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-Presenting Symptoms, Signs, and Laboratory Findings of Patients With Known Serogroups*
Source publication
In 1994, surveillance by the Chicago Department of Public Health detected a growing trend in the proportion of invasive meningococcal infections caused by serogroup Y.
To examine the emergence of serogroup Y meningococcal disease and compare its clinical characteristics with those of other meningococcal serogroups.
Population-based retrospective re...
Context in source publication
Context 1
... frequency of presenting symp- toms, signs, and laboratory findings dif- fered for patients with SYMD compared with those with NSYMD (Table 3). Pa- tients with SYMD were statistically more likely to present with sputum pro- duction and chest pain; however, these symptoms occurred infrequently over- all, and were predominantly reported by patients older than 20 years. ...
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Objectives
In 2015 the UK became the first country to implement the meningococcal B (MenB) vaccine, 4CMenB, into the national infant programme. 4CMenB is expected to cover meningococci expressing sufficient levels of cross-reactive proteins. This study presents clonal complex, 4CMenB antigen genotyping, and 4CMenB coverage data for all English inva...
Invasive meningococcal disease constitutes a worldwide health problem. Gram negative bacteria, Neisseria meningitidis is the causal agent of this disease. Plain or conjugated polysaccharide vaccines are available against four of five serogroups responsible of more than 95% of cases in the world. Because serogroup B polysaccharide is non immunogenic...
![[82]. Twenty of these test isolates were from an expanded set of MenB...](profile/Jamie-Findlow/publication/331458288/figure/tbl1/AS:863517825564673@1582890101468/82-Twenty-of-these-test-isolates-were-from-an-expanded-set-of-MenB-disease-isolates_Q320.jpg)
Introduction: Invasive meningococcal disease (IMD) can be devastating; it is associated with high case fatality rates and long-term sequelae among many survivors. Five serogroups (A, B, C, W, and Y) cause nearly all IMD cases worldwide, and serogroup B (MenB) is the most prevalent in Europe. The European Medicines Agency approved the use of MenB-fH...
Meningococcal carriage is a prerequisite for invasive infection. This cross-sectional study assessed the pharyngeal carriage prevalence in healthy subjects aged 1–24 years in Embu das Artes city, São Paulo, Brazil. Pharyngeal swabs were examined for the presence of Neisseria meningitidis. The isolates were tested for different serogroups using aggl...
Citations
... Med.Trop2018;13(1)41-54 10.18004/imt/20181341-54 incluyendo la experiencia Argentina de Gentile y cols (8). Cuatro pacientes (9%) presentaron neumonía concomitante, similar a lo descrito por otras series (2,21). La tasa de letalidad obtenida en nuestra serie ha sido del 20,5%. ...
Introducción:
La enfermedad meningocóccica ha sido y sigue siendo una causa importante de morbilidad y mortalidad.
Objetivos:
Analizar las características clínicas y epidemiológicas de pacientes con infección meningocóccica invasora hospitalizados en un centro hospitalario de referencia.
Materiales y métodos:
Estudio descriptivo, observacional y retrospectivo de revisión de historias clínicas de pacientes internados entre los años 2005 y 2018 en el Instituto de Medicina Tropical con aislamiento o detección de N. meningitidis en sangre o LCR.
Resultados:
Fueron captados 44 pacientes con enfermedad meningocóccica invasora durante el periodo estudiado (3±2 casos/año). Los casos predominaron en el grupo etario <5 años (36% de todos os casos), siendo la distribución de sexo similar. Veintiseis pacientes (59%) presentaron meningitis y 18 (41%) meningococcemia, 12 de ellos (27%) con meningitis concomitante. El 43% de los pacientes requirió ingreso a UCI. La letalidad fue del 20,5% (9/44), superior en pacientes con meningococcemia, aunque sin significancia estadística (p=0,16). La presencia de choque (p<0,01), el requerimiento deUCI (p=0,001), la leucopenia <5000, leucocitos/mm³ (p<0,01), la leucocitosis >15000 /mm³ (p=0,03), la plaquetopenia<150000/mm³ (p=0,01) y la presencia de <100 leucocitos/campo en LCR (p=0,02) fueron factores asociados a mayor mortalidad. No se encontró asociación entre severidad con serotipos. Al analizar en conjunto todos los años, el serogrupo B fue el predominante (50%); sin embargo, en los últimos 3 años todos los aislamientos (n=14) correspondieron a los serogrupos C (n=10, 71%) y W135 (n=4, 29%).
