares ; elles peuvent être responsables de mort in utero. Le méningocoque est en règle retrouvé dans les voies génitales maternelles [109] . Les infections tardives ont une symptomatologie analogue à celle des infections du nourrisson (méningite). ...
Las infecciones neonatales bacterianas son un problema mundial de salud pública. Su incidencia es del 0,5-1% de los nacimientos en los países industrializados y más elevada (3-5%) en los países en desarrollo. Las infecciones producidas en el primer mes de vida son responsables de 5 millones de fallecimientos por año en el mundo. Todos los agentes patógenos (bacterias, hongos, parásitos y virus) pueden ser responsables de infección en el recién nacido. Las infecciones precoces, maternofetales, se revelan en los primeros 4 días de vida. El diagnóstico de certeza está limitado por la baja sensibilidad de los hemocultivos y debería mejorar gracias a la biología molecular. Las infecciones tardías se producen entre los 5-28 días. Las infecciones nosocomiales se adquieren durante la estancia en un área de cuidados neonatales. En Francia, por ejemplo, los estreptococos del grupo B y Escherichia coli causan el 80% de las infecciones neonatales primarias. La epidemiología de estas infecciones varía en el tiempo y según los países, lo que impide extrapolar de un país a otro las propuestas terapéuticas y, en particular, los tratamientos de primera línea de las infecciones primarias y secundarias. También difiere según las semanas de amenorrea. Los adelantos recientes se refieren a una mejor utilización de los antiinfecciosos y un mejor conocimiento de la epidemiología en función del término del embarazo. Las infecciones nosocomiales, cuya incidencia sigue siendo elevada, están muy relacionadas con los catéteres venosos centrales.
... RN, más baja que a otras edades, probablemente por el traspaso de anticuerpos maternos. Ocurre generalmente en madres que presentan colonización nasofaríngea o genitourinaria por N. meningitidis 19 . Clínicamente se presenta en forma inespecífica, con fiebre y desarrollo de shock y falla orgánica múltiple a las pocas horas. ...
... Clínicamente se presenta en forma inespecífica, con fiebre y desarrollo de shock y falla orgánica múltiple a las pocas horas. Se describe una mortalidad de 40% en aquellos pacientes que presentan la infección durante la primera semana de vida 19 . Cobra importancia la identificación adecuada de la especie en el laboratorio, dado que N. subflava y N. meningitidis presentan un biotipo similar de fermentación de los azúcares 11 . ...
... La sepsis por N. gonorrhoeae es generalmente silente en su fase bacteriémica, ocurriendo más frecuentemente en RN prematuros. La meningitis por este agente es muy infrecuente, aunque es recomendable descartarla ante una infección localizada o sistémica 18, 19 . ...
Neisseria subflava belongs to Neisseriaceae family, is considered a comensal specie, however in certain host, mainly inmunosuppresed patientes and children, the literature has documented invasive infections. We present a case of a bacteriemia due to N. subflava in a newborn, treated with cefotaxime with good outcome. In newborns, the most common Neisseria bacteria to cause invasive infections are N. meningitidis, with highly fatal clinical course and N. gonorrhoeae which compromise the eye, oftalmia neonatorum, with uncommon invasive infections. It’s very important the adequate microbiological diagnosis because the biochemical tests may be inconclusive. MALDITOF mass spectrometry technique is a useful tool.
... meningitides) is not common in neonatal bacterial meningitis. There have been 48 cases of Neonatal Meningococcal Meningitis (NMM) described since the first case reported in 1916 [3]. The incidence of NMM ranges from 0.8 to 1.3 per 100,000 in USA as reported. ...
... For the review of previously reported cases [3][4][5][6][7][8][9][10][11][12][13][14][15][16], we defined cases of meningitis associated with N. meningitidis when cases had microbiologic evidence of N. meningitidis consisting of at least one of: a positive culture of blood and/or Cerebrospinal Fluid (CSF) and/or positive Polymerase Chain Reaction (PCR) for meningococcal DNA. ...
... We identified 37 previous cases of N. meningitidis meningitis reported in English literature (included our case) between 1916 and 2014 [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. The clinical features, microbiologic results, sero-group outcomes and complications of the 37 cases were summarized in the table (Table 1). ...
... Otros serogrupos identificados en neonatos con meningitis meningocóccica han sido serogrupos A, 15,27 C, 10,28,29 Y, 30 W135 31 y no agrupables. 32 Las formas más comunes de presentación de la infección meningocóccica son meningitis y meningococcemia, esta última con una evolución muy grave, acompañada de estado tóxico-infeccioso, shock, y en ocasiones, púrpura fulminante, por lo que su pronóstico es habitualmente calamitoso. 16,23 No menos grave es el curso de la forma clínica de meningitis, pues también puede ser letal o dejar secuelas neurológicas invalidantes. ...
Meningoccocal meningitis is a rare infection in the neonatal period worldwide and there is just one publication in the Cuban medical literature dated 25 years ago, which presented some neonates with bacterial meningitis caused by Neisseria meningitides. This is a febrile neonate with toxicity manifestations and bulging fontanelle; he was performed a lumbar puncture to find spinal fluid pleocytosis and the serogroup B N. meningitides was then isolated, so he was diagnosed with neonatal meningococcal meningitis with favorable progression. Some characteristics of the meningococcal infection, the diagnosis and recommended treatment were described in addition to making reference to case reports published in the international literature.