Conclusión:
La enfermedad meningocóccica presenta en el Paraguay un patrón estable de endemicidad, con un aumento reciente de casos de serogrupo C y W135, representado el serogrupo C más del 70% de los casos actuales. La presencia de choque, la leucocitosis >15000 /mm³, la leucopenia <5000/ mm³, y la plaquetopenia se asociaron a mayor mortalidad.
... IMD may also present clinically without neurological involvement as bacteremia, arthritis, pericarditis, pharyngitis, urethritis, conjunctivitis, or immune complex disease. Nevertheless, the second most common end-organ disease of IMD remains widely neglected despite accounting for 5-15% of cases -meningococcal pneumonia [15][16][17]. This review aims to highlight the clinical relevance, as well as the diagnostic and management challenges related to this disease. ...
... National surveys on the incidence of IMD indicate that meningococcal pneumonia is the most common non-neurological endorgan disease of IMD and occurs in about 17% (61 of 364) of patients (Table 1). This is consistent with the previously published range of 5-15% [15][16][17]23,[33][34][35]. Still, the incidence of meningococcal pneumonia is very likely underestimated as discussed in more detail in ''Microbiological diagnosis of meningococcal pneumonia" below. ...
... Meningococcal pneumonia is considered to affect mostly older adults (>50 years) in contrast to meningococcal meningitis which affects predominantly children and teenagers, based on epidemiological surveys [16,32,34,36]. In patients aged >65 years, pneumonia is even the most common manifestation of IMD [34,36]. ...
Neisseria meningitidis remains the most important cause of bacterial meningitis worldwide, particularly in children and young adults. The second most common and a potentially severe end-organ manifestation of invasive meningococcal disease (excluding systemic sepsis) is meningococcal pneumonia. It occurs in between 5% and 15% of all patients with invasive meningococcal disease and is thus the second most common non-systemic end-organ manifestation. To establish the diagnosis requires a high level of clinical awareness – the incidence is therefore very likely underreported and underestimated. This review of 344 meningococcal pneumonia cases reported in the Americas, Europe, Australia, and Asia between 1906 and 2015 presents risk factors, pathogenesis, clinical manifestations, diagnostic approaches, treatment, and prognosis of meningococcal pneumonia.
... Outbreaks of this strain occurred during the Hajj pilgrimages to Mecca in 2000 and 2001 (25). Serogroup Y infections have increased in the US and Israel (23,27). Serogroup X endemics have occurred in sub-Saharan Africa (17,28). ...
We mainly refer to the acute setting of meningococcemia. Meningococcemia is an infection caused by Neisseria meningitidis, which has 13 clinically significant serogroups that are distinguishable by the structure of their capsular polysaccharides. N. meningitidis, also called meningococcus, is a Gram-negative, aerobic, diplococcus bacterium. The various consequences of severe meningococcal sepsis include hypotension, disseminated intravascular coagulation (DIC), multiple organ failure, and osteonecrosis due to DIC. The gold standard for the identification of meningococcal infection is the bacteriologic isolation of N. meningitidis from body fluids such as blood, cerebrospinal fluid (CSF), synovial fluid, and pleural fluid. Blood, CSF, and skin biopsy cultures are used for diagnosis. Meningococcal infection is a medical emergency that requires antibiotic therapy and intensive supportive care. Management of the systemic circulation, respiration, and intracranial pressure is vital for improving the prognosis, which has dramatically improved since the wide availability of antibiotics. This review of the literature provides an overview of current concepts on meningococcemia due to N. meningitidis infection.
... Noteworthy, the proportion of MenY among IMD cases increased almost eight times between 2007 (2%) and 2013 (17%). Previous studies reported that, relative to other N. meningitidis serogroups, MenY is usually found in older patients [15][16][17] . Nevertheless, recent data analyses from several countries yield conflicting results as to the principal age groups affected by MenY: Of note, since 2011, an increase of septicaemia cases attributed to serogroup Y was observed. ...
In Italy, the incidence of invasive meningococcal disease (IMD) has remained stable since 2007 (around 0.3 cases/100,000 inhabitants). However, as reported for other European countries, an increase of serogroup Y Neisseria meningitidis has been observed. In this study we report IMD cases from 2007 to 2013 in Italy and investigate the clinical and epidemiological features of cases affected by serogroup Y. Molecular characteristics of serogroup Y strains are also described. During the study period, the proportion of IMD cases due to serogroup Y increased, ranging from 2% in 2007 to 17% in 2013 (odds ratio (OR): 8.8), whereby the five to 14 years age group was mostly affected (p < 0.001). Overall 81 serogroup Y IMD cases were identified, with a median age of 18 years, ranging from three months to 84 years. Of the 81 respective patient samples, 56 were further subject to molecular typing. The sequence type (ST)-23 complex (clonal complex (cc)23) was predominant among serogroup Y meningococci (54/56 samples), and included nine different STs. Presumably, ST-23 was the founding genotype, with all the other STs presenting as single-locus variants. All cc23 isolates analysed harboured mutations in the lpxL1 gene; however, no associations among lpxL1 mutations, ST and age group were identified. Overall, these findings generate scientific evidence for the use of the quadrivalent meningococcal conjugate vaccine in the five to 14 years age group.
... Meningococcal disease caused by serogroups Y has been observed in Israel [15] and it is responsible for 13% of cases in Canada [79] and the USA [137]. In the latter country, the incidence of serogroup Y has increased by the mid-1990s [15], reaching about one-third of cases in certain regions [10,104,138], whereas serogroup B and uncommon strains are responsible for the remaining cases in this country [104]. ...
Neisseria meningitidis is a Gram-negative β-proteobacterium responsible for an endemic worldwide infection. The epidemiology and serogroup distribution can change very quickly. The incidence of meningitis infection varies from very rare to more than 1000 cases per 100,000 of the population yearly. The carriage of N. meningitidis, which represents an exclusive human commensal, is asymptomatic, but in rare cases bacteria proliferate in the CNS and rapidly lead to the death of the affected subjects. Host genetic factors, such as single nucleotide polymorphisms, can promote meningococcal disease, being able to influence the individual predisposition to the pathology. Although a reduction in meningococcal disease has been observed in Europe, a continuous surveillance is necessary to control any possible outbreaks of new hypervirulent clones into populations that could modify the epidemiology of meningococcal infections and the clinical spectrum of affected subjects.
... Outbreaks of meningococcal disease have also been reported in Asia, which were caused by two clones of serogroup A that originated in northern China, and eventually spread throughout the world (Wang et al., 1992). Most cases of meningococcal disease in the United States are due to serogroup Y (Racoosin et al., 1998). ...
... In a more recent study Racoosin evaluated 132 patients in Chicago, with 50% presenting with meningitis, 30% bactaremia, 20% meningococcaemia and 15% concurrent pneumonia. 5 The study describes an increase in serogroup Y disease incidence similar to that described in this report. Compared with non-serogroup Y, serogroup Y patients were older, black and with underlying illness, but showed no signifi cant difference in mortality, ICU stay, or complication rate. ...
An elderly lady was admitted for pain management and rehabilitation following a fall. During her stay she developed a new heart murmur and sepsis. Subacute bacterial endocarditits was excluded, empirical ciprofloxacin was initiated and later converted to aztreonam with gentamicin for clinical deterioration. Subsequent investigations revealed meningococcal Y septicaemia secondary to pneumonia, with a possible oropharynx focus. Upon discharge she had returned to baseline state. The case reflects an unusual and increasing cause of pneumonia. A steady increase of infective serogroup Y isolates over the past 12-years in England, with tendency towards elderly makes it a significant differential among the general medical population. This trend corresponds with the US, but is yet unknown whether to be a periodic cycle or true change in dominance and, or, virulence among serogroups. If the latter were true, it would support the inclusion of serogroups beyond menigitides C in the vaccination program.
... This variability has been observed in the United States, where serogroup Y disease has increased dramatically over the past 20 years in terms of both absolute rate and proportion of cases of meningococcal disease. 19,20 Carriage studies are important to improve our understanding of the population structure of N. meningitidis and the epidemiology of meningococcal disease. Our study investigated for the first ...
Studies of meningococcal carriage are essential in improving knowledge of the epidemiology of meningococcal disease. The aim of this study is to ascertain the carrier rate and the serogroups of Neisseria Meningitidis circulating in a sample of students from the University of Bari. The population consisted of university students from the University of Bari - School of Medicine, who were invited to take a nasopharyngeal swab. The swabs were plated on selective plate medium; cultural and MLST tests were performed. Of 583 university students 12 carriers were identified (2%). 9 isolates proved auto-agglutinable. The other strains belonged to serogroups B, W135 and Y. Auto-agglutinable strains belonged to different clonal complexes, of which ST-53 was the most common. Only one strain, that belonged to ST-23/cluster A3 clonal complex, could cause meningococcal disease. No type C serogroup strain was detected and this could be directly related to immunization policies that provided meningococcal serogroup C conjugate vaccines for newborns and adolescents. The changing pattern of circulating serogroups of Neisseria meningitidis in healthy carriers could support a new immunization strategy which could provide quadrivalent meningococcal conjugate vaccines to pre-adolescents and adults.
... The epidemiology of meningococcal disease is highly variable, and rates of disease, as well as the serogroup distribution of cases, fluctuate by geographic region, by age group, and over time. This variability has been observed in the United States, where serogroup Y disease has increased dramatically over the past 20 years in terms of both absolute rate and proportion of cases of meningococcal disease [33,34]. In the current study, the largest differences in immune response between the 2 vaccines were to serogroup Y, with GMTs of 51 after vaccination with MenACWY-CRM and of 18 after vaccination with Menactra. ...
Neisseria meningitidis is an important cause of invasive bacterial infection in the United States, and disease rates are higher for adolescents than for the general population. Quadrivalent meningococcal conjugate vaccine is recommended for routine vaccination of adolescents and high-risk groups. This study compares the safety and immunogenicity of the Novartis Vaccines investigational quadrivalent meningococcal CRM(197) conjugate vaccine, MenACWY-CRM, with the licensed meningococcal conjugate vaccine, Menactra.
In this multicenter phase III study, 2180 adolescents 11-18 years of age were randomly assigned to 4 groups (1:1:1:1) to receive a single dose of 1 of 3 lots of MenACWY-CRM or a single dose of Menactra. Serum samples obtained before vaccination and 1 month after vaccination were tested for serogroup-specific serum bactericidal activity using human complement (hSBA). The hSBA titers after vaccination with MenACWY-CRM or Menactra were compared in noninferiority and superiority analyses.
The hSBA geometric mean titers after MenACWY-CRM vaccination were higher than the hSBA geometric mean titers after Menactra vaccination, and criteria for superiority were met for this end point for all 4 serogroups. Also, the criteria for superiority of MenACWY-CRM, compared with Menactra, were met for the end points of proportion of subjects with postvaccination hSBA titers 1:8 and proportion of seroresponders for serogroups A, W-135, and Y. MenACWY-CRM was noninferior to Menactra for serogroup C for these end points. Reactogenicity was similar, with 64% of the MenACWY-CRM recipients and 70% of the Menactra recipients reporting mild and/or moderate solicited reactions. Neither vaccine was associated with a serious adverse event.
MenACWY-CRM vaccine is well tolerated in adolescents and generates a stronger immune response than Menactra for all 4 serogroups.
Clinicaltrials.gov identifier: NCT00450437 .
... The increase in incidence of serogroup W135 disease goes beyond serogroup redistribution and is consistent with the introduction of antigenically distinct meningococci [39][40][41][42]. In outbreaks caused by new strains for which there is little herd immunity, older persons generally are at increased risk of disease [39,43]. ...
In the African meningitis belt, Neisseria meningitidis serogroup W135 has emerged as a cause of epidemic disease. The establishment of W135 as the predominant cause of endemic disease has not been described.
We conducted national laboratory-based surveillance for invasive meningococcal disease during 2000-2005. The system was enhanced in 2003 to include clinical data collection of cases from sentinel sites. Isolates were characterized by pulsed-field gel electrophoresis and multilocus sequence typing.
A total of 2135 cases of invasive meningococcal disease were reported, of which 1113 (52%) occurred in Gauteng Province, South Africa. In this province, rates of disease increased from 0.8 cases per 100,000 persons in 2000 to 4.0 cases per 100,000 persons in 2005; the percentage due to serogroup W135 increased from 7% (4 of 54 cases) to 75% (221 of 295 cases). The median age of patients infected with serogroup W135 was 5 years (interquartile range, 2-23 years), compared with 21 years (range, 8-26 years) for those infected with serogroup A (P<.001). The incidence of W135 disease increased in all age groups. Rates were highest among infants (age, <1 year), increasing from 5.1 cases per 100,000 persons in 2003 to 21.5 cases per 100,000 persons in 2005. Overall case-fatality rates doubled, from 11% in 2003 to 22% in 2005. Serogroup W135 was more likely to cause meningococcemia than was serogroup A (82 [28%] of 297 cases vs. 11 [8%] of 141 cases; odds ratio, 8.9, 95% confidence interval, 2.2-36.3). A total of 285 (95%) of 301 serogroup W135 isolates were identified as 1 clone by pulsed-field gel electrophoresis; 7 representative strains belonged to the ST-11/ET-37 complex.
Serogroup W135 has become endemic in Gauteng, South Africa, causing disease of greater severity than did the previous predominant serogroup A strain.
